For me, a major strength of the Dementia and Imagination study is the mixed methods we will use to understand the impacts of the art interventions.
Typically, research measures clinical outcomes or medically determined factors. Yet there is clearly much more to how we experience illness than what can be described in these terms. This project uses such measures, but also seeks to explore wider and more nuanced outcomes.
Psychologists consider the complex interactions between a person’s history, relationships, perceptions and environment, which might result in a particular set of beliefs or behaviours. This formulation of clinical problems can allow a person to understand how a problem developed, how it is maintained, and how they might act to effect therapeutic change.
In a recent review exploring how therapeutic processes are affected by engaging in the arts, I was amazed by the unique and multi-layered effects reported. Engaging in the arts can soothe, distract and offer a release or outlet, which can be hugely beneficial to people in distress.
And engaging in creative expression can alter people’s inner worlds. Participants commonly report that engaging in art offers a route to self-expression, facilitating understanding. This in turn can lead to improved communication with others. Moreover, a sense of accomplishment after completing an artwork can improve self-esteem, self-efficacy and confidence. People who use art in a mental health recovery context report feeling more effective in the world as a result. This experience encourages them to reach out towards other activities and other people, allowing a greater sense of connectedness with others.
During a time of psychological and spiritual stress, the acknowledgement and processing of difficult emotions can be key to well-being. It is clear to me that engagement in creative activities and the arts facilitates a number of important processes. Art and creativity not only foster self-exploration, but have the ability to enhance interactions and links between people during challenging times. Creative expression nurtures peoples’ fading abilities to communicate, and does so in ways that do not require use of language, much less complicated or emotional language.
The imagination, and faculties which allow creative thought, are among the last to remain intact in many forms of dementia. People may still draw or recognise images long after they have lost the ability to name an image, providing a much-needed anchor and outlet.
I wonder what I am going to see unfold when observing people engaging in arts interventions in dementia services. I am expecting to encounter many a universal theme and witness some intensely moving exchanges.
That the arts contribute to well-being is a well-documented phenomena, and as a communication tool, art-making is infinitely more flexible, responsive, accessible and fun than talking on its own.
The use of the arts is ever more relevant to people with dementia or indeed anyone with communication difficulties or cognitive impairment. There is the potential to encourage expression and reduce confusion, foster improved communication, and keep a record of people’s thoughts, feelings, and wishes for when they can no longer remember aspects of their lives.
In order to inform the arts intervention and, importantly, how we might best capture its effects, we consulted a range of stakeholders from people with dementia and their carers, to the staff who support them. We sought to expose their experiences and ideas about what makes a good intervention. The existing literature on arts and dementia care was scrutinised to reveal the key ingredients of a successful arts programme. The artists who will deliver the intervention, who already work in a range of settings with people with dementia using the arts, were also asked to advise the research team. This allowed the development of a set of principles which should enable an intervention that maximises the benefits previously reported.
Our research aims to provide a rich, layered and much needed understanding of the role of the arts in dementia care, from which a good practice manual will be collaboratively developed.