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The Psychodynamics of Dementia (3/5): Supporting Family Carers

Powerful projections, loss of recognition, longstanding relationship dynamics: caring for a family member with dementia is a complex emotional task. In the third part of her blog series coinciding with Alzheimer’s Month, psychotherapist and author Dr Esther Ramsay-Jones looks at how psychotherapy can help carers understand their own feelings, and the communications of the person with dementia

 

Being an informal carer of someone with dementia – whether he or she is a parent, a spouse or a sibling – can be exhausting, both physically and emotionally. Often a carer will notice that each day is filled with new anxieties and urgencies, and that there is little room for thinking about what might be taking place in the relational field.

Becoming a carer can, for some, build on a tendency towards caring – this might follow a good experience of parenting, working in the context of care or simply having made long-standing commitments to care in a marriage.

However, for others, caregiving might be a challenge too far. For instance, a client now responsible for caring for the person with dementia might have historically, and unconsciously, inhabited the care-recipient role: this is particularly true of parents and children. A child might also have had a poor experience of maternal or paternal care, and so the role of caregiving will possibly be underpinned with feelings of resentment, or even a desire, far beneath the surface, for power or retribution. It is possible that, in conjunction with the therapist’s non-judgemental reverie, a client may be able to investigate some of these more hateful feelings, allowing him or her to continue to care without the pull to act on them.

Family carers can be supported to understand the patterns of separation anxiety in a person with dementia, to gently prompt someone’s memory without recourse to infantilisation, to use music to draw someone out, to calm, to engage.

But it is likely that at times they will be in receipt of some powerful undigested projections from the person they are caring for. The frustrations of not being able to find words to articulate experience, or the worry that greater dependency may evoke, mean that a person with dementia could begin to communicate his distress behaviourally. Caregivers then have the task of translating the communications. The intensity of regularly taking in raw feelings, and finding meaning in them, can be hard work.

A therapist can support this process each week, by offering a containing space for the client in which her feelings can be thought about. It will be hoped that she can go back to the caring work, with a model of reflection in her mind, which can be drawn upon to tolerate and process all those more difficult communications of the person she is caring for.

Finally, a particularly painful aspect of dementia is when someone begins to struggle with recognition, at least of a factual sort. A person with dementia might forget his son’s or his wife’s name, for example. It is important to acknowledge how saddening this can be for a caregiver, though it is equally important to investigate whether the client is able to recognise the subjectivity of the person with dementia, his or her continued agency, playfulness and humour.

Therapy can help caregivers to become more comfortable with their own emotional, intuitive repertoire, their own capacity for spontaneity and play, which will often create connection with the person with dementia and can even enable caregivers to recognise that someone with dementia, in the more advanced stages, is also engaging with the world in this way.

But though good connections can still be maintained, there is also a great deal of mourning work involved in therapeutic sessions with caregivers, as they bear witness to the shifts and changes and losses that their husband, wife, or parent undergoes.

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Esther Ramsay Jones

Dr Esther Ramsay-Jones is a specialist psychotherapist in palliative care. She has conducted psychoanalytically informed research, and observations, in the field of dementia care, and her grandmother died of Alzheimer’s disease. Her book, Holding Time: Human Need and Relationships in Dementia Care, will be published by Free Association Books on 30 September.

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