Therapeutic value



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Children’s Rights





The therapeutic value of dolls.


"A puppet is a soul in the palm of hour hand" Mikki Aronoff


1. Dolls and their therapeutic value


1.1. Introduction


Because of their important symbolic, their typical movements, their appearances and adventures, dolls are extremely useful to the extra care in ordinary education as to extraordinary (special) education and therapeutic interventions. They help to understand and communicate with children that are victims of a severe accident or of a life threatening illness. For children, who have to deal with feelings of uncertainty and anxiety, dolls may be of great help.


When children manipulate dolls and play with them, we get extraordinary and purposive opportunities to observe them. Related differentiation opportunities present themselves. They result from interpersonal and interactive situations with individual language development opportunities, from cooperation opportunities, exchange of talents and social trainings. This allows us to anticipate in a better way the potential possibilities, talents or restrictions of children and the environment in which they grow up. Playing together with dolls stimulates the eagerness to learn, children learn from each other and develop at the same time their basic vocabulary.


Looking at children that manipulate puppets and play with them provides us with a lot of useful information. An image of each child in particular and of the entire class is created.



1.2 Specific problems



Dolls can be quite a comfort to children who lost a dear person. The teacher gave the class doll to a pupil that lost his twin brother in a tragic accident. This doll was not only the child's only comfort and support but also an important contact person. The child was able to talk about the loss and sorrow and to cuddle the doll.


We can help children that have to deal with specific problematic situations to cope with intense emotions and tensions and to overcome them.


At the start of the new school year, a new pupil enters the classroom. The girl wears nice colourful glasses. The class doll notices the girl, in particular her colourful glasses, and says: "Hello! Nice glasses! What a nice colour! I am sure you see very well with such glasses. I would like to have the same. Can I try them on?"

The doll takes the glasses and puts them on its nose. All children laugh. The doll says : "Now, I can see all of you very, very well. Do those glasses suit me? What do you think?" In this way, the doll shows children that wearing glasses is very common and not unpleasant at all. The doll also teaches children that one never bullies a person wearing glasses. The same scene can be played when a child that has to wear braces.


When the class doll appears one morning with glasses on its nose, it can prepare a child that has to see the eye doctor by telling about its own visit to the eye doctor. The fact that the doll has to wear glasses is certainly not unpleasant, because it sees a lot better now. If the teacher is fortunate enough to have several glasses frames in the classroom, children will be able to try on all of them. The teacher takes the opportunity to take pictures for the class album.



1.3. The hospital and being ill



Dolls can be used to counter the feelings of uncertainty and insecurity of children and/or to prepare them to a visit to the dentist, to guide them in view of a stay in hospital or during an illness.


The Kiwanis Service Club has started the "Kiwanis Doll" project. This project finds its origins in South Australia where it has been very successful. The doll is a stylized 30 cm tall doll, made of cotton. It is distributed in children's hospitals to children that have to stay in hospital in order to receive medical treatment. These children often have to undergo major surgery. As they find themselves in an unfamiliar environment, they are anxious for what is going to come. Sometimes, they just need a doll to cuddle or to play with, a doll that cheers them up. One can just do anything with that doll: stitch up wounds, give injections, bandage, put casts, perform surgery… as well as show, explain… The dolls can accompany the children to the big machinery such as X-ray, scanners, ultrasound imaging. They also stay with them during medical treatments such as the stitching up of wounds, the putting on of an oxygen mask or the preparation for surgery.


With the help of the nurse, the child first puts the oxygen mask on the doll or performs the operation on the doll. The doctor then explains with the doll what is going to happen and how it will happen. As the doll is neutral, the operation can even be drawn on it. The doll gets a wristlet with its name on it, just like the child. By making the unknown known and familiar to the patient, the hospital personnel minimizes or even takes away the anxiety and possible fear for surgery.


Hospitals and dentists' offices are no pleasant places to stay and may cause a lot of stress. Because of earlier, less pleasant experiences or just because the environment is not familiar, children may be really frightened. It is essential that children be mentally and emotionally prepared for a possible stay in hospital, with or without surgery. Hospitals in the United States of America started already in 1960 to use dolls for that purpose. The doll may be - depending on the situation - a patient, a doctor, a nurse or a dentist.

The therapeutic value of dolls is shown by the fact that dolls manage to involve children in what is going to come and to touch their feelings. When young children play with the dolls (children's language), the feelings of these very young patients surface. The doll doctor examines the child, takes its blood pressure, looks in its mouth and ears, measures its length, etc. The dentist doll examines the teeth and says what treatment will follow. The dentist doll also underlines the importance of brushing the teeth, of using dental floss, gives a demonstration and gives for instance a toothbrush as a present. A doll with beautiful healthy teeth may serve as a model.


The hedgehog doll may help children that are afraid of injections.

A hedgehog spine-prick does not hurt at all!



1.4. Psychotherapy



Psychotherapy considers the use of dolls as a great opportunity to establish contact with invalid, injured and sick children. Dolls can be promptly and interactively brought in and are able to catch the attention of children. Fear and uncertainty diminish and are minimized. A therapist always tries to establish the right interaction between his patients and himself where dolls constitute the connecting object and means. Such contact by means of a doll inspires confidence and creates a kind of solidarity that is essential for the healing process. It helps children to express their feelings, sensations, to get rid of their aggression and/or frustration, to show or suppress or project such feeling on dolls. In this way, possible obstacles are cleared away and the way is smoothed for self-expression and personality development. Dolls are excellent means to help inhibited, hurt, abused and traumatized children to vent their feelings.

Children must be involved as much as possible in each phase of the process in which dolls are used. They should have the opportunity to make their own choices. Dolls "free" children from restlessness, tensions, distress and problems. A doll can for instance tell a child what a lumbar puncture means, how the child can relax when such puncture is administered. But a doll may also support the child when touchy matters preoccupy children or when a discussion about some subjects is difficult.



1.5. Suggestions concerning the use of dolls in hospitals



How to introduce dolls to very young patients?

Children in general do like dolls but one cannot take it for granted that very young children in hospitals always know that dolls are not real. We advise to be careful when entering a hospital room with a doll. It is better to carry the doll in a bag from which the doll's head is peeping.

When seeing very young children that are not yet familiar with dolls, we advise to start with finger puppets and bit by bit to use larger dolls, always keeping an eye on the children's reactions. The puppet should be manipulated in a playful way, at head height of the children. It is important that you take your time to make the children acquainted with the dolls.

Dolls are only effective and efficient when their use has been thoroughly prepared.

It is important to consider the hereafter following questions, suggestions and advice:

  • Are you an experienced therapist and are you sufficiently informed about therapeutic applications and play techniques?
  • Learn about relaxation techniques, co-operation techniques and respiratory techniques.
  • Some knowledge of feelings of fear and anxiety related to the age of the patient is useful.
  • Do you have the necessary medical and psychosocial information to prepare the child for what is coming up?
  • Observe the reactions of the children when they see the doctor and/or go to the treatment room or the operating theatre and note them.
  • Get acquainted with the medical personnel the child is going to deal with.
  • Try to know who will do what, where and when and what the consequences for the child will be.
  • Always use a language the child is able to understand.
  • See to it that the child understands what you are going to do.

    We advise to use glove puppets in hospitals.

    Glove puppets have mobile mouths, an expressive face and limbs. It is very important to test the puppet before using it: does it fit my hand? Breakable dolls or dolls made of hard material are less appropriate because they may hurt children. Having several expressive puppets or dolls at your disposal is ideal. Always choose the dolls according to the aim you want to achieve. And finally, children generally prefer animal dolls.

    Dolls help children to express their sorrow, illness and sadness and to restore the balance. They clear the way to deal with their feelings and to share them with other people. Dolls can help to talk about the situation of a sick mom, the loss of a beloved pet or the consequences of a severe accident and support the process to deal with such grief. Dolls help children to overcome obstacles that inhibit their self-expression and development. They make subjects such as being afraid of hospitalization, mutilation and even death accessible. Group therapy sessions successfully help to endure pain, to express pain sensations and to share such sensations with other people.



    1.6 Courageous little Scott



    Therapist Mikki Aronoff uses dolls to prepare children for major surgery such as amputations of limbs and/or cancer treatment. Children tell her dolls about friends they know and who have died. One of the children she treated wanted to be buried with her dolls. But the most touching story is that of the guidance of the incurably ill Scott.

    She used books and dolls as the ultimate solution whenever she met the eleven years old Scott, a weak and tired leukaemia patient. After his parents had abandoned him, he courageously endured his pain day after day. Scott's trousers always were a little bit too short and showed his slender little legs. He always seemed to move in 'slow motion'. No one ever saw him run. When he spoke, his voice seemed to come from a thick fog. His sandy hair, which had been cut at home, was sticking out in all directions.

    Scott became worried. Just like his parents, he did not know how to ask the right questions. His social abilities and eye contact were almost inexistent.


    My work with Scott started in the haematology/oncology clinic. Initially, I only used puppets. Scott was a passive spectator and listener. I gave him a lot of information with the help of my dolls and tried to impart the necessary contact skills to him. He seemed to be very interested. I just hoped that he assimilated them sufficiently. Scott was a child that did not say much, but we learned how to have contact with each other. He learned how to talk to me and I learned how to understand him with the poor quality of the few words he spoke to me. In this silence, I often had to guess what he expected or wanted to know.


    I never could have imagined how important a book and a doll could be to help children understand themselves as well as the situation in which they had ended up. Scott became seriously ill and was transferred to an isolation room. Probably because they were not able to cope with the fact that Scott was dying, his parents all of a sudden no longer came to the hospital to see him. Scott was abandoned without getting an answer to, what I thought, was his most important question: "What's happening to me when I die?" But no, he only asked: "Why have my parents abandoned me now?" So, what could be done in order to fill the emptiness since his parents did no longer come to the hospital?


    I thought it was my duty to tell Scott that, in spite of their absence, he would never be alone. As the child was very tired since he had been transferred to the isolation room and as every physical effort was one too many, I suggested that I should read to him with the puppet. He approved the idea. I then started a new and unknown journey as I did not know at all to where the books and stories would bring us. I started with simple questions such as "Do you want me to read to you?" - "Yes" - "Which book do you prefer?" - "I don't care". I then took the book "Abel's Island". It was a story about a mouse that goes for a pick nick with her family and ends up in a storm. The story then tells about the physical efforts the mouse has to make in order to return home. We had a lot to discuss.

    I then decided to use alternative communication techniques. I first tried to remember what I knew about his parents and his home. "Your mom has pretty eyes. I think you have the same eyes." I then talked about things he had done with his family. "Do you remember coming to hospital, together with your little sisters? Do you remember us playing with the dolls?" And: "If you think of your parents, they certainly think of you too."

    I reassured Scott and he heaved a deep sigh. The doll and Scott sighed at the same time. Once he was relaxed, I let him close his eyes and I went on telling him about his family.


    Speaking became very difficult for Scott.

    The mouse in the book was dreaming and her dreams seemed real. Would Scott be dreaming as well? The mouse said: "Why does this happen to me?" Perhaps Scott asked the same question.

    Life became very difficult for Scott and for me. Every day, I looked through the window, with my heart racing, because I wanted to know if Scott was still there. I patiently waited for the doctor and listened to what he said about the time that was left. Of course, nobody knew that! I was worried. Would I be able to accompany him to the end?


    The last book I read to Scott was "There is a Rainbow behind every dark Cloud", a book that has been written by children who had to deal with severe illnesses and death. Even if Scott was no longer able to meet other children, he could meet them through that book. Scott did no longer ask questions, but he listened intensely. He made the link between his own experiences and those in the book. When I asked him: "Did you feel the same?" he nodded his confirmation. He was no longer alone.


    His endurance constantly surprised me. How could he stay alive in such condition? It was as if his brains were programmed in such way that he wanted to hang on until he would meet his family. He kept on until his family found the strength to pay him a visit. Three days later, Scott peacefully died in the presence of his family.


    I will never forget the effect and impact of these books and dolls on Scott and myself. The doll made Scott understand that somebody still cared for him and supported him in his unequal fight.

    There are so many ways in which we can have contact with children. It is only a matter of bringing the right story in the right way to the right child and introducing the right doll at the right moment.


    I often asked myself if I was naïve to think that I had been able to make Scott forget for a short while his mental and physical pain by reading him stories. This was however the aim I had wanted to achieve. I have now a different opinion about books. I learned a lesson from this exceptional experience: "Just listening" requires a lot of time and effort. One's inner self is troubled as the written story is experienced. Books and dolls relieve suffering.

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