A Snapshot of Practice

Geoffrey Mellon​Process Recording #10​
Marilyn Best LMSW
Process Recording #10
Mr. F
Geoffrey Mellon
Jan 26, 2011
Today Mr. F said goodbye to the Alzheimer’s/dementia unit.  Late last night, my field instructor came to my office and alerted me to the fact that Mr. F had an opportunity to move into a private room that just opened up on a less confused floor.  Being that this was such a unique opportunity, we immediately went to show Mr. F the new room, in order to get the transfer process started before someone else tried to claim the open room.
The nurse told me that when they moved Mr. F to his new room, he had no recollection of our trip the day before.  I was surprised but I probably shouldn’t have been so surprised because forgetting things has become common for Mr. F, since he came back from the hospital.
I went up to Mr. F’s new room about a half an hour before our scheduled meeting.  The door was closed, so I knocked and waited for a response before entering.  Mr. F was lying on his bed relaxing when I entered his room.  Slowly he sat up and then he gestured for me to sit next to him on his bed, so I did.  He thanked me for getting him this new room.  I explained to him that I did nothing deserving of thanks.  He worked hard all his life to earn what he now received and my field instructor was the one who found him his awesome new room.  Nonetheless, Mr. F continued to thank me, profusely, throughout our meeting.  After the third time, I gave up explaining why I didn’t deserve thanks and I just accepted it with a smile and a nod.
We sat together for a few minutes enjoying the view and commenting on the majestic nature of freshly fallen snow.  Mr. F asked me where I live, so, I pointed it out to him.  He sounded comforted by the fact that I don’t live so far away.  At the same time that I found this comforting, I also found myself a little uneasy considering that the termination phase is nearing.
Mr. F showed me a wooden necklace with a cross that he had found in his new room.  He shared with me his profound feelings of divine providence after having found what he believes to be a gift from G-d.  I am pretty sure that the resident who lived in that room before him left it behind, but I encouraged him in his beliefs, nonetheless, because he seemed strengthened by the experience.
Mr. F asked me to tip him off if I find a job opportunity for him.  Once again he thanked me for the room but this time he emphasized that he would like to be able to afford some coffee to offer his guests.  I reminded him that he has a savings account and that we had taken out money from his account for a candy bar, just the other day.  I suggested to him that we could do the same thing if he wanted to get a cup of coffee.  He seemed comforted because he smiled widely.
I explained to Mr. F that I would certainly continue to meet with him every week, even though he switched floor, but that we had to switch our day from Wednesday to either Thursday in the afternoon or Friday in the morning.  He had no preference because both days and times suited him so he asked me which one I preferred.  I told him that I was not sure which suited me best and that I would let him know which one I have chosen at the beginning of next week.  I explained to Mr. F that I had to end our meeting abruptly in order to make it to my class.  He was fine with my leaving abruptly but as I left he encouraged me to come visit him again, as if I hadn’t already assured him that I would continue to meet with him every week.  So, once again I assured him that I would see him next week and tell him when we would have our weekly meeting.
Before I left the room, I asked Mr. F, regarding the self anchoring scale for contentment that we have been using, how he rated himself over the last week.  We have been using a scale of 1 to 10, where 10 represents contenment and 0 represents a lack thereof.  Mr. F said he felt like a five overall. As usual, he said that he felt like a 10 today because we had the opportunity to converse. He added that felt particularly happy today in his new room.
I came back later in the week to visit with Mr. F.  I printed out a copy of Mr. F’s credit balance and showed it to him, but he couldn’t read it.  So, after lunch I brought my magnifying glass from my apartment, to work.  I put a label with Mr. F’s name on my magnifying glass and I brought it up to give to him.  I also printed a larger copy of his credit balance, which I took with me as well.  Once again, I explained to Mr. F that he actually has some money in the bank.  I have noticed that each time I have to repeat something Mr. F, it gets a little easier for him to remember it the next day and he remembers things for longer after I have repeatedly explained them to him as well.
After Mr. F remembered/realized that he had some money, which he could be spending on things that he could use, he told me that he wanted two things.  The first thing was a watch.  He slapped his wrist enthusiastically and told me that he doesn’t like searching for a clock.  He doesn’t even have a clock in his room.  Mr. F told me that he needed a watch.
There was one more thing that Mr. F felt like he needed, but he couldn’t remember what it was.  As Mr. F contorted his facial expression into one of frustration, I realized that he seemed to feel as if he would only have one opportunity to request my help for this type of endeavor.  I quickly tried to address this by telling Mr. F that we could go shopping as many times as he wanted. I tried to explain further that I would even prefer to make more trips with him than get everything at once.  So I encouraged him to relax and not to worry about the second thing that he wanted to get because eventually he will remember and will have many more opportunities to make other trips together.  Mr. F was delighted to hear me offer to go on more trips with him and so again he thanked me profusely.
During my lunch break I had checked the prices of watches at a few nearby locations and the cheapest watches were just under twenty bucks.  When I got back to work I went to the gift store and found that not only were their watches less expensive but they also had features that were perfect for Mr. F.  The watch’s numbers were very large, the glass cover magnified their visibility even more and there was a button to light up the watch for nighttime visibility.
So, I walked with Mr. F to the finance office.  I explained what we were doing to Mr. F, thinking that it might help him remember that he has some money.  Lately he has been nervous about not having any money on him.  He has asked me a few times if I could help him find a job because he wants some spare cash to buy candy or treat a guest to coffee.  Each time I have explained to why he doesn’t need a job; but I feel like the most effective way of helping him remember that he actually has some money is by showing him.  For the sake of clarity I have been calling the finance office Mr. F's 'bank' because it essentially serves that purpose for him.  After he took out money, we went to the gift shop.  Mr. F bought the watch that he liked best and then we rested for a minute before going back upstairs.  While we rested, I asked Mr. F how his exercise classes were going.  He complained that the residents were crazy and the staff refused to let him do a lot of the exercises.  I assured him that I would discuss the matter with the staff and that i would look for other residents who are more interested in taking his exercise class.  In his words, Mr. F told me that he "didn't want to force anybody to do anything", he just wanted to make "recommendations" from his "experience".  I think what he was trying to say is that he has been trying to interact with other residents; unfortunately, he has not had much success even after I helped develop this class.  Again, for the millionth time, I asked Mr. F to rate how well he felt he has been interacting with others, but he never answered the question.  Mr. F thinks that the other residents are the ones with the problem.  I have tried unsuccessfully to use CBT to help Mr. F realize his problem, but eventually I gave up on that because his dementia has been progressing.
This account accurately portrays my interventions.  I found Mr. F a private room because he was being tortured by the annoying behavior on my advanced dementia unit.  I helped him move there and adapt to the new environment.  Furthermore, since I will not be able to continue my weekly sessions with Mr. F, once I move on to my next placement, I have been trying to empower Mr. F to become more independent.  I keep trying to bolster his understanding of his finances as well.  Furthermore I have been trying to find opportunities for Mr. F to interact with other residents in spite of the fact that Mr. F thinks every other resident is crazy.