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Developments in Music Therapy in the Netherlands

by voices | Thu, 09/30/2010 - 23:00

Introduction

In this article, updating the original 2003 Country of the Month entry, we observe developments in music therapy in the Netherlands. Music therapy practice continues to be widely implemented in general healthcare, varying from job positions in general psychiatry, forensic psychiatry, work with cognitively and physically handicapped, in elderly care settings to private practice. Music therapy is gaining more and more influence in general healthcare, since its first development in the late fifties. Over a thousand arts therapists are currently employed in our relatively small country, with over 300 music therapists and the number continues to grow. Research is developing effectively in the recently founded research centres.

Historical Introduction

Steps in Professional Growth

In 1957, the Dutch psychiatrist Van der Drift, commissioned the development of a music therapy position within the setting of a psychiatric hospital. He played an important role in the development of arts therapies as they are known nowadays.

From 1967 onwards, the first professional meetings for music therapists were organized. In the spring of 1968, the first courses in music therapy started on topics as "Making music with the handicapped". Music therapists with practical experience with a variety of client populations, gave lectures and workshops, amongst whom were : Holthaus, Gretener-von Sury, Kassels-Kroon, Noske-Fabius, Haans and Ter Burg. Foreign speakers were Nordoff and Robbins. Many more national courses with both Dutch as foreign speakers were organized by members of the Eduard van Beinum Foundation, the first Music Therapy Foundation and later the Music Therapy Section of the Dutch Association for Creative Therapy and the second Music Therapy Foundation (Stichting Muziektherapie). Guest speakers were Breitenfeld from Berlin (1979) and Schmölz from Vienna (1980).

Holthaus was one of the first therapists to publish a coherent methodology for music therapy in 1970. He developed a rhythm test in which the items were indicative of the client's ability to vary the tempo and dynamics, to be able to follow and to be followed. This diagnostic scale was standardized through the use of the Electronic Holthaus Metronome and the Holthaus Chirograph.

In 1977, Fockema Andreae and Steenhuis, who were students of Holthaus, published a book on music therapy in psychiatry. This book played an important role for Dutch music therapy. It contains a process-oriented vision on creativity, in which the "creative moment" holds a key position for the therapeutic process. Fockema Andreae was chairman of the Dutch Association for Creative Therapy (NVCT) for many years and in this capacity she stimulated the professionalization of the profession.

Since 1970, music therapists such as Van den Berk, Waardenburg, Noske-Fabius, Ter Burg, Haans, Van Nieuwenhuijzen, Wijzenbeek, FockemaAndreae and De Bruijn have made considerable contributions to making the profession known in The Netherlands and Belgium by giving lectures and workshops on music therapy in psychiatry, geriatrics, the care of the mentally handicapped and in rehabilitation. Haans, since 1967, has also been involved in the organization of music therapists in Belgium, where in Neerpelt Alvin & Fenwick (1978), Mayer (1988) and Frohne-Hagemann (1990) were invited.

Like Fockema Andreae, they all played an important role in the professionalization of music therapy. For example, Ter Burg was a co-founder of the Dutch Association for Creative Therapies, Van Nieuwenhuijzen was the chairman of the first research group of the association and initiated the alliance with a large civil service union, De Bruijn for some years was the chair of the association.

Documenting Methods

Methods that were developed besides those mentioned earlier, are the Gretener-von Sury method, consisting of exercises to increase concentration of and social interactions between handicapped people, the "Le Bon Départ" method by Bugnet-van der Voort for cognitively handicapped. Gerits developed a music therapy method for working with deaf people.

Although Lievegoed's anthroposophic dissertation Measure, Rhythm, and Melody was published as long ago as 1939, music therapy did not develop within anthroposophy in the Netherlands until later. In 1968, Mees-Christeller started a private educational course on Artistic Therapy of the Fine Arts at the academy De Wervel, followed by Musical Artistic Therapy in 1983 and is now offered in Leiden. The anthroposophic paradigm has little influence in the Netherlands. The Creative Process Theory became the leading paradigm for all arts therapies in the seventies and eighties. This theory and other recent theories will be described in the paragraph on theory.

In the seventies and eighties, publications of a more recapitulating nature appeared, such as the book by Stavenga (1979) and the book edited by Adriaansz, Schalkwijk and Stijlen (1986). In the latter work, a large number of experienced music therapists reported in a systematic way about their own methods. There were also publications, which reflected a method developed in a single field. Examples of this are the methods by Ter Burg (1985) for working with partially-sighted mentally handicapped people, by De Bruijn (1984) for working in (children's) rehabilitation and the so called "snoezelen" for the fundamentally and severely mentally handicapped (Hulsegge&Verheul 1986). Freund (1986) introduced a method of receptive music therapy, which was further developed with variations added to it by, amongst others, Wijzenbeek, Van Nieuwenhuijzen, Raijmaekers, Gabriëls and Bueno de Mesquita (Herman & Overdulve, 1990).

Promoting Research and Dissemination

It was Schalkwijk who made a considerable contribution to research and the development of theories in the eighties. In 1984, he gave the initial impetus to defining music therapy as psychotherapy and later, based on research, made the distinction between working psycho-therapeutically, orthoagogically and recreationally.

In the second half of the eighties, Smeijsters started with the development of theories on indication, analogy and research methodology. He is the author of many standard works in music therapy. The books such as Muziektherapie als psychotherapie, the Handboek muziektherapie and the Handboek creatieve therapie are widely used within the training programs in the Netherlands as well as in Germany. In the nineties he organized lectures and symposia to which Langenberg, Frohne-Hagemann, Lecourt, Aldridge, Neugebauer, Dileo, Davis, Muthesius, Spintge, Decker-Voigt, Tüpker, Jochims, De Backer and other outstanding music therapists and researchers from abroad have been invited. Smeijsters initiated the first research centre for arts therapies in the Netherlands in 2003 (KenVaK) and started the first Master program in Arts Therapies in 2004.

In the recent decades, Dutch music therapists published and presented internationally. Illustrative of this are the lectures delivered by Dutch music therapists at international congresses, the increase in (inter)national publications as well as chairing the international scientific committee of the 8th World Congress of Music Therapy in Hamburg (1996), participating in scientific committees in European Music Therapy congresses and organizing conferences, such as the 5th International Congress Music Therapy and Music Education for the Handicapped (1989), the 2nd European Conference on Arts Therapies Education (1992), the Congress 'Arts, Illness and Trauma' on September 26th-27th 2003, Amersfoort and in 2007 the 7th European Music Therapy Congress in the Netherlands.

Professional Associations for Music Therapy

The first Dutch Association for Creative Therapy (NVCT) was established in 1962 and continued to promote the study, practice and development of arts therapies, including music therapy, while protecting the social interests of the members. The NVCT became in 2005 a federation for all arts therapies (music, drama, art, dance-movement) and psychomotoric therapy known as Federatie Vaktherapeutische Beroepen (FVB). This FVB unites the strengths of the five associations in collective (re-)registration procedures, the description of the basic and Master competencies of arts therapists, and the development and research of the profession and office facilities.

The FVB publishes a quarterly journal in Dutch, with (research) articles related to the arts therapies (Tijdschrift voor Vaktherapie). The FVB initiates and coordinatestask forces involved in research and the development of evidence based guidelines. Important also is the task forces that coordinates the development of treatment manuals for specific client problems(including indications, goals, interventions, and rationales) and the commission for training.

Within the structure of this federation, the Dutch Association of Music Therapy (NVvMT) was formed in January 2006. This association is one of the five independent associations which are united in the FVB. The NVvMT has formulated a professional music therapy profile for the practice of music therapy. The last version has been published in 2009 (Beroepsprofiel voor Muziektherapeuten, 2009). These profiles include the institutional as well as the private setting. The NVvMT has a special interest in organising structuring and stimulating current music therapy developments. The group lists existing music therapeutic activities in the Netherlands and promotes the communication among music therapists by means of study groups, newsletters and symposia. They account for the Dutch music therapy profile, stimulate and disseminate music therapy methods and manuals.

Whereas the association mainly has a national function, the second Music Therapy Foundation (Stichting Muziektherapie), established in 1987, has international contacts. The foundation aims at promoting music therapy by organizing international congresses and workshops. Examples of undertaken activities are the 5th International Congress Music Therapy and Music Education for the Handicapped (1989) and the Pre-conference Music Therapy in Health and Education in the European Community (1991) and the 7th European Music Therapy Congress (2007).

In 1992, the Music Therapy Foundation, financially supported for this by the Department of Creative Therapy at the University of Applied Sciences (UAS) of Nijmegen, assisted in composing the Music Therapy International Report Volume 8 of the American Association for Music Therapy. In 1995 the Music Therapy Foundation published the second European Music Therapy Research Register. Recent activities include the development of a web-based register of Dutch music therapists. In 1997 the Music Therapy Foundation produced a documentary film on recent developments in music therapy in the Netherlands and in 2004 a documentary film on music therapy in the care for the elderly with a special focus on observation, referral and evaluation of music therapy's effectiveness.

Training Programs

Within the regular educational system in the Netherlands, there are four full-time, four-year programs for music therapy within which Dutch, German, English and Belgian students follow music therapy courses. Three of these programs are located at the departments of health or social work at the Universities of Applied Sciences (UAS) of Utrecht, Arnhem-Nijmegen, and Zuyd Heerlen. The fourth music therapy training program at ArtEZ (UAS) School of Music in Enschede is located at a conservatory. The UASs are accredited, and are controlled and supervised by the government (Ministry of Education, Culture and Sciences). All training courses at the UASs have been transformed into a Bachelor format, conforming to the Bologna Process. Apart from the accredited training courses above, a 2 ½ year course is offered at the UAS Stenden and a part-time course based on anthroposophical music therapy at the UAS Leiden.

In 1999, the training institutions for arts therapists, which in the new century have been transformed into Universities of Applied Sciences (UAS), agreed on basic competencies for arts therapists at the Bachelor level, and which have been developed with a special pathway for music therapy. These training competencies were deduced from the description of therapeutic and professional tasks that have been described by the FVB and the NVvMT. In 2009, the job description designed by the FVB the training competencies at the UAS have been renewed. Training competencies at the Master’s level have been developed too. Therefore, all training programs fulfil the same national standards. All training programs are members of the European Consortium of Arts Therapies Education (E.C.Ar.T.E.). In The Netherlands the transformation to the Bachelor-Master structure has been made. Since the introduction of this structure the Universities of Applied Sciences (UAS), which host the arts therapies training programs (as listed in the ECArTE directory), have started or are developing Master programs.

In the Netherlands all public (non-private) training programs, which have been mentioned before, are located at the Universities of Applied Sciences (UAS) and not at the Universities of Sciences (US).

At this time there are two Masters’ programs to which music therapists can apply. The first is the Master of Arts Therapies at Zuyd UAS established by Smeijsters in 2004, which is affiliated to the Research Centre for the Arts Therapies KenVaK. KenVaK is a joint venture of UAS Zuyd Heerlen, UAS Utrecht, UAS ArtEZ School of Music Enschede, and UAS Stenden Leeuwarden.

The KenVaK Master program focuses on competencies to develop and research the treatment methodology by means of evidence-based practice, practice-based evidence, qualitative and quantitative research. The program is accredited and financed by the Dutch Government. The second Master program is the International Master of Arts Therapies, offered and accredited by both KGH Freiburg as well as Arnhem-Nijmegen UAS. The latter program awards a qualification from KGH Freiburg as well as Arnhem-Nijmegen UAS. The curriculum focuses on reflection on theory and methods an research competences.

As all previously mentioned public (non-private) training programs in the Netherlands are located at universities of applied sciences (UAS) and not at scientific universities, it is not (yet) possible to obtain PhD in the arts therapies. It is possible to start a PhD research on the basis of individual arrangements with a scientific university. Researchers within KenVaK can pursue their PhD in one of the arts therapies, because KenVaK established a scientific relationship with several scientific universities in The Netherlands and Germany.

The Professional Status of Music Therapy

The largest setting in which music therapists are employed is within psychiatry. In all, there is some form of arts therapies at 95% of the psychiatric institutions. In 65% of the cases, music therapy is part of that. The music therapist is the only music therapist (50%) or is part of a team made up of several full-time and/or part-time music therapists. In about 80% of the cases, the music therapist is a member of the treatment team consisting of psychiatrists and psychotherapists.

The music therapist's payment is equivalent to that of occupational therapists and varies between the lower and higher levels. The music therapists in psychiatry have the disposal of one or several workrooms, an extensive group of instruments and their own budget. In some cases (for example in elderly care settings), music is still used as a form of occupational therapy, which results in less facilities and also less payment.

The profession of arts therapists is a semi-professionalized profession (Van Praag & Schalkwijk, 1990). The performance of the profession has not yet been officially protected. In the domain of health professions there is a system of legislation by the government, called the Professions in Individual Health Care and Cure Law (BIG-wet) by which professions are protected by law. There are negotiations within the Council for Postgraduate Training in Mental Health (CONO), which is the advisory board of the Dutch Ministry of Well-being Health Care and Cure, to take arts therapies into the BIG law[2], and to establish arts therapies as a protected profession. This would certainly aid the goal of stabilizing the pay scale and status of arts therapists in the Netherlands.The Ministry of Education Culture and Sciences has accredited the training programs at the UAS, from the very beginning.

There is a professional register, established in 1987 in order to allow arts therapists to be registered as a qualified professional that meets the competencies for the arts therapist (music therapist). In order to meet registration, the music therapist needs a graduation from an official training program at one of the UAS settings, and sufficient practical experience and further training as a senior therapist. Registration is possible at the Foundation for Registration of the Arts Therapists (SRVB) .

Economic, Social and Cultural Influences on the Development of Music Therapy

The dissemination of music therapy in the Netherlands was positively influenced when in the sixties and seventies the medical model was gradually being replaced by social-psychological methods that emphasized group processes (Van Nieuwenhuijzen, 1983). The anti-psychiatry movement has also had a favourable influence on the development of music therapy (Haans, 1992). In the 1980’s, the Dutch government, due to the oil crises and economic stagnation, plotted a "no-nonsense" policy. Music therapy, being a "soft therapy" within health care, had to watch its step. The need for music therapists who could stand their ground within a changing health care, became stronger.

The practice of music therapy, however, was not in danger and remained, also afterwards, embedded in the Dutch welfare state which hardly has its equal worldwide. The government bears the cost of the institutions where music therapy is practised and music therapists hold full-time or part-time permanent appointments, which have been laid down on the basis of legislation and employment contracts. The distance to the more established professions, such as psychiatrist and psychotherapist is still great, which is also expressed in the salary. But this distance is getting smaller because of the growth of Masters’ and PhD programs for arts therapists.

Currently, the Dutch health system requires that all treatments are described in so-called treatment manuals: a description of goals, indications, contra-indications, interventions, rationales, resources, frequency and length of treatment connected to one particular problem of the client. The Dutch health system also requires the development of guidelines, based on research evidence, which show what sort of therapy is most successful with what sort of client problem or diagnosis. Evidence includes results from randomized controlled trials, professional tacit knowledge and client experiences. This is in line with Evidence- Based Practice (EBP).

Theoretical/Philosophical Traditions and Research Foci in the Netherlands

Theoretically, music therapy education in the Netherlands has been influenced by several psychotherapeutic schools, such as psychoanalysis, gestalt therapy, client-centered therapy, cognitive (behavioural) therapy and systemic approaches. Nowadays cognitive-behavioural therapy, schema-focused therapy, dialectical behaviour therapy, mindfulness, mentalisation and acceptance- commitment therapy have influenced music therapy.

Besides these influences, specific theories for the arts therapies have been developed. One important theory in the earlier days was the Creative Process Theory (Smitskamp & Te Velde, 1988), based on a combination of Freudian developmental stages and theories from art psychology and humanistic psychology. Another theory and practice that has been developed by Kurstjens is based on morphologic music therapy by Tüpker, Weymann and others. Currently within music therapy, the Analogue Process Model is favoured, which has been developed by Smeijsters (2003a/b, 2005c, 2007b, 2008a/b/c). This model is based on Stern’s and Damasio’ research and describes musical phrases as equal to felt vitality affects in the person’s core self (Smeijsters, 2010). Also improvisational models of music therapy are integrated in music therapy training, based on Bruscia’s techniques (Bruscia, 1987).

Research in Music Therapy

Since 2003 at the Universities of Applied Sciences research centres have been established for research into the arts therapies. One of these centres is KenVaK in which Zuyd UAS, Utrecht UAS, ArtEZ UAS and Stenden UAS cooperate. Another centre has been established at Arnhem-Nijmegen UAS. In these research centres research into all arts therapies (drama, music, art, dance-movement) takes place. There is cooperation between the research centres at UASs and Scientific Universities, where students after their Master’s degree from UASs can do their PhD. At this time several PhD studies on music therapy are in progress.

Students in the Netherlands now have the possibility to get their Bachelor’s degree, their Master’s degree and their PhD. This will have an enormous impact on the body of knowledge of the arts therapies. Note that the Master’s degrees are in arts therapies, but within this program from the very start music therapists focus on music therapy. Qualitative research is conducted, such as phenomenology, constructivistic inquiry and grounded theory, as well as quantitative multiple baseline designs and randomized controlled trials. Systematic reviews for the treatment of depression, ADHD, autism, schizophrenia, personality disorders, eating disorders, anxiety and mood disorders have been and will continue to be published.

Music Therapy Web Pages in the Netherlands

National Music Therapy Associations:

Training Programmes (Bachelor):

Training Programmes (Master):

Other:

Notes


[1]Parts of the text has been published before in: Maranto, Cheryl. D. (Ed)(1993). Music Therapy: International Perspectives. Pipersville-PA: Jeffrey Books. It is republished here with the kind permission of the author and the publisher.


[2]BIG Law: The Individual Healthcare Professions Act regulates the qualifications to practice a profession in the individual healthcare sector.

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How to cite this page

Smijsters, H. & Vink, A. (2010) Developments in Music Therapy in the Netherlands. Voices Resources. Retrieved January 11, 2015, from http://testvoices.uib.no/community/?q=country/monthnetherlands_october2010