Assimilation of problematic voices within psychotherapeutic work with people with dementia

This paper presents an outline of how the Assimilation of Problematic Voices model (APV) can be used as a framework to understand change in awareness of people with dementia. APV is a dialogical model of change developed within psychotherapy process research. Within this framework, the concept of dementia can be understood as being psychologically problematic for people affected by the illness in the sense that the existential threat of dementia prevents an easy assimilation into the person’s existing self-concept. Successful assimilation is viewed as the result of a process that involves a series of conversations between a Dominant Voice, typically asserting a continuation of the status quo, and a Problematic Voice or voices which articulates emotionally difficult material. This process of assimilation is illustrated through accounts given by people with dementia about their illness within psychotherapy groups run by the author. Representing the accounts of people with dementia in this way is important as it enables a fine grained analysis of changes in expressed awareness, including those that occur during psychosocial interventions, such as psychotherapy or counsellin

A feasibility study of translating “Living Well with Dementia” groups into a Primary Care Improving Access to Psychological Therapy service (innovative practice)

© 2016, © The Author(s) 2016. This paper describes the use of the “Living Well with Dementia” or LivDem model of group support for people affected by dementia within a Primary Care setting. Five people affected by dementia and their carers joined a 10-week group, although one man withdrew before the start due to illness. Joint sessions were held on the first and the final meetings, with separate parallel group sessions for people affected by dementia and their carers for the remaining eight sessions. One person affected by dementia and their carer withdrew due to illness before the end of the sessions. A self-report measure of Quality of Life suggested improvements for two of the three people affected by dementia who completed all of the sessions. The proxy ratings of carers indicated improvements for all three participants. Qualitative interviews were carried out with participants and carers to assess their experience of the group. Although both people affected by dementia and their carers found the LivDem intervention helpful, concerns remain about the continued need for support by a Dementia specialist

Does personal experience of dementia change attitudes? The Bristol and South Gloucestershire survey of dementia attitudes

Background: it is unclear how attitudes towards people with dementia are formed and whether, for instance, increased contact with people with dementia, either through work or personal experience alters attitudes. This study used a validated questionnaire (the Approaches to Dementia Questionnaire or ADQ) to examine whether having experience of dementia (either as a result of work, or by being affected by dementia) is associated with differences in attitudes towards dementia.Methods: a modified version of the ADQ was completed by 2,201 participants, either on-line or in written form. Participants also recorded their age, gender and ethnicity as well as whether they worked with people with dementia, or had been personally affected by dementia.Results: increased contact with people with dementia was associated with increases in both total ADQ scores and across both sub-scales reflecting more positive person-centred attitudes toward dementia. The highest levels of increase were found amongst non-white participants.Conclusions: this study is, we believe, the first attempt to look systematically at whether greater contact with people with dementia is associated with changes in attitudes. The results strongly support the contention that increased contact with people with dementia leads to more person-centred attitudes, and by inference, less stigmatising views

Re: An investigation of public attitudes towards dementia in Bristol and South Gloucestershire using an online version of the Approaches to Dementia Questionnaire

Letter accepted for publication in the International Journal of Geriatric Psychiatr

Individual and group psychotherapy with people diagnosed with dementia: a systematic review of the literature

Copyright © 2016 John Wiley & Sons, Ltd. Objectives: Psychotherapy provides a means of helping participants to resolve emotional threats and play an active role in their lives. Consequently, psychotherapy is increasingly used within dementia care. This paper reviews the existing evidence base for individual and group psychotherapy with people affected by dementia. Design: The protocol was registered. We searched electronic databases, relevant websites and reference lists for records of psychotherapy with people affected by Alzheimer's Disease, Vascular dementia, Lewy-body dementia or a mixed condition between 1997 and 2015. We included studies of therapies which met British Association of Counselling and Psychotherapy definitions (e.g. occurs regularly, focuses on talking about life events and facilitates understand of the illness). Art therapy, Cognitive Stimulation and Rehabilitation, Life Review, Reminiscence Therapy and family therapy were excluded. Studies which included people with frontal–temporal dementia and mild cognitive impairment were excluded. Data was extracted using a bespoke form, and risk of bias assessments were carried out independently by both authors. Meta-analysis was not possible because of the heterogeneity of data. Results: A total of 1397 papers were screened with 26 papers using randomised, non-randomised controlled trials or repeated measured designs being included. A broad mix of therapeutic modalities, types, lengths and settings were described, focussing largely on people with mild levels of cognitive impairment living in the community. Conclusions: This study was limited to only those studies published in English. The strongest evidence supported the use of short-term group therapy after diagnosis and an intensive, multi-faceted intervention for Nursing Home residents. Many areas of psychotherapy need further research. Copyright © 2016 John Wiley & Sons, Ltd

The ADAPT Study: Adapting the dementia care pathway for south Asian families in the UK

The ADAPT study got started because there were so few culturally appropriate dementia resources for South Asian families. Sahdia Parveen and colleagues describe the toolkit created by the study to help families navigate the system

Evidence briefing: Psychological therapies with people with dementia

The aim of this document is to provide an overview of the evidence base for psychological therapies with people with a diagnosis of dementia and their families. This briefing paper aims to summarise research and clinical evidence in this area and to aid commissioners and other stakeholders to shape the service landscape. It is not intended to be read as a set of recommendations for practitioners

Special education leavers in Central Scotland: a socio psychological perspective

The principal aim of this thesis is to examine the reasons that special education leavers with a mental handicap give for their labelling. The thesis consists of three parts. In the pilot study seven trainees at an Adult Training Centre were interviewed between March and April 1985. Six of these trainees were reinterviewed between November 1986 and January 1987. In the second part of the thesis, the normative study, a survey was carried out which established the employment history of 80 of the 105 leavers from a special school and a special unit between 1982 and 1985. The normative study also established that at least 35 of the 60 leavers on whom it was possible to gather information had been the victims of informal labelling. In the final part of the thesis, the ipsative study, eleven special school and special unit pupils were interviewed. The first interviews were carried out in the term before the participants left school in 1985. The final interviews were conducted at the end of the participants’ first year after leaving school, in January 1987. I argue that the leavers that I interviewed actively interpreted labelling and produced often quite detailed and complex explanations. For the leavers these explanations served the function of limiting the extent to which they were personally responsible for their placement in a special school or a special unit

Markers of assimilation of problematic experiences in dementia within the LivDem project

© 2015, © The Author(s) 2015. This study aimed to determine whether the Markers of Assimilation of Problematic Experiences in Dementia scale (MAPED) can be used to identify whether the way in which participants talk about dementia changed during the group. All eight sessions of a LivDem group, which were attended by participants were recorded and transcribed. An initial analysis identified 160 extracts, which were then rated using the MAPED system. Inter-rater reliability was 61% and following a resolution meeting, 35 extracts were discarded, leaving 125 extracts with an agreed marker code. All of the participants were identified as producing a speech marker relating to dementia, and these varied between 0 (warding off) to 6 (problem solution). Examples of these markers are provided. The proportion of emergence markers (indicating the initial stages of assimilation) compared to later markers changed significantly between the first four sessions and the final sessions. This difference was still significant even when the markers produced by the most verbal participant, Graham, were excluded. The use of process measures within psychotherapy complements more conventional outcome measures and has both theoretical and clinical implications

The dementia experiences of people from Caribbean, Chinese and South Asian communities in Bristol

This report is the product of an eight-month research project funded by Bristol City Council which set out to establish the dementia experiences and needs of people of Black and other Minority Ethnic (BME) origins. The study was overseen by the Bristol BME and Dementia research group, which was made up of representatives from Bristol and Avon Chinese Women’s Group, Alzheimer’s Society, the University of the West of England, Bristol City Council, Bristol Black Carers and Bristol Dementia Wellbeing Service (BDWS)