MIND THE GAP

Musical encounters with people with special needs:

the art of attuning

Scriptie ter verkrijging van de graad van Master aan het

Koninklijk Conservatorium Den Haag, te verdedigen op

donderdag 22 juni 2017 klokke 13.30 uur

door Manon Heijne

geboren te Wormerveer in 1964

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Summary Being a musician today means that one finds oneself more and more employed in new contexts and having portfolio careers in which one combines several musical activities. Some of us find work in the regular professional field (including music education), others in the health care sector, in social or justice settings. In any case, there is - on the one hand - a tendency that musicians become increasingly in touch with people suffering from motor, cognitive, social and/or emotional vulnerability. Overall one can see there is a growing need from within society to provide (interactive) concerts and/or ditto workshops for people with special needs. On the other hand there is a trend that musicians create themselves practices as working with this target group, because of personal gratification and drive. In this research thesis I will deal with the interaction between the musician and people with special needs and put a slight focus on two different target groups that often occur during a teaching practice (although the findings can be useful for any target group), namely people who suffer from (certain characteristics of) ASD and ADHD (see 2.2.1. for the explanation of the abbreviations). What does the musician need to enable this interaction? There is an increasing group of musicians who are interested in working with people with special needs and are not or don’t feel prepared enough to do so. And how can this specific musical practice be of beneficial influence on (the self image of) the musician? The higher professional music education programs (Bachelor and Master system) in The Netherlands, don’t provide enough content to facilitate musicians as outlined above, whereas I think that offering specialized education in this particular domain, leading to acquiring knowledge and experience, can build a proficient consciousness that allows them to do this work at an appropriate and knowledgeable level. What would be the desirable content and form of teaching and learning for students in the various phases of music education, when they have the ambition to work with people with special needs? I have chosen to initiate a module, in order to facilitate this aspect of the musical practice for which there is a growing need. To complete the module, and therefore execute the required phases of the methodology concerning the Educational Design Research model as prescribed in paragraph 4.1. (in particular in relation to the practical application of the theory), more time is required. In short: with this thesis I want to present the beginnings of a module, which is an important first step in finding out what a musician needs when invited to work with people with special needs, and hopefully in this way contributes in helping them to reduce their uncertainty and -possibly- frustration. The aim of the module is to equip the musician with three ‘domains’: skills, attitude and knowledge, which can be strengthened through interaction and improvisation, by: providing appropriate knowledge about some relevant characteristics of people with special needs, and its implications for education; understanding the importance of reflection and musical identity; building awareness of what is required to communicate with and function well in relation to this target group; understanding the difference between music-based and therapeutic-based activity, and by putting an emphasis on an open attitude.

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Foreword and acknowledgements In 2006, I first came in contact with the joint Research Group Lifelong Learning in Music of the Hanze University Groningen (Prince Claus Conservatoire) and the University of the Arts The Hague (Royal Conservatoire), when musician and lector Rineke Smilde (not yet a professor at that time) asked me to become one of the 32 portraits of musicians as Lifelong Learners. Here and now is not the place to enumerate the many different areas of my activities of the past (and present), but in the eyes of Rineke I was at that time already the perfect example of having a portfolio career. Despite all my (portfolio) activities, my anchor was contemporary music. During my tours abroad as a singer with a specialization in this field, I gave numerous master classes in both repertoire and performance practice of the contemporary music, among others in Moscow, Budapest, Vilnius, Skopje, Nish and Santiago de Chile. In a later fase of my career I decided to take my Bachelor in music therapy (I completed this study ‘cum laude’ in June 2015). Both my years of working with professional singers with a passion for music, as well as from my personal love for the same, it is my strong conviction that it is also possible to pass on the ‘power of music’ in a broader context, e.g. by working with people suffering from dementia or with braindamage/-trauma and the like. Also working with youngsters who have psychological problems is an interesting and challenging field. Approximately at the same time I was studying music therapy, the (joint) Research Group successfully developed a training program for musicians in the field of Music and Dementia. This program included participatory music workshops for people with dementia: as a teacher at the Royal Conservatoire and as a music therapist, I was engaged to give this course within the curriculum of the Master NAIP, as well as to assist professional musicians during their first steps on this fascinating path. Eventually, all the elements above led to this thesis, with precisely this topic, and I am grateful that the school board allowed me to investigate this specific subject. Special thanks go to my supervisors Adri de Vugt (teacher in Educational Pedagogy and Music Education at the Royal Conservatoire), and Han Kurstjens (psychologist, music therapist, teacher in music therapy at Codarts Rotterdam and researcher at KenVaK), who provided me during the past two years with fruitful and positive feedback (and personal thanks to Adri who gave me the opportunity to work with students). Consulting my supervisors on a regular basis certainly helped me achieving the necessary steps in the design and execution of this research. Likewise Henk Borgdorff, my Master Cicle leader: he was a fine co-reader and his remarks were of great importance. Additional words of thanks are for Karst de Jong, who was so kind to bring my thesis into the Research Catalogue. I also want to thank the interviewees and the musicians for their cooperation, feedback and open mind. Furthermore, I want to thank Renee Jonker for our exchange of views at the right time and place, and all the other people that supported me. My special thanks go to my husband Frans de Ruiter, for all his tips, advice, feedback and support. They were of great value. And finally, I would like to give a thanks to music: without it life would be not half as livable! Music makes a connection with stomach, heart and head, loosens, and ‘reconnects us with our innerselfs’..... Manon Heijne, May 2017, Zaandam.

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Table of contents Summary Foreword and acknowledgements 1. Introduction 1.1. Motivation/Rationale 1.2. Reading Guide 2. Context 2.1. Higher Music Education in the 21st century, A bird’s eye view on the terrain 2.2. People with special needs, A bird’s eye view on the terrain 3. Theoretical Framework 3.1. Definition and the two forms of music therapy 3.2. About processes and theories 3.3. ‘Gut feelings’ 3.4. The present moment 3.5. The power of improvisation (from a therapeutic angle) 3.6. The four main developmental areas 4. Methodology 4.1. Type 4.2. Three different types of data gathering 4.3. Quality criterion 5. Findings 5.1. Interview findings 5.2. Observation findings 5.2.1. Participating observations 5.2.2. Observation of video material 5.3. Discussion findings of focus groups 5.4. Short résumé of the findings 6. Key components for the initiation of the module: ‘Music and Special Needs’ 7. Conclusion 8. Recommendations 9. Bibliography 9.1. Books and articles 9.2. Websites 10. Annex 10.1. Characteristics of ASD and ADHD 10.2. Eriksons eight stages of development 10.3. Interviews 10.4. Component diagram 10.5. The 64 improvisation techniques of Bruscia 10.6. Translation of techniques on empathy and structuring techniques into English 10.7. Personal process 10.8. Glossary

Exertion 1 Sound is music and everywhere...... Exertion 2 Opens the unknown….. Exertion 3 And frees itself from the forms of the recent past. Exertion 4 Care for every man…. Exertion 5 With music being the starting-point.

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1. Introduction 1.1 Motivation/Rationale

‘Thinking about myself I see a musician who is the perfect example of having a portfolio career…..’

In the final thesis of my music therapy study I wrote about the fact that these days musicians, including myself, are more and more employed in new contexts and that they have portfolio careers in which they combine several musical activities (Heijne 2015: 40). This is confirmed by professor of Lifelong Learning in Music Rineke Smilde in a chapter in The Oxford Handbook of Music Education in which she states that professional musicians holding a portfolio career have to respond to the variables within different cultural contexts, with roles that include those of performer, composer, teacher, mentor, coach, leader, and more. She also mentions that these diverse roles require musicians to be innovative, reflective and responsive, collaborative and entrepreneurial (Smilde 2012: 291). Writer and consultant on arts and education Rick Rogers observes in his report ‘Creating a land with music’ (Rogers 2002: 4-9):

‘Being a musician today involves having the opportunity to take on a series of roles, different from and broader than the act of performing and composing [….] Many, and especially those termed, or who term themselves, community musicians, work in health care, social care, formal and informal education, and youth and criminal justice settings (the size of this part of the music industry may be indicated by the fact that annually there are over 4.000 concerts in UK hospitals). Hence musicians become increasingly in touch with people with motor, cognitive, social and/or emotional vulnerability.’

On the website of the Hanzehogeschool Groningen1 (University of Applied Sciences) research by the AEC (Association Européenne des Conservatoires2) shows that, especially in countries like the United Kingdom, the Nordic countries and the Netherlands, an increase in work in the wider community has been seen in the last decade. The new demands of the rapidly changing professional sets as described in the above mentioned document of Rogers, give an interesting overview of the ever-broadening cultural landscape and the changing career opportunities for musicians in the UK. Although this study was conducted in England, the outcomes are compared with results at European level3, and therefore can be held true for a lager part of Europe. In this research thesis I will deal with the interaction between the musician and the person with special needs. What does the musician need to enable this interaction? And how can this specific musical practice be of beneficial influence on (the self image of) the musician? Subsequentially, what would be the desirable content and form of teaching and learning for students in the various phases of music education, when they have the ambition to work with any target group of people with special needs (See Context, 2.2.1.)? 1 https://www.hanze.nl/nld/onderzoek/kenniscentra/kenniscentrum-kunst-en-2 http://www.aec-music.eu/about-aec 3 https://www.hanze.nl/assets/kc-kunst--samenleving/lifelong-learning-in-music/Documents/Public/expandingcareeroptions.pdf

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Not long ago a book was published by oboe-player Kate Page, sociologist Peter Alheit and Rineke Smilde While the music lasts (2014), where a recent study describes the innovative practice of 'Music for Life', a project managed by the Wigmore Hall dementia UK and in London, and of professional musicians through creative music workshops working with people with dementia and their caretakers. They state that the transformative processes the musicians go through are of central concern for them, when they engage with new audiences, like for instance people living with dementia. These processes are based on increased moments of insight through reflective practice according to Smilde, Page and Alheit (2014: 22).They say that transformative learning is based on gaining new understanding emerging from critical reflection on one’s own assumptions and presuppositions. […] The musicians must be able to reflect on their practice, on their roles, and be responsive to what they perceive. My research thesis contains proposals that could lead into a module, elective or otherwise, for enriching or complementing the existing curriculum of the Royal Conservatoire. Musicians who feel an intrinsic drive to (also) work with people with special needs should not be held back by feelings of insecurity concerning this practice. That is why it is important that musicians during their learning career within the higher professional music education programs (BA & MA) in The Netherlands are offered this kind of education on which they build a proficient consciousness that allows them to do this work at an appropriate and knowledgeable level. In order to find answers to these questions it is important to give first an overview of the three main problems, which are for me the reason/motivation to write this thesis.

• There is a growing need from within society to provide (interactive) workshops, teaching situations and concerts for (or with) people with special needs.

• There is an increasing group of musicians who are interested in working with

this target group people with special needs and are not or don’t feel prepared enough to do so4.

• The higher professional music education programs (BA & MA) in The

Netherlands don’t provide enough content to facilitate the musician as in the above.

All the elements in the above lead to the necessity to compose a study program, a specialized module, in order to facilitate this side of the musical practice for which there is a growing need. This being said, it is time to introduce my: Research question Which skills, attitude and knowledge are useful for musicians when entering into musical dialogues and connections with people with special needs? and

4 This excludes musicians who study or studied music therapy

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Subquestions

a) How can this specific musical practice be of beneficial influence on (the self image of) musicians?

b) What starting points can be formulated for materials to be used and approaches to be taken?

c) What are key components when designing a course that offers the appropriate equipment to musicians?

I would, however, at this point immediately like to make a comment about my research question: the boundaries between people with special needs and people with 'normal' needs are obviously very vague. In my search to what a musician needs to enter into musical dialogues and connections with the target group, I am looking for a broad general basis, precisely because of this vague dividing line. Beginning from this base helps to enter every setting desired, or to create a more specific translation towards any target group of people with special needs. Although, aware of the criticism that has been directed to psychologist Carl Rogers, I see myself, in this respect, guided by him (he was one of the founding fathers of the ‘Humanistic Psychology’) and his ideas about humanity. In his book On becoming a person5 he assumes that every human being lives in his own subjective reality and has the innate tendency to self-realization (Rogers 2012: 86-90). Especially in their youth, but also afterwards, people have a strong need for positive regard, in order to evolve to a coherent self. Therefore the valuation of significant others for their developmental activities should be positive and without conditions. If this process becomes unbalanced therapy can help, provided the therapist meets three basic attitudes: authenticity, unconditional acceptance of the client and empathy (Rogers 2012: 61). Rogers does not speak in terms of disease on the basis of psychological disorders, because this does not correspond to the basic principles of his approach. He regards people in their core as good and healthy. Rogers also focuses on the person as a whole and especially on the awareness of experiences, rather than specific symptoms of psychopathology. Music and musicality offer in this respect a lot of tools. Although musicality is seen by many people as something special, it seems to be that almost all people have the basic building tools for this. According to professor of music cognition Henkjan Honing everyone is musical, as can be read in his book Iedereen is muzikaal6 (Honing 2012: 72). He says that musicality in large is based on skills that are present at birth by almost everyone and come down to recognizing and appreciating melodies and rhythms. In his chapter in The Oxford Handbook of Music Education, composer, performer, teacher and researcher Adam Ockelford comes to the same conclusion, which I will summarize here (Ockelford 2012: 8). He says that engaging with music involves a range of different skills like listening, composing, performing, improvising, or simply recalling a favorite melody. Much depends of the nature of the activity. Thus, what may be termed ‘musicality’ is therefore not a single skill, but a profile of capacities and, according to internal and external motivating forces and opportunities, the development of these capacities will inevitably vary between individuals. Important is 5 Translation title: Mens worden, een visie op persoonlijke groei 6 Translation title: Everybody is musical

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that it appears that some degree of musicality is to all intents and purposes universal, and even being present among those with the most profound disabilities. Furthermore, Ockelford observes that it is important to note that music education is distinct from music therapy, although the overlap between the two professions is of course a point of concern when focusing on musical growth and development of the person in question. And he continues:

‘All too often, if children or young people or adults have disabilities or other special educational needs, there is an unquestioned assumption that a therapeutic approach will be the most appropriate way for them to access music (in school and beyond), whereas music education and therapy could (and, I believe should) be complementary, each driven by distinct musical and extramusical aims’ (Ockelford 2012: 8).

Ockelford’s interpretation reflects how I personally relate to music education and music therapy. Besides the fact that during a teaching situation the musician pays attention to the appreciation of the music and the chosen instrument, as well as to musical goals and technical skills, I think above all it is important that he connects with the person with special needs sitting or standing in front of him; that he has an open feeling for the human development of this person. Furthermore, it should be the case that the musician looks beyond the normative and functional approach of the instrument which is the subject of the learning process of the person in question; that he has a flexible attitude towards music making in general. And that the process includes working on cognitive, social, and communication skills. Entering the terrain where music education and music therapy meet provides (future) professional musicians opportunities to expand their employment possibilities, but it is no easy task to function successfully within the diverse demands of this area. Having talent and artistic skills are necessary but not enough. Such customization is not usually a part of e.g. church music or piano degree programs, say professor of music therapy and music education Alice-Ann Darrow and clinical professor, music therapist and music educator Mary S. Adamek in their chapter in the same handbook mentioned above (Darrow and Adamek 2012: 86). According to e.g. both music educators Janet Montgomery and Amy Martinson research shows that musicians often do not feel prepared enough for teaching and involving themselves with people with special needs (Montgomery and Martinson 2006: 34-39). In relevant literature, the need of a kind of 'cross-over' of music therapy and music education is indicated. They discuss frustration and uncertainty on the part of the musicians and their needs for information on musical, social and theoretical subjects in relation to the demands of working with people with special needs (Patterson 2003: 35-38; Randall 2011: 68). It is vital to stress at this point the utmost importance of the phenomena ‘listening and looking’ without pre-suppositions. Here is an obvious liaison with phenomenology. A phenomenon is an observable event. The word phenomenon is derived from the Greek and literally means ‘something that can be seen’. Phenomenology is an approach to philosophy that has emerged in the late 19th and early 20th century, and

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aims to describe reality as it appears to us in the concrete experience7. The value of phenomenology according to musician and music teacher Kees Buurman in his ‘Lecture about Phenomenology’ (Utrecht University, Music therapy) is that it emphasizes how people experience the world (e.g. how a person experiences illness and grief, how the teacher experiences the pedagogical encounter) (Buurman 2014: 22). It not only appeals to intellectual skills, but also to practical intuitive skills. The phenomenological approach leads us to ‘see’ all of a sudden something in a way that enriches our understanding of everyday experiences. Here I refer to the generally accepted phenomenological concepts in the domain of music therapy. Phenomenology in music is about listening in the moment, to perceive and listen freely to sound and rhythm without concepts and conventions. Clearly it is not a moral obligation to work with persons with special needs since musicians are of course allowed to choose their paths of employment. Musicians should feel an intrinsic drive to also work with people with special needs and should therefore not be held back by feelings of insecurity concerning this practice. The ultimate practical elaboration of this research does not have the aim to turn musicians into music therapists, but rather wants to broaden and open the view of the musicians regarding their work with people with special needs. This thesis provides no ‘ready’ answers to questions for this specific work field. Though, it can be seen as a document that supports the musician in a further exploration and realization of his professional competences in a perspective that is both broad and has sufficient focus. 1.2 Reading Guide My research thesis aims to be a guidance for those who are interested in working with people with special needs. I am therefore aware of the fact that the target group for whom I write is a multiple one. The outcomes of my research are open for anyone active in this domain. They may be students and teachers of Conservatoires, already graduated musicians, and even music therapists ..... Before reading this research thesis, I want to stress out that all translations and explanations in the footnotes (from quotes through citation to titles) are by the author. The structure of the thesis is as follows: Chapter 2 gives a contextual meta-view on what is needed in Higher Music Education in the 21st century when musicians have the ambition to work with people with special needs, and also outlines this target group. Chapter 3 is the Theoretical Framework and presents the following paragraphs: 3.1. About processes and theories 3.2. Definition and the two forms of music therapy 3.3. ‘Gut feelings’ 3.4. The present moment 3.5. The power of improvisation (from a therapeutic angle) 3.6. The four main developmental areas 7 https://nl.wikipedia.org/wiki/Fenomenologie

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The chosen literature is mainly recent and covers the topic of my research. In this extensive chapter I clarify the most important theoretical processes of music therapy. I also dedicate a paragraph to improvisation, which is the cornerstone of a music therapy context. In paragraph 3.6. I clarify on the one hand the four main developmental processes when becoming an adult, and on the other hand certain imbalances within these processes from which people with special needs may suffer. On top I add after paragraph 3.5. five exertions. In exertions 1,2, and 3 I want to highlight three icons (John Cage, Earle Brown and Raymond Murray Schafer) who all gave very important input to the field of improvisation in music.Through exertions 4 and 5 I want to point out that approximately simultaneously with the release of the fixed forms in composing, a similar change in the health care system became unfolded. Chapter 4 deals with the Methodology. I justify why I choose certain research methods and how I use them. The paragraphs I describe are successively: 4.1. Type 4.2. Three different types of data gathering 4.3. Quality criterion In chapter 5, I describe the Findings: 5.1. Interview findings 5.2. Observation findings 5.2.1. Participating observations 5.2.2. Observation of video material 5.3. Discussion findings of focus groups 5.4. Short résumé of the findings Chapter 6 provides key components for the initiation of the module: ‘Music and Special Needs’. In chapter 7 I draw the Conclusion by means of the Findings of the research. Chapter 8 contains the Recommendations and an Epilogue. N.B.: Wherever ‘he’ and ‘his’ are stated, also 'she' and 'her' are included.

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2. Context 2.1. Higher Music Education in the 21st century, A bird’s eye view on the terrain In my research question I ask myself how musicians who have the ambition to work with people with special needs can enter into musical dialogues and connections; which skills, attitude and knowledge could be useful in order to become open for a specific way of looking, listening and acting. The consequences of this line of thinking are quite often absent, unconscious and/or invisible in the usual professional music education programs at conservatoires. In order to reach this specific state of looking, listening and acting at least two things are important: 1). Assuming that graduated musicians increasingly will have a portfolio career and for that reason often will have to take on different 'roles' which go beyond playing and composing a.o., it is important that the musician knows himself well. The fact that he is able to reflect and, in principle as a consequence, can distinguish between music as a core activity and music as means is equally important. 2). As I mentioned in my Rationale, research shows that musicians often do not feel prepared enough for teaching and involving themselves with people with special needs. They discuss frustration and uncertainty on their part and express their needs for information on musical, social and theoretical subjects in relation to the demands of working with their target group (see the Rationale). Music as a core activity or means? It might be an unnecessary contradiction, but it is important that the musician is aware of these different approaches. His whole (musical) life, the musician is busy to create the highest level of music. Also during his educational practice after graduating, teaching musical skills is more often an end in itself. But in some situations, there may be extramusical aims at stake (e.g. communicating, releasing, expressing oneself, processing, etc.), which can be developed through the use of musical means. Teachers and pupil(s) playing music together can be an end in itself, and thus a means of creating security and solidarity with the other, without the concept of right or wrong. When these kind of initiatives are taken, an intrinsic motivation and enthusiasm can and most of the times will arise. If a musician is prepared to enjoy these aspects of music making he will create this ‘margin’ within himself and he is then in fact already open to work with people with special needs. What could be helpful for him while working with this target group? At that moment the following questions are immanent: what does the musician hear when he listens (to himself as well as to his pupil(s)) and what does he see when he looks (see the Rationale for phenomenology). 2.2. People with special needs, A bird’s eye view on the terrain Being a music therapist one needs to have understanding and expertise in the interpretation of syndromes and associated behavior of different target groups:

• People who are mentally limited • People in a rehabilitation course • People with addiction problems

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• People with mood disorders • Children, adolescents and adults with mental health problems or disorders

(such as ASD8 (Autism Spectrum Disorder) and ADHD9 (Attention Deficit Hyperactivity Disorder)

• People with trauma or PTSD10 (Post Traumatic Stress Disorder) • Elderly people with mental health problems and psycho-geriatric problems

(geriatric psychiatry, also known as psychiatry of old age, is a subspecialty of psychiatry dealing with study, prevention, and treatment of mental disorders in humans with old age).

• People with schizophrenia On my internship at Triversum11 (Center for Child and Adolescent Psychiatry) as a ‘music therapist in the making’, I learned a lot about mood disorders, psychoses and personality disorders such as schizophrenia and autism. Music is an integral part of the care program Autism. Evidence has been established previously. There, I was able to accompany several children with an Autism Spectrum Disorder (ASD). Many autistic characteristics are reflected in making music together. During the sessions with this group, the targets mostly relate to making contact and advance communication. Music therapist Kathinka Poismans writes in her article ‘Shared Time, Timing in muziektherapie met autistische kinderen’12 in the Wetenschappelijk Tijdschrift Autisme that ‘shared time’ is of vital importance for the development of reciprocity in contact and communication (Poismans 2011: 16). Shared time ensures consistency over time. If there is no consistency in time, then the communication ends and becomes one-way; when a baby smiles back to his mother, but only a few minutes after receiving the smile, there is no longer a joint sensed/experienced moment. This joint sensed/experienced time is a prerequisite for further development of the intersubjective relationship and verbal communication. Where in the verbal communication shared time is sometimes difficult or even impossible to reach, musical communication can provide a natural framework of related structures, beat, rhythm and time; a framework that can carry within itself a high degree of predictability. From this predictable, shared beat can, - through rhythmic exchanges and dialogic phrases - reciprocity in musical communication be developed. As I mentioned already in the Rationale, the ultimate practical elaboration of this research does not have the aim to turn musicians into music therapists, but rather wants to be a help in broadening and opening the view of the musicians in regard of their work with people with special needs. In this research, I will put a slight focus on two different target groups that often occur during a teaching practice, namely people who suffer from (certain characteristics of) ASD and ADHD (see Annex 10.1.), although the findings can be useful for any target group mentioned above. Naturally, it is then important that the musician is made aware of some basic knowledge about the ‘normal’ development from child to adulthood, and of the most common characteristics and problems of people who suffer from (certain aspects of) ASD or ADHD.

8 www.autismspectrum.org.au/content/characteristics 9 www.drhallowell.com/20-common-adhd-characteristics 10 www.psychischegezondheid.nl 11 www.triversum.nl 12 Translation title: Shared Time, Timing in music therapy with autistic children

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However, whether the musician is notified of an official diagnosis of a person suffering from ADHD or ASD, or that he sees various characteristics of this ‘disorders’ in a teaching situation come along, it is very important not to label in order to keep an open view on, and ditto mind about the situation. A particular disadvantage of a diagnosis is that it creates an artificial separation between people: too many people without a diagnosis suffer from ‘abnormal’ traits that could be attributed to autism, and people who are labeled by psychiatry as being autistic, can often function well.

‘Music is given to us with the sole purpose of establishing an order in things, including, and particularly, the coordination between man and time.’13 Igor Stravinsky

13 www.stichtingmuziektherapie.nl/congres2007

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3. Theoretical Framework In this extensive chapter I successively report about the two ways of carrying out music therapy (namely in a receptive and active way), and its definition; I clarify the four most important theoretical processes in and of music therapy; I explicitly point out the importance of one of those four processes, namely: the analogy-process model (and clarify this model in paragraph 3.3. and 3.4.), and I dedicate a paragraph to improvisation, which is an important cornerstone of a music therapy context. Furthermore I add after this paragraph (3.5.), five exertions in order to highlight three icons (John Cage, Earle Brown and Raymond Murray Schafer) who all gave very important input to the field of improvisation in music. The last two exertions are presented to make clear that approximately simultaneously with the release of the fixed forms in composing, a similar change in the health care system became unfolded. In paragraph 3.6. I clarify on the one hand the four main developmental processes when becoming an adult, and on the other hand certain imbalances within these processes from which people with special needs may suffer. 3.1. Definition and the two forms of music therapy Definition: In 2009 the NVvMT (Nederlandse Vereniging voor Muziektherapie/Dutch Association for Music Therapy) published the following definition: ‘Music therapy is a methodical form of care, in which musical means are used within a therapeutic relationship to achieve change, development, maintenance and acceptance in emotional, behavioral, cognitive, social and physical areas.’14 Music therapy falls under the overarching domain of art therapy, and is a so called experiential therapy. It can either be followed individually, in groups or with a partner and/or children. Music therapy is directed to the elderly, adults and youth, and applied within many settings, such as institutions which focus on mental health, youth-services, special education, mental and/or physical disability, rehabilitation, forensic health, different kinds of addiction, imprisonment and refugee assistance. Music therapy can be divided into receptive and active music therapy; although many subdivisions are possible in music therapy I choose to use the rough distinction between receptive and active music therapy. In receptive music therapy, the client has the role of listener. In active music therapy, however, the client has the role of participant.

• Receptive music therapy: is in principle an individual therapy, but can also be used in groups and no single style is excluded. Listening to music is a common and accessible form of being in contact with music. Nevertheless, listening is a complex neurological, cognitive and emotional process and calls upon responses and associations like recognition, joy, rejection or confusion, and the ability to recognize, accept and express these emotions. Receptive music therapy is used to get more control over thought and action, but also to enhance the perception of compensation for lost opportunities. 14 http://www.nvvmt.nl/muziektherapie/muziek-en-therapie

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In their article ‘Receptive music therapy’ in the Handboek Muziektherapie, music therapists Gaby Wijzenbeek and Niek van Nieuwenhuijzen point out that there are four different listening forms (Wijzenbeek and van Nieuwenhuijzen 2006: 118): Determined listening (this allows the client to identify and localize a sound). Technically listening (here the client asks himself: what do I hear? What instruments are used? Who is the composer?). Qualified listening (here the client asks himself: do I find it beautiful or not?). Associative listening (this is the personal association and/or personal feeling related to the music in question). Here it should be noted that lyrics are not recommended because of their indicative and directive nature. On the website of the Trimbos Institute15 one can find the following guideline regarding the receptive music therapy:

‘De therapeut selecteert doorgaans muziek die aansluit bij de stemming van de patiënt om doelen te bereiken, zoals het bewust maken van gevoelens en het stimuleren van associaties. In latere stadia van de therapie zal gewerkt kunnen worden aan activering en het beïnvloeden/veranderen van gevoelens en cognities door bijvoorbeeld muzikale rollenspelen en improvisatie. Ook kan gekozen worden voor het beluisteren van muziek die geleidelijk aan van stemming verandert.’16

Casus 1 During my internship at Triversum, a polyclinical centre for child- and adolescent psychiatry, I worked with a boy (16) with psychotic symptoms who in many areas let himself emotionally be carried away very easily. Likewise in music. With him I practiced to listen in a technical way to music. This created more distance to the music and gave him the experience to get a grip on his emotions and associations.

• Active music therapy: focuses on the influence of action while making music. According to psychologist and musician Han Kurstjens and music therapist Anneke Baerends in their chapter in the Handboek Muziektherapie, the term active music therapy refers to music, therapy and acting being the three central data (Kurstjens and Baerends 2006: 135). The client chooses an appropriate instrument and starts actively making music. Patterns will become audible and changes will take place thanks to the therapist. In (active) music therapy the process is the most important, and not the audible musical outcomes. Music is the means and not the end. During treatment the therapist focuses on specific issues that have come up during his or her earlier diagnosis. The approach is related to different methods of making music such as: play, play together, exercise, experiment, improvise, compose, (re)produce and fantasize. Goals are related to what is observable and manageable during active music making within the music therapy context. This makes that you can discern three areas: interaction, sensing and form (fig. 1).

15 http://www.ggzrichtlijnen.nl/index.php?pagina=/richtlijn/item/pagina.php&id=1307&richtlijn_id=88 16 Translation guideline: The therapist usually selects music that fits the mood of the patient to achieve goals such as raising awareness of feelings and stimulating associations. In later stages of the therapy will work on activating and influencing / changing feelings and cognitions for example musical role-playing and improvisation. You can also choose to listen to music that gradually mood changes.

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Explanation of the three areas: • Form refers to the ‘how question’: How is this played? E.g. chaotic, inflexible,

soft, loud and the like • With interaction a mutual influence, reciprocity is meant • Sensing is the way one experiences or interprets things

Form

Sensing Interaction fig. 1 3.2. About processes and theories By far the best description of the creative processes that play an important role in music therapy comes from musicologist and researcher Henk Smeijsters, as found in his article in the Handboek Muziektherapie and presented in his powerpoint (2011) about ‘Creativity and Music Therapy’17 on behalf of KenVaK18 online (Smeijsters 2006: 98-100). He makes a clear distinction between the four main processes in music therapy (from the emerging of music therapy up until the present day), and uses also the findings and opinions of psychologist Max Kliphuis, Rogers and others. In this paragraph, I want to outline his main view on these processes as part of the development and coming of age of art therapy in general: I start with an explanatory quote from Smeijsters from the Handboek Muziektherapie:

‘Muziektherapie is een manier om de psychische ketens van de client te doorbreken. Zingen en muziek maken, vergezeld van een tekst die problemen verwerkt en kansen articuleert biedt de mogelijkheid een weg te zoeken naar een ander leven.’19

• Creative process:

Kliphuis developed on the basis of research an ‘appèl-list’ which is an observation scale that indicates the ‘appèl’ of the chosen musical instruments in relation with the actual needs of the client. Expressing these in music functions as an aesthetic

17 http://www.debeeldendtherapeut.nl/assets/Creativiteit-Creatieve-therapie-KenVak.pdf 18 On this website you will find information on research into art therapy conducted by the research group Knowledge development art therapy (in Dutch: Lectoraat kennisontwikkeling vaktherapieën). KenVaK is a nationwide collaboration between various universities and headed by professor Dr. Susan van Hooren. You also will find more about mission and objectives, research projects, publications and members of the research group. 19 Explanation quote: The fact that clients can bring/express their own music, with or without text, can work in a highly motivating way. This leads to relaxation, inviting them to associate and act, and give them the possibility of changing things. Translation quote: Music therapy is a way to break the psychological chains of the client. Singing and musicking accompanied by a text that incorporates concerns and articulates opportunities offers the possibility to find a way into another life.

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illusion, and is therefore less threatening. Mental health exists by being creative.

• Self-actualising process:Within this process there is a strong emphasis on the clients ‘authentic self’. This approach was originally based on work of the founder of humanistic psychology Carl Rogers. He emphasized that illness arises because people act and think differently to what they feel inside themselves. This difference is also called ‘being not congruent’, or being ‘discongruent’. In music, the client searches in an exploratory way for his musical authentic (and therefore (more) congruent) self.

• Art-analogy process: This process is based on the assumption that the client goes through a process of creation that is similar to that of an artist, namely: preparation, incubation, illumination and verification. This creative process is essential and is implicitly seen as an expression of psychological health. According to philosopher Hans-Georg Gadamer experiencing art is a form of knowledge and hence the experience of the truth. In the book Gadamer - ein philosophisches Porträt written by philosopher Donatella Di Cesare, she refers to his late essay Wort und Bild - so wahr, so seiend (Di Cesare 2009: 78). I quote:

‘Was hingerissen ist, wer etwa an einem Kult teilnimmt, lässt das Göttliche herauskommen. [.....] Wir sind dabei - und am Ende vertieft sich der Eindruck immermehr: ‘So ist es’. Wir sagen ‘Es is richtig’, ‘so ist es’.’20

Seen in the light of working within the means of music therapy the creative work tells you something about yourself.

• Analogy-process model: The analogy-process model does not emphasize the analogy with art, but the similarities with how a person thinks, feels and acts outside and inside the therapy. It shows how the mental process of the client is reflected in music. The model was originally developed by Smeijsters: he linked the developmental psychology of psychologist Daniel Stern and the neuropsychology of neurologist Antonio Damasio (an authority on the field of research about consciousness) to music and is of more recent origin (Smeijsters 2006: 104). I will clarify this model in paragraph 3.3. and 3.4. Casus 1 continued…. For the boy I worked with during my internship (see Receptive music therapy), the aims were to learn to tune in others (also: keep away, do not lose in others), practice experiences with emotion-regulation and improve planning and coordination skills. Because of his psychotic problems his emotions and thoughts easily overwhelmed him. This was reflected in his music making. You could say that the behavior he showed in his music making was reflected in his behavior in everyday life and vice versa. He absolutely could not structure himself and he lacked all kind of pulse. So at

20 Translation quote: What is carried away, who takes part in a ritual, let the divine come out. We are part of it and in the end the impression deepens more and more: 'So it is'. We say 'It is true’, ‘so it is'.

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a certain moment we were working on a rap. Speaking in a rap-tempo structured his sense of rhythm and feel of pulse. After the session he felt more grounded and relaxed. 3.3. ‘Gut feelings’ For centuries, society has been fond of using the famous Descartes saying cogito ergo sum ‘I think, therefore I am’. But according to Damasio there is no mind without a body (Damasio 2016: 34). He says:

‘There is no such thing as a disembodied mind. The mind is implanted in the brain, and the brain is implanted in the body’.

He thinks it is a mistake to assume that thinking occurs independently of the body, and that feelings should not affect the rationality. But rationale thinking processes are often much less effective in taking decisions than they appear. ‘Gut feelings' play an important role in solving problems and making the right decisions. Damasio wrote the book I feel therefore I am (first edition in 1999), in which he identifies feeling as the basis of consciousness. He distinguishes the following layers of the ‘self’:

• Autobiographical self: The ‘expanded consciousness’ is characterized by comparing problems, analyzing, solving, reasoning, and ethics and aesthetics. ‘Expanded conciousness’ is filled with past and future and goes beyond the here and now of the core self.

• Core self: The consciousness of the ‘self’ is the basis for all forms of consciousness in humans and animals. Without core consciousness, expanded consciousness (as is the case with human beings) cannot exist (unlike the opposite: a core consciousness can exist without expanded consciousness). This emergent process happens when an organism becomes consciously aware of feelings associated with changes occurring to its internal bodily state. According to Damasio emotions are the basis of the core self and the ‘proto self’. An emotion is a pre-programmed, automatic reaction that is largely carried out by the motor system and the autonomous nervous system which lead to so called automatic and unconscious reactions of the body to external or internal events or objects (proto self). These patterns develop into mental images, which then float into the organism’s awareness (core self). When the organism becomes aware of the feeling that the bodily state (proto self) is being affected by its experiences, or responses to emotion, the consciousness of the core self is born. Put simply, consciousness is the feeling of knowing a feeling. According to Damasio therefore feeling is the basis of all consciousness. The 'I' (me) is basically a feeling. Also according to Damasio language doesn’t play a role in core consciousness. Language arises only in the form of a translation afterwards, a conversion of the non-linguistic representation. So language plays a role, but particularly at other levels of knowledge. Moreover, besides a good memory people have vast amounts of knowledge and rational capacities, in which analyzing is possible at much higher levels (expanded consciousness).

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• Proto self: Damasio finds the basis of the I-feeling in structures (non-conscious neural patterns) that provide the most important requirement for every living being, namely homeostasis. In order to regulate the biochemical balance in the human body, the brain stem and the thalamus reflect continuously the state of the organism and all the changes that it is undergoing (Damasio views this as a rudimentary precursor of the I-feeling).

This ‘mapping’ of the body comes in the form of primordial feelings and provides stability and grounding to the self. fig. 2

fig. 3: Music Therapy and Multimodal Arts Reflections, 2015 (Buurman and Kurstjens 2015) N.B. Explanation of figure 2 and 3: 2 is a rough sketch of figure 3. In other words: problems that manifest themselves in people with special needs find their blueprint in the core self. And if language is a non-effective station, it turns out to be that music therapy can play a pre-eminent role. In music, says Smeijsters, the non-linguistic (non-cognitive) receives its form and non-verbal communication takes place (Smeijsters 2006: 97). And I add that musical (non-verbal) communication is used as a tool to come to verbal communication (if possible) (Heijne 2012: 11). Verbal communication leads to a better understanding of a person and this may be put into music again to deepen the (mutual) contact and communication.

Autobio-graphical

self

Core self

Proto self

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Casus 2 During my internship I worked in a nursing home in Amstelveen with a client who had traits of a personality disorder NOS (Not Otherwise Specified) with dependent and schizoid signs, together with a mild form of a ‘deffered puerperal psychosis’ with strong hysterical infantile colouration (this is a consciousness disorder in which the client has lost his grip on reality). Her attention, concentration and orientation in time and place were disturbed. She also suffered from depression with psychotic features (there were indications of acoustical and visual hallucinations). On top dementia was diagnosed. It seemed like she was totally absent, in a world where she heard voices. But by pointing out the here and now, and letting it sound on an instrument, she became less disoriented and more relaxed. Through working with musical instruments with warm low tones and tactile vibrations I could catch her attention with simple sounds and vibrations, and tune in with her. Nowadays also the developmental psychology of Stern is used by many music therapists as a foundation for their therapy. In his book The Interpersonal World of the Infant Stern talks about ‘vitality affects’ as global dynamic processes that underlie the psychic phenomena (and are characterized by movement aspects like accelerate, decelerate, increase in strength, etc.) (Stern 1985: 53). They are the content of the core self and represent self-perceived changes of feeling. Stern has demonstrated that the vitality affects of thinking, feeling and acting are marked by musical parameters. People think, feel and act in a certain pace, with a certain rhythm, a certain dynamic, shape. This is not only the matter with feelings and emotions which are also characterized by these parameters, but likewise in the way people think: fast, slow, chaotic, structured, and how they act: impulsive, thoughtful, methodical etc. What we feel, think and act is a combination of the parameters that can be found in music, and they enable us to let this thinking, feeling and acting resonate in music. Musical parameters enable, without words, the interaction between a baby and his parent c.q. the expression of the inner self. Because musical and psychological processes are characterized by these vitality affects, it is possible that we recognize our self in music and above all that these affects lead us to psychic areas that are new to us. 3.4. The present moment Vitality affects in the core self and musical expression come together in the present moment. Creativity means acting ‘non-thinking’, and surrendering yourself to the present moment based on intuition. Art enables us to match the interior with something outside of us in the present moment21. According to Stern the present moment is lived through as it is happening and thus is not distanced by language or abstract explanation from those experiencing it. By placing the present moment of a client at the center of music therapy, it a) does an appeal to the core self, b) brings the vitality affects within the core self to expression and c) shows by means of the analogy-process how the mental process of this particular client is reflected in music.

21 http://www.debeeldendtherapeut.nl/assets/Creativiteit-Creatieve-therapie-KenVak.pdf

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fig.4

fig. 5

Vitality affects

22

fig. 6: WC Kennisonderwijs, Hogeschool Utrecht22

N.B. Explanation of figure 2, 4, 5 and 6: 2 and 4 together make figure 5, figure 6 is the ultimate version. 3.5. The power of improvisation (from a therapeutic angle) In this paragraph I want to reflect on improvisation as an important tool in working with people with special needs. Next to the fact that improvisation allows everyone to join in, her function can be summarized as providing an open, free musical space where direct expression of identity and personal feelings of the authentic self resonate and are heard, says music therapist Martijn Derrix in his article ‘Muziek-gecentreerde muziektherapie binnen het behandelprogramma psychotische stoornissen’/’Music-centered music therapy within the treatment program psychotic disorders’ (Derrix 2011: 13). In his article in Praktijkonderzoek in vaktherapie23 (edited by Smeijsters) Kurstjens writes (Kurstjens 2005: 147):

‘Zoals gezegd plaatst de improvisatie de cliënt in een open ruimte, hij is teruggeworpen op zichzelf. Wat hoorbaar wordt, is de directe uiting van de identiteit van de cliënt. De muzikale vormgeving is een directe parallel van het algehele functioneren. De muzikale uiting in de improvisatie maakt hoorbaar hoe iemand in het leven staat. Er is sprake van analogie, verwantschap, de expressie van de staat van de state of being in de muziek en de herkenning in de muziek hoe dingen lopen en vastlopen. In de wijze waarop de cliënt klanken structureert, is hoorbaar hoe hij handelt, hoe hij omgaat met gevoelens en hoe hij communiceert.’24

22 Werk College Kennisonderwijs, Institute for Social Work/Utrecht 23 Translation title: Practice based research in art therapy 24 Translation citation: As mentioned improvisation places the client in an open space, he is thrown back on himself. What is audible is the direct expression of the identity of the client. The musical style has a direct parallel with the overall functioning. The musical expression in improvisation makes the direct

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Music therapist Mary Priestley describes in her book Essays on analytical music therapy the force of improvised music (Priestly 1994: 127, 297). It offers space to express the personal feelings of the client rather than those of the composer. People who have no experience with making music, still have their own musical structure and form. They will always try to seek for structure, it provides safety and direction. In his book Improvisation Methods and Techniques for Music Therapy Clinicians, Educators and Students music therapist Tony Wigram refers to a list of 64 improvisation techniques which are applicable in music therapy (Wigram 2004: 34). These techniques are invented by music therapist Kenneth Bruscia and can be found in his book Improvisational Models of Music Therapy (Bruscia 1987: 401) (see Annex 10.5 for a complete list of the techniques). Bruscia divides them into techniques of empathy, structure, elicitation, taking back the lead, intimacy, procedures, referrals, exploring emotions and conducting a conversation. All these techniques have a therapeutic purpose and can be used intentionally during an improvisation with a client. Through the use of empathetic techniques such as for example mirroring, imitating and copying, the music therapist synchronizes his musical communication with the person in question and confirms and/or ratifies their musical encounter. Casus 3 In the same nursing home in Amstelveen which I already mentioned in Casus 2, I worked with a client who just recovered from a stroke. She also suffered from depression and Alzheimer’s disease. The demand for music therapy consisted therefore of providing comfort and distraction, and of creating a positive self-image. While playing together on the piano (with her), emotions were expressed through the musical interplay. I used the empathetic, structuring techniques, and techniques concerning intimacy, which caused for her the greatest possible freedom, space and security, in that way making it possible to open up and to sense musically. Melodies and harmonies empowered by me were, as far as possible, based on her musical preferences, and therefore the musical improvisation felt familiar to her, which helped to create and highlight successful experiences. On frequent basis during the sessions, I also spontaneously offered her a musical gift in the form of performing one of her favorite pieces. This was a form of nurturing her musically as well as personally. Bruscia states in his book Defining Music Therapy, that his improvisatory interventions are based on three criteria; 1) the client must need outside help; 2) there must be a purposeful intervention; 3) the intervention must be carried out within the context of a therapist-client relationship (Bruscia 1998: 54). A useful distinction has been made between music as therapy and music in therapy. When used as therapy, music is the foreground, and the relationship provides a context/background; when used in therapy, music provides the background, while the relationship serves as the foreground. Music therapy interventions are unique because they are sound-centered (ear-orientated), beauty-centered (search for beauty as aestatic endeavor is the metaphor for the journey of the client toward connection to the daily life audible. There is analogy, affiliation, the expression of the state of being in the music and the recognition in how things flow and strand. In the way the client structures sounds, is audible how he acts, how he deals with feelings and how he communicates.

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wholeness) and creativity-centered (the way sound becomes beautiful and meaningful through the creative process). As I mentioned in my thesis ‘Music for a while’ (Heijne 2015: 43) there was, according to Wigram, a lot of discussion in England in the 70's about what exactly was meant by the term improvisation and the level at which this improvisation with a client took place in regard to musical content and/or therapeutic intent (Wigram 2004: 36-37). Wigram makes a clear distinction between 'Musical technique' and 'Therapeutic method’. Musical technique refers to him as a way of playing or singing when the style, modality and musical elements are prescribed by musical parameters. The Therapeutic method refers to a way of acting and behavior when the intention, approach or frame is determined by therapeutic parameters. These parameters can be divided into both a predominantly musical congruent response to the person in question with primary attention to the balance and the salient aspects of the musical content and where expression and body language also play a major role; and the so-called ‘empathic improvisation’ and reflection, which are more specifically related to the emotional state of the person in question. Exertion 1 Sound is music and everywhere... . . . As an icon I refer to the Canadian composer, writer, music educator and environmentalist Raymond Murray Schafer, who is perhaps best known for his World Soundscape Project (the idea of soundscape refers to both the natural acoustic environment, and other environmental sounds created by humans). His thoughts about the use of space brought music outside the concert hall into the street, the square and even to the Canadian wilderness. Like Schafer says himself25:

‘A soundscape is any collection of sounds, almost like a painting is a collection of visual attractions.’

In his book Ear Cleaning (1967), which is a collection of notes for an experimental music course given to first year university students, Schafer explains that he as a practicing musician became to realize that one learns about sound only by making sound. He felt that it was his primary task to open ears in order to obtain ear cleanliness, which is an important prerequisite for all music listening and playing (Murray Schafer 1967: 1). According to what composer, educator and conductor Keith Bissel wrote in the introduction

in Ear Cleaning, Schafer is more than a gifted teacher with a flair for communicating with young people (Bissel 1967: 1). Schafer’s involvement in music education led, apart from Ear Cleaning, to The Composer in the Classroom (1965), The New Soundscape (1969), When Words Sing (1970), and The rhinoceros in the Classroom (1975). Exertion 2 Opens the unknown ... . . . Music sings itself apart from the score and the fixed notation. Prominent features of this trend are in the works of the famous and notorious John Cage. He came in 1958 to Darmstadt where since 1946 the Ferienkurse für Internationale Neue Musik/International Summer Course for new Music26 took place.

25 https://www.nfb.ca/film/listen 26 http://www.internationales-musikinstitut.de/en/

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Diametrically opposed to the ideals of serialism Cage proclaimed his ideas on aleatoric music (music in which some element of the composition is left to chance, and/or to the determination of its performers27), on (guided) improvisations, on a totally different way of thinking that is largely based on Zen Buddhism and elements from Indian and Chinese cultures, states composer, writer and musicologist Leo Samama in his book Nederlandse muziek in de 20e eeuw (Samama 2006: 253).28 In addition, he contributed greatly to the idea of the need for the independence of sound. Not melody and harmony but timbre and rhythm became the main pillars. As writer about music for The Guardian, Tom Service says in his article ‘A guide to John Cage’s music’ that all of his concepts opened gates of perception to new kinds of thinking about music. ‘Happy new ears’, as Cage himself put it29. He was one of the greatest innovators of classical music from the 20th century. It is striking how quickly these developments also permeated into the Dutch music. The most extreme form of aleatory, the full graphic score, music that looks like a painting, are found in Paintings (1961) for flute and piano by Louis Andriessen (Samama 2006: 255).

fig. 2: Paintings, 1961, Louis Andriessen

27 https://en.wikipedia.org/wiki/Aleatoric_music 28 Translation title: Dutch music in the 20th century 29 http://www.theguardian.com/music/tomserviceblog/2012/aug/13/john-cage-contemporary-music-guide

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Exertion 3 And frees itself from the forms of the recent past. Various forms of openness in creating and performing music came to existence. I discussed them already earlier but want to stress them out again: 1) Aleatoric 2) Spatial 3) Graphic and 4) Improvisation. At the same time the rigid classical forms like symphonies, concertos, suites and other forms disappeared to the background. Another icon that contributed highly to ‘openness’ in music was Earle Brown. He was an American composer who established his own formal and notational system, and he has influenced many composers since. According to critic and music feature writer for The New York Times, Allan Kozinn, Brown quickly became an influential member of The New York School, which was an informal group of American poets, painters, dancers, and musicians active in the 1950s and 1960s in New York City. I quote from Kozinn’s article ‘Earl Brown, 75, Composer Known for Innovation, Dies’30:

‘[.....] in which the other prominent composers were John Cage, Morton Feldman, Christian Wolff and David Tudor. He adopted some of the philosophical hallmarks of Cage's approach, including the use of indeterminacy, a technique in which performers were given parameters within which they could choose what, when or how to play. One of Mr. Brown's best-known works in this style, December 1952, invites performers to interpret a visually elegant score that consists of rectangles of different sizes and thicknesses, some horizontal, some vertical.’

fig. 3: December 1952, Earl Brown31

30 http://www.nytimes.com/2002/07/08/arts/earle-brown-75-composer-known-for-innovation-dies.html 31 https://graphicnotation.wordpress.com/tag/earl-brown/

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Apart from December 1952 (an entirely graphic score), other famous pieces are Available Forms I & II, Centering, and Cross Sections and Color Fields.

fig.4: Cross Sections and Color Fields, 1975, Earl Brown32

Exertion 4 Care for every man... . . . In opposite to the rigid forms that still dominated ‘music’ in the first part of the 20th century, the aforementioned avantgarde composers opened the way for a new era of composing and experiencing music. Approximately simultaneously with the release of the tight forms in composing, there unfolded a similar change in health care. In De ontwikkeling van muziektherapie in Nederland. Impressies van pioniers33, musician and psychologist Han Kurstjens tells about the anti-psychiatry in the 70s which aimed to give the patient more say and rights (Kurstjens 2014: 11) . I quote:

‘Er ontstond een nieuw denken over wat 'problemen hebben' of 'ziek zijn' is en betekent. De hele psychiatrische cultuur kwam meer in het teken te staan van de innerlijke mens in de patiënt, in plaats van voor de patiënt te bepalen wat goed voor hem was. De patiënt werd hierdoor cliënt [...] Ook vonden er veranderingen in muziek plaats, zoals bijvoorbeeld bij Varèse. Het hele normatieve, schoonheids- en

32 http://www.earle-brown.org/ 33 Translation title: The development of music therapy in the Netherlands. Impressions of pioneers

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esthetische ideaal werd op de kop gezet. Het individu werd zowel in de psychiatrie als in de muziek belangrijker. Er vonden dus op verschillende gebieden veranderingen plaats’34.

The internet shows an article with the title ‘Verplegen door de eeuwen heen’35 which was commisioned for het Openbaar Centrum voor Maatschappelijk Werk (OCMW) in Gent. The scope of this article is that social developments and the emergence of the social sciences and humanities, resulted in more attention to the psychological side of health care. In addition, there emerged an increased focus on theory development and professionalization of the nursing profession. The patient as individual together with his particular environment became increasingly approached from a holistic view. Ultimately, this led in the eighties to the rise of the methodical and patient-centered nursing. The client-centered therapy introduced from the United States turned out to be an important ingredient in this development. Carl Rogers was an American psychologist and therapist who designed this client-centered approach based on self-determination and empathy (see the Rationale). Characteristic in Rogers's view is that man is seen as an experiencing creature. Rogers approach consisted of an interested and empathetic following of the thinking of the individual. Empathy works better than directing or advising. The Rogerian attention to authentic empathic contact has become the attitude of many forms of health care. These client-centered attitude has a central position in my research. Replace the word 'client' for 'people with special needs’ and the result is as it were a ‘people-with-special-needs-centured’ attitude. Exertion 5 With music being the starting-point. Before 1900, there seemed to be no interest in the Netherlands in music therapy for the benefit of the mentally ill, says sociologist Hans van Keken in his book Helende Kunsten36 (van Keken 2014: 20). In the United States however, indications that go back to the 18th century show a much earlier interest in music therapy. The earliest known reference to music therapy appeared in 1789 in an unsigned article in the Columbian Magazine titled ‘Music Physically Considered’37. Interest in music therapy continued to gain support during the early 1900s and lead to the formation of several short-lived associations. Dutch-born harpist, choral director and professor of music education Willem van de Wall pioneered with the use of music therapy in state-funded facilities. He wrote in 1929 Methodical application of music in the treatment of unusual persons (later translated into Dutch) and in 1935 Music in Institutions. According to Van Keken the small publications, writings ánd personal meetings with Willem

34 Translation quote: There emerged a new way of thinking about what ‘having issues’ or ‘being sick’ meant. The entire psychiatric culture came to be dominated by the inner being of the patient, rather than to determine what was good for him. The patient became client [...] also changes in music took place, for example in the music of Varèse. The whole normative, beauty and esthetic ideal was put upside down. The individual became either in psychiatry as well as in music more important. So there were changes on various fields. 35 http://www.ocmwgent.be/assets/documents/Archief/Verplegen%20door%20de%20eeuwen%20heen Note: I could not find the author of this article, but after a long search I found almost the same information on Wikipedia: https://nl.wikipedia.org/wiki/Geschiedenis_van_de_verpleegkunde 36 Translation title: Healing Arts 37 http://www.musictherapy.org/about/history/

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van de Wall ensured that people like Mr. D. Balfoort, Curator of the ‘Muziekhistorisch Museum Scheurleer’, Mr. W. Slot, Director of the ‘Rekkensche Institutions’, and others, promoted music as therapeutic means in the Netherlands. After World War II the interest in music therapy really started to grow and first music therapists began their practice. In 1957 psychiatrist H. van der Drift, in the fifties and sixties physician and director of a psychiatric hospital, wrote Cultural Therapy38, which is the first original work on music therapy (and other arts therapies) in psychiatric institutions. Nowadays, there are more than 500 music therapists working in different fields like mental health, care for the elderly, rehabilitation centers, special needs education, forensic psychiatry and in private practices in the Netherlands. After psychiatrist Louis Vaessen had introduced the term ‘art therapy’, music therapy became part of the overarching domain of art therapy, along with visual art, drama and dance therapy, and psychomotor therapy. Psychologist Max Kliphuis already stressed in 1957 the means of process within art therapies.39 Nowadays, according to musicologist and researcher Henk Smeijsters who edited the book, but also is the author of some chapters in the Handboek Muziektherapie, the product is more in the center of the attention, although certain process characteristics still come across. The term 'product' fits into a vision on health care whereas usually short treatment is tailored to a specific complaint (Smeijsters 2006: 98). 3.6. The four main developmental areas In this paragraph I report about four general developmental areas, which are described by occupational therapist and psychologist Jane Ayres, in the book Muziekstrategie, Orthopedische muziekbeoefening40, written by music educator Marc Rutten and remedial educationalist Miriam Stuijts. Ayres distinguishes roughly four main areas in a child’s ‘normal’ developmental process when becoming an adult, namely, sensorimotor, cognitive, relational-affective and conative. At the same time she describes the problems that may be related to these areas (Rutten and Stuijts 2014: 18). In order for the musician to act and react in an appropriate way while working with people with special needs it is important to know something about a child’s ‘normal’ developmental process when becoming an adult. Important is to examine in which developmental area(s) stagnation occurs, or may have occurred, because this information can be very helpful for the musician when judging ‘how to act’ while working with this target group. At the same time I give examples of how a musician - during a music session - can give direction to the (intended) musical activities in order to respond to the (hidden) needs of a person from the target group.

• Sensorimotor development: Sensorimotor development: man as a moving creature (the nature and level of physical development, often expressed in small and gross motor skills). According to Ayres we have about five sensory systems that play a role in our movement 38 http://emtc-eu.com/country-reports/the-netherlands/ 39 http://cearcall.home.xs4all.nl/mt/muziektherapie/historie.htm#2.2 verenigingen 40 Translation title: Music Strategy, Orthopedic music practice

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behavior: the auditory; the vestibular; the visual; the proprioceptive and the tactile system (Rutten and Stuijts 2014: 32). A good co-operation within these different systems is essential in order to achieve optimal development. The senses provide information about the area and the position of the body. Proper functioning of the senses and a good processing of incoming sensory stimuli are needed to build a good image of the body and its environment. A good example in which this all happens is a music session: During a music session all sensorimotor systems below are used: aurally: to hear the music, the singing of the other children, to observe cues, etc. vestibular: to stand or sit up straight, to keep the balance while moving. visual: to watch the music teacher while playing for, to imitate a playing movement, to watch a score, etc. proprioceptive: to play familiar motor patterns and rhythms and to feel the expected resistance. tactile: to hold an instrument, to feel the keys, etc. The sensorimotor development of a child to adult is embedded in the overall development. Parallel to the sensorimotor development there is the development of intellectual (cognitive) and social skills.

• Cognitive development: Cognitive development: man as a creature of know how (the nature and level of development of knowledge and learning capacity). Cognition than is the umbrella term for a range of possibilities as perceiving, propose, organize, etc. Children or adults may experience problems with cognition within the areas of observation, structuring, concentration, application, etc. These areas point in the direction of two core needs: I. The child or adult has a need for structuring his learning environment, when he is not (enough) sufficiently able to control his stimulus perception and focus on task-relevant elements. This concerns often individuals with characteristics of ADHD and persons with intellectual disabilities. During a music session the musician can cater this core need by making a concrete relation to the content of the following verbs: -to decrease -to shorten -to repeat -to limit -to temporize -to visualize -to accentuate (musical features which are responsible for accentuating musical patterns through breaks, accents, etc.) -to create overview -to simplify -to structure -to ignore

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II. The child or adult has a need for varying his learning development, when he experiences reality as uncontrollable and unpredictable and therefore tends to fall back on routine behavior. This concerns often individuals with characteristics of ASD, including PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified).

During a music session the musician can cater this core need by making a concrete relation to the content of the following verbs: -to invite -to apply diversity -to offer choices -to challenge -to explain -to reflect -to draw attention -to provide safety -to encourage -to make connection -to find a balance between safety and change

• Relational-affective development:

Relational-affective development: man as a feeling creature being embedded in a relationship (the nature and level of the relational and emotional development); how a person experiences situations, the relationships with his surroundings, the way he expresses emotions, etc. An important perspective to grasp this affective development is the philosophy of developmental psychologist Erik Erikson. He developed a psycho-social model41 (see annex 10.2.) consisting of eight stages. Each phase has its own psycho-social crises to be resolved. According to Erikson, there is the possibility that an unresolved crisis or one that was not processed well in an earlier stage, yet in the next phase can be completed successfully. As shown in the model of Erikson, the environment of a child appears to have an important influence on his affective and social-emotional development. Children with emotional problems tend to focus their feelings inward or outward. I. The ‘outside targeted’ children often have difficulty controlling their emotions. During a music session an environment is provided in which the child or adult can directly show his emotions and 'play them out'. Music provides an answer to the increased demand of their stimulus needs and the methodical activities partly meet the need for activity and their (often) inner turmoil. II. The 'inside targeted’ children by contrast, have difficulty expressing their emotions. During a music session these children and/or adults appear to have a strong preference for clear, safe situations. With adequate security and predictability, it is likely that a feeling of well-being and reciprocal contact can increase, which may have beneficial effects on their learning ability.

41 http://www.slideshare.net/lemasney/erik-erikson-1565991

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• Conative development: Conative development: man as a choosing creature (the nature and level of unfolding of the individuality, the own identity, the urge to be somebody, to give direction to oneself). This development domain contains -as it were- the integration of the earlier mentioned development areas. During a music session attention is paid to the personality and individuality of the child or adult. One gets space to ‘show’ oneself within acceptable limits and thereby a contribution to the development of the personality is made.

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4. Methodology

4.1. Type My research is a search for musical practice, since my findings can be used in musical practice. The research consists of two cornerstones, theory and practice, that continually support and complement each other and is qualitative in nature. Moreover, it is of importance to underline that my research is development-oriented. It is also interdisciplinary since it integrates knowledge and methods from different disciplines, using a real synthesis of approaches. Because of its character, I choose for Educational Design Research. This type of research aims to be practically relevant since it is initiated to design and develop innovative interventions. According to Professor of education Tjeerd Plomp in his chapter in Introduction to Educational Design Research, Educational Design Research is perceived as the systematic study of designing, developing and evaluating educational interventions - such as programs, teaching-learning strategies and materials, products and systems - as solutions to educational problems, this type of research also aims to advance knowledge about the characteristics of these interventions and the processes to design and develop them (Plomp 2010: 9). I quote:

‘By its nature, design research is relevant for educational practice as it aims to develop research-based solutions for complex problems in educational practice. Starting point for design research are educational problems for which no or only a few validated principles are available to structure and support the design and development activities’ (Plomp 2010: 13).

Petra Cremers, who is an educational consultant and researcher at the Hanze University, Groningen and the Wageningen University, states in her article ‘Onderwijskundig ontwerponderzoek: onbekend maakt onbemind?’42 that Educational Design Research is not a science that describes or declares phenomena, the goal being to develop knowledge in order to change something in reality. I quote:

‘OO is geen wetenschap die verschijnselen beschrijft of verklaart, het doel is kennis te ontwikkelen om daarmee iets te veranderen in de werkelijkheid’ (Cremers 2012: 25).43

I will now summarize from the same article, four common steps or phases which one can identify as being a model for Educational Design Research: 1. Diagnosis and research agenda; 2. Analysis and exploration; 3. Design, implementation and evaluation; 4. Knowledge and consolidation. In step 1 the research process is shown. My research thesis starts with the Rationale defining the practical problem(s) by the investigator (me). This led to the Research question: Which skills, attitude and knowledge are useful for musicians when entering into musical dialogues and connections with people with special needs? 42 Translation title: Educational Design Research: unknown, unloved? 43 Translation quote: Educational Design Research is not a science that describes or explains phenomena , the aim is to develop knowledge in order to change something in reality

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To avoid confusion, I would like to point out that my research thesis is intended for students and teachers of Conservatoires, already graduated musicians, and even music therapists (see also the Reading guide). I am therefore aware of the fact that the target group for whom I write is a multiple one. In other words, although I refer to musicians and students in my research thesis, all three target groups are meant.

Step 2, analysis and exploration, consists of finding a possible solution to the problem(s) and is based on theory and practical experience (see Theoretical Framework p.24). During this process I interviewed four different persons and I was reading specific literature about my topic. The presentations during the Master's Circle, and the discussions afterwards with this Circle’s participants (Royal Conservatoire teachers who are doing a Master program) ensured that, for example, regarding the Research question I had to choose my words more careful and precise. From step 2, a creative step was taken (step 3): drafting provisional (initial) design guidelines. Subsequently, the guidelines are translated into concrete instruments and educational activities. In the case of this research trajectory it included four sessions (December 2016 – January 2017) at the Royal Conservatoire: two sessions with both Master students with a major in Education and students from the Bachelor who chose for a minor in Education, the other two sessions only with Education minor students. Although all students were interested in what I was presenting, the last type of student (Education minor) seemed to be a little bit more receptive to what I had to offer, maybe because they are more often exposed to this kind of work. Two of them were particularly interested, because coincidentally it just happened that they both got a request (independently from each other) to work with children with autism. The reason I chose for this setting was a pragmatic one since the meetings were part of a fixed setting: they were organized as part of their curriculum. Strictly spoken, here is exactly the point where this research no longer synchronizes with the original Educational Design Research model. I executed only half of step three: I have designed guidelines and implemented this ‘new teaching’ in the form of musical activities with the students mentioned above. In addition, I provided them with useful information. Ideally, the ‘new teaching’ takes place in multiple cycles being evaluated and adjusted, but here is exactly the point where my research no longer synchronizes with the original Educational Design Research model. Due to time pressure I have chosen to initiate a module instead of designing a complete one, and the ‘new teaching’ I offered the students contained musical activities as being part of these initiations. To complete the whole module, and therefore execute the required phases of the methodology attributed to the Educational Design Research model, in particular in relation to the practical application of the theory, the related evaluation and (possible) adjustments, more time is required. Apart from not completing step three, also the last step (step 4) is not taken in this research. However, to arrive at the complete picture of the model, it is important to draw here also the last phase, knowledge and consolidation: refining the draft guidelines based on the experiences in the practice, and the embedding of the new teaching in the educational program. According to Cremers the research results are partly based on pragmatic validity: do the solutions or interventions indeed lead to the intended outcomes? It handles not primarily about whether it is true, but whether and how it works (Cremers 2012: 26).

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4.2. Three different types of data gathering The following methods were used to gather data: interviews, observations and focus groups. Interviews The interviews, which serve as the data for this study were held in the period November 2015 – February 2016. A total of four interviews were conducted. Two out of four had an unstructured character; the other two were semi-structured interviews. One interview took place at the home of the interviewee, the second was conducted in the school were the interviewee works, the third interview was held in a bar in Leuven and the last interview took place in the work office of a psychiatric centre in Kortenberg. During all the interviews, only the interviewee and myself were present.

• Unstructured interview: For two interviewees I chose the unstructured interview form since I wanted the interview to be more like a conversation. In my opinion it was the best way to learn a lot about a subject (e.g. concerning Special Music Education). With an unstructured interview, one can get fairly quickly information about many subjects and one can react immediately with ‘follow up’ questions says sociologist Ferdi Migchelbrink in his book Praktijkgericht onderzoek in zorg en welzijn44 (2006: 172).

• Semi-structured interview: My choice for the semi-structured interview is a pragmatic one since I wanted to leave enough space for the personal views and experiences of the interviewees. In this way I can extract from the interview what I think could be of importance for my research. The structure of this interview form takes shape by means of a so-called topic list. I use this list as a checklist to make sure that it covers all topics; how I ask the questions and how I phrase them, however, I decide on the spot. The central question was: ‘What do you miss in the ideas below? Do you have any additions?’ And I quote myself (Recorder Pro: 00:34): ‘Eventually I want to design the beginnings of a module with a wide (humanistic) basis (and therefore in principle of interest for every musician) which helps the musician to enter a variety of settings, or to create a more specific translation towards any target group of people with special needs. The full content of the module would ideally provide an 'awareness' and a flexible attitude towards music (education) through:

- To become (more) aware of personal dynamics (the reflective side of the musician) - To become aware of improvisation from a therapeutic angle (Bruscia techniques) - To understand how to attune with people with special needs - To discuss case studies

Two interviews were not recorded due to audio problems (though summaries are found in the Annex, paragraph 10.3), the other two interviews were recorded with the Voice Recorder Pro+ application of a Nokia mobile telephone. This resulted in a total sum of 93 minutes of audio material.

44 Translation title: Practice oriented research in care and welbeing

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There are aspects of the Delphi Method presented in the way I conducted the interviews for my research. This method handles not about facts, but about opinions and arguments that give support to these facts. According to Smeijsters the characteristic of this method is that a document (in my case a module-in-the-making) arises to which respondents may respond in several rounds (Smeijsters 2006: 52). Smeijsters’ steps to achieve this are as follows: 1. Selecting experts 2. Exploring the theme through literature and interviews 3. Developing topics for the interviews 4. Analyzing the content of the answers 5. Asking for comments on previous answers from the interviewees 6. Confronting the interviewees in multiple rounds with answers of themselves and others I do justice to the Delphi Method using steps 1, 2, 3 and 4. Step 1: I consulted selected experts (see 4.2. Individual persons), since I agree with the assumption that the opinions of experts add value to the available empirical data. It may be clear by reading the Rationale, Context and the Theoretical Framework that I did justice to at least the first part of step 2: exploring the theme through literature. In addition I also had an exploratory meeting in September 2015 with Renee Jonker45 who is coordinator of the Music Master for New Audiences and Innovative Practices (NAIP) at the Royal Conservatoire in The Hague since 2008, which handled about defining the target group people with special needs. In step 3 the topics are gathered in a natural way by means of processing step 1 en 2. The last step (step 4), analyzing the content of the answers, becomes clear in the Findings (chapter 5). The interviewees:

• Jos De Backer, who is a professor of music therapy at Leuven University College of Arts (LUCA), campus Lemmensinstituut, Belgium. Both the music therapy department of Leuven University and Jos De Backer himself have a renowned name in this field.46

• Thomas De Baets, who is an/the education coordinator working at the same institute mentioned above. My deliberation to interview him as well has to do with the fact that my topic finds itself at the cutting edge of music therapy and music education. Both interviews with Jos De Backer and with Thomas De Baets have taken place in the framework of an

45 http://www.musicmaster.eu/faculty 46 Jos De Backer studied music education and music therapy in Belgium and Vienna and he completed his PhD in music therapy at the University of Aalborg, Denmark. He is head of the Music Therapy Department in the University Psychiatric Centre KULeuven, campus Kortenberg where he works as a music therapist treating young psychotic patients and patients with personality disorder. De Backer specializes in clinical improvisation, is a member of the advisory Editorial Board for the Nordic Journal of Music Therapy and of the Editorial Panel of the British Journal of Music Therapy and is a past President of the European Music Therapy Confederation. www.jkp.com/author/authors/view/id/jos-de-backer

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Erasmus exchange (I was visiting Leuven University College of Arts (LUCA from February 24th until 26th 2015).

• Yolande Eymael, who teaches at the department of Music Education of the conservatoire of Maastricht and coordinates the internship primary education/OMB education (Orthopedagogische Muziek Beoefening/Special Music Education47). This specialisation, which is part of the Bachelor’s program Music in Education allows the student to deepen his knowledge of special education and enhances his remedial teaching skills. This includes working with people with a mental or physical impairment, geriatric patients, children with socio-emotional problems and the like. My considerations to interview Yolande were a) one of sharpening the mind in finding my own path without loosing sight of certain overlaps with the Special Music Education program and b) because of her involvement in this department, which is unique in The Netherlands.

• Wouter Tempelaar, who was at that time coordinator of the Bachelor of Music Education at the Royal Conservatoire, The Hague. I wanted to interview him because of the equilibrium (having two interviewees from different Music Education departments). On account of the interview with Yolande and the Music Education department in Maastricht, I wanted to know whether within the same department in The Hague there could be a place (in future) for certain aspects of OMB education, since there are so much more vulnerable children in primary schools than before (the need to reconsider priorities has increased because of the growing care side in education).

Observations The four sessions (four (clock) hours total) with the students that serve as the data for this study were held on December 6th and 13th 2016 and on January 24th and 25th 2017. They all took place in a room at the Royal Conservatoire. On December 6th, December 13th and January 24th five students and myself were present. On January 25th three students and myself were present. Every student brought his own instrument, I ensured that there were a few rhythmical instruments available. I observed in two ways: participating observation and observation of video material (in which I also observed my own teaching). Participating observation: Through participating observation I gained information whilst participating in the sessions, and thus collect data. I was physically present in situ, and therefore can describe the gathered data as lifelike and detailed as possible and interpret them with regard to the specific field context. For the first two sessions (December 6th and 13th) I handed out a manual with information containing a) the characteristics of ASD and ADHD b) a small selection of the 64 improvisational techniques of Bruscia and c) some background information concerning different assignments I wanted to do with the students. Although the emphasis was on ‘general’ improvisation, the assignments had different perspectives: a) musical experience of oneself and the other b) improving reflection

47 http://www.specialmusiceducation.eu/mainmenu.html

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skills by paying attention to three different areas (form, sensing and interaction) and c) being aware of using Bruscia techniques. For the third and fourth session (January 24th and 25th) I made a PowerPoint, because looking back, I was not happy with all the paperwork I handed out during the first two sessions. To my mind, it gave a ‘schoolish’ character to the meetings and at the same time I felt I was loosing contact with them. Furthermore, during the second session (December 13th) one of the students told me that she wanted to have more explicit information about how to deal with people with e.g. autism. Hence, in the PowerPoint I included a video of a music therapy session with an autistic girl, and after the PowerPoint was done I asked a student to join me in order for me to show what kind of exercises one can do when working with a person with autism. The exercises built up from very easy rhythmic patterns to more difficult ones aiming at getting a clear insight in the cognition level of the person with autism. It is of greatest importance to make all the time a connection (to tune in) and clearly explain the exercise: only then you can teach someone something substantial. Having said this, I realize that this is the case for every learning situation. In the case of people with special needs, special attention for the characteristics of the individual person, nevertheless is an additional point of concern. Observation of video material: In order to record all sessions I reserved a camera. Three out of four succeeded, the third session though, was -due to initialization problems- unfortunately not recorded. All and all, it resulted in a total sum of 150 minutes of video material. At home, I watched all the sessions on the computer; made a selection of -in my opinion- important fragments and edited them. The selection: Imitation of a teaching situation with a person with ADHD Improvisation about experiencing oneself and the other Improvisation with Bruscia technique of imitation Exercise session 4 Feedback of students session 1 Feedback of students session 2 Feedback from and discussion with students session 4 Apart from the feedback moments that are important anyway, it is my opinion that in the other chosen fragments (see selection) something ‘happened’. With that I mean e.g.: deep concentration; understanding of the assignment; musical connection; good atmosphere; focus, and a lively discussion. The reason I did not opt for other fragments is located on the other side of the coin: week concentration; confusion about the assignment; students arriving late and leaving early and thereby disrupt the concentration; other students coming in by mistake but really should be in another room, etc. Observations of my own teaching: During the sessions I was wearing two different hats: one moment I was the 'teacher' and the other moment the ‘participatory observer’. Being the teacher meant - during the first two sessions - reading information from a manual and asking whether there were any questions. That part did not feel so good: I felt I was loosing their attention and therefore wanted to ‘hurry up’ (my solution for this was to present a PowerPoint during session three and four, which was much

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better). The assignments during the first two sessions worked out quite well, although a student told me afterwards that she did not understand completely what was the idea. When I was looking back through the video material I saw I was not always particularly clear with my instructions. I have to remember myself that the information I want to share, is for me placed and ordered in the proper context (music therapy study, internships, etc.), but does not apply immediately to the students in question. So providing enough clarity in specific settings (structured, not structured or semi-structured) is utterly important. Being the participatory observer I saw that the students were generally quite open and interested in what I had to offer, though I did notice quite quickly that they found it actually quite scary to improvise. I regularly had to take the initiative to provide a sense of security. There was only one student who felt really comfortable with improvising. This person did not mind being a guinea pig. Because one girl in the group is diagnosed with ADHD, and for that reason wanted to ‘play’ somebody with this disorder, there arose an interesting and lively discussion afterwards. I was more clear and specific with my instructions during the last two sessions: we did not do any improvisations, I just showed, together with a student, what kind of exercises one can do with a person who suffers from (certain characteristics) of autism. Since the last two sessions began at 9.00 and ended at 9.50, I constantly felt the pressure of time, not in the least because of some students coming late anyway (difficulty with trains etc.), but also because I knew there were two students who already attended the first two sessions, so I had to bring something new. Hence, the group was a mixed one and that entailed that I had to repeat the general information quickly, but also reserve time to address somewhat more explicit information. For me there was a big difference between the four sessions. I experienced the first two sessions as more challenging because I wanted a) to share a lot of information about improvisation with them; to my opinion this information is useful in their work with people with special needs, and b) I felt that students are not really comfortable with improvising in general. To become more at ease, they need more time and experiences. During this first two sessions there was a natural balance between teaching and participating. The last two sessions were in that way somewhat easier, because I presented a PowerPoint and I showed some very structured exercises. Hence, I was in the ‘teaching’ mode instead of the ‘participating’ one. Focus groups Providing individual and/or collective feedback ánd organizing discussion by and with the students, is the core of Educational Design Research (see step 3: Design, implementation and evaluation). The evaluation of the new educational practice delivers again theoretical knowledge in the form of tested and stricter guidelines for the design of the module-in-the-making. There was an interesting discussion with one of the students about ‘being ill’ (see Feedback below). He said not to believe in illness. According to him ‘every kind of student should be tackled in a different way’. As a music teacher I could not agree more with this last sentence. That is why I believe in teaching from a phenomenological perspective. Whether the teacher is notified of an official diagnosis of a person with special needs, or that he sees various characteristics of

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e.g. ADHD or ASD in a teaching situation come along, I think it is very important not to label in order to keep an open view on, and ditto mind about the situation. But as one can read in my Rationale, there are musicians who feel insecure in their work with people with special needs and really would like to have specific instructions (see also feedback), and exactly for those musicians I am doing this Research. Feedback of the students:

• ...I wasn’t really aware of this reality, so for me it was really useful…

• ...I wasn’t aware of this, it opened a new world for me, it was very interesting…[...]..but I would like to have more clear instructions..

• ...I feel like we were connecting...

• ...I was never aware about what you should change from a ‘normal’ situation

to a ‘special needs’ situation…

• ...It could have been more specific on special needs…

• ...I would like to see a video of a lesson about how they behave…[...]..an example about Asperger?

• …it was more clear, specifically on special needs….

• …Drum is good: opposite to each other: eye contact…

• …There was short time…want to experience it in real time…

• …Like the subject. Important for us…[..]..want to have a real experience…

• …Interesting, would like to know more..

• ...Interesting, but still general. Want to know more details ..[..] we as musicians have special needs…

• …got some information. More clear. I have it myself….

• …Interesting but every kind of student should be tackled in a different way. I don’t believe in illness….

4.3. Quality criterion In order to ensure the quality of the research I use the criterion of Triangulation: Through the different ways I use to investigate the same ‘phenomena’, I support the validity and reliability of my data. According to psychologist Jane Ritchie several authors nowadays argue that the value of triangulation lies in ‘extending understanding’ through the use of multiple perspectives or different types of readings. In other words, the 'security' that

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triangulation provides, functions through a fuller picture of phenomena, which not necessarily means a more certain one (Ritchie 2003: 43-44). I fully agree with this view. In particular the words ‘extending understanding’ disclose for me the core of my interpretation on triangulation. A few last words: In this chapter I explained in detail how I have built my research. My approach to the research was a very precise one, and I have spent a lot of time reading relevant and recent literature on this topic. I have also reported as accurate as possible and as independent as I could be (see Interviews, Observations and Focus groups). I also guarantee the precision of the execution, the sources used and the argumentations for the findings and conclusions. Concerning research ethics, I gained consent from the interviewees and the involved musicians, I guaranteed them confidentiality, and I did justice to everybody. Finally, I carefully guarded my integrity by way of keeping a professional distance and independence.

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5. Findings I divide this chapter in 3 paragraphs: interview findings, observation findings (participating observation and observation of video material (in which I also observed my own teaching)) and discussion findings with focus groups. They contain the basis of outcomes of the three methodological pillars of data gathering and are in direct relation to the subquestions. For reasons of transparency and good guidance I repeat now my Research (Sub)question(s) as well as describing the aim of my project on the basis of the outcomes of the research, leading to a detailed proposal for the initiation of a module. Research question Which skills, attitude and knowledge are useful for musicians when entering into musical dialogues and connections with people with special needs? and Subquestions

a) How can this specific musical practice be of beneficial influence on (the self image of) musicians?

b) What starting points can be formulated for materials to be used and approaches to be taken?

c) What are the key components when designing a module that offers the appropriate equipment to musicians?

5.1. Interview findings The interview I had with Jos De Backer on February 26th 2016, was from all four interviews the most fertile (see Annex 10.3.). He was quite clear about what musicians who have the ambition to work with people with special needs, need to know, do and learn, and how they personally profit from this learning process. Jos emphasized three important issues: the importance of reflection, of connecting, and he underscored the importance of the phenomenological, or in other words, the open attitude of the musician. a) The importance of reflection from the side of the musician, and I quote:

‘It is with no doubt of great importance to know oneself: both music- and person-wise. It is even more important to know yourself when you work with people with special needs, because you have to listen, watch and search all the time for connections. In that respect it is unavoidable that you ask yourself questions, e.g.: do I know my own musical identity; what is my relation with my instrument; how do I express myself on my instrument, etc. Musicians speak to ‘the other’ through their instrument, therefore they need to know how they personally relate to their instrument. Some musicians regard their instrument as a subject, as a person. Others have a relationship with their instrument in which the instrument has become a ‘transitional object’48 as stated by Donald Winnicott49, they feel naked without their

48 http://www.psychoanalytischwoordenboek.nl/

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instrument, they cannot take it away… (the transitional object is part of the atmospheric transition between the inner and outer world and represents the mother. At Kindergarten age this transitional object typically will become less and less important for the child: the transition to a relative autonomy is created).’

If - apart from the four sessions that took place in December 2016 and January 2017 in the Royal Conservatoire - there would have been more time and opportunity over a longer period, I would have done with the students the following exercise: because it is important to give the reflection skills of the musician a boost I would strongly suggest musicians who are interested in joining this module/elective, to write at the beginning and end of the course a letter to their instrument (and compare the outcomes afterwards). b) The importance of connecting, and I quote again:

‘During improvisation the emphasis lies on listening and connecting intuitively with the other with only one note….two notes…..three notes, etc. How and in which way does the musician recognize himself in the sound(s) of the other (and vice versa) and gets connected? The more sober the more intense. Sobriety! Intuition! Musicians have to learn that. You can learn to reach people and listen to what lies beneath their given material. For musicians this is not an easy task; they have to get rid of their result-oriented thinking: when a sound doesn’t ‘sound’, it might be still a good sound because there is a fair chance the sound has authenticity (very important when connecting with the other).’

c) The importance of the phenomenological attitude, or in other words, the open attitude of the musician, final quote:

‘If one works with people with special needs he has to be flexible and creative in the moment. It is important that one is open to a ‘non-normative’ use of the instrument one ‘teaches’. The phenomenological perspective could be a helpful tool while acting in the moment.’

In the Rationale I already mentioned this phenomenon: phenomenology in music is about listening in the (present) moment, to perceive and listen freely to sound and rhythm without concepts and conventions. This way of listening is very convincing because activities can be carried out from within the concrete expression of music and covers two questions: what do I see and what do I hear (commissioned by the music therapy program of the University of Utrecht, Kurstjens developed a simple component diagram (see Annex 10.4.), which helps to make the ‘two questions’ clear in a notable and inventory way). According to Buurman what you see and hear should be as free as possible from conceptual representations (everything which is real or appears to be real; what is objective or subjective and what is absolute or relative, should be ignored or in any case delayed) (Buurman 2014: 11). Only at a later stage, if needed, one can draw the analogy between the previously identified on one hand, and any (musical) goals, etc., on the other. Here the situation shows the same problem as in the above (see a) in 5.1.). If - apart from the four sessions that took place in December 2016 and January 2017 in the Royal conservatoire - there would have been more time and opportunity, I would have done with the students the following additional exercise:

49 https://en.wikipedia.org/wiki/Donald_Winnicott

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The musician can use the component diagram as an observation guide (see Annex for the complete component diagram), in combination with looking at some case studies on video and discuss these afterwards; they then are supposed to write their findings in the diagram (as a way of exercising to think from the phenomenological perspective): Sound, Rhythm, Melody, Dynamics, Form and Instrumentation. Also the other interviews brought information, which is worth mentioning. When I asked Wouter Tempelaar in our interview on January 4th 2016 (see Annex 10.3), what he thought would be key components when designing a course that offers skills to musicians who want to work with people with special needs, he also put the emphasis on how one looks and listens, and deals with people (with or without symptoms!). He did not use the word phenomenology like Jos De Backer, but he certainly thought there should be a focus on the attitude of the musician. It is in his opinion very important not to label, and I quote:

‘These are people with disabilities, but in essence you do not know that.’ The interview with Yolande Eymael on November 24th 2015, was also a fruitful one (see Annex 10.3.); one of the reasons was that she had a lot to tell about the Special Music Department in Maastricht (see 4.1.), but also because she reminded me of a book: Muziekstrategie. Orthopedische muziekbeoefening (2014) by Rutten and Stuijts (see also 3.6). Thomas De Baets warned me during our interview on Februari 26th 2016, for the risk of too much abstraction; there is fear for abstraction among music students, he said (see Annex 10.3.). The profile of the music student is practical oriented; their interest is as well for 95% practical. This was a very good tip and I have certainly thought about that when I was preparing for the sessions. 5.2. Observation findings: participating observation and observation of video material 5.2.1. Participating observation The first two sessions (December 2016): During the first two sessions I tried to use and approach the concept of improvisation from four different angles: a) Musical experience of oneself and (connecting with) the other through improvisation: This first assignment was about musical identity and ditto sobriety: about musical experience of oneself and the other through using as little notes as possible; about trying to connect with the other (I wanted to try out one of the ideas Jos De Backer suggested during the interview I had with him, see Annex 10.3. and also a) in 5.1.) The students had to tune in with their neighbour by playing only one note (after each other). With this data we did three rounds. I noticed that the exercise was quite difficult for them, if only because they were just allowed to play one note at the time. The conditions in themselves were a source of confusion, I quote: ‘How can you make yourself heard ánd try to connect with your neighbour with only one note’.

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The feedback I got afterwards on this exercise was dichotomous of character: yes, I thought we were connecting; no, I did not think we were connected. There was not so much in between. Furthermore, a single student had not understood the assignment. Personally, I think this exercise was actually too much out-of-the-box for that moment, despite my consideration of first musically ‘get acquainted’ with each other through this exercise; a kind of (re)presenting oneself, since they saw me for the first time and vice versa. In hindsight, I had better turned the order of assignment 1 and 2 around, that might have been less confrontational. b) Musical Technique: In paragraph 3.5 I wrote about Wigram and his two ways of improvising, namely 'Musical technique' and 'Therapeutic method’ (see d) below). Musical technique refers to him as a way of playing or singing when the style, modality and musical elements are prescribed by musical parameters. The assignment we did was one of improvising without rules; of floating only on musicality, feelings and hearing. This went very well. One of the students was so honest to mention that this improvisation was far better (and I quote: ‘nice tonality, coherence, musical connection etc.’) than the improvisations during the compulsory lessons belonging to this subject. c) Awakening the awareness of reflection skills through improvisation: The manual I handed out during the first two sessions contained fig. 5 (see 3.1) below. Form Sensing Interaction fig. 5 The core of the assignment was about watching your fellow students and articulate what you see and hear (there were two students improvising, the others were watching). The students who did not play had to choose in advance one of the three areas mentioned above: interaction, sensing and form; their task afterwards was to articulate what they saw and heard regarding their chosen area (explanation of the three areas, see 3.1.). This exercise was a useful one, although it did struck me that none of the observers chose to investigate the area of form; for them the areas of interaction and sensing obviously felt more interesting, or perhaps it had to do with the fact that the students thought that investigating the areas of interaction and sensing implicitly would give more information about working with people with special needs, which is comparatively spoken not really the case: see the Analogy-process model of Smeijsters, 3.2. (the outlined assumption above is entirely on my account, the choices could also have been made coincidentally; I wanted to check this afterwards, but did not do it due to time constraints).

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Overall, the two students who were improvising did a fine job and the students who were watching had good comments, which presented the core of what they observed. The exercise was not too difficult, and could therefore make a contribution in becoming aware of and reflect on different ways of looking and listening. A next level in this exercise would be to play and observe at the same time and reflect afterwards on what was seen and heard. d) ‘Therapeutic method’: This method refers to a way of acting and behavior when the intention, approach or frame of the improvisation is determined by therapeutic parameters. The fourth assignment was entirely devoted to the Bruscia techniques. In paragraph 3.5. (The power of improvisation (from a therapeutic angle)), I already mentioned the 64 improvisation techniques of music therapist Bruscia (see Annex 10.5.). During session 2 we were exploring - while improvising - the Techniques on empathy and the Structuring techniques (see Annex 10.6). I translated the above mentioned techniques from Dutch into English and handed them out to the students at the beginning of the session. These techniques are fairly easy to implement. For both type of students it is true that they already used intuitively many Bruscia techniques, and I noticed that it was helpful for them to become aware of the underlying meaning of certain interlarded patterns/rhythms/and the like, which they used in their improvisations. Maybe it was because of this that I sensed more joy and less discomfort among the students while improvising; just as if the techniques provided them with concrete tools to express themselves somewhat more freely on their instrument (unfortunately this is another point which I did not check with them due to time pressure; it is an assumption on my part, which I draw on the basis of what I saw and heard). The techniques of Bruscia do justice to the basic principles of the personal attitude of the musician. For example, in a process of acceptance and loss, it is important that the musician can provide someone with positive experiences. Examples of techniques that can be used in accommodating successful experiences, are rhythmic grounding, imitating, synchronizing and incorporating. One can use them a) to increase and support the general well-being of a person; b) in dealing with emotions and processing losses; c) to build self-awareness and structure; d) as a tool to reward positive and avoid negative behavior; e) to commit interventions that challenge, convey empathy, change the mood, add value, and the like. They were an interesting starting point for students who want to improve their (therapeutic) improvisation skills and in that way use them in their work with people with special needs. The last two sessions (January 2017): First of all there was the presentation of the PowerPoint that already covered half of the session time. Furthermore, there was a student who’s English was not quite so good, hence it was of importance that there was enough time for him to digest the information. Had I known this in advance, I maybe would have used more simple language and terminology. One of the other differences with the first two sessions was that - apart from me being more in the ‘teaching’ mode - we did not improvise together. Instead, I wanted to demonstrate a very structured exercise. So I asked a student to join me in order for me to show what kind of exercises (see below) one can do when working for

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example with a person who shows (some) characteristics of autism. The aim of the exercises is to get a clear insight in the cognition level of the person with autism, only then one is able to make a connection and to tune in. But the same exercises work also very well for a person who shows (some) characteristics of ADHD, since the sequence of exercises builds up from very easy rhythmic patterns to more difficult ones. People with these characteristics tend to have difficulty with focus and concentration, therefore structured exercises are very useful. The following exercise is the one I proposed above. I did justice to steps 1 until 4: Sequence:

• Step 1: to encourage mutual imitation (after each other). This exercise tells me e.g.: how does the person who suffers from (certain) characteristics of ASD/ADHD use his sensory motor system; does he have an overall picture of what he needs to do?

• Step 2: to lead and follow. I start with a rhythm and ask the person who suffers from (certain) characteristics of ASD/ADHD to join me with the same rhythm. Afterwards I ask whether I may join him in a rhythm of his choice. Again, this exercise provides me with a lot of information, e.g.: does he dare to take the lead; can he repeat where he came up with?

• Step 3: to change roles of leading and following while playing. I start with a rhythm and ask the person who suffers from (certain) characteristics of ASD/ADHD to join me with the same rhythm. While playing I ask him to take over the lead with another rhythm; when he feels like changing, he asks me to take over and so on. This exercise tells me for example: how long will he take the lead; how easy or difficult is it to change roles during playing. Tip: make it playful and dynamic!

• Step 4: stick to your own playing! I start with a rhythm and ask the person who suffers from (certain) characteristics of ASD/ADHD to join me with the same rhythm. Slowly I will play another rhythm but he needs to stick to the rhythm we started with. After that we do it vice versa.

If there had been more time, a next level in this exercise would have been:

• Step 5: to play with an intention. I start (without a rhythm) with playing sounds that communicate a certain emotion. The assignment for the person who suffers from (certain) characteristics of ASD/ADHD is then to respond to that emotion, and vice versa. Tip: make it playful, dynamic and try to outdo each other.

Within the four sessions with the students (December 2016 and January 2017), I noticed in general two little differences among them (there were Master students with a major in Education and students from the Bachelor with a minor in Education present, see also Methodology): 1) Although all students were interested in what I was presenting, the Bachelor students with the minor seemed to be a bit more receptive to what I had to offer, maybe because they are more often exposed to this kind of work. 2) The Master students with the major, on the other hand, were slightly more at ease with improvising, and demonstrated a higher musical and artistic level (which fortunately leads to the observation: training and education do generally matter). Although the training ‘Aural skills and Improvisation I, II and III’ is part of the Bachelor curriculum of the Royal Conservatoire, I still sensed a certain discomfort regarding improvisation. This is understandable, because improvising means for a lot of students entering an unsafe area. Improvisation literally means unforeseen/unforeseeable; improvisation is among others in motion and

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unpredictable. Most students would be well advised to acquire somewhat more experience; it is not easy for classical trained musicians to release themselves from already written and rehearsed music. 5.2.2. Observation of video material (and of my own teaching) In paragraph 4.2. I already gave an enumeration of the edited fragments that are in my opinion of value. Apart from the feedback and discussion moments that are important anyway (one will find them below in paragraph 5.3.), I sensed ‘something was happening’ in the other chosen moments (see below). I will now shortly give an explanation per video fragment of the three sessions with the students I recorded. Imitation of a teaching situation of a person with ADHD:

• In this fragment the teacher asks the girl (who does not really need to ‘act’ that she suffers from ADHD, since she is diagnosed herself with this disorder) to whistle the tune of ‘Jingle Bells’. This surprised her in a clearly visible, but also in a positive way, while up to that point she was not focused at all. The teacher, on the one hand, ignored her impulsive and chaotic behavior, and drew her attention in asking something ‘odd’ and ‘unexpected’ on the other hand. One sees clearly that a connection arose.

Improvisation about experiencing oneself and the other:

• This is the exercise, which subsequently triggered here and there somewhat resistance and confusion (this turned out to be the case afterwards). My share in this could have been that I should have explained the exercise more in detail, despite my consideration of first musically ‘get acquainted’ with each other through this exercise; a kind of (re)presenting oneself, since they saw me for the first time and vice versa. Nevertheless, I think the assignment went quite well: the concentration was fine; the commitment was there, and as a result there were nice moments of attunement.

Improvisation with Bruscia technique of imitation:

• Before I told the students about the Bruscia techniques, there was far less mutual connection among them who were improvising. After an explanation on my part about these techniques (which I had provided as a written manual and what was gladly taken home by most students), this improvisation arose. I saw and heard a beautiful concentration; attunement with each other and with the musical material.

Exercise session 4:

• This fragment is part of a larger exercise (see section 5.2.1.). To be precise: I arrive here at step 4, and explain the purpose of this exercise to the student (who acts as somebody suffering from ASD). Again, also for this exercise it is valid to say that I could have been clearer in terms of explanation. Another thing which I noticed about my ‘teaching’ is, that I regularly give a compliment to the student in front of me, after the assignment is executed (it happened during session 4, but I do this in general quite often). The phenomenon is not new for me: during my music therapy study I got this feedback several times from my teachers. They believe that the moment you say for example, 'very good' or ‘well done’, you actually say this for and to yourself, because you then find that the other has done the exercise in a way that it meets your criterion. My motivation for praising within a one to one relationship stems

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from the past (during my training as a singer particularly the vocal lessons were no joy; I was at the mercy of an ‘anti-educator’ with a huge ego). I know at least for myself that my intrinsic motivation to give a compliment predominantly comes from a supportive attitude. I want to give the student a successful experience. The attempt is already worth a positive opinion and for that matter part of the process, I think.

5.3. Discussion findings with focus groups Feedback of students session 1:

• Most of the students indicated that they were not aware of this ‘reality’ and that they found it interesting. One of the students declared that ignoring strange behavior was an eye-opener for her and she can enclose this information in her work. Another student felt that she needed more instruction since we did not reach ‘my goal’ regarding the first exercise (see 5.2.2., 0241.mp4). She thought we were not connecting and that we were playing randomly, instead of ‘playing nice’, in some kind of key. Furthermore, she also implied that another student was disappointed as well about this (which was not the case). And yet another student reacted on this by saying that she felt we were connecting, although we did not play a melody. The feedback above gives in a way an indication of how (some) students think. For example, the sentence: …..playing randomly, instead of playing nice, in some kind of key, says something about a ‘mind frame’: e.g. when something is not in a kind of key, it is not nice; but is it therefore difficult to connect with? It certainly tells me that it was not the right moment and time for this exercise, and they need more time to become familiar with it.

Feedback of students session 2:

• In this fragment, a student indicated that she wanted to have more specific information about people with special needs. In her words: ‘now we did ‘it’ (the exercise) with a beginner student, but not with somebody with autism’. Another student would like to see a film about how people with this disorder behave. According to yet another student, they do not show the same behavior, so he finds this impossible to tackle (but also not necessary). In other words: the foregoing feedback means that concrete information is highly important and that I will have to find a video about for example someone with Asperger50 (Asperger is a form of Autism). Providing a concrete impression of the terrain is achievable, but it remains an almost impossible task to make them come in contact with someone with Asperger.

Due to technical circumstances the third session unfortunately was not recorded (see also 4.2.). Feedback from and discussion with students session 4:

• The first student said that she found it interesting and that she would like to know more about people with special needs. Yet the information was too general because of time pressure. Furthermore, she mentioned that musicians have special needs themselves and that we should think about why we cannot do certain things. Another student also thought it was

50 www.autism.org.uk

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informative, but he made a very interesting remark about not to believe in illness and that it is too easy to say that somebody is sick. He stated that every kind of student should be tackled in a different way; you just have to find out what their needs are. One could say that these two opinions are diametrically opposite to each other. This tells me that if there was to come a module, the providing of detailed information is crucial, but giving enough attention to the fact that one should not label is just as important.

Below, one finds a table with the most important feedback of the students, ordered by more or less similar thoughts and statements:

Remaining (relevant) feedback: • …It could have been more specific on special needs… • …It was more clear, specifically on special needs…

A lot of students declare not to be aware of this ‘world’, and were or come never in contact with its biotope, but this does of course not mean that it doesn’t exist. On the contrary: this ‘world’ is increasing. Due to a law, which was called ‘Appropriate Education’51 and introduced in August 2014, one meets more and more students in regular primary and secondary schools that are in need of care (see interview Wouter Tempelaar Annex 10.3.). Just think only at the ascending number of pupils from a migrant background, who often suffer from traumas. The observation of the student, who does not believe in illness, is an interesting one. I have commented previously on this statement, but I would like to emphasize once again that I understand very well what he means. It is very important not to label in order to keep an open view on, and ditto mind about the situation (too many people without a diagnosis suffer from ‘abnormal’ traits that could be attributed to autism,

51 www.rijksoverheid.nl (translation: Passend Onderwijs)

• ...I was not really aware of this world...I wasn’t really aware of this reality, so for me it was really useful…

• ...I wasn’t aware of this, it opened a new world for me, it was very interesting…

• ...I was never aware about what you should change from a ‘normal’ situation to a ‘special needs’ situation

3 x

• …I would like to see a video of a lesson about how they behave…[…]…an example about Asperger?

• …There was short time…want to experience in real time… • …Like the subject. Important for us…[…]…want to have a

real experience…

3 x

• …Interesting, would like to know more… • …Interesting, but still general. Want to know more

details…[…]…we as musicians have special needs… • …Interesting…[…]…but I would like to have more clear

instructions…

3 x

• ...Interesting, but I do not believe in illness, every kind of student should be tackled in a different way...

1 x

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and people who are labeled by psychiatry as being autistic, can often function fine). An extensive part of the students’ feedback after the sessions is about how to achieve as much as possible the concretization of a teaching situation with a person with for example Asperger. Several students even expressed a preference for a situation in real time. During the sessions it even turned out that there were two students in the group who - a while before - were both asked to work with a person with ASD (to be precise: independently of each other, and two different people with ASD), but were hesitating to do so. Exactly what I described as being one of the core problems (not feeling prepared and secure enough to start a teaching liaison with a person with - in these both cases - ASD) was here at stake. 5.4. Short résumé of the findings In this paragraph I begin with answering the first two subquestions (the third one will be answered hereafter). One subquestion deals with looking for an answer how this musical practice can be of beneficial influence on (the self image of) musicians, and the other handles about formulating starting points for materials to be used, and approaches to be taken. If you work with people with special needs, it is important to know yourself: both music- and person-wise, because you have to listen, watch and search all the time for connections. Through self-examination and reflection you learn about your musical identity; about the difference between music as a core activity and music as means; about process- versus result-orientated thinking; about authenticity and intuition, which are very important ingredients in attuning with the target group. All these elements (can) have a beneficial effect/influence on (the self-image of) the musician. The techniques of Bruscia do justice to the basic principles of the personal attitude of the musician. They are an interesting starting point - as far as materials are concerned - for students who want to improve their (therapeutic) improvisation skills and in that way use them in their work with people with special needs (see also 5.2.1.). In order for the musician to act and react in an appropriate way, it is important to examine in which area(s) in a child’s ‘normal’ developmental process when becoming an adult, stagnation occurs, or may have occurred, because this information can be very useful. In 3.6. I give examples of how a musician - during a music session - can approach and give direction to the (intended) musical activities with somebody from the target group in order to respond to the (hidden) needs of this person. Subsequently, in order to answer my main research question about useful skills, attitude and knowledge for musicians when entering into musical dialogues and connections with people with special needs it is important that musicians realize that there are some basic ‘domains’ which are useful in connecting with this target group. These domains can be seen as an extension of the regular capacities of musicians in view of their personal and professional development. Skills, attitude and knowledge can be strengthened in the areas of interaction and improvisation; herewith the employability as a musician is significantly enhanced through orientation on this target group.

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The basic domains are: Skills:

• If you work with people with special needs, it is important that you can reflect on what happens during the interaction with a person of this target group.

• If you work with people with special needs, it is of importance that you can connect with the level of the person in front of you.

• If you work with people with special needs, you need to learn to reach them through listening to what lies beneath their given material. You have to get rid of your result-oriented thinking: when a sound doesn’t ‘sound’, it might be still a good sound because there is a fair chance the sound has authenticity (very important when connecting with the other). The more sober, the more intense.

Attitude:

• If you work with people with special needs, you have to release this knowledge immediately, in order to keep an ‘open’ attitude. When you are notified of an official diagnosis of a person suffering from for example ADHD or ASD, or that you see various characteristics of this ‘disorders’ in a teaching situation come along, it is very important not to label in order to keep an open view on, and ditto mind about the situation. A particular disadvantage of a diagnosis is that it creates an artificial separation between people: too many people without a diagnosis suffer from ‘abnormal’ traits that could be attributed to autism, and people who are labeled by psychiatry as being autistic, can often function well.

• If you work with people with special needs, you have to be open for ‘music as means’, because apart from musical aims, in some situations there may be extramusical aims at stake (e.g. communicating, releasing, expressing oneself, processing, etc.), which can be developed through the use of musical means.

Knowledge:

• If you work with people with special needs, you have to delve into the characteristics of the different disorders/syndromes in relation to the target groups, in order to be prepared in a professional way.

• If you work with people with special needs, it is important to know yourself: both music -and person- wise, because you have to listen, watch and search all the time for connections.

• If you work with people with special needs, it is useful to have some knowledge of the improvisational techniques of Bruscia.

Finally, the answer to the third subquestion, in which I asked myself what key components offer the appropriate equipment when designing a module, is treated in the next chapter (6). N.B.: The module in chapter 6 is written for students. The content is similar to the three basic domains (skills, attitude and knowledge) as described in the above (paragraph 5.4.), though abbreviated and summarized in a concrete way. However, the module also contains elements, which I was not able to try out as yet.

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6. Key components for the initiation of the module: ‘Music and Special Needs’ Context Nowadays, musicians are more and more employed in new contexts; they have portfolio careers in which they combine several musical activities. Many of them work in health care, social care, formal and informal education, and youth and criminal justice settings. Hence, musicians become increasingly in touch with people with motor, cognitive, social and/or emotional vulnerability. The content of this module aims to provide relevant skills that can be of use for students who have the ambition to work with people with special needs.In addition to getting aware of the characteristic features of people with special needs, and, in particular, of people who suffer from (certain characteristics of) ADHD and ASD, the use of various ways of improvisation will be explored and discussed. Module content The module consists of five parts.In the introductory part, the focus will be on providing concrete information through a.o. lectures about certain imbalances in the developmental process when becoming an adult, from which people with special needs may suffer. Subsequently, concrete case studies will be shown on video and phenomenologically described, and session(s) with people with specific special needs (e.g. ASD or ADHD) will be organized. The third part highlights the use and approach of the concept of improvisation from different angles, namely:

• Musical identity and the importance of reflection (of and from the side of the musician). Musicians who are interested in joining this module, are well advised to write at the moment they enter and finish the module a letter to their instrument (and compare the outcomes afterwards), in order to reflect on their musical identity; the relation with their instrument and the like.

• Connecting with ‘the other’, trying to reach the ‘other’ by having the antennae on full alert. Herewith, the musicians’ sensitivity towards people with special needs is of key importance.

The fourth part consists of introducing, c.q. working with the improvisational techniques of Bruscia, which are a useful starting point for improving the (therapeutic) improvisation skills of the students. The students are furthermore expected to engage convincingly through the use of voice, the body as a whole, working with percussion, and playing their own instrument. The above five elements form together a combination of theory and praxis. Objectives

• You know some relevant characteristics of people with special needs, and its implications for (musical) education.

• You understand the importance of reflection and musical identity. • You can demonstrate an awareness of what is required to communicate with

and function well in relation to people with special needs.

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• You can demonstrate an understanding of and capacity for music-based activity in which the ability to communicate with a person with special needs through music is the core.

• You can demonstrate an awareness for therapeutic-based activity in which the ability to communicate with a person with special needs through music determined by therapeutic parameters is the core.

• You can apply the improvisational techniques of Bruscia. • You can demonstrate an attitude, which perceives and listens freely to sound

and rhythm without concepts and conventions. • You can demonstrate an attitude, which is open for ‘music as means’.

Organization Lecture(s) about

• Certain imbalances in the developmental process when becoming an adult, from which people with special needs may suffer.

• Concrete case studies, which will be shown on video and phenomenologically described.

Discussions about

• Concrete case studies • A real time teaching situation with a person with special needs

Used instruments

• Voice • The body as a whole • Percussion • Your own instrument

Improvisation

• To improve reflection skills • To experience oneself and the other • To build awareness of what is required to communicate with and function well

in relation to the target group • To understand the difference between music-based and therapeutic-based

activity (e.g. the improvisational techniques of Bruscia) • To encourage an open attitude

Presentations in groups and/or in pairs

• Through showing examples and giving explanation on the spot to an audience or fellow students

Home assignment

• To write a letter to one’s instrument, at the beginning and at the end of the module.

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• To study on the Bruscia techniques Used materials Bruscia, K. (1987). Improvisation Models of Music Therapy. Charles C. Thomas, Springfield. Buurman, K. (2015). Powerpoint over Fenomenologie/Diagnostiek. Creatieve Therapie, Hogeschool Utrecht te Amersfoort. Poismans, K. (2011). Shared Time, Timing in muziektherapie met autistische kinderen. Wetenschappelijk Tijdschrift Autisme, 2011 (p. 16-20). Stichting WTA. Smilde, R. (2012). In McPherson G.E. and Welch G.F. (eds.). The Oxford Handbook of Music Education, volume 2. Lifelong Learning for professional musicians. Oxford University Press.

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7. Conclusion: why this module, and why a module? In this final chapter, I will first repeat the problems that create the gap between ‘society and the conservatoires’ that initially made that I wanted to start this investigation. Secondly, I draw a final conclusion on the outcomes of the four sessions in relation to the feedback of the students. Thirdly, I clarify the similarities and differences with the elective ‘Music & Dementia’ and the module ‘Music and Special Needs’ (since 2014, students at the Royal Conservatoire have the possibility to choose the elective ‘Music and Dementia’ within the Master Specialization NAIP (New Audiences and Innovative Practice)). The gap:

• There is a growing need from within society to provide interactive workshops, teaching situations and concerts for (or with) people with special needs.

• There is an increasing group of musicians who are interested in working with

this target group and are not or don’t feel prepared enough to do so.

• The higher professional music education programs (BA & MA) in The Netherlands don’t provide enough content to facilitate the musician as in the above.

To start with my final conclusion: following my thoughts about and the outcomes of the students’ feedback of the four sessions in December 2016 and January 2017, I am even more invigorated by my idea that there is a legitimate place within the curricula of the conservatoires for this module. Moreover, I think that the choice for a module in itself is a logical one: a module is seen within the BA & MA program, as a part of an educational program or curriculum, and may be as large or small as necessary. It can - without obligation - be offered to different types of students in both the Bachelor and Master. Nevertheless, one very important key component of the module needs to get ‘flesh on the bones’: to achieve as much as possible the concretization of a teaching situation with a person with special needs (several students even expressed a preference for a situation in real time/life). I completely understand the urge for a real time education and practice, but to realize this will be a difficult task. However, it is not impossible and even challenging and provoking. If there is genuine interest for this module, potential partnerships with institutions within the city of The Hague need to be found and set up (e.g. Stichting Papageno). The RC is an institute that believes it is important to respond to the current social developments. 'Art' is - compared with earlier days - more often deployed through various projects that reach out to the community (especially the Master Specialization NAIP52, New Audiences and Innovative Practice, focuses on excellent

52 In 2006, I first came in contact with the Research Group Lifelong Learning in Music. The joint Research Group of the Hanze University Groningen (Prince Claus Conservatoire) and the University of the Arts The Hagsue (Royal Conservatoire) succesfully developed a training program for musicians in the field of music and dementia. This program includes participatory music workshops for people with dementia, and can not only be converted into the elective ‘Music and Dementia’ within the Master Specialization NAIP, but also be offered as further training of professional musicians who after graduation want to expand their opportunities in this particular practice.

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musicians who want to reach new audiences with innovative projects). Ideally, all the Master trajectories at the RC should be much more aware of the changing society and the necessity to connect with and react on these changes. One can read some interesting conclusions for the conservatoire in general in relation to the outside world in the book of Smilde: Musicians as Lifelong Learners: Discovery through Biography (2009). I quote:

‘A dynamic synergy between the conservatoire and the outside world is clearly needed. Often conservatoires still act in an isolated way, but could instead be part of a wider network of professional training and development, challenged to build up a more informed perspective which impinges upon developments in the profession, including cross-arts, music technology, and a cross-cultural and cross-sectorial world. [….] The conservatoire needs to constantly fine-tune and adjust itself to the needs of the profession, and vice versa. This requires a reorientation by the conservatoire, where a shift in culture has to be accompanied by a reappraisal of what actually counts in today’s world. Portfolio careers are the result of the big changes in the music profession and should not remain on the periphery of the conservatoire, but instead become part of core business’ (Smilde 2009: 251).

Although there is an overlap between the elective ‘Music & and Dementia’ of the Master NAIP and the proposed module ‘Music and Special Needs’, there are also quite some differences:

• The elective M & D (Music & Dementia) does only take place in groups, this in contrast with the module ‘Music and Special Needs’ (herewith to be called MSN) that focuses on groups and individuals.

• The content of the elective M & D is only based on improvisation, whereas in the module MSN emphasizes on improvisation and individual teaching methods.

• The content of the activities within the elective M & D relate only to understanding of and capacity for music-based activity in which the ability to communicate with a person with special needs (dementia) through music is the core, whereas the activities in the module MSN are twofold, namely: 1) to create understanding of and capacity for music-based activity in which the ability to communicate with a person with special needs through music is the core, and 2) to cultivate an awareness for therapeutic-based music making in which the ability to communicate with a person with special needs through music determined by therapeutic parameters is the core.

Final conclusion: I think it is wise to try to complete the whole module, and execute all the required phases of the methodology attributed to the Educational Design Research model (due to time pressure I have chosen to initiate a module instead of designing a complete one, and the ‘new teaching’ I offered the students contained musical activities as being part of these initiations). The module has enough potential to be part of an educational program: the content is relevant and can bring the student a lot.

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8. Recommendations and epilogue Looking back on the past two years that I have been working on this thesis, I had very different experiences. The first year existed mainly of dealing with building up a theoretical framework; the second, on the other hand, had a much more practical and concrete approach. The whole structure and chronology of these two years felt for me very organic, moreover, in this way I provided myself time and space to think about the structure of the module. The downside is that since the second year was more loaded, I could not ‘run’ the whole module. All the more reason to finish it in the near future. Finally, is the content of this module considered being music therapy, or not? This question has basically nothing directly to do with my research, but is relevant in relation to the possible procedure for dealing with the module. There are of course similarities because some strategies that musicians and music therapists use within an improvisation may be the same: think of the use of powerful natural processes in order to enable musical dialogues like mirroring, imitation, turn taking, and the like. These processes include creating a natural sense of invitation and connection. From there, it requires only a little step in making the underlying therapeutic meaning of certain interlarded patterns/rhythms used in improvisations somewhat more explicit. The module offers this possibility but does not have the aim to turn musicians into music therapists; it rather wants to be of use in broadening and opening the view of musicians in regard of their work with people with special needs. Anyhow, musicians are often very good players/singers, and they oftentimes have a tremendous sensitivity towards fellow musicians and their 'public', which - with a little guidance through for example this module - can have a positive effect in an environment where people with special needs are at stake. I personally would like to consider musicians who want to work with people with special needs as a kind of ‘musical agogues’: professionals, who can use music (also) in a subservient way for (musical) development and well being of a person with special needs. Although, in this module, musicians are not trained to be certified music therapists, they could find themselves, in future, being located in a situation in which music therapists usually work. Hence, it is important that the musician has a clear picture of his own abilities and qualities (for some people their autism presents milder forms of problems and challenges, while for others autism is a severe disability), and of the expectations of the person with special needs, or the network around him. Despite the fact that one should not label (see Context 2.2.), it is of importance to realize with whom, what, how and why one starts a commitment in a situation where special needs are immanent, because ‘good acting’ - which should always be carried by moral standards - is a key element in the (musical) encounter.

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9. Bibliography 9.1. Books and articles Bruscia, K. (1987). Improvisation Models of Music Therapy. Charles C. Thomas, Springfield. Bruscia, K. (1998). Defining Music Therapy, second edition. Barcelona Publishers. Buurman, K. (2015). PowerPoint over Fenomenologie/Diagnostiek. Creatieve Therapie, Hogeschool Utrecht te Amersfoort. Cremers, P. (2012). Onderwijskundig ontwerponderzoek: onbekend maakt onbemind? Onderwijsinnovatie magazine, maart 2012 (p. 25-27). Damasio, A.R. (2016). Ik voel dus ik ben. Hoe gevoel en lichaam ons bewustzijn vormen. Amsterdam, Wereldbibliotheek. Darrow, A. and Adamek, M. S. (2012). In McPherson G.E. and Welch G.F. (eds.). The Oxford Handbook of Music Education, volume 2. Preparing for the future: music students with special education needs in school and community life. Oxford University Press. Derrix, M. (2011). Muziek-gecentreerde muziektherapie binnen het behandelprogramma psychotische stoornissen. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Di Cesare, D. (2009). Gadamer - ein philosophisches Porträt. Mohr Siebeck Tübingen. Heijne, M. (2012). Casusanalyse. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Heijne, M. (2015). Essay: En de auctor is... Een essay over ‘verhalende zorg’. Onderdeel: PPP Methodiek Essay. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Heijne, M. (2013). De Nootzaak: anders leren. Een cross-over tussen muziektherapie en muziekeducatie voor muziekdocenten e.a. die werken met kinderen of volwassenen met een beperking. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Heijne, M. (2015). Music for a while.Een meervoudige gevalsstudie over Muziek & Dementie. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Heijne, M. (2015). Praktijkleerverslag. Creatieve therapie, Hogeschool Utrecht te Amersfoort. Heijne, M (2014). What is music therapy? Notes from a guest lecture at the University of Nish, Faculty of Arts, Serbia, 7-8 November 2014. Honing, H. J. (2012). Iedereen is muzikaal. Wat we weten over het luisteren naar muziek. Nieuw Amsterdam Uitgevers. Keken, H., van. (2014). Helende Kunsten. Over de oorsprong van het gebruik van

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muziek, drama en beeldende kunstvormen voor het welzijn. Rozenberg Publishers, Amsterdam. Kurstjens, H. (2005). Improvisatie in: Smeijsters, H. (ed.). Praktijkonderzoek in vaktherapie. Bussum: Uitgeverij Coutinho, Bussum. Kurstjens, H. and Baerends, A. (2006). In Smeijsters, H. (ed.). Handboek muziektherapie. Evidence based practice voor de behandeling van psychische stoornissen, problemen en beperkingen. Actieve muziektherapie. Bohn Stafleu van Loghum, Houten. Kurstjens, H. (2014). In: Poismans, K., Smeijsters, H. and Vink, A. (eds.).De ontwikkeling van muziektherapie in Nederland. Impressies van pioniers. Enschede: Ipskamp drukkers. Kurstjens, H. and Buurman, K. (2014). Werk College Kennisonderwijs, Institute for Social Work/Utrecht. Kurstjens, H. and Buurman, K. (2015). Music Therapy and Multimodal Arts Reflections, Palermo, Italië. Martinson, A. and Montgomery, J. (2006). Partnering with Music Therapists: A Model for Adressing Students’ Musical and Extramusical Goals. Music Educators Journal, March 2006, Vol. 92 Issue 4, (p. 34-39). Database: Academic Search Premier. Migchelbrink, F. (2006). Praktijkgericht onderzoek in zorg en welzijn. BV Uitgeverij SWP, Amsterdam. Murray Schafer, R. (1967). Ear Cleaning. Notes for an Experimental Music Course. Clark & Cruickshank, Berandol Music Limited, Canada. Ockelford, A. (2012). In McPherson G.E. and Welch G.F. (eds.). The Oxford Handbook of Music Education, volume 2. Commentary: Special abilities, special needs. Oxford University Press. Patterson, A. (2003). Music Teachers and Music Therapists: Helping Children Together. Music Educators Journal, March 2003, Vol. 89 (p 35-38). Database: Academic Search Premier. Plomp, T. In: Plomp, T., and Nieveen, N. (eds.)(2010). An Introduction to Educational Design Research. Educational Design Research: an Introduction. Netzodruk, Enschede. Poismans, K. (2011). Shared Time, Timing in muziektherapie met autistische kinderen. Wetenschappelijk Tijdschrift Autisme, 2011 (p. 16-20). Stichting WTA. Priestley, Mary (1994). Essays on analytical music therapy. Barcelona Publishers, Phoenixville. Randall, M. (2011). Music Education and Music Therapy: Strengthening the Bond. Teaching Music, April 2011, Vol. 18 Issue 6 (p.68). Databank: Academic Search Premier. Ritchie, J. In: Ritchie, J. and Lewis, L. (eds.)(2003). Qualitative Research Practice. A Guide for Social Science Students and Researchers. The Applications of Qualitative

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Methods to Social Research. SAGE Publications, London. Rogers, C. (2012). Mens worden. Een visie op persoonlijke groei. Erven J. Bijleveld, Utrecht. Rogers, R. (2002). Creating a land with music: The work, education and training of professional musicians in the 21st century. London: Youth Music. Rutten, M., and Stuijts, M. (2014). Muziekstrategie. Orthopedische muziekbeoefening. Schrijen-Lippertz, Voerendaal. Samama, L. (2006). Nederlands muziek in de 20e eeuw: voorspel tot een nieuwe dag. Amsterdam University Press. Salomé, Amsterdam. Smeijsters, H. In Smeijsters, H. (ed.)(2006). Handboek muziektherapie. Evidence based practice voor de behandeling van psychische stoornissen, problemen en beperkingen. Indicatiestelling. Bohn Stafleu van Loghum, Houten. Smeijsters, H. In Smeijsters, H. (ed.)(2006). Handboek muziektherapie. Evidence based practice voor de behandeling van psychische stoornissen, problemen en beperkingen. Kwalitatief onderzoek. Bohn Stafleu van Loghum, Houten. Smeijsters, H. In Smeijsters, H. (ed.)(2006). Handboek muziektherapie. Evidence based practice voor de behandeling van psychische stoornissen, problemen en beperkingen. Verklaringsmodellen. Bohn Stafleu van Loghum, Houten. Stern, D. (1985). The Interpersonal World of the Infant. A view from psychoanalysis and developmental psychology. Karnac, London. Wijzenbeek, G., and van Nieuwenhuijzen, N. (2006). In Smeijsters, H. (ed.). Handboek muziektherapie. Evidence based practice voor de behandeling van psychische stoornissen, problemen en beperkingen. Receptieve muziektherapie. Bohn Stafleu van Loghum, Houten. Smilde, R. (2012). In McPherson G.E. and Welch G.F. (eds.). The Oxford Handbook of Music Education, volume 2. Lifelong Learning for professional musicians. Oxford University Press. Smilde, R. (2009). Musicians as Lifelong Learners: Discovery through Biography. Eburon Academic Publishers, Delft. Verhaeghe, P. (2009). Het einde van de psychotherapie. De Bezige Bij, Amsterdam. Wigram, T. (2004). Improvisation. Methods and Techniques for Music Therapy Clinicans, Educators and Students. Jessica Kingsley Publishers, London and Philadelphia. 9.2. Websites Online article of Rogers, R., https://www.hanze.nl/assets/kc-kunst--samenleving/lifelong-learning-in-music/Documents/Public/273creatingalandwithmusic.pdf [18-10-2015] Website of The Hanzehogeschool Groningen,

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https://www.hanze.nl/assets/kc-kunst--samenleving/lifelong-learning-in-music/Documents/Public/expandingcareeroptions.pdf [18-10-2015] Website of the history of Music Therapy, www.musictherapy.org/about/history/ [4-11-2015] Online magazine, http://etudemagazine.com/etude/1925/09/how-music-is-saving-thousands-from-permanent-mental-breakdown---willem-van-de-wall.html [4-11-2015] Website of the European Music Therapy Confederation, http://emtc-eu.com/country-reports/the-netherlands/ [4-11-2015] Website of Smeijsters, H., about the Dutch history of music therapy, www.cearcall.home.xs4all.nl/mt/muziektherapie/historie.htm [4-11-2015] Website of KenVak online, www.debeeldendtherapeut.nl/assets/Muziek-meer-dan-geheimzinnige-mathematica.pdf [25-11-2015] www.debeeldendtherapeut.nl/assets/Creativiteit-Creatieve-therapie-KenVak.pdf [25-11-2015] Website of the Nederlandse Vereniging voor Muziektherapie, http://www.nvvmt.nl/muziektherapie/muziek-en-therapie [25-11-2015] Website of the Trimbos Instituut, http://www.ggzrichtlijnen.nl/index.php?pagina=/richtlijn/item/pagina.php&id=1307&richtlijn_id=88 [25-11-2015] Website of OCMW (Openbaar Centrum voor Maatschappelijk Welzijn) Gent, http://www.ocmwgent.be/assets/documents/Archief/Verplegen%20door%20de%20eeuwen%20heen.pdf [12-3-2016] Website of the history of health care, https://nl.wikipedia.org/wiki/Geschiedenis_van_de_verpleegkunde [12-3-2016] Website of Bloomline Net, Samama, L., http://www.bloomline.net/sites/download [12-3-2016] Website of the Canadian Music Centre, www.musiccentre.ca/node/37315/biography [22-3-2016] Website of the National Film Board of Canada, www.nfb.ca/film/listen [22-3-2016] Website of The Earle Brown Music Foundation, www.earle-brown.org/#index [22-3-2016] Online article in The New York Times by Kozinn, A., http://www.nytimes.com/2002/07/08/arts/earle-brown-75-composer-known-for-innovation-dies.html [22-3-2016] Website of Just anoter Wordpress, graphic notation, https://graphicnotation.wordpress.com/tag/earl-brown/ [22-3-2016]

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Website of Wikipedia about Aleatoric music, https://en.wikipedia.org/wiki/Aleatoric_music [25-3-2016] Website of the Internationales Musikinstitut Darmstadt, http://www.internationales-musikinstitut.de/en/ [25-3-2016] Online article in The Guardian by Service, T., http://www.theguardian.com/music/tomserviceblog/2012/aug/13/john-cage-contemporary-music-guide [25-3-2016] Online blog of Hallowell, E., http://www.drhallowell.com/20-common-adhd-characteristics/ [21-7-2016] Website of Autism Spectrum Australia, https://www.autismspectrum.org.au/content/characteristics [21-7-2016] Website of Psychische gezondheidszorg, www.psychischegezondheid.nl [21-7-2016] Website of Slideshare, http://www.slideshare.net/lemasney/erik-erikson-1565991 [21-7-2016] Website of Wikipedia about Phenomenology https://nl.wikipedia.org/wiki/Fenomenologie [21-7-2016] Website of the Stichting Psychoanalytisch Woordenboek, www.psychoanalytischwoordenboek.nl/ [21-7-2016] Website of Wikipedia about Winnicott, D., https://en.wikipedia.org/wiki/Donald_Winnicott [21-7-2016] Website of Triversum Alkmaar, www.triversum.nl [16-11-2016] Website of Special Music Education of the Conservatoire of Maastricht, www.specialmusiceducation.eu/mainmenu.html [22-11-2016] Website of Jessica Kingsley Publishers, www.jkp.com/author/authors/view/id/jos-de-backer [4-12-2016] Website of the Royal Conservatoire, www.koncon.nl [4-12-2016] Website of NAIP, European Master of Music, www.musicmaster.eu/faculty [12-12-2016] Website about Autism, www.autism.org.uk [7-3-2017] Website of the Rijksoverheid, www.rijksoverheid.nl [15-3-2017] Website of Houzz, www.houzz.com [19-3-2017] (photo frontpage)

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10. Annex 10.1. Characteristics of ASD and ADHD ASD (Autism Spectrum Disorder)

• Unusually intense or focused interests • Stereotyped and repetitive body movements such as hand flapping and

spinning • Repetitive use of objects such as repeatedly switching lights on and off or

lining up toys • Insistence on sticking to routines such as travelling the same route home

each day and doing things in exactly the same order every time • Unusual sensory interests such as sniffing objects or staring intently at

moving objects • Sensory sensitivities including avoidance of everyday sounds and textures

such as hair dryers, vacuum cleaners and sand • Rigidly sticking to routines and spending their time in repetitive behaviors are

ways for them to reduce uncertainty and maintain the predictability of their environment

• Limited use and understanding of non-verbal communication such as eye gaze, facial expression and gesture

• Difficulties forming and sustaining friendships • Lack of seeking to share enjoyment, interests and activities with other people • Difficulties with social and emotional responsiveness • Delayed language development • Difficulties initiating and sustaining conversations • Stereotyped and repetitive use of language such as repeating phrases from

television ADHD (Attention Deficit Hyperactivity Disorder)

• A sense of underachievement, of not meeting one’s goals (regardless of how much one has accomplished)

• Difficulty getting organized • Chronic procrastination or trouble getting started • Many projects going simultaneously; trouble with follow-through • Tendency to say what comes to mind without necessarily considering the

timing or appropriateness of the remark • An ongoing search for high stimulation • A tendency to be easily bored • Easy distractibility, trouble focusing attention, tendency to tune out or drift

away in the middle of a page or a conversation, often coupled with an ability to focus at times

• Often creative, intuitive, highly intelligent • Trouble going through established channels, following proper procedure • Impatient; low tolerance for frustration • Impulsive, either verbally or in action, as in impulsive spending of money,

changing plans, enacting new schemes or career plans, and the like • Tendency to worry needlessly, endlessly; tendency to scan the horizon

looking for something to worry about, alternating with inattention to or

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disregard for actual dangers • Sense of impending doom, insecurity, alternating with high risk-taking • Depression, especially when disengaged from a project • Restlessness • Tendency toward addictive behavior • Chronic problems with self-esteem • Inaccurate self-observation • Family history of ADD, manic-depressive illness, depression, substantial

abuse, or other disorders of impulse control or mood

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10.2. Eriksons eight stages of development.

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10.3. Interviews a) Yolande Eymael op 24 november 2015 te Maastricht: -Hoe lang bestaat deze opleiding? Vanaf 1990. En vanaf 2001 werd Yolande erbij gevraagd vanwege haar achtergrond als methodiekdocent schoolmuziek en creatief therapeut. Haar huidige functie omvat de stage-coördinatie basisonderwijs/OMB onderwijs (Orthopedagogische Muziekbeoefening) en het geven van zanglessen aan studenten van Docent Muziek breed. De opleiding heeft predicaat excellent. Naast haar werkzaamheden aan het conservatorium is Yolande als muziekdocent reeds 34 jaar werkzaam in het SO (Speciaal Onderwijs), en in dienst onder de functie van leerkracht. -Waarom is deze opleiding in het leven geroepen, is hier behoefte-onderzoek naar gedaan? Neen, het was een samenvoeging van HBO-kinderopvoeding en Docent Muziek algemeen. -Hoe zit het met de alumni, zijn ze tevreden, wat misten ze in de opleiding, zouden ze haar weer doen, vinden zij werk in deze branche? Zij zijn heel tevreden, vinden over het algemeen allemaal werk. Ze hebben grote communicatieve vaardigheden en goede reflectieve skills die ze beide blijkbaar goed kunnen ombuigen naar andere beroepen, want je komt ze overal tegen. Vaker dan reguliere docent muziek student. Waarschijnlijk door aard van opleiding grotere bagage opgebouwd. De teamleider van OMB betrekt de alumni vaak bij allerlei symposia en workshops en hun feedback is van zeer groot belang voor de opleiding. -Is er uitval? Nagenoeg niet. Er zijn 80 à 90 studenten docent muziek waarvan 50 % kiest voor OMB. OMB is ook mogelijk voor DMI (Docent Muziek Intensief), een tweejarige zij-instroom opleiding. Dan wordt er tijdens toelating gekeken of de desbetreffende student affiniteit heeft met OMB. -Waar liggen de verschillen ten aanzien van de reguliere docent muziek opleiding en/of het docerende element in de bacheloropleiding (het D-deel van het oude DM) wanneer het gaat over orthopedagogische en orthodidactische kennis en vaardigheden mbt de muziek? Extra vakken zijn: Orthopedagogiek/psychopathologie en OMB-methodiek (combinatie met stage: de studenten brengen allen hun eigen stages in, zo komt iedere keer een werkveld aan bod). Uiteraard hoort hier een uitgebreide literatuurlijst bij waar ook boeken over muziektherapie en muziekpsychologie op staan (Nordhoff-Robbins, Alvin, Sloboda, etc.). Het boek van Mark Rutten en Miriam Stuijtjens over Muziekstrategie is een belangrijk onderdeel van de lessen en gaat uit van 4 ontwikkelingsdomeinen, nl: het cognitieve, sociaal-emotionele, motorische en het conatieve element. Ook worden o.a. observatietechnieken beschreven. Overigens wordt de term muziektherapie bewust nooit in de mond genomen: ondanks dat het daar zeker raakvlakken mee heeft, wordt er alleen gesproken van muziekdocent. -Beschrijf eens een concreet geval? Bijvoorbeeld: je werkt op je stage met kinderen met autisme, dan moet je tijdens de les methodiek muzikaal insteken op een dusdanig niveau dat duidelijk wordt waarom je voor deze muzikale handelingen kiest en wat het verband is met bovenstaande 4 domeinen (problemen op voor- en achtergrond). -Hoe verhoudt de opleiding OMB zich tot de labels die de DSM op kinderen plakt? Wat de instelling ‘vindt’ van een kind wordt overgenomen door de student en de leraar. Uiteraard wordt de studenten die stage lopen op plekken waar dit gebeurt, geleerd om kritisch te blijven kijken. Maar je moet als OMB’er weten wat de ziektebeelden inhouden want je moet didactisch kunnen schakelen wanneer iets niet

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helemaal lekker werkt. Dit alles heet ortho-pedagogisch handelen. Deze handelingen leiden tot een muzikaal goed resultaat dat de kinderen doet opbloeien. -Zou je iets meer kunnen vertellen over de opvoederspresentatie die deze groep studenten moet houden? De beroepshouding als opvoeder is toch sowieso van zeer groot belang bij docent muziek? Waar zit het verschil? Dat is eigenlijk een beetje een ouderwets woord. Eigenlijk heet het nu ‘handelingsgericht werken’. OMB past wat dat betreft als een handschoen op passend onderwijs. En nee, er is in principe wat belangrijkheid betreft geen verschil met de reguliere student muziek. -Zijn gedeeltes van deze opleiding ook toegankelijk voor de ‘gewone’ studenten in de bachelor? Zo ja, heeft dit een naam, is het een keuzevak, en is het opgenomen in het Curriculum? Nee, op dit moment helaas niet. Maar ik zou willen dat het anders was, want ik denk dat het voor ieder muziekstudent belangrijk is om te weten hoe je met kinderen met een handicap omgaat. Alleen al door de grote toestroom van asielkinderen in het basisonderwijs zijn initiatieven en oplossingen nodig om een aantal van deze kinderen ‘passend’ te begeleiden. En vanaf 2014 werden ‘speciale’ leerlingen zoveel mogelijk geplaatst op reguliere scholen. Dit alles vraagt om een zorgvuldige en gekunde aanpak. Bovendien zijn er nog op dit moment nog nooit zoveel kinderen gediagnostiseerd met ontwikkelingsstoornissen zoals autisme en PDD-NOS, en ook deze kinderen willen zingen of een instrument bespelen. b) Wouter Tempelaar op 4 januari 2016 te Den Haag: -Wat vind je van het onderwerp van mijn Master? Uitstekend idee. -Wat weet en vind je van de opleiding OMB? Volkomen ander uitgangspunt. Hier in DH hebben wij artisticiteit als speerpunt. Maastricht is veel meer methodisch en onderzoekend. Muziek is ondergeschikt. -Zie jij het belang van deze specialisatie mbt tot het vinden van werk? Onze muzikanten komen terecht in regulier onderwijs. Noodzaak tot heroverweging speerpunten is wel opgelopen vanwege de zorgkant in het onderwijs (veranderde wetgeving). Buitenschoolse opvang wordt ook steeds belangrijker. -Heb jij het gevoel dat ‘onze’ studenten docent muziek hiermee iets onthouden wordt? Nee, het komt bij alumni ook nooit naar boven. -Ik heb een interview gehad met Y E waarin ze zegt dat zij OMB’ers over het algemeen vaker tegenkomt in het werkveld dan reguliere docent muziekstudenten vanwege hun verhoogde communicatieve vaardigheden en vermogen tot reflectie (die ze hebben opgebouwd tijdens hun studie). Er is wel een onderwijsmodule, die wordt gegeven door Adri. -Mijn research paper mondt vermoedelijk uit in een ontwerp voor een module/keuzevak. Denk jij dat zo’n module ook interessant zou kunnen zijn voor de student docent muziek? Nee, want altijd groepsonderwijs ipv individueel. Ik denk aan een soort ‘open’ module waarbij de studenten toch uiteindelijk zelf de vertaalslag moeten maken hoe en of ze te werk gaan met mensen met een beperking, maar dat de module wel zorgt voor een ‘awareness’ en een flexibeler denken over muziek(educatie) door middel van: -Bewust zijn van improvisatie vanuit therapeutische hoek -Bewust zijn van eigen dynamiek en attitude (reflecterende kant musicus). -Bruscia technieken -1 leerachtige situatie (praktijk erbij) -Bespreken van case studies

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-Mis jij hier iets, heb je nog aanvullende ideeën? Als docent heel open en voelend. Ontwikkeling van iemand als mens. Soort metagedachte van is voor iedere docent belangrijk. Ook: niet labelen<aandacht verplaatsen dat neemt de arousal weg<aandacht schept en bekrachtigt. Het gaat om mensen met een beperking maar in wezen weet je dat niet. Dus focus: hoe kijk en luister je en ervaar je mensen (met of zonder ziektebeeld). c) Jos De Backer op 26 februari 2016 te Leuven: -Wat is jouw rol inzake de opleiding muziektherapie aan het LUCA-instituut? Coördinator muziektherapie afdeling. -Werk je ook wel eens met musici in de vorm van workshops, trainingen? Nee, helaas niet. Bij collega’s muziektherapeuten worden ze soms wegwijs gemaakt. Is amateuristisch vind ik. Soms mensen in de supervisie die ik wat wegwijs maak, maar kan eigenlijk niet. Maatschappelijke behoefte om ManaMa (Master na Master) op te richten die hierin voorziet. Ortho(ped)agogische stroming bestaat niet in België, is wel behoefte aan. -Wordt jullie expertise gedeeld? Nu raak je een pijnlijke snaar. Informatie wordt niet gedeeld, maar de student is ook anders. Therapeuten denken abstract, pedagogen daarentegen moeten heel concreet weten hoe het in elkaar zit. -Zal ik nu uitleggen waar mijn onderzoek over gaat? En waarom het zo gekomen is? Is deze ontwikkeling ook in België aan de hand? Er zijn zeker initiatieven op dit vlak. Niet slecht, je gaat terug naar de essentie van het artistieke: muziek gaat de mensen raken. Je behoudt je identiteit als muzikant, je stelt je vaardigheid/kunstzinnig denken ten dienste van de ander. Het wordt aangeboden. Sterkte ligt in medium. Hoe leg je contact....etc. (bij mensen met dementie: transsubjectief: je wordt geleid in je spelen door de psyche van de ander; in resonantie treden met de psyche van een ander). -Hoe wordt er in België aangekeken tegen mensen met een hindernis? Hoe gaat jullie samenleving om met deze mensen? Gaat zij uit van onze behoefte of van die van hen? Mentaal gehandicapten tegenwoordig ook toegang tot de muziekschool. Men gaat in België uit vanuit de behoefte van de persoon met een beperking. Net zo als in Nederland. Inclusie in scholen in België wordt niet opgelost. Dus nu 700 kinderen met beperking weer terug naar het buitengewoon onderwijs. -Heb jij nog relevante informatie over dit onderwerp voor mij? (ik probeer een balans te vinden tussen cultuurfilosofische onderzoek (Bowman, Biesta) en de therapeutische en psychologische invalshoek (Ockelford, Smilde, Rogers, Darow & Adamek, Smeijsters, Damasio, Stern, Verhaege etc.)). Hanne Mette Ridder. Wereldexpert dementie. In Aalborg hoofd van onderzoek. Promotor van Anke Coomans. -Ken jij relevante literatuur over transdiagnostische factoren? Ik wil uiteraard wegblijven uit de klininsche en diagnostische hoek. Dus ik zou me liever focussen op de zogenaamde ‘probleemgebieden’: Cognitie/Interactie/Emotie/Zelfbeeld. Muzikanten gaan niet met diagnoses in de weer. Wel moeten ze weten wat ze kunnen verwachten. -Uiteindelijk wil ik een soort ‘open’ module ontwerpen, met een brede (humanistische) basis -en daarom voor iedere student interessant kan zijn- en van waaruit de student zelf een vertaalslag kan maken richting het werken met mensen met een hindernis: de module zorgt voor een ‘awareness’ en een flexibeler denken over muziek(onderwijs) door middel van: -Bewust zijn van eigen dynamiek en attitude (reflecterende kant musicus).

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-Bewust zijn van improvisatie vanuit therapeutische hoek: Bruscia technieken -1 leerachtige situatie (praktijk erbij) -Bespreken van case studies -Mis jij hier nog iets? Heb jij nog aanvullingen of goed ideeën (Recorder Pro: 00:34)? Attitude van luisteren en kijken: oefenen in fenomenologisch beschrijven zonder interpretatie. Reflectief vermogen: eigen muzikale identiteit kennen: hoe druk ik mezelf uit met mijn muziek; welke relatie heb ik met mijn instrument. Opdracht aan elke muzikant: je schrijft aan het begin en eind van de module een brief naar je instrument. Instrument als subject beschouwen. Muzikale zelfervaringsworkshops rond improvisatie (leren luisteren.....muzikanten kunnen niet luisteren): proberen samen te klinken met maar één noot. Intuïtief. In welke toon van de ander kan ik mij terug herkennen en in verbinding komen? Hoe soberder hoe meer verbinding. Soberheid! Muzikanten moeten dat leren. Je kunt de mensen leren raken en luisteren naar achter datgene wat de cliënt geeft. Voor muzikant: ook als het niet klinkt kan het goed zijn. Authenticiteit is belangrijk. In een improvisatie word je geleid door de psyche van de ander. Videomateriaal Anke Coomans (over wat muziek bijvoorbeeld met dementerenden doet). d) Thomas de Baets op 26 februari 2016 te Leuven: -Wat is jouw rol inzake de opleiding muziektherapie aan het LUCA-instituut? Coördinator Master muziekeducatie. -Wordt de expertise van de muziektherapie-afdeling van het LUCA-instituut met jullie gedeeld? Via docenten van de afdeling muziektherapie die lesgeven aan de afdeling muziekeducatie sijpelt deze expertise wel wat door. -Wat vind je van de opleiding OMB in Maastricht? Het boekje dat geschreven is door Mark en Mirjam bevat een zeer herkenbaar pedagogisch verhaal. We hebben wel eel module die over ortho gaat die we misschien willen uitbreiden (samen met Jos). Het is een tussenvorm waar wel behoefte aan is. In de vorm van minoren of zo. Stukje muur afbreken die is opgebouwd vanwege zichtbaarheid. Maar dan hebben we wel draagvlak nodig. -Volgens Henk B. een brede module, wat vind jij daarvan? Pas op dat het niet te open of te weinig concreet wordt (muziek en mens bij LUCA, gevaar dat het te abstract en te weinig concreet is). Profiel van de muziekstudent is concreet georiënteerd. -Uiteindelijk wil ik een soort ‘open’ module ontwerpen, met een brede (humanistische) basis -en daarom voor iedere student interessant kan zijn- en van waaruit de student zelf een vertaalslag kan maken richting het werken met mensen met een hindernis. Volgens Henk B. een brede module, wat vind jij daarvan (Recorder Pro: 00:26)? Ik begrijp Henk wel, maar pas op dat het niet te open of te weinig concreet wordt (‘muziek en mens’ bij LUCA is zo’n voorbeeld). Gevaar voor teveel abstractie. Profiel van de muziekstudent is concreet georiënteerd. Interesse is 95 % praktisch. Zo’n module ‘mens en muziek’ is wel okee, maar er is schrik voor het abstracte. Pas op met het woord ‘open’ en ‘breed’.

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10.4. Component diagram, music therapy program University of Utrecht

10.5. The 64 improvisation techniques of Kenneth Bruscia

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10.5. The 64 improvisation techniques of Bruscia

I. Technieken betreffende empathie

Techniek Inhoud Doel 1. Imitatie De echo of herhaling van

de reactie van de cliënt, nadat deze reactie was beëindigd.

- Attenderen op eigen acties - Reactie of communicatie versterken - Relevante acties benadrukken - Gedrag cliënt accepteren - Boodschap bevestigen - Om de beurt spelen als voorbeeld van

interactie - Controle over en leiding geven aan de

therapeut - Imitatief gedrag te modelleren

2. Synchronisatie - Unimodaal - Crossmodaal

(in een ander medium)

Op hetzelfde moment doen wat de cliënt aan het doen is. Varianten: - canonische

synchronisatie - muzikaal spiegelen

- Responsen cliënt ondersteunen, versterken of stabiliseren

- Zelfbewustzijn vergroten - Vergroten betrokkenheid/intimiteit - Scheppen leidersrol cliënt - Acceptatie en herkenning terug te geven - Empatisch vermogen cliënt ontwikkelen

3. Incorporatie Muzikaal motief of gedrag cliënt gebruiken als thema voor eigen improvisatie of compositie en uitwerken.

- Cliënt versterken in presentatie - Acceptatie van muziek bevorderen - Model voor muzikale creativiteit en

expressie. - Opbouwen muzikaal repertoire

4. Pacing - Unimodaal - Crossmodaal

(in een ander medium)

Overeenstemmen met energieniveau cliënt: intensiteit en snelheid.

- Cliënt fysiek contact met omgeving leren krijgen

- Bevorderen zelfbewustzijn - Empathie ontwikkelen - Cliënt voorbereiden op overstap naar

andere energieniveaus.

5. Reflecteren - Unimodaal - Crossmodaal

(in een ander medium)

Overeenstemmen met cliënt in stemming, houding en gevoelens.

- Stimuleren emotioneel zelfbewustzijn - Accepteren van acties en gevoelens die

cliënt heeft leren uitdrukken - Demonstratie empathie en begrip

6. Overdrijven Iets wat de cliënt onderscheidt of uniek maakt in spel of gedrag uitvergroten en naar buiten brengen.

- Aandacht richten op bepaald aspect van de expressie

- Kwaliteit van overdrijven onder de aandacht brengen

- Overdrijven gebruiken in de muzikale ontwikkeling

II. Structurerende Technieken

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Techniek Inhoud Doel 7. Ritmische basis Basis-beat of ostinato

verschaffen voor improviserende cliënt.

- Helpen ordenen improvisatie cliënt - Tempo cliënt stabiliseren - Cliënt helpen impulsen te beheersen - Gevoelens van veiligheid en stabiliteit

bevorderen - Fysieke en psychologische steun aan

prestatie cliënt bieden - Cliënt in fysieke realiteit houden

8. Tonaal centreren Tonaalcentrum, toonsoort of harmonische basis verschaffen voor cliënt.

- Helpt cliënt ordenen melodieën - Succes cliënt verzekeren - Stimuleren muzikaal denken - Ontwikkelen opvatting over consonantie

en dissonantie (binnen en buiten de muziek)

- Gevoelens cliënt stabiliseren en/of vasthouden

- Structuur en geruststelling bieden

9. Shaping Lengte en vorm van een muzikaal idee leren herkennen en bepalen. Twee manieren: - laat de cliënt 2

instrumenten gebruiken: 1 voor crescendo en accelerando en 1 voor climax toon bij de cadens.

- improviseren met imitatie, synchronisatie en pacing.

- Impulsen cliënt vormgeven - Inzetten bij onmacht motorieke impulsen

omzetten in expressieve eenheden - Inzetten bij onmacht gevoelens omzetten

in idee-en of frase eenheden - Ontwikkeling thematisch materiaal te

ontwikkelen voor incorporatie en bonding.

III. Uitlokkingstechnieken.

Techniek Inhoud Doel 10. Herhalen Enige malen aanbieden

dezelfde melodie of hetzelfde ritme, opeenvolgend of met kleine tussenpozen.

- Muzikaal antwoord uitlokken - Emotioneel klimaat/stemming bepalen

11. Modelling Vertonen van model gedrag, kwaliteit, gevoel, trots voor de cliënt om na te streven. 'peer modelling': cliënten die voor elkaar model staan.

- Ontwikkelen specifieke respons

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12. Ruimte maken Cliënten gelegenheid geven te antwoorden of geluiden in te vullen door "lege" plekken in een improvisatie bouwen.

- Uitnodigen tot deelnemen

13. Tussenvoegingen

Enkel ruimte invullen die de cliënt laat en suggesties geven: Cliënt verantwoordelijkheid geven over improvisatie.

- Continuïteit in de improvisatie verkrijgen - Aandacht vestiging op iets en tevens

afstand bewaren - Aangeven bereidheid voor

steunverlening - Focussen of opnieuw oppakken v/d

improvisatie

14. Uitbreiding De zin verlengen van de cliënt door aanvullen; met of zonder overlapping.

- Helpen een compleet idee of gevoel te uiten

- Continuïteit verschaffen aan de improvisatie

- Spel cliënt vasthouden

15. Afronden Beantwoorden of afronden van de muzikale vraag van de cliënt.

- Opbouwen vormconcepten - Interactie met therapeut bevorderen

IV. Technieken om de leiding weer terug te nemen

Techniek Inhoud Doel 16. Introduceren van een verandering

Inbrengen van nieuw thematisch materiaal, ritmische of melodisch, om de improvisatie van de cliënt een nieuwe richting in te sturen.

- Een cliënt die vast zit in doen en laten stimuleren een andere richting in te gaan

- Cliënt wil iets nieuws doen maar is in impasse geraakt

17. Differentiëren Bij gelijktijdig spel onderscheidt de therapeut zijn eigen spel door het spelen van ritmes, melodieën, timbres etc. die zeer verschillend zijn met wat de cliënt speelt.

- Contrast maken tussen twee muzikale identiteiten

- Onafhankelijkheid tussen cliënt en therapeut vastleggen met behoud van relatie

18. Modulatie Tijdens improvisatie geleidelijk maat- of toonsoort veranderen. (NB: de muzikale inhoud hoeft niet te veranderen).

- Stemming veranderen - Het samenbrengen van cliënt en

therapeut in een andere maat- of toonsoort

19. Intensiveren Intensiveren van de muziek door de dynamiek en de ritmische en/of melodische spanning te verhogen.

- Aandacht vasthouden - Energie en opwinding geven - Laten ervaren dat hij energie en

impulsen kan beheersen - Spanning op aanvaardbare manier

toelaten

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20. Kalmering Muziek “relaxeren” door dynamiek en tempo gematigd te houden, ritme en melodie eenvoudig en met veel herhaling te brengen en de zinnen neerwaarts te laten lopen.

- Oproepen van ontspanning en emotionele rust

21. Tussenbeide komen

Onderbreken of opnieuw sturing geven aan fixaties, volharding, of stereotypen die in de muziek van de cliënt tot uiting komen. Door - ritme

destabiliseren/beëindigen

- melodische responsen destabiliseren

- veranderen van instrument en

- manipulatie technieken

- Alleen gebruiken als de cliënt uiterst onbekwaam is en het therapeutisch een averechtse uitwerking zou hebben als men de cliënt zou toestaan om door te gaan

V. Technieken betreffende intimiteit

Techniek Inhoud Doel 22. Het bespelen van hetzelfde instrument

Cliënt en therapeut bespelen afhankelijk of onafhankelijk van elkaar hetzelfde instrument of de cliënt deelt een instrument met gelijke of belangrijk ander iemand.

- Werken aan grenzen onderlinge band en kwesties van beheersing

- Grotere intimiteit in verhouding - Ontwikkelingen

samenwerking/werkrelatie - Wederkerigheid tot stand brengen

23. Het aanbieden van een geschenk

Een muziekstuk, instrument, partituur of iets persoonlijks geven aan de cliënt.

- Muzikale koestering - De therapeut laat iets persoonlijks zien - Laten zien dat je geeft om de cliënt

24. Bonding Muzikaal thema uit een gezamenlijke improvisatie die symbool staat voor de relatie cliënt/therapeut.

- Een band met de cliënt bewerkstelligen - Aanvaarding en betrokkenheid

overbrengen - Gevoelens van vertrouwen in de cliënt

verstevigen

25. Alleenspraak De therapeut improviseert een lied alsof hij tegen zichzelf praat over de cliënt. Variatie: de cliënt een lied laten improviseren alsof hij met zichzelf praat.

- Als de cliënt niet bereid is om over een bepaald onderwerp directe vragen of mededelingen te accepteren

- Teksten geven uiting aan onzekerheden over de gevoelens van de cliënt of geven reacties door die de therapeut ten opzichte van zijn cliënt heeft

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VI. Procedurele technieken

Techniek Inhoud Doel 26. Gelegenheid geven

Geven van demonstraties, opdrachten, technisch advies of fysieke hulp.

- Deelname ervaring te vergemakkelijken - Werkrelatie te bewerkstelligen - Helpen verwezenlijken therapeutische

doelen

27. Verschuiving Verschuiving van het ene medium naar het andere of binnen het medium van het ene naar het andere instrument.

- Makkelijker maken moeilijke gevoelens te uiten

- Meer emotionele diepte aanbrengen in de uiting van de cliënt

- De cliënt zijn gevoelens laten consolideren of mobiliseren

- Verzet van de cliënt ten aanzien van het gebruik van een medium of instrument te doorbreken

28. Pauzes inlassen

Cliënt laten “rusten” of “bevriezen” tijdens een improvisatie. Tijdens de pauze kan de cliënt terugblikken of vooruitkijken.

- Bevorderen zelfbewustzijn - Herzien doelen, vooruitgang bespreken

(evalueren) - Voortzetting definiëren/overwegen. - Opbouwen zelfrespect en

probleemoplossend vermogen

29. Het zich terugtrekken

Na een prominente rol trekt de therapeut zich terug en geeft hij de cliënt de ruimte de improvisatie te leiden.

- Cliënt verantwoordelijkheden geven - Cliënt toestaan zichzelf op de muziek te

projecteren zonder zich door de therapeut te laten beïnvloeden

30. Experimenteren Structuur, procedure of idee inbrengen en cliënt vragen hiermee te experimenteren.

- Cliënt helpen met keuzes/alternatieven testen

- Bevorderen creativiteit - Wegnemen blokkeringen in denken - Effecten diverse manieren van

structureren te onderzoeken - Bevorderen vrijheid met

verantwoordelijkheid

31. Dirigeren Improvisatie leiden met expressieve gebaren, muzikale symbolen, mondelinge boodschappen en andere tekens. Therapeut en cliënt kunnen beide leider zijn.

- Gelegenheid geven leidersrol en volgersrol te leren

- Opbouwen zelfvertrouwen - Opbouwen groepssamenhang

32. Instuderen Improvisatie instuderen met (deel) van de groep.

- Helpen deel improvisatie te leren - Voorbereiden op een uitvoering - Trots laten ervaren op eigen werk - Aanmoedigen doorzetten en discipline - Ontwikkelen zelfbeheersing

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33. Uitvoeren Uitgewerkte en ingestudeerde improvisatie uitvoeren.

- Objectiveren proces van improviseren - Resultaat verschaffen - Aandacht geven aan werk en motiveren

van cliënt - Gelegenheid scheppen voor zelf kritiek

34. Terugspelen Opnemen en later afspelen improvisatie.

- Bevorderen zelfbewustzijn - Identiteitsontwikkeling stimuleren - Zelfbeeld verbeterende vaardigheden

ontwikkelen

35. Verslag doen Verslag laten doen van de improvisatie ervaring inclusief gedachten en gevoelens.

- Zelfbewustzijn kweken - Inlichtingen verkrijgen over de beleving

om zo je interpretatie van de improvisatie te toetsen

36. Reageren Gevoelens opvragen na beluisteren resultaat.

- Inlichtingen verschaffen over zelf bewustzijn cliënt

- Verhelderen houding en gevoelens over programmatische opdrachten

- Kweken positieve zelfgevoelens

37. Analogiseren Vragen naar een levenssituatie die analoog is aan de zojuist gespeelde/beluisterde improvisatie.

- Verbanden leggen - Verwoorden persoonlijke opvattingen te

stimuleren - Muziek als middel inzetten om gedachten

te onderzoeken en te projecteren

VII Verwijzingstechnieken

Techniek Inhoud Doel 38. Pairing (koppelen)

Geïmproviseerde muzikale motieven combineren met gedragsreacties van de cliënt.

- Beschikbaarheid en bereidheid van de therapeut om de cliënt te volgen over te brengen

- Te komen tot interactie - Om “rapport” te verkrijgen

39. Symboliseren Cliënt muzikaal laten associëren op iets buiten muzikaals - of vice versa.

- Aanmoedigen verkennen muzikale gegeven

- Gevoelens onderzoeken - Aanmoedigen persoonlijke gevoelens en

ervaringen te projecteren

40. Recollecting (opwekken herinnering)

Herinneren van gebeurtenissen/situaties en de geluiden reproduceren binnen een improvisatie.

- Verband leggen tussen geluiden en mensen, gebeurtenissen en gevoelens

- Voorbereiding op abstracte verwijzingsimprovisatie

Of: - Toegang krijgen tot onderbewustzijn mbv

geluiden uit het verleden of huidige leven - 'Geluidsgeschiedenis' cliënt te ontdekken

41. Vrij associëren Therapeut improviseert om verbeelding, herinnering en associaties bij cliënt op te wekken.

- Voorbereiden op verwijzingsimprovisaties

- Onderzoek onbewuste zaken

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42. Projecteren De cliënt een stuk laten improviseren dat een situatie, gevoel of probleem beschrijft dat therapeutisch onderzocht moet worden.

- On- en -bewuste aspecten uit thema onderzoeken

- Uiten en loslaten gevoelens vergemakkelijken

- Dieper bewustzijn en inzicht verschaffen

43. Fantaseren Cliënt improviseert een fantasie, droom, mythe of verhaal.

Zie projecteren

44. Verhalen vertellen

Therapeut/cliënt improviseren en cliënt verzint verhaal erbij.

- Loskrijgen autobiografisch materiaal - Projectie op onderdrukte gevoelens t.a.v.

Verhaal aan te moedigen - Irrationele gevoelens tot volgorde van

oorzaken terug voeren

VIII Technieken ten behoeve van het onderzoeken van emoties

Techniek Inhoud Doel 45. Holding Cliënt improviseert en

therapeut beweegt op de achtergrond mee op de gevoelens van de cliënt.

- Volledig uiten en loslaten van moeilijke gevoelens aanmoedigen

- Steun verlenen - Inzicht verschaffen in gevoelens

46. Doubling

De therapeut geeft uiting aan gevoelens die de cliënt niet kan erkennen of volledig kan uiten. Variant: peer-doubling.

- Onbewuste gevoelens in bewustzijn brengen

- Volledig uiten gevoelens stimuleren - Vergemakkelijken catharsis - Accepteren en erkennen eigen

gevoelens

47. Contrasteren Cliënt tegengestelde eigenschappen of gevoelens laten onderzoeken.

- Leren om emotionele overgangen te maken

- Uitbreiden expressie mogelijkheden - Uitelkaar houden gevoelens en

definiëren in expressie eigenschappen - Voorbereiding op ordenen van

tegenstrijdigheden in emoties - Opbouwen van muzikale vormconcepten

48. Overgangen maken

Geleidelijke overgangen aanleren tussen gevoelens en thema's.

M.b.t. Gevoel: - Een spelvorm leren creëren die een

verbinding heeft met het beleven van en gevoel

M.b.t. Thema's: - Emotionele overgangen leren maken - Structureren gevoelens in een

ervaring

49. Integreren Conflictueuze of tegengestelde elementen binnen een ervaring inbrengen.

- Zoeken naar gemeenschappelijke noemer die strijdige elementen samenvoegt in harmonisch geheel

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50. Sequencing (maken opeenvolgingen)

De cliënt helpen om zinvolle opeenvolgingen voor improvisatie, verhaal of vinden autobiografische gegevens te vinden.

- Wanneer de cliënt behoefte aan samenhang of bewustwording oorzaak-gevolg

51. Splitting Zoeken naar breuken of polarisaties binnen zelf-ervaring.

- Bewust maken eigenheid - Inzicht geven in verhouding

conflicterende delen - Voorbereiden op het integreren van de

conflicterende aspecten

52. Overdracht Via geïmproviseerde duetten zoekt de cliënt naar een belangrijke relatie in zijn leven.

- Verkrijgen autobiografische gegevens - Ontdekken interactionele patronen - Bewustzijn van een rol in een relatie te

vergroten - Projecties blootleggen - Onderzoeken ontwikkelingsgebieden

relatie

53. Nemen van een rol

De cliënt probeert verschillende rollen binnen een improvisatie uit.

- Vaardigheden trainen passend bij een rol - Bevorderen flexibiliteit - Ontwikkelen sociale vaardigheden

54. Verankeren De therapeut zorgt ervoor dat een belangrijke ervaring van de cliënt “verankerd” wordt.

- De cliënt kan onthouden wat hij geleerd heeft zodat hij het in een andere situatie, buiten de therapie om, toe kan passen

IX. Gesprekstechnieken

Techniek Inhoud Doel 55. Verbanden leggen

De therapeut vraagt de cliënt om te verwoorden hoe het ene aspect van de lopende discussie/improvisatie verband houdt met het andere.

- Helpen eigen ervaringen te verhelderen. - Cliënt confronteren - Bewustzijn en inzichtgeven in vroegere

ervaringen

56. Probing (porren)

Ondervragen. - De therapeut probeert informatie over de cliënt los te krijgen

57. Verduidelijken Vragen stellen. - Gegevens die de cliënt al verstrekt heeft verduidelijken

58. Samenvaten Terugkijken en recapituleren belangrijkste gebeurtenissen

- Om iets af te sluiten - Om losse punten te verbinden - Ervaringen te consolideren

59. Feedback Mening als objectieve buitenstaander geven.

- Opbouwen zelfbewustzijn

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60. Interpreteren Bedoelingen of verklaringen aandragen voor ervaring cliënt.

- Zelfinzicht geven - Gestalte geven aan zelfanalyse - Cliënt leren zelf interpretaties te maken

61. Verwerken van het geheel

De cliënt wordt in staat gesteld om te observeren en te reageren op wat er gaande is.

- De cliënt te bewegen van een spontane manier van bewustzijn naar en nadenkende manier van bewustzijn te gaan

62. Reinforcing Belonen/onthouden van beloning.

- Om eigenschappen/gedrag te doen toenemen/afnemen

63. Confronteren Antwoord eisen van de cliënt.

- Inzicht geven - Motiveren om te veranderen

64. Onthullen. De therapeut onthult iets over zichzelf dat in direct verband staat met een gegeven over de cliënt.

- Vergemakkelijken therapeutisch proces

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10.6. Tranlation of techniques on empathy and structuring techniques from Dutch into English Techniques on empathy Technique Content Target To imitate The echo or repetition

after the person with special needs having completed a musical action

- To strengthen response or communication - To emphasize relevant actions - To accept behavior - To confirm a message - To take turns as an example of interaction - To model imitative behavior

To synchronize -Unimodal* -Crossmodal*

At the same time doing what the the person with special needs is doing. Variations: - Canonical synchronization - Musical mirroring

-To support, enhance or stabilize a response - To increase self-awareness - To increase participation, intimacy - To create leadership - To return acceptance and recognition - To develop empathy skills

To incorporate To use a musical motif or a persons behavior as a theme for improvisation or composition

-To strengthen a presentation - To promote acceptance of music - To model musical creativity and expression - To build musical repertoire

To pace -Unimodal -Crossmodal

To correspond to energy, intensity and speed of a person

-To teach a person getting physical contact with surroundings - To promote self-awareness - To develope empathy - To prepare a person to switch to other energy levels

To reflect - Unimodal - Cross Modal

To correspond to a persons mood, attitude and feelings.

-To encourage emotional self-awareness - To accept actions and feelings which a person learned to express - To demonstrate empathy and understanding

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To exaggerate

To exaggerate or enlarge something that distinguishes a person playing or behavior and bring that out

- To focus on some aspect of the expression - To point out the quality of exaggerating - To use exaggeration in musical development

Structuring techniques Technique Content Target To provide rhythmic base (rhythmic grounding)

To provide beat or ostinato for a persons improvising

- To help organizing the improvisation of a person - To stabilize tempo - To help controling impulses - To promote feelings of security and stability - To provide physical and psychological support a performance - To keep a person in the (physical) reality

To provide tonality To provide harmonic base To help a person organize melodies To assure success To stimulate musical thinking To develop understanding of consonance and dissonance (inside and outside the music) - To stabilize feelings - To structure and offer reassurance

To shape To recognize length and to define a musical idea. Two ways: - Allow a person to use two instruments: one for crescendo and accelerando and one for the climax tone cadence. - To improvise with imitation, synchronization and pacing

- To design impulses of a person -To transform motory impulses into expressive units - To transform impotence feelings into idea or phrase units - To development thematic material for incorporation and bonding

*Unimodal: using the same instruments e.g. two djembé’s *Cross modal: using two different instruments e.g. djembé and marimba

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10.7. Personal Process In this paragraph I describe how I experienced the work I did on my research over the past two years; was there a route planned, did I fall from one idea into another, or was there maybe something in between? The most important Fases/Turning points/U-turns are described below: Fase 1: In September 2105 I was actually still planning to do more research on working with people with Dementia. In order to finish my music therapy studies at the University of Utrecht I had to write a PGO (Praktijkgericht Onderzoek), which comprised a search for the most effective musical interventions for people with dementia during a project in a cycle of 8 weeks (this was a participatory music workshop: the so called elective Music & Dementia, which was organized in the Flevohuis, from April 1st to May 20th 2015). After a conversation with Renee Jonker I decided that I could broaden my research: there are more people who may be characterized as ‘with special needs’. Fase 2: In the first year of the Masters program I had to follow a mandatory elective. Reading through the Curriculum of the Royal Conservatoire, I ended up choosing the elective Research in Music Education given by Adri de Vugt (see Foreword and acknowledgements). He made it possible that, along with another Master student/teacher, I could give this elective my own interpretation regarding content and organization of the classes (which existed of reading relevant literature and giving a power point presentation). Throughout the year we had six meetings in which we discussed several books and articles. Obviously there is much literature available about the concepts of people with special needs in relation to music/education/therapy, and in this respect The Oxford Handbook of Music Education, turned out to be an important pillar under my research. I did not process all the reading material in my research, but it has definitely contributed to context and demarcation of my topic. Fase 3: In February 2016 I did an Erasmus exchange with LUCA, School of Arts (Leuven, Belgium) to talk with professor of music therapy Jos De Backer, who is the local coordinator of the music therapy department. Up until that moment I was 'stuck’ in the middle of shaping my module in a concrete way. I had written already a lot about context, theory and processes, but I could not come to a more concrete content. He was of great value to me and with his input I could bring my research extensively further. Fase 4: From the end of March 2016 up until July 2016, I had serious shoulder problems and therefore my computer work was hugely delayed. There is not so much to say about this period, only that I did a lot of thinking about the form of my thesis (working with exertions to highlight topics/composers); I hardly wrote something down. Fase 5: During the summer I tried again to work a little bit (on the computer), and was in less pain, so I started creating a format for Chapter 5, with as central focus point: the answers concerning the Research (Sub)questions in the left column were -where applicable- seconded in boxes in the right column, being the core of the module.

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Fase 6: In Yogyakarta (September 2016) I had again a fruitful period: I changed my way of handling the footnotes and the bibliography, and I finished Chapter 2. Fase 7: After a correspondence with Adri (October 2016), I could finish the Methodology; that felt great, on the other hand he wanted me to take apart (again) the information I put in the boxes which were supposed to be the core of the module (Chapter 5), since he thought that the chosen structure was not clear enough. For me, at that moment it was a bit of a downer and it caused me a lot of work, but in the end I am happy with how the module looks like now. Much more clear! Fase 8: In December 2016 and January 2017 I had the opportunity to run four sessions with Master students with a major in Education and students from the Bachelor with a minor in Education. During these sessions I got the chance to put some of my ideas regarding the module, into practice. I designed guidelines and implemented this ‘new teaching’ in the form of musical activities with the students mentioned above. In addition, I provided them with useful information. Ideally, the ‘new teaching’ takes place in multiple cycles being evaluated and adjusted, but exactly at this point my research did no longer synchronize with the original Educational Design Research model. Due to time pressure I had to choose to initiate a module instead of designing a complete one, and the ‘new teaching’ I offered the students contained musical activities as being part of these initiations. Until the end of March I've been busy writing and describing what happened during the four sessions. During this period also a number of vital elements for the Module got their final shape.

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10.8. Glossary Aesthetics: a branch of philosophy dealing with the nature of art, beauty, and taste. Affiliation: the act of connecting or associating with a person or organization. Auditory: based on the Latin word audire, meaning to hear. Authenticity: the quality or condition of being authentic, trustworthy, or genuine. Brain stem: the posterior part of the brain, adjoining and structurally continuous with the spinal cord. Congruence: Carl Rogers stated that the personality is like a triangle made up of the real self, the perceived self, and ideal self. According to Rogers, when there is a good fit between all three components, the person has congruence. This is a healthy state of being and helps people continue to progress toward self-actualization. Consolidation: the process of becoming solid. Customization: to modify or build according to individual or personal specifications or preference. Detrimental: causing damage or harm. Empathy: awareness of the feelings and emotions of other people. It is a key element of Emotional Intelligence, the link between the self and others, because it is how individuals understand and sometimes even feel what others are experiencing. Endeavor: a strenuous effort, attempt. Equilibrium: the conditions of systems in which all competing influences are balanced. Ethics: a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. Exploration: the investigation of unknown regions. Geriatric psychiatry: also known as psychiatry of old age, is a subspecialty of psychiatry dealing with study, prevention, and treatment of mental disorders in humans with old age. Holism: systems (physical, biological, chemical, social, economic, mental, linguistic, etc.) and their properties that should be viewed as wholes, not just as a collection of parts. Humanity: the human race, which includes everyone on earth. It’s also a word for the qualities that make us human, such as the ability to love and have compassion and be creative. Incubation (psychology): the process of thinking about a problem subconsciously while being involved in other activities.

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Illumination: the act or process of making something clearer or brighter or a device for doing so. Impairment (in health): any loss or abnormality of physiological, psychological, or anatomical structure or function, whether permanent or temporary. Identifying impairments that contribute to disability is a key factor for a health professional to determine appropriate treatment. Innate: existing in somebody from birth. Intervention: something that comes between two things or something that changes the course of something. Integrity: the qualifications of being honest and having strong moral principles; moral uprightness. It is generally a personal choice to hold oneself to consistent moral and ethical standards. Intrinsic: qualities of something that have to do with its nature. Anything intrinsic comes from within. If one likes someone for intrinsic reasons, then he has no other motivation. Mandatory: required or commanded by authority; obligatory. Metabolism: a term that is used to describe all chemical reactions involved in maintaining the living state of the cells and the organism. Non-linguistic representation: an imagery mode of representation. The imagery mode is expressed as mental pictures and physical sensations such as smell, taste, touch, kinesthetic association, and sound. Primordial: existing at or from the beginning of time. Proprioceptive: relating to stimuli that are produced and perceived within an organism, especially those connected with the position and movement of the body. Precursor: a person or thing that comes before another of the same kind; a forerunner. Reciprocity: mutual exchange; the practice of exchanging things with others for mutual benefit. Rudimentary: relating to an immature, undeveloped, or basic form. Subjective reality: refers to the reality inside one’s mind. It is the meaning one assigns to things and events. All objects, dreams ideas and ‘truths’ are different for each person. Synthesis: the combination of components or elements which form a connected whole. Tactile: relating to the sense of touch. Thalamus: the large mass of gray matter lying between the cerebral hemispheres on either side of the third ventricle, relaying sensory information and acting as a centre for pain perception.

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Validity: the extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world. The word valid is derived from the Latin validus, meaning strong. Verification: the process of establishing the truth, accuracy, or validity of something. Vestibular: relating to a vestibule, particularly that of the inner ear, or more generally to the sense of balance. Visual: relating to seeing or sight. Vulnerable: exposed to the possibility of easily being attacked or harmed, either physically or emotionally.