Reflections on Mirroring in Dementia

Mirroring to Connect and Communicate in Dementia

Photo by Anastasia Shuraeva at Pexels 


*Resident names and any identifying details have been changed for privacy.

March 05, 2021

What is Mirroring?



Mirroring – imitating another person’s speech or body language – is something we humans do naturally, usually without even realizing it. We have been mirroring one another since we were babies, and our brains are hard wired to respond to it. It’s key to learning, connecting, building rapport and communicating – and mirroring is very effective in dementia care.  

As babies, we mirror those around us. And they mirror us back.

Babies and toddlers famously watch and copy others in order to learn and develop. Pre-verbal babies connect and communicate with those around them by making eye contact, noises and gestures. Baby smiles, sticks out his tongue and says “a-goo” – and, very often, the adults in his life tend to do the same right back to him, especially when they are trying to share a social or emotional connection.

We recognize that babies want and need to connect with others, even when their verbal skills are extremely limited. We are learning that the same holds true for people with advanced dementia – and that mirroring their facial expressions, vocalizations and body language is the first step toward connecting socially, emotionally and meaningfully. 

Mirroring in Practice

Mirroring generally occurs on a one-to-one basis. It occurs all around us, all the time, between people who are emotionally attuned to one another. It may look like two people:

Crossing their legs or holding their hands in a similar fashion
Sipping from their drinks at the same time
Touching their hair, head or face in sync 
Maintaining a similar posture or expression
Leaning in towards each other 

Walking in unison

Mirroring occurs naturally between people who are feeling comfortable and at ease with each other.

Mirroring: Active Listening with the Whole Body

People subconsciously mirror friends, family or others when they feel attuned and in sync with them.

Mirroring can also be used consciously to promote and enhance those same feelings. It's a way to create empathy with another person, and better understand what they are feeling. It requires that we are attuned and attentive to their body’s messages. Are they feeling open, trusting and relaxed? Or, defensive, stressed and insecure?

By adopting another person’s posture and body language we non-verbally communicate that we are willing to be open to them, and to understand and connect with them.

Essentially, mirroring can be thought of as a form of active listening using the whole body.  

Mirroring to Connect and Build Rapport in Dementia

When mirroring to connect and build rapport, it’s important to engage in truly active listening and tap into a sincere desire to empathize with the other person. 

Keep it subtle

Don’t copy accents, speech impediments, or other obvious or potentially offensive mannerisms. Being too overt or obvious will feel insincere, condescending or downright insulting.  

First tune in

Take a minute to tune into where the person is, energetically and emotionally. Start by meeting them there. Are they excited? Playful? Upset? Agitated? Frustrated? Hopeless? Depressed? You don’t necessarily have to match their intensity of emotion, but try to be in the same ballpark, at least. 

Next match speech patterns

Pay attention to the person’s verbal energy, pace, rhythm and volume and adjust yours accordingly.  

Finally mirror body language

Once your verbal speech patterns are in sync, you can subtly adjust your body language, position or movements to reflect theirs. Are their legs crossed? Leaning forward or back? Relaxed or animated? 

Avoid mirroring negative body language

Avoid mirroring negative body language, such as glaring, crossing your arms, turning away or closing your eyes. Hands in pockets or behind your back is also usually viewed as a defensive or negative posture. 

Keep it natural

If all this seems awkward or mechanical, don’t overthink it or get caught up in the details. Remember – we humans do this all the time, instinctively and naturally. The most important thing is to pay attention to their current state and try to more or less meet them there. 

Adaptive Interaction: Connecting in Advanced Dementia


Mirroring can be an effective way to enhance connection with people living with advanced dementia. A technique called adaptive interaction can help fulfill the social needs of individuals with advanced dementia who may have great difficulty connecting on a verbal level.

Adaptive interaction evolved from proven methods of communication with non-verbal people, such as infants and people with special education needs. The evidence shows that after people with advanced dementia engage in adaptive interaction they experience positive outcomes, such as showing more interest in others around them, and laughing more readily.

As humans we have an instinctive desire for connection and communication. As infants without language, we have limited avenues of connection. We can smile or cry. We can make eye contact, gestures and little noises – and there’s not a lot else we can do. Luckily, adults around us tend to intuitively respond to many of these attempts at connection simply by imitating them. And it feels great! We feel seen, heard and valued. We have affected the world around us!

Not only is social connection a desire, it is a human need. Lack of socialization has been shown to drastically increase aggression, behavioral disturbances and exacerbate physical and cognitive decline related to dementia.

By remaining highly attuned to the person with dementia and mirroring their sounds and body movement, we can forge a meaningful connection that replenishes the social and psychological well of a person living with advanced dementia. 

Practicing adaptive interaction is simple.

 Spend a little time following the lead of a person with advanced dementia. Pay attention to their sounds, movements, facial expressions and gaze direction, using these things as a basis of communication and connection.

The back-and-forth interactions you share based on their unique communication behaviors will form a rich and meaningful exchange. Each individual has their own particular repertoire of communication behaviors. A few common ones include:


Eye gaze: Eyes closed, gazing at your face, gazing elsewhere
Facial Expressions: Smile, surprise, eyebrow raise, frown, wink, blow kiss
Sound: Speech sounds, sing, tut, click tongue, laugh, sigh, high pitched sounds, growling sounds
Movement: Point, nod, shake head, wave, shrug, touch something, stroke chin, rub body part, play with hands or fingers, stick out tongue

When engaging in adaptive interaction with someone with advanced dementia, remember SOLER:

Sit Squarely, facing the person so they can see your face
Open Posture, with relaxed arms sets an open tone
Lean Forward, slightly to signal engagement and attention
Eye Contact
Relax, consciously relaxing will prompt the person with dementia to relax as well

Mirroring to Guide and Influence in Dementia

In addition to enhancing rapport and connection, we can also use mirroring to guide and influence people with dementia’s behavior and state of mind. We can influence their moods, better respond to intense emotions, and demonstrate what we want them to do much more effectively than we can using words. They’re mirroring us anyway, whether we realize it or not. By being conscious in our actions we can help them feel better, which enables them to cooperate more. In the end, we all make better use of our energy, spending less on struggle and frustration.

Enthusiasm

When we approach someone with a sense of dread, or a foregone conclusion that they aren’t going to cooperate, we are usually right. We’re putting forth a resistant energy that they'll probably mirror right back at us! Fortunately, this same phenomenon can also be flipped and used for good! If we consciously emit a positive, open demeanor, we will influence them accordingly.

I can’t say how many times I’ve had success by approaching the person with a big smile, and summoning sincere enthusiasm and excitement.

“Anna, there you are! Hi! How are you! I'm so happy to see you! I’ve been looking for you!”

Usually, the person automatically feels more upbeat, and is more likely to go along with whatever I might have in mind.  

Confidence

We all find ourselves in situations in which we feel rattled or insecure – especially when we are new to dementia care. Often this comes up during personal care. While we may feel awkward, if we can manage to find (or fake) some confidence, and project it, the person with dementia will reflect it back. The entire experience will run much more smoothly. (Also – stop talking so much! Many of us tend to chatter when we are feeling nervous or uncomfortable, which will only make things worse!)

Anger

If someone is angry, it can be very effective to “be angry” alongside them, if possible, at the thing they are angry at.

“Are you telling me that someone took your wallet? This is an outrage! I’m going to see to it that we get to the bottom of this! You’re one of our top clients! You do NOT deserve this! I am so sorry this happened!”

Often, they end up the voice of reason, reassuring us that it’s okay. They are palpably relieved that someone has taken them seriously, and will take care of the problem. 

Anxiety

It’s not always advisable to match intense emotions, and in some scenarios it may be wiser to just EXUDE calmness with a calm, slow, deliberate or confident voice and movements. If someone is having a catastrophic reaction, for example, you’d be wise to stay still and quiet as possible, because they won’t be able to process any further stimulation. Trust your intuition and look for the message in the behavior.

In the case of most anxious behavior, taking deep breaths may be most effective. It won't hurt to exaggerate the breaths. Soon they'll start to follow suit.

Dementia trainer Teepa Snow does a nice job demonstrating this concept in this video where she explains how to de-escalate a crisis. 

ADL’s

Sometimes people with dementia need a little help to get started brushing their teeth, eating or with other such activities. Often the quickest, easiest and most effective way to get the message across is to simply show them.

One savvy staff member used to bring her toothbrush to work so she could brush her teeth along with certain residents. It was effective communication that promoted feelings of camaraderie and friendship rather than inadequacy and shame. A lovely way to enhance cooperation and build a relationship!

Likewise, sitting down and taking a drink of your own cup models the behavior, allowing them to mirror it. It also provides a real moment of connection and positivity (not to mention better hydration for all of us, which we all need!)

When we adopted the Dining with Friends program, in which staff began to sit down and eat with residents, we found that many residents required less overt assistance. Staff consciously, yet naturally, modeled what they were supposed to do, and prompted them subtly when needed. The result was a very special dining experience. 

Affecting the Environment

The environment affects people with dementia profoundly. If the environment is full of people bustling about, talking loudly and looking stressed, the residents will quite naturally follow suit. Their behavior is very often a direct reflection of the environment, or the emotional state of their caregiver, or someone near them.

Make a conscious effort to move and speak calmly, and appear relaxed and speak quietly and be amazed at the enormous impact on the environment – and in turn, on the person with dementia’s emotional state and behavior.

I received one of my favorite compliments when I was an activity director. A musician who came to play regularly said she could tell whether I was on duty on any given day just by the demeanor of the residents.  

Whispering

Whispering is a very effective tactic to quiet someone who is yelling, and for calming a noisy, chaotic environment. More often than not, once you start whispering, the person you’re addressing will follow suit. It works as well with staff as residents! 

Mirroring: A Powerful Tool in the Dementia-Care Toolbox 

There’s no denying the power and potential of mirroring in dementia care, whether we are using it to build trust and improve rapport, connect meaningfully, influence behavior or communicate without words.   


What are your experiences with mirroring in dementia care?

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