Doll therapy

Doll therapy is a practice used for patients with dementia. The patients are provided with dolls that they play with and care for, changing their clothes and talking or singing to them. Patients who are aggressive, anxious, or agitated often become calm while caring for the dolls. Sometimes caregivers use dolls to help patients talk about their own children or grandchildren. Caregivers are often unsure whether the patients believe they are caring for human babies or if they understand they are playing with dolls. However, caretakers should respond to the doll in the way the patient does.

Despite the obvious benefits to patients, doll therapy is controversial. Some critics call doll therapy, which is also known as child representation therapy or nurture therapy, demeaning. Many insist the practice infantilizes elderly patients. Proponents say patients are happier and more engaged when they participate in doll therapy, and the practice often helps patients avoid pharmaceutical treatment.

Background

British developmental psychologist and psychiatrist John Bowlby developed attachment theory during the 1940s in the United Kingdom. This theory states that very young children have a strong need to develop a close emotional relationship with a caregiver, ideally a parent. His research looked at strong and weak emotional bonds between children and their mothers. Bowlby looked at the effects of separation from their primary caregivers on young children. His work emphasized the importance of consistency and loving maternal care in healthy development of young children. He published his attachment theory in his three-volume work, Attachment and Loss, between 1969 and 1980.

During the 1950s, British psychoanalyst and pediatrician Donald Winnicott developed his theories about transitional objects. These are items, usually a soft cloth or plush toy, that infants become attached to. They often soothe themselves by stroking or sucking on these special objects as a substitute for their mothers soothing them. According to Winnicott’s theory, children use transitional objects to move from relying on their caregivers to comfort them, to learning to use a transitional object for comfort, and eventually abandoning the transitional object when they can soothe themselves.

Clinical psychogerontologist Bére Miesen applied attachment theory to people with dementia in the 1990s. His research found that many dementia patients at some stage of the disease experience parent fixation, or the belief their deceased parents are alive. Miesen found that such patients often felt insecure.

The first empirical evidence of doll therapy benefits was developed in the United Kingdom. One study offered thirty soft toys to dementia patients at a care home. Half were teddy bears, while the other fifteen were dolls. Researchers found that 93 percent of the patients preferred the doll, and most of the patients were less anxious when they had the dolls.

A 2006 study provided dolls to residents in two care homes over a period of three weeks. The majority of care home staff reported the residents seemed much better after doll therapy. About a third of staff reported the residents had some conflicts because they laid claim to specific dolls.

Various types of dolls have been used for doll therapy studies. Some are vaguely human, others are weighted to feel like babies and have eyes that open and close. Some experimental models can change their features to present various emotions. Many care homes provide cribs, changes of clothes, and other objects individuals may use in attending to the dolls.

Overview

Therapy dolls have been prescribed for people experiencing a number of mental health issues, including anxiety and depression. The dolls serve the same function that a stuffed animal might provide for a child—it provides a sense of comfort and well-being. Doll therapy in such cases should be used with care, and for a limited time. An individual being treated for anxiety disorder, for example, might find a doll comforting. However, the practitioner must also address the patient’s anxiety and help the individual learn coping skills. Relying too heavily on the doll to relieve feelings of anxiety does not help the patient overcome his or her problems.

Doll therapy is most commonly used for patients with dementia. Between 60 and 90 percent of patients with dementia exhibit distress. In some cases, patients are treated with medication to help them remain calm. Several types of therapy have been developed that help to relieve distress. Some of these are reminiscence therapy, reality orientation, aromatherapy, and music therapy. Doll therapy is an intervention to which many patients readily take, particularly during the middle or late stages of dementia. While more women than men seem interested in doll therapy, many men have benefited as well.

Doll therapy relieves the boredom many dementia patients experience. Those in care facilities are often restricted in their movements—for example, they may be limited to one floor. Boredom can lead to depression or agitation. Doll therapy offers opportunities for engagement. Some patients interact with the dolls as if they are children, changing them, talking to them, and singing lullabyes. At time therapists or visitors may use the dolls to begin conversations about patients’ children or grandchildren. Patients who benefit from doll therapy are generally calmer, less aggressive, and less prone to wandering.

Some care home staff and family members, as well as practitioners, object to doll therapy. They say giving adults baby dolls is demeaning. Some researchers say doll therapy brings up ethical considerations, in particular the concept of malignant social psychology. This refers to a social environment in which interactions reduce the personhood of patients, though this is not necessarily the intent. For example, examples of malignant social psychology include infantilization, mockery, and disempowerment of patients; positive elements of care include play, creation, and relaxation. Depending on one’s perspective, doll therapy could be viewed either way. Patients engaged in doll therapy should be treated with respect to ensure they maintain dignity. Care home staff and therapists should inform family members of the potential benefits of doll therapy and seek their input before introducing doll therapy to avoid misunderstandings.

Bibliography

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Burgo, Joseph. “No Shame in Adult Comfort Dolls.” Psychology Today, 12 June 2018, www.psychologytoday.com/us/blog/shame/201806/no-shame-in-adult-comfort-dolls. Accessed 10 Mar. 2020.

Croxton, Kate. “For Those in Need, Therapy Dolls Provide a Sense of Control.” Times-News, 20 May 2018, www.thetimesnews.com/entertainmentlife/20180520/for-those-in-need-therapy-dolls-provide-sense-of-control. Accessed 10 Mar. 2020.

Gordon, Michael. “More than Child’s Play: Ethics of Doll Therapy in Dementia.” Annals of Long-Term Care, 19 Mar. 2014, www.managedhealthcareconnect.com/blog/michael-gordon-doll-therapy-dementia. Accessed 9 Mar. 2020.

Gorman, Anna. “Doll Therapy May Help Calm People with Dementia, but It Has Critics.” National Public Radio, 3 Oct. 2016, www.npr.org/sections/health-shots/2016/10/03/495655678/doll-therapy-may-help-calm-people-with-dementia-but-it-has-critics. Accessed 9 Mar. 2020.

Heerema, Esther. “Pros and Cons of Doll Therapy in Dementia.” Verywell Health, 17 Jan. 2020, www.verywellhealth.com/therapeutic-doll-therapy-in-dementia-4155803. Accessed 10 Mar. 2020.

Kitwood, T. Dementia Reconsidered: The Person Comes First. Open UP, 1997.

Mitchell, Gary, and Michelle Templeton. “The Therapeutic Use of Doll Therapy for People with Dementia: A Systematic Review of the Literature.” Queen’s University Belfast School of Nursing and Midwifery, Oct. 2012, pure.qub.ac.uk/en/publications/the-therapeutic-use-of-doll-therapy-for-people-with-dementia-a-sy. Accessed 9 Mar. 2020.

Sauer, Alissa. “Pros and Cons of Doll Therapy for Alzheimer’s.” Alzheimer’s.net, 22 Mar. 2017, www.alzheimers.net/8-6-14-doll-therapy-alzheimers/. Accessed 9 Mar. 2020.

Vaccaro R., et. al. “Doll Therapy Intervention for Women with Dementia Living in Nursing Homes: A Randomized Single-Blind Controlled Trial Protocol.” Trials, vol. 21, no. 1, Feb. 2020, pp. 133, doi: 10.1186/s13063-020-4050-8. Accessed 9 Mar. 2020.