Family therapy and dementia: Review and clinical experience

Abstract

SUMMARYFamily therapy techniques have, until recently, had little impact on the development of old age psychiatry and the services provided. The literature on family therapy in relation to people with dementia and their families is reviewed and illustrated with results from a study of families coping with dementia who attended the York House Family Clinic. Similar therapeutic techniques were used with families coping with dementia as with those coping with other mental illnesses in later life, but some differences were found in the areas of discussion during sessions. Families coping with dementia were seen for fewer sessions, but more family members were present per session and sons and daughters-in-law were more likely to attend. The literature and various hypotheses which might explain these differences are presented and discussed. Further work in this area is needed, but our findings suggest that family therapy can be useful in work with dementia sufferers and their families, and can be offered within an old age psychiatry service.

Psicoterapia na idade adulta avançada

“…Uma grande parte das preocupações com que o adulto chega a uma terapia individual envolve outro elemento da família (por exemplo, a distância face aos filhos, desilusão face ao estilo de vida adoptado pelos filhos, depressão, perda de papéis, ansiedade em torno das capacidades de auto-cuidado e segurança). No que diz respeito aos modelos de ajuda psicoterapêutica na idade adulta avançada, a intervenção e a terapia familiar parece ser uma boa opção para situações de crise familiar cujo 'paciente identificado' seja um dos elementos mais velhos do sistema ou sempre que a família se mostre preocupada com o processo de envelhecimento, revelando dificuldade em aceder aos recursos internos do sistema (Alarcão, 2002;Benbow et al, 1993;Huckle, 1994;Mitrani & Czaja, 2000;Penn, 2001;Qualls, 1996Qualls, , 1999Qualls, , 2000Sousa et al, 2004;Zarit & Zarit, 1982). Uma família tem indicação para terapia familiar sempre que usa as mesmas estratégias face às diferentes mudanças, mostrando-se ineficazes para resolverem os problemas ou diminuir a ansiedade e stresse dos elementos da família.…”

Family therapy with elderly people

“…We use family therapy with families where functional illness leads to their contact with the service, often utilising family therapy alongside other therapeutic activities (Benbow et al, 1990).…”

“…Dementia is one chronic illness with repercussions for the whole family. We have reviewed our experience in this area (Benbow et al, 1993). We commonly involve the cognitively impaired family member in family meetings and often see families for a small number of sessions stretched out over a fairly long time course, sometimes years, as they struggle to adjust to the dementia sufferer's decline.…”

“…Controlling studies can be difficult and outcome measures are not well established, particularly when working with a family coping with a terminal illness such as a dementia. We have used team consensus ratings (Benbow et al, 1993) but these are blunt instruments and open to observer bias. We have also experimented with asking families to rate the outcome of their contact with the clinic.…”

Book Reviews

“…Perhaps the practicalities of therapy come into this: deafness can interfere with our conversations, speech problems do too, cognitive impairment may appear a bar to therapy (but isn't: Benbow et al, 1993), physical ill-health may lead to cancelled sessions, and work in the home setting can be an amazing experience for us as therapists.…”