Choosing to participate in psychotherapy can be a difficult decision. It's easy to make a list of excuses to put it off -- it costs too much, I don't want to pay someone to listen to me, my problems aren't that big. Besides, what do they know about me that I don't already know? And what will my friends and family think? Adding a diagnosis of dementia does not make these common doubts go away, it may even intensify them. However, therapy CAN be helpful, even to someone who does not remember it.
Psychotherapy creates a container through which understanding can be reached, meaning can be made, and personal development actualized. All of this is also possible for someone with a diagnosis of dementia. Sarah Robinson, in her doctoral dissertation Alzheimer's the Difficult Transition, broke down which types of therapy have proved most effective with different stages of dementia. (For more in-depth information and resources I highly recommend reading her dissertation in it's entirety.) These broad categories can give those diagnosed with dementia, and those caring for them, a starting place to seek support.
(Tip: Psychology Today offers listings of therapists in your area which you can filter by modality. A Google search with your city name and the modality of therapist you are looking for will point you in the right direction as well. Be prepared to call and meet with a few therapists; finding the right fit is worth the hassle in the beginning.)
1. Early Stages: Insight Based Therapies: This includes what most people probably think of when they think of therapy -- talk therapy, group therapy, cognitive behavioral therapy, etc. In the early stages, especially with diagnosing happening earlier and earlier, having the support of a therapist can be very helpful. Often depression and anxiety accompany a diagnosis of dementia. Working with a therapist can help develop coping strategies and skills. Insight based therapy can also provide support as one learns to live with their diagnosis and prepare for the future.
2. Mid Stages: Expression Based Therapies: With expression-based therapy, expression more than insight is valued. Examples include: validation therapy, person centered dementia care, and expressive arts therapy. These therapies provide an outlet of expression for the client and can provide insight for the therapist, which can be helpful in working with caregivers to develop a care plan that takes into account the client's needs -- needs which the client may not be able to express verbally.
Language, which may seem meaningless, taken metaphorically, can offer clues to unmet needs. Observing behaviors can show what precipitates upset behavior, allowing caregivers to change their behavior, or the environment, to better meet the needs of the client. In my experience with this work and I have seen the suffering which can be alleviated, and medicating which can be avoided, by using these therapeutic techniques. This is by no means a cure, but can offer an increased quality of life for those with dementia and those caring for them.
3. Late Stages: Process Based Therapies =- In the late stages of dementia, communication can be very challenging. Process-oriented psychotherapy is one of the few therapeutic modalities equipped to handle this situation. Process work focuses on using multiple channels of stimulation and expression such as visual, auditory, kinesthetic and spiritual. The founders of POP are Arny and Amy Mindell. Although process work is helpful at many stages of life, it is one of the few, if not the only, modalities that works at the very end of life, including late-stage dementia, comas, and the dying process. Within communication, there is the content, or the 'what' of our communication, as well as the process, or the "how," such as body language. Process work offers a way of being with someone experiencing the late stages of dementia in a meaningful and respectful way.
There is no cure to dementia and I do not pretend to offer any. The above are simply tools which can increase the quality of life, and decrease suffering for those living with a dementia diagnosis, and for those who care for them.