Folding back the years: 2. Drama, poetry and visual arts
Knocker S (2024) Folding back the years: 2. Drama, poetry and visual arts. Journal of Dementia Care 32(6)29-33.
Sally Knocker reflects on some of the drama, poetry and visual arts work featured in over 31 years of JDC
Having trained as a dramatherapist in my 30s and been actively involved as a facilitator and a trainer in some wonderful arts-based projects over the years with Magic Me, NAPA, Ladder to the Moon and the European Reminiscence Network, I am a passionate advocate for arts and creativity to become more integrated into the everyday “offer” for those living in care homes or using day or hospital services.
In my culture change work with Meaningful Care Matters, I use many techniques to draw out the playful spirit in care teams, and use poetry, stories and movement-based activities in both my training and my direct work in care homes. In my personal life, I know that creativity feeds my core spirit, particularly when I write, read poems, take photographs and (more rarely!) dance. But I share Sarah Zoutewelle-Morris’s view, “You don’t have to do art, sing or perform to be ‘creative.’ In the broadest sense, creativity starts with breaking away from the ‘way things are always done’ in order to discover or imagine fresh approaches” (Zoutewelle-Morris 2009). This sense of breaking new ground is at the heart of many of the great arts initiatives featured here. Lots of the artists who approached the work didn’t have much previous experience of relating to older adults or those living with dementia. This seems to have given them a more open mind to what Zoutwelle-Morris describes as an awareness of ‘potential, rather than limitations’ and a ‘What if…?’ approach to the possibilities.
Telling and sharing stories – universal themes
One of the first articles I remember was Judith Hodgkinson (1994) talking about attending a course run by dramatherapists, Alison Kelly and Paula Crimmens. The parts played by people with dementia were not just conventional roles, but elements of the story, for example playing the “seeds of life”, “a little star”, the skyline and the sea. Crimmens and Kelly used fairy tales as a basis for some of their work with older adults with dementia, as these tales touch on universal themes … letting go and new beginnings, loss and finding what has been lost, reaching peace after a long journey, and so on. Paul Batson’s later article featuring his groups using drama and story-telling echoes some of these themes. He also stresses that the “use of story can provide a safe way in which to express our hopes and fears” (Batson 1998).
Dramatherapists refer to the importance of props to unlock memories or create moments of playfulness and engagement. Batson used his cuddly bear Branson as a familiar face with a ritual to open each group. He also used lots of hats, which iencourage people to “become” different characters as well as link them with special occasions or memories and to be more open to miming and role playing.
The power of the imagination and the possibilities of pretend worlds
Ladder to the Moon pioneered the concept of a theatre residency in a care home over two weeks which devised a “soap opera” type story in a care home with professional actors creating lots of improvisational elements within a broad agreed story line. By being present every day, relationships could be nurtured, and the story could be held and developed more easily than the traditional once a week structure of many arts projects. (This obviously comes with a significant investment, which sadly many care groups might not commit to.) Chris Gage, Ladder’s founder and creative director talks about interactive theatre creating a “playful space” where “with a nod and a wink, we acknowledge that we are all playing together, we can do everything we like, everything is accepted” (Benson 2009). I had the pleasure of visiting Compton Lodge on one of these days, where The Grand, an “upstairs, downstairs” story about a maid and a well-to-do gentleman in a hotel culminated in their wedding at the end of the residency.
Truth and lies?
Gage acknowledged that this pretend world can sometimes raise questions about the ethics and lines between truth and lies, and indeed whether it might increase confusion for people. Ladder’s experience was that it did not cause problems, but he stressed the sensitivity of the actors in reading the non-verbal and sometimes vocal responses of individuals to each unique encounter. The sense of excitement and fun in the home was palpable and the actors were highly skilled in ensuring that even those who were much quieter or more advanced in their dementia were not forgotten. Perhaps equally significant was the ways in which the Ladder team were able to involve care staff too – “When residents see their carers dancing and singing and wearing costumes, the shared experience leaves behind more of a legacy after we leave the home”.
Pushing boundaries
At the heart of a lot of great artistic projects is the ability to take risks and have a tolerance for uncertainty to explore uncharted territory and often then reap rich rewards.
One such initiative has always stayed in my memory: the Frames of Mind project (Flynn & Chapman 2011). The elements of Frames of Mind were:
- creating animated films using personal objects and belongings to prompt a narrative
- recording voice-overs to narrate the story
- using music of the person’s choice.
They explained: “We draw on our experiences as filmmakers to explore new ways of communicating. For example, we plugged a video camera into a large screen TV, and this enabled residents to see themselves on TV.”
They described how an Irish woman, Mary, chose a framed photograph of her mother when she was a young woman, a china horse and a crucifix: “She was able to move the objects, direct the action and operate the animation software on the laptop.” They were keen to stress that “none of the people with dementia we have worked with have been intimidated or reticent to try something new.”
I vividly remember another scene from their films where two chairs draped in clothes were set up as a budding romance story between a man and a woman, and how people in the group developed the story and the animated chairs (pictured above) moved accordingly. The result was both bizarre and curiously emotional and magical. Thirteen years on from this exciting initiative, we can only imagine how many more digital technology developments there must now be to further expand these creative possibilities.
Vamos, the Mask Theatre Company also pushed boundaries, as many would expect there to be complications around using masks for audiences for those living with dementia. (Hoskins 2018). They did a tour of interactive performances in care homes, hospitals and other venues, delivered training to carers and enabled families and care staff to see their award-winning show, Finding Joy. The show combined music, dance, nostalgia, masks and puppetry. Vamos’s way of working is very non-verbal and so their Listening With Your Eyes training for care teams explored how to make connections, particularly when words don’t make sense. This is another example of how artists have something special to offer care workers in terms of distinct skills and fresh approaches.
The right mix – integrating different arts approaches and abilities
Some of the most successful projects featured in the Journal recognised the value of integrating different arts approaches within one project. This was my own experience of a Magic Me Sense of Adventure project (Gilfoy & Knocker 2009) with a group of nine-year-olds working alongside residents in a care home in East London. We did lots of working in pairs creating collages and other visual art activities, which provided a quieter more focused sense of collaboration between people, and then more drama-based, storytelling activities in the wider group, which were more enlivening and playful (and at times it must be said, more unpredictable and chaotic!). Having the mix of both seemed to create a good shift in energy and atmosphere during the session. The visual arts activities seemed to create a safer place for more introverted personalities, while the dramatic elements brought out the extroverts! A special memory of this project shared in the article was of Betty who loved the drawing activities and confided that when she was younger, she had always wanted to go to art school, but her mother had not felt it was a “sensible career”. There are many other wonderful examples of other individuals coming to life when given permission to explore their, often suppressed, creative sides.
Patricia Aspinall (1997) used a combination of poems and painting to stimulate responses and she also involved a postgrad photography student to take photographs of people involved in various creative activities. The writing group then chose pictures to go with the words, which again involved a mixed media approach.
Artists can involve people differently according to their abilities and interests, for example a murals project by Elisha Maran-Barnell enabled one man to do lots of the larger scale painting directly on the wall, while others worked in a group to create the detailed sensory elements of the seasonal collage (Maran-Barnell 2002).
Judith Perry (1997) leading a wall hangings project linked to Tudor-inspired and wartime themes over eight months in Warwickshire described the power of those who just enjoy watching the work too: “Three ladies stayed all afternoon. We chatted about their memories of sewing. One lady told me of the quilts her mother used to make.”
Process and/or Product?
The other constant dynamic is balancing the process of involvement with the idea that there needs to be an end product – a finished painting, a performance, a complete poem etc. Batson (1999) sums up his perspective: “Putting on a performance is too stressful for some clients, but for others it can provide an exhilarating sense of achievement.”
The Photobook project (Robinson-Carter 2024) is an example of where both the process of participation and the product of a professional curated book was rewarding. One of their projects, partnered with David Truswell and Ronald Amanze, focused on those living with dementia with ethnically diverse heritage. Participants took one photograph a day over four weeks, capturing the experience of life in the Covid 19 lockdown of the summer of 2020. One man felt he didn’t have much to share, since he spent a lot of time in bed, but his book showed some striking, small changes in the photographs taken in the same space at different times. Participants were also invited to respond to specific questions: “What is your story?”, “What are your favourite things to do?” etc. The cultural variations were interesting: for example, Chinese participants didn’t include their faces in any of the images. Funding enabled the books to be translated into people’s first language. When participants were given back their curated books, many described the positive experience of returning to them: “I went through it again and again, I had the feeling…” Cultural diversity is an area of focus which deserves to be prioritised in future arts initiatives.
I was involved in a small photography workshop in a care home, funded by the NAPA Arts in Care Homes initiative, and found it incredibly powerful. It proved an accessible way of involving people in making choices about the images they wanted to take – and they delighted in the outcome, especially when this followed immediately, with a Polaroid or equivalent camera.
Many initiatives featured in JDC took place in care settings, but a lovely example of a Welsh community-based initiative in a mental health unit (Wood 2003) told of a couple living in their own home. Ginty learned to spin her own wool and then her husband Bob used this to weave, creating cushion covers and a wall hanging, “…an absorbing way to spend time, especially during the winter months.”
There are many other stories over the years of individuals who emerge to find their voice, their talent, their pride and, in the above example a restored relationship, through the process of involvement in the arts experiences.
Authorship: Who’s in charge?
Sitar Rose (Rose 2006) an independent documentary film maker, was involved in creating video portraits with and for people with dementia. Some of these focused on life stories but others focused on elements of everyday life, for example one woman’s relationship with her cat. Sometimes she would go and film places they had spoken about, to bring the footage back. Rose explored the issues around ownership of the material: as a filmmaker her focus was to edit in order for the essence and the character of the person to come through, but she stresses, “I do, however, as much as possible regard the person conceptually as the ‘director’ looking over my shoulder even though they may not be there in person.” She learnt that some of the work she created, while pleasing to her from an aesthetic point of view, was too fast or too abstract for the person themself to grasp. Sharing her experience with “Eileen”, Rose said she had to learn to hold shots still for a long enough time for Eileen to look at them and understand what was happening. Many artists featured in the JDC articles discuss this tension of satisfying artistic integrity with maintaining the core focus on the person living with dementia who is ultimately “in control” and owns the finished product.
Those creating poems written by and with people living with dementia are also conscious of the role of the listener in terms of how words might be received and interpreted.
In his fascinating piece reflecting on thirty years of poetry and dementia, John Killick acknowledges the issue of the attribution of poems. He says that in his early years of the work, he could not get permission from his employers to print the names of his subjects under their poems (Killick 2022). Another brilliant poet pioneering this work is Karen Hayes, and her way of acknowledging the collaborative process, in her two books The Edges of Everywhere and Only Just Orchid, is to print both names under the text.
An important contributor in the field of poetry and dementia is Susanna Howard and her work with Living Words on many projects through the years. Her Listen Out Loud action learning methodology, to develop staff skills and confidence, included powerful virtual support sessions for care staff during the pandemic, which culminated in a moving book detailing their experiences of that extraordinary time (Howard 2022).
Existing talents or new pursuits?
It is important to consider the way we work with those people living with dementia who are already talented amateur or professional artists in their lives before dementia. For some there may be frustration, especially when they have insight that their work is not as it used to be, and this realisation might make continuing painting, writing etc. a painful process. However, there are others like the well-known Jamaican poet, James Berry who worked in partnership with Susanna Howard, who found a way to continue his creative process through his dementia. As Susanna describes:
James is aware of using different words and often asks me if the word that has presented itself “makes sense” within context. When I repeat James’ words back to him, we often find ourselves revelling in the alternative words that present themselves. James is able to find humour in his frustration, and when he slips into complete metaphor and I follow, we trust the new “Berryisms” will bring affirmation and personal clarity. (Quoted in Killick 2022.)
Neil McCarthy emphasises the importance of finding out more about individuals and balancing building on previous interests and trying new things (McCarthy 2022). He describes the work of activity coordinator Josephine Ibrahim in sheltered housing settings: a range of artistic activities, including card making, collage, sculptures, making model homes as well as using “magic table” technology to do creative things in the digital arena.
A space to share complex emotions
John Killick’s work with the Elderflower Hearts and Minds programme in Scotland (Killick 2003) stayed with me: the clown can be a relatable figure for a person who is struggling with aspects of everyday life, as the clown frequently ‘falls over’ and yet can still retain humour in the situation. As Killick describes it, “The clown is a symbolic figure, both comic and tragic, and so can uniquely hold elements of sadness and fun for people.”
Killick’s feature Communication: A matter of life and death of the mind (1997) explored where the worlds of “art” and “therapy” meet. The central message of his work is to never dismiss muddled communication as meaningless and therefore no longer listen. By taking the time to record and share the words, “the profundity of some of the communication is incredible and shows much higher levels of insight than many would expect of those living with dementia.”
Paula Jennings (2006), a poet and creative arts worker, used reading poems to people as a way of eliciting reactions and feelings—sometimes with people reading to her:
Mim also reads poetry to me, repeating a phrase until she is satisfied… she exercises choice in her reading sometimes rejecting one book in favour of another…
Jen, another of the Scottish women Jennings worked with, was a keen hill walker. She expresses feelings of both comfort and loss when she describes the hills: “They are quietly telling you all the time that they are out there.”
This connection with the natural world is a recurring theme in many arts projects, sometimes as a type of metaphor for the internal world an individual is experiencing.
Metaphor provides a way of accessing difficult personal material and creating some safe distance through the use of imagery and allusion, which is explored in my own article on Play and metaphor in dementia care (Knocker 2002). Duggen and Grainger (1997), quoted in this article, say metaphor “both distances us from our pain and lets us communicate with it.”
Who is creative? Can this work be done by those who aren’t trained artists?
This is an ongoing area of debate in terms of the extent to which untrained care staff might be able to learn from artists and continue some aspects of the arts-based activities once the artists have left. Many artists like Killick and Zoutewelle-Morris have run training and written books (Killick 2013; Zoutewelle-Morris 2011) providing many practical ideas for activities coordinators or care teams to try out. Organisations like NAPA and Magic Me, funded by forward-thinking arts funders, also have a huge range of resources aimed at sharing art-based ideas. Yet, the reality remains that many of these initiatives are highly reliant on the motivation and interests of team members and can quickly get lost when those individuals leave. This has been my experience in all culture change work in care services and it is still work in progress to create structures in place to sustain creative approaches, beyond individuals of influence in post at any given time.
Challenges and learning from our mistakes
Some of the article writers are refreshingly open about some of the difficulties and barriers to success in making things happen in care services. Chris Sherratt, a sculptor leading the Lighting Up arts project in Bristol (Sherratt 2010) gives an honest account of some of the practical challenges of delivering a project in a care home. These frustrations are reiterated with so many of the arts projects I have been involved with. Moving forward, there perhaps could be more exploration of how to address these obstacles. More projects are building in team engagement and training at the outset and ongoing, to ensure that care staff do become more involved and can continue the experiences.
Sherratt compares the care home experience with a much more successful project in a day service creating three outdoor murals of a tropical island dream, a hot air balloon activity and the Clifton Suspension Bridge, a famous local landmark. Was the reason for this success because people in the day service were more independent and able to engage, or was it more that the culture of day care is more focused on activity and enablement?
Creativity in Dementia Care Calendar
For several years from 2006 onwards, JDC produced a calendar featuring art of all kinds, and poetry by John Killick and others.
This cover image (right), introducing the calendar in November 2005, featured the Treasure Chest banner made by older people living with dementia in a specialist hospital in Sandwell, West Midlands, working with Sandwell Third Age Arts. Techniques used included podging (rag rugging) batik, free machine embroidery, collage, metalwork and fabric painting.
Conclusions: What next?
As we discover the person who has dementia, we also discover something of ourselves. For what we ultimately have is not technical expertise, but ordinary faculties raised to a higher level; our power to feel, to give, to stand in the shoes of another through use of our imagination. (Killick & Allan 2001.)
Reading back issues of JDC was like a reminiscence experience for me, reflecting on my own professional and personal experiences in dementia care. So many of the names and voices are familiar, uplifting and rooted in the same core positive beliefs around what it means to work creatively alongside those living with dementia and to learn from each other. I have a sense of being among old friends who continue to inspire me, and I want to thank every one.
I long for a time when arts-based initiatives aren’t just called “projects” as this inevitably implies a limited life. The Baring Foundation funded NAPA’s publication A Manager’s guide to Arts in Care Homes; its director David Cutler said: “We have known for a long time that whether or not a care home resident has access to creative opportunities is entirely a lottery and therefore inequitable.” (See Teader 2024.)
Cutler also stresses that in order for arts and cultural participation to be embedded there will need to be a systems approach which will require the input of all stakeholders “including the regulators”. The NAPA National Day of Arts in Care Homes has celebrated many great initiatives in recent years which it is hoped will inspire others (Teader 2023). However, the issue of sustainability and legacy underlies much of the work I have highlighted here. Some of the organisations are still struggling to survive in the current financial climate, others have retired or closed the chapter on this part of their work. I try not to regard these as “losses” as these individuals and organisations have undoubtedly left their own ripples of influence.
Holding on to blue-sky dreaming, I feel that the ‘artist in residence’ concept is one which has the most potential: I mean a writer, visual artist, musician or drama worker (or one who combines these skills) who is on the payroll and works regularly in the home over months or even years.
This enables deeper relationships to be forged, and for spontaneous creative opportunities to be woven into the fabric of the service. Some activities coordinators have arts backgrounds, but they have many other jobs to do, so will be pulled in too many directions. By investing in an artist residency, a care provider is giving a clear indication of the priority it is giving this work. This is not to minimise the many great things which can be done to bring everyday creativity into life in a care service (Magic Me 2024).
I am concerned and excited in equal measure that we continue to cultivate the next generation of artists from all disciplines to take us forward with new stories and possibilities for all our creative futures.
It feels appropriate to end with the words of a poet and a man who lived with dementia capturing the essence of what creativity gives us:
We have thoughts, all away along through life. Your thinking machine within you realizes it has been switched on and it delves and there is wisdom in you. There is wisdom in the creative drive. It’s your own ideas that are dormant within you. That is the joy to stitch yourself on to.
James Berry talking to Susanna Howard (Howard, 2013)
Resources
Magic Me (2024) – Dare to Imagine – a care home’s guide to creativity https://magicme.co.uk/resource/dare-to-imagine-a-care-homes-guide-to-creativity/
NAPA has many excellent resources on the arts and creativitiy,includng here: https://napa-activities.co.uk/arts-in-care-homes/arts-resources/everyday-creativity
Sally Knocker is a Consultant Trainer with Meaningful Care Matters, an international culture change organisation. She has been involved in a range of arts-based initiatives with Magic Me, NAPA, the European Reminiscence Network and Ladder to the Moon. She recently was involved in supporting Magic Me to create a new resource, Dare To Imagine – a care home’s guide to creativity. For more information about Meaningful Care Matters and the Butterfly Approach, please contact admin@meaningfulcarematters.com
“The clown is a symbolic figure, both comic and tragic, and so can uniquely hold elements of sadness and fun for people” – the Elderflowers Hearts and Minds programme (Killick 2003)
References
(JDC= Journal of Dementia Care throughout.)
Aspinall, P (1997) Catching the waves: the making of a book of poems. JDC 5(5) 19
Batson P (1998) Drama as therapy: bringing memories to life. JDC 6(4) 20-21.
Benson S (2009) Ladder to the Moon: interactive theatre in care settings. JDC 17(4)20-23
Duggen M, Grainger R (1997) Imagination, Identification and Catharsis in Theatre and Therapy. Jessica Kingsley Publishers.
Flynn Z Chapman B (2011) Making animated films with people with dementia. JDC 19(6) 23-25
Gilfoy K, Knocker S (2009) Magic across the generations. JDC 17(3) 22-25.
Hodgkinson J (1994) Our greatest resource is ourselves. JDC 2(5) 14-15.
Hoskins H (2018) Loudly (but silently) finding and sharing joy. JDC 26(2) 12-13.
Howard S and Guss R (2022) Bringing the inside out. JDC 30(1) 30-33.
Howard S (2013) And so it goes on. Writing in Education 61 41-3.
Jennings P (2006) Poetry: a powerful tool to explore words and meaning. JDC 14(6) 28-30
Killick J (1997) Communication: a matter of life and death of the mind JDC 5(5) 14-16.
Killick J (2003) Funny and sad and friendly: a drama project in Scotland JDC 11(1) 24-26
Killick J (2013) Playfulness and dementia: a practice guide, Jessica Kingsley
Killick J (2022) Thirty years of poetry and dementia. JDC 30(5) 17-19.
Knocker S (2002) Play and metaphor in dementia care and dramatherapy. JDC 10(2) 33-37
Maran-Barnell E (2002) Creating a mural for the senses. JDC 10(2) 17
McCarthy N (2022) Creative homes: an arts project in extra care housing. JDC 30(1) 16-17
Perry, J (1997) The rich texture of memories. JDC 5(4) 16-17
Robinson-Carter E (2024) The Photobook Project: empowerment through creativity. JDC 32(1) 23-25
Rose S (2006) Video portraits: creating lasting records. JDC 14(5) 23-24
Sherratt C (2010) Lighting Up: lessons learned in establishing an arts project. JDC 18(6) 22-24
Teader A (2023) The National Day of Arts in Care Homes 2022. JDC 31(1) 14-15
Teader A (2024) A manager’s guide to arts in care homes JDC 32(1) 13
Wood K (2003) Spinning a yarn to weave the arts into care. JDC 11(3) 19-21
Zoutewelle-Morris S (2009) Creative encounters: applying skills learned from the arts. JDC 17(5) 32-34.
Zoutewelle-Morris (2011) Chocolate Rain: 100 ideas for a creative approach to activities in dementia care, Hawker Publications