Maybe you’ve watched and enjoyed improv comedy, maybe you’ve participated in it. Regardless, I’d say most of us are aware of the concept of “yes, and” that is the foundation of a successful improv sketch. It’s the fundamental rule for improv actors, when faced with a scene, that they agree to whatever their fellow actor serves up, as well as that they move the plot forward. There is no disagreeing or no’s, because, as you’ll see if you attempt to participate, it usually will ruin the scene.
Now, assuming you understand the fundamental rule of improv, imagine I told you that it is also the fundamental rule of communicating with your loved one with dementa? Because it is. Just like an improv actor, the person living with dementia has their own reality and story that they are living out. For us to successfully join them in that reality and engage as a fellow actor, we must abide by the “yes, and” rule here as well.
What does this look like?
Imagine you are visiting with a loved one who has dementia, your Aunt Betsy, and today she is fixated on getting home to prepare dinner for her husband, Uncle Ralph. Uncle Ralph has been gone with over a decade, but Betsy is not aware of that today, and she is anxious and worried about having enough time to make dinner and tidy up before he arrives home from work.
I’ve seen so many families in this scenario attempt to reorient their person. It’s certainly not their fault to want to do this- especially when all of your life this person was the one telling you what to do, where to be, how to behave. However, it’s largely accepted in the dementia care community that reorientation (trying to remind them of the true reality) has largely detrimental short term and long term effects on the person with dementia, as well as the relationship. Take, for example, this scenario with Aunt Betsy. You may be tempted to say to her, as gently as possible, “Aunt Betsy, Uncle Ralph has been dead for 12 years, and you live here now.” But I bet you can almost anticipate how she may react to that. I’ll even go a step further to say that I bet you can anticipate how it will make you feel, in that moment, in the moment on the car ride home after your visit, and on your way to visit her next time, to approach interactions that way.
Now, if instead, you imagine that you and Aunt Betsy are improv actors, imagine how this same scenario may play out. Aunt Betsy greets you in a tizzy. She is anxious because she needs to get home and prepare dinner for Ralph. Rather than reorienting, you put on your improv shoes and join her. You say something along the lines of “Yes, it is soon time to get home to make dinner. We still have some time though, and I could really use your help with the laundry. I’ll keep an eye on the clock for us.”
It’s as important, when following the “yes, and” rule, that you follow it with redirection. This allows you to avoid the “therapeutic fibbing” that some dementia professionals may encourage. The problem with fibbing is two-fold. First, it demeans the person with dementia, assuming they cannot tell a lie from a truth, which in many cases they can. Second, it makes you feel like a liar and may strain the relationship. There may be times where you find it absolutely necessary, but in most cases, redirection will work as well, if not better.
This is not to say that “yes, and” will make communication easy. At first it will be hard to get into the mindset of treating your interactions like improv. With practice, though, you’ll find that you’ll become accustomed to the redirections and assurances needed for your loved one to be put at ease and refocused.