Transcending Dementia Through the TTAP Method is one of a growing number of publications about the role of the arts in promoting wellbeing for people with dementia. The Therapeutic Thematic Arts Programming (TTAP) method originated in America and was developed by Linda Levine Madori. She describes it as combining ‘the principles of therapeutic recreation and creative arts therapies into a single, structured technique that stimulates different areas of the brain through all creative arts forms, linking each project to a specific brain function’ (p. 25). This book is very much dedicated to exploring the approach in detail, describing the various elements and steps of the TTAP method, and relating these to a wide range of theories about ageing and dementia.
Chapter One begins with an overview of Alzheimer's disease, focusing on a ‘stages approach’ (mild, moderate, severe) and this is followed in Chapter Two by a general overview of the TTAP method and the potential benefits of ‘thematic programming’. This use of themes is seen as central to the overall method both for the person with dementia and for the therapist. Madori emphasises how it is this thematic programming that ‘facilitates creative thinking, then brainstorming and finally implementation’ (p. 27). Further detail is provided in Chapter Three, which looks at some of the communication difficulties facing many people with Alzheimer's disease and how the TTAP method addresses these.
Chapters Four and Five of the book are dedicated to placing the method in a broader theoretical context. These chapters are all encompassing and variously relate TTAP to studies on brain plasticity, the phenomenon of cognitive reserve, Bloom's six levels of learning, and Gardner's seven learning styles. Chapter Six goes on to look at theories of ageing that stress the importance of activities throughout the lifespan: again Madori discusses a number of other ageing and human developmental theories that the TTAP method integrates, including person-centred theory; neuro-developmental theory; object-relations theory; theme-centred interaction theory; and the theory of gerotranscendence.
Clearly the TTAP method has been welcomed by the wider community of recreational therapists and care staff working with older people and people with dementia. The book describes how Madori's approach has been implemented across Australia, America and Finland. Her focus on themes and the utilisation of a multi-modal approach has much to recommend it, providing opportunities for participants to engage in arts activities which stimulate all the senses. She also challenges a number of existing pre-conceptions in relation to what people with dementia can achieve and I particularly liked her exploration of meditation and relaxation in this respect. All these elements are to be commended, particularly her emphasis on recognising and drawing on individual strengths.
There will, however, always be an uneasy tension in approaches which focus on the arts and emphasise the promotion of self-expression and freedom of creativity, yet at the same time advocate a structured and formulaic approach. Little detail is provided in this book on how to manage this tension. Similarly, while the book very much advocates an approach which recognises the value of person-centred care, descriptions and theories are highly medicalised and the voices of people with dementia are at times absent.
My other main concern is that although the book draws on a wide range of research and makes a number of broad claims in relation to the evidence base to support TTAP, it should be noted that these studies are extremely small. While research undertaken in 2008 included 50 participants, these were well older people. Studies focusing on people with Alzheimer's disease had smaller numbers of participants (between four and eight). Clearly Madori recognises the need for further research and the book ends with the call for more studies on the effectiveness of therapeutic art and recreation for those who have Alzheimer's disease.
Placing these concerns to one side, the book provides a clear and detailed description of the TTAP method and would offer a useful complement to other arts-based approaches used to engage with and promote the wellbeing of people with dementia.
