The Therapeutic use of Doll Therapy in Dementia Care
On numerous occasions, whilst visiting the houses that provide care and support to people with dementia, I come across ladies who carry with them dolls or cuddly toys. At first sight, one might think this behaviour to be childlike, a return to infantilism or even totally and completely age inappropriate. But is it right to think that way?
I have spent some time watching the interaction between the person and doll or cuddly toy. My observations have taught me that this is not just an inanimate object to a particular person. For example, you canít simply take it away and replace it with something else like a box, as to do so leads to distress and agitation within that person.
The doll or cuddly toy has meaning for that person. The true meaning is unique and individual to each person, but meaning it has.This is a very important factor to consider when thinking about any kind of therapy.
In this article, I aim to describe the possible benefits of doll therapy Ė I do this by considering the principles in relation to person focused and person centred care. It is then left for the reader to determine whether or not Doll Therapy is of benefit to particular individuals living in the house.
All care provided must be person focused. We must focus on the person with dementia, not their diseased brain; on their emotions and understandings, not memory losses; on the person within the context of a marriage or a family and finally within a wider society and its values(Understanding Dementia, the Man with the Worried Eyes, Cheston and Bender, 2003).
We must therefore consider the personality and character of the individual in relation to their life and the stories that are contained within that personís life. If we do this, we may discover a tragic loss of a baby or very young child. The person may then find comfort in the doll or cuddly toy as it is symbolic of that loss. Perhaps, in the reality of that person Ė and it is that personís reality that matters - the object of loss has been rediscovered. Therefore, the symbolic representation helps the individual to meet a very important emotional need.
All care provided must be person centred. We must provide support that aims to maintain abilities. This means we need to maximise personal control: believing the person has the right to opportunities to use whatever abilities they retain; enable choice: actively encourage communication and expression of individuality; respect dignity: recognise that self-worth and self-esteem are part of overall health and wellbeing; preserve continuity: remember that the person has a past, present and future; promote equity: create opportunities that are non-ageist and non-discriminatory (Dementia Care A Professional Handbook, Second edition, Alan Chapman, Donna Gilmour and Iain McIntosh, 2001)
There are countless clinical anecdotes of residents who appear to get very distressed at times and relate stories of having lost their little one. Very often, they start to seek this little one and, understandably, grow distressed when they are unable to locate the baby or infant.
Much of the time, we are providing residential and nursing care to elderly ladies who lived their younger years during times of very high infant mortality rates, so the above scenario is understandable.
If we can use doll therapy to assist people during times of distress and agitation, then clearly we are able to rely less on pharmacological interventions. We will be supporting people in the use of any abilities they retain to manage those inner feelings of distress; we will be enhancing the personís communication strategies to express their individuality; we will clearly be respecting their dignity; we will be expressing empathy by demonstrating that we are aware of a personís past.
Attachment is vital for people with dementia living in long-term care. According to Bowlby (1951), the need for attachment to others is as important to human development as vitamins. Having dementia may increase this need for security and comfort. Attachment behaviour can often be observed, for example, constant searching for deceased relatives or holding/carrying an inanimate object such as a slipper.
Itís like a gold medal and itís mine Ė Dolls in Dementia Care (JDC Nov/Dec 2001 pp 20-22, David Moore) is an article that describes Doll Therapy as a very useful approach.
The Methodological Aspects of Doll Therapy:
There are two key ways in which Doll Therapy can be applied.
The first is to set up a kind of nursery in the house. Residents are then able to go and pick up a doll whenever they choose to do so.
The second approach is to leave a number of dolls around the house so that people can simply pick them up whenever they feel the need.
If you consider using doll therapy, be aware that dolls are not a cure and they must not be forced upon residents. Do your research Ė obtain as full a life story as possible and involve relatives where they are involved with the care of the resident.
David Mooreís article identifies some potential difficulties with the use of dolls. He cites an example where one person became very distressed after being given a doll. It became apparent that she thought the doll had died because she could not wake it up. This particular doll was the type whose eyes are permanently closed; offering her a doll with eyes that opened resolved the problem. Best practice must always be considered.
Those familiar with my clinical practices are well aware that I attach a great deal of importance to both the humanistic and mechanistic aspects of the life and care of people living in our houses. To that end, I promote the use of humanistic therapies, and it is my belief that doll therapy has a very valuable role in the care of some of our residents.