The January edition of my monthly online newsletter, Wiser Now Alzheimer's Disease Caregiver Tips  (www.wisernowalz.com) focuses on the wonderfully insightful book Improv Wisdom by Patricia Ryan Madson. While she does not write specifically for caregivers, most of her maxims apply. Here is an excerpt:

The first and perhaps most important maxim is to say, "Yes, and . . ." This short phrase really combines two rules into one. "Yes" leads into a new world of possibilities; it's an act of courage, optimism and hope.  When you say yes, you abstain from blocking, which is a way of trying to control a situation instead of accepting it. We are blocking when we change the subject, fail to listen to what is really being said or ignore the situation - as well, of course, when we actually say no. Practice affirmative phrases: You bet, I'm with you, Good idea, You're right. Then look for how you can put a positive spin on your reality.

Saying, "Yes, and . . ." is how the action moves forward in improv. Agreement is just the beginning. If an improv scene begins with my partner saying to me, "You have a duck on your head," and I respond with just "Yes," it's almost like saying, "No, I don't," because I have given my partner nothing else to work with. If I say, "Yes, and I think she's about to lay an egg. Quick, give me your purse," my partner has a clue about what to do next. "Yes, and . . ." challenges us to find a positive way of moving any conversation forward.

In caregiving, particularly when someone has Alzheimer's disease, saying "Yes, and . . ." means that we are willing to join that person's reality. If the person wants to talk about his mother who died a half century ago, but whom he thinks is still living, we look for ways to draw out positive reminiscences about his mother.

If the person's communication abilities are vastly diminished, we can say yes to the tone of voice or body language: It sounds like you had a good time, or That seems to have been upsetting. If we simply want to encourage the person's attempts at communication, we can be neutral: How interesting!

"Yes, and . . ." can also work in situations when what we mean is "Yes, but . . ." For example, if someone says, I'm leaving! you can respond with Yes, and let's get your coat so you won't be chilled. That is usually a more effective response than No, it's much too cold outside, or even, Yes, but you will need a jacket, because we all stop listening after the "but." When you show your agreement, the person is much more likely to be willing to slow down long enough to find warm clothes, which will either make going outside a reasonable thing to do, or if he needs to be further distracted, buys time for doing it. For example, you could also say, Yes, and when you come back, I bet you'd like a cup of hot cocoa - or would you like some now?

"Yes, and . . ." is the first step in finding flexibility as a caregiver, and that's absolutely key to success.