Therapeutic dialogue with Persons with Alzheimer type dementia
Therapeutic dialogue with Persons with Alzheimer type dementia
Ten Cues for dialogue with persons with dementia
I would like to present my key points, in psychotherapy, which I have learned through a everyday practice of trial and error. This is the coherent strategy in therapeutic dialogue with a person with dementia. Although there are some different dialogue depending on individual situation and subjects, the following is my consistent therapeutic attitude. The main points of ten are as follows:
1. To be sincere to clients
The therapist must accept limitations to medical and welfare services in order that we are sincere to a client and his or her family. For example, therapists must understand and accept ambiguity and limited reproducibility in test results, limits of precision and accuracy in a clinical diagnosis and limited efficacy of treatment . Furthermore, we must share these with clients and their families. Having an understanding of this, we devote a collaborative effort to push the limits with clients and their families, which can be said to be the sincerity of a therapist to clients and their families.
2. To draw out an intention of clients
Clients remain to feel bewildered and confused when not only having a diagnosis but also undergoing treatments or rehabilitation. It appears that they hesitate to make a decision regarding receiving medical services and care services and sometimes confused. They are exposed to different opinions such as advices by various health care professionals and suggestions from family members. However, these diverse remarks can cause clients to lose track of their role and what to do. One of the essential tasks is to find a client’s preferences or intentions through dialogues, before thinking about a realization of the client’s will.
3. Be aware of how people with dementia perceive their illness
By repeating empathy for people with dementia, they gradually gain insight into their illness. However, it is not realistic to set the goal of psychotherapy to gain insight to a certain degree at the beginning of treatment. On the other hand, the therapist should understand how people with dementia perceive the illness and what they are trying to understand in the future. Their perception of the disease includes motivation for treatment and preparedness for the possibility of progression. It’s a good indicator of how to proceed with psychotherapy with them. The therapist should provide the information that people with dementia seek, but on the other hand, there is a risk that the patient will drive himself out due to a biased understanding. Therefore, the desired treatment is to strike a balance between responding to the patient’s needs and correcting prejudice against their illness.
4. To deal with negative emotions
Some therapist could hesitate to treat the negative emotions of people with dementia as a dialogue theme. However, it is natural that cognitive decline causes negative emotions towards themselves. It is thought that the non-illness part of the mind is reacting to the illness. The problem is that family members and friends do not try to understand that feeling. When the person tries to express negative emotions, family and friends advise that “you shouldn’t think about it, and you shouldn’t say it.” Family and friends try to encourage and cheer him up, but as a result, he feels emotionally isolated and lonely.
For people with dementia, it is necessary to express negative emotions in words, just like positive feelings, and have them accepted by others. Certainly family and friends do not want to hear words with negative emotions. Listening to them can be stressful. Therefore, at least the therapist must listen to and sympathize with his or her honest feelings in psychotherapy, whether negative or positive. People with dementia can be psychologically prepared to move forward by verbalizing their honest feelings.
5. Respect effort and patience
Many people with dementia make repeated mistakes in their daily lives, which reduces their self-esteem and self-efficacy. However, they are by no means helpless against the disease called dementia. Certainly, it is difficult to obtain an intervention effect for memory impairment, which is one of the most core symptoms of Alzheimer type dementia (Finger). It shows that it is difficult to slow the progression of the disease itself. However, activities that combine multiple cognitive functions may be slowed down by intervention. Even if dementia progresses, I presume that by trial and error, we can improve our goal by combining cognitive functions. People with dementia each have their own trial and error in their daily lives. Even as dementia progresses, we maintain activities of daily living in each way. I think that even with the help of family members and caregivers, you can improve by trial and error. Then, when they complete the activity, the healer should pay homage to the effort and share the joy of accomplishment. That strengthens their self-esteem and self-efficacy. As a result, people with dementia are psychologically comfortable, able to accept themselves, and maximize their remaining cognitive function. Even if they can’t do trial and error, if they endure the misery and embarrassment of failure, that alone is commendable..
6. Let them talk about their worth and sense of accomplishment
Even people with early-onset dementia have a lot of life experience, so they have a lot of valuable experience to gain the wisdom to live. Some may be unfortunate experiences, but they have been overcome. Some may have been very successful in their business. Some were teaching someone how to work, giving advice to someone, helping someone, becoming a matchmaker, building a new home, or raising their children. Each person has something worth doing and has achieved. When such topics emerge in the dialogue, it is important to encourage them to express their worth and sense of accomplishment in words. They may think they are not doing anything special. When the healers listen with respect and respect, they can positively accept themselves as well as their past lives.
7. Help people with dementia recognize their own needs
When people with dementia are asked what they want from medical care, they say, “I want my illness to be cured.” They know it can’t really be done, but it’s a common feeling for people with dementia. It is important that medical and welfare professionals do not deny and accept hope that cannot be fulfilled. When people with dementia feel that their feelings have been accepted, I think they start talking about other hopes and needs. People with dementia may have been stopped by family and friends when they started talking about impossible hopes. However, people with dementia feel affirmed by having the therapist listen to their needs without deciding whether or not they are possible.
8. Be aware of your body’s senses
It is inevitable that persons with dementia suffer from difficulties in daily life and anxiety about their own future. The suffering is thought to be promoted by the prejudice associated with dementia. As they focus only on their difficulties and anxieties, they will feel them bigger and stronger, narrowing their horizons. In these cases, it is better not just to endure difficulties and anxieties, but to direct awareness to other things. For instance, it is effective to focus on the senses of the body. This is because everyone has a sense of the body and can feel it as a reality for them. Generally, It is desirable to be interested in diet, sleep and exercise for better health. However, whether or not you can eat deliciously than the amount of food, whether or not you wake up feeling better than sleeping time, comfort after taking a nap, feeling of accomplishment after exercising, refreshing after bathing, a fresh air and warmer sunlight than the length of walking time should be emphasized. The therapist is better to ask them physical sensation in order to be conscious body condition.
9. To convey the feelings of the family to the client
People with dementia are not responsible for getting sick, but many think they are annoying their families and caregivers. Many people think it’s better to die than to bother their families. However, they do not seem to be able to put their thoughts into words and convey them to their families. Communicating your serious feelings to your family seems to be more difficult than telling your friends.
Similarly, families of people with dementia do not seem to tell people with dementia that they want to help. Not telling may increase the feeling of sorry for the family of people with dementia. I think it is effective for the therapist to listen to the feelings of the family toward the person with dementia and convey it to the person with dementia in order to maintain the self-esteem of the person with dementia.
10. Rejoice together, not praise
People with dementia are trying their best to go out for walks, do household chores, participate in day care rehabilitation, etc., despite the symptoms of decreased motivation and spontaneity. I will. I think it’s more important to rejoice with them than to praise them for what they have done. The symptoms of dementia vary, but we put a lot of effort into our daily lives. It’s better to share the joy of accomplishment than to praise. The reason is that people with dementia are facing and trying to overcome huge challenges that we professionals have never experienced. Therapists and healthcare professionals must be supporters who live with them, not managers or leaders.
These ten points also apply when talking about accepting a disease, discussing treatment, or asking for a medical history. This is my comprehensive attitude and my basic strategy is consistently used throughout healthcare. This is shown in all treatment and care settings and is mentioned repeatedly in this book.