Research in practice
‘Genuine warmth is called for, given the fear, isolation, unknowing and confusion that can accompany dementia’
REFERENCES 1. Prince M et al. Dementia UK: Updated Second Edition Alzheimer’s Society report. London: King’s College London/London School of Economics; 2014. 2. Lewis F et al. The trajectory of dementia in the UK – making a difference. Office of Health Economics Alzheimer’s Research UK 2014. 3. Leung DK et al. Prevalence of depression, anxiety, and apathy symptoms across dementia stages: a systematic review and meta-analysis. International Journal of Geriatric Psychiatry 2021: 36(9): 1330-1344. 4. Lipinska D. Person-centred counselling for people with dementia – making sense of self. London: Jessica Kingsley Publishers; 2009. 5. Cooper M, McLeod J. Pluralistic counselling and psychotherapy. London: Sage Publications; 2011. 6. Pörtner M. Being old is different: person-centred care for old people. Ross-on-Wye: PCCS Books; 2008. 7. Mearns D, Thorne B. Person-centred therapy today: new frontiers in theory and practice. London: Sage Publications; 2000. 8. James O. Contented dementia. London: Vermilion; 2009. 9. Behers R. Spiritual care for people living with dementia using multisensory interventions – a practical guide for chaplains. London: Jessica Kingsley Publishers; 2018. 10. Swaffer K. What the hell happened to my brain?: living beyond dementia London: Jessica Kingsley Publishers; 2016.
Nuances The more I read about di ff ering approaches to working with people with the diagnosis of dementia, the more I come to appreciate the nuances in approach that still include working with the core conditions but which require a shift in perspective and practice to meet clients where they are. Responses to my survey highlighted for me the complexity of working with the client group, reminding me that if we are to provide meaningful interventions, we need to explore how counselling is experienced by the client, how it is experienced by the counsellor and how each person experiences the other. The research was an invitation to grapple with my own preconceptions about working with clients and to recognise that what counsellors perceive as challenges may di ff er markedly to what the client views as challenging, and that, ultimately, to be person-centred requires inclusion of people with a diagnosis of dementia. I end with a bittersweet memory of being with my father at a wetlands centre. Suddenly drawn to a gathering of children at elevated ponds, the person running the event noticed my father’s non-verbal interest and o ff ered a small fi shing net to him so that he could join the children in fi shing for water creatures. After a while my father netted one before any of the children and, unbeknown to us, there was a small gift for the fi rst person to make a catch. Much to the chagrin of the children and their parents, my father had won; he was blissfully unaware of the responses of others and delighted. It is a salutary reminder that as counsellors we are to follow our client’s lead and be creative, including with the use of playfulness when appropriate, meeting people in their expression and reality to achieve richer and safer practices so that when verbal communication is lost we can ‘continue to value and encourage that person’s right to be here still, and still making an impression’. 4 ■
need for those working with people with dementia to be authentically open in countenance, making it clear that you are pleased to meet that person and are relaxed in that person’s presence, whatever is shared. Genuine warmth is called for, given the fear, isolation, unknowing and confusion that can accompany dementia. Early onset Ethical practice also means being aware of the well-documented abuses that many experience at the hands of others when communications change and as people age. Kate Swa ff er was diagnosed with younger onset dementia at the age of 49, and writing of her experience of care provided in homes she questioned why it is considered appropriate for sta ff without training to work with clients with dementia. 10 ‘Everyone must start including us in this work. It is personal, and not including us simply means we have less chance of ever achieving this goal. If it’s about us without us it’s not even remotely dementia-friendly,’ she said. As a counsellor I am called to consider my competence and what that means in terms of training requirements. Alongside this I recognise the need for inclusion of people with a diagnosis of dementia in all relevant funded research. As counsellors working to the Ethical Framework , it may be that di ff erent ways of working are required to work with people with a diagnosis while still adhering to ethical practice. Examples of changed practice may include fi nding new methods, words and images for consent; checking each time a client is seen that they do want to attend, and readily allowing people to leave if they do not; continuing to respect con fi dentiality although third parties may be more involved in day-to-day care; and noticing changes in clients in all their varied forms. Working with changing cognitions requires re fl ection on the communication shared, a moment by moment noticing of the sounds and expressions shared by the client.
About the author Francine Beadsworth MBACP works in private practice in London and Broadstairs with adults and children/young people, and also for a charity in Kent.
MAY 2024 51
THERAPY TODAY
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