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Wardipedia – 70. Comfort objects

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Touchy feely

Introduction

Cuddly toys, snuggly blankets, toys, photos, ornaments, clothing (eg fluffy dressing gowns), pillows…. Certain objects soothe, reassure and comfort us. They provide an emotional anchor to ‘feel good’ memories or associations, making us feel a little bit better in the here and now. Some of the classic features include soft, tactile, or childhood associations or anything which provides a warm emotional link.

Some patients bring these kinds of objects to the ward with them; they accompany them on their (often very traumatic) journey providing a level of solace and security. While being attached to an object like a soft toy or blanket can seem quite childish, it’s actually an important and healthy process for adults. Objects (along with their familiar smells, textures, tastes, sounds and appearances) can evoke specific memories, thoughts and feelings about comforting relationships and experiences.

Comfort objects are an essential component of  soothing kits for relevant wards, most obviously teddy bears and other cute, fluffy things along these lines:

We strongly support patients bringing comfort objects with them to the ward and encourage staff to validate this. However, it’s probably best to avoid bringing in a rare collectible 19th century teddy bear as things can have a tendency to go missing on wards. So a  small replica or photo might be an acceptable substitute.

Shabby teddy bears, fluffy sharks, hairy orangutans – these and a zillion other toys are greatly cherished, and become ‘comfort objects’ at time of stress and distress. The literature tends to refer to them in these contexts as ‘transitional objects’. The highly influential paediatrician and psychoanalyst Donald Winnicott coined the term in 1951 to refer to any object (typically something soft such as a plush toy) which a child regards as particularly special to them. Winnicott identified that having the comfort of a beloved object helps kids make the transition from reliance on their mother to the start of greater independence. It’s now well recognised that we continue using ‘transition’ or comfort objects through our adulthood, with not just soft toys but also photos, souvenirs and other items which we warmly associate with happy times, places and relationships.

What comfort or transitional objects can represent:

  • Emotional memories
  • Something specific about the item
  • When it was given to them
  • Who gave it
  • What traumas and joys it’s seen the owner through
  • What it reminds them of eg a soft toy dog or cat which brings happy thoughts of patient’s pet.

Benefits of comfort or transitional objects:

  • They can provide a springboard for conversation, including in therapy
  • Staff can use them proactively, e.g. including the comfort object when a patient is very distressed or disoriented
  • They can help prepare the patient for sleep (eg as part of a getting to sleep ritual)
  • They can help staff and carers orientate within the person’s framework of who they now are
  • They’re soothing, reassuring, supportive, uplifting, consoling, reliable, constant, permanent (unless lost…)

In an interesting experiment, researchers found that “being able to touch the teddy bear while estimating its value seemed to provide existential comfort to participants with low self-esteem, reducing their levels of ethnocentrism, a common defensive reaction to reminders of death. Our findings show that even touching an inanimate object — such as a teddy bear — can soothe existential fears,” notes Koole. “Interpersonal touch is such a powerful mechanism that even objects that simulate touch by another person may help to instill in people a sense of existential significance.”

People with dementia having a strong attachment to a doll can produce very uncomfortable feelings in others, including relatives and staff. This attachment often has powerful, poignant associations with being a child playing with a doll and/or of being like a child who is being cared for. It can be very soothing, even orientating within the person’s framework of who they now are. Does it matter that it looks ‘odd’, or even disturbing? It may well be that for some people, and those who care about them, it really does matter. This might be because that individual had a traumatic background which cuddling a doll could retrigger or exacerbate. Or it might be part of the agonising dilemmas that relatives go through to try to balance staying true to who the person was before their dementia with accepting the irreversible change inflicted by dementia. (See info about validation therapy in Idea #68 Talking Therapies.)

What’s important is to separate out what is discomforting for staff (and visitors) and what is comforting for the patient. Many wards have a very ‘playful’ culture, one in which staff are willing to muck about – as vividly illustrated by the examples in Idea #28, Funnyness. In this sort of very engaged environment, staff have strong relationships with patients and their relatives and are well-placed to encourage, go along with or divert from doll playing.

People with Borderline Personality Disorder are one of the groups most closely associated with comfort objects and having soft toys with them in hospital. There has even been research whose write-ups (see below) could, on a pressurised day, be confused with promoting diagnosis by fluffy dolphin! Attachment trauma as infants is a primary cause of BPD, and as staff working with this troubled group know, attachment issues are often at the root of many admissions. Underneath all the self-harming and suicidality, there’s usually searing anguish, which the individual can only release in a highly visual and physical way. (See Idea #14 on multi-sensory resources. In fact, see each of #s 12-22!) An enlightened women’s secure unit introduced a bunny rabbit and (the notoriously difficult to impact on) rate of self-harming fell by 50%. Illustrating once more the therapeutic power of animals and why even a representation of a pet (i.e. via a fluffy toy) can be powerfully soothing.

 

 

Patient examples

  • Bringing in my favourite mug gives me a connection to home and my family.
  • I had a short nap every afternoon with my favourite blanket. I then felt rested and relaxed before my visitors arrived.
  • To the untrained eye – cuddling a teddy bear at the age of 30 might seem silly….but to those of us in the know – it smells of home and makes us smile
  • I have a special box from hospital which I kept letters, notes, drawings, items etc that I collected during my time in there. It holds such a lot of pain, such a lot of happiness and most importantly such a lot of evidence that things get better.

A little note from Marion Janner (founder of Star Wards)

This is a revealing photo of one of my favourite visitors when I’m in hospital, along with a comfort object. It’s strange but of all the many, many coming outs I’ve done over the year, being open about finding fluffy toys deeply soothing is about as humiliating as it gets. Yup, telling people that I’m a depressed, medicated, self-harming, suicidal, sectioned lesbian doesn’t feel a fraction as embarrassing as my menagerie of soft fake animals.
To compound matters, my cuddling of cuddly toys would appear to be stereotypical of people who share my condition, Borderline Personality Disorder. To quote from the article on transitional objects and people with BPD below: “A transitional  object brought  to the hospital may help remind the inpatient  with borderline personality  disorder of home or provide soothing during separation from home. The persistence of transitional objects into adulthood may inform  the therapist of possible transference paradigms that may develop in treatment.” I think we’ve had more than enough personal revelations for one little note, so I won’t comment on that last sentence!

Helpful practices

  • Selling comfort object in the hospital shop.
  • Asking patients if they’d like a visitor to bring them something from their home (e.g. soft toy, model racing car, snuggly scarf)
  • Feelings first! Concerns about age-appropriateness, stigma etc can be sensitively addressed, for example by encouraging patients who can cope not to clutch their pink fluffy elephant when the boss is coming for a visit. And encourage (or minimally avoid making them feel silly or mocked about) cuddling or looking at the object when they’re distressed, including people with dementia ‘nurturing’ a doll.
  • Comfort object as a leaving gift – offering positive memories of recovering in hospital, sustaining and prompting feelings of having been cared about by staff and patients.

Ward examples

  • “There’s a patient on the ward who used to run his own haulage business which he’s recently sold due to deterioration in his mental health. His wife brought him a model kit to work on while he was in hospital which was an exact replica of the truck he used to drive – the Volvo FH-16 Globetrotter. This meant an awful lot to him; not only does he have something positive to focus on, the model has become a kind of comfort and the source of good memories. We provide him with the space and resources he needs to work on this project.”
  • “There was a patient on the ward who had a massive soft cuddly toy dog. The dog which lived on her bed, became the focus of many conversations. At one point the patient was on level one observations for a while. Each member of staff who took over the observation was introduced the dog and was offered a cuddle with him. This was a little odd at first but it soon became a way to be accepted into the patient’s personal space and meet someone who was important to her.”

Anchoring: Creating Soothing Multisensory Links

As mentioned above, comfort objects are anchors to certain emotional states. In Neuro-Linguistic Programming (NLP), anchoring is the term that’s used to describe the process by which sensory memory recall is triggered by associated stimuli.

For example:

  • The smell of freshly cut grass (an olfactory anchor) may trigger a sunny memory of childhood summer holidays.
  • Or the appearance of your favorite coffee mug may stir up a state of cosiness and relaxation.
  • A certain song comes on the radio that makes you think of your ex! A tinge of pain instantly throbs in your chest like a piercing hot coal, coupled with a series of associated memories which dance through your mind uncontrollably.

It’s possible to form and reinforce anchors by repetition, i.e. continually repeating the association of a strong emotional state with the object (stimuli). In this way, anchoring is analogous to classical conditioning.

Sensory based modes that dominate mental processing

  • Visual – i.e. sight, mental imagery, spatial awareness
  • Auditory – i.e. sound, speech, dialog
  • Kinesthetic – i.e. somatic feelings in the body, temperature, pressure
  • Gustatory (taste)
  • Olfactory (smell)

Resource Anchors

Anchoring is an effective tool often used by NLP practitioners. One of the ways a practitioner may help someone is through installing a ‘resource anchor’. This technique rapidly moves the person into a resourceful state. It’s done by asking the client to recall a time in the past when they’ve felt the way they want to feel (i.e. more empowered or motivated etc) when the anchor is’ fired’ (eg squeezing their index and thumb together or stroking their toy seal.)

Emergency teddies
Intriguingly, the use of comfort objects in times of trauma seems to be well-established in America. According to Wikipedia: Stuffed toys are sometimes equipped in emergency vehicles and police patrol cars, to be given to victims involved in an accident or traumatic shock, to provide them comfort….Stuffed animals may be given by emergency workers, police, and others to victims of disasters such as fires and crime. After the September 11 attacks, writes Marita Sturken in Tourists of History, “the Oklahoma City National Memorial sent six hundred teddy bears and then the state of Oklahoma sent sixty thousand stuffed animals to New York, which were distributed to children in schools affected by 9/11, family support organizations, and New York fire stations.”

 

Categories: Empathy, Wardipedia
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