Susan Shortridge describes a creative storytelling program that allows people with dementia to communicate in imaginative ways
Creating an environment in which people with dementia are invited to express themselves imaginatively, without judgment, reflects an important aspect of the person-centred care approach to health and well-being. The process of creative engagement can allow people with memory loss to feel purposeful and valued.
TimeSlips is a program, available worldwide, that uses creative storytelling as a pathway to communication and social interaction for people with dementia. It takes a participatory approach to creativity. In groups, or one-on-one, TimeSlips facilitators invite imagination-based responses to a prompt, such as an image. Facilitators gently guide the participants by asking them a series of open-ended questions, and then accept whatever answers are given. The responses are recorded verbatim and read back to the participants, forming a story. This creative interaction allows people with memory loss to communicate in innovative ways.
I have been involved in implementing the TimeSlips program in my role as a volunteer at Mary Potter House, a day respite centre for people with dementia operated by Calvary Health Care Sydney.
The TimeSlips program was developed by Anne Basting, Professor of Theatre at the University of Wisconsin in the US. In 1996, Professor Basting started investigating the use of improvisation and creative drama techniques as a tool to help people with dementia. She discovered that imagination-based techniques were the most effective for encouraging communication and social interaction amongst people with memory loss (Basting 2009).
After shifting the focus from reminiscence toward imagination, the small group she was working with went from very little talking or eye contact to laughing, singing and communicating (Basting 2009). Over several years, in conjunction with care providers and people with memory loss, Professor Basting developed TimeSlips, a replicable, imagination-based storytelling process.
To make the program more accessible, free web-based interactive storytelling software was created in 2011. Visitors to the website (www.timeslips.org) can click on images that link to a story page, with examples of open-ended questions. They can also publish stories online and read stories that others have shared from around the globe.
Training is available through the website for organisations and individuals to become certified TimeSlips program facilitators. The certification process ensures that facilitators are confident and competent in delivering the program, and offers ongoing support and additional resources.
After completing the online training modules, trainees are required to practise the method for several weeks and submit a minimum of six stories, which they post to the website. Trainees also complete a detailed self-evaluation, which is reviewed by a Master Trainer, who assesses their skills and grants certification when appropriate. Certification must be renewed every three years, following a further assessment. This ensures the facilitators are still practising the method correctly and allows them to keep up-to-date with training and practice changes.
The program’s adaptability is reflected in the diverse range of professionals and individuals, with varying educational backgrounds, who have undertaken the training. These include museum educators, students, volunteers, family carers, pastoral care providers, CEOs, visual artists, musicians, dramatists, psychologists and therapists.
While training is encouraged to reap the full benefits of the program, the site is free for anyone to use, and visitors can watch a video on the home page to see TimeSlips in action.
TimeSlips in practice
There are TimeSlips facilitators in Western Australia, South Australia, Queensland, Victoria and NSW. The program is a simple and inexpensive option for providing creative engagement, and can be used in long-term or short-term care facilities, or privately at home. The requirements for implementing TimeSlips are minimal. They include: time (half-hour to an hour per session), an appropriate environment (such as a quiet room), images (used as a story prompt), a notepad or flipchart and pen or marker.
TimeSlips at Carinya Dementia Unit
Paul Hurst is a TimeSlips facilitator and pastoral carer in the Carinya Dementia Unit at St Joseph’s Village, Sydney. He has run the TimeSlips program there for the past two years and has experienced its positive impact on people with memory loss.
“By sharing in the creative story experience the participants are no longer alone or isolated,” Paul explains. “Closer friendships develop during the story time that would normally take many conversational encounters to achieve. As the participants become chroniclers of their own story, their dignity and humanness begins to infuse their being.”
A typical TimeSlips session at Carinya usually lasts an hour and involves a group of about seven participants. They assemble weekly on a Thursday afternoon in a designated small activities room that offers a quiet space in the dementia unit. It is important that participants feel the storytelling is a special event to which they are invited, not an activity they are obliged to attend. Everyone sits in a circle, Paul welcomes each person and explains how the story sessions work, emphasising that there are no right or wrong answers.
TimeSlips sessions follow the same basic format every time, reinforcing a sense of ritual and routine. To help break the ice, Paul reads a story from a previous session. Participants are shown a new image and invited to make up a story. The content emerges from responses to open-ended questions, such as: “what do you think is happening in this picture?”, and “what sounds or smells would there be?”. These types of open-ended and sensory questions are specifically designed to stimulate the imagination.
The storytellers’ responses are echoed to show that their words are being understood and recorded. Paul works with a volunteer who writes down the answers. The emphasis is on imagination rather than memory, so even responses that may appear to be nonsensical or contradictory are still valid and add a depth of metaphoric meaning.
Participants with limited language skills can still contribute. Storytellers are valued for whatever they bring to the story, whether it be a sound, a gesture or even a movement. The creative process is as important as the story.
Every so often, the story is read back to the group, with the same energy and emotion as the storytellers. This is a vital component of the TimeSlips process, and helps keep participants engaged. Their answers dictate the direction and length of the story. They also come up with a title.
“I never know what will occur,” says Paul. “I travel alongside the clients, sharing their journey. Sometimes the story evokes a song title and then we stop and all sing as much of the song as we can remember. We do this at every reading, so that by the end we may have sung the song three or four times.”
Paul has received positive feedback from participants: one said it was “good to get together and talk and sing and laugh”, while another described the sessions as “fun”. The imaginative process invites playfulness and experimentation. Participants are encouraged to laugh, sing, repeat sounds as a group, dance and mime.
A Happy Ending
He’s a nice little baby. His name is Jimmy, poor kid. If they shut up the bag they will take him away. His mum carries him in the bag. You can’t see anyone around. His family is making him smile. He is a cheeky little fellow and he is from Papua New Guinea. He is a nice little fellow and is saying “I am free at last”. That is why he is smiling.
As far as Maureen knows he is in Sydney. He’s a cheeky young fellow. He grows up to be a handsome young man. He will have plenty of girls with that smile.
He must have been playing near the bag when someone put him in. He is loving it because it’s different. Maybe there is a snake in the bag. Monica said you can keep the snake. He will throw the snake out and put the fire on the snake. “Good God”, says Val. Monica will put the snake in the bag and in a bin and close it.
In the end there is a possibility that something might happen.
This story was created by Monica, Val, Pat, Mabel, Joan, Maureen, Nora, Brenda, Margaret and Sevinch on 24 July 2014.
TimeSlips at Calvary Health Care
Calvary Health Care Sydney implements the TimeSlips program for two of its services. Calvary’s Inpatient Rehabilitation Unit (which is not specifically for people with dementia) offers clients the opportunity to participate after their daily gym workout, while Mary Potter House, the day respite centre for people with dementia where I volunteer, runs weekly sessions. Pastoral carer Mary Ashton explains how she implemented TimeSlips after being challenged to come up with a program to foster deeper relationships with clients and leave them feeling empowered in the face of constantly evolving challenges.
In 2012, Mary attended a conference on spiritual care for people with dementia, where Elizabeth MacKinlay, Professor of Theology at Charles Sturt University, NSW, spoke about a creativity program designed for people with memory loss – TimeSlips – being run through the University of Wisconsin in Milwaukee. As Mary recalls, “I searched their website that night and found the TimeSlips program. I was so excited I stayed up until 4am doing the online training. Coincidentally, another team member did the same. Within the week we had the program up and running.”
Since starting the TimeSlips program at the Inpatient Rehabilitation Unit, Mary has noticed clients appear more willing to engage socially with each other after the storytelling sessions, often choosing to stay and chat with each other rather than returning to their rooms.
In Mary Potter House, Mary feels that staff who participate in TimeSlips get the opportunity to see the clients with dementia in a new light.
“They develop a better understanding that a dementia client’s personality has not vanished – rather it is hidden away by the disease – and on a good day at a TimeSlips session we get to meet that personality. The stories created are infused with bits and pieces of the client’s own life story. Sometimes funny nonsense stories happen; other times they appear to be directly related to days past. A photo of a soldier provokes details of time spent overseas fighting a war, a photo of a dog brings memories of childhood pets, and beach scenes bring waves of memories from family holidays from years ago,” Mary explains.
Improved self-esteem is another feature of creative storytelling noted by Mary. “For most of our clients it has been a long time since they felt they have contributed to the world. When clients hear their stories read back to them, they feel pride in their creative accomplishment,” she says.
“It brightened up my day, made me feel like I was making something,” reported
one client. “Today I felt like my brain was not out of date,” said another.
Although more comprehensive research on the benefits of creative engagement is yet to emerge, preliminary research involving the TimeSlips program has been promising. A recent study (Daniel & Houser 2014) found that involvement in TimeSlips can engender benefits for people with dementia and staff in aged care homes and for care home communities.
In another study (Phillips et al 2010), TimeSlips participants were found to have increased expressions of pleasure and initiation of social communication.
A 2009 study (Fritsch et al) compared aged care homes that embedded the TimeSlips program to homes using other activities. Residents at the homes using TimeSlips were found to be more engaged, staff members had more positive views of residents with dementia, and staff-resident interactions were more frequent, as were social interactions.
Creative storytelling is an easy and affordable activity, offering enormous benefit. TimeSlips allows people with dementia to express ideas creatively in their own words, without being edited or censored by others. It inspires new avenues of communication and social activity, which can be extended to include caregivers, family members and volunteers.
It can also give people with dementia a renewed sense of purpose and meaning, particularly as their stories and words are shared with the larger community. The facilitators can do this through the TimeSlips website or creative projects, such as assembling the stories into a book to be shown to family and friends. TimeSlips stories have inspired dramatic plays, art exhibits, paintings and poetry. This type of positive engagement with the community helps raise awareness of dementia and reduce its stigma.
For more information about TimeSlips visit www.timeslips.org. Certified facilitators and their locations are listed on the training page.
Susan Shortridge is a volunteer at Mary Potter House, Calvary Health Care Sydney, where she is involved in implementing the TimeSlips program. Contact her at: firstname.lastname@example.org