Doll Therapy and Dementia

Doll Therapy and Dementia

Categories: Activities Articles Dementia

Doll Therapy can provide satisfaction and comfort to people with dementia or Alzheimers. It provides them with the opportunity to nurture and satisfy an emotional need that wouldn’t be fulfilled otherwise.
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The origins of Doll Therapy

In the 1990’s, long-term care institutions were introduced to doll therapy with the aim of reducing behavioural and psychological disorders in people with dementia. Doll therapy is a non-pharmacological intervention suitable to some people living with dementia.

The rationale was inspired British Psychologist John Bowlby’s ‘Attachment Theory’. Although Bowlby’s work focused on children, his theoretical explanation for attachment was thought helpful to apply in people with dementia to ease emotional problems and anxiety.

Doll Therapy is also known as Child Representation Therapy and Nurture Therapy.

Attachment behaviours are instictive

Bowlby believed that attachment behaviors are instinctive and are activated by conditions that threaten the achievement of proximity, such as separation, insecurity and fear.

Attachment behaviours can be observed in people with dementia. Parent fixation (searching for long deceased parents) is said to be an expression of an attachment need. This searching behaviour indicates that the person is insecure and seeking to be reunited with or attached to a familiar figure in order to find safety.

Doll therapy can meet this attachment need in some people with dementia. Although conclusive research data has not yet been produced, positive anecdotal and empirical studies are gathering momentum.

Doll Therapy as a therapeutic intervention

Doll therapy as a care tool is similar to other therapeutic interventions including music therapy, aromatherapy, art therapy and other sensory pursuits. As the number of people affected by dementia dramatically increases, more research into nonpharmacological interventions like doll therapy is taking place. This is fueled by concerns about the effectiveness and side effects of pharmacological treatments to manage the challenging behaviours of people with dementia.

Controversy and misconceptions

The introduction of Doll Therapy to treat people with dementia was met with much controversy and strong resistance from some staff and healthcare professionals which continues to this day. The therapeutic use of dolls for people with dementia can be a contentious issue for numerous reasons including an absence of clinical guidelines and misconceptions about the doll therapy as a demeaning practice. Those critical to the practice argue that:

  • Evidence of benefits is mainly anecdotal
  • Staff validating the doll as ‘real’ is inappropriate
  • Infantilisation of old age as a second-childhood is patronizing
  • Enabling older adults to engage with dolls is a breach of trust

The Benefits of Doll Therapy

For those in favor of doll therapy, the empirical evidence supporting its use is compelling. Research in various countries including the United States, England, Australia and Canada indicate that there are strong benefits to the use of doll therapy including:

  • An increase in positive social behaviour
  • A decrease in medication
  • Diminished agitation, aggression & wandering
  • Maintaining abilities they are still able to engage in (dressing, hugging, rocking, cuddling, dancing, and singing for a doll)
  • Assistance in expressing other unmet needs

There are a growing number of care facilities embracing doll therapy as an effective intervention for people with dementia.


Getting started with Doll Therapy

Before implementing a doll therapy program, time and resources need to be allocated to the following:

  • Training staff on how to practice doll therapy
  • Educating relatives on the benefits of doll therapy
  • Purchasing dolls that are as life-like as possible.
  • Purchasing baby clothes, shoes, hats, and cribs for the dolls.

How to determine who would benefit from Doll Therapy

Doll therapy is not for everyone and candidates should be carefully chosen. People who may benefit from doll therapy include those with Alzheimer’s Disease. More women than men will choose a doll to nurture, but some men do benefit greatly from holding a doll, so don’t rule them out.

Assist residents with dementia to make their own choices by having them ‘find’ the doll rather than giving it to them. Leave it in a cot or lying on a table where it will be easily found.

How to practice Doll Therapy

Standard guidelines are not yet available and every facility implements their own procedures which leisure staff must comply with. Here are some general guidelines that may be helpful:

  • If a resident perceives the doll as a real baby, do not correct him/her. Make sure staff on other shifts are aware of this to avoid contradicting each other and the resident.
  • Do not share dolls as this is bound to cause ownership confrontations. Infection control is another reason dolls should not be shared.
  • Monitor fatigue in residents caring for dolls.
  • If a doll has a name, use it; the doll should be treated in a manner conducive to how the resident perceives it.
  • Do not use dolls to bribe or punish residents.

Doll Therapy can be considered an appropriate therapeutic intervention by care staff when the person caring for the doll displays any of the following:

  • Serene emotional engagement with the doll
  • Improved attitude towards their peers and staff
  • Improved communication
  • Decline in aggressive behaviour
  • A sense of wellbeing and liveliness
  • Agitation is abated
  • Anxiety is diminished leading to a reduction in medication.


My Experience with Doll Therapy

I have witnessed the positive effects of doll therapy as an intervention numerous times in my working life. In my experience, the use of doll therapy promotes feelings of contentment in the person with dementia and improves their social rapport with staff.

Doll Therapy can provide satisfaction and comfort to people with dementia. It provides them with the opportunity to nurture and satisfy an emotional need that wouldn’t be fulfilled otherwise.

Related: 15 Activities for Late-Stage Alzheimer's Disease

We'd love to hear your feedback.
What has been your experience with doll therapy?

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Tracey 4th Aug 2016
How would you go about assessing if a resident is going to be suited for 'doll therapy'? Would you maybe bring the baby in for a 1:1 with the resident and see how they feel about the baby?
Suzana 23rd Jul 2016
I think doll therapy is great in our facility we have a resident constantly looking for a baby we gave her a doll and has been more settled
Julie 25th Jun 2015
Hi, we are looking to purchase a good baby doll for doll/baby therapy but are finding it difficult to find out where! The dementia shop seems to be out of stock & we really want to get the right kind! Can anyone help us?
Irma 2nd Jun 2015
Is there anyone who has an assessment form for doll therapy?
dorothy 8th Feb 2015
i use doll therapy in our facility firstly i researched for evidence of why this works for some and not other people then i printed off a simple to the point article for staff and found that staff in the beginning ,was a barrier to it working effectively but over time they are now all seeing the benefits .
Then i purchased life like dolls and a crib and placed the dolls all wrapped up in there and waited for a response within an hour of setting up the display a lady saw the babies and went over and she asked me if she could look after this one , she instantly called the baby Thomas and cradled him , over the period of the day her whole outlook changed and as the days went on her need for medication decreased as she no longer was banging on the doors to go home because her children needed her . Staff now see the benefits and her family are just so pleased to see her happy and content. So to wrap it up you cannot really asses someone for doll therapy they will be drawn to it if the need is there then you have to put in place a management plan so the person doesn't get overwhelmed by the caring they need some down time , e.g. meal times , rest time , bed time .I hope my story helps you decide if you will give it a try if it meets one persons needs than you have done something fantastic .
Sue 24th Nov 2014
sue 24-11-14
Nurture therapy is a wonderful way to encourage caring interaction in a person, male or female.
careful observation of the individual will determine suitability, family and friends can give the staff valuable insight as to the suitability.
There are many and varied interactive "babies" to choose from.
Trish 4th Oct 2014
I found doll therapy to be very beneficial in the recent Dementia
area I worked in. There can however be a lot of friction between
residents as they fight over whose doll it is. Best to have many
on hand. A handy tip, if you need to take the doll away from the resident
for e.g. its morning tea time, say that the doll is going to the nursery
for a sleep.

Karen 30th Sep 2014
During a singing session I often pass the lifelike baby doll around the group, the residents singing to the "baby". It creates a positive atmosphere and feelings of contentment. What can be more natural than the desire to hold and cuddle a baby, which brings back so many memories for residents. No point analyzing the "therapy", just enjoy the moment.
Sharon 30th Sep 2014
Agreed Nurture therapy is a much better name. We use this therapy at our facility but is not for everyone. For some of our residents it is a very beneficial activity, calming the resident and actually giving that resident some enjoyment, minimising behaviours, so it's a win win as far as I am concerned.
cindy 30th Sep 2014
yes great article we already have introduced doll therapy don't forget to get a signed document were family agree for there loved one to have.
DMAS in Tasmania do supply lifelike dolls at a price.
Pam 30th Sep 2014
....Nature Therapy or Nurture Therapy? Call it what suits the culture in which it is used. This (as for any therapy) work with, & for, some dementias but not for other types (or different resident mix). If staff are accepting and non judgemental (as they should be) then others will be too... It is great for residents to have feelings and emotions of any type!
Dot 30th Sep 2014
Used to love doll therapy until a resident, and those near her, became very distressed by the "dead" baby because it did not move. Now have interactive kitten, the small one. When this kitten has not moved for some time, a cuddle/stoke will cause it to move.
So as always we need to monitor.
Claire 30th Sep 2014
I use doll therapy at my facility, one man who has since passed away used to sit and cuddle the doll in the evenings, it stopped him roaming the hallways, he thought it was one of his grandchildren. He would rock and sing to her, I found doll therapy to be very successful with him, it curbed his behaviors. Nurture therapy is a great term, but i haven't had any negative feedback from other staff or residents families at this stage, so will continue with our 'Doll therapy'.
Debra 30th Sep 2014
I have always been an advocate of Doll Therapy however have also experienced the down side which was usually caused by individual staff who did not understand the therapeutic benefit and sabotaged the experience for the resident. Totally agree you need to very carefully pick your residents and monitor closely to gauge reactions. I have been told off soundly when saying how beautiful 'she' is when it is a 'boy'. Also love the term 'Nuture Therapy' which removes the stigma of childlike. I have also witnessed this therapy work extraordinarily well with certain men with behavioural issues, (more around looking after/nursing than caring tasks)
jacquie 30th Sep 2014
l use dolls and am introducing other baby itens to our resources. l think its a valid therapy as it promotes conversation and socialising especially among the female residents and evenif they are not interested in the dolls we talk about the knitted clothes and some enjoy folding and washing them
Jacqueline 30th Sep 2014
I am still sitting on the fence with doll therapy. I have seen it work very successfully for some residents but I have also seen it back fire and become another behaviour issue. I think as Diversional therapists we need to ensure that we have assessed the person correctly for this therapy, ensure that staff and family are on board with it before we try it. At the end of the day if you have a calm content resident then it was the right thing to do. I like the term Nuture therapy rather that Doll therapy.
Cathy 29th Sep 2014
At our facility we use a "reborn" doll which is life-like for 1x1 or group therapy use and the usual kind of baby doll for our dementia unit were residents wander and or hold the dolls all the time. We call it "Nurture therapy" on our programming due to the negative connotations of "doll therapy".


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