Where is emotion in dementia? A psychodynamic observation. M Potts, S Petty, D Anderson

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Pauline Sherman
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1 Where is emotion in dementia? A psychodynamic observation. M Potts, S Petty, D Anderson Presented at the Institute of Mental Health Annual Research Day 12 th May 2015 Awarded Best Oral Presentation 1

2 The workplace two older adult challenging behaviour units one for males and one females, predominantly having a dementia diagnosis people requiring a hospital setting due to the complexity of presentation 2

3 Psychodynamic observation Qualitative observation 30 hours of reflective observations No directional hypotheses Exploratory question: where is the emotion in dementia? 3

4 Thematic analysis: Braun and Clarke (2006) 4

5 5

6 Three themes Disintegration Extreme fragmented emotions, without the necessary dialogue, avoidance. Seeking integration Seeking attunement with others, use of metaphor, grounding, fantasy. Integration The sense of a whole self that is ambivalent and thinking. 6

It isn t always easy to second guess what others are thinking or I don t find it easy and I must get it wrong all the time.

7 Disintegration The TV was the only sound I could hear as the rest of the unit it was quiet. I didn t feel quiet. My words can t be heard or understood so I tried to be understood through my face or my body language. It isn t always easy to second guess what others are thinking or I don t find it easy and I must get it wrong all the time. Conversations are sort of always laced with confusion. very strange, completely incongruent. I found it hard to concentrate on our conversation, what was around us just didn t make sense. I want to my feet firmly on the ground on one side of the fence. I was kind of trying to avoid being around people for too long. 7

To be someone s safety is a huge responsibility, not just their physical safety but their emotional safety like a rag doll, being hugged and loved one minute and then tossed aside or nipped and

8 Seeking integration We, me and the client, were doing it together, almost making up some kind of fiction together. I honestly started to feel a little resentful and maybe disappointed that the atmosphere wasn t what I expected; I kind of wanted the place to reflect how I felt a bit sad and mopey. To be someone s safety is a huge responsibility, not just their physical safety but their emotional safety like a rag doll, being hugged and loved one minute and then tossed aside or nipped and punched the next... Tears started to come to my eyes too and we just looked at one another for what felt like ages in reality it probably wasn t that long I felt like we were completely connected, only for a few moments. Wherever you were on the unit this afternoon you could hear music and smell paint, I found this soothing and kind of grounding in a way, I hope that was felt by others too. 8

9 Integration Conversations are sort of always laced with confusion. I feel like we muddle along together, always almost getting things wrong but just about getting it right I forget there is confusion most of the time, it doesn t feel important that conversations or interactions are not based on what makes sense and instead rely on an appreciation of just being. but in that moment at the window, with the clock reminding me of how slow time can be I felt sadness, or maybe not sadness but a sense that something wasn t quite right? And it might be not only confusing but irritating, the outside world not matching up with your inside world. At least I get to leave at some point and I m able to make sense of my experience, I can think, decipher what s mines and what s theirs and what s just lingering in the atmosphere. If I couldn t do this, madness would surely ensue. 9

10 The context There is a mixture of myth and truth about emotions becoming less salient and therefore less deserving of attention. If you allow yourself to notice, it is apparent that emotions are commonplace in dementia care. (e.g. Evans, 2008). Miesen (2004) describes the strange situation of dementia, where a person experiences feeling unsafe for long periods of time, powerlessness and having no structures to hold on to. We are contrasting the us and them narrative of patients being held separate, as different (Sheard, 2009). Relationship-centred care in dementia. 10

11 Thank you. 11

12 References Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), Evans, S. (2008). Beyond forgetfulness : How psychoanalytic ideas can help us to understand the experience of patients with dementia. Psychoanalytic Psychotherapy, 22(3), Miesen, B. M. (2004). Towards a psychology of dementia care: awareness and intangible loss. In G. M. Jones & B. M. Miesen. (Eds.). Care-giving in dementia: research and applications (Vol. 3). Psychology Press. Pp Sheard, D. (2009). Nurturing: emotions at work in staff. Alzheimer s society. 12

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