Context Is Vital When Engaging with Someone with Dementia
In fact, context matters ALL of the time, and for all of us.
When a person with dementia says something that doesn't make sense to us, how do we make sense of that person's statement? Do we see that as a symptom of dementia? Do we seek to understand its meaning for that person.
This was the theme of last week's Memory Bridge TCL (The Caregiver's Library) webinar Our Body Lives for Meaning.
In the webinar, Michael Verde provides the listener with a concrete scenario to consider: A man in a care home suddenly becomes alert and says: "Is the truck coming? The truck is coming - I've got to get ready." Michael asks the listener, "How do you imagine what's going on in his mind?” “What is going on in your mind?" He suggests that what is happening in our imaginations affects what happens within the person with dementia.
So, I asked myself, "What's going on in my mind?"
I observe that the man begins with a question, followed quickly by a statement which leads to an assessment of a need for action. The quickness is how I imagine the scenario plays out. I imagine that this man is experiencing a sense of urgency for some reason. I want to know why. I'm curious. I want to know what is happening in his mind. I experience his urgency as an expression of some anxiety that may be founded in a past experience. I want to ease his anxiety if my perception is accurate. I attempt to ease the anxiety I feel by joining him. This is how I understand co-regulation.
In the webinar, Michael suggested that we allow what could be labeled a 'behavior' to be an opportunity for a meeting - a relationship. We are companions in the same world.
In The Dance of Interaction: Embodied Relationships in Dementia Care, in a chapter entitled "Relationship-Centered Care", I offer the following:
“Relationship centered care, as the name suggests, is care that puts the relationship between people at the forefront. Care that centers on the emotional connection encourages a strength-based mutuality that considers what is possible rather than the deficits of a person living with dementia. In such a relationship, the quality of a person’s daily life becomes more important than the schedule to be met. Rather than care that is centered on completing a task such as getting dressed, or is directed to managing a symptom such as agitation, often referred to as a behavior in the medical model, care that puts the relationship first sees each person living with dementia as a human being who has something to contribute and who benefits from caring interaction. Rather than ignoring an individual’s request because of disorientation, the caregiver strives to satisfy the person’s needs and wishes. Therefore, relationship centered care is based on capabilities and interests — what the individual can and wants to do, and is holistic — it considers the whole person.”
“Every interaction with a person with dementia is an opportunity to build a relationship.”
If you are interested in deepening your capacity for empathy, I highly recommend Memory Bridge's TCL webinars.
Dr. Heather Hill, Australian dance/movement therapist and internationally renowned expert in dementia care wrote, "The revolution of this manual is that it brings to attention the embodied, relational nature of care and offers some stepping stones towards changing the way we train for care.” You can purchase The Dance of Interaction here.