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

I was recently alerted to a new 'discourse analysis' research paper about the potential use of Intensive Interaction with people with dementia. The paper looks at the way people think and talk about caring for people with dementia; and how this care falls prey to medicalised ways of thinking, talking and responding. Below I set out a brief overview of the paper. 

Intensive Interaction and discourses of personhood: A focus group study with dementia caregivers:  Heap C. J. & Wolverson, E. (2018) Dementia, online.

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).’

The Method: Paid staff from 2 residential care homes attended an Intensive Interaction training day, with these caregivers taking part in 2 focus groups, before and after the training. Transcripts of the focus groups were 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 and 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’. (For more on 'Being with' - see my Blog of 18/12/17) 

Some Conclusions: 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'. 

However, Intensive Interaction may enable caregivers to ‘access person-centred discourses’ (including ‘hopefulness’) and develop practices aimed at improving a person’s quality of life. But 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’.