Voices ResourcesA website for the worldwide community around the journal Voices: A World Forum for Music Therapy

|Introduction| |Historical Introduction| |Professional Associations for Music Therapy| |Training Programs| |The Professional Status of Music Therapy| |Economic, Social and Cultural Influences on the Development of Music Therapy | |Theoretical/Philosophical Traditions and Research Foci in the Netherlands| |Research in Music Therapy| |Music Therapy Web Pages in the Netherlands| |References|

Introduction

Music therapy in the Netherlands is widely implemented in general healthcare, varying from job positions in general psychiatry, forensic psychiatry, work with mentally and physically handicapped, in elderly care settings to private practice. Music therapy in the Netherlands is commonly regarded as being part of creative therapies. Music therapy is gaining more and more position in general healthcare, since its first development in the late fifties. Over a thousand creative therapists are currently employed in our relatively small country and the number continues to grow. Research is being initiated by the recently founded research centres.

Historical Introduction

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 creative therapy as it is 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: 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 for the client's ability to vary the tempo and dynamics, to be able to follow and to allow being 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 Waardenburg, Noske-Fabius, Ter Burg, Haans, Van Nieuwenhuijzen, Fockema Andreae and De Bruijn have made considerable contributions in 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 chairman of the association.

Methods that were developed besides those mentioned earlier, are the Gretener-von Sury method, consisting of exercises to increase concentration and social interaction of handicapped people, the "Le Bon Départ" method by Bugnet-van der Voort for mentally 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.

The anthroposophic paradigm had little influence and became overruled by the Creative Process Theory that for many years became the leading paradigm for all creative therapies. This theory and other recent theories will be described in the paragraph on theory.

In the seventies and eighties, publications of a recapitulating nature appeared, such as the book by Stavenga (1979) and the book edited by Adriaansz, Schalkwijk and Stijlen (1986). In the latter a large number of experienced music therapists reported in a systematic way about their own method.

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).

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, his role was gradually taken over by Smeijsters who, besides doing quantitative and qualitative research, is also working on 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 programmes 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. Recently, he initiated the first research centre for creative therapies in the Netherlands (KenVaK).

In the recent decade, Dutch music therapy has started to occupy an important position 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) 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), and recently the Congress 'Arts, Illness and Trauma' on September 26th-27th 2003, Amersfoort, the Netherlands.

Professional Associations for Music Therapy

The Dutch Association for Creative Therapy (Nederlands Vereniging voor Creatieve Therapie, NVCT) is the professional organisation which offers several facilities to creative therapists, such as an employment service for creative therapists. They have formulated professional profiles for the practice of creative therapy in general and all creative therapies (including music therapy) in particular. These profiles include the institutional as well as the private setting.

The association has set out to:

• promote the study, practice and development of creative therapy in various media and
• protect the social interests of its members, as far as they relate to the performance of their profession as creative therapists (Nederlandse Vereniging voor Kreatieve Therapie, 1988).

The association tries to achieve its aim by holding general meetings, organizing courses and seminars, by reaching collective agreements through negotiation and by publishing a journal: the Dutch journal for creative therapies (Tijdschrift voor Creatieve Therapie). In 1984, the association joined a large civil service union. The association has various commissions, such as the commission on ethics, and the commission for social interests. Very important is the commission for research and guidelines, which coordinates the development of evidence based guidelines and initiates research. Important also is the commission that coordinates the development of treatment modules (indications, goals, interventions, and rationales for specific client problems) and the commission for training.

On the occasion of its 40th anniversary in 2002, the association organized several national congresses, during which by means of lectures and workshops the 'state of the art' has been presented.

Within the structure of the NVCT, the music therapy section (Beroepsgroep Muziektherapie) has a special interest in organising and structuring current music therapy developments. This group lists existing music therapeutic activities in the Netherlands and promotes the communication among music therapists by means of study groups.

Whereas the association mainly has a national function, the second Music Therapy Foundation (Stichting Muziektherapie), established in 1987, has international contacts. The foundation, which aims at promoting scientific research and the development of music therapy methods, tries to realize its aim 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).

In 1992, the Music Therapy Foundation, financially supported for this by the department of Creative Therapy at the UPE 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 music therapists. In 1997 the music therapy foundation produced a documentary film on recent developments in music therapy in the Netherlands. The last product is 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

At the moment, there are 4 full-time training programs for music therapy with a length of 4 years within the regular educational system in the Netherlands, on which both Dutch, German, English and Belgium students follow music therapy courses.

The training programs are departments of the Universities of Professional Education (UPE) of Utrecht, Arnhem & Nijmegen, Zuyd and Saxion Enschede. In the UPE Zuyd there is also a training program for Instructional Music Therapy.

The five UPEs are accredited, and are controlled and supervised by the government (Ministry of Education Culture and Sciences). All training programs of the UPEs have been transformed in a bachelor format, conform the Bologna agreement.

In 1986 and 1990, the departments for creative therapy of the institutions that later became the UPEs of Utrecht (location Amersfoort), Arnhem & Nijmegen (location Nijmegen), Zuyd (location Sittard) and the Christian Hogeschool Nederland (location Leeuwarden, no music therapy) decided on joint final levels. In 1999 they agreed on basic competences for the creative therapist, which by a commission of experts have been deduced from the association's description of the profession (the professional profile). These competences are leading for the curriculum development of the bachelor training programs (see the Landelijk Opleidingsprofiel Creatieve Therapie). In these training programs, music therapy is part of creative therapy. In Enschede only, music therapy can be studied at a conservatory combined with professional music education.

All training programs meet the standards of the Register for Creative Therapists and are full members of the European Consortium of Arts Therapies Education (E.C.Ar.T.E.).

Besides the training programs mentioned above, there is a private training programme on an anthroposophic basis at the academy 'De Wervel' in Zeist and a follow-up training in instructional music therapy at the Conservatory of the UPE in Alkmaar.

In the Netherlands all public (non-private) training programs, which have been mentioned before, are located at the university of professional education and not at the scientific universities. Because of this there is (yet) no structural possibility for obtaining a masters and Ph.D. degree. On basis of individual arrangements it is possible to start a PhD research for students who graduated - in for instance psychology - at one of the scientific universities, such as the work of Vink. Because UPEs recently have the opportunity to establish research centres and master programs the situation will change soon. A master programme, which has been developed by Smeijsters at the UPE Zuyd and will be carried out in cooperation with the UPEs of Utrecht and Saxion Enschede, will start in 2004. Other master programs will be developed by the UPEs located in Nijmegen and Leeuwarden.

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 creative therapy 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 team of treatment consisting of psychiatrists and psychotherapists.

The music therapist's payment varies between the lower level of occupational therapist and higher levels. The music therapists in psychiatry have the disposal of one or several workrooms, an extensive instrumentarium and their own budget.

Music therapy within the care of the elderly, the mentally and physically handicapped did not always develop fully in every institution. In some cases music is still used as a form of occupational therapy, which results in less facilities and also less payment.

The profession of creative therapist is a semi-professionalized profession (Van Praag & Schalkwijk, 1990). The performance of the profession has not yet been officially protected, a situation which soon will change when creative therapy is included in the 'BIG'-law, which regulates the professional protection of professions in health care and cure. The Ministry of Education Culture and Sciences has accredited the training programs at the UPEs, from the very beginning. Soon they will be accredited too by the CONO institution, which is the official representative for all treatment institutions in health care and cure and advices the Ministry of Health. The CONO has a system of accreditation that results in submission under the 'BIG'-law. There are negotiations going between the training programs and the CONO to recognize graduates form the bachelor training as basic practitioner under the 'BIG'-law. In the future graduates form post-graduate and master training programs can be recognized as senior practitioner under the 'BIG'-law. Then the professionalisation of creative therapy has reached a next milestone and the title of creative therapist will be protected to those practitioners who have been trained and experienced conform the CONO regulations.

To protect the profession from within, in 1985, the association passed the Register Statute and established the Register Commission, followed in 1987 by the Register for Creative Therapists Foundation. The foundation runs, independently of the association, the register and tests whether training programs meet the register's criteria. The commission takes care of the admission to the register of the individual creative therapist, c.q. music therapist. In order to meet registration, the graduated music therapist must have been trained musically, therapeutically as well as music therapeutically at the UPE level, and have sufficient case load experience and further training to become a senior therapist. Registration by the Register for Creative Therapists Foundation will be matched to the CONO accreditation.

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 the group processes (Van Nieuwenhuijzen, 1983). The anti-psychiatry has also had a favourable influence on the development of music therapy (Haans, 1992). When in the next period during which 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 steps. 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 payment.

Theoretical/Philosophical Traditions and Research Foci in the Netherlands

Music therapy in the Netherlands has various non-music therapy theoretical influences. Especially the influence of psychoanalysis, gestalt therapy, humanistic orientations and cognitive behavioural therapy are large, even though the theoretical background is not always explicitly indicated. In recent years, the emphasis with several music therapists has moved from a method of working based on a single theory to an eclectic approach, geared for the client's specific disturbance and the change in it.

In certain wards in psychiatry, especially the closed wards with their more serious problems, behavioural therapeutic techniques are used, which can be traced back to music therapy (Haans, 1992). Wijzenbeek and Van Nieuwenhuijzen (1984) introduced concepts taken from communication theory, such as 'analogous communication', 'complementarity' and 'symmetric escalation'. Music therapy has also been embedded in a therapeutic approach, such as the 'therapeutic community model' or the 'cognitive restructuring' by Beck (Van Hest-de Witte & Verburgt, 1992).

Working with mentally handicapped often takes place against the background of the cognitive development model by Piaget. But also the psychoanalytic and humanistic way of thinking have been adopted. Actualising the available possibilities, empathy and unconditional regard - concepts from client-centered therapy - are encountered more than once (Van Rest, 1986). Structured behavioural therapeutic approaches and techniques are also used (Vodegel, 1984).

In rehabilitation a client-centered and actualising approach is very common (De Bruijn, 1984, 1986, 1994).

Besides the non-therapeutic influences, theories have been developed or adopted which are much more close to art itself. Most prominent was the development of the Creative Process Theory, which is based on Freud's developmental stages on the one hand, and theories from art psychology (the 'artist view') on the other hand. Central to this theory is that music, and other art forms, give the client the opportunity to express and fulfil his suppressed and fixated needs, and by this will be able to recapitulate his development, and eliminate his fixations. The therapeutic process is described as equal to the artist's creative process, in which there is an exchange between a primary process, which is emotional, vague, chaotic and primitive, and a secondary process, which is articulated, logical, and controlled. The client is seen as cured when he is able to find a balance between the primary and secondary process. The Creative Process Theory for many years has been the paradigm for nearly all public (non private) training courses for creative therapies (Smitskamp & Te Velde, 1988; Smitskamp, 1991, 1993). At the same time concepts from morphological music therapy have been adopted (Tüpker, 1988).

A recent model, which has been developed by Smeijsters (1995/1999, 2000, 2003a, 2003b, in preparation) is the Analogue Process Model. This model connects Stern's theory on vitality affects, a-modality and cross-modality with a semiotic perspective on musical form and musical parameters. The concept of analogy proposes that psychic processes are formed by the same parameters as music, which makes it possible to find an expression for psychic processes in music. A client can find in the music a musical equivalent for his problems, disturbances, handicaps, abilities, and explores changes in the music, which are equal to changes in his psyche. Because of the equivalence of the psychic and musical parameters (the a-modality of parameters forming the vitality affects) the musical process can be a healing and developmental process. The interested reader is referred to the new book Sounding the Self in music. Analogy in improvisational music therapy that will be published in the near future (2003/2004).

Research in Music Therapy

As mentioned before, in the Netherlands, music therapy is not embedded within scientific universities. Until recently, apart from single research projects in music therapy, there has not been a continuous scientific climate in which relevant practices and developments were researched. In the nineties the Music Therapy Laboratory in Nijmegen, led by Smeijsters and Van den Berk, has been the only place where during several years (funded) research could be done that reached international standards (see the publications of Smeijsters et al). Important research has been done also by Drieschner and Pioch (1997, 2000) on regulating anger in forensic clients and developing treatment categories (receptive/active, music/problem oriented, levels of structure). The Trimbos-institute, a national research centre for health by means of qualitative research developed treatment modules for all creative therapies (Van Hattum & Hutschemaekers, 2000).

Nowadays the research centres of the UPEs have become established. Four of them include research projects for creative therapy. For instance Krantz is researching rationales music therapists use during their interventions. Krantz is a member of the research centre of the UPE Arnhem & Nijmegen. KenVaK is the first research centre on a national level that exclusively conducts research in creative therapies (drama, music, art, dance & movement). The music therapy researchers from KenVaK focus on: indications, goals, interventions, effects and rationales when using improvisation (Kurstjens), module development and effect research for all arts therapies, including music therapy, in forensic psychiatry (Smeijsters), and research competences and facilities within the bachelor training programs (Vink).

All research centres at the UPEs focus on tacit knowledge, consensus based evidence, research in practice, qualitative and quantitative designs and topics like: assessment, indications, goals, interventions, effects and rationales.

A specific research focus of KenVaK is to find and test research methodologies that are suitable to describe the practice of music therapy and to produce research results with a high level of clinical validity. In this effort, qualitative methodologies, like naturalistic inquiry and grounded theory, are favoured and practice oriented research. Smeijsters, head of research of KenVaK, has been involved in the international discussion on qualitative research methodologies with Bruscia, Langenberg, Kenny, Aigen, Amir, Wheeler, Ruud and others. In the present he takes part in the international discussion on the pros and contras of randomised controlled trials and types of evidence.

Currently, many therapists are also involved in writing systematic reviews. In the Netherlands, multidisciplinary guidelines are being developed in which the effect of a variety of therapies is described in relation to a specific disorder. Guidelines are currently being developed on the treatment of depression, ADHD, eating disorders, anxiety- and mood disorders in which creative therapies are included.

Music Therapy Web Pages in the Netherlands

National Music Therapy Associations:

• Dutch Association for Creative Therapy: http://www.creatievetherapie.nl
• Dutch Music Therapy Foundation: http://www.stichtingmuziektherapie.nl

Training Programmes:

• University of Professional Education (UPE) Zuyd, Sittard: http://www.hszuyd.nl
• UPE Amersfoort/Utrecht:

http://www.ct.hvu.nl/

• UPE Saxion Enschede (conservatory): http://www.hen.nl/
• UPE Nijmegen: http://www.han-cto.nl/

Private Homepages:

• Klaas Kloppenburg: Music therapy playwise
• Henk Smeijsters: Henk Smeijsters
• Annemiek Vink: Info music therapy

[Parts of the text above 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.]

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How to cite this page

Smeijsters, Henk & Vink, Annemiek (2003). Music Therapy in the Netherlands. Voices Resources. Retrieved January 08, 2015, from http://testvoices.uib.no/community/?q=country/monthnetherlands_september2003