Last summer I took out my aunt for an ice cream cone. Chocolate scoops in hand, we took a seat inside and made our best effort at having a conversation. My aunt doesn’t like conversational pauses but has lost the ability to chat freely over the years as her dementia has advanced.
So I defaulted to a favorite topic of both of ours: pets. I chattered on about my dog Jacky, a doe-eyed Labradoodle. And she chimed in about her own beloved dog, Timmy, a Shaggy D.A.-type canine.
“My dog tells me about that,” she said at one point, nodding when I told her I would have to leave our date soon to take my niece to the airport. Alarm bells rang in my head. Did she think her dog could talk?! Also: Timmy had been dead for at least 40 years. I worried my aunt’s reality now had entered the fourth dimension and she was not coming back.
Outwardly, I did not skip a beat. With a smile on my face, I tried to keep the conversation flowing. “Oh! Timmy told you that?” “Yes,” she responded, but then got a look in her eyes like she knew something was off.
Our conversation foundered. I worried I was feeding into a mentally unhealthy delusion.
Go with the flow
“The key with dementia patients is getting into their world and not demanding they get into ours,” said Nancy Heckler, director of Adult Day Services with Cedar Sinai Park in Portland.
Luckily there’s a trick for remembering how to do this, and it borrows from the world of theater. It’s the methodology of “Yes, and…”
Fortunately, I’ve since learned that my reaction to her seemingly absurd statement was right on. When communicating with people with dementia, it’s often better to just go with the flow. Dementia care experts say that whatever and wherever my aunt’s reality is, that’s where I should meet her, not the other way around.
“The key with dementia patients is getting into their world and not demanding they get into ours,” said Nancy Heckler, director of Adult Day Services with Cedar Sinai Park in Portland, Ore. This is important to the overall health and well-being of folks with dementia because they feel listened to, legitimized, and humanized, she said.
Luckily, I have found, there’s a trick for remembering how to do this, and it borrows from the world of theater. It’s the methodology of “Yes, and…” It’s the watchword of improvisational comedy.
“Yes” means one agrees with the speaker; “and” facilitates ongoing discussion and makes the person feel heard and validated. These two simple, single-syllable words can do wonders for those with dementia and their family members and friends.
Karen Stobbe-Carter, 54, an improv and theater professional based in Black Mountain, N.C., realized years ago that “Yes, and…” is the perfect, common-sense tool to use with people with dementia.
It’s essential in improv because not continuing a line of conversation stops any sketch in its tracks. Likewise, it’s essential in communicating with someone with dementia, because denying their reality only stokes confusion and unhappiness, Stobbe-Carter said.
“You never have the same moment” on stage, Stobbe-Carter said, just as in life, particularly with a loved one with dementia.
She learned this tool while caring for her father, who was diagnosed in 1996 with Alzheimer’s and later for her mother, who was diagnosed with the disease seven years later.
“She lived with this disease for 17 years, and we know it was a good life because we went with the flow,” Stobbe-Carter said, adding: “I’m not saying she never was upset or threw a piece of toast at me.”
Getting to “Yes and…”
Stobbe-Carter and husband Mondy Carter founded In the Moment, a training program that reflects the creative nature of improv and the experience of living with dementia. Stobbe-Carter now is working on web-based videos demonstrating how best to get through the day with a loved one with dementia. Here are some essential tools.
- Step into their world. Think about what is clear to your loved one. Long-term memories are often the most vivid. Present and past can get confused. Once we stop wishing they were back, then we can move on.
- Just say it. In response to almost any comment, you can respond to your loved one with “Yes, and…” It validates and gives permission for them to share more. In more difficult situations, modify with empathy. “Yes, I understand, and…” diffuses tension and opens up the conversation.
- Go with the flow. Wherever your loved one is taking the conversation, go along with it.
- Fully listen. You may have heard the same story 80 times, but your loved one is telling it for the first time.
- Recruit new improv partners. Bad days happen. If you are not up for the task of performing today, acknowledge that, ask for help from others, and remind yourself you’re doing the best you can.
Additional tips are available at ALZ.org.