Creating a Therapeutic Relationship Resource Package

Transcription

1 Creating a Therapetic Relationship Resorce Package

2 ABCC Model* Behavior P I E C E S Antecedents (Cases) Physical health Intellectal capacity Emotional health, spiritality Capabilities Environment Social, cltral 1. What has changed? Individal Conseqences (Reslts) Environment Staff 2B. What are the possible cases? 2A. What are the RISKS? Care Strategies Individal Environment Staff 3. What is the action? *Modified from: Geropsychiatric Edcation Program, Vancover/Richmond Health Board 1997 P.I.E.C.E.S. Consltation Team, 2009

3 Listen When I ask yo to listen to me and yo start giving advice yo have not done what I asked. When I ask yo to listen to me, and yo begin to tell me why I sholdn t feel that way, yo are tramping on my feelings. When I ask yo to listen to me and yo feel yo have to do something to solve my problem, yo have failed me, strange as that may seem. Listen! All I asked was that yo listen. Not talk or do jst hear me. Advice is cheap: 50 cents will get me both Dear Abby and Billy Graham in the same newspaper. And I can do for myself: I m not helpless. Maybe discoraged and faltering, bt not helpless. When yo do something for me that I can and need to do for myself, yo contribte to my fear and weakness. Bt, when yo accept as a simple fact that I do feel what I feel, no matter how irrational, then I can qit trying to convince yo and can get abot the bsiness of nderstanding what s behind this irrational feeling. And when that s clear, the answers are obvios and I don t need advice. Irrational feelings make sense when we nderstand what s behind them. Perhaps that s why prayer works, sometimes, for some people becase God is mte, and he doesn t give advice or try to fix things. They jst listen and let yo work it ot for yorself. So, please listen and jst hear me. And, if yo want to talk, wait a minte for yor trn; and I ll listen to yo. Anonymos

4 BLOCKS TO LISTENING 1. COMPARING (my kids are better I ve had it harder ) 2. MIND READING (I bet he s really feeling she really means ) 3. REHEARSING (next I ll say then I ll nail em with ) 4. FILTERING (hear only what concerns yo ) 5. JUDGING (prejdge, bias, negative, labeling ) 6. DREAMING (half-listening, daydreaming ) 7. IDENTIFYING (lanch into yor similar experience before they can finish telling theirs ) 8. ADVISING (yo re the great problem solver how abot jst be there listen) 9. SPARING (be qick to disagree debate pt down ) 10. BEING RIGHT (shot make excses yo can t take criticism twist the facts accse ) 11. DERAILING (change the sbject make a joke of it avoid discomfort or anxiety ) 12. PLACATING ( Really Oh I know Um-hmmm don t tne in jst nod yor head )

5 REAL verses PSEUDO-LISTENING BEING QUIET DOES NOT MEAN THAT REAL LISTENING IS HAPPENING REAL LISTENING IS BASED ON THE INTENTION TO DO ONE OF FOUR THINGS: UNDERSTAND SOMEONE ENJOY SOMEONE LEARN SOMETHING GIVE HELP OR SOLACE

6 ACTIVE LISTENING PARAPHRASE STATE IN YOUR OWN WORDS WHAT YOU THINK WAS SAID: Do yo mean? What I hear yo saying is CLARIFY ASK QUESTIONS TO GET A CLEAR PICTURE. FEEDBACK IN A NONJUDGEMENTAL WAY TO SHARE WHAT YOU FELT, THOUGHT, OR SENSED. BE HONEST AND SUPPORTIVE. LISTEN WITH EMPATHY THERE IS ONLY ONE REQUIREMENT FOR LISTENING WITH EMPATHY: SIMPLY KNOW THAT EVERYONE IS TRYING TO SURVIVE. LISTEN WITH OPENNESS NEARLY EVERYONE HAS TROUBLE LISTENING OPENLY. BEING WRONG HAS VAST PROPORTIONS. YOU NATURALLY WANT TO ARGUE OR SHOUT IT DOWN. HEAR THE ENTIRE COMMUNICATION BEFORE JUDGING. PICTURE YOURSELF AS ONE WHO WANTS TO FIND THE TRUTH.RATHER THAN PROTECTING OR BUILDING YOUR SELF-ESTEEM BY HAVING TO BE RIGHT. LISTEN WITH AWARENESS DOES THE PERSON S VOICE, TONE, EMPHASIS, POSTURE, FACIAL EXPRESSION FIT WITH THE CONTENT OF HER/HIS COMMUNICATION?

7 Commnication Basics Checklist Commnication Skills Skill OK Usally I Need to Work on This I physically attend to others I listen careflly before talking I speak in descriptive terms I discss negative feelings I own my feelings ( I messages) I speak clearly and specifically I se good timing I consider other s needs I encorage others to commnicate with me Listening As an observer, yor job is to pay attention to the spporter s se of this skill. Dring the interaction, give yor fll attention to what the peer spporter and peer say and do. At the end of the demonstration or practice period, qickly check the behavior yo observed. After the practice period(s), report to the spporter the behaviors yo have checked. Gidelines for effective attending are: To commnicate listening throgh freqent and varied eye contact and throgh facial expression To physically relax and lean forward occasionally, sing natral hand and arm movements To verbally follow the peer, sing a variety of brief encoragements sch as mhm, yes, or repeating the key words. Indications that effective attending is not taking place inclde: Little eye contact, a fixed stare, a frozen expression, stiff or tense postre, no head movements, no hand movements, sloching, topic jmping, and ctting off the peer.

8 Listening Feedback Form Qalities Displayed On each of the following scales, pt a check aat a location on the continm to reflect jdgment of the qalities displayed by the spporter. Warm Concerned, Involved Understanding Open, Sharing Relaxed, At Ease Cold Uninterested Not Understanding Closed Tense Behavior 1. Maintained freqent and varied eye contact 2. Looked away from peer when talking or maintained a fixed stare 3. Displayed varied facial expressions or alertness 4. Showed little or no facial expressions or alertness 5. Used affirmative or encoraging gestres 6. Had relaxed body postre, leaning forward occasionally 7. Sat in a fixed or rigid position throghot 8. Sloched or leaned away from the peer to contine talking 9. Offered brief vocalizations that encoraged the peer to contine talking 10. Interrpted the peer and changed topics arbitrarily

9 SELF CONTROL YOUR ABILITY TO REMAIN CALM AND RATIONAL UNDER VERBAL PERSONAL ATTACK IMPORTANCE OF SELF CONTROL REFUSAL TO BE CONTROLLED BY OTHERS OR BY YOUR EMOTIONS AVOIDS FOCUSING ON SINGLE WORD OR ACTION AVOIDS POWER STRUGGLE BEHAVIOR RETAIN THE ABILITY TO MAKE SOUND DECISIONS

10 EFFECTS OF LOSING SELF CONTROL FOCUS CHANGES FROM THE PERSONS BEHAVIOR TO YOUR EMOTIONS YOUR EFFECTIVENESS IS DECREASED SOME TECHNIQUES TO MAINTAIN SELF CONTROL MAKE LISTS OF EMOTIONALLY CHARGED WORDS, GESTURES, AND SUBJECTS COMMIT LIST TO MEMORY PRACTICE SELF-TALK: ROLE PLAY DIFFICULT ENCOUNTERS WITH STRATEGIES THAT HELP YOU MAINTAIN SELF- CONTROL CONCENTRATE ON DEEP BREATHING, YOU WILL MAINTAIN CONTROL OF YOUR MIND AND EMOTIONS WHEN YOU CONCENTRATE ON KEEPING YOUR BREATHING REGULAR

11 SETTING LIMITS PROTOCOL: 1. POINT OUT THE SPECIFIC BEHAVIOR THAT IS INAPPROPRIATE 2. SAY WHY IT IS INAPPROPRIATE 3. GIVE CHOICES (CONSEQUENCES) YOU MUST GIVE POSITIVE CHOICE FIRST! 4. ALLOW TIME 5. CARRY OUT CHOICE (CONSEQUENCE) REMEMBER: S A F E T Y C O M E S F I R S T BEFORE YOU INTERVENE HAVE SUFFICIENT STAFF ON HAND AND KNOW WHAT THE CHOICES ARE THAT YOU WILL OFFER. DON T OFFER WHAT YOU CANNOT PROVIDE OR BACKUP; DON T GET CAUGHT UP IN A POWER STRUGGLE, Got cha, or Btton Psh REACTION. Adapted from: The Art of Setting Limits (VCR tape); National Crisis Prevention Institte, 3315-K North 124 th St., Brookfield, Wisc

12 101 THINGS TO DO WITH THE PERSON WHO HAS DEMENTIA 1. Clip copons 35. Read alod from label 2. Sort poker chips 36. Dye Easter eggs 3. Cont tickets 37. Make a basket of socks 4. Rake leaves 38. Take a walk 5. Use the carpet sweeper 39. Reminisce abot the first day of school 6. Read ot lod 40. String Cheerio to hand otside for birds 7. Bake cookies 41. Make a fresh frit salad Look p names in the phone 8. book 42. Sweep the patio Read the daily newspaper ot 9. lod 43. Color paper shamrocks green 10. Ask a friend, neighbor, chrch 44. Fold towels acqaintance who has a baby or yong child to visit 11. Listen to polka msic 45. Have afternoon tea 12. Plant seeds indoors or ot 46. Remember great inventions 13. Look at family photographs 47. Play pictionary 14. Toss a ball 48. Paint a sheet 15. Color pictres 49. Ct ot paper dolls 16. Make homemade lemonade 50. Identify provinces and capitals 17. Wipe off the table 51. Make a family tree poster 18. Weed the flower bed 52. Color a pictre of or flag 19. Make cream cheese mints 53. Cook hot dogs otside 20. Have a spelling bee 54. Grow magic rocks Read the Reader's Digest ot 21. lod 55. Water hose plants 22. Fold clothes 56. Reminisce abot the first kiss 23. Have a calm pet visit 57. Play horseshoes 24. Ct pictres ot of greeting cards 58. Dance 25. Wash silverware 59. Sing favorite hymns 26. Bake homemade bread 60. Make homemade ice cream Sort objects sch as beads by 27. shape or color 61. Force blbs for winter blooming 28. Sing Christmas carols 62. Make Christmas cards

13 Say "Tell me more" when they 29. talk 63. Sort playing cards by their color 30. Pt silverware away 64. Write a letter to a family member 31. Make a Valentine Collage 65. Dress in red on a football Satrday Play favorite songs and sing 32. together 66. Pop popcorn 33. Take a ride 67. Name the Prime Ministers 34. Make a cherry pie 68. Give a manicre 69. Make paper btterflies 86. Ct p sed paper for scratch paper 70. Make a May basket 87. Take care of a fish tank 71. Make homemade applesace 88. Trace and ct ot leaves 72. Finish famos sayings 89. Ask simple qestions 73. Feed the dcks 90. Finish Bible qotes 74. Mold with Play Doh 91. Paint with string Look at pictres in a National 75. Geographic 92. Ct ot pictres 76. Pt a simple pzzle together 93. Read classic short stories 77. Sand wood 94. Pt coins into a jar Rb in hand lotions with a 78. pleasant scent 95. Sew sewing cards 79. Decorate paper place mats 96. Pt bird feed ot for birds 80. Arrange fresh flowers 97. Clean ot a pmpkin 81. Remember famos people 98. Roll yarn into a ball 82. Straighten nderwear drawers 99. Make a birthday cake 83. Finish nrsery rhymes 100. Reminisce abot a favorite smmer 84. Make peant btter sandwiches 101. Decorate Christmas tree 85. Wipe off patio frnitre Sorce Unknown

14 Pro-Attention Plan Name Sn Mon Tes Wed Thrs Fri Sat A. M. P. M. A. M. P. M. A. M. P. M. A. M. P. M. A. M. P. M. A. M. P. M.

15 Creating a Therapetic Relationship Handot Package

16 Creating a Therapetic Relationship Creating a Therapetic Relationship Learning Objectives Upon completion of this modle, yo shold be better able to: 1. Give examples of verbal and non-verbal commnication skills. 2. Explain se of verbal prompts, annoncements, object ceing, toch, msic, hmor, graded physical assistance and client choice in ADL care. 3. Explain se of positive reinforcement, distraction and replacement in preventing/redcing behavioral distrbances. Cstodial care: Providing basic health care Protecting the client Over care Therapetic care: Therapetic care: Providing basic health care Spporting an enriched environment Enabling the client to perform as many activities as possible by himself/herself Encoraging atonomy Rosehaven Program 1

17 Creating a Therapetic Relationship Therapetic Caregiving Reqires: Knowing the Client Understanding Adjstment Potential Commnication Deficits of the Individal with Dementia Attention-giving Inability to attend to social ces Cooperation principle affected Confablation Potential Commnication Deficits of the Individal with Dementia Diminished facial expression Disorientation to person, place, time Comprehension of langage Verbal expression Rosehaven Program 2

18 Creating a Therapetic Relationship Commnication Strengths of the Individal with Dementia Grammar preserved Atomatic langage Sensitive to emotional ndertones Affective memory Hmor appreciation Msic appreciation Commnication Skills Being an effective commnicator is the most valable skill yo can develop Verbal Commnication Skills Attending behavior Introdce yorself Address the person by name Speak slowly and allow time to commnicate Initiate prposefl conversation Benefit of silence/ acknowledgement Rosehaven Program 3

19 Creating a Therapetic Relationship Verbal Commnication Skills Use open qestions with the cognitively-well client Listen with empathy Active listening Give instrctions based on cognitive ability Use positive statements Avoid negative statements Active Listening Paraphrase Clarify Feedback Listen with empathy Listen with openness Listen with awareness Non-Verbal Commnication 38% 7% 55% Voice Volme Words Expression Rosehaven Program 4

20 Creating a Therapetic Relationship Non-Verbal Commnication Skills Ensre personal space Approach from the front Establish eye-contact Show calming and friendly expressions Use gestres Non-Verbal Commnication Skills Avoid a tone of impatience Keep yor volme appropriate Use an even cadence Use of toch Ensre non-verbal message is congrent with verbal Written Commnication Skills Use written memory aids Create opportnities for writing Sggest letter writing, signing cards, preparing name lists, etc. Rosehaven Program 5

21 Creating a Therapetic Relationship Additional Tips for Commnicating with a Client with Dementia Expect repeated qestions and story telling Go along with his/her reality Do not arge or try to reason Assist with word-finding Incorporate singing Verbal Commnication and ADL Care Verbal Prompts Instrct the client to initiate or do a specific activity Do not give general prompts Try sing right/left ces Use ces based on level of nderstanding Rosehaven Program 6

22 Creating a Therapetic Relationship Annoncements Annoncements tell the client what is happening arond them or what yo are abot to do for them. Use annoncements when prompts are not responded to Annoncements shold always precede assistance Annoncing an activity enhances nderstanding of what is happening Provide Choice Allow the client to make simple choices dring caregiving rotines. Give more options when there is no cognitive impairment. Positive Reinforcement Reward the behaviors that yo want to contine Rosehaven Program 7

23 Creating a Therapetic Relationship Attention Reward the client with yor time and attention when he/she is not having a behavioral distrbance Make time to sit and talk for jst a few mintes Use treats to reward good behavior Praise and Appreciation Take a few mintes to say something positive or offer a compliment Let the client know that yo appreciate it when they help yo ot Rosehaven Program 8

24 Creating a Therapetic Relationship Admiration Admire the client as a person Say something positive abot the person Comfort Let the client know yo care by giving them some physical, verbal, or non-verbal comfort Rosehaven Program 9

25 Creating a Therapetic Relationship Rles for Reinforcing Positive Behavior: Give reinforcement immediately following the desired behavior Be consistent Mst be meaningfl to the client Client shold not get the reinforcer nless the desired behavior occrs Reinforcers shold be short-term Distraction and Diversion Distraction reqires staff to shift the client's attention away from the distrbing behavior to a more acceptable one Especially sefl when yo cannot ignore the behavioral distrbance Replacing Disrptive Behaviors An effective way to end a behavioral distrbance is to replace it with a more desirable behavior The type of behavior that yo want to change will tell yo what kind of activity yo can se as a sbstitte Rosehaven Program 10

26 Creating a Therapetic Relationship Non-Verbal Commnication and ADL Care Object Ceing Visal Recognition Recognition Throgh Toch Use of Symbols and Personal Belongings Meaningfl Symbols Belongings that stimlate affective memory Rosehaven Program 11

27 Creating a Therapetic Relationship Toch or Gestres Helpfl to focs attention Provide a Role Model Use of Hmor Concrete Abstract Use of Msic 60 beats per minte Individalized Cltrally appropriate Rosehaven Program 12

28 Creating a Therapetic Relationship Direct Physical Assistance Hrdle Help Hand Over Hand Seqencing Total Assist Smmary Therapetic caregiving reqires knowing and nderstanding the client and adjsting yor interactions. Commnication skills are easy to se and very helpfl in redcing behavioral distrbance. Use these verbal, non-verbal, and written skills at all times. Smmary Verbal prompts, annoncements, providing choice, and positive reinforcement help to prevent difficlt to manage behaviors. What is meaningfl for one individal may not be for another! Rosehaven Program 13

29 Creating a Therapetic Relationship Smmary Providing activities is an effective way to prevent behavioral distrbances. Distracting the client and replacing behaviors are often necessary to redce behaviors that are already present. There are many valable tools yo can se to assist with ADL care. Rosehaven Program 14