Book review

Dramatherapy with elders and people with dementia: Enabling developmental wellbeing, by Joanna Jaaniste

Routledge, New York, 2023. 

Paperback: ISBN 9781032030302
Hardback: ISBN 9781032030326
eBook: ISBN 9781003186328

Reviewed by Kirsten Meyer

Dramatherapy with elders and people with dementia: Enabling developmental wellbeing is an important and welcome contribution to the field of dramatherapy, the arts therapies and aged care. Exploring Western concepts of aging, dementia and dramatherapy, Jaaniste carefully weaves theory, research case examples and personal anecdotes together in this book. While situated in the Australian context, the book speaks to the universality of what it means to grow older, as well as the value of working actively through dramatherapy to create connection with self and others, past and present, to meet the developmental tasks of living and aging with dementia. Jaaniste’s book forms part of a series, edited by Professor Anna Seymour, Dramatherapy: Approaches, relationships, critical ideas. It complements two others: Haythorne, D. (Ed.). Dramatherapy and autism and Seymour, A., & Morris, N. (Eds). Dramatherapy and borderline personality disorder. This valuable series brings together leading practitioners and researchers in the field of dramatherapy to explore theory, practices and the evidence base for dramatherapy.

In a recent global survey of the field of dramatherapy conducted by the World Alliance of Dramatherapy (2022), preliminary findings indicated that only 4.68% of those dramatherapists who responded to the survey (n=409) are working with older adults. Given the ageing population is growing worldwide (Dunphy et al, 2019), this is interesting data and the reasons for dramatherapists not engaging in this area begs for deeper exploration. Jaaniste’s book offers up valuable research into the need for more dramatherapy interventions in this space. This book feels likes a coming of age for Jaaniste, bringing together her extensive research and publications (2011a, 2011b, 2013, 2015, 2016) concerning older adults and dramatherapy. She is a leading practitioner, researcher and an elder in the field, and it is interesting to note the autoethnographic stance Jaaniste takes, acknowledging her purpose to be one of witness “to her own developmental stage on life journey” (preface xvi).

Jaaniste chooses to use the term “elders”, noting that even though gerontologists consider this stigmatising, she purposefully borrows from Indigenous Australian practices, where the term “implies a certain wisdom that is present in older people, whether they have dementia or not” (preface xvi). Through this choice, Jaaniste sets the tone for the book, challenging Western capitalist thinking of privilege and the quality of life as people age. The book is an extension of Jaaniste’s doctoral research, where she chooses to centre a humanist perspective, honouring the stories and work with elders (with or without dementia). The work is bookended with a forward by Caroline Miller, and an afterward by Sue Jennings, who are also elders in our field.

Central to the book is Jaaniste’s critique of the recent Australian Aged Care Royal Commission Report (2021) that focuses on “quality of safety”, with little consideration given to quality of life (QoL) care from a person-centred perspective. The book takes up this challenge and offers a counter narrative to the dominant discourse in aged care. It moves beyond risk frameworks and invites scrutiny of the lived experience of the elders receiving such care, illustrating clearly what dramatherapy can offer: being in the here and now, playful and spontaneous interactions, imagination, sharing and listening to past stories, connection to one another and oneself. Woven throughout is what Jaaniste calls the “feeling intelligence” of those living with dementia, embracing the human qualities that go beyond a medical diagnosis, and validating the developmental process of getting older.

The book is divided into eleven chapters. Each chapter focuses on a theme, with theory, dramatherapy practice examples and references. The chapters build on each other, in keeping with the central theme of developmental journey, or “unfolding discovery that belongs to our humanness” (p.143). There is a developmental flow to the chapters starting with the exploration of Life Stages and Transitions and ending with the Mystery of Death. Jaaniste generously provides 16 group therapy session plans, excerpts of which are interwoven into each chapter. Chapter 1 begins with an exploration of life stages and transitions that detail investigative approaches emphasising what Jaaniste calls “a feeling intelligence”.

In Chapter 2, Jaaniste asks what it is like to have dementia. Using contemporary neurological theories, she explains the different types of dementia, noting typical symptoms. Some of these symptoms overlap with what is normal in the context of aging, for example, forgetfulness, social withdrawal, feeling close to people who have died, etc. Jaaniste references the thoughts and feelings of those living with dementia in this chapter. She focuses on movement, song and embodiment, as well as the metaphor of growth.  

Chapter 3 moves into the role dramatherapy can play in the lives of elders and people living with dementia. Jaaniste speaks to the capacity of dramatherapy to holistically integrate mind, body and emotion. The value of this to an elder with dementia (as it is to all people) is that it resists various forms of splitting – both in the arts and in oneself. Acknowledging that each has equal value, Jaaniste focuses on the role of play in development, generally, but particularly in people living with dementia.

Chapter 4 focuses on the research project Jaaniste conducted for her doctoral thesis. In this chapter she argues strongly for a person-centred QoL approach, drawing on her case studies to illustrate the role dramatherapy can play in enabling this. Chapter 5 focuses on the intelligence of feeling, exploring memory, feelings and finding meaning in memories.

In Chapter 6, Jaaniste highlights both the possibilities and potential risks of modern technology’s use of artificial intelligence, arguing against robots doing the caring work for elders, and stresses the importance of relational human care in this sector.

Chapter 7 moves into theories of trauma and intersubjectivity in dementia, illustrating the use of dramatherapy to allow safe uncovering of early childhood trauma in peoples’ developmental stories. Recovery is iterative and ongoing, never ceasing until the day we die.

Chapter 8 focuses on the processes of grief and loss in old age, highlighting the importance of spirituality and religious affiliation for many as they age, noting it as important for how we make sense of life and impending death. Jaaniste makes a strong case for dementia care to recognise the importance of this, leading into Chapter 9, which explores the mystery of death.

In Chapter 10 Jaaniste discusses dementia assessment and evaluation, emphasising the importance of documenting processes to further our profession and the evidence base for it. The final chapter serves as a conclusion.

Janniste’s book will appeal to dramatherapy academics, practitioners, allied health professionals, carers, or anyone interested in a strengths-based, person-centred approach to aging and dementia care. For those of us privileged to live a long life, we will certainly all age, experience loss, grief and change. This alone is reason enough to read it. I was left with welcome but nonetheless discomfiting reflections. I found myself reviewing my impressions of older people and the invalidating stereotypes that shape our cultural perspectives. Why isn’t there more dramatherapy work happening in the fields of aged care, aging and dementia sectors? Jaaniste leaves the reader with more questions than she perhaps intended, turning the lens and gaze right back on us as readers, researchers, and practitioners. What are our views of ageing? Where do these come from? How do they influence the way we view older adults, ageing and dementia? How do we avoid turning away out of fear of what we all must confront if we live long enough?

References

Dunphy, K., Baker, F.A., Dumaresq, E., Carroll-Haskins, K., Eickholt, J., Ercole, M., Kaimal, G., Meyer, K., Sajnani, N., Shamir, O.Y., & Wosch, T. (2019). Creative arts interventions to address depression in older adults: A systematic review of outcomes, processes, and mechanisms. Frontiers in Psycholology, 9, 2655.

Jaaniste, J. (2011a). Dramatherapy and dementia care. In T. Adams & H. Lee, (Eds), Creative approaches to dementia care (pp.54–72). Palgrave Macmillan.

Jaaniste, J. (2011b). Dramatherapy and spirituality in dementia care. Dramatherapy, 33(1), 16–27.

Jaaniste, J. (2013). Pulled through a hedge backwards: Improving the Quality of Life of people with dementia through dramatherapy [Unpublished PhD thesis]. University of Western Sydney.

Jaaniste, J. (2016a). The role of dramatherapy in improving quality of life. Australian Journal of Dementia Care, 5(2), 24–26.

Jaaniste, J. (2016b). Lifestage and human development in dramatherapy with people who have dementia. In C. Holmwood & S. Jennings (Eds.), Routledge international handbook of dramatherapy. Routledge. https://doi.org/10.4324/9781315728537

Jaaniste, J., Linnell, S., Ollerton, R.L., & Slewa-Younan, S. (2015). Dramatherapy with elders with dementia: Does it improve quality of life? The Arts in Psychotherapy, 43, 40–48.

Pillow, W. (2003). Confession, catharsis or cure? Rethinking the uses of reflexivity as methodological power in qualitative research. Qualitative Studies in Education, 16(2), 175–196.

Royal Commission into Aged Care Quality and Safety. (2021). https://agedcare.royalcommission.gov.au/publications/final-report

World Alliance of Dramatherapy. (2023, February 2). Global state of the field: Preliminary findings (Paper presentation). NYU Drama Therapy Theatre and Health Lab Symposium: Foundations and Futures 2023, New York, USA.