We have wondered if the reason for this is actually a hangover from ‘old culture’ attitudes, and old-world emphases on the word and the concept of ‘care’. Nowhere is the term ‘care’ more overworked than in the field of older people and people with dementia. The terms dementia care and dementia carer are common currency, as are elderly care, home care, respite care, day care, carers’ support, etc., etc. And there is of course nothing inherently wrong in the use of these terms. It is not until we understand the term in contrast to the term ‘therapy’ that a question mark appears. For we don’t have elderly therapy or home therapy or day therapy; neither do we have occupational care or speech care or psycho-care. Why not? Well, it all seems to hinge on a concept of potential for change. Generally speaking carers care, with no anticipation of response or change on the part of the one cared for. Care is, effectively, one-sided – a ‘doing-to’. Therapists care, on the other hand, with every expectation of change in the one cared for. Therapy is reciprocal – a ‘working-with’. Care ministers, and expects nothing of the cared-for. Therapy demands, and expects much of the cared-for. Therapy does not accept the status quo. Therapists work with a person towards change, improvement, growth, adaptation – and herein lies the difference.

Building then on this comparatively recent cultural shift, we would want to add a further challenge: that we actively embrace the terms ‘dementia therapy’ and ‘dementia therapist’, and if not the terms, at least the concepts. For there is a movement, a reciprocity, a dynamic about therapy that is lacking in care, and as the culture continues to evolve, it is movement and change which are going to take us forward.

What would be the role of a dementia therapist, and who would take such a title? Well, it is conceivable that anyone who has a sustained and direct involvement with a person with dementia could take such a title. We ourselves could probably legitimately take the title, for all of our work revolves around people with dementia. But then we would perhaps lose something of our specialism (or there would be a perceived loss from outside the field), for we are first and foremost occupational therapists; occupation is our contribution and complements that of other disciplines. The RMN or the social worker who manages a residential establishment would probably also want to retain their own distinctive title and specialism.

We have wondered if maybe this is a role and a title for those whom we currently most commonly call care assistants. Now we know of course that of the many thousands of people who hold that title across the country, a good proportion do just that – assist with care. But we know, too, that there is also a good proportion who do considerably more than just assist with care. We all know those who genuinely love and give of themselves in the service of those for whom they have responsibility – people who make mistakes to be sure (don’t we all?), but people who thirst for knowledge, who avail themselves of every possible opportunity for training, and who turn a job into a vocation. And most of us in the professions feel distinctly embarrassed that this army of skilled and devoted people should not attract a title, status and salary commensurate with their abilities and the quality of their service. We believe that this undervalued and underpaid group are worthy of recognition, and have wondered if a new role of dementia therapist might redress the balance.