Archive of ‘Grief and Loss’ 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).


What is Non-Directive (Child-Centered) Play Therapy?

Do your kiddos ever sit you down on the couch and explain to you what they are feeling and why? Well, usually not. You see, adult brains are fully developed and are able to talk and share what’s going on in their lives. Children, on the other hand, are still building their brain and don’t have all of the words to be able to express themselves. However, children can connect, process, and express themselves through play. Garry Landreth, the Founder of Child-Centered Play Therapy, shares, “Toys are children’s words and play is their language”.

What is Play Therapy? What does Non-Directive Mean?

Let’s start with the definition of play therapy, which means children, usually ages 3-12, using toys and art to express themselves and process what they need. That’s right, this counseling room is filled with toys and art supplies. These items serve as a child’s way of expressing what an adult would share with their words. Non-directive allows the client to lead the sessions, meaning getting to play freely without the counselor directing activities or questions. Counselors who use this theory believe the client is the expert in their own lives and will bring into session what they need that day. It can be harmful to force clients to process before they are ready, ultimately delaying progress. 

What Happens in Non-Directive Play Therapy?

Play therapy takes the form of what the child needs it to be in that session. Play therapy could involve the child playing with toys to act out a fight they just had or using art supplies and the sandtray to regulate themselves. Play therapy could also be connecting with the counselor in an activity together, that the child came up with on their own, to build trust and self esteem. The counselor is there to support the child and assist with processing, regulation, and limit setting. If the child invites the counselor into their play, then the counselor will continue to follow the child’s lead. Allowing the client to take the lead enables them to build self-esteem and confidence.

Who Could Benefit from Non-Directive Play Therapy?

Really any child could benefit from play therapy! Play therapy has proven success with children from pre-k to middle school. It is a safe space for them to process and express themselves with someone who isn’t a family member or friend. It establishes a personal relationship that is free from any connection to their outside world. Play therapy can be used with anxiety, depression, emotional dysregulation, anger outbursts, life transitions, divorce, low self esteem, social skill issues, school behavior problems, grief and so much more.

How Does Non-Directive Play Therapy Work?

First of all, play therapy takes lots of time and is thought of as a journey. It is extremely important for the child to come to weekly sessions to create safety, trust, and consistency. Sometimes things can get worse at home before they get better, which is normal since a child is having big feelings that they are not used to expressing. 

The counselor will meet with the child one-on-one, so they are fully able to process what they need without their parent present. The very first step is building trust and rapport with the counselor. Without that, how could anyone process what’s going on in their lives? The counselor will observe and be fully present with the child in a calming space, track the child’s play, and reflect feelings. The counselor will also set limits as needed to provide safety for the child, counselor, and room. The counselor will label positive characteristics and strengths they notice in the child as well.

Is There Parent Involvement?

Yes, and this is so important, you and the counselor are on a team now. The counselor is only with the child once a week for 45-50 minutes, while you, the parent, are with your child the majority of the time. The counselor will first set up an initial intake session with the parent to hear all concerns and goals for the child before even meeting with the child. The counselor will then set up separate sessions, usually every 4-8 sessions, to discuss play themes they are seeing in the session, to hear how the kiddo is doing at home, and to provide parenting support while teaching skills to use at home.

It will be so challenging to not know what is going on in session right away, and it is common for it to take at least 10 sessions before safety and trust is built with your child. It is quite valuable for parents to recognize that when their child begins their journey through therapy, the parent does too. With that comes the task of parents being patient and understanding that their child’s progress is fully maximized when the parent changes alongside with them.

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


Growing Through Grief: You Will Never Feel the Same Again… But You May Become Better

Losing a loved one may shatter your life. You may feel numb. You may feel that you can’t think straight. Every heartbreak that you have suffered previously may hit you full force, simultaneously. At times, the pain can almost paralyze you. 

Be patient with yourself. Healing from grief is a slow process. It moves, not at the tempo of technology, but at the tempo of agriculture, as slowly as plants grow. But as you heal, you may discover in yourself new strengths that were not there previously. 

In my case, my mother’s death forced me to re-examine my identity and my purpose in life. This exploration eventually led me to seek a master’s in social work. I discovered that my interests include caring for older adults, persons who are nearing death, and persons who are grieving. 

Each experience of grief is unique, as unique as you are, and as unique as your relationship with the person you lost. But there are some patterns that humans share. It helps to learn these patterns, as they will help you understand yourself and other persons.  

Elisabeth Kubler-Ross’s 5 Stages of Grief

This was the first research model of grief, and it is still used. People do not go through the stages in a neat, sequential way. But they usually experience all 5 emotions, and move in a gradual, bumpy way from shock toward healing. 

  1. Denial (shock)—This is the emotional equivalent of an airbag in a car. It protects you from feeling the impact all at once, which could be overwhelming. 
  2. Anger—You may protest and feel, “This is terrible! This shouldn’t have happened!”
  3. Bargaining—You may think, “I’m trying to regain some control of my life, when I feel so out of control. If I change my life in such-and-such a way, then I should feel less bad.” A religious person may make deals with God, such as, “Dear Lord, if I start teaching Sunday school, You should make me feel less awful.” 
  4. Depression—This stage is not well-named. It’s not depression, but it can look that way. There is a general withdrawing from activities and social life, a conserving of energy. The person may feel powerless, but not hopeless. They are starting to come to terms with the loss.
  5. Acceptance—At this point, you may feel, “This situation stinks. I don’t want it this way. But it’s reality, and I am going to acknowledge it and deal with it as best as I can.”

William Worden’s 4 Tasks of Grief

Again, people don’t go through these tasks in a neat, sequential way. There may be setbacks and cycling. But there is a gradual movement toward healing.

  1. Acknowledge the reality of the loss. State that the person is dead. Describe how it happened, how you learned, and what you saw.
  2. Experience the pain. Face it. Don’t try to pretend that it doesn’t hurt much. It does. Don’t try to dull it out with alcohol.
  3. Adjust to an environment without the person there. The longer that people are in relationship, and the more closely their lives are intertwined, the more adjusting needs to be done.
  4. Withdraw some emotional energy from that relationship and invest it in another relationship. Be careful! You can’t replace one person with another. (We all know a grieving widow or widower who remarried out of loneliness, but chose altogether the wrong person.) Some marriages and other relationships aren’t happy. In this case there may not be much emotional pain after the death. Or there may be intense pain, as the person grieves for a relationship they craved, but never had. Sometimes a loss leads to a new project. A mother whose child was killed by a drunk driver started MADD (Mothers Against Drunk Driving), to try to prevent this tragedy from happening to others. 

Corr & Doka’s 5 dimensions of grief

  1. Emotional
  2. Physical—You may feel cold. (When we feel threatened, blood flow goes to our inner organs, and we feel cold.) You may get sick, since grief weakens the immune system.
  3. Spiritual—Grief may impact your belief system.
  4. Social—It may be hard to socialize, as some people may misunderstand you, or say clumsy things.
  5. Cognitive—You may have poor attention, poor concentration, or difficulty learning new material. Some children who are grieving are diagnosed incorrectly as having ADHD. When these children heal from grief, they do not show ADHD behavior. (This research study was my professor Dr. Helen Harris’s doctoral dissertation.) Some older adults who are grieving fear that they have dementia; but when they heal from grief, they can think just as well as they did before the loss. 

Alan Keith-Lucas’s study of children’s resilience after a loss

Shock and denial: After a significant loss, every child experiences shock and denial. Then there are 2 different paths:

  1. Protest: If the child is allowed to have and express the feelings, “No! This is unfair! This can’t be!” then the child can achieve “mastery,” becoming stronger than before the loss. The key is for the child to learn to express their feeling of anger in a way that doesn’t hurt themself or anyone else. 
  2. Despair and Detachment: If the child is not allowed to protest, the child falls into despair and detachment. These children are not troublesome. However, as adults, they may not function very well. They struggle to keep a job or stay in a relationship.  

Books—Some of my favorite books about grief are:

  • Doka, Grief is a Journey 
  • Neeld, Seven Choices: Finding daylight after loss shatters your world 
  • O’Brien, The New Day Journal 
  • Wings of Change Publications, The Nature of Grief: Honoring and Healing the Seasons of Loss. 

Are you currently grieving? 

We experience grief not only when a loved one dies, but also when we lose anything that is important to us, such as our health, a job, or a treasured relationship. If you are grieving, it would be my honor to share your journey with you. Grief is too hard a journey to travel alone.

[I wish to thank Dr. Helen Harris and Dr. Richard D. Grant, Jr., 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, where one of her internships was in a hospice agency. She is a PAC Certified Independent Consultant, trained by the Positive Approach to Care organization; a Certified Practitioner of the MBTI, trained by The Myers & Briggs Foundation; and an associate member of the Aging Life Care Association.




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