IMPROV FOR PEOPLE WITH PARKINSON’S DISEASE

Improv for PD Class

IMPROV FOR PEOPLE WITH PARKINSON’S DISEASE

Margot Escott LCSW

Parkinson’s Disease (PD) is a movement disorder that affects up to 1 million people in the US and over 40 million worldwide. There are many other kinds of movement disorders, with over 40 million in the U.S.

Improvisational Theater Games, based on the work of Viola Spolin, are being used around the world with diverse people suffering physical and emotional issues.

PD is characterized by many problems such as facial rigidity (or masking), gait impairment characterized by a stuttering gait as well as anxiety and depression. Some of the Improvisational exercises we teach are directly related to helping these issues.

We do an exercise called “Show, don’t tell, your feelings” where students have to use facial muscles to portray a feeling. This exercise is important as students with facial masks need to practice using their muscles to indicate their emotions, as opposed to the usual lack of affect.

A typical session starts with singing a familiar song, with lyrics on a YouTube Karaoke video, easy to read. We teach “Yes, and…. “  in various games.

PD can be isolating not only for the individual with PD but for the family as well. In my weekly classes, participants play a variety of improv exercises each week. In these classes, participants get a chance to express themselves non-verbally through movement and music activities which aid in cognition and memory skills, improvisational games present fun challenges to solve.

I’ve been working with some of the same students for over the past eight years and they’ve formed a social support group, making dates to share a meal or go to an event. Our meetings have been virtual for the past few years allowing students from other parts of the country to join us!

We focus on the concept that there are no mistakes, only gifts. Students with PD, other movement disorders, and dementia often feel embarrassed or hesitant to speak, afraid of saying the wrong word or getting confused. Often their care partner shares the screen with them for tech support and will try to “correct” their loved ones. In a gentle way, I remind all players that there’s only one coach! From the first classes, students learn to raise their hands over their heads and say “ta, da” if they think they’ve made a mistake.

Acceptance is an important concept as people with PD have difficulty accepting their disease. The idea that they don’t have to like it but rather accept the reality helps with the denial that often accompanies this disorder. This holds true for the care partners as they are often frustrated with the demanding schedules and role reversals. (PD is more common in men.)  Allowing time for games, no one is pressured to speak quickly which supports those with vocal issues.

I teach mindfulness, which helps students learn to be in the here and now, so essential for improv play. It gives them time to slow down and calm their thoughts. I use many of Viola Spolin’s games like “Feel your Body”. One of Spolin’s quotes speaks to the importance of this.

If you can get it out of the head and into the body…Body, Mind, and Intuition. This is what we’re after. Body, Mind, Intuition” – Viola Spolin

Since we’ve been holding virtual classes since the pandemic, I’ve seen wonderful improvements in many of my students and am honored to work with these brilliant, genius improvisers.

As a clinical social worker, my job is to help people who suffer. Applied improv is a wonderful tool to help people living with behavioral issues such as anxiety and coping with chronic diseases, like PD. Discovering improv has not only benefited my life but those of my patients.

REFERENCES

Boyd, Neva. Handbook of Recreational Games Paperback – June 1, 1975

Spolin, V. (1999). Improvisation for the Theater (3rd ed.). Evanston IL: Northwestern University. Stern, D. N., Sand

ABOUT MARGOT ESCOTT, LCSW

Margot Escott LCSW is considered a leader in the development and use of applied improvisational theatre techniques to benefit those with Parkinson’s Disease and other neurological issues. She presents her improv for PD teaching techniques at national mental health conferences throughout the country and teaches improvisational theatre classes locally for people with anxiety, PD, Care Partners, and children with autism. Margot hosts a popular podcast highlighting people who are using and researching improvisational theatre as a therapeutic tool — including Ed Asner — to benefit adults and children with anxiety, mental health issues, autism, PD, and more. Margot has been a social worker in Naples, Florida for over 35 years and has presented workshops on humor, laughter, and play for over 25 of those years. Since being introduced to improvisational theater, Margot has been performing and teaching improv to diverse groups such as people with neurocognitive issues like Parkinson’s disease, anxiety disorders, caregivers, children on the autism spectrum, and to therapists. You can learn more about her at Improv4Wellness.com.

 

Treating Pain and Anxiety with Mindfulness and Improv

TREATING PAIN & ANXIETY WITH MINDFULNESS & IMPROV

Margot Escott, LICSW, RfG-CP

I have been a licensed social worker for over 35 and trained in Mindfulness 30 years ago and have been teaching and performing Improvisational theater for the past 12 years.  In my clinical practice, I combine cognitive behavioral therapy with mindfulness and applied improvisation to help people heal their chronic pain and anxiety among other complaints. Applied improv is a wonderful tool to help people living with behavioral issues such as anxiety and coping with chronic issues like pain and anxiety. Discovering improv has not only benefited my life but those of my patients.

Let’s discuss the case of my recent client, Carla, a 63-year-old, former nurse.  She has been seen in my practice since February 2022.

She received a BSA in nursing and owned a Home Infusion Center for 24 years. She was forced to take early retirement due to an accident. She has been happily married for 30 years.

Carla suffered an accident in 2018 that led to a spinal fusion and subsequent pain in her lower back and generalized anxiety. She reported a history of depression that started after her accident and timely correlated with the use of morphine. Her daily pain is not controlled with morphine and other medications.

My training has included pain management, and mindfulness training and I’ve found that using improvisational theatre games is very useful. When the patient is focused, they often become unaware of their pain, and the production of endorphins and dopamine increase feelings of well-being.

Because of her sense of humor, self-confidence, and intelligence, I decided to introduce mindfulness, meditation, and improv games quickly into her treatment. However, not all of my patients have such high self-confidence. Many of my clients struggle with social anxiety and it often takes several sessions for them to develop a trusting, therapeutic relationship with their therapist before we can try some of these experiential techniques. But they can also be helped with Improvisational Games.

At our first session, I introduced the concept of mindfulness and meditation. We explored the idea of being in the present. When she started to experience anxiety, I asked her to say to herself “be here now.” I used a technique called “body scan,” where I led her to relax each part of her body, from the top of her head to her feet. The Viola Spolin exercise called “Feeling Self with Self “, teaches students to connect with their bodies and produces calm feelings as well. We worked on her breathing and the idea that her thoughts of anxiety and fear would dissipate through focused breathing as we increased the time of each silent meditation. I directed her into a two-minute silent meditation. She reported that even after such a short time, she was feeling more relaxed.

In session two I introduced the improv concept of “Yes, and.” This is a concept that teaches you one of the basic skills of improv. It is about agreeing with your scene partner and accepting whatever they say to you. For example, your improv partner says “I heard you just returned from Mars.” You accept their thought (the Yes) that you went to Mars and add to that statement (the and). You might respond with, “Yes, and  I’ll be spending Thanksgiving and Christmas back on Mars.”

We also taught the Gibberish exercise and games. Gibberish is a Spolin exercise that she developed while working with Neva Boyd at Hull House. Their students were immigrant children from all over Europe and spoke many different languages. Gibberish is exactly what it sounds like! The player speaks in a non-sensical language made up of vowels and consonants. Gibberish allowed the children to be able to communicate with each other while using facial expressions and miming to be understood.

Like most newcomers to improv, she was concerned about “doing it wrong,” but was able to overcome that with the improv concept that “nothing is wrong or a mistake when we improvise.” This idea that there are no failures in improv and that you can’t get things wrong decreases the anxiety or performance stress when they understand that no matter what they do it’s going to be a gift to their partner, me a therapist, or the other students if they’re in group therapy. Quite often I teach the “Ta-Da “

A fun way to overcome a perceived mistake is the “Ta-Da” exercise. This is a movement combined with the words “ta-da”. They throw their hands up in the air and in a loud voice say “Ta-Da”! I frequently observed that when one person says the Ta-Da and breaks the ice, soon everyone is using that little phrase and laughing at themselves.

These interventions produced laughter and smiles from Carla. Laughter increases Dopamine levels, which decreases feelings of sadness.

We began meeting bi-weekly as she had many doctor appointments and physical therapy at a therapeutic indoor pool with licensed physical therapists. In our fourth session, we played the game “Tiger, Martian. Cow.” In this exercise, the player is required to change their facial expression, use specific body movements, and make a sound as either a tiger, a Martian, or a cow. When making these faces and sounds like a tiger, my patience “get out of their head” and just relax into the game. It’s very hard to have stressful thoughts when you’re involved in such a game. Carla and other of my patients find that this exercise takes them away from those anxiety-provoking thoughts and leads them into the relaxation response.

We increased the time of the meditation to seven minutes, with the suggestion that she practice this daily (the caveat being that if she didn’t practice, she wouldn’t be graded or judged).

In the following session, we played the Fortunately/Unfortunately a storytelling game that requires focus and active listening. Then I introduced a two-person scene game with a Who, What, and Where. Carla threw herself into this experience. She described how much better she felt at the end of this session.

Over the next few sessions, we played Spolin’s exercise Mirror and Follow the Follower at the beginning of each meeting. Carla found this game particularly calming.

Carla was seeing multiple pain specialists about injections to decrease pain and possible surgery.  She was disappointed that her injections weren’t helping with the pain. And, there was no evidence that the suggested surgery would be successful, which led to the “What If” game. This is used in CBT to help a patient go to the very worst scenario when they have fear about an event that may or may not happen. This reinforces the use of meditation which Carla is currently practicing for ten minutes, usually twice a day.

In our fifth month of treatment, I asked Carla if she was feeling any benefit from the improv. She responded “It makes me laugh! I feel less anxious and forget the pain.” She is one of several patients who have reported this after doing improv in therapy.

Many researchers are investigating and measuring the impact that improvisational theatre games have in psychotherapy with individuals, couples, and families.  The results are encouraging and we hope that Improv Therapy will someday be considered a creative arts therapy like music, art, and drama.

Another improv technique is called Story Spine, attributed to Kenn Adams.

This is a form of telling a story where one could use flashcards for each part of the story.  I use this method when working with improv groups for people with Parkinson’s disease and their care partners and clients with mild dementia. The flash card has the beginning line for the first player, “Once upon a time..” and the player completes that thought. The next player adds to the story with the line “Every day”. The point of this tool is to provide a model for a well-constructed story with a beginning that establishes a routine, an event that breaks the routine, a middle that shows the consequence of having broken the routine, a climax that sets the resolution to the story in motion, and the resolution. It goes like this:

  • Once upon a time…
  • Every day…
  • But, one day…
  • Because of that…
  • Because of that…
  • Because of that…
  • Until, finally…
  • And, ever since then…

These are just a few of the many improvisational theater games that I use in my practice. There is growing research among psychologists and doctors on the psychological and physical benefits of improv and those are included in the Resources below.

If you are a clinician and have ever thought about using applied improv, there are many sources you can go to, especially the book “Rehearsals for Growth, which you can find at  www.rehearsalforgrowth.com. Dr. Daniel Wiener, a psychologist who studied improv with Keith Johnstone, wrote this groundbreaking book in 1994. He has a training program for clinicians to understand and use applied improv in their practices.

In this book he illuminates the connection between theater and therapy, shows how performing improvisation enriches our understanding of social behavior, and enables players to experience greater freedom of expression and power based on cooperation, imagination, and spontaneity.

Over 160 improv games, modified for use in psychotherapy, are described, along with a score of case examples. As a recognized “Drama Therapy of /Relationships” Rehearsals for Growth continues to evolve as a helpful method that may be used in combination with nearly all other psychotherapy and counseling approaches.

 

BIBLIOGRAPHY or RESOURCES?

Benson, Herbert & Miriam Z. Kipper. (1975) The Relaxation Response. William Morrow and Company.

Boyd, Neva.  (June 1, 1975) Handbook of Recreational Games. Dover Publications

Campbell, J., & Christopher, J. (2012). Teaching mindfulness to create effective counselors. Journal of Mental Health Counseling, 34, 213–226.

DeKoven, B. (1978). The Well-Played Game.  Anchor Books. Garden City, New York.

DeMichele, Mary & Kuenneke, (2021) Scott. Short-Form, Comedy Improv Affects the Functional Connectivity in the Brain of Adolescents with Complex

Developmental Trauma as Measured by qEEG, NeuroRegulation, Vol 8 No 1

Felsman, P., Gunawardena, S., Seifert, C. M. (2020). Improv experience promotes divergent thinking, uncertainty, and affective well-being. Thinking Skills and Creativity, 35, 100632.Golding, M. (2014). Listen Harder. ISBN-13:978-1497418028.

Jagodowski, T., Pasquesi, D., & Victor, P. (2015). Improvisation at the speed of life. Chicago, IL: Solo Roma.

Kornfield, Jack. (1993). A Path with a Heart. Bantam.

Krueger, K. R., Murphy, J. W., & Bink, A. B. (2019). Thera-prov: a pilot study of improv used to treat anxiety and depression. Journal of Mental Health, 28(6), 621-626.

Romanelli A. Tishby &. Moran, G. (2016). Coming home to myself. School of Social Work and Social Welfare, Hebrew University, Israel Mt. Scopus, Jerusalem, 9190501.

Spolin, V. (1999). Improvisation for the Theater (3rd ed.). Evanston IL: Northwestern University.

Wiener, D.J. & Oxford, L.K. (2003) Action therapy with families and groups. Washington, DC. APA

Wiener, D. J. (1994) Rehearsals for Growth. New York. W.W. Norton.

 

 

 

He Says I’m Great But Doesn’t Want a Relationship – What Should I Do? – Deep Soulful Love

by Kat Peoples – Ph.D., LMHC, LPC, Amy Sherman – M.A., LMHC, Margot Escott – MSW, LCSW, Dana Hall – LCPC, MA, TF-CBT

# Quit taking it personally

Margot Escott

Many men have reasons why they don’t want a relationship and it often has nothing to do with you. 

I love the acronym Q-Tip. Quit Taking It Personally!

There’s a line we often hear in comedies that have become a cliché. “It’s more about me than it is about you.” We can laugh at that thought unless it’s happening to ourselves.

If you have been “seeing” a man – going to movies, having coffees, and sharing meals – you have a friend! 

Perhaps you received “signals” that he wanted a more intimate relationship with you or you were imagining a different relationship and confronted him. You got the response that he “doesn’t want a relationship”.

Well, if you are already friends, you Do have a relationship. 

The “R” word gets bandied about and many of us consider it to mean a committed, intimate partnership. But relationships can have many forms.

We have relationships with our family, siblings, and friends. 

In these relationships, the only expectations are to be a friend, which means honoring commitments, honesty, trust, and other values. But when we set expectations with someone, like an intimate relationship, we may be misreading the signs.

I’ve had many “boyfriends” in my life and a few really good male friends. These are men that I can hang out with, share ideas with, and just be myself with any of the anxiety that often accompanies “Intimate” relationships.

Having male friends, and that is a relationship, is wonderful in so many ways. 

It can help us to better understand men, especially when they enjoy and appreciate me.  And besides, the best way to have a friend is to be a friend.

Margot Escott, MSW, LCSW – www.margotescott.com

Click here to read the full article

MEMORIES OF THE WTC

Margot WTCI’d just been in NY for the most popular game show and it was pretty exciting. But the memory that stands out in my mind the February night in 2001 was the indelible sight memory of the Twin Towers that cloudless night. I’d lived in the city when the towers were being built. There were wonderful memories of being at the top where one could see for miles and miles and miles. Enjoying meals with my parents, also long gone, at Windows of the World.

As we approach 20 years since the towers went down I am forever grateful that ABC paid for a trip to the city so that I could see them one last time!

Improv in the Third Act

“You can’t help growing older, but you don’t have to grow old.” George Burns

Improv Anonymous – WIth Improv Master and my first teacher Craig Price at the start of my Third Act

Almost a decade ago, my family sat in the hospital waiting room, waiting to hear the outcome of the surgery I was undergoing to repair the damage caused by a sudden cerebral aneurysm. My surgeons appeared with the good and the bad news for my family. I had survived the surgery, but my surgeon warned, it was too early to know if I would recovery my memory or ever speak again. To which my brother responded, “Too bad about the memory.”

As you can tell, I grew up in a family that laughed a lot. The 1950s were the stage for the “First Act” of my life. It was filled with hours of us gathered around a black and white television laughing along with “Leave it to Beaver,” “I Love Lucy,” Imogene Coco, Sid Caeser, Jack Parr, Red Skelton, Danny Kaye, Ernie Kovacs, George & Gracie, Carl Reiner. Regardless of what was happening in the world, these shows made you laugh and feel better.

Inspired by these comedy greats and by the work and teachings of Norman Cousins and others like him on “The Healing Power of Laughter & Play,” I used my “Second Act” to become a social worker and tour the country holding workshops to teach other therapists to use humor and play to help their clients.

I did recover my memory and to my brother’s dismay, my ability to speak following the surgery. But recovery took time and a friend suggested I try an acting class in a local community theater to help me through this period. My first classes were in a rundown former bar that had been abandoned during the great recession. Some of my classmates were actual rats and cockroaches. The teacher of the class was a charismatic fellow who taught improvisational theater. Although following directions was challenging, I had so much fun at the first class that I decided to sign up for a six-week class and have continued taking Improvisational Theatre classes and workshops ever since.

Improvising as the mother of the bride in Who Killed the Rabbi

So, there I was in my “Third Act,” recovering from brain surgery and a double knee and double hip replacements.  I was the eldest member of my improv group and I was not as agile as the predominantly young white men who made up the group. If I played a game that required sitting on the floor, I wasn’t sure if I could get up again! I suppose it’s not surprising that I was often cast as someone’s mother or grandmother. But I kept going because my teacher encouraged and validated me and soon, I began teaching as well. Being part of that improv team and working on supporting and loving each other was an incredible mind-blowing experience for me.

I wanted to learn everything I could about this improv and went to different parts of the country to study improv at festivals. Each time I attended a workshop, I came home with renewed energy and commitment to play. For 9 years I was fortunate to attend the Annual Improv Festival at Will Luera’s FST. I learned from so many terrific teachers and discovered that I could make choices! Through the festival, I met many folks that I’ve studied with on Skype and continue to do so on Zoom.

With my dear friend Dr. Daniel Wiener at his Rehearsals-for-Growth Improv for Therapists Workshop.

I left that team about five years ago and ever since then I’ve been teaching improv which I have learned in my “Third Act,” which is my love and my mission. As a psychotherapist I’ve applied improvisational theater techniques to my work with people with Parkinson’s and other neurodegenerative diseases along with their care partners, people with anxiety and depression, and people on the Autism spectrum.

The results have been terrific, and I believe I get as much out of teaching than my students do.

 

Ed Asner joined me for my Improv Interviews podcast

Several years ago, I started a podcast called improv interviews. Because there were a limited class-opportunities in my area, I wanted to talk to other improvisers, play with them and learn more about improvisation. Through my podcast — Improv Interviews — I met terrific therapists and other professionals who use improv clinically to help others. I have been blessed to interview some of my favorite improv teachers including David Razowksi, Jay Sukow, Aretha Sills, Jimmy Carrane, Susan Messing, Racheal Mason, Joe Bill, and a host of other wonderful improvisers.

Improv became the theme of my “Third Act” when I was 61 years old. I’m 71 now and am thrilled to meet other improvisers like Miki Manting and the folks at “Vintage Improv” who are making their “Third Act,” the best one ever by embracing improv.

The Pandemic has hit the theatre and improv world very hard. Improvisers rose to the challenge and immediately began offering online classes and workshops to support people through this difficult time. Being guided by Acceptance and Yes, and… we are resilient folks and giving hope and inspiration around the world.

Margot’s next workshop, “Improv for Wellness” starts soon. Contact her via email for more info: margotescott@mac.com

 

 

 

 

 

Tele-therapy during COVID-19 Social Distancing

Stress

As an LCSW who has been practicing in Naples for 35 years, I know that mental health is being impacted by COVID-19 and that affects our physical bodies as well.

My greatest concern for people who are experiencing fear is that they trigger the “Stress Response” or Fight or Flight Syndrome, stress hormones are released and these “stress hormones” cause several changes in the body, including an increase in heart rate and blood pressure. While we need to stay socially distant to protect ourselves and others, we shouldn’t socially isolate ourselves with our fear and concerns.

Fortunately, technology makes it possible for health care professionals to see their patients online. Physicians have been using Telehealth for the past 40 years and Tele-therapy since the 1990s. To ensure client safety, the CMS has lifted any HIPPA restrictions on this type of treatment and are recommending it as a safe way to continue counseling sessions or see new patients. You don’t need to be computer savvy to use Tele-therapy, and it allows us to see our patients and them see us. Telephone therapy is also available to people who aren’t computer friendly.

To find a therapist in Collier who is providing this service you may go to Psychologytoday.com and search by your zip code. I am here to answer any questions you may have margotescott@mac.com

Mary Guzzy Rehearsals for Growth

 

Mary GuzzyMeet Mary Guzzy, professor of Humanities and Theatre at SUNY Corning Community College I Corning, New York. I had the pleasure of hearing Mary present at Dr. Daniel Weiner’s 4th Annual Conference for Growth Conference this past October, Rehearsals for Growth.

Mary has been a student of Rehearsals for Growth for several years and is finding a way to use improvisational therapy in her work. Mary’s presentation was on her visit to the Greek Island of Samos where refugees from the conflicts in the Middle East have been relocated.

Continue reading “Mary Guzzy Rehearsals for Growth”

Support for those with Parkinson’s

 

Finding Support & Information
While the diagnosis of Parkinson’s Disease (PD) may be frightening, it is important to remember support and interventions are available right here in Naples, Florida both for those diagnosed with this disease and those family members who now find themselves in the role of Care Partner. Many people are familiar with Parkinson’s disease, which affects one million Americans, with 60,000 new diagnoses each year. But there are several other neurodegenerative disorders that have Parkinson’s like symptoms called A-typical Parkinson’s or Parkinsonism that are important to be aware of.

Continue reading “Support for those with Parkinson’s”

Tips to Help Seniors Thrive During Their Transition to Assisted Living – Guest Post Sharon Wagner

 

Sharon Wagner
(Guest Post)
Moving to an assisted-living campus does not have to feel like walking into a foreign land. Change is not always easy. At no other time in life is this as blazingly true as in our senior years when we have to make a decision about where to live. Mobility issues, financial struggles, and living too far away from loved ones can compound to the point where it is no longer safe for us to stay in our own home. When this happens, you have a choice: go into assisted living feeling like it means defeat or have a positive attitude and make the most of your situation.

Here are a few things you can do to make your new community feel like home.

Continue reading “Tips to Help Seniors Thrive During Their Transition to Assisted Living – Guest Post Sharon Wagner”