One of the biggest challenges we face as companions is finding creative ways to engage with individuals who have dementia. Many of our clients are living with cognitive impairment. Some have difficulty finding the right word to use, others may be resistant to accepting help or experience anxiety around being in an unfamiliar environment. Creative engagement is important in helping individuals with dementia feel a sense of security and acceptance. People with dementia are often self-conscious about their memory issues and are told “no” frequently. We’ve discovered the best way to engage with individuals is to “just go with it”.
Improv is an acting method that uses creative and spontaneous engagement techniques that are applied in real time. The main premise of improv is to respond to most conversations with “yes, and…”. This is an affirming way to begin a conversation and also allows for the conversation to expand, which can sometimes be a challenge for individuals with cognitive impairment. For example, many of our clients who live in a facilities are not aware that the facility has become their new home. It’s very common to hear the phrase, “when I go back home…”. In these situations, it’s important to step into the person’s reality (another improv best-practice) and one way of responding may be, “yes, and tell me about your home”. This small engagement strategy opens the door to meaningful dialogue. It also begins on a validating and positive note.
People with dementia often are told “no”; “no, it’s not time for lunch yet”, “no, you can’t go back to bed”, “no, you can’t leave the building to go on a walk.” In our experience, “no” shuts down dialogue, creates a negative environment, discourages ideas and interests, and sometimes invokes sadness and frustration. Even though we aren’t always able to give our client exactly what they want, it is possible to be affirmative and redirect. If we are working with someone who would like to get outside, but that’s not possible, we may say “yes, and let’s wait a few minutes for the weather to get a little nicer” or “yes, and perhaps we can go out after lunch.”
When working with individuals with cognitive impairment, it’s important to avoid conflicts, and by stepping into the person’s reality, you’re opening a dialogue with them that they are able to engage with. This will ultimately help by minimizing conflict and preserving the dignity of your client.