My client’s memory has unfortunately debilitated to the point where it has become very unreliable. So I have changed my goal from trying to help improve his memory, to trying to help him improve his level of overall satisfaction. I have devised three interventions, in light of the recent changes in my client. My first intervention involves meeting with my client for weekly therapy sessions. I have found that my client is most confused when he wakes up in the morning. Interestingly enough, even when my client is in his most confused state (that I have observed), he remains oriented as far as his understanding of who he is and who I am. However, in the mornings he has a tendency to be disoriented in regards to his whereabouts and location. I have also noticed that immediately after a meal, my client seems to be the most interested in meeting with me. As a result, I have scheduled our therapy sessions in the afternoon, following lunch.
In our future sessions I would like to use CBT to address some issues that I have noticed in my client. My client has discussed a number of his tragic experiences with me. Most of theses tragic experiences have involved a friend, relative and even my client’s spouse lying and taking advantage of my client. After recounting such experiences, my client often remarks “don’t trust anybody”. The odd part about these conversations has been that my client doesn’t seem irritated or paranoid and doesn’t exhibit much anxiety. I was under the impression that my client has issues with trusting people. But he seems to trust me wholeheartedly, so it seems to me that my client doesn’t have trust issues that interfere in his life. I would even go so far as to suggest that the trust issues were not my client’s but rather they were problems created as a result of the fact that my client has had a long history of having a healthy trust in mankind.
Unfortunately, it seems that my client just had a lot of bad experiences with untrustworthy characters. The sad result of this is that my client doesn’t really talk to anyone other than myself. However, this phenomenon could also be the result of the fact that my client lived on a dementia unit for his first few months and now he believes that all of the resident’s at my field agency are crazy. During our therapy sessions I would like to investigate this issue more and try to find out why exactly my client doesn’t interact with the other residents
During our past sessions, I was assessing my client. I assessed him for his strengths as well as his risks. One of the obvious risks that everyone living in an institution faces is that of becoming institutionalized. Individuals living in an institution have everything done for them by the institution’s staff. This effectively takes a lot of power and control, over their lives, away from the individual. A sad eventuality for many people who are institutionalized is that they become powerless and dependant because they get used to having everything done for them. (Stephens, 1991)
Another risk that my client faces is his lack of a social support system. He has no family or friends that visit him. I have been trying to find ways of using my client’s strengths in order to empower him. One of my interventions has been to create a synthetic social support system around my client. It has been suggested that amongst the aging population there are very few protective buffers against developmental risk; however self efficacy and social support are the two exceptions because they have been shown to be quite effective buffers that are present in the aging demographic (Zimmerman…et el., 1999).
One of the things that I have done to try and create a social support network is that I have tried to engage my client in conversations with others. Every Friday, there is a fancy breakfast in the coffee lounge. The coffee lounge environment was created to look more similar to reality than having breakfast with all of the other residents in the institution’s dining room. So, I will take my client there for breakfast, in order to try and create a more realistic and less institutionalized atmosphere for my client to interact within and use as a medium for reorientation.
Hopefully, starting the day in a more realistic setting will empower my client to take control of his life and encourage him to be more outgoing. Hopefully this will lead to two things. A stronger sense of coherence and the establishment of a rapport between my client and other residents and eventually turn into meaningful relationships that compose a healthy social support system for my client.
In 1996, Rak and Patterson developed the buffering hypothesis, which detailed four conditions that provide a buffer against the risks associated with childhood development. In its primitive stages, research related to resilience theory was primarily focused on the developing child, the adolescent and the young adult. However, resilience theory has also been demonstrated to be applicable to the aging demographic.
“By acknowledging older adults’ resiliency and spiritual resources in light of past and present risk factors, care providers can focus on capabilities, assets, and positive attributes rather than problems and pathologies….a conceptual and practical framework for teaching strengths perspective counseling for older clients in which resiliency and spirituality best describe the application or operationalization of strengths” (Lewisa, 2007)
Many scholars maintain that the developing individual continues to develop throughout his or her entire lifespan. Since individuals are repeatedly faced with both normal and abnormal changes in themselves and their environment, throughout their lives, it is necessary for the developing individual to maintain his or her ability to adapt to the consistently changing circumstances, which they may find themselves in, in the most productive or beneficial way possible; and since those variables could potentially change at any point during the individual’s entire lifespan, the individual must continue to maintain his or her ability to adapt to the consistently changing circumstances for the entirety of her or his life.
In my field work at Isabella Geriatric center, I have been witness to similar demonstrations of resilience within another demographic, the aging population. In particular, one of my clients seems to be able to live contently despite the fact that he is constantly faced with overwhelming hardship. However, I am extremely impressed with many of my clients who are able to cope with difficulties of being institutionalized. Many of them exhibit the ability to accept very difficult circumstances and to adapt to those circumstances in constructive ways. Resilience theory states that there are environmental and personal factors that act as a buffer between at-risk individuals and the developmental obstacles that they are faced with, which provide the developing individual with the resilience to overcome hardship in regards to their human development.
Through my understanding of resilience theory I came to appreciate the strengths perspective. The protective buffers, as described by Rak and Patterson (1996) are good examples of the types of strengths that I have been looking for in assessing the qualities connected with my clients’ resilience. I have used the resilience theory in conjunction with a strengths based intervention model to assess my clients. In doing so, I have focused on ascertaining the qualities that have helped my clients overcome developmental obstacles in the past. I composed lists of all of the strengths of each of my clients. Then I compared each client’s strengths with the obstacles that they were facing.
I will attempt to increase my client’s awareness of his strengths and encourage him to use and develop those strengths that account for the resilience he has clearly displayed by surviving so many years and hardships. A strengths based intervention is supposed to help my client overcome developmental obstacles and adapt constructively to changing circumstances. When I first began meeting with this client, he would talk about his profession as a dance teacher quite a lot. He spoke about his experiences, with the fire and passion of a ‘true artist’; which was also how he referred to himself, a number of times.
Since my client uses a walker, I was saddened by the fact that his life used to be all about his ability to dance and now he could no longer do dance well. But, I quickly realized that my client was also a teacher of dance for many years and he still enjoyed teaching me during our conversations. I organized a group of residents who were interested in having an exercise class and proposed the idea, of teaching an exercise class, to my client. My client was very excited at the prospect of returning to teaching.
If not for resilience theory and the application of the strengths perspective, I would not have noticed the potential of the intervention that I am attempting. Thus it is clear that resilience theory has certainly proven to be helpful for informing my assessment of my client and formulating intervention strategies.
Finally, it is important to note that the Friday morning breakfast with my client also serves another purpose. By putting my client in a more realistic setting and engaging him in more lifelike rituals, hopefully he will also come to reorient himself with who he was when he lived normally in the community. Such interventions have been shown to have a positive effect on the sense of coherence felt by the individual, which, in turn, has been proven to be particularly compatible with the strengths based perspective (Langer, 1997).
Works Cited
Langer, N. (2004) Educational Gerontology, Resiliency and Spirituality: Foundations of the Strengths Perspective Counseling with the Elderly. 30: 611–617. New York.
Lewisa, Judith S. (2007) Journal of Gerentological Social Work : Sense of Coherence and the Strengths Perspective with Older Persons. P. 316-372. New Orleans, LA 70118 (http://www.informaworld.com/smpp/title~content=t792304007)
Rak, C.F. & Patterson, L.E. (1996) Promoting resilience in at-risk children. Journalof Counseling and Developmen, 74, 368-373.
Stephens, M. A. P., Ogrocki, P. K., & Kinney, J. K. (1991). Sources of stress for family caregivers of institutionalized dementia patients. Journal of Applied Gerontology, 10, 328-342.
Zimmerman, H., Gruber-Baldini, A., Fox, K., Hebel, J., Kenzora, J., (1999) Social Work Research: Short-Term Persistent Depression Following Hip Fracture: A Risk Factor and Target to Increase Resilience in Elderly People Vol. 23
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