Dementia and Person-Centred Counselling
There is a dementia crisis looming. The condition affects one in 14 people over the age of 65, one in six over the age of 80 and it is estimated that there are an additional 15,000 people under the age of 65 suffering from the condition. The projections for the increase in the incidence of Alzheimer’s disease are truly shocking: some estimates project one million sufferers by 2020, at a cost of £20 billion a year
Dementia affects 820,000 people in the UK. 25 million of the UK population have a close friend or family member with dementia. As well as the huge personal cost, dementia costs the UK economy £23 billion a year, more than cancer and heart disease combined. At present there is no cure for dementia
The effect upon sufferers and carers can be devastating; with families struggling to cope with the difficult demands of the sufferer and at the same time trying to understand what is happening to their loved one.
For the sufferer it can be frightening, what once was familiar may now seem foreign and unknown, and is often accompanied by a progressive ‘loss of self’, which in turn can lead to profound anxiety and depression.
Family members may despair at the thought of not knowing who this person has become – someone who has turned their world upside down and who gets lost from the bedroom to the dining room in their own home.
Frequently sufferers are objectified and are perceived as being nothing more than shadows of their former selves. This can be compounded by society’s ageist culture and the ongoing stigma of mental illness.
What can be done? Drug treatment can slow the progressive effects of dementia, but that in itself does nothing for the increasing feelings of isolation and estrangement which sufferers may experience.
Can counselling help those suffering with dementia?
A specialist dementia therapist will be able to appreciate, acknowledge and value the client, irrespective of how affected they are by the effects of dementia.
The counselling relationship does not judge, but accepts that the client is how they are now. There is no expectation that they should be, or do anything other than who they are. The emphasis is on the relationship.
It is about being supportive and patient. Helping the sufferer explore those memories that may be over half a century old, but are still fresh as today – when ‘today’ itself is a concept which is not always readily grasped by the sufferer.
From the perspective of the outside world some dementia sufferers may appear to be engaged in random monologues which do not seemingly make any sense; but these fragments, when attended to, can contain a narrative or story that give a sense of the client’s life, and may lead to a reaffirmation of the ‘self.’ These fragments can be shared with and witnessed by the therapist.
‘I want to tell you my story before I forget the words’. Counselling can provide the focused time and attention needed to explore this narrative and to offer the space and safety to say it out loud, re-claim the words and particular meanings, making it real, having a second, or often several chances for continuation of the story.
The specialist dementia therapist will have no agenda for the sufferer, other than respecting her total autonomy. Through a gradual process of acceptance, empathy and genuineness, there may emerge a sense of empowerment for the sufferer.
Through this process clients can begin to feel heard and understood. No longer isolated; something has been ‘shared‘, as a consequence there can be a greater understanding of how the sufferer perceives herself and her sense of self.
Also, where there may be ‘contact impairment’, the therapist may use situational reflections, word for word reflections, and reiterative reflections which can facilitate communication, and gradually begin to build a relationship with a sufferer.
All too often the emotional needs of carers are ignored when looking after a family member or partner with dementia, with the feeling that the sufferer must at all times take precedence. As a consequence, carers can often become anxious and depressed, with feelings of guilt that they are not coping as well as they would wish.
With an aging demographic, combined with more accurate diagnosis, the incidence of dementia is only going to get more prevalent. The reality is that dementia can affect any one of us; the problem of dementia will not go away, a fact which urgently needs to be addressed. But crucially, it requires a change in attitude from society, and an awareness that person-centred counselling can be part of the solution for sufferers and carer.
Method of enquiry
There are many modalities practiced by dementia counsellors, ranging from the Person-centred , Psychodynamic and Integrative approaches.
Research studies have shown that:
1. Effective psychotherapy is primarily predicated upon the relationship between the therapist and client and the inner and external resources of the client.
2. The type of modality practiced is largely irrelevant in terms of successful outcome.
3. Clients who receive psychotherapy improve more than clients who do not receive psychotherapy.
4. The most consistent of the relationship variables related to effectiveness are the conditions of empathy, genuineness and unconditional positive regard.
Sources: Alzheimer Research UK/Dementia UK/Jerold Bozarth/Garry Prouty/Danuta Lipinska.
Recommended reading: Person-Centred Counselling for People with Dementia.
Making Sense of Self. Danuta Lipinska. Jessica Kingsley Publishers.