Therapeutic Engagement

Picture this: Elsie is 42 and a home care aide for more than 20 years. Marie is 85 and Elsie’s client; she has just returned home from the hospital. After a week in the hospital bed, Marie is unstable, so she uses a wheelchair. One glorious sunny day, Elsie takes Marie out for fresh air. “Pushing this wheelchair is exactly the exercise I need,” Elsie tells herself. Then she ponders, “What about Marie?” So Elsie stops, taps Marie on the shoulder, leans over, and smiles. Marie looks up and gently squeezes Elsie’s hand. They communicate, although they say no words. Elsie helps Marie to get up and stand holding onto the wheelchair. Elsie slips into the wheelchair and Marie, at first tentatively, and soon confidently, pilots her young passenger down the sidewalk. The comic situation soon has them both laughing and draws the friendly attention of passersby. By week’s end Marie has gone from wheelchair to walker, her bond with Elsie has deepened, and both have new friends in the neighborhood.


Such a role exchange seems unorthodox and incongruous, but Elsie had anticipated its therapeutic effect, tutored as she was by Karen Love in Therapeutic Engagement, an approach to people with dementia that Karen pioneered. Karen is one of a kind; she marches to her own drummer down a path of her own creation. Her approach to life came to public attention when the December 12, 2005 Kiplinger Letter put Karen on its cover with a story of how she had brought a recalcitrant auto shop to its knees, but had then turned its manager into her “new best friend.” The story was titled, “Satisfaction Guaranteed: Have a complaint? Street smarts and a spoonful of sugar can get results.”

Her approach in long-term care is no less notable. Karen is the founder of Consumer Consortium on Assisted Living, a quality and advocacy coalition. When she saw how readily elders slide into dependency, she reached back to the days when she had marveled at the effect the Montessori preschool had on her kids; they had become as eager for school as to stay home. “If Montessori has that effect on kids, why not try it on the elderly?” Karen thought. That thought matured and gave birth to Therapeutic Engagement; a way to reach out and touch elders with disabilities.

The Montessori Method is named after an Italian physician and educator, Maria Montessori (1870-1952). Her work with children led her to conclude that a child’s true normal nature needs freedom to blossom; it needs a teacher who creates a conducive environment, uses proper learning tools, guides self-directed learning, and directs shared activity. In Montessori, children learn at their own speed using an approach that sustains their interests, whether by “handling” objects or by using visuals. Its intuitive appeal and validation by research have made it popular. Of the 7,000 Montessori schools worldwide, more than half are in the United States.

Treasure in a shell

Looking at a person like Marie, Karen says we should notice more than what our eyes behold. An elder is actually the sum total of all that he or she is now at present and of all he or she has been in the past. An elder may be dependent, confused, and a mere shell of an earlier vibrant self, but he or she hides within that shell an untold story, a unique biography laden with fond experiences, treasured mementos, and rich memories. Montessori detects in every child a yearning for enough room to grow and to achieve; Therapeutic Engagement detects in a frail elder a yearning for purpose, self-worth, and recognition of one’s accomplishments. Karen schooled Elsie in the ways that assist you to reach within the aging shell and to awaken something meaningful in a life richly lived.

To learn more about her approach, follow Karen to her favorite destination-the Dollar Store, a treasure trove of affordable, interesting materials. She pushes the shopping cart down the aisles and quickly fills it with the teaching aids she so effectively uses in training caregivers-skeins of knitting wool to roll, hair curlers, stretchy bands, decks of cards, ping-pong balls and other things. The color, feel, shape, and smell of these low-cost, high-value materials stir memories in elders and resurrect long-buried experiences.


Therapeutic Engagement has helped staff and family caregivers enhance the quality of life of elders in nursing homes, assisted living, adult day care centers, and in home care. Its physical, mental, and social therapeutic benefits have been videorecorded, they have been testified to by families, by staff, and by research supported, among others, by the Virginia Alzheimer’s and Related Diseases Research Fund, the National Institute on Aging, and the U.S. Administration on Aging.

Thank heavens for pathfinders like Karen and the Elsies that she mentors who help the caged spirit in many a Marie to break free and take wing.

V. Tellis-Nayak, PhD, is a medical sociologist. He has been a university professor, has conducted research in the United States and abroad, and has authored books and articles.

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Long-Term Living 2010 August;59(8):16-17

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