Try Imagination

Improv for Alzheimer’s uses theatre techniques to improve quality of life

The members of Club 36 are watching Dukes of Hazzard when Naomi Esau and Karen Johnson-Diamond enter the room. The women are carrying a whiteboard on an easel, a plastic bin full of odd objects and a white binder. On the cover of the binder are four words: Forget Memory. Try Imagination.

Club 36 is an adult day program for people living with Alzheimer’s and dementia. Its eight members, plus two caregivers, are here to participate in Improv for Alzheimer’s — “improv” is short for improvisational theatre — led by improv artists Esau and Johnson-Diamond. Dukes of Hazzard gets switched off. A spring storm rattles the windows. Johnson-Diamond opens with a group question: “What do you like to do on a rainy day?”

The group is hesitant at first, but within minutes everyone is laughing. Esau begins to pass around an imaginary gift and a member named Carol* mimes opening it with theatrical delight. Johnson-Diamond calls up a member named Michael to perform a two-person scene. He has mobility issues so she offers him a chair.

“I got this for you,” she says. “It’s beautiful!” Michael exclaims, and the group laughs. He sits on the chair backwards. “How do I ride it?”

Improv for Alzheimer’s is a joint project by Inside Out Theatre, a theatre company for Calgarians with disabilities, and the Alzheimer Society of Calgary, which runs Club 36. The improv program began in 2014, two years after Inside Out artistic director Col Cseke wrote Jim Forgetting, a play inspired by conversations he’d heard while sitting in on group counselling sessions for people with early-onset Alzheimer’s. The members of that group came to see the play and no one — certainly not Cseke — wanted this emotional and creative experience to end. It was Cseke’s colleague Johnson-Diamond, an experienced improviser and actor, who suggested they explore the possibilities of improvisation techniques for the Alzheimer’s community.

“We said, oh, that’s an idea that should have always existed,” Cseke says. “That just seems like a clear, obvious fit.”

The rules of improvisation and the goals of dementia care have proven an ideal pairing. The first and most fundamental rule of improv is always to say, “yes, and…” In short, anything said in an improv context is accepted, validated and built upon. Cseke says people with cognitive challenges get used to being corrected and hearing “no,” which isn’t a positive experience for people with dementia or their caregivers. He remembers his mother’s compassionate approach to caregiving when his grandmother was living with dementia.

“There are times when it’s a happier day if you accept what they’re giving you and you build on that,” he says.

As he began to investigate the idea further, Cseke discovered the work of Anne Basting, an American scholar and educator in aging and dementia who began an improvisational group storytelling program in 1998. Today, Basting’s TimeSlips is an award-winning, evidence-based elder care technique that is used in 12 countries. Cseke and his colleagues were inspired. The four words on the cover of the Improv for Alzheimer’s binder come from the title of one of Basting’s books.

The principles of improv have inspired other programs too. In 2011, researchers at Northwestern University in Chicago began to collaborate with Tony Award-winning Lookingglass Theatre Company on the Memory Ensemble, an improv program for people living with early stage dementia. North Carolina improv team Karen Stobbe-Carter and Mondy Carter delivered a 2016 TEDMED talk on the subject of improv and dementia, and The Second City, a renowned improv theatre company in Toronto, Chicago and Hollywood, offers an Improv for Dementia workshop.

Calgary’s Improv for Alzheimer’s sessions run for an hour a week for six-to-10-week stretches. The program is designed for people who are still living at home with family members (rather than in care facilities), and has welcomed participants ranging in age from mid-40s to early 80s. Session facilitators, sometimes Cseke, Esau or Johnson-Diamond, sometimes local improv artists recruited from organizations like Loose Moose Theatre Company and Dirty Laundry, work with men’s groups, women’s groups and co-ed groups on a rotating basis.

Facilitators have narrowed down about a dozen particularly effective exercises, including group activities, one-on-one scenes and a game called “Yes It Is,” in which facilitators hand out objects from the plastic bin and invite club members to identify them. Participants can be as literal or absurd as they choose. This game, like many others, is physical, which allows club members to participate even if using language has become more of a struggle.

While Improv for Alzheimer’s doesn’t call itself a therapy, Cseke says its beneficial effects are obvious to him and his fellow facilitators, as well as to caregivers and participants. Engaging in the improv sessions visibly reduces signs of anxiety and anger in club members, and the sessions also provide clear social benefits; not only are they an opportunity for participants to connect, but they give caregivers a rare opportunity to engage with club members in a fun, casual way.

“We had a very emotional talk with one of the staff members who said she really looks forward to [Improv for Alzheimer’s] because it’s one of the few times she can be friends with the club members,” Cseke says. “She can just laugh with them — she doesn’t have to be on duty.”

The program is in the process of launching a formal assessment process in collaboration with the Alzheimer Society of Calgary and an independent consultant specializing in program evaluation. If Improv for Alzheimer’s becomes an evidence-based program like Basting’s TimeSlips, it will be able to access external funding (the program is currently co-funded by Inside Out and the Alzheimer Society), which will allow the program to expand.

At the moment, it’s spread thin; when Esau and Johnson-Diamond’s leave today’s session, they’re unlikely to see this group again for a year or more. Judy, a club member who has spent the hour laughing and clapping her hands, pleads with Esau and Johnson-Diamond to find a way to return sooner. “Why can’t you come here every week?” she asks.

Cseke and the other program faciliators would love to be here every week. If Improv for Alzheimer’s can expand its operational capacity, it plans to increase the quantity and frequency of its sessions. Cseke would also like to see sessions held at an independent facility such as a small theatre (rather than at the supportive living facilities that host Club 36), where family members and caregivers can participate and socialize.

Meanwhile, Improv for Alzheimer’s is launching a training program for recreational and occupational therapists as well as other caregivers who focus on quality of life. The training will provide an introduction to the program and the improv exercises, as well as tools in order to help facilitate sessions independently.

Back at Esau and Johnson-Diamond’s session, a member named George gets up to play a policeman who has to arrest Esau for dangerous driving. At the end of the scene Johnson-Diamond congratulates him. “You’re officially an actor,” she says.

“Well, I started out as a liar and I built from there,” he deadpans.

When the games end, Esau and Johnson-Diamond go around the group to ask club members what they thought of the hour. The word “happy” is used again and again. Michael, who rode the chair during his two-person scene, says, “The day you start making a fool of yourself is the day you start to enjoy it.”

The question moves to a man named James, who became visibly frustrated at one point during the session when he forgot what he wanted to say. Johnson-Diamond asks him what word comes to mind when he thinks about the day’s activities. He gives her a broad smile. “Fun,” he says. [ ]

*Names of Club 36 members have been changed to protect their privacy.

Applying Improv Tactics to Caregiving

Say, “Yes, and …”
In improv, saying “no” is called blocking. Instead, accept and validate whatever is said to you and take it in a constructive direction.

Accept the reality you’re given
Be in the moment with your improvising partner and engage without correcting or redirecting.

Practice attentive patience
When you ask a question, wait for as long as it takes to get a response. No hints or suggestions.