Doll Therapy and Dementia

Doll therapy, a non-pharmacological intervention, has gained recognition in long-term care institutions as a means to address behavioral and psychological challenges faced by people living with dementia. This therapy offers a unique approach to alleviating emotional distress and anxiety in dementia patients.

Understanding Attachment Behaviors

Attachment behaviors are instinctive; they are activated by conditions that threaten physical or emotional proximity, such as separation, insecurity, and fear.

In dementia patients, behaviors like parent fixation, wherein they search for long-deceased parents, reflect unmet attachment needs, indicating insecurity and a longing for safety. 

Doll therapy emerges as a potential way to fulfill these attachment needs, although conclusive research data is still evolving, backed by promising anecdotal and empirical studies.

Doll Therapy as a Therapeutic Intervention

Doll therapy, viewed as a form of child representation therapy or nurture therapy, is akin to various non-pharmacological interventions like music therapy, aromatherapy, and art therapy.

As the prevalence of dementia rises, there is growing interest in non-pharmacological alternatives like doll therapy, driven by concerns regarding the effectiveness and side effects of pharmacological treatments in managing challenging dementia-related behaviors.

Controversy and Misconceptions

The introduction of doll therapy has not been without controversy, facing strong resistance from some healthcare professionals and staff.

Concerns stem from a lack of clinical guidelines and misconceptions about doll therapy being demeaning or infantilizing. Critics of the practice argue that:

• Evidence of benefits primarily relies on anecdotal accounts.
• Staff validating the doll as 'real' is considered inappropriate.
• Treating old age as a second childhood through doll therapy is viewed as patronizing.
• Encouraging older adults to engage with dolls raises concerns about a breach of trust.

Benefits of Doll Therapy

For advocates of doll therapy, the empirical evidence supporting its use from research conducted in various countries is compelling.  These benefits include:

• Improved social behavior.
• Reduced dependency on medication.
• Diminished levels of agitation, aggression, and wandering.
• Maintaining functional abilities, including dressing, hugging, rocking, dancing, and singing.
• Assistance in expressing other unmet needs

A growing number of care facilities are adopting doll therapy as an effective intervention for people with dementia, further highlighting its growing recognition and acceptance.

Related:

• How to Manage Wandering Behaviour
• Social Isolation - How to Support your Clients

Getting Started with Doll Therapy

Before implementing a doll therapy program,  it is crucial to allocate time and resources to the following essential steps:

• Staff Training: Ensure that staff members receive proper training on how to effectively implement doll therapy.
  
  
• Family Education: Inform and educate relatives about the valuable benefits of doll therapy for their loved ones with dementia.
  
  
• Lifelike Dolls: Acquire dolls that closely resemble real infants, prioritizing their lifelike appearance.
  
  
• Doll Accessories: Provide baby clothes, shoes, hats, and cribs to enhance the realism and engagement of the therapy.

Selecting Candidates for 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, and while more women tend to embrace doll nurturing, some men can also benefit. 

Promote resident independence and choice by letting residents discover the doll themselves rather than giving it to them. Leave it in a cot or lying on a table where it will be easily found, giving them the freedom to decide how they engage in this therapeutic activity.

How to Practice Doll Therapy

While standardized guidelines are yet to be established, some general principles can guide doll therapy implementation:

• If a resident perceives the doll as real, staff should not correct them to maintain consistency.
• Dolls should not be shared due to potential ownership conflicts and infection control concerns.
• Monitor residents for signs of fatigue while caring for their dolls.
• If the doll has a name, use it and treat it in a manner consistent with the resident's perception.
• Avoid using dolls as tools for rewards or punishment.

The Effectiveness of Doll Therapy

Doll therapy can be considered a viable therapeutic intervention when it leads to:

• Serene emotional engagement with the doll
• Improved interactions with peers and staff
• Enhanced communication
• Reduced aggressive behaviors
• Increased sense of well-being
• Reduced agitation
• Diminished anxiety, and a corresponding decrease in medication usage.

Related:

• Goal-Directed Behaviour
• Sundowning: Symptoms, Triggers & Strategies

My Experience with Doll Therapy

Drawing from my experience in a long career in senior care, I have observed the positive impact of doll therapy on many occasions. I have seen it bring feelings of contentment and comfort to residents while enhancing their social interactions with our staff.

Doll Therapy provides people living with dementia 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?