Drama Therapy has been used in nursing homes and assisted living facilities for years as a way of enlivening residents and building community. This is true whether the drama group participants have normal cognition or if they have begun to develop dementia. In fact, because drama therapy engages the imagination and stimulates the senses through embodied, concrete activities, it can bring adults struggling with Alzheimer’s Disease lucidly into the present moment and connect them clearly with memories of their past for the duration of the group.
Drama involves the whole person in an active manner. As a result, individuals who have been out of touch with themselves or with their surroundings will often become very alert, energized, and cognizant during a drama group. Acting out a memory makes it more real because an abstract thought is given form and movement in an improvised scene. Drama can be done with dialogue or in silence (as pantomime), making it adaptable to the verbal abilities of the group. Even without using words, participants become aware of the others around them and start to connect and create social relationships. And best of all, drama is fun!
Drama therapy incorporates all the other arts. A session may move from brainstorming an idea to acting out a scene to singing a song to playing a game to drawing a picture all on the same theme. Whatever strengths the group members bring will be accessed by several of the activities incorporated into the session, even if they aren’t engaged by everything in the lesson plan.
Typically a group begins with a warm-up activity which introduces a dramatic theme to be explored. The group might sing a song or look at a picture or touch an object that brings up memories and begins to connect them to themselves and to the group around them. Then group members take the memories into action, replaying parts of their past or trying out new adventures they have just imagined.
Most participants, even those who may be confused generally, understand when they are pretending in a drama group and when they aren’t. As far as I know there has been no research to explain how or why this phenomenon happens; however, I suspect that since the ability to use the imagination and to pretend begins early in development – between ages 2 and 3 when children begin to imitate others and use dramatic play to learn about the world around them – that we retain this ability even when certain parts of the brain that developed later in life begin to malfunction.
But enough talk. In theatre we say, “Show me, don’t tell me!” What follows is a partial record that Hailey Gillespie, a graduate student in drama therapy at Kansas State University, kept of a series of drama therapy sessions held in fall 2005 for a group of adults with early stage Alzheimer’s Disease. These sessions were led jointly by Hailey, Karen Johnson, and Stacey Pierce, all drama therapy students, who ran a forty-five minute drama group once a week at Tinklin Point neighborhood at Meadowlark Hills Retirement Community, Manhattan, Kansas. All names of participants have been changed to provide anonymity.
As you read through these descriptions of sessions you will note that the activities are planned ahead of time, but the leaders follow the interests of the participants. Sometimes the “plan” gets off track. That’s OK. What is important is keeping everyone focused on the logic of the moment. As the group improvises together, no one gets lost or confused or distracted; everyone communicates clearly and understands what is going on in the shared imaginary world.
Pirates: Aarrggh! – September 14
Pick a Pirate name.
Treasure Hunt.
Magic Box – we can take anything we want out of the treasure box.
This theme was a lot of fun. The residents had a good time coming up with various pirate names, and they laughed when we leaders would describe the story of how we got our pirate names. The transition into the pretend realm was aided by our use of costumes: hat, scarves, and eye patches. I used a pirate’s voice that they found entertaining. We discussed going on a treasure hunt, which became very exciting when they described the jewels they’d find. Lew was particularly animated about digging up his “booty.” We had to do some encouraging and offered suggestions when developing our scene of the treasure hunt, but I whipped out a map, and they were very interested in its contents. They told me they saw a forest we’d have to go through, and we’d have to swim across a river because we left our ship at the shore. Molly got frightened in the forest of deadly animals. To ease her anxiety, we tamed the wild beast together (the Meadowlark black cat), and it became her mascot. I had to leave early, and Karen told them I had gone looking for firewood; they quickly forgot about me.
Creating Stories from Pictures – September 21
Create a story from selected pictures.
Enact the story or write them down (whichever the group is more interested in doing).
Create a poem about what happened today.
Karen provided various pictures to elicit memories; however, the conversation seemed to focus on the weather, so we decided to talk about fall. Most of the group seemed distant and didn’t participate as actively as usual, but we were able to engage in a lot of conversation about harvest, dances, school, and the cool weather. We did not enact any memories, but during the conversation Karen wrote down key words on a large white sheet of paper. Afterwards, she showed the group all of the words they had come up with: colors, leaves, chill, falling, and more. She read the words aloud rhythmically and it turned out the group had created a poem about fall. Lew mentioned in a good-natured way that it didn’t rhyme, but no one else was bothered by that.
Creating Stories from Props – September 28
Create stories from selected props.
Enact story.
My intention for this session was to get people to talk about different memories as they held a prop in their hand (e.g., a doll, phone, old time egg beater). However, when I provided an example of a memory about school, they all decided to share school memories. This turned out to be a great theme as many of the residents had shared similar experiences of one-room schoolhouses, spelling bees, and playgrounds.
Each of them remembered the words to a song about school. The other leaders and I didn’t know the words, so the residents sang it several times for us until we had learned it. Another way we connected was by playing a game that was very popular during recess for them. Again, they all knew how to play and had to teach us! We spent a while playing an adapted form of catch with a chair in the middle of the room to represent the schoolhouse that we threw the ball over.
We divided the group in two and talked about other games and activities we did at school, then we acted them out for the other group. My group was very focused on recess, so we acted out hopscotch. The other group enacted the scene where the teacher rings the bell and everyone runs to the schoolhouse from the playground.
We helped create bonds and group cohesion by finding memories the residents shared. I think they also enjoyed teaching the leaders a thing or two for a change.
On the Farm – October 12
Discuss the farms everyone grew up on.
Farm Animal Charades
Plastic Egg Toss
Since almost everyone grew up in rural Kansas, the residents easily remembered something about being on a farm. Vicky and I wore pig noses and everyone got quite a kick out of that. Others decided to wear sun hats or cowboy hats.
We talked about barn dances, barn raising, milking cows, chores, and chickens. The residents were clear about their reminiscences. The charade game was quite a hit. We placed all the ideas into a cowboy hat and passed it around. Each person picked a piece of paper and acted out what it said. They were encouraged to use props, hats, and costumes.
The egg toss was wonderful. We lost track of time because the residents were having so much fun. We placed four buckets in the center of the room, gave each participant a mixing spoon and a pile of eggs. Taking turns going around the room, each resident got three tries to hit the target. Helen started getting impatient for her turn and just started chucking eggs into baskets at random. We accommodated and made it a race: who could get the most eggs in their baskets the fastest? Our job was to refill the spoons and keep the egg piles full.
Halloween – October 26
Acting out Halloween creatures
Making masks
TPing the house
Monster Mash
I drew on the knowledge that the residents really enjoy physical activities, and we brainstormed various things associated with Halloween to act out. We used costumes: white scarves draped over the face for a ghost, a monster hat for a zombie, etc. One of the Meadowlark pets was a black cat which was a nice addition.
We then created masks for ourselves out of paper plates and markers. We had to assist the residents quite a bit, but most of them had an idea of what they wanted to become. Helen and Gert wanted to make pumpkin masks, Molly was a Princess, Katherine was a black cat, and Lew was a vampire. We each held our masks to our faces when we finished and had the others guess what we were.
Then we played a game based on what happens when you don’t get a treat on Halloween: we TPed the Tinklin living room – playing catch with toilet paper rolls and wrapping up appendages when the TP roll dropped. They really liked this and it was safe since the roll was so soft.
The closing was The Monster Mash. I played the song on my CD player and we thought up actions for each character. A witch stirred a cauldron; zombies staggered around; bats flew. We were all tired at the end of this session!
Harvest Time – November 2
Corn Maze
Mystery box – identify item with your sense of touch
Scarf Dancing
The residents seemed off in their own world today, but I had some tactile stuff that got them interested. When they first arrived, I had created a “corn maze” on the floor of the room with masking tape. I assisted them in finding a seat by navigating the maze and avoiding obstacles (the dog decided to take a nap right in the middle). They thought this was pretty neat.
We first reminisced about harvest time. I brought a box of vegetables and they took turns reaching into the box and guessing what was inside. Vicky touched an ear of corn first, which she guessed after I had her smell it. I asked if she’d ever shucked corn before and her eyes got very large. “Why, no!” she said. So we went ahead and made a mess shucking the ear of corn. The other things in the box included a squash, tomato, little pumpkin, and a sheaf of wheat.
The last thing we did was a scarf dance. Vicky and Lew didn’t want to stand, so Stacey and I adapted the activity and pretended the scarves were leaves, which we threw everywhere. It turned into a leaf fight! They had a good time with this!
Trip to Hawaii – November 9
Take an airplane to Hawaii
Luau with feast and hula dancing
Group photo
Cruise back home
This session was one of the best we had. The theme provided for much creativity and imagination. We had many props to assist in our pretend play, which helped everyone get into it more. Karen, Stacey, and I greeted each resident as they arrived at “Meadowlark International Airport” and handed each a ticket. I wore a pilot’s hat and name badge. As they came in the doorway, they were instructed to check their baggage, walk through the metal detector, and were escorted to a window or aisle seat in the plane. They all got a kick out of this and played along immediately without getting confused at all.
All of the chairs were in rows facing me and Karen (my flight attendant) and I enacted pre-flight instructions. Before take off we talked about where they would like to go. Katharine wanted to visit her daughter in New Jersey. Molly wanted to go to China. Vicky mentioned Hawaii where she grew up and at that I told them they’d guessed our plane’s destination. We talked about what we needed to bring on the trip, enacted the take-off, and dealt with the turbulence. We even had a pretend in-flight beverage service complete with cart, napkins and cups.
After landing in Hawaii we put on grass skirts, went fishing, cooked our fish, and had a great feast at the luau. Hawaiian music was playing. I asked Vicky (who grew up in Hawaii) if she would teach us the Hula, which she did. Even Helen, who was in a wheelchair, got into the arm movements and had a great time. We took a [pretend] group picture before we left to come back home – one “nice” one and one “silly” one. Then we took a cruise ship home which gave us time to reflect on the favorite parts of our trip.
The residents really enjoyed this session. They were all in character the whole time and played along. They thanked us as we were packing up. I don’t think they wanted us to leave. I told Vicky I was glad she came along to guide us around her home state. She beamed and told me that we should go again soon.
The Olympics – November 16
Create flags
Play several Olympic Games
Medal Ceremony
We started the session around the table so they could decorate flags while we discussed the Olympics and our favorite sports. Stacey, Karen, and I helped draw pictures and add stickers. When we finished, everyone displayed and explained their flag. Vicky created a Hawaiian State flag while Helen did a Kansas State University flag. They were all very proud of their creations and enjoyed the compliments they received.
We had a fanfare into the next room where we sat in a large circle for our Olympic games. First, we did the Shot Put: everyone threw a bean bag underhand to see how far they could make it go. Next was the Javelin: where they tried to throw a bean bag into a hula hoop on the floor. Third, was Archery: tossing bean bags through the hula hoops while Stacey held them up in the air. Finally, we played Volley Bean Bag: counting how many times they could catch the bean bag before it dropped. Everyone received a gold medal in one event. They were all very proud of their accomplishments. From their reactions, I think this was one of the most therapeutic sessions we did.
Reflections on the whole process:
I really enjoyed working with every one of the residents. They each had their own interests and backgrounds to create a rich atmosphere for acting and playing. Vicky, for instance, was from Hawaii and taught us to Hula. Lew was never without comical and good-natured wit, often keeping us on our toes. He once told me with a wink to bring more of my young friends with me next time. Helen challenged us to keep her attention and when we succeeded in doing so, we felt rewarded. She was very direct and honest with us. Whenever she would comment that she had had fun, I would chalk that up to a great success because she never said anything just to be polite. Katherine would glow when she spoke about her memories. Her only reservation was allowing herself to be silly and play, but she came around and toward the end and wore silly hats with the rest of us. Molly was a creative actress who got totally into her roles.
The two biggest things I learned from working at Meadowlark were:
- Be flexible and accommodating. Don’t try to force a session in any direction. You must be willing to go along with where the residents want to go.
- Keep your attitude upbeat. The residents are very tuned into your body language, tone of voice, and facial expression. The way you present yourself will have an effect on the group. If I was tired and was metaphorically “watching the clock,” the residents became anxious and difficult to work with. If I decided to genuinely have a good time no matter what, the residents would, too.
Recommended books on drama with older adults who have dementia:
Basting, A. D. & Killick, J. (2003). The arts and dementia care: A resource guide, Brooklyn, NY: National Center for Creative Aging.
Clements, C. B. (1994). The arts/fitness quality of life activities program, Baltimore: Health Professions Press.
King, K. (2014). Engage! 28 enrichment experiences for older adults, Portland, OR: ArtAge Publications.
Sandel, S. & Johnson, D. R. (1987). Waiting at the gate: Creativity and hope in the nursing home, New York: Haworth Press.
Thurman, A. H. & Piggins, C. A. (1982). Drama activities with older adults: A handbook for leaders, NY: Haworth Press.
Weisberg, N. & Wilder, R. (2001). Expressive arts with elders: A resource, 2nd ed., London: Jessica Kingsley.
Many thanks to Hailey Gillespie, M.A., who provided the session descriptions!