Music therapists acknowledge the need to support families of children with profound intellectual and multiple disabilities (PIMD) to use music therapy strategies in home settings. Four families were supported by a music therapist to independently engage in therapeutic music-making at home with their child with PIMD over eight months. This multi-interpretivist case study analysed caregiver diaries, caregiver interviews, music therapist clinical notes and a reflexive journal to uncover the processes that supported the families. A thematic data analysis revealed a five-step process for supporting these families. This five-step process included the family observing and reflecting on music therapy practice, working as partners with the music therapist, engaging in joint-music making with the music therapist and their child, consciously observing subtle engagement cues from their child and then independently engaging in music-making with their child. This study provides a framework for music therapists to support families of children with PIMD in home settings.