Empowering Independence: Art Therapy for Individuals with Dementia

Today I write from my observations and my heart. I hope by listing challenges and possible solutions to encouraging independence with dementia that you might be able to takeaway a tip or deeper perspective when working with someone experiencing cognitive challenges.

The bottom of this post is meant to show the benefits art therapy has had on a client in terms of their feeling independent. All identifying information for this client had been changed. The story remains the same. Don’t forget to save this blog as inspiration in your own work or day-to-day life encountering dementia.

Introduction

According to the population resource bureau the number of people living with dementia will increase. It is estimated that currently 7 million people in the US, aged 65 and older, live with dementia and by 2030 that number will increase to 9 million.

Often times where dementia lives, stigma does as well. You may even think as you’re reading, well how can someone who forgets things be independent? What is the point in promoting their independence? In my experience as an art therapist for people with dementia, feelings of independence is at the core of being human. It’s something we all crave to exist with. The ability to make decisions, makes us - us.

The American Art Therapy Association defines art therapy as, “"An integrative mental health and human services profession that enriches the lives of individuals, families, and communities through active art-making, creative process, applied psychological theory, and human experience within a psychotherapeutic relationship." When applying art therapy theories and responsibilities to working with people living with dementia I focus on enriching their lives through creative choices.

Understanding Dementia and Independence

Most dementia-related diagnosis are progressive, which means the disease will continue to get worse over time. Their memories will fade and you’ll begin to see their abilities to complete tasks decline. They may have trouble stringing sentences together or look at you with a glazed over expression on their face. As a clinical term, this is called apathy.

fear lies in stigma

The challenge faced by most with a new diagnosis in the early or middle stages of the disease is that most outsiders will jump to the conclusion that the person is no longer capable of doing things for themselves. Stigma lies in the picture that people relate the word dementia to what someone might look like in the later stages of the disease. This could look like someone in a wheelchair or bedridden, unable to carry on a conversation or maintain eye contact.

That viewpoint is far from the truth of dementia. People living with dementia can live 20-30 years past a diagnosis. That’s a long time to push someone to the side because they aren’t “independent” or are incapable of being independent. What kind of life is worth living if all you’re seen is by the label of a diagnosis?

The Power of Art Therapy

Adaptions to art therapy for dementia

As mentioned above, art therapy is a wholistic approach to care. It’s a way for someone to tap into their creativity as a way for insight, control and connection. It is a combination of using art supplies and speaking to communicate for yourself in the moment. It is often associated with the word healing.

Healing implies there is something that needs fixing. With dementia there isn’t necessarily a way to “fix” or “cure” or “heal” a diagnosis. The person won’t grow from their diagnosis, they will decline. In my experience as an art therapist for people living with dementia, art therapy becomes more of an aide to daily living. It can create space, promote independence and instill confidence in the person experiencing the artmaking experience.

the dementia trained art therapist

How does art therapy do these things for someone with dementia? The answer lies in the facilitator, the credentialed therapist, with knowledge and understanding of dementia and the art supplies they provide to make those connections. By understanding a client’s capabilities, an art therapist for someone with dementia can focus on their strengths.

Questions I often ask myself when first starting with a new client include: Are they good at and feel confident in selecting colors, using a paint brush, or coloring in the lines? Do they have a thirst for learning new things or do they seem to grow from the same type of exercises each session? What’s their vision truly like? Can they see more than people assume? Would slight modifications, like darker lines or brighter colors help them be more successful? All these questions race through my mind when working with my clients.

If you’re interested in hearing more about how we can find your person with dementia’s strengths head on over here, where we can set up a time to help you.

Approaches to Encouraging Independence through Art Therapy

strength-based approach with dementia

In therapy terms I would call our care person-centered, strength-based or even Rogerian. In this type of therapy clients are given the ability to take the lead. This type of therapy is for anyone, any age or diagnosis. When it comes to someone with dementia, we provide a base and they get the control and power to dictate where the session goes. To highlight this, I’d like to introduce you to Emily, living with an Alzheimer’s diagnosis.

real scenario

Emily had an exciting career in graphic design. Her caregiver provided all the details of Emily’s early years because Emily is unable to tell her own story with words. Her Alzheimer’s has taken away her ability to speak, otherwise known as aphasia. She uses one to three phrases and then is unable to finish her sentences.

Emily and I tried projects in the very beginning of our sessions and I quickly learned that Emily appeared unable to follow verbal direction. She appeared unable to connect my verbal instructions, but sometimes was able to mimic my physical modeling of instructions. When Emily caught on to my physical modeling, she often was able to do that same motion 2-3 times, without prompting, but then stop. This led me to realize that there was a muscle memory going on, but something wasn’t right.

After weeks of the same results and my trying to work on projects I thought, what would Emily do if I brought paint, canvas and an easel for her to work on? I remembered Emily’s background in graphic design and realized Emily was probably used to using an easel. I modified the traditional acrylic brush to foam brushes because I knew Emily would have a difficult time with the task of reapplying paint to her brush and that foam brushes hold more paint for longer amounts of time.

unstructured painting

The day came for me to try painting with Emily. I cleared any clutter from the table, placed brown paper to create a clear space to work in and placed the easel on top of it. I gave Emily three colors to choose from and she pointed to the color she wanted to use. With assistance, Emily pressed on the paint tubes and aimed the paint into the individual palette.

I asked Emily which paint she wanted to use first, she again pointed to the color. I placed a foam brush in the paint, coating each side with the acrylic paint and left the handle sticking out towards Emily. To my surprise and excitement, Emily immediately picked up the brush from the handle. She lifted her head up to be eye level with the white canvas, brought the brush to the canvas and started to move it along the surface of the canvas.

Emily was free painting, no instruction from me. I said few words to set her up. I said few words when sitting next to her. I said nothing, until Emily started speaking. Emily had made 4 strokes across the canvas in about 5 minutes of time. She turned her head towards me and said, “where do you live?”

On the inside I was screaming for joy. On the outside I calmly repeated her question back to her, inserting I, because I was speaking for myself. “where do I live? Great question!” and I answered the question. Emily turned her head back towards her canvas and continued to paint.

Building Communication and Emotional Expression

When Emily looked at me and asked where I lived, I was taken back. I was surprised and not surprised at the same time. The creative process freed her from her aphasia in that one small moment. It allowed her to speak, the way she wanted to speak. How did she get to the point?

As I set up the space for Emily, I made sure she would have the opportunity for what I call micro choices. Micro choices are small choices that lay the foundation for big impacts. Emily was able to decide what colors, how and where she wanted to put them.

Those small choices also reminded Emily that she still had capabilities and that her choices mattered. On my end, I wasn’t denying her decisions, I was empowering them by allowing her to have the control. That control leads to feeling confident in oneself. It allowed for a moment of joy to come through and without trying the think about what she wanted to say, Emily said it.

Empowering Caregivers and Families

A caregiver hearing their Loved One speak, when they haven’t in a long time can bring up a lot of emotions and desires for that person. For many it can lead them to want more and in those moments I find that caregivers will start doing art with their loved ones outside of the weekly art therapy session I have with them.

Emily’s family started to mimic the art therapy set up everyday. She was given the option to create and paint. The family was also given the confidence to create art with their loved one through my modeling during sessions.

In this situation we made sure Emily had canvas, foam brushes and clear space to work. The art area needed to be clear of distractions and Emily appeared to work best with her setup facing the outdoors. Emily’s caregiver would hold her paints and try to give her the opportunity to paint in silence or with music Emily selected.

Was this time a break for her caregiver, not exactly. What it was thought, was the opportunity for her caregiver to see her in a new light. Emily was seen as a capable person, able to make choices thought her painting process. Joy was created for Emily with independence. Joy was also created by her caregiver to see her in a capable light.

Conclusion

I think if we look at independence with dementia outside of daily life activities, we might find more for people living with dementia to do. Art Therapy has the power to bring out moments of independence for the person with dementia and their caregiver to see this.

The ability to make choices may be at the core of this. When we can make choices, we come back to being human. Without choice, then who are we? We may continue to fail to thrive in that situation.

Art therapy may be a good option for your person with dementia if you’re looking to make them feel more independent. Let’s collaborate and try to create a magical moment and bring more joy to your lives. You can learn more about art therapy for someone with dementia here.

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LOOKING FOR ART THERAPY FOR YOUR PERSON WITH DEMENTIA?

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If you have questions, feel free to email me hello@arttherapistsathome.com