Relational counselling as a psychosocial intervention for dementia: Qualitative evidence from people living with dementia and family members

Abstract

Counselling and other psychotherapeutic interventions can be offered to people with dementia and their caregivers, to treat specific conditions or symptoms (e.g. affective disorders such as depression). Psychotherapeutic interventions also offer the opportunity for individuals with dementia and their families/caregivers to engage in psychological support for a wide range of presentations. However, little is known about how those within this demographic who receive these interventions perceive the experience. This study aimed to understand the experiences of individuals with dementia or caring for someone with dementia, before and after a 12-week relational counselling intervention delivered through a third sector organisation within England. Semi-structured interviews were completed with participants (29 pre-intervention and 25 post-intervention). Framework analysis was conducted, with four main themes identified; expectations and outcomes of counselling, emotional impact of life with dementia, appraisals of identity and importance of therapeutic relationship. Participants reported that counselling interventions addressed a range of needs and concerns that they had, enabling them to reassess and reconsider these. Specific training is needed before therapists deliver therapeutic interventions with people with dementia, to ensure that appropriate support is provided for those with more severe cognitive impairment or who may have fluctuating capacity. Future research should explore the experiences of people with dementia and their caregivers, across different counselling modalities, to establish the appropriateness and effectiveness of relational counselling.

Delivering effective counselling for people with dementia and their families: Opportunities and challenges

“…Themes developed from discussion with the service counsellor and co-ordinator emphasised the importance of therapist attributes in nurturing such a relationship, with importance placed on practice philosophy and capacity to appreciate the lived experience of their clients. This was also highlighted by clients who expressed their comfort in disclosing information, and viewed the therapist as an impartial listener (Griffiths et al, 2020). Based on this philosophy, a reciprocal therapeutic connection, one that involves open communication from the client and understanding from the counsellor, is central to the effectiveness of the intervention.…”

“…Practitioners should also be mindful of practical and psychological barriers for family carers to engage in a therapeutic relationship. Individuals may feel cautious about disclosing unwanted feelings associated with the caregiver role such as resentment or guilt, for fear that this may reflect negatively on their relationship with their relative (Griffiths et al, 2020). Such feelings may affect a person's commitment to counselling and should be addressed, not only by counsellors at the start of the intervention, but also by referring services.…”

“…Participants were mainly female (n = 24) and identified as White (British, Irish or other, n = 30). Concurrent interview data from individuals with dementia and family carers reflecting on their experiences of the intervention and its impacts are reported in Griffiths et al (2020).…”

“…Previous work with this client group has explored the role of counselling in facilitating acceptance of their situations (Griffiths et al, 2020), a process which the counsellor described as a pivotal step towards coping with the impact of dementia. In her interview, she suggested that the prospect of accepting a trajectory towards declining health and end of life was a difficult subject to address with her clients.…”

“…The study findings are limited due to the involvement of a single therapist in the intervention delivery. However, the exploratory nature of this work triangulates evidence of the acceptability of counselling for people with dementia from the perspectives of the therapist, service co-ordinator and clients (see also Griffiths et al, 2020).…”