Effectively Using Doll Therapy for People Living with Dementia: International Guidelines

Dr Gary Mitchell author of Doll Therapy in Dementia Care: Evidence & Practice, Dementia Specialist Nurse & Lecturer at Queen’s University Belfast

What is doll therapy?

Doll therapy is an activity that is used internationally to help people with all types of dementia to maintain a sense of wellbeing or to alleviate episodes of distress.  Doll therapy occurs in many ways and the activity can take the form of a person with dementia holding the doll, talking to the doll, cuddling, or hugging the doll, feeding the doll, or dressing the doll.

What are the main benefits?

Doll therapy has been associated with many benefits in dementia care.  Empirical research has shown that doll therapy can lead to:

• Improved Communication – because people living with dementia have something new or important to talk about.
• Improved Nutritional Status – because doll therapy has the potential to improve mealtime experience.
• Improved Social Engagement – because people with dementia can share or engage in doll therapy with other people.
• Reduction in Distress or Challenging Behaviour – because doll therapy can help maintain a person’s attention and can have a calming influence.
• Reduction in Behavioural Modifying Medication – because people with dementia who were previously receiving medication for distress or challenging behaviour may no longer require this due to the therapeutic effects of the doll. 

What are the barriers?

There have been some barriers to doll therapy identified in the empirical research.  These are:

• It is very difficult to predict if a person with dementia will engage with doll therapy prior to trying it – doll therapy has been successful for people in the early, middle, and late stages of the dementia disease.  It has also been successful in both women and men.
• Knowledge about doll therapy in dementia care is still poor – this means that many people who would benefit from the therapy will not have a chance to experience it.

How do I introduce doll therapy to the person living with dementia?

Introduction of the doll should follow these steps:

• Inform family, friends, or healthcare professionals before introducing the dolls. Ideally these people should be provided with a summary of the potential benefits of the therapy.
• All should be made aware that when a doll is introduced and is accepted by a person with dementia, it will not usually be removed.
• Place the doll or dolls in an area where the person or people with dementia can see or touch these; this may be difficult if their mobility or sight is reduced.
• If a person with dementia calls their doll by a certain name, all healthcare professionals, friends, and family members should be encouraged to do the same.
• If the person with dementia believes their doll is a baby the person with dementia should not be corrected and the healthcare professional, friend or family member should also treat the doll like a baby.
• Once the doll is introduced, the doll should never be removed without the permission of the person with dementia.
• When removing the doll, healthcare professionals and family members should always hold the doll as if it is a living baby because people living with dementia can believe the doll is a living baby.
• If the doll needs to be removed you should explain where it is being taken, for example, if it is dirty, the doll is going for a wash.

What are the rules?

There are no rules to doll therapy, but there are several recommendations that can be followed to facilitate optimum therapeutic effect:

• Never remove the doll as a form of punishment.  The person living with dementia may perceive the doll to be their child and this can cause extreme distress.
• Do not place the doll in a box, on the floor or on a radiator when storing the doll.  It should be placed in a safe place since the person engaging with the doll may perceive their baby to be at risk.
• Ensure that the person living with dementia is not putting their own health at risk by caring for the doll.  It is rare, but some people who engage with doll therapy become very tired because of caring for the doll and may, for example sleep poorly or have a reduced appetite.
• If the person living with dementia moves to a new home, a care home or is admitted to hospital, the doll should come with them.  In other words, once doll therapy commences the ownership of the doll should always remain with the person.

Where can I use doll therapy?

Doll therapy can be used in any setting.  It has been used effectively in people’s own homes, hospitals, and care homes.  Doll therapy can also be used on-the-go, for example when travelling.

Can I use it as a group-activity?

Doll therapy can be used as part of a structured group-activity.  In group activities, people living with dementia come, or are brought, together to engage with their dolls.  In one research study, a care home regularly hosted group doll therapy with extremely positive results.  Group doll therapy facilitates people living with dementia, with a shared interest, to communicate and connect with one another.  This form of group activity usually occurs when a few people living with dementia meet for a short period of time (approximately one hour) and collectively engage with their dolls.

Can I use it as an individual activity?

Doll therapy is mostly used as an individual therapy which is led by the person living with dementia.  The therapy is unstructured and should not have scheduled start or stop times.  The person living with dementia may engage with their doll continuously throughout the day, for example dressing the doll, attempting to feed the doll, putting the doll to bed for a sleep, cuddling the doll or stroking the doll.  Conversely, the person living with dementia may engage with their doll routinely during different points of the times, for example the early evening time.

Do I need a qualification to provide doll therapy to people with dementia?

No but it is very important to know how to facilitate doll therapy to enable the person living with dementia to derive maximum therapeutic benefit.

What additional information do friends and family, or healthcare professionals need to know?

There are some important things for family, friends, and healthcare professionals to know about doll therapy in dementia care:

• The most important thing is that the person living with dementia leads doll therapy.
• There will be periods of their illness where a person with dementia may engage more, or less, with doll therapy and it is important to respect this.
• Friends, family, or healthcare professionals must ensure that all people who visit or care for the person living with dementia have knowledge about how doll therapy.
• If you are introducing doll therapy to a care home or hospital unit, it is advisable to have several different-looking dolls, for example different genders, ethnicities or dolls wearing different clothes.  This will help reduce confusion about doll ownership.

How do I know if it is working?

If the person with dementia is living in a care home or staying in hospital, doll therapy should be care-planned and evaluated monthly.  Healthcare professionals should monitor the person’s level of wellbeing, anxiety, depression, and distress when using doll therapy.  If the person living with dementia is using doll therapy at home, family and friends will know if doll therapy is working based on the person’s overall mood and level of distress experienced.

How do I find out more information?

There are several research articles, commentaries, blogs, and news stories about the therapeutic use of dolls in dementia care and many of these can be accessed online.  There has also been one book written on the topic.  If you want to learn more about doll therapy from an expert in the field please contact Dr Gary Mitchell via email: Gary.Mitchell@qub.ac.uk

What steps do I need to take to begin?

The following is needed to begin doll therapy:

• A therapeutic doll
• An open mind
• Knowledge about how to support someone living with dementia to effectively engage with doll therapy (achieved by reading these guidelines)
• A notebook, or care-planning documentation, to record the effectiveness of doll therapy

Internationally the number of people living with dementia who are benefiting from doll therapy is growing.  The benefits of doll therapy are unique to the person living with dementia and it is often difficult to predict exactly what benefits a person living with dementia will have.  What we do know is that doll therapy has the potential to be life-changing for people living with all types of dementia.

Further resources:

• Book: Doll Therapy in Dementia Care: by Gary Mitchell
• Empathy Dolls