Article 3: Geropsychology

 How Providing Person-Centered Therapy To People With Dementia In Long Term Care Facilities Can Improve The Quality Of Their Lives

By Judith Rand, PhD

Copyrighted 2010

Did you know that not all long-term care facilities offer psychological services to the persons with
who reside there? Counseling and therapy services should be available to every person
with dementia (i.e., those with diminished memory, neurological health, and cognitive ability), if he
or she wants them. Why? For two reasons: To support them in making sense of their lives, and to
support them in making sense of themselves in their present condition and experience.

Many psychologists who do practice in long-term care (LTC) facilities base their work on the
medical model of treatment. In this model, hierarchy in the relationship is essential in order to
observe the client as the subject of inquiry. The psychologist focuses on using his or her own
expert knowledge to make treatment decisions for residents. Residents are considered to have
deficits and dysfunctions; the psychologist is called in to “fix” them. This form of treatment
often does not view the client as an expert about his or her own life. It views clients as lacking
information and the ability to make decisions about what is best for them. Regarding dementia,
those using this approach assume that there is little or nothing you can do for the patient. They
tend to focus largely on assisting the family and long-term care providers.

In contrast, those psychologists who utilize person-centered therapy base their work on
collaboration with residents in a joint endeavor to effect positive change from the resident’s view.
The counseling relationship is based on discovering who the person is and what she or he is
thinking and feeling about what is happening to her or him. The assumption is that a person with
dementia "is making an urgent request to make sense of Self -- to make sense of the past as it has
affected the present and how the past has collided with what appears to be a wall blocking the
future" (Lipinska, 2009). According to psychologists who utilize person-centered therapy,
therapeutic relationships with residents emphasize unconditional acceptance; responding with
empathy; generosity of spirit – giving the benefit of the doubt and not making premature and
often inaccurate assumptions; belief in human development as occurring throughout life; and the
spiritual dimension of experience.

What does the psychologist providing person-centered therapy do? She provides opportunities
for people with dementia to tell their stories and to be listened to in psychotherapy. She also
provides them with an opportunity to make sense out of the world in which they live now and to
grieve the losses they have suffered.

What happens in therapy? The assumption is that older adults continue to develop in the
emotional, social, and spiritual dimensions of their lives up to the point of death. Story-telling is
a way for individuals to become known to themselves and to others. They gain a sense of their
own worth as their stories fill them with status and importance in the relationship. What are the
outcomes in person-centered therapy? Defeat of the 3 most common plagues in LTC -- boredom,
helplessness, and hopelessness; reduced anxiety and depression; enhanced feelings of being
heard, worthwhile, valued, respected; increased desire and ability to express how they are
feeling during the session without needing to wonder if it is appropriate to do so; experiencing
of forgiving and resolution; and feelings of being taken seriously and empowered to be 
themselves within their relationships at their home.

What are the implications for families when choosing a long-term care provider? Assuming the
provider offers psychological services, the first implication concerns the issue of power and
influence in therapy. Here there are two choices. Does the psychologist utilize a “power over”
strategy based on the medical model to induce compliance among residents living in the facility?
Or does the psychologist utilize an “empower to” strategy to invite collaboration with residents
regarding their own care? The second implication concerns the issue of “resistance” versus
“protection” on the part of the resident. Consider the following. Does the psychologist
understand that residents hold a lifetime of beliefs, decision-making and choices to which they
may be wedded strongly? Does the psychologist encourageresidents to honor their past choices?
Does he or she enable residents to trust their own instincts about their care? Does the
psychologist understand that residents may need to protect themselves and their position
(i.e., appear “resistive” to care) in the new world of long-term care until they better understand
and trust that new world? Does the psychologist understand that residents have the right
to say “no” to a particular treatment? Does he or she understand that residents may need to say
“no” (i.e., appear resistiveto care) before they can say “yes” (i.e., comply with treatment and care)?

In conclusion, families who are considering long-term care for a loved one, and families who
have already placed a loved one in long-term care, should consider the choices now available to
them. Does the facility offer psychological services to all residents? Do the psychological
services offered at the facility emphasize person-centered therapy? Do you believe your loved
one might benefit from psychotherapy that facilitates a search for meaning in his or her current
situation? Does your loved one know that these services are available to him or her?

Reference: Lipinska, D. (2009). Person-Centred Counseling for People with Dementia: Making
Sense of Self
. Philadelphia, PA: Jessica Kingsley.

Dr. Judith Rand is a licensed psychologist in Arizona and provides expert, person-centered psychological services to residents at home in long-term care facilities in Tempe and Mesa. She also provides services on an outpatient basis. For more information, please contact her at 480.399.6100 or [email protected] (please put “Person-Centered Therapy” in the subject line).

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