In this video from the 2015 Intern Orientation and Training at AgeSong, Nader talks with the GeroWellness interns about interns connecting with the AgeSong staff. The interns have been given introductions to the different staff at AgeSong Communities to help begin the familiarization with the staff they will be working with on a regular basis.
Tips for Interns Connecting with the AgeSong Staff
During this orientation and training we have purposefully brought up the different members of staff because we would like you to see a visible manifestation of the multi-disciplinary approach used within the AgeSong Communities. To integrate into the communities you need to be able to relate to the myriad of different staff at AgeSong.
One of the first things that can help interns connecting with the AgeSong staff is what you do you when get onto a floor within the AgeSong Community. Most important to check in with the CarePartners on each floor. Find out what has been going on. They know what is currently happening in the community and what has happened recently and what will be coming up.
If you have not been introduced to the CarePartners on the floor, then please introduce yourself. We want to cross any barrier of perceived rank that might occur between interns and carepartners so we ask that our interns make the first move to engage. Please do not wait for the carepartners to engage with you, be proactive and engage them.
Dr Nader Shabahangi, CEO of AgeSong talks to the incoming Pacific Institute GeroWellness interns about the CarePartnering program employed in the AgeSong communities. He discusses with the interns the difference between carepartnering they will see at AgeSong and caregiving found in more traditional models. Nader also discusses why AgeSong uses the more empowering carepartner system.
An Introduction to CarePartners at AgeSong
What does it mean to become more “psychological”? To develop a more psychological attitude?
Awareness of others and their emotions? To have that you need to be interested in the other’s awareness, and emotions, and behavior. You need to be able to have answer the question behind the others emotion and behavior, you need to know they “why?” Why is the big one. You’re talking about meaning, what happened? What is behind it?
At AgeSong t is not only about giving care but it also about partnership. We want to give the Elder the feeling that they themselves have something to offer and that they are partnering with us in their care.
Nader gives an example of the difference between caregiving and carepartnering. “One is I’m relating. I’m asking for permission. I’m asking “where is she?” Where is she in her world? Does she feel like she wants to take a walk? Does she want to get up? Leave me alone, I had a bad dream. Who knows? But, I am actually relating with her first. And I’m asking what kind of help does she need, if any? So I am partnering in the care, rather than assuming, “Ok, let’s go. And this, “Come On Let’s Go,” is what we call custodial care.
Custodial care, custody, control, means I know what is good for you. Which is basically, in many ways, kind of a mainstream care operation, eldercare operation, hospital operation. The nurse knows best. Right? We know what’s good for you. And certainly when you are in an ICU you want a doctor to tell you what’s best for you. You cant think very much about whether you want this or that medication or surgery or not. So custodial care works very well in an emergency situation. But that has been exported to everywhere. So now in a care environment that is supposedly based on psycho-social care we are also now using custodial care. And we want to change that. To create more of a respectful interaction.
Creating a more respectful interaction is something that you can help us teach our CarePartners. Because you as a therapist are all about relationships. That is your bread and butter, relationships. Relationship with a client to him or her self, relationship to others. Ninety-nine percent of the world’s problems are about relationships, all relationships.
In the system of relational care there are no problems, there are challenges. So really what’s the problem? We are the problem, we are being challenged all the time by certain behaviors. When needs are not met then what happens over time, or maybe quickly? Something happens. All behaviors, in some way or another, any kind of expression that we call aggression and that’s also a difficult word. Because what is aggression to you might not be aggression to another. So we are saying all the issues that we are facing, behaviorally speaking, and that’s really what were dealing with as counselors, are really about unmet needs. ‘
Unmet needs again bring us back to the question of “why?” Why is this person behaving in the way that they are behaving? And we have a dominant model that is saying: because there’s a chemical imbalance or we need to do a behavior mod. Our model would say no, there is a need that I am not understanding. If I understood them better I could meet their need. That is the foundation of what we want to do here.
The bias in existential work is that if I can understand your world. My goal as an existential therapist is to understand your world. It is not to fool with it, change it, make it different, I want to understand your world.
In my trying to understand your world you become more self aware of what that world actually is. Because most of us don’t really take time to understand who we are. When was the last time you sat down to understand who you are? Often it only happens actually when you are sitting with someone else, right? In the mirror of the other. You need the other its actually almost impossible to sit down yourself and figure out who you are because you are stuck in your own mindset. You’ve got your own thinking. You need the other who says hey wait a minute what are you thinking? You need conflict for crying out loud. Without conflict you do not ever grow. And you need to suffer. There’s a word I almost forgot. The foundation of consciousness is suffering. therapy or work is a little bit about being in discomfort because if you are not then why change?
In the video, An Introduction with Blanca Reyes, AgeSong CarePartner, we meet Blanca one of the CarePartners who specializes in Forgetfulness Care at the AgeSong Laguna Grove Community.
An Introduction with Blanca Reyes, AgeSong CareParnter
Blanca welcomes the new 2015 Pacific Institute GeroWellness participants to AgeSong Laguna. Blanca speaks about her Forgetfulness Care work on the second floor of AgeSong Laguna where residents include those with severe forgetfulness (dementia.) Blanca shares some extra care and caution that should be taken when working on the second floor. Some of the elders on the second floor with forgetfulness no longer communicate in the same ways they used to and it is important to understand each of them because each of them is different. Blanca has a special affinity for working with the elders on the second floor and encourages the interns to come to her. She can introduce the interns to the individual elders she works with. Interns are always encouraged to work with the CarePartners in getting to know the elders they will be working with. The CarePartners in each community are those with the most detailed knowledge and understanding of each of the elders residing within an AgeSong community. The CarePartners can work with the interns to show them the ways relational care works with each individual elder and help them get to know the elder, to build a relationship with the elder.
Combing a woman’s hair can mean all the difference in the world to her. Just the thought of being there for someone when she needs attention. She may be asking for something completely different from what she says, because the thought of saying what she really needs to say escapes her mind. It’s also the way you care for a person. She knows if you are just doing it as a routine. When you show that you really care, it makes the world of difference to her.
In assisted living and eldercare in general, it is common to refer to assistants as caregivers. This implies a one-way direction of care: I give care to you. Understood as such, care-giving can easily lead to a one-way, custodial type of care where the caregiver is in control of the care he or she administers. This can also lead to a diminishing of the elder for whom we care: rather than being sensitive to what elders are still able to do for themselves, we override those abilities and do for them rather with them. This points out the difference between a custodial type of care directed by task completion and a relational type of care directed by the deepening and nurturing of the relationship with the elder for whom I care.
By being present to the person whom we encounter, we value relationship. Valuing the relationship means we feel ourselves as partners with the person with whom we relate – not superior or inferior, not better or less good. We meet in our shared humanity. As in an existentially based psychotherapy where therapists understand themselves as partners in the journey towards a deeper understanding of their clients’ lives, so those helping elders in eldercare communities understand themselves as care-partners in the care and services they provide. Only through such an attitude of equality can a genuine relationship be formed and continually nurtured. And only through such an attitude do we human beings ever feel valued, ever feel loved.
Pacific Institute GeroWellness Students Present on “Depathologizing Institutional Care” and
Pacific Institute Gerowellness students recently presented two poster presentations at the Alzheimer’s Association International Conference. One of the presentations was intervention-based and the other on policy and systems:
Depathologizing Institutional Care: An Existential Program of Treating Forgetful Patients
Stephanie Rothman1, Jacob F Engelskirger1, Kyrie S Carpenter1, Kelly Guina1, Nader R Shabahangi, Pacific Institute for Counseling, Education and Research , San Francisco, California, United States
Description: With the rapid increase in Alzheimer’s disease (“forgetfulness”) diagnoses, strong institutional policies are essential in providing a stellar exemplary for wider cultural dissemination. The Pacific Institute augments the forms of treatment available by biomedical research. Currently, forgetfulness is widely viewed from the perspective of pathology, and yet its “victims” often live a decade beyond this terminal diagnosis. In the meantime, people with forgetfulness continue to grow and experience the world artistically, relationally, and spiritually. The inevitability of cognitive decline in forgetfulness, compounded by cultural expectations, renders these residents (patients) disempowered from participating meaningfully in social life. In a hyper-cognitive society, human resources are evaluated on the basis of cognitive ability. From another perspective, however, one’s ability to relate to others would be valued as most essential. The current mainstream cultures of care emphasize caregiving as a method of separating the individual from the greater community and treating or ameliorating an undesirable disability, thereby potentially submitting residents to further distress (i.e. increased hospitalization, risky psychotropic medications, confinement, and restraints). This is a human rights issue. In the context of incredible loss of functional capacity of residents, systems of care typically fail to account for and capitalize upon the residents’ full range of functional strengths. The philosophical perspective of Pacific Institute prioritizes a de-pathologizing evaluation of the losses associated with forgetfulness, thus empowering the forgetful resident to persist in developing strengths through both cognitive and noncognitive forms of experience. In the progression of forgetfulness, affective and creative channels become more prominent, provoking an existential shift the in experience of living. Access and stimulation through these channels of experience should be maximized as the forgetful resident becomes increasingly oriented to modes of psychological processing beyond conscious cognition. Through individually-tailored psychotherapeutic techniques, we engage with forgetful residents via verbal and nonverbal channels of contact, promoting communication, equanimity, and joy among residents, psychotherapists, and care staff. Through these channels of experience and communication, forgetful residents uniquely express needs, as well as strengths. Quality care can be achieved through holistic interventions addressing the needs of forgetful residents as expressed through behavioral symptomatology.
Existential Alzheimer’s Care: An Adjunctive Program of Treatment for Unique Psychological and Behavioral Symptomologies
Jacob Feiner Engelskirger1, Stephanie Rothman1, Kyrie S Carpenter1, Kelly J Guina1, Nader R Shabahangi1, 1Pacific Institute for Counseling, Education and Research , San Francisco, California, United States
Description: Psychotherapeutic behavioral support serves an important function adjunctive to the developing psychopharmacological treatments available from biomedical research efforts to treat and cure Alzheimer’s disease. Through Pacific Institute’s GeroWellness program, psychotherapists-in-training from a variety of practice-oriented graduate programs throughout California work with residents (patients) in moderate-to-severe stages of ‘forgetfulness’ (Alzheimer’s disease) to support the residents’ continued psychosocial development. Forgetful residents often develop new and more deeply-felt approaches to living in the context of dramatic cognitive changes. These shifts in the experiencing of reality deserve unique and validating forms of therapeutic engagement, in addition to support available through standard care and enrichment programing. Underscoring all practices at Pacific Institute facilities is a shift in perspective from forgetfulness as a disease to forgetfulness as a teacher for the resident, psychotherapist, and greater culture. An ongoing shift in awareness to maintain a respectful, reverent non-pathologizing language in our communities facilitates this perspective shift. Utilizing the philosophy of existential psychotherapy, therapists support residents via multi-modal process-oriented therapy in order to take advantage of the many channels of experience and expression persisting in forgetful residents. An increase in meaning making and a reduction in distressing symptoms and suffering results. Our psychotherapists employ a process model via individual and group psychotherapy to understand and support residents as they find meaning amidst the existential crisis accompanying aging and loss of familiar abilities. The process model allows for extrapolation from traditional psychotherapeutic principles for use in this population, including the use of meta-observation (“process” orientation) and symbolic interpretation of behaviors (symptoms and expressions). Importantly, rather than privileging the retention of cognitive abilities—an impossibility—psychotherapists emphasize the integration of multiple perspectives of neurocognitive disorder and its significance in the context of the resident’s life and the lives of the individual’s family members and friends. Psychotropic intervention, common practice in this population, is often the first line of treatment. Minimizing medication through effective behavioral intervention decreases potentially harmful and unintended physical and psychological side-effects. The combination of an existential perspective, non-pathologizing attitude, individualized psychotherapeutic modalities and conscientious medication offer ‘freedom to be’ to those with forgetfulness within a flexible and adaptive model.