1. Helping Families through The Emotional Journey Alzheimer Society of Manitoba Conference March 6, 2007 Peter S. Silin, MSW, RSW Diamond Geriatrics, Inc. ©www.DiamondGeriatrics.com

2. The Meaning of Adjustment  More easily said than done  Patronizing and discounting  Internal process vs. external appearance

3. Levels/Stages of Adjustment  I. Crisis  II. Adjustment is habitualization  III. Acceptance  Acknowledging  Lingering sadness  Lack of meaning purpose or passion  IV. Embracing is choice

4. Adjustment as Practical Process Four L’s  Landing—orientation. Crisis  Labeling—getting bearings  Learning—learning patterns and culture  Living—confidence in how things work  Families learning to be “ The Family Member”

5. Crisis Theory  A period of disequilibrium and decreased functioning brought on by event or situation which cannot be dealt with by normal coping methods. (Roberts, A. Crisis Intervention Handbook 2000)  Fear, anxiety, anger, confusion, inadequacy, guilt, and grief are common. From the sheer intensity of the emotions, the person becomes unable to deal rationally with the situation. Usual thought processes are disrupted by feelings, and "thinking about the problem" is not only difficult, but also frustrating and unproductive. (211bigbend.org)  Helplessness, confusion, anxiety, shock and anger ( Golan, N. Treatment in Crisis Situations 1978 )  Difficult to process information, difficult to make decisions

6. The Emotional Range of Adjustment  Grief  Guilt  Shame  Fear  Anxiety  Lonely  Helpless  Anger

7. Admission and Adjustment as Crisis  Shock  Emotional systems take over  Decreased information processing ability  Decreased problem solving ability  Tells us about timing and type of help  Be aware of/help with range of emotions

8. Emotions

9. About Guilt and Shame  Guilt is about what we have done  Normal part of being human  Lack of guidelines on behaviour  Conflicting need, desires, influence

10. About Guilt and Shame  Shame is about who we are  Attachment theory ( Bowlby,John 1988 )  Core issues of Self  Differentiation and Boundaries  Guilt activates shame  Shame is more difficult to deal with

11. Grief and Loss  Loss is event  Grief is emotional experience or process  Unique Types of grief and loss  Recurrent/Ongoing  Ambiguous  Anticipatory

12. Kubler Ross “On Death and Dying,” 1969 Bowlby “Loss, Sadness, and Depression,” 1980 DenialAngerBargainingDepressionAcceptanceNumbnessDisequilibrium--DisorganizationReorganization Grief

13. Bowlby: Grief  Bowlby: Four Stages:  Numbness,  Disequilibrium: yearning, searching, hanging on  Disorganization/Despair: recognize loss, hopeless, withdrawal  Reorganization: grief recedes, new patterns established

14. Emotions and Process  Grief and Loss can play out as:  Guilt  Burnout  Resentment  Anger  Guilt and Anger  Active doing of grieving  Can inhibit grieving  Kicks to shame

15. Dealing with Transitions: Us  Self awareness  Our own issues  Dealing with loss  Projection  When we can’t help

16. Dealing with Transitions  Do they want help: Permission  How do they want it  The meaning of help  Are they ready for help  Help must fit the receiver

17. Dealing with Transitions: Resistance  Reinforcing resistance  Secondary gain  Loss resulting from release  Protection from primary emotions  Role loss  Resentment

18. Dealing with Transitions Stage 1: Emotional  Supportive counselling  Listen  Identify  Empathy  relationship  Follow-up

19. Dealing with Transitions: Stage 1: Cognitive Responses  Information  How someone is  What happened  Education—simple to more complex  About care,  Systems  About decline, dementia  Grief and other emotions

20. Dealing with Transitions: Fear and Anxiety  Identify  Understand  Educate and explain  Reframe  Normalize

21. Dealing with Transitions: Stage 2: Cognitive and Supportive  Therapeutic: Guilt and Grief  What is underneath the feeling  What does it remind you of/ bring up  Skill based  Solution focused: Guilt and grief  Miracle Question  Doing guilt  What would you rather be doing

22. Dealing with Transitions  Cognitive Behavioural Approaches: Guilt and Grief  Diaries/Journals  Two chairs/Voices  Alternatives to the end  Writing letters  Rituals  Visualizing: scales  What would you have done differently and where would that take you?  Tell me why you should feel guilty

23. Transitions: Changing Thoughts FeelingThought What is untrue about thought/ Why is it untrue New thought Supporting Evidence Guilty I should be able to handle this I have done it a long time I am sick I have many responsibilities I am doing it by myself It is OK to set limits and say no My journal I have done a lot already I still love my father I won’t fall over if I do. David Burns : The Feeling Good Handbook, 1999 Christine Padesky, Dennis Greenberger: Mind Over Mood: Change How You Feel by Changing the Way You Think, 1995

24. Dealing with Transitions Guilt and Grief  Bibliographic  Internet—info and chat rooms  Systemic approaches :  Buddies and peer systems  Support Groups  External  Self help Groups  Therapists  God

25. Stage 3: Forgiveness*  Forgiveness  Cheap forgiveness  Acceptance  Genuine forgiveness  Forgiveness of self  Forgiveness of other Janice Abrahms Spring, PhD. “ How Can I Forgive You? The Courage to Forgive, the Freedom Not To” Harper, 2005Janice Abrahms Spring, PhD. “ How Can I Forgive You? The Courage to Forgive, the Freedom Not To” Harper, 2005