The dos and dont’s of doll therapy

People living with dementia, particularly those living in residential aged care, have benefitted from doll therapy for years.

Doll therapy involves offering dolls to people who are living with dementia in order to improve their comfort, engagement, and overall quality of life.

Often viewing the doll as a real baby, both men and women can engage in care-taking behaviours that can restore a sense of purpose and joy.

But if not done properly, with the right education and process, doll therapy can create issues and concern for aged care residents, their families and carers.

So how can doll therapy be rolled out properly?

The benefits of doll therapy

Doll therapy has been proven to have overlapping theraputic benefits such as:

• Decreased anxiety levels
• Decreased agitation and other challenging behaviours
• Improved mood
• Increased social interaction
• Increased physical activity
• Improved sleep
• Improved ability to receive care
• Improved food intake

Karen Cmiel, Program Review Coordinator and Facilitator for Dementia Australia Centre for Dementia Learning, has 25 years of aged care experience and has seen doll therapy be integrated both well and poorly.

She explains that people living in aged care often have everything done for them which can take away opportunities to nurture or look after something, a feeling that promotes good well-being. The doll, which should be as life-like as possible, can restore that feeling of being needed and wanted for those living with dementia while also encouraging more healthy behaviours.

“They also might walk their doll in a pram which keeps them active, change their clothes and put it to sleep, so it gives them that meaningful role every day to participate in something that brings some purpose.”

It is always a benefit to have non-pharmacological therapies and options available to residents and staff and doll therapy offers a way to address challenging emotions and behaviours that may develop for people with dementia without the use of medicine. This means there are no medical risks or health side effects to worry about.

No one-size-fits-all approach 

Like all therapeutic practice, doll therapy should be person-centred and adhere to proper processes and monitoring. 

How beneficial doll therapy is for a resident depends on their level of engagement and how they view the doll. Depending on the person, some may view them as a real baby, but others may still view it as a toy and not show much engagement. 

Ms Cmiel suggested trialling the therapy amongst clients with one doll to gauge their reaction, but one doll per resident is ideal. Present the doll to engage the resident by pointing out its life-like qualities and see how they react. “We don’t want to trick the person. We want to introduce the doll and see what they interpret it as,” Ms Cmiel explained. If it is a shared doll, carers need to help facilitate the sharing by asking residents if someone else can hold it and allocating a communal space for it.

To ensure the therapy goes smoothly, it is also wise to have back up dolls. This is helpful to avoid internal confrontation amongst residents and it allows staff to replace dolls when needed to avoid distressing the resident. 

Before integrating doll therapy into a resident’s care plan, risk assessments need to be done and policies and procedures should be put in place before dolls are given to residents. Should it be appropriate for a resident to engage in doll therapy, regular monitoring and reviews should be conducted with each resident.

Viewing the doll as your resident would

Care workers play a huge part in the success of doll therapy. In the old days, understanding of dementia and the benefits of doll therapy were limited.

In order for doll therapy to work, carers need to understand that residents may view the doll as a real baby, not a toy. With this in mind, dolls should never be put away in a cupboard or stored on a shelf for residents to see.

Some advocates raise concerns about doll therapy and residents’ dignity, pointing out that an adult with dementia is not a child and shouldn’t be treated as such. While dolls are typically associated with children, it’s vital to remember residents are not children and are adults living with a cognitive impairment. 

To avoid this, it is important to respect the dignity of all residents by avoiding demeaning language, such as “cute”, when referring to them and their doll. 

Ethical concerns and the importance of education

For some family members, visiting their loved one in a residential aged care facility and seeing them with a doll can be distressing. They may be confronted by the reality of their loved one’s cognitive status or it may raise concerns about their dignity.

Families and advocates have questioned whether it is ethical to “mislead” residents with dementia by letting them think the doll is a real baby. Ms Cmiel said that so long as it is safe, items of comfort should be promoted. 

“It could be a rug, a soft toy, a pillow – It could be any matter of things.”

While these concerns are all valid, education is the key to dispelling distress around the subject.

It is vital for carers to be trained around doll therapy before it is implemented at a facility and educational opportunities can also be extended to residents and their loved ones to ensure it is integrated properly.

To avoid families feeling left in the dark about therapeutic decisions involving their loved ones, providers can host a presentation outlining scientific research and case studies for all to attend. 

Do you know someone accessing doll therapy? Did it improve their well-being? Let us know in the comments below.