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. 

Life After Diagnosis | The New Normal

Life After Diagnosis | The New Normal

Mary Gilliam, MBA, LNHA

The New Normal

Receiving the diagnosis of a degenerative disease for yourself or a loved one instantly changes everything.  In the moment, fear and thoughts of what the future holds are consuming.  Denial.  Anger.  Guilt.   Hope?

Slowly over time, the normalcy of life without diagnosis transitions to a “new normal.”  Perhaps for someone with Alzheimer’s, that means repeating forty-three times in a ten-minute period that a loved one is at work.  Or, for someone that was diagnosed with ALS, transitioning from walking to a motorized wheelchair.  Maybe it is removing imaginary snakes from the ground because a loved one suffering from Lewy Body Dementia has the disturbing hallucinations each night.

After diagnosis, there are many changes that happen over time and respective idiosyncrasies, but it is still a life to be had.  It’s what I call the new normal.

The new normal changes throughout the disease process.  At first, the new normal is static; perhaps a reflection of the past with apprehension of the future.  Then the disease can turn from subtle to drastic, creating new norms for everyone in the path.

This new normal should be one that is embraced and cherished.  Each day is a blessing and although someone might excessively repeat something because they forget, it doesn’t mean they have forgotten love.  Just because someone with ALS is losing muscle mass and to transition to a wheelchair, doesn’t mean they can’t embrace a moment.  And just because someone with Lewy Body Dementia has disturbing hallucinations doesn’t mean they can’t have moments of a beautiful reality.

Tips to embrace The New Normal:

  • Be flexible to change

Use the principles Dr. Spencer Johnson illustrated in “Who Moved My Cheese” to help with family members.  Know that change is inevitable, anticipate it, monitor it and adapt to it.  Don’t be surprised if the mother you knew to hate fish wakes up loving it one day or a priest and family man start swearing like a sailor.  To accept the new normal, you have to be flexible to the changes that come with it.

  • Savor the good, get over the bad

There are good days and bad days when it comes to degenerative diseases.  When your loved one is having a good day, spend the extra time enjoying the moments.  If it is a bad day, cut the time short and re-approach.  Often, just an hour and a new approach can create a different response.

  • Stay educated and objective

Staying objective is harder said than done when it comes to the care of a loved one.  Heed the advice of professionals.  For example, if multiple professionals are telling you it is time to make some changes; listen.

  • Learn different realities

When a loved one has a diagnosis of dementia, it is especially important to live in their moment.  While it is very easy to correct and criticize, it is impossible to rationalize with an irrational disease process.  Learn the other person’s reality and get in it.

  • Take care of yourself

Finally, as a caregiver of someone with a degenerative disease, it is most important to take care of yourself.  Give yourself space and rest so that emotionally you can be present.  Take care of yourself physically so you have the strength and the stamina to pursue your labor of love.