Ann Fretwell and David Sheard of Dementia Care Matters, first introduced the dolls at Merevale House in Warwickshire as a complementary therapy to promote feeling of well being for some people who appeared agitated and unsettled.
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When I first started working there, I was surprised to see several of the residents carrying dolls. My previous training had taught me that giving an Individual with Dementia a doll was childish, patronising and demeaning - the opposite of our aim to treat each individual with the respect they deserved.
However, after spending only a coupe of hours at Merevale, I saw that the residents did not discard the dolls, as I thought they would, but openly accepted them. During my first day I noticed one of the residents searching for something. I followed her into another room (a makeshift 'nursery') where she discovered a doll lying in a cot. She went over to it, picked it up, cuddled it, kissed it and her face lit up with joy. Her positive reaction made me realise that this lady did not feel patronised. Instead she was receiving a great deal of joy and comfort from this doll. In this article I aim to explore the use of dolls with people who have dementia and try to discover why dolls seem to be beneficial for some individuals.
Positive Changes
Since introducing dolls to Merevale House we have come to believe that they do indeed have great benefits for certain individuals. Relatives and staff report changes in some residents' behaviour - for example a reduction in agitation, aggression and wandering. The dolls have also stimulated increased interaction between the relatives, staff and the individual with Dementia. Staff and the individual talk about the doll, about what clothes the doll should wear, and help fold the clothes.
A number of residents, both male and female, have accepted the dolls. Some are clearly aware that the dolls are dolls, but still value them. Other residents seem to believe the dolls are real babies, referring to their chosen doll as their 'baby' or calling it by the name of one of their children. We have witnessed residents feeding the dolls, dressing them and washing them. Such interactions have led us to the conclusion that these individuals do not find dolls childish, so why should we?
Multiple Roles
One interesting factor we have observed is that the doll can play a number of roles to the resident, nit just as baby. Dolls are also referred to as husbands, wives, teachers or other significant figures in the resident's life. This is where background knowledge about the resident becomes so valuable in enabling us to understand the possible role a doll fulfill.
Staff Reactions
Another interesting occurrence observed is the way staff and relatives interact with the dolls. We have seen staff patting the dolls' bottoms and rocking them; staff regularly refer to the dolls as babies, even when they are away from residents. Such acceptance by staff of the resident's beliefs about their doll has clearly been beneficial. We believe that dolls may meet a number of needs experienced by the individual with dementia.
The Need to Communicate Underlying Emotions
We have observed that people often use the dolls as a tool to explain to us how they are feeling. Individuals will often transfer their emotional state onto the doll. One lady at Merevale will occasionally claim that her baby is upset; we have taken this as acknowledgment of her own feelings and therefore we try and comfort her.
The key, we believe, lies in the doll's ability to unlock emotions; this then allows emotional floodgates to open and repressed emotions to flow.
The Need for Attachment
According to the psychologist Bowlby, (1951) the need for attachment to others is just as important to human development as vitamins. We all have a need for attachment and just because an individual develops dementia does not mean that this need suddenly disappears. In fact having dementia may increase this need for security and comfort. Having dementia and living in a home must be very stressful -not knowing you are, where your family are and not recognising the faces around you.
Individuals with dementia often exhibit so-called 'attachment behaviours' - for example holding a blanket or slipper, or constantly searching for a deceased parent or spouse. Dolls may help meet these attachment needs, by providing a sense of comfort and security.
The Need for Play
A doll can be a form of play for an individual with dementia. Most people suppress this need as they enter adulthood, due to the expectations of society. The need is still there. However, and may resurface as social inhibitions breakdown due to the progress of dementia.
Just as happens with children, the need for play may arise due to problems in verbal communication. As Erikson claimed: 'The chid uses play to make up for their defeats, sufferings and frustrations, especially those resulting from a technically and culturally limited use of language.' (Erikson 1968).
The same process could well apply to individuals with dementia. At Merevale we believe that play is something that we all do, whether we are aware of it or not. Play is a way we can a\t out a situation in our own minds or externally. Such actions may become prominent in times of psychological crisis, such as having dementia, as a way of working through unresolved conflicts. Dolls may help in this process.
The Need for a Sense of Purpose or Role
When asked to describe ourselves, most of us do so with reference to our work or our role as a parent. These roles are the building blocks of who we are and how we see ourselves. An individual with dementia may still have this need for a role to give them a sense of purpose, a sense of usefulness. Looking after the doll can make a person feel useful again.
Many of our residents were housewives and due to the effects of dementia many of them believe they are at the stage in their life when they had young children. Therefore having a doll can fulfill this maternal (or paternal) hunger. Having a doll can also rekindle all sorts of positive memories and emotions of loving and being loved and needed.
Some Suggestions for Success
Since the introduction of dolls to Merevale, a number of units have tried to introduce them. Some units have met with great success; others have not. We believe there are a number of points:
Staff need to be aware that dolls are not a cure. The individual will not suddenly transform into their previous self with the introduction of a doll.
Dolls must not be forced upon the individuals with dementia. Merevale has found that it is much better to create a 'nursery' area where dolls can be placed and collected by the person rather than giving them doll directly. Some people will ask for their doll, in which case staff will collect it for them.
Not everyone with dementia will like or want a doll. We must be aware that people with dementia are individuals and if they did not like babies or dolls before the illness, they probably will not now!
Staff need to be aware of some potential problems relating to the use of dolls. For instance one individual at Merevale became very distressed after being given the doll. A staff member spent some time with this lady and discovered she thought the doll had died because she could not wake it up'. The doll she had been given was one with its eyes permanently closed; giving her a doll with eyes that opened solved the problem.
A further issue was highlighted when a daughter bought her mother a very lifelike doll for Christmas. This doll 'cried' as a baby would when needing to be fed or changed - but the crying caused the resident great distress. Removing the doll's batteries solved this problem.
These examples illustrate problems that may occur, and the need for a practical problem solving approach.
Validating Perceptions and Feelings
A vital part of maintaining the use of dolls is the need for staff to validate resident's perceptions. For instance, a resident who believes a doll is really a baby should not have the belief challenged; instead their feeling associated with the doll should be supported. More harm can be done if the resident who believes the doll is their child is told that it is not, as you can imagine.
When dolls were first introduced to Merevale staff greeted them with scepticism similar to my own. However once they had seen residents' positive reactions, and received training to explain the reason why dolls s might be beneficial, such scepticism diminished.
Finally we have found that relatives/carers need to be informed about the dolls. As with staff, we found that some relatives were sceptical at first, but this later declined. Indeed many relatives have brought in new dolls, dolls clothes, rattles and even a cot and pram. Relatives have also reported to us that the doll has provided a new source of communication.
What Do People With Dementia Feel About the Dolls?
A number of the individuals who live at Merevale were asked about what they thought about the dolls: Here are some of their replies.
•  'It's King.'
•  'It's a great comfort to me.'
•  'I've seen one over there and it works'
•  It's like a gold medal and it's mine.'
Much more Good than Harm
A number of people have commented that dolls do nothing to make people with dementia more able to do things and fit into our world, but this is not the aim at Merevale. Our goal is to make our residents feel better rather than do better. What is most important to us is their comfort, contentment and well-being. My experience of working at Merevale House is that the dolls do so much more good than they do harm, and if the individuals with dementia do not find them demeaning, why should we?
The benefit of dolls was brought home to me by one particular lady who lived at Merevale. She became very attached to her doll, to the point where held onto it through her last few days. The lady's daughter, who understood the strength of her mother's bond asked for it to be buried with her mother. To this lady and her family the doll was so much more than a piece of plastic.
I would like to thank Anne Fretwell and David Sheard and Dementia Care Matters for their help in preparing this article.
This article was published in The Journal of Dementia Care, Vol 9 No.6 2001
Journal of Dementia Care Website: http://www.careinfo.org.uk/dementiacare/
References
Bowlby J (1951) Maternal Care and Mental Health. World health organisation, Geneva.
Erikson EH (1968) Identity: Youth and Crisis. Norton , New York
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Dolls in Dementia Care - By Bertha Scott
With reference to the article e 'It's like a gold medal and it's mine - Dolls in Dementia Care (JDC Nov/Dec 2001 pp20-22), I would like to share with readers how the information helped me to assist one of my clients Mrs. P, who is in her early 70s and suffers from Alzheimer's Disease.
Mrs. P has been a carer for most of her adult life. She has cared for and still does to a degree, her 32-year-old son who has Down's syndrome and lives at home. Mrs. P also cared for her elderly father until his death a few years ago. Her husband has also needed care following his diagnosis of multiple sclerosis about seven years ago.
Mrs. P's ability to care for her husband and son has gradually decreased during the last five years since she was diagnosed with Alzheimer's Disease. She herself needs help with all aspects of her personal care but remains at home and believes she is the main carer to her family.
The domicillary carers help her to carry out minor caring tasks with her son. Her husband and son often become impatient with her inappropriate attempts to help them. Her husband is beginning to get extremely frustrated at his wife's declining cognitive impairment, and intolerant of her affection.
While visiting the family one evening, I noticed Mrs. P hugging and talking to a large ornamental bronze dog by their fireplace. He husband said she had been doing this for several days - he was unable to understand her behaviour. By coincidence I read your article the day before; I discussed it with Mr. P, who rather skeptical.
However he understood that his wife needed to express her caring, loving feelings freely and with being reprimanded for doing things wrong. I gave the family and other carers involved a copy of the article.
For Christmas, Mrs. P was given a long-legged cuddly teddy bear. She loves it, and takes it with her everywhere in the house. She enjoys the touch of it's soft fur against her face. She does not refer to it as either her son or her husband but calls it my 'darling'. I think this teddy helps to meet Mrs. P's needs to be a carer and have a role.
Mrs. P seems to receive joy and comfort from the bear, and her positive reaction is now beginning to b respected by her family and carers. They all seem to be less sceptical and more understanding of the therapeutic effect on Mrs. P and the way it enhances hew well-being. However her husband still gets annoyed when she tries to feed the teddy!
Bertha Scott, social worker, East Anglia.
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Dementia Care Matters Ltd, 29 Bloomsbury Place, Brighton, East Sussex BN2 1DBÂ Â
www.dementiacarematters.com
E-mail: info@dementiacarematters.com
Tel & Fax: 01273 242335 Reg No: 0391640
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Robin VanHyning, RN, BSN says: | 2011-03-25 17:38:34 |
| See YouTube clip for my response to this topic: http://www.youtube.com/watch?v=Pp8aKaWN7EI | ||
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Alz Library says: | 2011-03-29 14:52:21 |
| Just in case readers fail to notice your comment, we''ve added your video to the library. It is delightful ... and says it all. | ||
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margaret says: | 2012-05-27 04:03:32 |
| I have introduced doll therapy in the facility I work at and it is just amazing how it changes the residents life..just as you say in your facility some staff take awhile to see the positives but it does work..keep up your good work in making there peoples lives better | ||
Comments: 3