Creative Clinical Tool

Bernice incorporated the Rippling Conversations game into two of her current clinical sessions with dementia patients living in a residential care facility. The result was very positive as it was shown that the toolkit became a new creative tool for patients to express themselves. And for the facilitator, Bernice also mentioned how she could get to know her patients on a deeper level. The samples of the marbling art are not those done by the patients as Bernice was unable to provide me with those due to ethical reasons. The samples are created by us to be used in the showcase on the educational website (www.intergendesign.com). After her execution of the pilot, 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 is very user-friendly and also very intuitive as I can easily access the instructions and step-by-step materials. Usually, I’m not a tech-savvy person, but this is very straightforward and easy to read. Sometimes when there are too many words, it is very off-putting. But this was very clear-cut. All the key information is presented clearly on the webpage.

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

Bernice: The preparation materials were quite minimal, so I didn’t feel overwhelmed and I don’t feel resistance to use what is 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 are 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 need to have the list of materials to make the kit. But otherwise (for this pilot), everything was available. The important part of the process was for me to decide which questions (conversation cards) to use. And there were already enough questions for me to conduct one session of group therapy. Sometimes, I find that it’s not about answering the questions per se. But rather, the questions help to kickstart the conversations with the patients. And by giving these cards to them, it was a way for them to physically see and process these questions, instead of just hearing them being asked. In a sense, there is an art element to this, and this provided them with a visual way to look at a question. From there, they could even start another conversation that is unrelated to the question on the cards. 

So, I’m curious to understand if these narratives (the participants share) 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, that turned out to be one surprising area of improvement. Many of my patients actually did recall their past. However, my objective was more on improving social interactions and communication among the group. The activity also gave them a stage or an avenue to talk freely about themselves and also share with the rest how they feel. And in the process of sharing their identity and about their past, they gained certain benefits. One example would be giving them a sense of personal agency. The ability to make choices and allowing them to act intentionally are important. Otherwise, in the usual setting, my patients don’t have the power to voice their opinions. So, this is like their only chance to do. 

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 my 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 they needed a lot of materials for the session. But in this case, the kit has many options (craft materials and marbling ink colours), and they liked to fiddle and pick the stuff they wanted. Perhaps, I could also give my patients more options in future. 

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 of an alternative way for them to play. I would term this as an art directive with a “play” element. 

I see. Were the previous activities mostly individual work? 

Bernice: My usual practice is to let them do some individual work in the early sessions. Then, as the group matures and develops, I would start introducing the group-based activity. Perhaps, in the past, I would not have thought of introducing “play” elements to my practice. But this game is a good starting point for me to start doing so. 

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

Bernice: I guess for the elderly, their fine motor skills are not very good. The dropper bottles turned out to be challenging for them to use. Another thing is that the water tank is a tad 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, it was also because of the height of the table or the width of it. 

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 will be nicer. As for the questions (conversation cards), I could vary them, and I didn’t insist on my patients answering all of them. It was just for them to start sharing verbally with the group. 

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, I realised that even though I had sieved out the questions for the two trials. Some questions seemed more friendly to them than others. I felt that the “Learn” cards were the best, as they were able to talk about themselves freely. As for the “Imagine” cards, those questions were slightly more challenging for them. But they had no issue with sharing about themselves or what they did in 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 perhaps, a longer-term therapy. If I were to run the activity at the early stages, the group would not have matured to the stage where they can just talk freely. If it’s going to be a six-months programme, maybe I would introduce it in the 5th or 6th month for a few sessions. If it is a relatively brief programme (similar to this pilot study), then I will just use it once or twice, and also provided that the activity aligns with my objectives. 

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