Improv for Dementia: Interaction Methods for Memory Loss Patients

Improvisational theatre, also called improvisation or improv, consists of unscripted performances, with performers creating characters, dialogue, and storylines as they go.

The improv techniques used by performers can be useful offstage to hone skills in personal life and business. They can even be useful in interacting with memory loss patients.

“[Improvisation] is beneficial for communications, not just performing,” Christine Walters, an improv instructor, told Boomer magazine. “[I’ve done] programs for kids, the blind and visually impaired, seniors, and caregivers of seniors with dementia and Alzheimer’s.”

Improv for dementia patients: techniques

To hone their skills, improv performers use specific techniques, practices that can also be used in interacting with memory loss patients.

Tina Fey, of Saturday Night Live and 30 Rock fame, cut her comedy teeth with the Chicago-based improvisational group The Second City. In her 2011 book, Bossypants, Fey listed “The Rules of Improvisation That Will Change Your Life and Reduce Belly Fat.”

‘Yes, and…’

In life, the words “no” and “but” are overused. Instead, improv suggests using “yes” and “and.”

The first rule of improv that Fey suggests using in life is “Always agree and SAY YES.” For example, she wrote:

If we’re improvising and I say, “Freeze, I have a gun,” and you say, “That’s not a gun. It’s your finger. You’re pointing your finger at me,” our improvised scene has ground to a halt. But if I say, “Freeze, I have a gun!” And you say, “The gun I gave you for Christmas! …” then we have started a scene because we have agreed that my finger is in fact a Christmas gun.

But don’t just say “yes.” Add something – “YES, AND.” Fey suggested:

You are supposed to agree and then add something of your own. If I start a scene with “I can’t believe it’s so hot in here,” and you just say, “Yeah,” we’re kind of at a standstill. But if I say, “I can’t believe it so hot in here,” and you say … , “Yes, this can’t be good for the wax figures” … now we’re getting somewhere … YES, AND means don’t be afraid to contribute.

Karen Stobbe was a career actor when her mother, Virginia, was diagnosed with Alzheimer’s, and she soon learned to use professional improv for dementia techniques in their communications. Stobbe noted that using “Yes, and” with someone who has memory loss “allows the conversation to continue in a more positive way and leads to less frustration.”

Stobbe recalled an instance when this yes, and approach to dementia helped her communicate with her mother, who moved in with Karen after the diagnosis. The two women were listening to a Beatles song when Virginia said she had once dated one of the musicians. Stobbe’s impulse was to dispute her mother’s claim. Instead, she answered, “Yes, and which one did you date? What was it like?”

Another time, Virginia said to Karen, “I want to go home. Take me home.” Instead of pointing out that Virginia was already home, Karen responded, “Yes, and tell me about your home.”

“[Improvisation] helps caregivers connect more with the person they’re taking care of, how to find ‘yes, and’ in such a challenging situation,” said Christine Walters.

‘There are no mistakes, only opportunities’

“If I start a scene as what I think is very clearly a cop riding a bicycle, but you think I am a hamster in a hamster wheel, guess what?” wrote Fey. “Now I’m a hamster in a hamster wheel. I’m not going to stop everything to explain that it was really supposed to be a bike.”

Stopping the show to explain – especially when contradicting another performer – is a real showstopper.

Similarly, stopping a conversation to correct another person – especially one who can’t comprehend the logic of your correction – can stop conversation and cause confusion and agitation.

‘Be in the moment’

Based on her experiences, Stobbe started a nonprofit called In the Moment. The website includes games and creativity exercises that help caregivers, both family and professional. The nonprofit’s name reflects an important principle: Be spontaneous – be in the moment.

“We are taught from an early age that we must censor ourselves,” Stobbe said. “We must watch what we say. We can spend so much time judging ourselves that we cripple our creativity (and happiness). In improvisation there is no time to critique or evaluate. You must create in the moment.”

Rather than judging an interaction with a person with memory loss, worrying that it isn’t typical or “normal,” just go with the flow.

Another way to view this is, “Step into their world.”

Stobbe’s husband, Mondy, also an actor, often stepped into Virginia’s world with her. He recalled an instance of going with the flow in relating to his mother-in-law through improv for dementia on This American Life. Virginia said she saw monkeys outside, so Mondy remarked on the monkeys: “It’s pretty early in the season for monkeys. I didn’t even know they were here in North Carolina,” he replied.

“Oh, there aren’t a lot of them,” said Virginia.

“Well, if you see one again, we should try to capture it!” The imaginative conversation continued, and it soon became humorous for them both.

Stobbe’s In the Moment website offers additional improv-like tips for working with persons with Alzheimer’s:

• Use gestures.
• Join in the person’s world, wherever they are. Agree with their reality.
• Do not argue. Instead of arguing and reasoning, acknowledge and validate.
• Acknowledge what is said – repeat back key points.
• Reframe a situation or give the person a new focus.
• Be flexible. Be ready for anything.
• Limit choices to minimize confusion.
• Redirect when possible.

The challenge of the new world

Being “in their world” with a person with dementia can be a struggle for family members. Family caregivers may want to walk down memory lane with their loved one, recalling good times from the past. But these memories are gone, especially when they step into the imagined world.

Virginia eventually forgot Karen’s childhood – and even who Karen was. Mondy became Virginia’s favorite, and she inserted images of her son-in-law into her own erroneous memories. Despite those challenges, Karen continued to live as best she could in her mother’s world.

“So often,” said Stobbe, “we focus on changing the behavior [of the person with Alzheimer’s] when we need to change ours.”

By learning to use improv for dementia when relating to people with memory problems, we can make easy changes that smooth interactions for everyone.

Related: How Social Connections Slow Dementia