Jason A. Staal, Psy.D. (for more information about Jason: Click here!)
In a dichotomous manner, Snoezelen (multi-sensory environmental therapy, multi-sensory behavior therapy, and Snoezelen behavior therapy) appears to be perceived as either a clinical intervention or a leisure pursuit. The consequences of Snoezelen being divided into two parts are manifold. The first, is the lack of standards for the practice of Snoezelen, based on what works, for whom and why. The second is the lack of acceptance for the practice of Snoezelen, which denies it legitimacy by third party providers and in turn reimbursement. Third, is the potential for academic polarization between people who use Snoezelen with different special needs populations (people with dementia, children with developmental disabilities, late life depression, stress reduction for health care workers, children with traumatic brain injuries, adults with chronic pain) in different contextual settings (hospital, school, home). What has led Snoezelen to be seen in this binary manner? The lack of a solid theoretical grounding for its practice (Hulsegge & Verheul, 1987, Staal, 1999). In the attempts of its originators for Snoezelen to be seen as a process -that can take place anywhere- (Hulsegge & Verheul, 1987, p32) which involves the senses, the physical world and the subjective experience of reward, rather than Snoezelen being merely seen as a technique with procedurally denoted methods, is commendable. Yet, the precise lack of theoretical grounding has left Snoezelen open to divergent interpretations based on a lack of unified principles and, as such, can inadvertently have Snoezelen attached to movements (fads), fail to provide adequate training for people who practice it, and limits the acceptability of Snoezelen with third party providers and in turn its overall recognition as an evidence-based approach to reduce suffering. In an effort for Snoezelen to be a free/pure subjective process, theoretical objectivity and scientific inquiry and discourse have been perceived as an intrusive impingement instead of complementary enterprise.
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Snoezelen developed based on systematic observation, not theoretical hypothesis development, empirical testing or the development of theoretical constructs that provides a framework which is predictive of behavior and has utility in determining clinical practice. I believe the avoidance of scientific inquiry is linked to the construct of scientific realism, which promotes an adversarial stance due to the act of verifiability being played out with parsimony and refutes.
I propose a middle ground, the shades of gray as it were, to reduce the polarization of the confrontational, tear-it-down stance of scientific realism on one hand, and the complete absence of any theory to guide practice on the other. I suggest the construct of scientific instrumentalism (Cacioppo, Semin, & Bernston 2004), which is a non-adversarial inclusive approach that advocates theoretical development, the combining of parts to form a whole, to bring new things into being, and the opportunity for freedom of thought.
The inclusive stance of scientific instrumentalism is central since Snoezelen, in its early stages developed without hypothesis development and empirical testing. Many of the non-evidenced based methods and procedures used in the practice of Snoezelen may have evolved from intuition and astute observation, yet this doesn't mean that they have any less value, just that verification of their utility is lacking within a theoretical context.
Empirical testing using single case designs, between groups designs and quasi experimental designs, can all be utilized with existing methods of Snoezelen assessment and intervention, not to deconstruct these practices but rather to use the outputs of such inquires to evolve the practice of Snoezelen through integration and theory building.
I have put fourth the integration of behaviorism with Snoezelen to address the lack of scientific instrumentalism from which to guide research and clinical practice (Staal, 1999). The paradigm of scientific instrumentalism doesn't preclude the use of other theories and their development. For instance, Lesley Pinkney, MSC. Dip COT SROT, University of Southampton, U.K., has long advocated for the use of brain imaging technologies to develop biological model building in relation to cortical stimulation from Snoezelen exposure. This fits with the biological orientation of Gillian A. Hotz, Ph.D., University of Miami, U.S.A., and a researcher studying the effects of Snoezelen with children suffering from traumatic brain injuries. Scientific instrumentalism allows both behavioral and biological theories to exist without polarization and antagonism. Other types of models could be integrated with the practice of Snoezelen as they are developed over time.
Does the mere act of scientific inquiry create a reactivity that reduces the benefits of Snoezelen: joy, interest and relaxation? I think not. What does create binary views of Snoezelen is the lack of a framework from which to look at the practice of Snoezelen from an inclusive friendly stance. I put fourth the model of scientific instumentalism, as a means of creating acceptance, not division, for Snoezelen, a growing and much needed practice to increase well being.
Cacioppo, J., Semin, G., Bernstson,G. (2004). Realism, Instrumentalism, and Scientific symbiosis: Psychological Theory as a Search for Truth. American Psychologist, 59 (4), 214-223.
Hulsegge, J., & Verheul, A. (1987). Snoezelen Another World. Rompa, England
Staal, J. (1999, October 6). An integration of Snoezelen with behavioral theory and practice to promote effective therapeutic outcomes, Paper presented at the 3rd Snoezelen
World Congress, Toronto, Canada.