I met with a man this morning who recently placed his wife into a specialized dementia care facility. The last two visits with him have centered around his unhappiness with the care she has been receiving. It is important to know that they have been married for 62 years and he loves her dearly.
He asked me if he was being un reasonable about his complaints and made several attempts to talk about other resident problems. Once he was directed gently back to the subject of his wife he asked if perhaps maybe, his expectations were to high. We spent some time processing his feelings about the level of care he provided verses the level of care they could provide. What we discovered was that an important ingredient was missing, Love. You see, no one could ever provide the kind of care that he could provide because he loved her so much and this transition was breaking his heart. He needed to see her daily yet he knew that his visits would not be remembered by the next day. It was also extremely painful for him to leave her especially these past two days because she would start crying and no matter what he did or said, he could not make her stop.
We talked about the area of the brain known as the Hippocampus. This area is one of the first areas of the brain to be affected by dementia and has several functions including indirectly affecting emotion regulation. As the disease progresses, it is becoming increasingly difficult for her to control her emotions. Studies also show that people who have this disease are aware that they are losing control of lifelong functions. This creates anxiety, fear, depression and most importantly, a sense of helplessness and hopelessness.
When I asked him what it was that led to her crying he said that he had told her about something his own doctor had shared with him. Since this man has a history of prostate cancer which can often lead to some incontinence issues, his doctor recommended he have some minor surgery to remedy his problem however, this included an overnight stay in the hospital. When he shared this with his wife, she became upset and began to cry for several reasons. One is that she was having trouble controlling her emotions and just could not seem to fully process what was expected to be a fairly routine procedure. The other reason I suspect is that she was totally helpless in her ability to be there for the man she has been married to for 62 years.
This led us into the realm of grief and the concept of reciprocity. You see, he and his wife have always shared everything with one another. She has a history of breast cancer and he has a history of prostate cancer. They have raised a beautiful family together. Everything about them has always been about them not just him or her. When he was worried about something he could always go to her and some how things were better. When she had problems, he was always their. because of this dreadful disease, he no longer has the reciprocal relationship he once had with his wife and he is grieving the loss.
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With every new family I meet a discussion about legal issues must be had. People have many questions about their particular family and I am often amazed by the depth of their knowledge. For this reason, I have devoted this article to Advance Directives and some other legal issues many of us have or will encounter when working with the elderly. I need to inform you of the fact that I am not an attorney and I do not claim to be the expert regarding this information. I chose this article from one of my favorite resources, (Personal MD. Com) because it is very informative and it is written in simple terms. For specific laws regarding this information in your state, please consult with your attorney. This is general information and is not to be regarded as specific.
Advance Directives
Taking care of yourself and your family means making decisions about medical care while your health allows you to do so.
Although death comes to everyone, many of us tend to fear its approach and may avoid confronting the issues surrounding the end of life. Nevertheless, it is important for each person to document his or her wishes in writing prior to serious illness or physical or mental disability. Otherwise, those wishes may not be known and cannot be honored; thus creating an unnecessary burden for loved ones.
What are advance directives?
Advance directives are written instructions in the form of a living will and/or durable power of attorney for health care. Advance directives do not go into effect until the signer loses decision-making capacity.
A living will (health care treatment directive) is a legal document that communicates a person’s desires about withholding and/or withdrawing medical treatment in the event that he or she suffers from an incurable and terminal condition. Living wills outline in advance the treatment choices and instructions to be followed by caregivers if the signer cannot take part in making health care decisions. It is called a “living will” because it must be signed with the same type of formality as a regular will but its provisions take effect before death.
A living will:
* May spell out specific measures that the person wishes, or does not wish, to have taken to extend life when He or she is clearly dying.
* May specify the use or non-use of breathing machines, feeding tubes, oxygen, intravenous fluids, or medication.
* May list specific illnesses or conditions (persistent vegetative state, coma, terminal illness with no hope of recovery or cure, end-stage dementia) under which the provisions of the living will are to go into effect.
A living will must be witnessed to be legal, and a person must be competent when he or she signs it. Requirements vary from state to state, but usually the witnesses must be unrelated to the patient, cannot be creditors or heirs to the patient’s estate, and cannot be the patient’s doctor. It is wise to prepare a living will at a time when you are healthy, not when you have been seriously ill or are in the hospital.
Most states have laws that recognize advance directives. Not all states do, however, and living wills may not always be binding. Some states do not recognize living wills that have been drafted in other states. You need to be familiar with the laws in your state.
A durable power of attorney for health care (DPAHC) designates a family member or friend to follow the person’s wishes and to make medical decisions on his or her behalf should the signer lose decision-making capacity. It is more flexible and comprehensive than the living will, and is regarded by some as preferable to it.
For this document to be legal, the person must be competent at the time he or she signs it. Anyone with a progressive brain disorder such as Parkinson’s disease or Alzheimer’s disease may wish to draw up the DPAHC papers early in the illness. The duty of an agent in the durable power of attorney for health care is to follow the signer’s wishes. In states that recognize such documents, families and physicians can not override a living will or the agent of a DPAHC.
Once signed, such documents should be kept in a safe place, but not in a safe deposit box where they may not be accessible when they are needed. It is a good idea to discuss your wishes with your friends, family members, and your physician. Giving these people copies of your living will or DPAHC also is advisable. That way, should you become incapacitated, others will have access to the documents that express your wishes.
The Midwest Bioethics Center (816-756-1735) provides information about advanced directives nationwide. Choice in Dying will provide a copy of state-specific advance directives free to anyone that writes the organization (Choice in Dying, 200 Varick Street, New York, NY 10014) or calls (1-800-989-WILL). Your state health department, local hospitals, or state bar also may be able to provide you with state-specific advance directives. You may wish to consult your lawyer about advance directives and drawing up a durable power of attorney for health care or a living will and a regular will that conform to the laws in your state.
What happens if the person is already incompetent or physically unable to manage his or her own financial and medical affairs?
Some people are unable to manage their own affairs due to medical illness or a mental impairment. The central issue is whether that person can understand and make decisions involving medical and financial choices. A person can be confused about time and place, but nonetheless may be able to understand his or her choices if they are carefully explained. It is also possible for an older person to be capable of making decisions about his or her health but not about finances. Physicians are often asked to evaluate the competency of a patient, but a doctor can only make a medical determination about someone’s decision-making ability. A court must make any legal determination about competency.
All states allow the courts to establish limited guardianships (also called conservatorships) and unlimited guardianships.
A limited guardianship allows the appointed guardian to make decisions for someone in areas where the court has determined that the person lacks the ability to function. This type of arrangement is often made for managing finances. Someone judged incompetent for financial purposes is still able to make decisions regarding his or her health.
An unlimited guardianship removes all rights of the individual to vote, to decide where to live, and to manage his or her money and health. That person is said to be incompetent for all purposes and receives the protections generally given to a child.
What is the meaning of “resuscitate” and “do not resuscitate (DNR)?”
If you are in a clinic, hospital, or nursing home, you may be asked to sign a code status sheet. This will indicate to the staff what measures, if any, you want taken should you be found not breathing and without a heartbeat. Code status may be changed at any time.
Cardiopulmonary resuscitation (CPR) was developed in the 1960s as a way to prevent sudden and unexpected death. When administered quickly, it is generally effective for heart attacks, drownings, drug overdoses, and similar acute situations. However, CPR is not generally as effective for people with chronic and severe illnesses or where death is expected to occur soon.
A full code means that you want everything possible to be done to revive you. This includes administering chest compressions, electrical shocks, and medication (to start your heart) and putting you on a ventilator (a machine to keep you breathing). This type of CPR has the most success but is still less successful for people with chronic medical conditions. Some people request a limited code, which usually excludes being put on a ventilator and is much less often successful.
When CPR is medically futile, your doctor should explain why. In those cases, a no code order (DNR, for Do Not Resuscitate) may be written. It is important to recognize that a DNR order only pertains to not having CPR and does not limit other types of treatment. A person should receive all indicated medical and nursing care, even when CPR would be of no benefit. A discussion with your doctor about CPR is an excellent opportunity to review your overall medical condition and treatment plan. (Personal MD.com)
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Being a care giver in my book is the hardest job in the world. Imagine going to work one day and your boss tells you that you can no longer leave at the end of the day. You will no longer be paid for the work you do and you must expect to be woken up during the night at any given time to do your job. Hear is the real zinger! Your boss also informs you that you no longer have a job description and that you must expect to fail at everything you do because you will not be given any training.
I remember when my daughter had Leukemia at the age of four. My wife Beth and I felt as though we had been sentenced to live in this bubble for two years and our prison guards were medical doctors and social workers. Our entire sense of being revolved around our faith in God and making sure our daughter Morgan was going to live through this. We had been given a sense of purpose that was not asked for much less desired. Even though we had thousands of people praying for us and the support of friends, family members, social workers, and doctors, it felt as though no one else in the world could do the job for us. We had to learn to embrace the mission, understand that we were not perfect, that we would make mistakes, but we were not alone. We had to remind ourselves that this was too big for us to handle however; we had the means to deal with this.
After a period of time went by, I began to understand that I must have another sense of purpose, a purpose other than being the dad of a child with a life threatening illness. I began to understand that by having another purpose, I could be stronger for my daughter and my family. It is like taking a trip on an airplane with a child. The flight attendants always instruct the parents of small children to put the air mask on themselves first before helping their child. I needed to come up for air!
I believe that “Any real meaningful purpose in life is most often, not recognized until after some of the most difficult training and preparation has taken place”. In other words, I had no idea at the time that my experience as a care giver would someday lead me to the work I do now. I was certainly dumbfounded to discover that I gained the skills necessary to empathize with the care giver of an individual with dementia. Is a person called upon to do a job based on their future potential or their background? By giving things over to God, we are free to embrace failure knowing that there is a sense of purpose behind our every move. The trouble is as human beings, we have the desire to know what that purpose is in advance.
The sense of purpose for you can be anything you desire. Some people audit a class at the local Community College. Some people join a Bridge Club or facilitate a small group for their church. People join civic groups or organizations that support their favorite hobby or interest’s. I’ve had people who joined gardening clubs, fishing clubs, hunting clubs, golf clubs, reading clubs; you may even find a new career. We were designed to have rest.
Is the paradox becoming clearer to you now? One sense of purpose is identified by looking back at your experiences. The other sense is identified by looking forward to what is comfortable to you. In my opinion, both are equally as important, we just need to begin our search.
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I have worked with hundreds of care givers and never have I experienced such a care giving warrior as this person whom we will call Ruth. Her husband is a retired law enforcement officer who was diagnosed with Alzheimer’s disease several years ago. He has a heart as big as hers and is the epitome of what we all pray for if our loved one is diagnosed someday with this disease. It is what I call a match made in Heaven.
In my experience, the Christmas Season is the most difficult time of the year for the family who has a loved one with dementia. If we could only know what is in store for the next year. I have had this conversation many times with my fishing buddies. The question is: “What would the world be like if we new what God had in store for us every day of our life?” Would your best friend be calling you to say that they could not drive today because they new they were to die in an auto accident? Would your daughter tell you that she would not date the man you approved of because she new that he would experience several tragedies in the future resulting in his own alcoholism? The world would be a mess!
Ruth has chosen the humble path of servitude and has accepted the cards she was dealt. When she promised her husband that she would stick by his side until death do us part, she meant it! What she did not promise was that she would do it with a positive attitude and a big heart. What a fortunate man! What follows is here Christmas letter to her friends and family:
“YOU’LL BE IN OUR HEARTS THIS CHRISTMAS SEASON- 2008”
We don’t have all of our Christmas decorations up yet but as we continue putting them up here and there, our hearts expectation is that Christ will do something new in all of us this special season.
We are reminded that Mary & Joseph were real people and they were deeply affected by all that took place. Likewise, Christ’s presence should deeply affect us. He is our God, our Savior, our friend, our King. He has come! He lives today! He is! That is indeed reason to celebrate!
Our daughter Shelly was here with us for two months this last summer. What a joy to have her here. We were happy to have our son Ben visit us also in the summer as well as a more recent visit. It is good that our daughter Karen still lives close by so she can stop in frequently. We are thankful for the many things our children do for us and the love they share with us.
The Lord has given us a good year because of his Loving Presence. We are doing ok physically, however, we both are learning to adjust and accept the progression of Larry’s dementia. Despite the many daily difficulties that contend with, secure in our love and knowing God is always with us, we are mostly content. Maybe it’s the pleasure of making another person happy. But we know it is in part, the encouragement we receive from family, from friends, from support groups, and the daily blessings from God.
The Lord is teaching me to release to Him my hopes and desires so that He can bring them to pass. I find that God takes yesterday’s hopes and challenges me to let go of them for a greater display of his Grace. Daily He says “let go, and trust Me. Watch me work”. My chosen scripture (Which has been printed in large letters on my dining room area wall) is found in Proverbs 3:5 “Trust in the Lord with all your heart…” May this scripture be yours in the 2009 year!
We wish you a Christmas Joy. And may the Spirit of the Season fill your heart during this special time.
Can you find anything about this letter that has to do with meeting her own needs? When families often ask me what are the qualities necessary to be a good care giver? The answer can be summed up into one word, “Grace”.
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Delirium is a sudden, fluctuating, and usually reversible cognitive disorder characterized by disorientation, the inability to pay attention, the inability to think clearly, and a change in the level of consciousness.
Delirium is an abnormal mental state, not a disease. Although the term has a specific medical definition, it is often used to describe any type of confusion.
Because delirium is a temporary condition, determining how many people have it is difficult. Delirium, which is usually a sign of a newly developed disorder, affects about one third of hospitalized people aged 70 or older.
Development or worsening of almost any disorder can cause delirium. Any person can become delirious when they are extremely ill or are taking drugs that affect brain function. However, delirium can result from less severe conditions in older people and in people whose brain has been affected by a stroke, dementia, or other disorders that cause nerve degeneration. In such people, delirium can result from a relatively minor illness, such as retention of urine or feces; sensory deprivation, such as that due to being socially isolated or not wearing glasses or hearing aids; or prolonged sleep deprivation. For example, the sensory and sleep deprivation that occurs in intensive care units (ICUs) may contribute to delirium. This disorder is sometimes called ICU psychosis.
Being in the hospital can also contribute to or trigger delirium. About 10 to 20% of older people develop delirium while they are in the hospital. Delirium is also very common after surgery, probably because of the stress of surgery, the anesthetics used during surgery, and the analgesics used after surgery. The most common reversible cause of delirium is drugs. (NIMH)
Delirium may occur in persons with a normal brain but is more common in those with underlying brain disease, such as dementia. It is more common in the elderly, probably due to changes in neurotransmitters, geriatric cerebral cell loss, and concomitant disease. Delirium may be due to primary brain diseases or diseases elsewhere in the body that affect the brain; causes are usually metabolic, toxic, structural, or infectious. Regardless of cause, the cerebral hemispheres or the arousal mechanisms of the thalamus and reticular activating system of the brain stem become physiologically impaired. Disruption of sleep and extreme stress superimposed on acute disease may worsen symptoms of delirium (as in intensive care psychosis).
Treatment
Symptoms are usually reversible when the underlying cause is identified quickly and managed properly, particularly if the cause is hypoglycemia, an infection, an iatrogenic factor, drug toxicity, or an electrolyte imbalance. However, recovery may be slow (days to even weeks or months), especially in the elderly.
All unnecessary drugs should be stopped. Identifiable disease should be treated, and fluids and nutrients should be given. A patient suspected of alcohol abuse or withdrawal should be given thiamine 100 mg IM daily for at least 5 days, to ensure absorption. During hospitalization, such patients should be monitored for signs of withdrawal, which can be manifested by autonomic disturbances and worsening confusion.
The environment should be as quiet and calm as possible, preferably with low lighting but not total darkness. Staff and family members should reassure the patient, reinforce orientation, and explain proceedings at every opportunity. Additional drugs should be avoided unless needed to reverse the underlying condition. However, sometimes agitation must be treated symptomatically, particularly when it threatens the well-being of the patient, a caregiver, or a staff member.
Few scientific data are available to guide the choice of drugs to treat delirium. Low doses of haloperidol (as little as 0.25 mg po, IM, or IV) or thioridazine (5 mg po) can help in managing the delirious patient. Larger doses (haloperidol 2 to 5 mg or thioridazine 10 to 20 mg) are sometimes needed. Newer drugs, such as risperidone, can be used instead of haloperidol for oral therapy but are not available IM or IV. Short- or intermediate-acting benzodiazepines (eg, alprazolam, triazolam) can control agitation over the short term; benzodiazepines may worsen confusion, but if required, the smallest effective dose should be used. All psychoactive drugs should be reduced and then eliminated as soon as possible so that recovery can be assessed. (Merk, 2nd Edition)
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A client I had been working with shared a letter with me she had received from her son who lives across the country. She cares for her husband who has Alzheimer’s disease. On this particular visit, she said that her son wanted them to move to the East Coast so that he could care for them. When I asked what he did for a living, she said he was a successful, but very busy Software Engineer. She had some concerns about a letter he had sent her and wanted to share it with me so that we could discuss it. I knew this would be interesting since most engineers are linear thinkers.
Keep in mind that this couple had only given some thought to the concept of moving to the East Coast in the past. At this time, they were not even remotely able or ready to take it to the next level. They have long standing relationships with their doctor’s, have an extensive social network, and a specialized dementia care program in which her husband attends two days a week, a program that specializes in increasing blood flow to the brain which has been proven to slow the progression of the disease. This program allows her to take a break during the day and it provides her husband with much needed socialization with people who are trained extensively in dementia care activities. Activities that increase blood flow to the brain include the following: Socializing, Diet, Monitoring of other conditions, Physical Exercise, Proper Diet, Exercises for the Brain, and Music.
Let’s take a look at an excerpt from the letter so that you yourself can examine his intentions. The names of the individuals as well as any other identifiers in the letter have been removed for privacy purposes otherwise; I have not changed a word from title to conclusion.
“Long term Planning for Mom and Dad” (This was the title of the letter)
“Premise:
Staying at 1234 Lane under the current conditions is not tenable for much longer-less than one and one-half years in the absence of persistent illness or significant crisis. At age 85, Mom is reaching the limits of her ability to maintain the house and care for Dad. A breaking point is on the horizon, and only if we become proactive will we be in the position to dictate the terms under which we live in the future rather than having those terms dictated to us by circumstances out of control.
A priority in our decision making is to be able to provide Dad with the quality of care and quality of life he currently enjoys. He receives extremely high quality care and thus he has to accept that in order to continue some semblance of such care, some sacrifices must be made.
Rationale:
Mom cooks, cleans, shops, drives, monitors medications, oversees all of Dads doctor’s appointments and handles the house along with everything relating to Dad. Some of these responsibilities are new as a result of Dad’s inability to drive, but most of them she has been upholding for decades. In either case, Mom is reaching the limits of her ability to maintain them. With each passing month, she is pushed closer to a breaking point at which she will be unable to provide care either for Dad or for herself. In short, Mom needs help!
Solution:
Either we begin using financial resources in Washington to hire help and alleviate the responsibilities on Mom, or we move Mom and Dad closer to family assistance. (Whose financial resources will be used?) Both options have drawbacks; no idyllic solutions exist. Either option we choose carries with it burdens and losses. For instance, the concern for the first option is the speed at which financial resources will be drained and the difficulty of maintaining safe and quality assistance. For this and other reasons, we believe the solution of relying on family help incurs the least amount of loss and maximizes the potential for gain. For this reason, we believe moving Mom and Dad to the East Coast is preferred.”
Unfortunately, parents are being subjected to this way of thinking everyday. The generation of people I have the honor of working with have several character traits in common. Lets take a closer look at the traits I admire the most: They keep their promises including “Until death do us part!”, They do not want to burden others with their problems, They have learned the hard way how to manage their money, They have a strong sense of commitment and loyalty to people they trust, It takes time and the correct actions to build their trust, They have a strong faith in a higher power, They understand the value of close relationships and understand that true love goes beyond what is on the surface, They understand that love is strengthened by the trials they have experienced together, They respect and listen to people who want to help them such as doctors, nurses, firemen, pastors, etc, They have a deep sense of honor for our country, They know how to laugh at themselves and with others, They still feel they are invincible, They have a strong desire to give and not take and they have humility, and above all else, they have a remarkable sense of grace!
Can you see these same traits in the letter written by the son to his parents? Something that is hard for most of us to understand is that it is impossible for us to know what others are thinking because we have not had the same experiences. Most of us were not raised by our grandparents, our parents were!
“Life is not about outcomes, but fragments of time in which we are designed to experience.” Reed Henry
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The fourth and final skill is called Integration. The act or instance of combining into an integral whole. (Webster’s) So now we have to pull all of our information together and actually attempt to institute change. Rather than discussing what integration is, I have decided to provide you with some case examples so you can see what integration actually looks like. The most important thing to remember at this stage is that you may or may not be correct in your findings.
The biggest mistake you can make is to be unwavering in your thoughts. Use all of the previous skills we have discussed, Attending, Empathy, and Confrontation before you begin to integrate your thoughts and feelings. Once you feel you have done this, ask the person if it is possible you are correct using an I statement. Example: I hear you saying you are having a lot of anxiety and are not comfortable about having to speak in front of a large crowd next week. You may get it right, you may not. Be prepared to accept either and move on. If you are not correct, continue to dialogue using the other skills until you think you can integrate again. Once the person confirms your integration, you have shown them you are a true listener!
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The third basic counseling skill is Confrontation. It is not unusual to think of confrontation as a negative experience or the perception of a negative experience. When somebody tells you they’ve had a confrontation, do you think about a tense, angry argument or possibly even a brawl? Most people do. Even my Webster’s Dictionary tells me that “confront” means “to come face to face with, especially with defiance or hostility.” In radical contrast, counseling textbooks refer to confrontation as “an act of grace” or “a true act of caring.” This is one of those annoying times when a specialized, professional use of a word is nearly opposite to the way people normally use it. Still, the concept of “appropriate” or “loving” confrontation is critical to what counselors, family members, good friends, and spouses do.
In order for this to work though, we must have utilized our previous skills of attending and empathy first. Confrontation means telling people about inconsistencies that they may not yet has spotted for themselves. It’s hard to do, harder to do it right.
Timing is critical. Effective confrontation can only happen after two people have had a chance to get to know each other. As a counselor, spouse family member or friend, you know that first impressions are often off base and almost always superficial. It takes some time to feel into another person’s experience and even more time to sense when they are ready to face and work through their more difficult issues. People need some time to size up whether the counselor is competent, caring and honest. It takes time to build trust, but only trust can allow the person to accept and integrate information that might be frightening, even painful. Appropriate confrontation can only happen in an atmosphere of trust. How many of you can do this? This is exactly why “Boundaries” are important.
There are two main circumstances in which we might offer confrontation, two very different kinds of inconsistencies: those between what we say and how we feel, and those between what we say and what we do. Sometimes a person tells you they feel a particular way, but their voice, facial expression, posture and the general feelings you are getting from them seem to be saying something else. If you feel the person is ready to take another step in self-understanding, you might choose to tell them what you’ve noticed, and what you think it might mean. I have used this when working with a spouse who refuses to believe that anyone else can care for her husband who has Alzheimer’s disease. On the one hand they are exhausted and their doctor has said “Your going to have another heart attack” and on the other hand they still hold onto the belief that they can continue to do the job. If you offer empathy, remember to be sure to own your inferences, present them tentatively, and gracefully accept correction from the person. Your role is to invite self-exploration, not to compel it.
Other times, a person tells you they want or believe one thing, but their behavior seems unlikely to bring them to that goal, or to be inconsistent with those beliefs. They don’t seem to you to be walking their talk. Again, confrontation means telling them about the inconsistency that you perceive, caringly and as gently as possible.
Here are some sensible guidelines for confronting inconsistent behavior. Pick a calm and grounded moment for both of you. Speak gently. Only address one or two key areas at a time. More is more than a person can process at once. Only discuss things the person realistically could change. Be as specific as you can about how the behavior is interfering with the person’s stated beliefs or goals. Do not confront someone as a family or couple. This must be done one on one to begin with. Check that communication was clear. Have the person restate what you said if possible. Allow time for discussion of what you have presented. Be prepared to handle a defensive or angry initial reaction. Be as firm and as patient as stone.
When working one-on-one with an individual, about either feelings or behavior, never confront them unless you are willing to deepen your involvement with them. Normally, offering loving confrontation means volunteering to be there with the person as they work through the implications of whatever they learn from what you share with them. It means volunteering to be even closer to them than you were before.
Special thanks to Judy Harrow (Confrontation: “The Dark Mirror”)
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The second basic counseling skill is “Empathy”. Empathy is often confused with the word “Sympathy” which pertains to sharing the feelings of others or to be affected by the nature of the problem. Unlike Empathy, Sympathy is felt on a deeper level. Once again, this information is basic and can be used or applied as you see fit. You can also improve your communications with everyone you meet by learning these skills.
Empathy: Intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another person. (Webster’s) In other words, the helper gets into a person’s world and looks from inside out rather than outside in. When you empathize with someone, you walk along side him or her instead of pushing or pulling them regardless of your own feelings. Empathy means understanding another person so well that you identify or feel like him or her. The Indians expressed it as: “Walking a mile in another person’s moccasins.” It is listening so intently and identifying so closely that you experience the other person’s situation, thoughts and emotions. Good therapists do this, so do good friends (Berger, 1987).
A good listener must respond, letting the talker know he/she was understood. This responding is empathy. It is even more complex than listening; no one is perfect. You don’t have to be perfect, but the more accurate an empathizer you can become, the better. Often, when we are upset, we want to express and share our feelings with an understanding person. So, the good empathizer focuses on the talker’s feelings, not on his/her actions or circumstances.
Let’s look at some of the purposes of empathy and why it is so important yet difficult to master.
1. It shows you care and that you understood the other person. Thus, people will enjoy talking to you and willopen up more. Imagine what this will do in your personal relationships!
2. If you have misunderstood, the talker can immediately correct your impressions. You learn more about people and what is holding them back from telling them the whole story.
3. It usually directs the conversation towards important emotional topics. It opens the gate!
4. It lets the talker know that you (the listener) accept him/her and will welcome more intimate conversation.
5. It invites him/her to tell his/her story and vent his/her feelings. This is the essence of reminiscing.
6. Since it is safe to talk about “deep” subjects, the talker can express feelings and self-explore, carefully considering all his/her deep-seated emotions, the reasons for those feelings and his/her options. Thus, it is therapeutic. You are beginning to get it!
7. It reduces our irritation with others because we understand. To understand is to forgive.
8. It may even reduce our prejudice or negative assumptions about others because we realize we now have ameans of finding out what another person is really like. Furthermore, we discover everyone is understandable. Do not assume you now have the power.
9. It fosters more meaningful, more helpful, closer friendships. People can actually trust you.
Empathy is one of the more important skills you will ever acquire especially when you are listening to someone with Dementia. It is amazing how few people do it well. If you can teach your children this, you will raise incredible people!
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1. Attending: to be present and ready to serve. (Webster’s)
Examples of good attending: Sharing a meal together, Prayer, Listening to anything they have to say. Non-Attending communicates disinterest, disrespect, abandonment, rejection, and arrogance. Communication is 55% facial, 38% verbal, and 7% non-verbal. Too often, we find ourselves wanting to jump right in and solve the problem. The moment you speak, you change that person’s agenda. Good attending communicates respect, availability, and reinforcement. The consequences of this are contentment, fulfillment, healing, togetherness and a collection of needed information to find, explore, and understand the problem. A note: If the person has dementia, good attending will often require you to listen to the same story over and over again. It is critical that you listen each and every time as though you have heard it for the first time. Things can become compounded when the person has poor hearing that cannot be remedied with a hearing device. Or what do we do when the person cannot see us?
Good attending is inherently designed to move the person from where they are to where they want to go. You can best accomplish this by being relaxed, have an open posture that conveys your intent, leaning slightly forward especially if they are hard of hearing, have consistent eye contact, and sit squarely. Something that’s very difficult for people to do is to allow for pauses no matter how long. Allow for strong feeling’s including tears, even if they are your own. Touch is critical to all of us. Our world of political correctness is killing us. If you are afraid of giving someone a hug or holding someones hand, ask for their permission. Think about the infant babies who die from the lack of touch.
So many people have such a difficult time just being with someone even though nothing is being said. Some of the best times I have had with friends and family are times when very few words were spoken. Just being present conveys to the other person that you desire to be with them because they mean something to you.
These are the 12 most common blocks to good listening: Comparing, Mind Reading, Rehearsing, Filtering, Judging, Dreaming, Identifying, Advising, Sparring, Being right at any cost, Derailing, and Placating. Avoid these pitfalls and you will be on your way.
Next time we will learn what the second skill is to socializing. It might be easier though to ask your grandparents.
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