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The Arts in Psychotherapy, Vol. 24, No. 4, pp. 395-397, 1997 Copyright 0 1997 Elsevier Science Ltd Printed in the USA. All rights reserved

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BOOK REVIEW

Music and People With Developmental Disabilities: Music Therapy, Remedial Music Making and Musical Activities

Frans W. Schalkwijk (Translated by Andrew James)

(London and Bristol, PA: Jessica Kingsley Publishers, 1994, 124 pages, $29.95 paperback)

This book is a summary of Schalkwijk’s doctoral research which focused on describing systematically the experience of those who take part in caring for people with a developmental disability through the medium of music. “The objective was to collate and analyze the practical experience of music therapists, in order to give some structure to the available meth- ods” (p. 108).

Chapter one is an introduction to the history of care; chapter two gives a definition of working meth- ods that are then divided into individual (chapter three) and group treatment (chapter four). A final chapter offering conclusions is followed by an appen- dix of the research method and a bibliography.

Based on interviews (by means of a decision- theory research strategy) with six music therapists, Schalkwijk developed sensitizing concepts of several “working methods.” These interviews and a litera- ture study resulted in the development of a question- naire that was answered by 112 music therapists working in several institutions for the mentally handi- capped. The 444 items in the questionnaire covered subjects such as individual/group treatment, how treatment is offered by the therapist, indications/ contraindications, objectives, techniques and instru- ments. By means of correlational techniques, ques- tions were linked to each other. This resulted in a final categorization of working methods.

In chapter two, “musical activities” are defined as recreational activities that differ from music lessons.

They are further characterized by general goals such as “education and development in and through mu- sic” and by a lack of indications for whom this method is appropriate due to the focus on the musical product rather than the need of the client. In addition, no attempt is made to establish a therapeutic relation- ship, and there is a lack of goals focusing on indi- vidual needs.

“Remedial music making” covers goals such as stimulating individual growth, developing and stimu- lating social skills, developing and stimulating cogni- tive skills and developing and stimulating motor skills. The goal “individual growth” has been further specified as emotional self-actualization, not focusing on psychic conflict. Music therapists often focus on the exploration and expression of new emotional pos- sibilities, telling their clients: “Do not forget what you are able to do in spite of the handicap.” A dis- cussion of interest is whether this therapeutic goal should be part of remedial music making or psycho- therapeutic music therapy. I believe this depends upon the therapeutic orientation of the (music) therapist.

In remedial music making, treatment indications are used, but these are very broad, such as there are possibilities for the client to develop. Although this follows from what has been referred to previously- that in self-exploration one is not focusing on the psychic conflict-I think that in the case of social, cognitive and motor impairments, more specific cri- teria can be used. The therapeutic attitude in remedial

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music making is, according to Schalkwijk’s research data, “client centered,’ ’ which of course is in line with self-actualization. Musical process and musical product can be equally important.

Schalkwijk uses the concept “music therapy” only when there is psychotherapy. His argument is that only in the case of working with psychic disturbances can there be therapy. On the one hand this is a strong point; on the other hand it is contrary to the interna- tionally accepted rule that “music therapy” covers many activities of music therapists when working in several areas (psychiatry, the mentally handicapped, rehabilitation, the elderly, medicine) with goals that can be either therapeutic or developmental. In other professions, too, “therapy” is used in a broader sense; therapy is not always equal to psychotherapy. Another objection might be that even in the field of psychic disturbances many times therapy in a strict sense is not possible. However, from now on (in this review) I will use “music therapy” as intended by Schalkwijk.

Music therapy is described as a form of psycho- therapeutic treatment where the therapeutic relation- ship is used to decrease psychic problems, conflicts and disturbances of the client. Problems are dis- covered and worked through, and improvisation is the main music therapeutic technique. The musical product is not the focus. In the area of the mentally handicapped, music therapy focuses on their psychic problems.

Schalkwijk’s categorization is important to help put one’s work in the appropriate methodological cat- egory. However, clinical problems may arise when, because of this categorization, distinct professions arise. A professional who is trained as a “remedial music maker”-in the category of development- will be unable to use psychotherapeutic musical tech- niques when his or her client needs psychotherapeutic help. In this case the client needs to be treated by two persons-the remedial music maker and the music therapist.

Thus, Schalkwijk’s categorization is very useful from a methodological point of view, but when it leads to distinct professions-as it did in The Neth- erlands-then in clinical practice the client might come up short. Most institutions are unable to hire a remedial music maker and a music therapist at the same time.

In my opinion, a more favorable situation would be to train music therapists who are able to cover devel-

opmental as well as psychotherapeutic goals for the client.

What professionals should strive for in the future is to train themselves within several categories (“work- ing methods”), to describe their tasks along these categories and to convince their superiors that they can work as a remedial music maker as well as a music therapist and that persons who are mentally handicapped at times need music therapy.

In the book, the four working methods that result from the questionnaire are described by means of clinical examples. They are divided into individual and group treatment (chapters three and four). There is the case within “individual music therapy” of Klaasje that shows how problems of attachment as a result of losing the complete family because of a di- vorce can be treated. As is shown in the case of “in- dividual remedial music-making” with John, this working method is indicated when there is no psychic conflict, but very low self-esteem and insecurity, making it impossible to treat the client in a group. The case of Miranda describes how “group remedial mu- sic-making” is used to develop social skills in a client who is very rigid when making social contacts on the one hand and very withdrawn on the other hand. Fi- nally, “group remedial music making” to stimulate motor and cognitive skills is illustrated by the case of Pascal. Speech disorders, underdeveloped bodily awareness, defective or undeveloped motor control, and concentration disorders are treated.

This book is based on the work of many profes- sionals. What was new at the time was (and perhaps still is) the categorization and conceptualization of working methods. However, the book is based on a description of the status quo in The Netherlands in the early eighties. Although the categorization and con- ceptualization of working methods are very important and inspiring, many questions remain unanswered. There is a description of treatment indications, objec- tives and techniques, but not a development of these aspects. If one remembers discussions about criteria for treatment that were initiated during international congresses in the early nineties, one realizes that the answers given by music therapists in the early eighties are behind the times. The book gives an answer to questions such as: Do you use treatment criteria? If so, which criteria do you use? Which goals and tech- niques do you use? The book does not answer ques- tions such as: Are the criteria, goals and techniques adequate when treating people who are mentally handicapped?

BOOK REVIEW

This work makes an important contribution to de- fining music therapy, although it is not as extensive as Bruscia’s Defining Music Therapy (1989). The lack of reference to Bruscia’s book is understandable because it was published in 1989, and the original data of the Dutch publication of Schalkwijk’s book was 1988 (based on his doctoral dissertation of 1987). One might question whether a work from 1988 should be translated and published in 1994 considering that it is in an area where scientific knowledge on an interna- tional level is accumulating very rapidly. Is it accept- able, considering that the book is based on practice and literature of the early eighties (the most current references are from 1987) and that no update is given? This raises the more general problem of completing a translation and having it published in time to be more contemporaneous.

Nevertheless, I want to stress that Schalkwijk’s book can have an important influence outside The Netherlands. It is based on sound scientific research; it is clear in terms of defining different working meth- ods; and it is practical because it gives case examples from clinical practice. Although not up to date, it is a work that should not be overlooked. It affords many opportunities for teachers to explore with students the

process in the case studies of the clinical reasoning of music therapists. This means analyzing the cases by means of questioning: In which way is the music therapist’s diagnosis based on his or her observations? Which treatment indications, goals and techniques are used by the music therapist? What is the degree of coherence for these aspects of treatment? The cases may also be used to make a more detailed analysis of how techniques and objectives fit together. For in- stance, in the case of John there are more than 16 objectives and four techniques! In this process of ed- ucational exchange between the teacher and the stu- dents, Schalkwijk’s book can be of great value.

Henk Smeijsters, PhD Director of the Creative Therapy Training Programs

Hogeschool Limburg-University of Professional Education

The Netherlands

Bruscia, K. E. (1989). Defining music therapy. Spring City, PA: Spring House Books.