I have been focused on working, as a therapist and gerontologist, with older adults and adult children of aging parents for over 12 years now. During this time, many different kinds of people and situations have presented themselves. Many unique situations have emerged as well as many commonalities as people first encounter and then work through the familiar landmarks inherent in the territory of older age.

A topic has recently come up in conversations with colleagues and I’ve been asked to write a little about it. That is the topic of doing talk therapy with people who have Alzheimer’s or other dementias – something which I believe can be a big benefit to many of these individuals.

In my experience, people with early stage Alzheimer’s or even early middle stage have benefited from talk therapy. The first ingredient in successful therapy with this group is, like with most therapy patients but even more so, is trust. I have found that people who may be cognitively challenged have other senses which are heightened, including their intuition and discernment of an inauthentic person, someone disrespectful or rushed.

I have come to believe that as in the case of people whose eyesight may be failing, and their hearing becomes more acute to compensate, so it is with people whose cognitive capacity may be declining. Their other senses become greater in order to compensate. As a general rule, in my experience working with early and middle stage Alzheimer’s patients, their ability to sense the environment, the “vibes” if you will is acute. They know when they are being treated disrespectfully or cruelly, i.e. in a demeaning fashion. Conversely, if you are genuine and caring and kind with them, they are forgiving and oh so grateful to be treated as a valued human being.

So often they are not treated as such. They are spoken over, or spoken around or ignored or infantilized or neglected. I have come in to their homes, invited by family members because the person was depressed. And when we begin to get to know each other, and I talk with them about their current situation and their past and their memories, using photographs or music or other “prompts”, I find their gratitude and increased self-worth palpable. I also find that they make good use of their intact long term memories, working on issues from childhood and young/middle adulthood that have haunted them, even if no longer consciously. Their depression may have simply been sadness.

For example, one woman I saw for two years had been in therapy as a young mother. So she was quite comfortable with the therapeutic setting. In therapy, she worked on some early traumas and experienced healing. The memories no longer elicited reactions of wincing and pain. We were able to diffuse them through recall and loving attention to them without judgment but with understanding and compassion. She had one memory of having to had to hide that she was Jewish when her father took a new job away from their beloved and closeknit NYC neighborhood. She was afraid that if she said anything that revealed her Jewishness he would lose his job which was undoubtedly true. That was a lot of pressure on a young girl! She also remembered, after we had worked together for a while, the shame of bed-wetting into teen years and how she had been demeaned and belittled by her mother about that.

This woman experienced healing through loving attention as she explored some painful memories. In her short term memory, as it declined, she did not remember everything we talked about from week to week. Her adult children joked that they should tell her she went to therapy and not really take her, she wouldn’t know the difference they said. But I knew that what she was experiencing in therapy was contributing to very real increased peace of mind for her, whether she recalled it consciously or not. I felt that subconsciously some pain, shame and sorrow eased.

I won’t take time here to go and find research studies to back up my in-the-field experiences. You can do that by searching for “talk therapy and dementia”.

I do believe, however, in the benefits that can be found in doing loving talk therapy with skilled, trained and experienced competent therapists. Please do not count dementia patients out for respectful treatment and gentle exploration of life review memories. This is what Eric and Joan Ericson said is our developmental task in older age: integrity vs despair. Integrity means to become whole, to look at the integral parts of our lives, using all of our senses. This can be done with Alzheimer’s patients. And they can be helped to expand their integrity and thus decrease their despair. And perhaps take less medications for depression! I have seen this with several of my older adult patients over the years. In fact, they are some of my favorite people and I consider them my teachers.

As a Family Therapist and Gerontologist, I often get asked this question by people who are coming to me for the first time.  As we begin to talk and find out what is going on for them now, an education process begins. The various pieces of the puzzle that make up a good quality of life are laid out, so to speak, on the table. We begin to examine each one in regards to them and to prioritize places where changes need to be made.

Doing this helps reduce overwhelm which occurs when people feel a whole wave of factors is coming at them – they feek like they are in danger of going under. As we begin to pick apart and prioritize the necessary ingredients of emotional health and wellbeing in their lives, we begin also to strategize a timetable and plan.

Lately, since I am asked this question so often, I have taken to drawing diagrams for my clients and their families. I have been asked to create a chart to help explain the process that we use. So, I did that and here it is.

Each category is a huge topic in itself but this chart is a map to give you the general lay of the land.

How to avoid depression during the holidays
by Joanne Williams

A half-sunny Sunday morning along the Mill Valley marsh path: A young woman leaned her bicycle against a tree, stepped up on a nearby bench and let out a loud scream of laughter, waving her arms in the air. Chasing the winter doldrums?

“Exercising in the fresh air is one of the best ways to chase away the holiday blues and all the guilt and ‘shoulds’ that pop up so much at this time of the year,” said Nancy Rhine, a marriage and family therapist and gerontologist.

“It’s easy to feel manipulated and overwhelmed during the holidays, when you’re pummeled by advertising and expectations that everyone else belongs to an idealized Norman Rockwell family,” said Rhine, who advises people to pause and get perspective on what’s really important to them during these sometimes superficially cheerful days and nights.

“There have always been human fears in this darkest time of the year,” Rhine said. “In ancient times people held spiritual celebrations, lit bonfires on hilltops, and danced to alter their mood and to remind them that the sun would return. Nowadays there is the most focus on the mundane, with a tendency to slip into overspending and overdrinking, and then depression.”

It’s no wonder we develop myths like Santa Claus. Some decorate a tree with twinkly lights, and others celebrate Hanukkah, also a festival of lights. When I asked around to find out solutions to the depression many experience at this time of year, I heard many ideas.

“I used to get depressed every December first,” said Mary C., a grandmother of nine. “There were so many expectations and no resources. Today I don’t shop,” she said. “I don’t believe in it.”

“I go to San Francisco to the theater, spend the night in the city and have breakfast with a friend,” a single man said. “And I stay away from parties where people drink too much.”

“I don’t read the news,” said another. “I watch sitcoms.”

“I put on lively music and go to funny movies,” Rhine says of herself. “Do what makes you feel good. Listen to upbeat music, watch comedies or other favorite movies, nurture yourself. Volunteer—helping others helps you as well as others. Give a gift of time. Teenagers who drive could offer to take seniors on a drive to see Christmas lights, or just visit them to bring cheer.”

“Also, remember that asking for and accepting help, if you need it, makes the giver feel good too—it’s a two-way street.” Exercise is a terrific way to chase the blues, “especially outdoors, in nature, and in sunshine if we have any,” Rhine has found. “I never understood bird-watching, but as I’ve gotten older, now I love it—science has shown that that activity lowers blood pressure and it just cheers you up!”

And if you get sick, which seems to happen when you need your energy most, rest and “let go” of demands—shift and adjust. There’s no shame in taking time for yourself—having to just “be” for a while and not “do” doesn’t negate your value as a human being.

“Meditation or prayer can help, too—it can give people a sense of purpose,” Rhine advises. “Talk to a pastor, a rabbi, a priest or a friend. One of the things we often learn as we grow older, after we’ve crashed and burned for over-doing for a few decades, is learning the value of pacing ourselves. And, listen to your ‘loving inner mother;’ sometimes the best answers come from within.”

Ask Joanne how she overcomes the holiday blues at letters@pacificsun.com.

RESOURCES AND VOLUNTEER OPPORTUNITIES

Whistlestop930 Tamalpais Ave., San Rafael.
415/454-0964. www.whistlestop.org.

Marin Community Food Bank75 Digital Dr., Novato.
415/883-1302. www.sfmfoodbank.org.

Salvation Army Services Center351 Mission Ave., San Rafael.
415/459-4520.  www.salvationarmyusa.org.

Ritter Center16 Ritter St., San Rafael.
415/457-8182.  www.rittercenter.org.

Homeward Bound of Marin830 B St., San Rafael.
415/459-5843.  www.hbofm.org.

St. Vincent de Paul820 B St., San Rafael.
415/454-3303. www.vinnies.org.

There’s something we all can understand about how hard it is to be on the receiving end of “tough love”. Everybody acknowledges that. But much less talked about in our society and in psychology circles is how hard it is for people who don’t like conflict to have to hang strong and administer the tough love. It can be excruciating for them. Let’s remember both sides of these relationships.

An exciting movement happening amongst our friends in the north country. More creative ideas will be coming forth about how we are going to live as we grow old, I predict. We boomers are just now beginning to face the what-are-we-going-to-do -when-we-get-old awareness. Radical rest homes although, as the article says, may be an oxymoron trenbolone enantato, is a Canadian movement that will be spreading here in America. People getting together in various intentional communities, urban and rural, smaller and larger, multigenerational and just seniors, to share resources, care and hopefully find a more affordable alternative to older style retirement homes which are ok but leave a lot to be desired. Can we improve on them? It will be up to us boomers to start pushing alternative scenarios forward.

Read the full article from CBC here:

Radical rest homes: Old people should live everywhere

Hearing loss presents often times like dementia: confusion, isolation, depression, defensiveness. – because the person can’t hear! It’s scary and frustrating to not be able to hear well or at all anymore and to feel left out. But too many times, people with hearing loss are quickly given a cursory diagnosis of dementia. Now *that’s* really scary! There is something logically called “Rule Out’s” in medicine and mental health. So, in this case, it is critical to rule out hearing loss before making a dementia diagnosis.

Here’s an excellent article with further thoughts on this very topic:

Dementia or just new batteries needed?