Archive of ‘General’ 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).


Creating Your Yellow Brick Road

What does it mean to feel at home?

There is a debate as to whether home is a physical place or a feeling. Dorothy captures this desire to fill the void of feeling distant, whether it be mentally or physically, when she recites, “There’s no place like home” (Fleming, 1939, 1:39:01). Home is the feeling of warmth, understanding, and inner peace. How do we capture the essence of home
when we are far from it? Whether it be a vacation, work trip or a new residence, feeling at home is essential.

What is a part of your home?

Think to yourself, aside from the physical structure, what else is a part of your home? Loved ones, beloved pets, specific scents, articles of clothing, and certain foods cultivate feelings of familiarity. When moving to a different city, visiting a foreign country or when physically distant from the ones I love, I turn to my phone. It houses resources, enabling me to bring my support system wherever I go. From calling my parents to ordering my favorite foods to my door, my phone is a portal. I can look at photos of my miniature schnauzer when I miss her cuddles, video chat with my best friends, and make to-do lists to feel a sense of structure over my time.

Finding peace.

Home can be anywhere, but it requires skills and resources to capture that feeling. Counseling provides clients with the coping skills to be patient and find inner peace. Our lives and the world around us are ever-changing. With teletherapy, you too can be a couple of clicks away from feeling at home.

Fleming, V. (Director). (1939). The Wizard of Oz [Film]. Metro Goldwyn Mayer.

written by Marianna Vanillo, M.S., LPC-Associate,
Supervised by Molly McCann, M.S., LPC-S


Why Aren’t They Ready Yet?? The Stages of Change.

Have you ever been frustrated when you know somebody needs to change something in their life, but they just can’t seem to understand it the way you do? It could be anything from working on physical health, to drug addiction, to a quasi-bad habit that needs to be broken. The other person just doesn’t see how bad things are and that they need to change! What this COULD mean is that you and the other person are at different stages of change.

What are the Stages of Change?

The Stages of Change as discussed in this blog come from Motivational Interviewing, which is a type of therapy that can either be practiced independently or in conjunction with other therapeutic modalities. Here are the stages:

1. Precontemplation Stage

In this stage, someone would not even realize that there is something worth changing. They wouldn’t think they have a problem, and they wouldn’t be contemplating any change. They could be in denial, they could be back at square one after trying a change and giving up, they could be told by folks that they need to change/have a problem but they say “I’m the exception” or “That’ll never be me” statements. 

An example: Jonah smokes a pack of cigarettes a day, and his friends tell him they are worried about his long term health. Jonah responds to his friends “I’m not worried about it. It’s just a pack and I could stop any time I want to! Other people get cancer, but it doesn’t run in my family and it won’t happen to me!”

2. Contemplation Stage

This stage is when someone knows they want to make a change, and they begin weighing their options. Here, therapists and friends will often hear this person express ambivalence about making the change, fear talk, and “I would, but…” statements. 

An example: Mel has been having stomach problems with her anxiety for a few months and knows that a trip to the doctor would likely help her figure out ways to feel better. She is afraid that they may have to run invasive tests or change her diet, which give her even more anxiety and make her stomach issues worse. She has talked to her partner about her stomach issues and has said many times, “I should make that doctor’s appointment soon, but I’m just too busy with school to take a day off!”

3. Preparation Stage

Here, folks will start to get ready to make a change, or they may make small steps toward the change. This could be the point at which we hear someone say “I’m about to start doing ___” as they get ready to make their change. They may start sampling their new lifestyle, or dipping their toe in to test the waters, but haven’t taken any formal action toward the change. 

An example: Jess has become aware of the fact that social media consumption exacerbates her depression and anxiety. She decided that deleting her social media apps off of her phone will be a big step to helping her mental health. She recently posted to her friends that she will be deleting her apps and will be much harder to reach soon. She gave them her other contact information so they can still text and facetime, without the obligation to see everything that has been giving her FOMO and anxiety. The apps are still on her phone for the time being, and she is mentally preparing for the day next week that she will delete them. 

4. Action Stage

A person in this stage is actively trying to make their change happen. This is often where the bulk of therapy work occurs, as our clients have taken steps to call our office and schedule a session, sit with a therapist and discuss their concerns. It is possible to get to the Action stage multiple times (like, with a pesky New Years’ Resolution) only to revert to an earlier stage a few times over. 

An example: Evan started going to the gym Monday through Thursday after work, made an accountability buddy at the gym, and is loving it! He used to go to the gym about once or twice a year, and recently became fed up with his sedentary lifestyle. He is really trying to find ways to keep his gym habit sustainable this time. 

5. Maintenance Stage

This is the stage that we would aim to be in for the longest amount of time. Maintenance is the goal of making a change; we want to maintain our change over time. A person in this stage has become proficient at their action stage and is looking to maintain the change. 

An example: Ori calls himself a “recovering anger-holic.” He grew up with enormous difficulty with expressing his emotions, and often would have angry outbursts. When he became engaged to Amber in his thirties, she asked him to go to therapy for his anger. In this way, Amber helped Ori move from stage 1 through stage 4. He worked with his therapist to express his feelings in healthier ways, manage his anger, and grow his support network. Ori and Amber participated in couples therapy a few times over the years (especially when Ori’s anger looked like it was relapsing), but now that they are in their fifties, they hardly need outside help. He can still be triggered into what used to be fits of anger, but now are fits of coping and emotional expression. Amber knows all of his most reliable coping skills and they use code-words when he really needs to go cool off and take a walk. 

6. Relapse Stage

A relapse is when an individual returns to a previous stage for any amount of time. It is common, when making a change, to be tempted to return to the pre-change lifestyle. It is important during a relapse temptation to seek support and try not to relapse. A relapse could be small or large, and it doesn’t mean you or your treatment failed. After a relapse, an individual could return straight to maintenance, or it may require a return to an earlier stage. It is possible to return to precontemplation after a relapse, as someone could say “oh that wasn’t as bad as I remembered” and be enveloped once again with their pre-change lifestyle.  

An example: Ellee realized she had a gaming addiction when she was 22. After the challenge of quitting video games and seeking help, she maintains an abstinence from video games as a 28 year old. She recently relapsed when a new group of friends had a housewarming party for their friend. She didn’t know that there would be a console with the expectation to play some party games over drinks, and she had gone home afterward and continued a game-watching binge on Twitch. Ellee felt guilty and embarrassed the next day when she realized what she had done. She called her dad (her “biggest supporter”) the next day to tell him what happened, and told her therapist about it in their next session. She made a plan to tell the new group of friends how they can support her and why she has to stay away from video games. They worked together to make a plan to have console nights without her, and include her for other activities instead. It was her third ever relapse, and she commented in therapy that the aftercare seems to “get easier every time” when she relapses. She will easily get back into her maintenance stage, as she does not own any platforms that allow for her previous video game habits, and she has now blocked Twitch on her laptop to prevent another similar relapse. 

Fun Facts

Fun Fact 1: Someone can bounce around to various stages many times before coming to their “final” maintenance stage. Even then, relapses may occur and require a re-do of some earlier stages before returning to maintenance. 

Fun Fact 2: It can be extremely frustrating when you are at a different stage of change from a loved one with a change that needs to be made. These stages can be discussed with your therapist, and you and your loved one can come to a decision about how best to proceed together in sessions. 

If you are ready to talk about making a change in your life, reach out to us at [email protected] or 512-298-3381. 

(The Stages of Change discussed in this blog are taken from Prochaska and DiClemente’s 1983 Stages of Change Model, and the book Motivational Interviewing, Third Edition: Helping People Change by Miller and Rollnick)


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