This has been a busy week for me. I’ve organised a second location for my therapy practice. Whilst I love the peace and grandeur of my own therapy room set in a converted mansion near Keston in Kent it is inconvenient if you don't drive. So I now can offer to see clients in the Strawberry House Clinic in nearby Hayes a stone’s throw from the mainline rail station with trains out of Waterloo, Charing Cross, Canon Street and London Bridge.
New Services
I have been busy meeting and building up relationships with other practitioners in the area so I can offer a more rounded service. For example, when I work with people seeking weight loss or just a healthier, less stressed lifestyle, I am not qualified to offer advice on exercise, nutrition or any physiological challenges. So now, where it is of benefit to my clients, I can refer them to local personal trainers, nutritionists and osteopaths where they need help in those areas.
This allows me to offer a more rounded and inclusive service to help people achieve their goals.
Dissolving of Personality
Over the past weeks I’ve been spending some time with my wife caring for some of our elderly relatives who suffer from dementia. They all are looked after and we were there to give their normal carers a break. As a human being I of course am saddened by their plight, regretful of the progressive loss of their abilities and personality and frustrated that there is not more that we can do for them. As a therapist, albeit one with no experience or training in this area, I want to accept, understand and help as best I can.
The Two Experts of Therapy
When describing my approach to therapy I often talk about it as the meeting of two experts. On one hand you have me, the therapist, an expert in restoring perspective and facilitating change; change of behaviour, of thought and of emotion and feeling. The second expert is the client – no matter if their issue is a common, well understood one – they are a unique individual and as such the sole expert on the unique way they experience their issue.
Accepting and Accepting
So as a non-expert in dementia, I have learnt a lot by reading, from my wife who has a much better understanding of the practicalities and from watching, listening and most importantly noticing what works and what does not. The person with dementia is the source of all expertise on their condition.
Dementia such as Alzheimer’s is a progressively worsening condition, there is no cure. Care is focussed on palliative care – which from my non-medical viewpoint means the focus of care is the relief of the frustration, depression and huge anxiety that can accompany the condition.
My Observations of Dementia
The dementia I have been exposed to seems to initially predominantly affect the short term memory. The intelligence is still there and memory of past history – though these things diminish. Questions and actions are repeated endlessly, conversations become circular covering the same points repeatedly. The ability to cope with change is dramatically affected, even the idea of an impending change to their environment or routine can be a cause of marked anxiety and stress. This includes a visit by family members, a train journey and will progress to cover even familiar journeys to the local coffee shop or park.
The personality can persist as their abilities diminish – meaning that they will still want to maintain control of their lives past the point at which they are capable.
Now I stress, this is not an area of professional expertise for me, but here are some rules I personally work to and have found useful in my situation. Many of my ideas appear manipulative and dishonest, and they are. I think this approach this is justified where the care, well-being and respect for the sufferer is paramount; where that sufferer has diminished mental capabilities.
Rule 1 – Avoid Corrections or Confrontations
My experience of people with dementia is that they develop the habit of creative invention to plug the gaps created by their disease. This is not the same as lying - it's called confabulation - fabricating memories without any intention to deceive. They will refer to actions they have taken, people they have interacted with and you will know that their account is distorted or completely untrue.
Where possible – let go of any need that you have to be right or to correct them. This is pointless and you are working against their coping strategy, risking generating conflict and anxiety. Obviously there are going to be situations where safety is at issue, like the taking of medication, where this is not possible – but check out rule 2 first.
Rule 2 – Deflect
You take their intended action and you deflect them into doing something you want them to do instead. So for example, if they say that they are going to call the doctor to check on an appointment, having already done this many times already, you can ‘remind’ them that the doctor asked them to call later and suggest that they were about to do some other activity.
Rule 3 – Utilise
As I mentioned above, a dementia sufferer at some level knows they forget things and will probably develop a habitual coping strategy, confabulating to fill in the gaps. This can be utilised by suggesting things that you want them to do as if they have already decided, planned to do them. For example you might state ‘Didn’t you promise to show me some of your old photo’s?’ or ‘Here are the pills you wanted, shall I get you a glass of water?’.
This is obviously hugely manipulative, the ethics of this being guided by your intention and the level of loss of ability in the suffer.
Rule 4 – Respond as if it is the first time they asked
One of the challenges is that you will be asked the same questions, told the same things, time after time. See rule 1 – don’t challenge and create conflict and anxiety, respond as if it the first time they asked. For them, it is. This can be a source of frustration for the carer but I was surprised that once you let go of the need to point out that they have repeated themselves it becomes much easier to deal with. You can to a degree develop a habit of acceptance and find yourself repeating answers semi-automatically.
Rule 5 – Keep Plans Secret
Again this can sound dishonest, a lie by omission. What I am suggesting here is that planned trips, say to the doctor, or visits, say by family members, should always be a surprise.
Dementia suffers will fret about remembering the event and the necessary preparations. They will use and repeat coping strategies; making and leaving notes, ringing repeatedly to check appointments; worrying about and making preparations like making beds, getting in extra food. All of this they will tend to do poorly and recognising this adds to their stress and even despair.
So my advice here – if the person with dementia has an appointment, tell them just when they need to get ready. If you are visiting, just turn up.
Finally
Something else I have noticed, and this is something I found interesting, is the reaction of dementia sufferers to animals, specifically visiting pets. My perception is that they find them an easy outlet for their affection and attention. I am guessing that they don’t see them as a potential challenge. Pets don’t do conversation, they don’t require memory or planning. Animals live ‘in the moment’ which suits someone with defective memory.
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Coping with Dementia and the Dissolving of Personality
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