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Guide VIII-181

Vaktherapie (Dutch arts and psychomotor therapies)

Netherlands
A 25 · L 51 · M 2423 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Dutch Zorgstandaard Vaktherapie (Akwa GGZ, authorised 24 February 2025; it replaces the 2017 Generieke module Vaktherapie) for the care process. The Landelijk domeinprofiel bachelor-opleidingen vaktherapeutische beroepen (LOO VTB, 2016) supplies the professional frame. Practice detail comes from Van Hooren (2018) and Haeyen (2020). All Dutch-to-English renderings are my own translations.

What it is. Vaktherapie (formerly creatieve therapie) is the Dutch umbrella profession for experience-based treatment through art materials, music, drama, dance and movement, play and the body. It is a professional and organisational framework, not one therapy. The current standard names seven disciplines: beeldende therapie (art), dans- en bewegingstherapie (dance/movement), dramatherapie, muziektherapie, psychomotorische therapie (PMT), speltherapie (play) and psychomotorische kindertherapie (PMKT, children only). [source: Zorgstandaard Vaktherapie 2025 §2.2; Van Hooren 2018] The 2016 domain profile lists only five bachelor disciplines and leaves out play therapy. Play therapy is still part of the federation through its own association, the NVVS. [source: Landelijk domeinprofiel 2016; Gemeente Eindhoven product description] The federation is the Federatie Vaktherapeutische Beroepen (FVB), which now presents itself as "Vaktherapie Nederland". Psychomotor therapy and PMKT are covered in Domain IV; this guide gives only a short pointer to them (end of section 4).

How change happens. The client's problems become visible in what they do with the medium. The therapist steers that doing towards experiences that change those problems. Interventions act "direct ... in het nu" (directly, in the present). This allows awareness, skill practice and trying out alternatives, with transfer to daily life as the goal. [source: Landelijk domeinprofiel 2016] Proposed mechanisms include:

  • action and experience;
  • changing action / changing perception (a predictive-coding account);
  • embodiment, meaning that movement shapes emotion and emotion shapes movement;
  • the protective distance of play;
  • the aesthetic experience. [source: Van Hooren 2018]

The current standard orders its mechanisms from basic to complex. It runs from regulating energy and restlessness, through noticing body signals, expressing inner experience, handling emotions and cognitive functions such as planning and concentration, up to new social behaviour. [source: Zorgstandaard 2025 §2.5] Talk supports the work but is not its main channel. Meaning-making follows the experience instead of coming before it. [source: Van Hooren 2018; Haeyen 2020]

Professional frame. Vaktherapists train in one of three bachelor routes (240 EC, BA):

  • Creatieve Therapie (art, dance, drama, music, psychomotor), offered at several hogescholen;
  • Psychomotorische Therapie en Bewegingsagogie;
  • Kunstzinnige Therapie (art, drama/speech, music).

Master's routes also exist. [source: Landelijk domeinprofiel 2016] Hogescholen in the profile's project group were HAN, ArtEZ, HU, Hogeschool Leiden, NHL Stenden, Zuyd and Windesheim. The profile does not state which of them offers which route. ArtEZ Muziektherapie did not take part in the profile. [source: Landelijk domeinprofiel 2016] Kunstzinnige therapie rests on its own school's theory, so read its concepts as that tradition's claims. [synthesis; its theoretical basis is not covered in the sources, so this is uncertain]

The current standard requires training at a recognised programme at hbo, post-hbo or master's level. [source: Zorgstandaard 2025 §2.7] Municipal youth-care contracts also require:

  • membership of an FVB association: NVDT (drama), NVBT (art), NVDaT (dance), NVvMT (music), NVPMT, NVPMKT or NVVS (play);
  • entry in the Register Vaktherapie;
  • for therapists in private practice, compliance with the FVB's Richtlijnen voor de Vrijgevestigde Vaktherapeut. [source: Gemeente Eindhoven]

The FVB's quality system includes:

  • the Beroepscode voor de Vaktherapeutische Beroepen;
  • a beroepscompetentieprofiel;
  • a visitation programme;
  • complaints and disciplinary procedures (klacht- en tuchtrecht);
  • the Register Vaktherapie. [source: FVB Kwaliteit]

It is [uncertain] whether Registerplein administers the Register Vaktherapie. [uncertain]

Vaktherapists are not a BIG-registered profession under Dutch health-profession law. They may not make diagnoses beyond a vaktherapeutische analyse (a discipline-specific analysis). [source: Landelijk domeinprofiel 2016; Zorgstandaard 2025 §4.2] Do not offer a discipline as vaktherapie without that training and registration. A psychotherapist without it can refer to or co-treat with a registered vaktherapist. They can borrow simple expressive tasks into their own work but should not call this vaktherapie. [synthesis]

2. Framework

The care process below follows the Zorgstandaard Vaktherapie 2025. The standard sets no fixed phase count. It describes care-process steps.

Step 1. Referral (toeleiding/verwijzing).

  • Goal: get the client to the right setting.
  • Referral usually comes via the GP. Settings are basis-ggz (primary mental-health care), specialistische ggz (specialist mental-health care), or a therapist in private practice.
  • In a mental-health institution, vaktherapie is always part of multidisciplinary care.
  • A private-practice vaktherapist can act as medebehandelaar (co-treating clinician) under a private-practice regiebehandelaar (the clinician with overall clinical responsibility). [source: Zorgstandaard 2025 §2.7]
  • Many vaktherapists work as co-treating clinicians under a clinical psychologist or psychiatrist. [source: Landelijk domeinprofiel 2016]

Step 2. Intake.

  • Goal: a whole-person, transdiagnostic picture and a check for contra-indications.
  • The vaktherapist decides whether to accept the client, even after a referral.
  • Existing diagnostic work can shorten the intake. [source: Zorgstandaard 2025 §4.3.2]

Step 3. Diagnostics and observation.

  • Goal: answer three questions: what the problem is, what causes and maintains it, and what the client needs.
  • The vaktherapist does not make the psychiatric diagnosis. Observation in the medium yields a vakspecifieke diagnose (discipline-specific diagnosis). [source: Zorgstandaard 2025 §4.2]

Step 4. Shared decision (samen beslissen).

  • Client (and family where needed) and clinician choose together, including an informed choice of discipline. [source: Zorgstandaard 2025 §4.3.1]

Step 5. Goals and treatment plan.

  • Goals are set jointly: one main goal plus sub-goals, written so they are specific, measurable, acceptable, realistic and time-bound. [source: §4.3.3]
  • The plan records:
    • the client's view and the vaktherapist's conclusions;
    • agreement with the regiebehandelaar;
    • goals, structure and duration;
    • evaluation points and consent. [source: §4.3.4]

Step 6. Treatment.

  • The therapist picks a working method (steunend supportive, focaal focal, or inzichtgevend insight-oriented) and works in the discipline's medium. [source: §2.6.3]
  • Vaktherapie is often embedded in a wider framework such as CBT, schema therapy, MBT, psychodynamic therapy or ACT. [source: Richtlijn Depressie 2024]
  • It can act as a "trigger" or "booster" for verbal therapy, or as an "anchor" that consolidates gains. [source: Haeyen 2020]

Step 7. Evaluation, relapse prevention and closure.

  • Progress is evaluated regularly. Vaktherapie can help prevent relapse. [source: §4.3.5, §4.3.8]
  • The sections on monitoring, closure and follow-up could not be read in full. [uncertain]

Format and dose.

  • Individual sessions usually last 45–60 minutes; group sessions 60–90 minutes.
  • Most clients have 6–24 sessions, but the range runs from one session to several years.
  • Frequency is often weekly at first, then lower. The standard sets no fixed norm. [source: Zorgstandaard 2025 §4.3.5]
  • Forms: individual, group, partner/relationship and family. Children to older adults. [source: Landelijk domeinprofiel 2016; HAN 2023]
  • Example of a municipal youth contract (Eindhoven, Jeugdwet, ages 0–18): 60-minute individual or 90-minute group sessions, about weekly. Up to 15 sessions, including parent–child sessions, with one extension possible after consultation with the referrer. [source: Gemeente Eindhoven]

Moving between steps. The sources give no numeric cut-offs.

  • Move from intake to treatment once the shared decision is made and the plan is agreed and consented.
  • Use evaluation points to decide whether to continue, adjust, or switch discipline or setting. [source: Zorgstandaard 2025 §4.3.4–4.3.5]
  • In standalone youth vaktherapie, refer to basis or specialist ggz if complaints become moderate to severe or safety is at risk. The standalone indication then lapses. [source: Gemeente Eindhoven]
  • Practical rule: within a phase, move from regulation and safety to expression, then to emotion handling, then to new social behaviour, following the mechanism order in §2.5. [synthesis]

3. Guiding principles

  • Doing and experiencing first (ervaringsgericht/handelingsgericht). Build every session around an activity in the medium, not a conversation about the problem. [source: Landelijk domeinprofiel 2016; Van Hooren 2018]
  • Experience before meaning. Let the client finish the experience before you interpret; hurried interpretation buries the lived moment. [source: Haeyen 2020]
  • What and how before why (micro-analysis). Ask what happened in the material and how, and leave why questions for later. [source: Haeyen 2020]
  • Triadic relationship. Treat the material or medium as a third party in the room; much can be said through it rather than face to face. [source: Haeyen 2020]
  • Talk is supportive, not required. Use words to anchor an experience, not to replace it; some sessions can be almost wordless. [source: Van Hooren 2018; Zorgstandaard 2025 §1.1]
  • Process over product. Do not judge the artwork or performance aesthetically; what counts is what happened while making it. [source: Richtlijn ASS kinderen 2025]
  • Strengths and development (ontwikkelingsgericht, cliëntkracht). Look for what the client can do and build success experiences, not only symptom work. [source: Van Hooren 2018; Landelijk domeinprofiel 2016; Haeyen 2020]
  • Whole-person, transdiagnostic view. Choose targets by function, not by diagnosis label. The functional domains are arousal, sensorimotor, affect regulation, cognition, social processes, expression, embodiment, meaning-making and wellbeing. [source: Zorgstandaard 2025 §2.6.2]
  • Pick and state a working method. Supportive (steunend): the therapist joins in, encourages and sets limits. Focal (focaal): the therapist sets pace and themes and gives exercises. Insight-oriented (inzichtgevend): the client sets pace and themes, and the therapist may use empathic confrontation. [source: Zorgstandaard 2025 §2.6.3]
  • Shared decision-making. Agree the discipline, goals and plan with the client and, where relevant, family or parents. [source: Zorgstandaard 2025 §4.3.1]
  • Craft plus therapy. Mastery of the medium alone is not enough; "een kunstenaar is nog geen vaktherapeut" (an artist is not yet a vaktherapist; own translation). [source: Van Hooren 2018]
  • Stay inside your remit. Make only a discipline-specific analysis, recognise your limits, and consult or refer. [source: Landelijk domeinprofiel 2016; Zorgstandaard 2025 §4.2]
  • Align with the clinician in overall charge. Agree goals with the regiebehandelaar and feed observations back to the team and to verbal therapies. [source: Zorgstandaard 2025 §4.3.4; Haeyen 2020]
  • Safety and risk awareness. Keep the room safe, limit side effects and stay alert to aggression, crisis and suicidality. [source: Zorgstandaard 2025 §4.3.7; Landelijk domeinprofiel 2016]
  • Structure and predictability where needed. Fixed, predictable activity routines give safety, for example for autistic children. [source: Richtlijn ASS kinderen 2025]
  • Match the medium's intensity to the affect. Soft materials and sounds invite gentle feelings; hard ones invite intense feelings. Choose deliberately. [source: Haeyen 2020]
  • Child safety comes first. Use the meldcode for domestic violence and child abuse (meldcode huiselijk geweld en kindermishandeling) and the afwegingskader (the mandatory assessment framework) for signals of abuse. [source: FVB Meldcode]
  • Professional code. Work within the Beroepscode voor de Vaktherapeutische Beroepen. [source: Zorgstandaard 2025 §4.3.7; FVB Kwaliteit] The text of the code is not drawn on here. [uncertain]

4. Intervention inventory

The Dutch sources mostly describe vaktherapie at the level of process, working method and medium. They do not give scripted named protocols. This inventory has three parts:

  • A. Process procedures shared by all disciplines.
  • B. Cross-disciplinary werkvormen (structured exercises) that the sources describe.
  • C. The medium-specific work of each discipline as the standard and practice texts describe it.

For detailed technique in one discipline, see that discipline's own entry in this domain. Steps written as [synthesis] put source content into a usable order; they are not prescribed by the source.

A1. Vaktherapeutic intake and contra-indication check

  • Purpose / when: At the start, to judge whether vaktherapie fits, which discipline, and whether to accept the client. [source: Zorgstandaard 2025 §4.3.2, §2.3]
  • Steps:
    1. Read the referral and any existing diagnostic reports, and use them to shorten the intake.
    2. Explore the complaint, history, strengths and what the client hopes for.
    3. Check the fit criteria. Does the client find it hard to recognise or express feelings? Prefer doing to talking? Understand the problem but feel stuck? Struggle with bodily experience, contact with own feelings, self-image or social functioning? [source: §2.3]
    4. Check relative contra-indications. The standard says research on these is scarce and that they depend on setting and therapist. If vaktherapie does not fit now, consider another discipline or a later intake. [source: §2.3.1]
    5. Offer a short trial with the medium so the client experiences the way of working before deciding. [synthesis]
  • Example language (illustrative): "Here we mostly work by doing, not talking. Would you like to try ten minutes with the materials, so you can feel whether this suits you?"
  • Watch for: Acute crisis, current safety risk, or a client who refuses any non-verbal activity. Note what the client says about the trial.

A2. Observation and discipline-specific diagnosis (vakspecifieke diagnose)

  • Purpose / when: In early sessions, to see in the medium how the problem shows itself, and to set goals from that. [source: Zorgstandaard 2025 §4.2]
  • Steps:
    1. Offer open or semi-structured tasks in the medium.
    2. Observe how the client works with the material, the space, rhythm, the therapist and the group. Examples: approach and avoidance, control, tempo, endurance, spontaneity, contact.
    3. Where an instrument exists, use it as published. The standard names PsyMot (Emck & Bosscher, 2010) for psychomotor diagnostics. Van Hooren (2018) mentions BeeldWaarNeming for art work: a non-judgemental reading of a work from several themes. She also mentions Laban Movement Analysis for describing movement qualities.
    4. Summarise as a discipline-specific analysis. Do not give a psychiatric diagnosis. [source: Zorgstandaard 2025 §4.2; Landelijk domeinprofiel 2016]
  • Example language (illustrative): "What I saw today is that you started very carefully and asked often whether it was 'right'. Does that sound familiar from elsewhere?"
  • Watch for: Over-reading. Never present a drawing, play scene or movement pattern as evidence of a disorder or of abuse. [synthesis] The sources give no validity or reliability data for these observation methods. [uncertain]

A3. Shared decision on discipline, goals and plan

  • Purpose / when: Before treatment starts. [source: Zorgstandaard 2025 §4.3.1–4.3.4]
  • Steps:
    1. Explain the available disciplines in plain terms.
    2. Agree one main goal and sub-goals. Make them specific, measurable, acceptable, realistic and time-bound.
    3. Write the plan: the client's view, your conclusions, agreement with the regiebehandelaar, structure, duration, evaluation points and consent.
    4. With children, follow the consent rules in A8.
  • Example language (illustrative): "Let's make the goal concrete. In eight weeks, how would you notice that you can recognise rising tension earlier?"
  • Watch for: Goals set only by the referrer. Check the client's own words are in the plan.

A4. Choosing the working method: supportive, focal or insight-oriented

  • Purpose / when: At planning and at each evaluation. [source: Zorgstandaard 2025 §2.6.3]
  • Steps:
    1. Supportive (steunend) for fragile or low-structure clients: join in the activity, encourage, and set clear limits.
    2. Focal (focaal) for a defined complaint: set the pace and themes, and give exercises.
    3. Insight-oriented (inzichtgevend) for clients with enough ego strength: let the client lead pace and themes, and use empathic confrontation.
    4. Record the method you chose in the plan and revisit it at evaluation. [synthesis]
  • Example language (illustrative): Supportive: "I'll play along with you; tell me when it's enough." Insight-oriented: "You've stopped three times just as it got loud. What happens for you there?"
  • Watch for: Insight work with a client who destabilises under it. Step back to supportive work.

A5. The experience → reflection → transfer cycle

  • Purpose / when: The basic shape of most sessions. [source: Haeyen 2020; Landelijk domeinprofiel 2016]
  • Steps:
    1. Brief check-in and choice or offer of a task. [synthesis]
    2. Experience phase: the client works in the medium. You observe and intervene inside the activity, for example by changing the material, tempo, role or distance.
    3. Micro-analysis: ask what happened and how, before why. [source: Haeyen 2020]
    4. Meaning-making: link the experience to the goal only after it is complete.
    5. Transfer: name one thing to try outside the session, and pass what emerged to the verbal therapy or team where relevant. [source: Haeyen 2020]
  • Example language (illustrative): "Before we talk about why, what did your hands do when the clay cracked?" Then: "Where else in your week do you push on like that?"
  • Watch for: Rushing to interpretation, which flattens the experience. A working cycle shows when the client can describe their own action and choose differently in the next round.

A6. Evaluation and adjustment

  • Purpose / when: At the evaluation points set in the plan. [source: Zorgstandaard 2025 §4.3.4–4.3.5]
  • Steps:
    1. Review each goal with the client, using examples from the medium and from daily life.
    2. Agree whether to continue, adjust the working method or discipline, reduce frequency, or close.
    3. Report back to the regiebehandelaar.
    4. In time-capped youth contracts, decide any extension with the referrer. [source: Gemeente Eindhoven]
  • Example language (illustrative): "In the first sessions you stopped as soon as it got messy. Last week you kept going. What made the difference?"
  • Watch for: Evaluation reduced to "it was nice". Tie it to the agreed goals.

A7. Relapse prevention and closure

  • Purpose / when: Towards the end. [source: Zorgstandaard 2025 §4.3.8]
  • Steps (synthesis; the standard's later sections could not be read in full):
    1. Announce the end several sessions ahead.
    2. Review the body of work or the session record (artworks kept, recordings, scenes) to consolidate what changed. The standard notes that art products can be kept and revisited. [source: §2.2]
    3. Make a personal plan: early signs, and which medium-based strategies to use at home (a playlist, movement, a drawing routine).
    4. Agree what happens to artworks or recordings.
    5. Hold a closing ritual in the medium.
  • Example language (illustrative): "Let's lay out everything you've made and choose the three pieces that show the change best."
  • Watch for: Abrupt endings in groups or with attachment-sensitive clients.

A8. Children and young people: consent, assent and parent involvement

  • Purpose / when: Throughout work with anyone under 18.
  • Consent rules:
    • Under 12: parents or legal guardians are the decision partners. The child is involved as much as possible.
    • Ages 12–16: both the young person and the parents consent.
    • From 16: the young person decides alone. [source: Zorgstandaard 2025 §4.3.1]
  • Parent involvement: In youth care, parents and carers are involved, and parent–child sessions can be part of the course. [source: Gemeente Eindhoven]
  • Steps:
    1. Explain the work to parents and child separately in age-appropriate words. Record consent per the rules above.
    2. Get the child's assent in their own terms, and repeat it at the start of new kinds of activity. A child's "no" to an activity is honoured even when consent is given. [synthesis]
    3. Agree with parents and child what will be shared from sessions. Explain the limits: safety concerns are passed on.
    4. Plan parent sessions or parent–child sessions.
    5. For autistic children, use fixed, predictable activity routines. [source: Richtlijn ASS kinderen 2025]
  • Example language (illustrative, to a 7-year-old): "In this room you can play, paint or build. You choose a lot, and you can always say 'stop'. If I'm worried you're not safe, I will tell someone who can help."
  • Watch for: Parental conflict over consent, and a child who goes along silently. Both need a check before you continue.

A9. Safeguarding: the meldcode for domestic violence and child abuse

  • Purpose / when: Whenever signals of domestic violence or child abuse arise. Private-practice therapists must have a meldcode. Note that a meldcode is "iets anders dan een meldplicht" (something other than a duty to report; own translation). [source: FVB Meldcode]
  • The five steps:
    1. Map the signals.
    2. Consult a colleague, and if needed Veilig Thuis (the national advice and reporting centre) or an injury-interpretation expert.
    3. Talk with those involved.
    4. Weigh the risk using the mandatory afwegingskader for the professional cluster that includes vaktherapists. Consult Veilig Thuis if in doubt.
    5. Decide whether to arrange help, report to Veilig Thuis, or both. Since 2019, reporting and continuing help can happen together. [source: FVB Meldcode]
  • Vaktherapy specifics (synthesis):
    • Record what the child said and did factually, with dates. Store artwork or photos as part of the file.
    • Do not interpret images or play as proof. Do not ask leading questions in play.
    • Leave forensic interviewing to specialists.
    • The opened FVB page gives no guidance on interpreting creative material. [source: FVB Meldcode]
  • Example language (illustrative): "You made the doll hide under the bed. Can you tell me about that?" (open). Avoid: "Did someone hurt you?" (leading).
  • Watch for: Your own pull to rescue or to over-read. Consult early.

A10. Materials, space and physical safety

  • Purpose / when: Every session. The standard asks the therapist to keep the therapy room safe and limit side effects. Known side effects are unpleasant emotions, re-experiencing, anxiety, muscle pain, minor injuries and dizziness. [source: Zorgstandaard 2025 §4.3.7]
  • Steps (synthesis; the sources give no material-specific rules):
    1. Art materials. Use non-toxic paints and glues, especially with children. Use solvents and sprays only with ventilation, or not at all.
    2. Clay. Clean clay dust wet rather than sweeping it.
    3. Tools. For wood, metal and stone work, supervise sharp tools and give eye protection. Count tools out and back with clients at risk of self-harm.
    4. Fire and heat. No open flame. Use kilns and heat tools only by trained staff.
    5. Music. Keep volume moderate in drumming and amplified groups. Offer ear protection and agree a stop signal.
    6. Movement. Use a clear, non-slip floor with enough space per person and suitable footwear or bare feet. Warm up before vigorous work. Stop on dizziness or pain.
    7. Food. Follow food hygiene and check allergies if food is used as material.
    8. Touch. Use touch only by explicit, revocable agreement, never sexual or genital. In dance, drama and play, ask before any contact and offer a no-contact alternative.
  • Example language (illustrative): "Before we start: if you want anything to stop, the sound, the movement, someone near you, raise your hand and it stops."
  • Watch for: Dizziness, overheating and tiredness in movement. Use of sharp material for self-injury. Noise distress in clients with sensory sensitivity.

B1. Matching material or sound intensity to the affect

  • Purpose / when: To help clients find or regulate an emotion's intensity. [source: Haeyen 2020]
  • Steps:
    1. Offer a range from soft and subtle (light pink, a gentle piano) to hard and intense (bold red, a firm gong strike).
    2. Let the client choose what fits the feeling now.
    3. Then explore moving one step softer or harder. [steps 2–3: synthesis on the source idea]
  • Example language (illustrative): "Which colour is as loud as the anger right now? And which would be one notch quieter?"
  • Watch for: Escalation with hard media in clients with poor impulse control. Signs it is working: the client can move intensity up and down on purpose.

B2. Giving form to conflicting emotions, then combining them

  • Purpose / when: Ambivalence, mixed or contradictory feelings, emotion regulation work. [source: Haeyen 2020]
  • Steps:
    1. Have the client give one emotion form in the medium (image, sound, play, dance or movement).
    2. Give the opposing emotion a separate form.
    3. Then make a combined piece that holds both.
    4. Reflect on what changed when they shared space. [step order: synthesis]
  • Example language (illustrative): "Make the part of you that wants to leave, and the part that wants to stay. Now find a way for both to be on one sheet."
  • Watch for: One emotion wiping out the other. Signs it is working: the client tolerates both in one product.

B3. Guided imagery of a difficult situation, then giving it form

  • Purpose / when: To approach a difficult situation through the medium. [source: Haeyen 2020]
  • Steps:
    1. Ground the client first. [synthesis]
    2. Guide brief imagery of a difficult (not the most traumatic) situation.
    3. Have the client paint, act or voice it.
    4. Close with regulation and grounding. [synthesis]
  • Example language (illustrative): "Picture last Tuesday at the counter, only as close as feels okay. Now let your hand show it on the paper."
  • Watch for: Re-experiencing and dissociation. In trauma work, coordinate with trauma-focused treatment and keep this inside the plan. [synthesis]

B4. Inner dialogue: critical voice and compassionate voice (schema-oriented)

  • Purpose / when: Self-critical clients, for example with personality disorders. [source: Haeyen 2020]
  • Steps:
    1. First build safety with protected werkvormen. [source]
    2. Give the self-critical voice a form, such as an image, a role, a sound or a posture.
    3. Give a milder, compassionate voice a form.
    4. Stage a dialogue between them, in drama, sound or images.
    5. Practise the new response. [steps 2–5: Haeyen describes the dialogue; detailed order is synthesis]
  • Example language (illustrative): "Let the critic speak through the drum for a moment. Now, what would a kind friend play back?"
  • Watch for: The critic winning. If so, the therapist may take or strengthen the compassionate role. [synthesis]

B5. Witboek (record of positive events)

  • Purpose / when: Building self-image and noticing successes. [source: Haeyen 2020]
  • Steps: The client keeps a book recording positive events and positive feedback, and adds images or entries over sessions. [detail: synthesis]
  • Example language (illustrative): "What went well this week that deserves a page?"
  • Watch for: The client dismissing every entry. Use small, concrete wins.

B6. Success experiences and creative problem-solving

  • Purpose / when: Activation, low mood and low self-efficacy. Mood improvement through success experiences is a stated aim. [source: Richtlijn Depressie 2024; Haeyen 2020]
  • Steps (synthesis): Grade tasks so the client can succeed. Pose a concrete problem in the medium, for example how to make a structure stand or how to end a piece. Name the client's own solution.
  • Example language (illustrative): "You found a way to make it stand. How did you do that?"
  • Watch for: Tasks that are too easy and feel patronising.

B7. Breathing and relaxation within the medium

  • Purpose / when: Arousal regulation, the first-level mechanism. [source: Zorgstandaard 2025 §2.5; Haeyen 2020; Richtlijn Depressie 2024]
  • Steps (synthesis): Short guided breathing, relaxation, slow movement or calm music at the start or end. Let the client choose eyes open or closed.
  • Example language (illustrative): "Breathe out a little longer than in, a few times, at your own pace."
  • Watch for: Trauma-related discomfort with relaxation. Offer active alternatives.

C1. Art therapy (beeldende therapie)

  • Medium: Painting, drawing, modelling and clay, textile, metal, stone, wood and digital media. [source: Zorgstandaard 2025 §2.2; Richtlijn Depressie 2024]
  • Purpose: The concrete work can be kept, revisited or put aside. This lets clients look at maladaptive and adaptive patterns from a safe distance. [source: §2.2; Richtlijn Depressie 2024]
  • Named werkvormen in sources: mask-making and painting; BeeldWaarNeming (multi-theme, non-judgemental viewing of a work); 186 schema-focused werkvormen in a HAN book. That book is not drawn on. [source: Haeyen 2020; Van Hooren 2018; HAN 2023]
  • Steps (synthesis):
    1. Choose the material for its structure. Fluid materials loosen control; firm ones contain.
    2. Set the task: open, themed, or a technique.
    3. Make the work, then view it together from a distance.
    4. Describe it before interpreting it.
    5. Decide whether to keep, rework or set it aside.
  • Example language (illustrative): "Let's put it on the wall and step back. What do you see first?"
  • Watch for: Perfectionism or destroying the work. Both are material for reflection, not failure.

C2. Music therapy (muziektherapie)

  • Medium: Receptive work (listening) and active work (playing an instrument, singing, composing, improvising). [source: Zorgstandaard 2025 §2.2; Richtlijn Depressie 2024]
  • Purpose: Group music-making quickly shows interaction patterns, and alternative behaviour can be practised directly. Goals include social and communication skills, recognising emotions, confidence, relaxation and concentration. [source: Richtlijn Depressie 2024]
  • Named elements in sources:
    • personal playlists;
    • singing to quiet the mind;
    • a drum kit used to re-enact a chaotic home;
    • after a stroke with aphasia, rhythm-and-melody work built up from sounds to a short meaningful sentence. Treat this as an adjunct within rehabilitation; neurologic music therapy has its own entry. [source: Haeyen 2020; Van Hooren 2018]
  • Steps (synthesis):
    1. Offer instruments that need no skill.
    2. Set a simple frame: a pulse, turn-taking, or call and response.
    3. Vary one parameter (loud and soft, leading and following).
    4. Reflect on roles and patterns.
    5. Repeat with a chosen alternative.
  • Example language (illustrative): "This time, you lead and the group follows your tempo."
  • Watch for: Hearing levels (see A10). Music or lyrics linked to trauma. Clients who feel exposed by playing. Offer receptive work first.

C3. Drama therapy (dramatherapie)

  • Medium: Role-play, improvisation, scene-making and net alsof ("just as if") situations. Scenes can be fictional, which gives distance, or realistic, which gives recognition. [source: Zorgstandaard 2025 §2.2; Richtlijn Depressie 2024]
  • Named elements in sources:
    • Levend schilderij (living tableau): clients take up a body posture to show their feelings in a conflict, then replay the conflict with role reversal (rolwisseling). Described with a couple in which one partner is autistic. [source: Van Hooren 2018]
    • One client leads a group play that others follow, then repeats it. [source: Haeyen 2020]
  • Steps (synthesis):
    1. Warm up.
    2. Choose the distance level: fiction or realistic.
    3. Set roles and a clear stage area.
    4. Play.
    5. De-role explicitly by leaving the stage area, saying one's own name and shaking out.
    6. Reflect.
    7. Replay with an alternative.
  • Example language (illustrative): "Freeze in a pose that shows how the argument feels. Now swap places and take your partner's pose."
  • Watch for: Over-involvement in a role, and residue after the session. Screen group members, pace exposure and always close with de-roling. [synthesis]

C4. Dance and movement therapy (dans- en bewegingstherapie)

  • Medium: Spontaneous and shared movement, improvisation, composition, play, synchronisation, relaxation, breathing and metaphor. [source: Zorgstandaard 2025 §2.2; Richtlijn Depressie 2024]
  • Purpose: Integrating emotional, social, cognitive and physical processes through the body. [source: Richtlijn Depressie 2024] Movement quality affects emotion; for example, round, light, upward movements went with more positive affect than angular, heavy, downward ones in studies the author cites. [source: Van Hooren 2018] Laban Movement Analysis is used to describe movement qualities. [source: Van Hooren 2018]
  • Steps (synthesis):
    1. Warm up.
    2. Explore one movement quality.
    3. Contrast it with its opposite.
    4. Synchronise or mirror in pairs or the group, with consent and a no-contact option.
    5. Compose a short sequence.
    6. Reflect on how it felt.
  • Example language (illustrative): "Try the same walk, but light and upward. What changes inside?"
  • Watch for: Falls, space and dizziness (see A10). Touch only with explicit, revocable agreement. Body-image distress.

C5. Play therapy (speltherapie)

  • Medium: Play as the main channel of communication, with figures, water and sand. The child's environment is sometimes included. [source: Zorgstandaard 2025 §2.2] Play keeps the situation recognisable while softening its sharp emotional edges. [source: Van Hooren 2018]
  • Steps (synthesis):
    1. Set up a consistent playroom.
    2. State simple limits: safety for the child, the therapist and the room.
    3. Follow the child's play, reflecting what you see.
    4. Hold parent sessions in parallel (see A8).
    5. Use the meldcode route for any signals (A9).
  • Example language (illustrative): "The dinosaur is very angry today. Everything is getting knocked over."
  • Watch for: Reading play as forensic evidence (see A9). Play therapy is practised by NVVS-affiliated play therapists; use the NVVS standards for its methods. [source: Gemeente Eindhoven; methods: uncertain]

C6. Psychomotor therapy (PMT) and psychomotor child therapy (PMKT): pointer

PMT combines movement activities from sport and physical education with body-oriented techniques: relaxation, breathing, sensory awareness and impulse regulation. It works in three modes: practising, experiencing and discovering. PMKT is the child-specific discipline, using movement, body-oriented play, drawing, talking and music. PsyMot is named as a diagnostic instrument. In one PMT exercise, clients lay ropes as "paths" and negotiate where the paths meet. [source: Zorgstandaard 2025 §2.2; Richtlijn Depressie 2024; Haeyen 2020] Full procedures are in the Domain IV psychomotor therapy entry.

5. Handling problems

The Dutch sources name a few difficulties: confrontation, temporary worsening, disappointment, overwhelm and side effects. Most responses below are my own [synthesis] unless a source is tagged.

  • Temporary worsening. As awareness grows, negative emotions can first get stronger, and clients may say they cannot do it. [source: Haeyen 2020]
    • Predict this at the start.
    • Normalise it when it comes.
    • Shift to the supportive working method for a while.
    • Check it against the goals at the next evaluation. [synthesis]
  • Disappointment when a strategy fails. Respond with compassion, not self-criticism. [source: Haeyen 2020]
    • Name the attempt as data, not failure.
    • Try a smaller or different form.
    • Illustrative: "That didn't calm you. Good to know. Let's try the opposite: louder first, then softer."
  • Overwhelm and fear of being flooded. Clients who fear flooding need safe, sheltered structure. [source: Haeyen 2020] Side effects include re-experiencing and anxiety. [source: Zorgstandaard 2025 §4.3.7]
    • Lower intensity: firmer materials, a smaller format, fiction instead of real scenes, receptive instead of active music.
    • Add grounding (B7).
    • Shorten the experience phase.
    • Agree a stop signal.
    • After an episode, inform the regiebehandelaar. [synthesis]
  • Clients who find the work too confronting. Some clients experience vaktherapie as confronting. [source: Zorgstandaard 2025 §3; Haeyen 2020]
    • Increase distance through metaphor, objects or working side by side.
    • Offer a choice of medium.
    • Consider switching discipline. The standard offers another discipline as an alternative. [source: §2.3.1]
  • "I can't draw / sing / dance" (performance anxiety). Restate process over product. [source: Richtlijn ASS kinderen 2025]
    • Start with tasks that cannot be done "wrong": scribbles, one note, walking.
    • The therapist can join in (supportive method). [synthesis]
  • Over-verbalising or intellectualising clients. The domain profile names overly verbal clients as an indication. [source: Landelijk domeinprofiel 2016]
    • Hold back reflection until after the activity.
    • Ask what and how, not why. [source: Haeyen 2020]
    • Use timed, wordless phases. [synthesis]
  • Stuck or flat sessions. [synthesis]
    • Change one parameter: material, tempo, space, role, or group versus solo.
    • Re-check that the goal is the client's own.
    • Consider whether the working method fits. For example, move from insight-oriented to focal with concrete exercises.
  • Non-attendance and non-adherence to home practice. [synthesis]
    • Shrink transfer tasks to one small medium-based action.
    • Review barriers.
    • In capped youth contracts, decide with the referrer before the session limit is reached. [source: Gemeente Eindhoven]
  • Ruptures. [synthesis] Typical triggers are a comment on the work felt as judgement, an exercise felt as forced, or an unwanted touch or closeness.
    • Name the moment.
    • Take responsibility for your part.
    • Ask what would have been better, and return choice to the client.
    • Illustrative: "When I asked you to show it to the group, you went quiet. I think I pushed too fast. What would have helped?"
  • Destruction of artwork, instruments or space. [synthesis]
    • Set limits in advance.
    • Treat controlled destruction (tearing paper you have offered) differently from loss of control.
    • If aggression rises, stop the activity, make space and follow the setting's aggression protocol. Safety risks are a reason to refer on. [source: Landelijk domeinprofiel 2016; Gemeente Eindhoven]
  • Self-harm with materials, or suicidality. [synthesis]
    • Remove or count sharp tools, cords and glass for at-risk clients.
    • If a client discloses suicidal thoughts or self-harm, follow standard risk assessment and the setting's protocol.
    • Inform the regiebehandelaar the same day.
    • The standard names suicidality as a risk area but gives no vaktherapy-specific protocol. [source: Landelijk domeinprofiel 2016; Haeyen 2020]
  • Dissociation in body, movement or imagery work. [synthesis]
    • Open the eyes and orient to the room. Use sensory grounding with materials (cold clay, a textured object).
    • Slow down and reduce intensity.
    • Coordinate with any trauma-focused treatment.
  • Group difficulties: dominance, withdrawal, conflict. [synthesis]
    • Use the medium to restructure roles: turn-taking, a different leader, pairs.
    • Name the pattern as a here-and-now phenomenon, since group music-making shows interaction patterns quickly. [source: Richtlijn Depressie 2024]
    • Use the pattern itself as the next exercise.
  • Children: parental conflict or unclear consent. Check consent per age (A8). [source: Zorgstandaard 2025 §4.3.1] Then:
    • Pause new activity types until consent is clear.
    • Keep separate parent contact.
    • If safety concerns arise, follow the meldcode (A9) rather than mediating alone. [synthesis]
  • Requests to interpret a child's drawing or play as proof (from parents, school or court). [synthesis]
    • Decline diagnostic or forensic conclusions.
    • Report factual observations only.
    • Refer to specialised assessment.
  • Scope creep in standalone youth vaktherapie. If complaints become moderate to severe or safety is at risk, refer to basis or specialist ggz. [source: Gemeente Eindhoven]
  • Lack of fit with the client's language or culture. [synthesis]
    • Ask which art forms, music or movement are meaningful or off-limits for the client.
    • Avoid using sacred or ceremonial practices as techniques.
    • Remember that some movement, touch or mixed-gender group work may conflict with the client's norms.
  • Clients with a mild intellectual disability. Put less weight on cognitive insight. Give more direct feedback linking regulating behaviour to its consequences. [source: Haeyen 2020]

Sources

Sources:

Pages tried but not readable: the FVB news item on the revised Beroepscode (blocked); the psychotrauma zorgstandaard's vaktherapie page (no body text returned).

Further reading (not drawn on), cited inside the sources: Emck & Bosscher (2010), PsyMot [uncertain]; Haeyen's book of 186 schema-focused werkvormen [title and year not verified: uncertain]; the Beroepscode voor de Vaktherapeutische Beroepen and the Richtlijnen voor de Vrijgevestigde Vaktherapeut (FVB) [text: uncertain].

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