As the founder and CEO of the DreamRem Institute, Jonathan Gerson has more than 20 years of experience working closely with Alzheimer’s disease and dementia patients. At the center of the Institute’s work is the DreamRem Method, which helps patients struggling with mild to moderate Alzheimer’s live more engaged and meaningful lives.
We had the pleasure of speaking with Gerson about the benefits of the DreamRem method for dementia patients and their families, and hearing about his fascinating work with Alzheimer’s patients in all stages of the disease.
Developed as a “talk-therapy” intervention, the DreamRem Method has proved effective in both group and individual sessions. The main therapeutic goal is to discuss dreams and reminiscences and use them as a means of a structured life review, through which a patient’s sense of self and identity can be restored, resulting in a more balanced person. The DreamRem Method is about trying to nurture that essential character through doing some detective work and giving patients ways to reconnect with those best moments.
“I find that patients with dementia are still telling a story of some kind,” says Jonathan Gerson. “They still need to express what they’ve done with their life. One thing I’ve come to learn is that depression seems to be a primary expression of dementia — depression that springs from feelings of isolation and loneliness. DreamRem is about fighting those feelings that Alzheimer’s causes. You can’t get back the cognitive losses, but you can work on improving their self-esteem, and you can work on improving their identity as well, improving their sense of who they were and who they still are.”
According to Gerson, one of the principles of reminiscence therapy is that there are pockets of memory that remain accessible. “Everything an Alzheimer’s patient says has some kind of history to it, and you have to find that history. As facilitator, you will have to do some detective work to help pull those memories to the surface. For patients who can recall their dreams, the catalyst can be dream fragments. Part of what I do is train people how to lead sessions, and to be an effective detective in helping people connect with those memories. So in the groups, they’re given a topic like World War II or something that they’ve all experienced.”
“Consequently, through these exercises, patients feel part of a society, part of a group, and this lets them know they’re not alone.”
“DreamRem operates on a continuum. So for early-stage patients, the process may start with dreams they have to share, then move into life issues. For others, it’s about reminiscing. In the late stages, it may focus on music therapy. Play a show, such as a salute to Broadway, then talk about the music, and it turns into a conversation. With late-stage patients, even if they can’t talk much, they can clap and enjoy the music, and the process seems to benefit them. The other vital thing about music is the mood it creates: music allows you to cheer people up. With a patient who is depressed, if you can put them in a good mood, they tend to remember the mood—in fact, the mood often lasts longer than the cognition. So if you can cheer them up, they may not remember why they’re happy, but the mood will last for a while. Mood is a very important part of DreamRem, and an effective practitioner of it needs to be a pretty positive person,” Gerson says.
“The mind is kind of like a muscle, in that if you don’t use it you lose it. But every life has pivotal moments, and I look at it like an anthropologist—let’s bring up weddings, big life events, and talk about those. I’ve been working with one group since 2005, and the group involvement gives members something to look forward to every week. One thing the DreamRem method accomplishes is to provide a sense of worthiness—it communicates to patients that their life is valuable.”
Gerson and his colleagues at the institute are currently developing a computerized Life Portrait program to help facilitate life review. They’ve identified 12 different categories of life, and photos and artifacts are entered into the categories, creating a whole timeline to a person’s life, and then the therapist can focus on 10-12 photos per session.
“It can have photos, videos, music—anything that triggers the senses,” says Gerson. “For any senior going into long term care, the family can build these life portraits, which then can be used as therapeutic tools by trained caretakers to reinforce the patient’s identity over the long term. Does he like to talk about gardening? Does she like to talk about the church? The Life Portrait program is about giving trained caretakers therapeutic tools that help Alzheimer’s patients to forge identity that they can hold onto.”
The program is still in development, and they’re hoping to find a corporate sponsor or other funding source to help them implement it.