Take two laughs and call me in the morning

Laughter Good Medicine for Dementia Patients and for those around them.
Nice to see this therapy from Australian humour therapist Jean-Paul Bell bringing life and living to those, too often, written off by society.

The ripple effect

As with any therapy form, drama therapy also has a ripple effect. You treat the person, and automatically family, school, work, and the wider community will benefit from the effects drama therapy offers.

System theory explains it all. Change one element, and the rest automatically has to change as well.

It is great to hear the stories from families, and the people involved in their lives, of the benefits that drama therapy has brought for all of them.

A while back, Linda and I ran a drama therapy program at a dementia day centre. The effects of the therapy were not only noted in relation to the clients. We also received feedback of the changes for the caregivers and the clients’ families. As a result of breaking the isolation felt by the clients, they started to re-engage with the people around them - newly established communication skills (expression, empathy and in some cases, speech) allowed for positive communication and reciprocity. Families got to see and reconnect with their loved ones again, aggressive behaviours diminished and mobility skills improved, allowing for meaningful participation in the community.

By way of another example, a previous client with Autism diagnosis, through drama therapy was able to become engaged in meaningful employment. The client went from being unable to participate in the community, due to fear and depression, to being a productive member of society.

Sometimes it is possible to become so focussed with a client that you tend to forget (or not realise) the changes that drama therapy makes to many people lives, over and above the client that you are directly working with. Whenever a difficulty is encountered in a client’s progress, it is often inspiring to look at the bigger picture and recognise this ripple effect, to appreciate that any short term challenges are just a step on the way to bringing changes for the better in many people’s lives.

The difference between work and play

I use action methods to improve communication and reduce conflict in the workplace. Using play methodology can often move past barriers that have appeared to be set in concrete. But these methods still rely on a shared understanding of why we are at work and how adults at work behave. It is an interesting paradox that whilst asking people to relax and enjoy being playful this is to improve performance at work. An increasing number of employees either do not know the boundaries between work and personal life or just ignore them.

When we go to work we are exchanging our time and skills usually for money. It isn't slavery largely thanks to some serious work put in over the years by various unions and supporting legislation. This does mean we are answerable to others and have to abide by rules around attendance, behaviour and dress as well as what we achieve.

This may well sound like stating – as Basil Fawlty says “The bleedin' obvious”, but recently I have dealt with people who have said how bad the workplace was. On talking with them it becomes clear that the badness was “Not sitting where I want”, “Not getting to do the bits of my job I like”, “Having to arrive at the same time every day”, “Interrupting my face book updates”,and “Having to wear something other than a stained track suit just because I'm a receptionist”.

All the people concerned had applied for their jobs, read the relevant policies and agreed to them but all had suffered a catastrophic memory failure almost immediately. All felt they could do things as they wished.The idea that someone might have the responsibility for their work and therefore the right to question them about it was unacceptable to all. They all either owned the role outright or felt that any discussion of performance was intrusive and cruel.

At this point I realised that my default state was becoming increasingly grumpy.

I want us all to achieve at work and enjoy it as much as possible. I work at shifting barriers and building effective working relationships. This is based on everyone being a grown-up for most of the time. The methodology is based in play not childishness. We can be adult and use play techniques at work. What we can't do is go to work and only do what we want.

Practice makes perfect

Acting out different situations and ‘what ifs’ helps the brain to store the different feelings

of these experiences. So next time the person is in a similar situation the brain can use this

stored knowledge to make a more appropriate/educated response.

Practising new situations can be scary, so often we change the characters and environment.

So it is the witch in the forest who needs to tell the garden gnomes to stop misbehaving.

This is a lot safer than the person telling classmates/colleagues to stop teasing him/her.

It allows the client to practice being assertive, allows him/her to be angry (letting go of pent

up emotions associated to this trauma), and be in control.

It is always a delight to see people act out different sides of their personalities. When the

executive/ professionals allow themselves to be mischievous, or vulnerable, or if a person

with a disability lets people trip over, or be in total control.

Giving your brain experiences helps improve the brain’s ability to make sense of what is

happening around you. Often when people get isolated, the world around them becomes a

scary place. Disassociating oneself from society is an all too common phenomenon. People

can become ‘narrow-minded’ and set in their ways of communicating, in some cases they

stop communicating all together, and this in turn leads to isolation.

Keep practising... it’s a lot easier than Sudoku.

Live in the moment

Following on from thinking about saying “Yes” more and taking more risks, I started to think about how dementia sufferes have to live in the moment. Memory loss ensures this. We seem to interpret this as a huge negative – and for others it may well be. But for the person concerned, if we can learn to value this and respond positively to it, how much better would their lives be?

Most of us are mindful of consequences – it's a good way to ensure survival – but have we moved past this to letting ourselves be inhibited in the present by always thinking ahead?

I was told possibly the most positive thing I have ever heard around dementia from the son of a lady with considerable memory loss. He said that, at first, visiting her in the safe home had been a huge trial. He and his wife had cared for mum for as long as they could but work and young children made this an impossibility. They felt guilty at “Giving up” but exhaustion was damaging them, their children and their relationship. The first visits were a nightmare of trying to talk, trying to keep a mother and son relationship alive. Then he realised, that was gone. It hurt but the next time he saw his Mum he just went with whatever she said. She was so much more relaxed and he began to see a lovely woman, not his Mum but a lovely person. A couple of visits later she told him it was great to talk to him because he was a good listener. She said that another man used to come but he was always thinking about other things and was never really interested in her. He did check with the carers but as he guessed, he was the only man visiting.

He said that learning from his Mum to stay with what is in front of you was a huge gift. It works for him as a father and as a manager.

We have to analyse and plan ahead but unless that is the purpose of our being with others, let's stay focused on the real people.

It all comes down to being with the living person you are with rather than the imaginary outcomes in your head.  

Taking a chance

I’m a cautious person by nature and experience. Much of my my training is about making progress slowly and carefully although it is also about going with the moment, working with “now” but sometimes that can get overlooked.
People living with dementia don’t have a lot of time to make slow, ordered progress. They can’t take time to build trust. Their world is immediate and often short lived in terms of memory. yet they are a shining example of willingness to take risks when there is some fun attached. I am continually amazed and impressed by their willingness to try anything imaginative with little knowledge of where it may go or what it might involve. There is some initial caution from some - quite right too -but all of them quickly get involved, share ideas and get stuck in. They embrace play in a way most of us take time to get to.
We can argue that their sense of self is different, they are less embarrassed by others’ potential opinion, but that is not always so.They say yes when they could say no.
This week the news featured an item on those whose memory it total. They forget nothing and have complete and instant recall. The impressive thing about them was that they approached every day thinking “I must make this count because it will always be with me.
At both ends of the memory spectrum there are people willing to take chances because that is where the true quality of their life is for them.
The action methods we use are such fun. The impact on me that working with people with dementia has had is totally positive. They have taught me that saying yes and taking a chance is so much more rewarding than standing in my own way. I haven’t seen the Jim Carey movie about saying yes yet but can I encourage all of us to say yes rather than no if at all possible?
Of course we shouldn’t take foolish risks. Most of us learn to assess risks once we make it through adolescence and realise we aren’t invincible. But then we stop a lot of our play.
using Improv, puppets and drama takes a long time with other groups because they have to get past their inner fogey saying “Don’t make a fool of yourself”.
The most fun I’ve had at work has come from doing just that. And when we do get groups past that barrier they grow and progress so fast.
So, don’t start climbing mountains, bungy jumping or going on the stage- unless you want to, but say yes to as many things as you can and see where it takes you.