The THELIA Project

Project Description: Theoretical and methodical basis
Aims
Results
Publications and Materials

Project Description

Theoretical and methodical basis

Within the THELIA project we developed the “Companionship on Themes of Dasein” which concentrates on the individuality and sociability of people with dementia. It involves training a non-demented person to provide companionship to a demented patient in connection with themes relating to themes in his or her life (“Dasein”). The Companion of Themes of Dasein serves as a partner to talk about life themes and to share things which are important to the demented person with. The ultimate goal of the project was to activate the person’s identity and mental self by providing opportunities to discuss and interact on topics important to the patient, which was assumed would increase their quality of life. Additionally, the intervention would also expected to have the potential to enhance further development and maturation of the patient.

The construct “Theme of Dasein” is the central aspect of Hans Thomae’s dynamic-cognitive Theory of Personality (1951, 1968, 1996) which ensures biographical continuity.
Themes of Dasein result in the guiding themes (“Leitthemen”) of man. Closely connected
to the Themes of Dasein are motivations (“Gerichtetheit”) and extended coping strategies as well as spontaneous strategies (“Techniques of Dasein”), which enable the individual to mature and deal with difficulties. The guiding theme of man is a should-be-pattern of human existence as it should be, which we follow until we die. Activation of this guiding theme is a way of achieving a clear, comprehensive sense of being. From a psychological point of view, we can refer to this as an autotelic movement in Dasein (cf. Stern, 1923).

Methodologically, we initially attempted to comprehend the person within their daseins-thematical cognitive structures by using specific social situations (“Sozialität”) allowing open and honest communication (Thomae, 1968, 1996). This created a situation in which the individual felt understood, enabling them to communicate better.

In order to assess the patient’s daseins-thematical structure, a semantic network structure technique called the “Heidelberger Strukturlegetechnik” (Groeben & Scheele, 1988) was combined with Kelly’s Theory of personal constructs (1955). This method represents a comprehensive way of illustrating subjective theories of self and the world, which are expressed in temporal, spatial, social and mental dimensions (“life space” after Lewin, 1935). Based on this information, we constructed individual interventions involving communicative and behavioral elements, which are intended to further unfold in the process of personal interactions with the companion. Thus, the intervention activates, updates, and develops the demented person’s individual Daseins-themes.

Aims

Firstly, the study aimed to enhance psychosocial interventions for people with dementia. We therefore applied a strictly theoretically derived method by using the nomopragmatic translation of a nomothetic concept. Secondly, in the THELIA project we made use of the potential for solidarity within the older generation. Volunteers who were themselves in the third age were trained in the technique of Companionship on Themes of Dasein and met older people with dementia living in a nursing home. The companion received an intervention plan listing a number of themes or activities which were known to be important to the demented person and were asked to talk about them. Regular meetings were scheduled to take place twice a week over the course of a month. As a specific outcome, it was anticipated that demented individuals would experience a greater sense of well-being as a result of the intervention. As a more global outcome, it was expected that the companions would benefit by developing their humanistic capacities and experiencing greater meaning in life.

Results

The intervention was evaluated with 18 nursing home residents suffering from the early, middle and late stages of dementia. Each resident was matched up to one volunteer. The effects were systematically evaluated within a controlled, two-factor repeated measurement design. Subjective well-being of the demented subjects was operationalised by the absence of depression and non-cognitive symptoms (e.g., psychiatric symptoms and deviating behavior). Specifically, we used ratings provided by the nurses caring for the subjects, using the Neuropsychiatric Inventory (Cummings et al., 1994) and the Montgomery & Asberg Depression Rating Scale (Montgomery & Asberg, 1979).

1. Effect on the group as a whole
The findings indicate a highly significant reduction of the NPI global score as well as a statistically significant decrease in anxiety. Additionally, dementia sufferers expressed a significant reduction in suicidal thoughts. The effects on depressive symptoms were complex. Apparently, interventions closely associated with a person’s guiding theme seemed to reduce depression. Nevertheless, these findings need to be repeated and to be investigated in further detail in future studies.

2. Analyses of subgroups
The study also focused on examining forms of personal continuation of the course of life as presented by the dementia sufferers in their interaction with their companion. Thus, a qualitative idiothetic analysis explored subgroups. Five typical forms of progression were identified: One in which the expression of an increasing burden plays the major role; another in which cognitive reframing that was started through the intervention characterized by searching and updating the guiding themes of human being is taking place; the third was characterized by stabilization of the sufferer’s identity; the fourth reflected rapid perception of details from the environment, indicating a willingness to find new themes, and the fifth and final form was characterized by stability of the themes of Dasein. In addition to this, subgroup analysis showed that such intervention counteracts apathy and agitation. The closer the daseins-thematic activities were connected to the individual’s guiding theme, the stronger this effect was. It was also possible to demonstrate an improvement in the ability to concentrate in the subgroup of dementia sufferers who used cognitive reframing.

3. Effects on the volunteers
As well as effects observed in the dementia sufferers, the analysis also documented effects on the volunteers serving as companions of Dasein. In particular, volunteers increased their levels of meaningful thinking as they mentioned more categories of sense in the Logo Test (Lukas, 1986) performed after intervention. Their documentation of the activities during companionship on themes of Dasein intervention are impressive records of the diversity of the patients’ inner worlds and indicate a special form of companionship with the dementia sufferers (“Mitsein”, after Heidegger, 1926) and even indicate that the volunteers experienced transcendent companionship situations.

Publications and Materials

Selected Publications:

Ehret, S., Kaspar, R., & Kruse, A. (in press). Daseinsthematische Begleitung zur Förderung der
Ehret, S. (2008). Ich werde wieder lebendig. Personale Geschehensordnung und Daseinsthematische

Selected Presentations:

Ehret, S. (2007). Ich werde wieder lebendig wenn ich die Carmen höre – Daseinsthematische Begleitung