Art Making and Working with Dementia By Carly Reifman

If you are a therapist working with clients with dementia, you have to come to grips early on that your population will not get better. For both the family and even you, it is a very long and slow grieving process. So it matters that you can make these individual's last years a little easier. It matters to let them know that they still matter, even if they will forget who you are in the next few minutes. But traditional talk therapy will not take your clients very far as they lose their memory and ability to speak. Their motor skills may be affected and they may often be confused and ask the same questions over and over. Cognitive therapy won't work with those losing their cognition. So how can you have a conversation with someone who is losing or even has already lost the ability to verbalize?

You make art. You stimulate them with color, shape, line, and texture. Although too many choices may be overwhelming; asking if they prefer the green or the purple paint might be the most choice they are presented with all day. Any level of choice is powerful for people who have lost their autonomy as functioning adults on so many levels. And clinical research has supported that art making is therapeutic in lowering stress, which in turn helps, not just the client; but also the family when they see a calmer loved one at the end of the day.

So what works? Every person is different and the stage of the dementia becomes a huge factor. A phrase I often hear repeated is "If you've met one person with dementia, you know one person with dementia." It just manifests so differently for each person as the disease attacks the brain in a seemingly random manner.

At OPICA, an Adult Day Care and Counseling Center, we make art with seniors with the diagnosis of dementia as well as with clients, who in their fifties have been diagnosed with early onset Alzheimer's. Art making in groups and individually allows older adults who have lost their voices to speak again. Painting is a fantastic tool. Long, large brushes dipped into bright watercolors or acrylics provide a gentle medium for expression. At first, simple lines may be encouraged. Sometimes a stimulus like a magazine cutout is helpful to get the ball rolling. I may use a picture of dog, small child, flower, car, or other simple innocuous symbols to stimulate cognition and long-term memory. Clients may paint around the image or on it directly. This also brings the client back to the image more easily, as finding something they recognize can be very grounding during an otherwise very disorienting time.

To many, a blank piece of paper is one of the scariest things around. It is really no different for seniors with dementia, especially if they forget what they're doing and don't remember the instructions. So… a little guidance to get something on that blank space is exceptionally helpful. Start with helping them dip the brush in their favorite color, then maybe gently take their hand and move the brush across the page with them. Something I do often is to playfully suggest that "I'll do something, then you something." I may start out with a dot or line first just to keep that stark white paper from being so dauntingly empty. There is no wrong way to add paint to the page, and who really cares if they paint the table anyway?

Oil and chalk pastels may prove a problem to those without fine motor control. So you might have to be their hands. Precut collage images or even cutouts of various shapes to stimulate their spatial cognition are especially helpful. They may be able to move the images around themselves and you can glue or tape them down. A completed image can be profoundly rewarding to the client. I once worked with a woman who found it painful to hold a brush or pastel, so we had to find a way to create without using her hands. She was getting frustrated quickly and was partially blind, so I needed to find a way to stimulate her other senses. I remembered the huge bag of dried acrylic paint that I had been hoarding in the cupboard. My colleagues often joked about me doing this, but I couldn't justify peeling and throwing away perfectly good dried acrylic paint from the wells of the plastic pallets. It was a 3D art directive waiting to happen! So…I ended up with a gallon-sized bag of at least a hundred pieces of colorful dried paint, each a little larger than the diameter of a quarter.

I pulled out about twenty pieces and allowed her to arrange them on the page however she wanted. I watched her feel the texture of each piece, remarking how different they all were. Some colors "felt right" in certain places, and some just had no business being on that page. One red piece stimulated a long conversation about a red dress she wore as a rebellious teenager. And as many people familiar with dementia will agree, the long-term memory is often much more intact than the short-term memory, so asking about the past can be very productive.

Encouraging social interaction is a huge component of treating a very isolating disease. In this way, groups foster an excellent foundation for treatment. A large piece of butcher paper or even a large canvas, if you have the budget, can provide an essential medium for nonverbal conversation. I once played some fun music in the background as group members laughed and abstractly scribbled in thick markers across the page with each other. Even making dots and shapes together on canvas with large foam brushes is particularly playful and satisfying. Creativity is a must for treating this population. And of course, both a sense of humor and lack of concern for paint getting on anywhere but the page are equally helpful.

Carly Reifman is a Marriage and Family Therapist Registered Intern under supervision and is working towards her Art Therapy Registration. She currently works at OPICA Adult Day Care and Counseling Center in West Los Angeles, where she works with clients living with dementia and assists their loved ones and caregivers in managing the impacts of the disease. Carly can be reached at carlyreifman@gmail.com. For more information about OPICA, please call 310.378.0226.