Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers

Cheyann J Heap & Emma Wolverson (2018) in Dementia, online.

Introduction: According to the authors of this paper, due to ‘the medicalisation of dementia … dehumanising social practices and attitudes are enabled, and reinforced by medical discourses of dementia which have become societal discourse … Within the medical societal discourse, people with dementia are excessively medicated.’ Also, ‘Intensive Interaction assumes that all interaction partners can be meaningfully engaged [and] … can offer an alternative to medicalised discourses (and by proxy, the dehumanising practices enabled by such discourses).’

Study Method: Paid staff from two residential care homes attended an Intensive Interaction training day. These caregivers took part in 2 focus groups before and after the Intensive Interaction training. Transcripts of the focus groups were then analysed using the method of Critical Discourse Analysis, an approach which ‘relates discourse to social power’. The focus group discussion were based on 5 themes identified as missing in medical/societal discourse: ‘personhood’, ‘communication’, ‘embodiment’, ‘reciprocity’ and ‘empathy’.

The Results: Before the Intensive Interaction training carers engaged in ‘medical discourses of loss, non-communication and lack of personhood’. Carers also talked about a lack of resources (time and staff), with job role/hierarchy being important in allowing time (and permission) to interact with residents. “Being with” people with dementia was framed as ‘inactivity’ (‘sitting’, not ‘working’) or ‘a luxury, and therefore separate to paid work within ‘an industrial model’.

After training, caregivers engaged in ‘discourses of communication and personhood’. Intensive Interaction reframed “being with” people as a part of ‘doing work’. Staff viewpoints significantly shifted with carers talking about going ‘into the world’ of the person with dementia, and they also thought that ‘Intensive Interaction would improve relationships’. Intensive Interaction was also seen to ‘legitimise and explain existing relational and creative practices’. However, there were worries that managers might be critical of the approach ‘unless they had training to understand the discourse (e.g. ‘mirroring’ not ‘mimicking’)’.

Some Conclusions and Discussion: According to the authors medical discourses of dementia reinforce ‘a status quo whereby interpersonal interactions are devalued in dementia care, and professional ‘knowledge’ (thereby professional power) is privileged over relationships’. The medical model also frames a person’s problems as being of the ‘individual’. Therefore ‘if distress, loneliness and lack of occupation are framed as an illness, rather than a legitimate response to one’s circumstances, society does not have to change. This fits well with an individualistic, industrial model of society, whereby medical and social care institutions are focussed on economic efficiency’.

However, Intensive Interaction may enable paid caregivers to ‘access person-centred discourses’ (including ‘hopefulness’) and develop related practices aimed at improving a person’s quality of life. However, without wider systemic change in dementia discourse, Intensive Interaction training will be limited in its effectiveness. The adoption of Intensive Interaction requires ‘support from management, organisational structures, and wider society’.

In conclusion, according to the authors ‘suggestions for future research into dementia care can be orientated around one basic principle: honouring the personhood of people with dementia. This is with a view to providing person-centred, ethical care – by improving communication, enhancing relationships and providing care from a place of collaboration and shared humanity.’

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