Working Without Words


When working with people living with dementia the reality is that many of the participants that you engage with may be experiencing varying degrees of difficulty with verbal communication. In the later stages of dementia this may reach the point where people no longer have any level of communication in a verbal sense. This could be happening for a range of different reasons which depend upon the type of dementia and is not always a reflection of overall cognitive capacity. For example for somebody with frontotemporal dementia difficulty with language can be one of the first symptoms that is noticed, whilst other aspects of cognitive capacity remain unaffected. Understandably this can be deeply frustrating for a person who is experiencing these changes.

Creativity in its widest sense can be a brilliantly effective way to enable people to make contact with others and to engage, especially when verbal communication is becoming more difficult.

Here are some of our reflections on working non-verbally based upon our experiences during The Storybox Project.

  • As people find it harder to communicate verbally their need to communicate may manifest itself in new and different ways making use of sounds and / or movements. As a facilitator it is crucial to value and respond to communication no matter what form it takes.


  • Planning activities which are multi-sensory and which have a range of entry-points, means of engagement and sharing is all the more important for non-verbal participants. It allows them to decide how and when they would like to take part as their need changes and develops, and also reduces a sense of failure that people may experience as there is not a single right or wrong way of joining in.


  • Non-verbal participants can benefit hugely from participating within mixed groups, whose members have a range of different needs. If given the opportunity to sit back and engage as and when they want to it may not always be immediately apparent how they are benefitting from taking part. But if you go with the flow and support people to choose how and when they join in you mat be surprised at the complexity of their response within the moments that they choose to share. You may also be surprised by the change in an individual after a session where their participation seemed limited. For example somebody may be much more calm and settled as a result of the activity that they have been part of.


  • If you are working with a group where the majority or all of the participants are non-verbal it is best to try to work with a smaller number of people so that everybody’s needs can be supported. Also make sure that there are multiple points of entry and expression so that everybody has the chance to engage and share on their own terms. Could you even try and create a session or activity which doesn’t use words at all and where the physical, tactile and musical take the lead instead? How would participation and confidence be increased if communication and expression focused upon participants’ strengths and capacities rather than on things that they no longer find do easy to do?