Using improv therapy to combat memory loss

From The NY Times:

Five of the six members of the Memory Ensemble were gathered in a nondescript conference room at Northwestern Memorial Hospital, ready to begin their weekly improvisational acting workshop.

“Where’s Irv? We need Irv,” one said.

“Oh, he’s always late,” said another. “He’s very dependable that way.”

At first glance, they could have been any group of energetic older Americans dipping their toes into amateur theater. But it was soon evident that this was not a social event: Ensemble members exhibited pronounced physical and verbal tics, abrupt lapses in conversation and other telltale signs of the cognitive disorders that characterize dementia and Alzheimer’s disease.

A collaboration between the Feinberg School of Medicine at Northwestern University and the Lookingglass Theater Company, the Memory Ensemble is what organizers believe is a first-of-its-kind program that seeks to improve the quality of life for people dealing with the early stages of memory loss.

The seven-week pilot session is designed to give newly diagnosed participants a “safe and supportive environment where they can challenge themselves but still feel secure,” said Christine Mary Dunford, an ensemble member at Lookingglass Theater.

Ms. Dunford co-founded the Memory Ensemble with Darby Morhardt, director of education and associate professor at the Cognitive Neurology and Alzheimer’s Disease Center at Feinberg.

Dozens of creative programs like quilting, painting and ceramics provide patients and their caregivers opportunities to express emotions and, it is theorized, maintain cognitive function for as long as possible.

The Memory Ensemble takes that template a step further with theatrical improvisation, a method that treats all words as useful and welcomes the expression of feelings that emerge on the twisting path of memory loss — terror, frustration, even joy.

The experience also helps participants learn to trust their instincts and make decisions based on the present, rather than the past.

The exchanges among ensemble members can be excruciatingly honest, as they talk about their emotions with a frankness that sometimes accompanies neurological damage. Ms. Dunford and her co-facilitator, Mary O’Hara, a social worker at the cognitive neurology center, negotiate this thorny terrain with considerable tact, gently prompting participants who grope for words or lose their focus.

“People with memory loss are often advised to stay mentally and physically active,” said Ms. Dunford, an anthropologist. But it is not always easy for patients or their caregivers to find those opportunities, she added.

Waiting for Irv, ensemble members chatted with Ms. Dunford and Ms. O’Hara. Frank and David were particularly jovial; beneath a swath of silver hair, Frank smiled broadly while David, loquacious and ruddy-faced, wore a T-shirt with a picture of Snoopy and the words “This is what awesome looks like.”

Evelyn and Janet sat together and were quiet, at least at first. Richard also took a bit of time to warm up, but by the end of the 90-minute session, he was sharing management tips gleaned over the course of a long career. Irv finally showed up to much fanfare. (All of them asked to be identified by only first names.)

The sessions follow the same dependable rhythm each week, opening with a metaphor-based “checking in” exercise. This particular week, participants chose a color to describe their emotional state. David, ever cheerful, was a sunny yellow. Janet picked a muted violet, while Evelyn said she was blue.

Ms. Dunford then started an energetic stretching sequence, and later directed participants into pairs to “sculpt” each other’s faces, hands and bodies into a physical expression of a “feeling” — loss, fright, pleasure, wonder and doubt.

“It’s like we had the ability to pass emotion between each other without talking,” Richard said.

The final exercise was the most challenging. Ensemble members each imagined a character who was grappling with issues the group had identified earlier — family, health and connectedness — and answered questions from the group in that character’s voice.

At the end of the session, Ms. O’Hara asked again about emotional “colors.” This time, nearly everyone chose yellow, Richard because he felt “energized” and Evelyn because she felt calm. “The blue has faded away,” she said.

Answering the key question — Does the Memory Ensemble improve participants’ quality of life? — will not be easy for the facilitators, in part because quantitative, double-blind scientific studies do not apply to this type of qualitative, narrative research.

“But we need to capture what effects we can,” Ms. Morhardt said. “Funding goes to evidence-based research, so we need to establish evidence for improved quality of life.”

Evidence may be forthcoming. After the final Memory Ensemble session on Monday, members’ friends and family members will report their observations of the workshop’s impact. Participants will also provide feedback, and there is little doubt about what they will say.

“Sometimes, I think, ‘What’s happening to me?’ ” Janet said. “I know I’m not the person I used to be. And sometimes I thought I’m the only person having these scary health issues. So it’s been great for me to know there are other people out there dealing with the same thing.”

Evelyn agreed, saying: “We all have a problem, or we wouldn’t be here. But when you’re here, you feel normal.”