Nicole Barrett

TOG is a system that assists psychiatric professionals in their selection of appropriate grounding objects with their clients who dissociate. It is an interactive therapy tool that allows therapist and their patients to interact in a new way that extends the benefits of therapy to be more present in the daily lives of these individuals.

Introduction

TOG is a tool that is intended to be used within a therapy environment between the client and the therapist. The project objective was to create a “grounding pack” of objects for individuals with dissociative episodes and was developed with the assistance and guidance of the BC Psychological Association.

In September 2013, this project was pitched as collaboration between Emily Carr University and Dr. Gayle Goldstein, who is connected to the BCPA. The preliminary goal was to provide tactile and natural ways for patients to carry the benefits of their therapy work outside the office to help them feel more grounded. I took a focused approach to the project, primarily designing for DID or Dissociative Identity Disorder which was formerly known as Multiple Personality Disorder.

Dissociative disorders are mental health issues that impair the normal state of awareness and limits and/or alters one’s sense of identity, memory or consciousness. People with DD have issues with losing touch with reality and often work with therapists to bring themselves back into the current situation.

How can design be used to create a way for people with dissociative disorders to manage or reduce fragmenting in their daily lives?

How can the therapy work be taken out of the office and into the daily lives of individuals with dissociative disorders?

Objectives

The process began with a large survey of research to determine the scope. Overall, the design was going to be based on the needs and comfort levels of the target user. There needed to be an investigation to determine the gap between what the user said they wanted and what they needed. This was a fine line as I was working with a vulnerable group of individuals but the design would not be effective if it did not push some boundaries.

After the initial meeting and investigation, I determined that the design needed to not only be a kit of objects for grounding but a system in which the patient learns different options for counteracting dissociation with the help and support of their therapist. The objects needed to be made from natural materials and address the idea of comfort vs. pain.

How can these extremes be incorporated to create multi dimensional objects that would offer different forms of grounding for a variety of people and situations?

The design needed to not be a series of objects but a system. The system was based around the basis of the trust relationship between the therapist and the client. As a designer, it was not my role to determine the best course of treatment for a patient in a vulnerable state. Rather, it was my job to decipher how to create the best possible tools I could offer the therapist in order to counteract specific problem symptoms (such as fragmenting, anxiety).

Co-Creation

Users of this product will come from a wide range of ages, social and ethnic backgrounds, income levels, education levels and genders. I wanted TOG to be a tool that can be used within a therapy environment between a client and their therapist. The aspirations for the artifacts/experience were for it to be clean and comfortable and to allow the user to have a positive and motivating experience. It was important to improve quality of life for the user and allowing them more on the go tools to cope in their daily life.

I designed and ran a series of co-creation activities that investigated ways to use sensory stimuli to help individuals maintain a sense of composure and ability to stay in the present. This co-creation session helped me to gain an understanding of day-to-day activities of the common user as well as reactions to sensory stimuli (ex. Fabrics, perfume swatches) As well, the session explored coping mechanisms and techniques already employed by the user(s). No photos or video were taken during the session(s) so I will provide an analysis to sum up the results. I began the co-creation with a questionnaire. Some example questions were:

I began the co-creation with a questionnaire. Some example questions were:

• Do you carry any items with you on a daily or semi-regular basis that you just enjoy or like?
• Do you view these items as essential even if they are not necessary?
• How many of these items are necessary? (i.e. your day wouldn’t really work without them)

Analysis

I took the co-creators through a series of tactile activities where they rated things on a scale of greatly like to dislike. Through this, we were able to determine which objects and smells made them feel comfort and the ones that made the uncomfortable or could act as a trigger. However, it was also determined that comforting objects (soft and warm) may not be the most effective tools to counter fragmenting. Pain or adverse stimuli may and can be used as a tool.

Insights

Anything can act as a trigger; noise, smells, tastes, sounds, touch.

• Hallmark of dissociative disorders is that sense is hyperactive or muted
• For DID, the goal is to help to prevent fragmentation
• Fragmentation is the brain coping
• Fragmentation can be a choice but is often a default
• The person should feel in control
• Pain or adverse stimuli can be a tool
• Help to counteract the triggers for dissociation
• Helps to soothe, comfort and empower

Survey

In addition to the above co-creation session, an anonymous online survey was given to assess the connections people have to the objects they interact with on a daily basis. I wanted to asses what makes that connection and how they are connected to sense and memory.

User Testing

Strategy

The testing strategy was particularly challenging. I needed to test the effectiveness of the prototype without putting co-creators in any undue distress. How was I to determine the effectiveness of the design and identify any changes needed without being able to truly put the design in context? I decided to simulate the experience of a normal therapy session by running a series of mock trials that tested the experience of the prototype and opened up dialogue about the effectiveness of the objects themselves.

This user testing session was set up to understand the best possible system and design for both the objects and the container with a focus on but not limited to aesthetics, material choices, sensory interactions with the objects, colour choices and look at expanding the spectrum of objects. This user testing session was intended to determine the final design direction of the objects, the container and the system of how they are used within a therapy setting.

Patient centred design

The final design of TOG includes a wood container and a set of objects that are made from three different materials: wood, ceramic and fabric. The objects are small and hand-held and offer a range of tactile stimuli ranging from textured to smooth and heavy to light. They were developed to be ergonomic, intriguing and inviting. The user should be drawn to begin the interaction with the objects.

The objects themselves have been created with specific symptoms in mind. The objects will be used as tools that the patient can work into their therapy plan. They will offer a variety of safe methods to counteract dissociation including jarring and/or painful stimuli. These will include rough textures or points on the materials. As well, some of the objects will engage the user mentally in tracing a pattern or completing a small task (i.e. putting their finger through a small hole). The anticipated outcome for the user is to help counteract dissociation and dissociative symptoms by offering alternatives that engage the senses.

The container itself allows for a safe and easy interaction for the user with the objects. The objects will be used both in the therapy session as well as offered as tools for the patient to take away.

Each therapist will determine their own treatment plan with the objects depending on the needs of the client. The client may use the objects in their daily lives as a way of counteracting the dissociative symptoms. Overall, the goal of the therapy kit is to allow the therapist will work with the client and help them to find new and safe ways to deal with their dissociative symptoms.