Improvisation Techniques to help Dementia Care Communication

Loved One Suffering From Alzheimer’s? 

7 Ways Improvisation Techniques Can Help With Communication

Mary Gilliam, MBA, LNHA, Certified Dementia Practitioner


Communicating with someone with Dementia can be challenging.  Such as any skill mastery, it can take time and practice to learn the nuances of keeping a conversation engaging.  While improving communication skills might not make being a caregiver less stressful, it can make the moments you have more meaningful.  Oddly enough, the principles of improvisation can be implemented to help create a positive dialog for you and your loved one.

  1. “Yes, And”

In improvisation, “Yes, And” is one of the most important rules.  This is the rule of agreement, where under no circumstance should you discredit your partner.  No’s stop the flow of conversation.  Someone suffering from Alzheimer’s receives a lot of “no’s” throughout any given day. “You can’t go outside.”  “You can’t get up and walk.”  “Your room isn’t that way.”  “No.  No.  No.”  By agreeing using “yes, and” you can give validation.  You can continue conversation in a positive way.  “Yes, we are going to go home right after we eat.”  “Yes, your Mom is on her way here.” “Yes.  Yes.  Yes.”

  1. Listen & Respond

During conversation, it is important to actively listen to your partner and respond appropriately.  Sometimes with Alzheimer’s or other forms of dementia, we have to read between the lines in our listening.  For example, if someone is looking down at their bare feet saying, “I’ve lost my monkey’s.”  They might mean, “I need to find my shoes.”  We as caregivers, must listen and respond to what is said but also to what is meant.

  1. Commit 100% to the Moment

In both improvisation and dementia, things can get weird fast.  It’s important to fully commit to the conversation in whatever direction it may go.  If your loved one lives in an assisted living but they are talking about how fun the cruise activities are – re-focus to the moment, you are on a cruise.  Each moment is a little different and it’s important to commit to whatever moment your loved one is experiencing.

  1. Go with the Flow

During improvisation, you can’t always control the direction of the scene.  Similarly, we can’t control dementia.  Sometimes, a caregiver might approach a loved one and start being yelled at.  The next visit could be mean an embrace.  It is vitally important to go with the flow with your loved one and where they are at in the moment.  If the visit is going in the wrong direction, make it short and try again at a later time.  If the visit is positive and productive – stay longer and take advantage of making a moment.

5.  Accept offers and gifts

During acting scenes, imaginary items add a new dimension to the scene.  Someone can pretend to be shooting a basketball through a hoop and our minds help us imagine what they are doing.    If someone suffers from hallucinations commonly associated with Parkinson’s or Lewy Body Dementia, a third party might witness a similar scene of a person handing an invisible item to someone else or perhaps picking up something from the floor.  Just as you would be participating in a scene – take the invisible item from them and go with it.  It’s not real to you, but it is very real to the person you are connecting with.

  1. Silence can be powerful

                Both on stage and during conversation, silence can be powerful.  There is nothing wrong with taking your time to answer a question to direct conversation.  Don’t be afraid to take several moments of silence to figure out where the conversation is going and the best strategy to keep it going in a positive direction.  Moreover, remember that it is not always necessary to fill the air with words, sometimes a gesture such as holding hands is the most powerful thing we can do with a loved one.

  1. Accept the reality given to you

When communicating with someone who has dementia it’s so easy to say, “no Mom, we aren’t at home” or “No Dad, your wallet wasn’t stolen.”  It’s easy to want to draw someone back into your world instead of attempting to jump in theirs.  With improvisation acting, the whole goal is to understand the story your partner is laying out and to jump in that reality and roll with it.

Both with improvisation and with communicating with someone with dementia, there are no rules and you can’t rehearse set scenes.  It is a learning process to grow and develop techniques of productive communication.  The guidelines established in improvisation acting transcend the stage and can be highly effective in guided communication with someone suffering from dementia.    Next time you are communicating with someone with Alzheimer’s or other form of dementia keep these principles in mind and see how it can help make more moments into memories.

Mary Gilliam presents Improv Principles to North Texas Area Gerontological Society, McKinney, Texas

Mary Gilliam’s passion for serving seniors has become a lifelong mission.  She is the founder of Monarch Senior Solutions and responsible for leading the in-home care partners and senior advisors.

Mary holds a Master’s Degree of Business Administration with an emphasis on Health Care Administration and is a multi-state Licensed Nursing Home Administrator.  She has been in long term care operations since 2002 serving those in assisted living, memory care and skilled nursing.