Alzheimer's and Improv03/22/2018

Alzheimer's and Improv

Creating stories together crafts a unique experience between two people or, in some cases, two people and a large audience. Improvisational theatre is a form of spontaneous and unscripted storytelling. Improv can be a tool used for actors to play and grow within their characters while rehearsing for a play or can be a standalone performance act. These comedic performances can include a variety of improv games, from mining and guessing  mysteries, to incorporating wacky audience suggestions into new scenes. Though there are no lines to learn, actors in an improv troupe must put in a great deal of work to build strong relationships and scenes together. 

Debi Dunkerly worked in the social work field for many years and has ran Pensacola's local improv troupe, Improvable Cause, for the past 20. According to Dunkerly, the principles that guide the improv experience are almost identical to the tools and tips suggested for caregivers of Alzheimer's patients. Improv's golden rule is that if you work to make your scene partner look good, the scene will work out and you too will look good. Caregivers, in a similar way, focus on providing muchneeded care for their loved ones so they can feel good and have a higher quality of life. Dunkerly shares that many of improv's guiding principles have a place in the caregiver's toolbox.

Yes, And...

The first rule of improv that an actor learns is to always say, "Yes, and." This rule states that the actor must always say yes to what his scene partner has presented and build upon it. This simple exercise can look like this: 

First Actor: I had a sandwich today. 

Second Actor: Yes, and it smelled amazing. 

First Actor: Yes, and it tasted great, too! 

While this exchange is simple, the "Yes, and" instinct is a vital one for all improv actors to have. It empowers the actors to be confident in knowing that what they have to say will be accepted and useful for someone else. Using this practice in conversations as a caregiver creates a positive environment in which the loved one is confident in their conversations, at a time in life when that is vital.

Label Emotions

Without a script and plot mapped out, it can be difficult for your scene partner to determine what emotion or idea in the scene you may be working up to. Newer or even advanced actors may aim to make an angry face, just to be told, "You don't have to be sad." A practice that actors may use in an improv scene is to label the emotion that they are acting out verbally to make it easier for their scene partner to pick up on and work with. Those with Alzheimer's may battle managing and expressing different emotions both within themselves and others around them. Labeling that emotion and saying, "I know you are mad about this..." or, "I am sad because..." helps your loved one identify the emotion to begin to work with it.


During a game asking for audience suggestions to set the scene, someone in the back row may shout out that the actor's home has been destroyed by a tornado. The scene could open on the actor wallowing in the terrible news and lamenting at his bad luck. While this may be realistic, it is not a lot of fun for the audience to watch. A good improv actor will reframe the problem and add an interesting twist to allow the scene to change and grow, such as, "I am so glad my house was destroyed by that twister and I found all of this gold buried underneath." The reframing of different details creates space to have fun. 

With Alzheimer's, managing one's emotions and reframing unfavorable situations is not always possible in the moment. A caregiver's role often includes stepping up in these moments not to agree that the situation is frustrating, but to help reframe it. By acknowledging the situation and adding positive comments on it, the caregiver can calm their loved one and empower them to take control of the situation. 

Avoid Blocking

An improv scene consists of a few people who have no idea what is going on that need to work together creatively to build something special and memorable. Two actors in a scene are actively reaching out to each other with new ideas. If one actor says, "My dog grew a third ear after eating my TV remote," and the other responds with, "That didn't happen to your dog," or even, "You don't have a dog," there is an awkward freeze. The first actor, blocked by the denial, has nowhere to go from there, and the audience can sense the tension while he is embarrassed and looking for something else to say. 

Those living with Alzheimer's disease feel frustration and disappointment with their lack of memory. Loved ones correcting them and becoming upset at this causes even more grief at their condition. As a caregiver, blocking and rejecting your loved one's stories or clearly untrue details can be hurtful and confusing. 

Accept New Realities

An improv scene about a husband and wife can go from the two of them arguing at the dinner table to the husband slaying a dragon to show his wife that he can protect their treasure when they move to Mars. If the actors work together to find a beginning, middle and end to their story, anything is possible. The mimed dragon fight could be a rousing and Oscar-worthy performance, and the audience never would have seen it if the scene partner refused to accept the new reality. If she had shut down the actor's outlandish ideas, this art would not have formed.

Reality is a difficult concept with Alzheimer's disease. It can be incredibly hard to accept that a spouse or parent is losing precious memories. For someone living with Alzheimer's, reality can shift and change. Your loved one may come out with things that seem silly and impossible, but avoid shutting those ideas down. Instead, jump into their reality and keep them company in it. If your father insists he was a general in the Civil War, ask him to tell you about his favorite battle he fought and accept the reality that is currently true to him.

Avoid Asking Questions

One improv principle that caregivers should differ from is to avoid asking questions. To ask a scene partner what they did last night puts them on the spot to come up with something and can be unfair, as suddenly your scene partner is doing all the work. Likewise, vague openended questions may be frustrating for someone with Alzheimer's. However, it is encouraged to ask leading questions. Dunkerly suggests not just coming home and asking, "What did you do today," but adding on to the question with details; for example, "Did you see anything good on television today? I saw a story on Neil Diamond. Do you have a favorite Neil Diamond song?" Add details to the scene until it sparks an idea for your loved one to add to. Asking leading questions allows them to participate in the conversation while having somewhere to start.

Offstage Exercises

Dunkerly suggests engaging your loved one by challenging them to a storytelling game, with the caregiver acting as both the audience and supporting scene partner. This exercise can be tailored to fit any stage of Alzheimer's. The story can be about anything, from asking your mother to tell you about the day she met your father, to asking your wife about her favorite childhood fishing trip with her brothers, to asking your dad about his first time going to a jazz concert. Adding details to the prompt is key to engagement. Feel free to ask clarifying questions along the way that include guiding comments such as, "Wasn't there a broken fishing pole?" While you should help guide them in the storytelling, it is important to listen intently to pick up on any cues that may be important. The structure of the story is vital, but not the accuracy. The most important part of this exercise is to accept their reality without correcting or blocking them. The goal of this exercise is to simply tell a story with a beginning, middle and end, without getting lost somewhere along the way. 

Doing this exercise daily will give you a good idea of the coherence level and progression of your loved one. More importantly, the exercise will open a dialogue and create a stronger bond. The fluidity of this exercise can bring up incredible stories of your loved one's life that you may not have thought to ask about. 

Another exercise Dunkerly suggests is a simple process miming game. As Alzheimer's progresses, a person may struggle to remember old processes and procedures, such as cooking or even handwashing. A miming activity game can be created for any type of process with steps, as simple or as complex as you see fit. You can work together, with step one of handwashing, asking them to mime turning on the water with you, and labeling it as you do it. The next step would be to both announce that you are running your hands under the water and continue miming each step. You can even mime the steps and have your loved one guess what you are doing. This activity helps those with Alzheimer's grasp activities that they may be losing hold of. By practicing different daily processes, your loved one may feel more confident in their ability to retain knowledge of the tasks. 

One thing improv actors must be wary of is losing sight of the relationship between the two characters. A scene can feature stand-up worthy jokes, but without an interesting relationship between the actors, the audience loses interest and it falls flat. The relationships between the actors in the scene are what drive the plot and provide a vehicle for stronger comedy. These improv principles can be used by caregivers to facilitate meaningful and fun interactions with those with Alzheimer's. Being a caregiver comes with a great deal of difficulties while working in an unknown new realm with a loved one. With caregiving, this is a unique time in the lives of you and your loved one. Focus on the special relationship that you have and together you can build beautiful scenes and even find comedy along the way. 

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