The Doll Therapy Debate

Members article

By Jane Verity ©dementiacareinternational.com

Despite Doll Therapy being utilised for many years, the debate on using dolls in dementia care can still provoke strong  responses in aged care facilities. This editorial aims to explain the two opposing views and demonstrate how dolls can be used for their symbolic significance with positive outcomes.

Those who support the use of doll therapy are likely to have had positive, personal experiences that dolls have strong symbolic meaning and provide purpose, nurture and healing for people with dementia. These staff members are likely to be passionate about these outcomes and fight for doll therapy to be an integral part of any therapy program.

Those who doubt the benefits of doll therapy may have thoughts such as, ‘I’d rather die than imagine myself as an old person in a nursing home, walking around with a doll.’  There is genuine concern that introducing dolls will be seen as childish, demeaning, and patronising so they ensure dolls are not permitted in their facility.

Undoubtably these carers want the best for people with dementia and respect and dignity are high on their agenda. They assess whether doll therapy is acceptable or not in a logical and rational way by interpreting how they themselves would feel.

This same logical, rational thinking is still active in most people in the early stages of dementia. When they say something like, Look at that silly old fool sitting with her doll. That shouldn’t be allowed’ many carers may feel their point of view has been validated.

However there is a distinct difference in the way a person who has moved beyond the early stages of dementia thinks. They may have lost some of their memory, logical and rational thinking as well as their social inhibitions. The beliefs and values they used to uphold are no longer important  and all that matters is that they live in the moment.

When caring for a person in the later stages of dementia consider a change of thinking from, ‘How will the person respond to this activity?’ to ‘What activity will this person respond to?’ When deciding if doll therapy is appropriate, seek direct input from the person with dementia. Let them demonstrate whether or not they will enjoy a particular activity. People with dementia will give immediate feedback on what you do and say. It is possible to either rekindle the spark or extinguish it so focus attention on their eyes for a genuine indicator and response.

Ask yourself, ‘If the person with dementia smiles, claps hands, sings, dances or in any way shows delight, such as speaking in a gentle, loving tone when they have a doll in their arms – how can we say the activity is not acceptable? How loud does the person with dementia have to ‘speak?’

Symbols

The use of symbols has always been an integral part of all cultures and dolls are no exception. These include the Russian ‘Matryoshka’ Nesting Dolls and the ‘Worry Dolls’ from Guatemala.

‘Matryoshka’ is a symbolic name used to describe brightly painted Russian wooden dolls with smaller dolls stacked inside. The word ‘Matryoshka’ derives from the Latin root ‘mater’, which means ‘mother’. A mother doll with numerous doll-children perfectly expresses the oldest symbol of human culture.

There is a legend amongst the highland Indian villages of Guatemala that says before going to bed, tell one worry to each symbolic Worry doll, then place them beneath your pillow. Whilst you sleep, the dolls will take your worries away.

When a child plays with a doll it acts as a symbolic representation for a real child. Through the doll the child learns to develop nurture, love and parenting skills. When an old person who has dementia takes a doll in their arms and lovingly talks, nurses, kisses, feeds, washes, dresses, tells stories and sings to it, the doll has again taken on a symbolic meaning.

Spark of Life 5 Emotional Needs

The five most significant emotional needs often unfulfilled in people with dementia are:

  1. To be needed and useful
  2. To have opportunity to care
  3. To love and be loved
  4. To have self-esteem boosted
  5. To have the power to choose

When these needs are not fulfilled in this reality they tend to go back in their memories and recreate significant people, places, objects or situations where those needs were fulfilled.

Eva’s Story

Eva stands at the door, vigorously shaking the door handle yelling,  ‘Let me out, I want to go home. My babies are crying.’ Eva feels isolated because she is no longer involved in meaningful activity so she recreates a time when she was a mother taking care of her children. She is longing to feel needed and useful, to still be able to care, to have her self esteem boosted and to give and receive love.

Freud spoke about the Eternal Eros – the ever constant love – innate in us all, and the ability to naturally display this nurturing love. Many women with dementia may return to this emotional state and some men may discover for the first time. The need exists  but what is  missing is a natural way to express and fulfil it. This is where a doll with its powerful symbolic significance can be of positive value.

Jean’s Story

A very active and helpful member of her nursing home, Jean kept busy by constantly ‘looking after’ the other residents; moving them in and out of their chairs, attempting to feed and help them get dressed. She was often restless and would get up and wander in and out of other resident’s rooms. Many different approaches had been attempted to curb Jean’s helpfulness, but nothing worked until her daughter brought in a doll just like a 6-month-old baby.

Jean’s whole face lit up. She took the doll in her arms and lovingly cuddled it into her shoulder, whispering, ‘You are my little darling – you are so beautiful. I love you.’ She turned the doll around and held it out for everyone to see and proudly said, ‘Isn’t she beautiful – such sparkly blue eyes and happy smile?

Jean knew she was holding a doll but it had taken on the role of a baby and became an integral part of her life. She would talk to  and cuddle it; check its clothes; take it on outings; and have it tucked into bed with her at night. The doll enabled Jean to feel needed, to have someone to care for and share her love with. Her need to ‘look after’ the other residents shifted to the doll.

Eric’s Story

The need to resolve unfinished business and conflict are important issues for many people with dementia. This real life story about the symbolic power of a doll helping the process of emotional healing was experienced by Heather Kobiolke, an outstanding reminiscence therapist in Victoria.

Eric was shown a doll dressed exactly how a baby would have been dressed when he was a young man. He reached for the doll, sat it on his lap and started talking to it, calling it by name.

In time, Eric began apologising to the doll, ‘I am so sorry that I didn’t have more time for you when you were a little girl.’  His daughter who was sitting next to him had tears  running down her cheeks. Eric did not recognise her as grown up because of his dementia, but through the doll he was able to apologise.

The doll enabled both Eric and his daughter to experience a deep emotional healing that may not have been possible without the interaction with the doll.

This story demonstrates the deep symbolic impact and healing power dolls can have on people with dementia and highlights that dolls are beneficial for both men and women.

Doll Therapy offers many and varied benefits that reach beyond providing the purpose and healing described. Doll Therapy can  improve the overall wellbeing of people with dementia as described below:

Benefits of doll therapy for the person with dementia

  • Speaking directly to a doll enables words to flow easily and often surprisingly correct sentence structure.
  • Providing care becomes an absorbing, enjoyable and stimulating activity that utilises past learned skills.
  • Dolls stimulate memories and provide an opportunity to reminisce.
  • Dolls can bring loved and missed ones ‘alive.’ They can represent children, parents, siblings and other significant people.
  • Provide opportunities for nurturing, boosting self-esteem, friendship and touch.
  • Reduce agitation, anxiety, feelings of loss and insecurity.
  • Pushing a pram or stroller can create a meaningful reason to walk, which improves mobility and pace.
  • May reduce psychotropic medication for behaviour modification.
Benefits of Doll Therapy for an Aged Care Facility

The following benefits need to be read as an extra bonus not as an aim in themselves. The primary reason for introducing Doll Therapy is always for the wellbeing of the person with dementia.

  • Open doors to communication between staff and residents.
  • Be a powerful cost effective way of dissolving challenging behaviour.
  • Provide solutions when nothing else works.
  • Aid peaceful nights.
  • May reduce psychotropic medication for behaviour modification.
Benefits of Doll Therapy for Relatives
  • The doll’s presence engages everyone and communication becomes easier during visits.
  • Accepting the doll as part of the ‘family’ enables everyone to be involved in its care.
  • May develop communication and intimacy in relationships.
  • May reduce psychotropic medication for behaviour modification.
Choosing the Right Doll

Lee Middleton Original Dolls elicit a compassionate response in everyone involved. Everyone instantly wants to pick up these babies and give them a comfort pat on the bottom. It was a Lee Middleton Original Doll that Jean’s daughter gave to her mum. (refer earlier story in this article.)

What makes these types of dolls so special is their life-like look and feel. They are weighted as a 6-month-old baby, with floppy heads and soft cuddly bodies. They sit up like a baby and their  hands and feet have been sculpted with close attention to detail.

These doll babies come with many variations of facial features, hair and colouring. We recommend one with a happy face, whose eyes are open and sparkly and the mouth is happy and sends a beaming smile. A smiling face can be important for a person with dementia as they are often surrounded by frowns and disapproving faces. A smiley, happy doll brings out the best in a person with dementia.

When using sleeping dolls, be careful to match them carefully with the person who has dementia. In some cases they can cause distress if the person is concerned that they can’t wake the doll and may therefore think it has died.

The need to have in place a Doll Therapy Policy as well as a training program is vital to the success of any doll therapy program. The winner of  any debate over the use of doll therapy should be the person with dementia.

Further Reading