Education and Care - Storytelling

Alzheimer's Foundation of America

Creative storytelling is catching on as a therapeutic tool for individuals with Alzheimer's disease - and their families. It is increasingly being used in adult day programs and other group settings. Pleased with the results, experts say families can adapt this technique for use in their home environments as well.

Storytelling sparks memories, encourages verbalization and promotes self-esteem among those with dementia, according to healthcare professionals. "Inevitably, storytelling is about memories, but it opens the rules to include imagination and to create something new that accepts who they are and where they are in the moment. That's a great thing for families," noted Anne Basting, founder of the Milwaukee-based National TimeSlips Project.

Renya Larson, a TimeSlips facilitator and the associate director of the National Center for Creative Aging, Brooklyn, NY, calls TimeSlips a "potent" tool designed for individuals in the middle to late stages of Alzheimer's disease who can no longer communicate through conventional methods. Participants can comfortably incorporate gestures, sounds and facial expressions into the story.

For individuals still in the earlier stages, Larson suggested, "Creativity may be threatening. They want to hold on to the true stories they still have." However, it may be possible to adjust the program by including more reminiscence and current events.

How-to of creative storytelling:

• Create the right scene. Eliminate background noise, like TV and radio, and set up in a dedicated space. Prepare a sketchpad, brightly colored markers and an image. Do storytelling during the "magic hour" for higher cognitive functioning - 9:30 am to 11:30 am or right after lunch. Maintain eye contact.
  
• Choose pictures carefully. The more unrealistic the picture, the better. Large, colorful pictures that are odd or include animals mimicking what people do spark creativity. While you might be inclined to use family photos, they raise the possibility of right and wrong answers, and a sense of failure. Instead, try a picture that triggers something from the past, but that is not too close so that it prompts the person to focus on remembering.
  
• Learn questioning techniques. The wording of the questions is even more critical than the images. Questions that elicit yes and no, or direct answers will not work. Inquiries like "Who is this?" or "What is this?" are outlawed. These create a pressure cooker for an individual with dementia, and set them up for a wrong answer. Only open-ended questions are encouraged, such as: "What should we call the person?" "Where are they going?" "What could this be?" "What is going on here?"
  
• Be persistent. If the method does not click one day, try again another day. It might take a lot of cajoling to get the person to respond. Engaging other family members in storytelling can stimulate more responses from the person with dementia, bringing the process closer to a group experience.
  
• Keep a stiff upper lip. The whole idea is to open up the thought process. Responses may be negative, incorrect or resurrect family baggage. Individuals often voice their contrariness or use sexual or bathroom language. Still, echo whatever is said and make that the story. Otherwise, if you frown upon their answers, they will be afraid to participate. It is important to validate comments-however shocking, and move on.
  
• Integrate music. Sometimes music will prompt responses even among individuals who are no longer verbal. Bring in music by asking open-ended questions, such as, "What might she be singing?" or "What music does the character like?"
  
• Go with the flow. You do not have to write the story down if you feel it will distract from enjoying the moment. Consider using a tape recorder or involving a youngster as the scribe.
  
• Redefine "story." Creative storytelling does not have to have a beginning, middle and end, nor does it have to make sense. For example, a character can have three names and words can be nonsensical. Most of all, remember this is creative storytelling. Noted Basting: "It can be scary for people to let go of literal language. But if you can follow to where the person is, you can find a whole new way to connect to your loved one."

Note: Experts caution that creative storytelling can be more challenging one-on-one than in a group setting. Families will need to jump over some hurdles, but, with that done, this technique can be successfully adapted to the home - and can be very rewarding all-around.