In negotiation with the OTs a number of sessions were planned where I would visit the Riverside Ward, these would provide the opportunity to test a number of the objects I had created as devices to support therapies. Early in this creative venture, Clive Parkinson alerted me to the research of American cultural critic Anne Davis Basting. Speaking at the North West Arts and Health Network Event on Dementia and Imagination, he states ‘[She] has produced a book Forget Memory about dementia, a wonderful piece of work, thinking less about memory, reminiscence and all the work about the past. It is more concerned about living in the present because no matter how much the cognition [of those experiencing dementia] has gone, you’re there and sentient at that moment, and it is about building that imaginative capacity and tap into that living, vibrant human being regardless of the state of their condition’.9
Basting invites us to value the present moment and highlights a number of programmes that find ways to suspend Western culture’s high-speed churning of the future into the past. She eloquently illustrates that you do not need to be a certified therapist to create moments of meaningful engagement and offers ‘The arts provide a way to open those avenues for meaning-making between people who cannot communicate through traditional, rational language. Music and song-writing, dance, non-linear storytelling, poetry, open conversation, painting, sculpting, responding to art: all of these give us ways to connect with each other, express who we are and what we believe. They can help put meaning back into what we fear are meaningless lives’.10 It was with a sincere hope that I wished to add ‘responding to design’ to that list.
As mentioned previously, it became important to impart to the OTs at the Riverside Ward that I would not describe myself as a community artist and to reiterate that the objects I wished to test were derived from a design perspective and it was a design methodology that brought them about.
For these sessions, I proposed to use the research method of ‘Participatory Action Research (PAR)’ or an interpretation of it. According to Gray and Malins, they define Action Research as situational by ‘intervening, diagnosing and solving a problem in a specific real world context. It requires the co-operation of the inhabitants/participants of the potential action context, and is self evaluative with modifications ongoing.’ 11
This process of self-evaluation and the application of results in the real world was key to the methodology. They explain, ‘Participatory Action Research, as the name suggests, values and uses the lived experience of people as a way of democratising inquiry’12. Community development strategies that employ Appreciative Inquiry similarly are an optimistic strategy for change that identifies the best of what is and to imagine what could be. This model encourages democratic participation, imagination and innovation, using a four stage model of discovering, dreaming, designing and delivering. Connections and associations became apparent in these modes of research to the overarching design methodology and influential in its future direction.
Also significant in my planning, was the Museum of Modern Art, New York, Meet Me Alzheimer’s Project. MoMA is one of the first museums to offer programs to make its collection accessible to people with Alzheimer’s disease and their caregivers, and gives those living with the degenerative disease an expressive outlet and forum for dialogue. Their website presents online guides offering an in-depth look at the preparations necessary to conduct an activity with individuals with Alzheimer’s disease and their caregivers. Their methods can be used with groups or one-on-one, can be adapted for various settings, and provided a foundation to help to create meaningful experiences.
With the OT, Laura Critchlow and other professional care staff on the ward we completed a number of stimulating and lively discussion based sessions where patients engaged with the objects. I intentionally requested the co-operation of the OTs to lead the sessions with the participants, in order that both were empowered through the process and crucially, that the normal group dynamic was maintained. We agreed a small participant group of six represented a workable size in order to be able to successfully observe and record anecdotal research findings, and these sessions that engaged directly with the participants were each approximately one hour in duration.
The sessions based on three scenarios were to designed test the objects effectiveness through a variety of interactions. The first session held in the ward therapy room was based on ‘Quality Circle Time’, facilitated by the OT and supported by another member of care staff. (Fig. 19) The group of participants sit together in an activity involving everyone, that provided a time for memory and reminiscence, sensory experiences, socialization, and enjoyment. Circle time is a complex, dynamic interaction among the participants and the resources used. This approach has roots in solution focused therapeutic approaches and is a democratic and creative approach in which the OT is a facilitator rather than a director. The prototypes or ‘pods’ as they came to be known by the patients and care staff, were used to encourage discussion through being passed around in the circle acting as a stimulus for open ended questioning by the facilitator. A prepared session plan for this activity can be found in appendix two of the supporting documentation.
Session Two was spent in the therapy room converted into the informal setting of a café, tables became covered by tablecloths, with tea and cakes served on china and wartime music playing. In this setting, the participants connected with each other in a social activity that aims to promote the individual. This scenario gave rise to the opportunity for my experimental objects to be placed on the tables and for the patients to explore them in a less prescribed manner. Finally, the third tightly structured session was based upon quiz questions that employed a strategy of direct questioning in order to measure participants responses. The impressed icons on the objects act as crafted representations of the world around us and informed a guessing game where participants were asked to name the subject. Here the experimental ‘pod’ objects were brought into play as Talking Objects where only the person who holds it is allowed to speak in response to a series of questions based on the theme of the deciphered images.
Through the support of the highly motivated staff at Newholme Hospital NHS Dementia Assessment Unit, a very practical working relationship developed and all concerned enthusiastically embraced this project. On completion of these activities the very positive feedback provided by the OT revealed;
‘In the sessions working with you, the objects held our patient’s attention and full interest throughout. They were fascinated by the shape of the outer object and they shared what they thought the object was, or what it reminded them of, which encouraged thought and communication. They then went on to work out how to extract the centre, most of whom were drawn to it by the bright colour, and once they had the centre they were encouraged to talk about the image etched onto the surface, sparking off a whole new set of questions and lots more communication and smiles, particularly when the image was easily recognisable and of a general subject…These objects worked so well in our group therapy sessions by stimulating speech, thought, memories and communication and allowing staff to learn more about the patients life prior to the illness. One of our ladies had significant word finding difficulties, yet during the session with the objects she was relaxed and calm enough to be able to freely join in. With the images triggering memories, this allowed her to share with the group, many stories from her childhood and younger years. During this session she was free from her symptoms’. 13
In a subsequent interview I invited a detailed response from the OT of her assessment of these objects potential within a healthcare setting, she offered that this was proven by how the objects can ‘divert’ problem behaviour and lessen symptoms by forming a positive intervention that fully absorbs and engages the patients. Covering three very different scenarios during the sessions, she suggested the first session intensely focussed on exploration of the objects and all the positive results observed came from this interaction.
In the second café scenario she was intrigued to see how they arrived at such different descriptions of the objects, saying how it was fantastic to observe improvement in some of the participants speech as they were much more relaxed in comparison to their responses within the third activity. This final session employed direct questioning that helps the professional care staff in defining a level of patient’s abilities. In asking patients direct questions the faciltiator can determine if the patient can respond with fully formed answers, that demonstrates a high level of function remaining. When direct questions were posed, it was noticable that speech quietened and this can be difficult to observe. Explaining the distinction between the sessions the OT highlighted that the perceptible difference was that the participants gave blank responses under direct questioning, providing stark contrast to the first group therapy session which was so successful in sustaining expression and encouraging communication.
The staff on the ward offered that to have the chance to work with these objects proved undoubtedly beneficial, and it provided them with pleasure and satisfaction to see their patients enjoying themselves. Dr Whittingham, the consultant for the ward was also very enthusiastic about the sessions, promoting therapy as a positive form of treatment. The favourable response to these ‘pod’ objects has suggested they are of value as therapeutic tools for individuals experiencing dementia who struggle to express themselves to others. Working with the objects brought focus to the nature of memory making, as a number of the participants were sometimes only able to access memories from the past, not knowing where they are or what is going on around them and this project has found value and meaning in this human connection in the present moment. In agreement with the view of Anne Davis Basting, memory is not only an act of retrieval, but is an act of creative story telling using the imagination based in the ‘here and now’. This ‘testing’ phase has emphasised the potential of objects to offset fears of meaninglessness by becoming a tool to fill that void. This interaction has given the participants confidence to touch on something that they really know. Stories from the participant’s lives shared with the group during the sessions also gave the opportunity for staff to learn more about the patient’s life prior to the illness. This emphasises the notion that memory is relational, existing between people and not belonging to one person.
I concluded that the experimental objects had worked well in the group therapy sessions, stimulating speech, thought, memories and communication. The participant’s interaction with the objects through close observation, handling and discussion, offered them the opportunity to;
- Recall long-term memories and personal experiences.
- Make connections between personal stories and the world at large .
- Explore and exchange ideas.
- Experience intellectual stimulation and engage in an imaginative activity
- To become fully absorbed in the present moment.
- Participate in a meaningful activity that fosters personal growth.
8.Turkle, S. Evocative Objects, Things we think with. (2007)
9.Parkinson, C. North West Arts and Health Network Event on Dementia and Imagination. [Network event] Manchester Metropolitan University. 27 May 2010.
10. Davis Basting, A. Forget Memory.(2009) p164
11.Gray, C and Malins, J. Visualizing Research; A Guide to the Research Process in Art and Design. (2004) p74
12. Gray, C and Malins, J. p75
13. Critchlow, L (2010). Staff Feedback. [E-mail]. Message to: D.Browett. 24 May 2010.