I was recently interviewed by the senior writer of Counseling Today for the January 2020 issue cover story about dementia. Below are the questions and my answers.
(Counseling Today Reporter) You mentioned that you have experience counseling clients with dementia. What therapeutic techniques and methods have been helpful with these clients?
In working with clients who are struggling with dementia, I’ve focused on using two tools: empathic listening and reflections. These provide a safe space for clients struggling with dementia to share their frustrations and fears. My efforts are focused on providing an interaction where they feel heard and understood, without feeling questioned or having someone trying to talk them out of their ideas.
With my senior clients, I often use a narrative orientation. I believe everyone has a life story and that it can be very therapeutic for people to tell their story and feel heard and understood. Even for clients struggling with dementia and short-term memory loss, they usually seem to be able remember and enjoy telling stories about their life
Normalizing frustrations and fears related to memory challenges and aging also helps clients feel less “defective.”
This summer I had an extremely tough conversation with a longer-term client about giving up her right to drive because of cognitive decline. This was very hard for her. She argued that she did not drive far, that she had not had any accidents, and that she didn’t care if she died in an accident. She became very emotional (tearful and angry). I listened empathically, validated her truths and reflected her logic and feelings. Then, I asked if she wanted her lasting legacy to be causing someone else’s injury or death. She agreed this was not what she wanted. We then explored options and resources that would allow her to maintain her freedom and active schedule without driving. We talked about local taxis services, friends who were going to the same activities and the obvious solution became allowing her home healthcare provider to drive her most of the time.
(CT) Please talk about the range of emotions that a client who has a loved one with dementia might experience and how a counselor could help them process these feelings. (If you have a case example to share, that can be helpful too.)
The caregivers and loved ones are often hidden victims of dementia. They can become completely overwhelmed as the role becomes all-encompassing . Taking care of someone can easily become an identity that gets affirmed and reinforced until it comes at the nearly complete expense of self-care. When being the caregiver for someone with dementia overtakes their life, the caregiver’s emotional and physical health frequently begins to decline.
It is common for loved ones and care-givers to experience a myriad of emotions including: sadness, frustration, hurt, fear, overwhelm and even anger.
I often help caregiver clients by providing a safe place for them to share the things they don’t feel they can share with family and friends. For caregivers, there are three tools I focus on using: therapeutic silence, empathic listening, and normalizing what they often describe as “terrible thoughts.” These self-described, “terrible” thoughts can be ideas like “they make me so angry”, “I dread going to the nursing home some days” or even “sometimes I secretly hope they don’t live for years like this.”
Another thing I do with caregivers is help them not take the mean things being said to them (by cognitively impaired loved ones) personally. Gently probing why someone with dementia might say mean things and reminding them “they’re sick.” It sounds obvious, but in the moment that fact can be overlooked.
There are three tangible things I can help caregivers use to improve their self-care: identify strategies for establishing healthy personal boundaries, creating caregiving or visitation schedules, and seeking help so they can get a break.
(CT) In your experience, what do clients with dementia need from a counselor?
In my experience, clients struggling with dementia need someone to listen to them for understanding without confronting them, trying to argue with them or trying to fix them.
(CT) In your experience, what do you families and caregivers of people with dementia need from a counselor?
Families and caregivers for those with dementia benefit from a counselor who can listen empathically and non-judgmentally to their challenges related to dealing with the dementia patient and encouragement of self-care.
(CT) Our readers are professional counselors of all types and specialties (including grad students). Is there anything else you would want them to know about working with clients with dementia and/or their caregivers? Are there any main take-aways (things to be aware of, keep in mind, etc.) you'd like to share?
The basic premise of the helping profession of counseling is the same for all clients. People deserve respect and dignity, including people with significant cognitive impairment and professional counselors can provide or contribute to that experience.
(CT) What draws you to work with aging issues/dementia as a professional specialty?
I have always enjoyed visiting with the elderly. As a kid I loved hearing my grandpa tell stories endlessly (even when everyone else was annoyed.) As a teen I delivered prescriptions for a local drug store to home-bound seniors. I was encouraged by the owner to take as much time visiting with customer as they wanted. He said “that might be the best medicine.”
I really enjoy working with senior citizen clients and have had some really fulfilling therapeutic relationships with senior clients where I felt I got as much from the work and relationship as they did. Elderly people have a lot of wisdom. I work in a semi-rural area of the Midwest. It saddens me that more seniors here don’t consider counseling. I appreciate and respect their “pull yourself up by the bootstraps” mentality, but I think they often suffer unnecessarily because of social stigma fears.
My motivation to work with dementia patients and caregivers also stems from a personal experience. It was hard for me to see a family member (whose identity was highly correlated with intelligence) begin to experience cognitive decline. It was tough for that person as they became aware of their own impairment. And it was extremely hard on everyone who cared for and loved them.