Archive of ‘Empathy’ category

Dementia: An Introduction

Have you been, or has your loved one been, diagnosed with dementia? Do you dread the journey that lies ahead? Here are a few facts and resources to help you face this difficult challenge.

Do not be afraid

Almost all of us who are over 50 fear that we will get dementia someday. But not many of us will actually get it. Among people who are over 65 years old, fewer than one out of 12 people (less than 8%) have dementia. Many centenarians (people over 100 years old) do not have dementia (source: The Merck Manual of Health and Aging, p. 307).  Dementia is very different from normal aging. 

What does normal aging look like? Each year, starting at age 25, our brains lose 1% of their processing speed. By age 50, we notice this, with chagrin. We also do not retrieve remembered information as quickly. Imagine how many names you learned before you were 20. Now imagine how many names you learned by age 50. When we are over 50, our “file cabinet” of names has a lot more items in it. No wonder it takes a little while to sift through that large volume of information to find the correct name when we see a familiar face, or hear a familiar voice. These are among the challenges of normal aging.

But remember that normal aging also has many advantages. At age 56, I value highly my life experiences. I would not trade in that hard-earned wisdom for the speed and agility that my brain had when it was young. As a grad student in my 50s, I was fascinated by classes about human behavior. Each concept that my professors presented was something that I could mentally illustrate with my observations of people whom I have known. 

Recall from history and literature that most cultures around the world, in most periods of history, have revered elderly persons as sources of wisdom and keepers of highly-valued traditions. Our culture might be in a minority in that it tends to glorify youth, and dismiss old age.

Get the facts

If you think that you or a loved one is experiencing some memory loss—not just normal aging—I encourage you to get the facts. As in many areas of life, even unpleasant facts are better than out-of-control fears. A good person to ask is your family doctor. He or she, or a member of the clinical staff, is likely to administer a standardized assessment at some point. There are several questionnaires for assessing memory loss that are well-researched, reliable (consistent) and valid (meaningful). These mental-status questionnaires take into account the person’s age and educational level, both of which can affect his or her scores. The questionnaires look not only at short-term memory, but also at the person’s ability to complete several different mental tasks. 

If you or your loved one scores below average for their age and educational level, that does not necessarily indicate dementia. There are several medical conditions that can mimic memory loss—but unlike memory loss, they are entirely reversible. During grad school, I interned in a medical clinic that primarily served older adults. Among my happiest moments were the times that I administered a mental-status questionnaire and found a normal result in a person whose result had previously been below average. These persons’ mental status returned to normal once they were treated for ordinary medical conditions such as urinary tract infection, vitamin B-12 deficiency, or depression. 

Safety first

If your doctor determines, after carefully eliminating all other possibilities, that you or your loved one has dementia, what comes next? Safety! You and your loved one need to think about safety, focusing on 5 areas of possible risk, namely:

  1. Driving. Is it still safe for your loved one to drive? If not, ask your doctor for help in having this difficult conversation with your loved one. What alternatives are available in your community (e.g. special public transportation services for handicapped persons, rural transportation that is sometimes covered by Medicaid, ridesharing services such as Lyft or Uber, and organizations of volunteers who serve elderly persons)? 
  2. Cooking. Sometimes persons with dementia forget to turn off burners on the stove, thereby causing fires. If needed, how can you protect against this?
  3. Medications. Sometimes persons with dementia skip doses or double-up doses of their medicines. Depending on the medicine, this can be dangerous. A first step in medication safety is to buy a pill container with a compartment for each day of the week and each time of day. Fill this pill container for your loved one each week, and check that the medicines have been consumed. Later, if the dementia progresses, you may need to hand medicines to your loved one, and watch him or her take them.
  4. Wandering. Sometimes persons with dementia get lost when they go out on walks. Even frail persons can walk surprisingly far. They may be searching with great determination for a place that they cannot find. Sometimes a person with dementia is searching for a place that no longer exists, such as a childhood home. Caring neighbors can be made aware of your loved one’s tendency to wander, so that they can gently redirect your loved one back home.
  5. Bills and taxes. Persons with dementia can inadvertently cause major financial problems by failing to pay bills or taxes, or by spending imprudently. If your loved one has been diagnosed with dementia, consider helping them find a financial services firm that can regularly pay their bills and taxes. Alternatively, try to persuade your loved one to sign a power of attorney that allows a responsible person to handle their finances for them when the need arises. 

A brain disease

Sometimes well-intentioned family members urge a loved one with dementia to try harder to remember information, or to practice skills. Unfortunately, the person with dementia cannot reduce the symptoms by trying harder. Urging them to try harder is based on a misunderstanding of the nature of dementia. Our common experience is the raising of children, who constantly learn new information and gain new skills. It is very hard for us to accept that in a person with dementia, the process goes in reverse—no matter how hard they try, and no matter how hard we try. 

Remind yourself frequently that dementia is a brain disease characterized by biological changes in the brain. Throughout the course of dementia, brain tissue is actually lost. The brain of a healthy, adult human weighs about 3 pounds. The brain of a person with end-stage dementia weighs only 1 pound. Recalling this fact can help a caregiver to be compassionate, patient, and understanding with their loved one who has dementia. Assume that at each stage of the disease, they are doing the best they can with the reduced amount of brain tissue that is left. 

An umbrella term

Dementia is an umbrella term that includes over 100 separate illnesses. Alzheimer’s is the most common form, accounting for over 60% of cases. The second most common form is Lewy Body Dementia, which has a distinctive pattern of symptoms. The third most common form is Vascular Dementia, which can result from strokes—either a major stroke, or a series of minor ones. 

Some helpful books

Here are my favorite books about dementia, with a brief description of each. 

The 36-hour day:  A family guide to caring for people who have Alzheimer Disease, related dementias, and memory loss, by N. L. Mace & P. V. Rabins. This is the classic, comprehensive guide to caring for a loved one with dementia. It can be used as a reference book: check the index for the topic you need, and read a few pages about it. 

Dementia caregiver guide: Teepa Snow’s Positive Approach to Care techniques for caregiving, Alzheimer’s, and other forms of dementia, by T. Snow. This book describes simply and briefly what life is like for a person who has dementia, at each stage of the disease; and gives practical instructions on how you as a caregiver can help the person. 

Alzheimer’s: A Broken Brain, by Dementia Education and Training Program, Tuscaloosa, Alabama. Available from the University of Alabama. Trigger warning: Do not look at this booklet if medical images bother you. This short booklet demonstrates in an unforgettable way that dementia is a brain disease. The booklet states 10 key facts about dementia, one sentence each. Each fact is illustrated with photos of 2 autopsied brains: the brain of someone who died from dementia, contrasted with the brain of someone who died of another cause. The difference between the brain images is dramatic. 

The whisper of the fallen oak: A family’s guide to early, middle, late, and end-stage dementia, by R. Wallace. Available from Wings of Change Publications. This booklet is a short, simple guide to the stages of dementia, and how to care for the person at each stage. 

Caregivers find meaning and purpose

Although caring for a person with dementia can be difficult and exhausting, it can also be extremely fulfilling. In 2016, researchers Cheng, Mak, Lau, Ng and Lam studied 57 caregivers of Alzheimer’s patients. The researchers identified ten positive themes that the caregivers reported, including “a sense of purpose and commitment to the caregiving role… increased patience and tolerance… cultivating positive meanings and humor… developing a closer relationship with the care recipient… and… feeling useful helping other caregivers.”

Key takeaway

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do.

The most important thing to remember about your loved one who has dementia is that he or she has the same value, dignity, and worth as you and I do. His or her value as a person is intrinsic, and does not depend on cognitive ability. In order to relate to your loved one, you may need to learn new skills. These skills are worth learning, because the person is worth relating to. If you make the effort to relate to a person with dementia, you will be rewarded in unexpected ways. 

[I wish to thank Laura A. Ellis, LMSW, James W. Ellor, Ph.D., D.Min., LCSW, Dennis R. Myers, Ph.D., LCSW, and Teepa Snow, MS, OTR/L, FAOTA, for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University. She is a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; an associate member of the Aging Life Care Association; and an associate member of the EMDR International Association (EMDRIA).


The Myers-Briggs Type Indicator: A Tool for Understanding Yourself and Others

Would you like a tool to help you understand yourself and others? I highly recommend the Myers-Briggs Type Indicator (MBTI). There are many personality assessments. Some are large and cumbersome, while others are oversimplified. The Myers-Briggs seems to hit a sweet spot. As psychologist Dr. Richard Grant puts it, the Myers-Briggs is “simple, memorable, portable, and applicable.” 

Introduction


Based on theories by Swiss psychiatrist Carl Jung (1875-1961), the Myers-Briggs Type Indicator was developed by two American women, Katharine Briggs (1875-1968) and her daughter Isabel Briggs Myers (1897-1980). Although some academics dismissed their work because they did not have PhD’s, the two women persevered in their research. They were followed by Isabel’s son Peter B. Myers and many other researchers who continued their work. The Myers-Briggs Type Indicator now has over 70 years of solid research behind it. It has been shown to be reliable (consistent) and valid (meaningful). It has been translated into many languages, and is used throughout the world. 

The Myers-Briggs is a way to appreciate an invisible form of human diversity: our personalities. The Myers-Briggs sorts humankind into 16 distinct personality types. People of the same personality type have striking similarities in outlook, even if they come from opposite sides of the world. Indeed, at some international conferences on the Myers-Briggs, participants are grouped with others of their personality type. Participants find it invigorating to meet others of their own personality type, from various nationalities and cultures. 

The Myers-Briggs is 100% positive and favorable. All 16 personality types are good. In fact, all of the types benefit from one other. They are complementary. We are able to give feedback for each other’s blind spots. A classic book by Isabel Briggs Myers and Peter B. Myers is entitled “Gifts Differing,” from the Biblical verse “Having then gifts differing according to the grace that is given to us…” (Romans 12:6, KJV). One of the main things that we have learned from the COVID pandemic is that we need other human beings more than we previously realized. The Myers-Briggs gives us a way to look at our need for each other.

If we compare human beings to computers, we all have a dazzling array of “applications”—all the skills that we have learned. But under the surface, we appear to have 16 different “operating systems”—our innate way of viewing the world. If you can identify your “operating system,” and the “operating systems” of your loved ones, you have a powerful tool for understanding each other. 

You are unique. There has never been anyone like you in the history of the world, nor will there ever be. But you have some characteristics that you share with some other human beings: for instance, your nationality, your gender, and your age. And you have some characteristics that you share with every other human being: for instance, you have a brain and a heart. Your Myers-Briggs personality type is in that middle category: you share your personality type with some other human beings, but not with all. Your Myers-Briggs personality type doesn’t label or stereotype you. It is simply a useful tool. There is infinite diversity within each of the 16 types. 

The Myers-Briggs Preferences

The Myers-Briggs Type Indicator sorts people’s preferences according to four two-ended dimensions: 

  1. Extraversion (E) or Introversion (I);
  2. Sensing (S) or Intuition (N—since the letter “I” has already been used);
  3. Thinking (T) or Feeling (F); and
  4. Judging (J) or Perceiving (P).

Developmentally, we become conscious through our preferences within each of these pairs. Determining your preference in each of the four pairs determines your personality type, which is designated by four letters. For example, I am an ISFJ, meaning that I prefer Introversion, Sensing, Feeling, and Judging. As you can see, the two choices for each of the four pairs yields 2 x 2 x 2 x 2 = 16 types. 

Myths and Facts

Myth: My Myers-Briggs type has changed as I have matured.

Fact: Jung’s theory is that we are born with a “true type” that remains the same all our lives, even as we learn and grow. Your “true type” is worth learning, because it’s a fundamental part of who you are. 

Myth: The Myers-Briggs is unreliable, because I got a different result on two different occasions that I took it. 

Fact: No psychological assessment tool is perfect. Human beings are dazzlingly complex. Psychology is not an exact science like physics or math. The result that you get from the questionnaire, your “measured type,” may not be the same as your “true type.” Once you know your “measured type,” I recommend that you meet with a “Certified Practitioner of the MBTI” to determine your “true type.” Sometimes one letter, or even 2 letters, need to be adjusted. In my MBTI Certification class, there were 15 students. The instructor met with each of us individually to determine our “true type.” For 12 of us, our “true type” matched our “measured type.” For 2 students, one letter needed to be adjusted. For one student, 2 letters needed to be adjusted. For each of the 15 students, learning one’s “true type” was a wonderful “Aha!” moment, a moment of feeling understood, appreciated, and affirmed. 

Myth: I can’t be classified, because I am equally good at both choices, in some or all of the pairs.

Fact: You may have developed strong skills on both sides of a pair. However, one side of the pair is more natural for you, and the other is more of a learned skill. When answering the questionnaire, if you are in doubt about how to answer a question, ask yourself which felt more natural to you as you were growing up—and which you may have learned later, because you needed to. An analogy is that one of my friends was born left-handed in the 1930’s. According to the custom of the time, she was taught to write with her right hand. However, all her life, for all skills other than writing, her left hand was more adept. The goal of the Myers-Briggs is to identify your natural, innate preferences.

Myth: My score on Extraversion is only slightly higher than my score on Introversion. That means that I’m only slightly Extraverted.

Fact: The Myers-Briggs is simply a sorting procedure. It does not indicate the degree or extent to which you have a characteristic. It sorts people as having a preference for Extraversion, or for Introversion, one or the other, not “how much.” The scores indicate how confident we are about the accuracy of the sorting procedure. If you score high on Extraversion, we can be fairly sure that you have a preference for Extraversion. If you score only slightly higher for Extraversion than for Introversion, we can’t be too sure about that preference. In that case, you especially need a “Certified Practitioner of the MBTI” to help you discover your “true type.” 

Myth: Introverts are shy and don’t like being with people.

Fact: Introverts can be very friendly and outgoing. Introversion and Extraversion have nothing to do with whether you enjoy being with people. They have to do with how you “recharge your batteries.” When you are tired or stressed, does it re-energize you to be with other people? Or do you need some time by yourself to regain your energy? This is an example of how the words in the Myers-Briggs are used a little differently from the way they are used in everyday speech. Try to drop your preconceptions about the words, and learn their Myers-Briggs meaning. 

Myth: Judging types are judgmental.

Fact: Having a Judging preference does not mean that you are judgmental; nor does having a Perceiving preference mean that you are perceptive. Here is another place where Myers-Briggs terms are different from the related, everyday words. Remember that everything in the Myers-Briggs is positive. The word “judging” is used in a positive way, as when you say that a person “has good judgment.” People with a Judging preference like to make decisions, make plans, and have things settled. People with a Perceiving preference like to be spontaneous, keep their options open, and respond fluidly to new situations. 

Myth: Thinking types can’t feel, and Feeling types can’t think.

Fact: All humans think, and all humans feel. In the Myers-Briggs, having a Thinking preference means that you like to make decisions based on objective, logical analysis. Having a Feeling preference means that you like to make decisions based on people, values, and harmony. Both ways of making decisions are valuable.

How to Proceed

The most accurate way to find your personality type is to take the actual Myers-Briggs Type Indicator questionnaire, and then to fine-tune the result in collaboration with a “Certified Practitioner of the MBTI.” The real MBTI is available online at themyersbriggs.com, or in a self-scorable, printed version. The real MBTI (online or printed) can be completed in about half an hour. You can consult with a Certified Practitioner of the MBTI either online or in person. However, be cautious if you explore the Internet about the MBTI. As with many other topics, there is a lot of inaccurate information available.

Your goal, in collaboration with your Certified Practitioner, is to find your “true type.” Your practitioner can give you some written descriptions of your “measured type.” Please consider them as if you were trying on a pair of shoes. Let your practitioner know whether they fit or not. If they don’t fit, tell your practitioner where they rub. That will indicate what shoes to try on next. A good way to decide whether the descriptions fit is to highlight the phrases that fit you; put an X beside the phrases that are very different from you; and leave unmarked the phrases that are neutral. If there are a lot of X’s, you probably will want to try on another pair of “shoes.”

Once you know your “true type,” you and your practitioner can look at how your personality type interacts with those of the people close to you. This is a way of appreciating your unique gifts, and the gifts of those around you. I think that you will find this exploration helpful and affirming of you and your loved ones. 

[I wish to thank Richard D. Grant, Jr., Ph.D., and Gerald P. Macdaid for teaching me the above material.] 

Written by: Catherine C. Stansbury, LMSW, supervised by Melissa L. Gould, LCSW-S. Catherine is a therapist here at Austin Family Counseling. She is an EMDR Trained Therapist specializing in trauma therapy for adults. She has a Master of Social Work from Baylor University. She is a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; an associate member of the Aging Life Care Association; and an associate member of the EMDR International Association (EMDRIA).




How To Tell Your Child You Love Them

Love is such a special feeling we experience with others, especially with a parent towards their child. There are many ways to show your child you love them without just saying it. Each child receives love differently, depending on what they are most comfortable with. Test these out and see what works the best for your kiddo, and, of course, feel the love!

1. Spend One-on-One Time Together

It’s so valuable to spend one-on-one time with each of your children, even if it’s 30 minutes every week. Pick the same day and time each week if possible so it’s a “date” your child looks forward to every week. Allow your child to pick the activity they enjoy. Devote all your focus on them and the activity they chose. This time should just be you and your child, nothing else. 

2. Listen and Reflect Feelings

Your child shares aspects that are important to them with you. Make sure they feel acknowledged and prioritized when they share those aspects. Put down your phone when they are talking and make eye contact while appearing interested. Reflect any feelings you are noticing in them or in yourself. Reflecting allows for you to understand your child and for your child to feel understood and connected by you.

3. Hug Them

Physical touch is a critical part in fostering a loving and trusting relationship with your child. Hug them, cuddle with them, high-five them, hold their hand, sit or lay with them on the couch. Be near them and show them you are physically there for them.

4. Create a Routine Together

Having your child assist in building their routine allows for esteem building and creates trust together. It also allows having a set schedule to provide safety and consistency for your child’s life, especially during the school semester when tasks feel more hectic. 

5. Share Strengths

When you notice a strength in your child, tell them. Tell them everyday. You are showing your belief in them, which allows for them to grow into that and believe in themselves as well.

6. Family Meetings

Having a family meeting to discuss topics that effect everyone, should include everyone’s voice. Allow your child to brainstorm on where to go for dinner or what changes need to be made at home to assist the family in working together. This acknowledges you care about their voice and value their opinion. This assists with feelings of belonging and security.

7. Be Patient

Having kids can be extremely challenging and stressful. Some days you just want to scream and run away. Breathe. Take care of yourself and figure out what helps you feel calm and regulated. You are the example at the house to show how to handle big feelings. 

8. Laugh Out Loud

Laughter can feel like the best medicine. Be silly with your child and allow for good times to roll together. Laughing can bring you both even closer towards one another.

9. Acknowledge When You’re Wrong

We are certain to make mistakes, we are only human. How we are able to recover and how we handle our mistakes is what makes the difference rather than the act itself. Do not be afraid to admit you were wrong to your child. This shows them that it is okay to admit when you have done something you should not have or misspoken.

10. Surprise them

Establishing that routine is crucial to consistent growth but an unexpected surprise shows your child you’re thinking of them, even when they aren’t around. This can be as small as bringing their favorite snack when being picked up from school, putting a sweet note in their lunchbox, or bringing home something from the store that reminded you of them.

Written by: Sumayah Downey, MA, LPC-Associate, NCC Supervised by Cristy Ragland, LPC-S, LMFT-S, RPT-S


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