Creative Clinical Tool

Bernice incorporated the Rippling Conversations game into two of her current clinical sessions with patients with dementia living in a residential care facility. The result was positive as the toolkit turned out to be a helpful creative tool for patients to express themselves. And for the facilitator, Bernice mentioned how she could get to know her patients on a deeper level. The samples of marbling art shown here were not those done by the patients, as Bernice was unable to provide me with them due to ethical reasons. The samples were created by us to be used in the showcase on the educational website (www.intergendesign.com). After implementation, I conducted an interview with her to gather more insights into her experience.

Interview with Bernice Lin

Hi Bernice. After conducting the activity for two of your clinic sessions, how was the experience like for you? Were the tools and materials (planning questionnaire, step-by-step guide, video) useful in helping with your planning and facilitation? 

Bernice: I guess right from the start, I liked how the information was presented to me on the website (InterGen Design). It was very user-friendly and intuitive as I can easily access the step-by-step instructions and materials. I’m not usually a tech-savvy person, but this was very straightforward and easy to read. Sometimes when there are too many words (on websites), it can be very off-putting. But this was very clear-cut. All the key information have been presented clearly on the webpage.

How about the game itself? Was the activity easy to conduct?  

Bernice: The preparation was quite minimal, so I didn’t feel overwhelmed or resistant to use what was already available. In terms of the game itself, I am not really sure as everything was prepared for me. My focus was on conducting (the sessions) and sieving out those questions that could be relevant. 

Do you mean that you are unsure because in future you might need to prepare the kit on your own? 

Bernice: Yes. If I were to prepare the kit myself in future, I would require a list of materials to make the kit. Otherwise (for this pilot), everything had been made available. There were already enough questions for me to conduct one session of group therapy, so the important part of this process was for me to decide which questions (conversation cards) to use. I find that it’s not about answering the questions per se. Rather, the questions helped kickstart conversations with the patients. The cards were a way for them to physically see, hold, and process these questions, instead of just hearing them being asked. From there, they could even start another conversation that was unrelated to the question on the cards. 

So, I’m curious to understand if these narratives (shared by the participants) and also the act of remembering their past important in therapy work? 

Bernice: That would depend on my therapeutic objective for the group. Although this (narratives and reminisce) was not my intention, it turned out to be one surprising area of improvement. My objective was to encourage social interactions and communication among the group. However, many of my patients actually did recall their past. The activity gave them a stage or an avenue to talk and share freely about themselves to the rest of the group. And in the process of sharing their identity and about their past, they gained certain benefits. One example would be improving their senses of personal agency. The ability to make choices and allowing them to act intentionally are important. In the usual setting, my patients have limited power to voice their opinions or talk about themselves extensively. So, this was a chance for them to do so.

Has the activity with your patients gave you new insights or has it influenced your practice in any way?

Bernice: Yes. I guess it informed me about what I can or cannot do with the elderly patients. One surprising finding was their reactions to the number of options I gave them during the sessions. I started working with this group of patients thinking that a limited number of materials would be more appropriate. In this case, the kit had many options (craft materials and marbling ink colours), and they enjoyed fiddling with and picking the stuff they wanted out of the box. 

Was there any differences between this game with your other activities?

Bernice: The marbling game itself was fun. I won’t say that it’s different. It’s more an alternative way for them to play. It ia an art directive with a “play” element. 

I see. Were the previous activities mostly individual work? 

Bernice: I find it more appropriate to have patients do some individual work in the early sessions. Then, as the group matures and develops, I would start introducing group artmaking. Perhaps, in the past, I would not have valued “play” elements in practice. This game has been good starting point for me. 

Are there any improvements you think this could have? Were there any difficulties you encountered or extra facilitation needed? 

Bernice: The fine motor skills of elderly persons are not very good. The dropper bottles turned out to be challenging for them to use. Another thing was that the water tank was too high. As most of my patients were either seated or wheelchair-bound, it was difficult for them to look at what was happening inside the tank. 

Perhaps, in future, we can try using a lower water tank? 

Bernice: Yes. Maybe a transparent one so they can see the colours floating inside the water tank while being seated. That might be more effective. 

Would you consider incorporating this activity as part of your practice for other clinical sessions or other programmes in general? 

Bernice: Yes, definitely. I don’t think there’s a lot of marbling work done in therapy. This is a very nice “controlled” activity that could be introduced to my future patients. In terms of questions, patients were more receptive to some questions than others. I felt that the “Learn” cards most effective in eliciting verbal sharing. Questions
that required patients to “Imagine” were slightly more challenging. The patients had no particular issue with sharing about the past (“Reminisce” cards). 

Do you think it’s feasible to conduct this as a series of art sessions or a programme, where you would start with the easy questions in the early sessions and then progress to the harder ones in the later sessions? Do you think this could work? 

Bernice: I would use this activity at a later phase of the therapy. And probably, a longer-term one. If I were to run the activity at the early stages, the group would not have matured to a stage where they could just talk freely. This is also provided that the activity aligns with my therapeutic objectives for the group. 

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