Dementia communication tip: Say yes.
In my role as an SLP and family educator, I often explain the importance of meeting people with dementia where they are. This usually leads to a conversation about lying to loved ones, which makes everyone uncomfortable at first. Even I am uncomfortable with the idea of “lying” to people with dementia. Treating someone with respect and dignity is telling and enforcing the truth, right?
When I began working with people with dementia, I had to reconsider the guilt I felt when I didn’t tell the complete truth. The more I examined the situations I was in, I realized when working with people with dementia (or other cognitive impairment) telling the truth can be self serving. If people no longer have the ability to rationalize, forcing the truth is drawing attention to their weaknesses (e.g. decreased memory, problem solving, etc.) and causing discomfort.
Your part in the story
We are part of a story, but the story isn’t about us. It is about the elders or loved ones in our life. Keep them the protagonist of the story, driving the action. Some people may find this concept similar to a Montessori approach.
But this can be a difficult concept to teach. Discussing lies and truth is emotionally charged, which is why I was overjoyed when I heard a recent podcast from This American Life (Magic Words, Act Two). The story follows two improv comedians, who discovered a popular “Yes, and…” improv technique worked really well with their family member with dementia.
In brief, “Yes, and…” asks comedians to always say “yes, and…” rather than “no, actually…” When you say “no” the conversation ends. So if a comedian enters the stage and their fellow comedian says, “Look at this amazing new cheese snack for cows!” If they say, “That doesn’t makes sense, cheese is made from cows milk” the conversation ends. But if they say, “Wow! How do they get the farmers to buy the cheese for the cows?” the conversation continues.
How to say “Yes, and…”
I love this way of looking at meeting people where they are. It’s not about lying. It’s about something positive – saying yes. What does this look like in communicating with those with dementia? Say yes. Acknowledge their thoughts and feelings. Then contribute. Here are some examples:
Situation – Just after lunch in the dining room.
Elder: I need to pay my bill. (Looks in pockets for wallet)
Me (saying “no, actually”): You don’t have to pay. It’s all included in your monthly bill.
Me (saying “yes, and”): You got the bill last time. Let me get it this time. Thank you for visiting with me at lunch.
Situation – One on one conversation prior to therapy
Elder: There are bananas in the bathroom.
Me (saying “no, actually”): We don’t keep bananas in the bathroom. We keep them in the kitchen.
Me (saying “yes, and”): Well let’s make a banana split! Where is the ice cream?
If we are trying to force the “truth” into the story, what are we missing or leaving out? How can you use “yes, and…” rather than “no, actually…” to increase the value of emotions and participation in the story?
A clarification: My thoughts on using the “yes, and…” technique and not forcing the truth are not meant to discourage informed consent or resident rights.