What Mental Health Providers Do Not Tell You about Why Residents in Long Term Care Are So Depressed

Forward-looking long term care administrators have				We undergo waking hypnosis all the time e.g. in the
long pondered how to eliminate the dejection and				theatre when an endearing character dies we may
malaise that infests their facilities. They have heard				cry and feel hopeless; if our parents continually told us
about culture-change and tried various solutions: staff				how stupid we were, we may grow up actually feeling
wearing regular clothes, pleasant bird cages, providing				stupid. THE SAME SITUATION can be perceived
more resident options and meetings about				differently by different people based on the story of
communication skills with the staff.				themselves that was internalized by repetitive
However, nothing seems able to generate the				pervasive conversations.
meaningful changes needed for a pleasant and more				One person is treated for cancer and describes the
optimistic environment.				therapeutic experience as miserable and the worst
How Do You Transform Long Term Care from Being				time in my life. Another describes it as just a difficult
A Festering Incubator of Malaise and Hopelessness to				challenge.
Becoming an Uplifting Gallery to Resident Achievement				Both had almost identical experiences and walked
and Accomplishment?				away with vastly different interpretations, stories and
I have practiced clinical psychology for 30 years and				feelings. We learn thru repetition. Repeated
treated hundreds of elderly patients for depression and				suggestions and conversational themes associated
anxiety. I have concluded that insidious communication				with emotionally charged experiences are powerful in
patterns within long term care facilities themselves are				crafting a certain role for a resident in a particular
often at fault.				story.
These, combined with the out-dated techniques used				The residents internalized story can change over time
by the mental health providers they use, inadvertently				because it is contingent on the type of consistent
create the conditions which cause residents to be				interactions in which s/he is engaged. Interactions or
even more depressed and dejected.				conversations need not be verbal, but are often
There is a growing concern that the only mental health				composed of nonverbal components. A nurse who is
care residents often get is from geriatric psychiatrists				gruff in manner is sending the suggestion that the
who often miss the feelings they experience about				resident is a pain or perhaps inept. Every interaction
their plight. Just write a prescription, maybe tell them				with a resident should be seen as resulting over time in
how their thinking processes are distorted, check in				a better or worse outcome for the residents felt
occasionally and see you later.				sense of self.
The use of medication is often the only treatment a				Strength-Embedded Psychotherapy starts to treat
resident receives, even though the research literature				resident depression and anxiety by using asset mining,
clearly and consistently emphasizes that it must be				a method of sensitively, yet tenaciously, unearthing any
combined with psychotherapy to achieve optimal				improvements, large or small, that can be credited to
outcome.				the resident. Then s/he implements the skillful use of
However, many psychologists use pathology-driven				conscious conversation: manifesting attention, imbuing
psychotherapy in their treatments. They build and				constructive meaning and significance to resident
expand on the problems and repeated complaints of				suffering and replacing problem-saturated
the resident thereby encouraging their impact on his				conversations with strength and progress saturated
her awareness. They often contribute to the lack of				ones.
significance and de-humanization residents feel				These techniques are reinforced by the long term
because their approaches are often too impersonal,				care staff and are used over time with repetition and
mechanistic and dismissive. Consequently, resident				consistency. The therapist then incorporates them
losses continually loom larger in consciousness.				deftly in the residents internalized story, occasionally
They generate impersonal case histories, which fail to				over his/her objections, so that the new plot can be
illuminate each individual's experience in the struggle to				internalized and eventually changed from one starring
survive illness. Residents, too, increasingly complain				resident victimization to one showcasing mastery.
about this crisis of having no meaning-nothing to live				Throughout the process, the resident will often
for.				tenaciously attempt to revert to saturating
This underscores the need for a cutting-edge mental				conversations with problems and references to
health program that addresses meaning obtained by				victimization. The resident craves continuity of the
the resident from his/her travails and his/her strengths				problem-saturated story which s/he has internalized.
and successes, no matter how small. This dignifies him				After all s/he has depended upon it, often at great
her. After all, that is what culture-change is all about!				emotional cost, for a consistent sense of identity.
What Most Mental Health Providers Do Not Know				However, with consistency and over time, the new
about How Residents in Long Term Care Become So				trance starts to take effect with the resident
Depressed				experiencing him/herself as masterful and potent,
Conventional mental health providers miss the point				rather than miserable and hopeless.
that the resident makes sense of his/her world by				Compare SEP-strength-embedded psychotherapy
creating a coherent facility persona by subconsciously				with the usual pathology-focused techniques of most
crafting a particular story and role for him/her in it. We				mental health providers. Talk to a resident for 15
have all seen the abandoned residents, betrayed				minutes; just write a prescription and follow-up
residents, and the ostracized residents. When we see				occasionally. If you are a psychologist, tell them how
no objective verification, we conclude that they are the				their thinking processes are distorted. Then over-use
result of internal dramas that the residents are really				empathy to the point that the resident is repeating the
feeling and living which have been created by				same miseries and complaints over and over to the
inadvertent, though insidious, hypnotic processes taking				point that they loom ever larger in consciousness.
place in the facility itself.				These pathology-driven treatments continue to infest
Just like the stage hypnotists subject really feels like				long term care with dire results. They build on the
and becomes a barking dog, the facility resident				problems of the resident and build their impact on his
becomes and feels like a victim drowning in his/her				her awareness. They often contribute to their
own tragedy. Therefore, the residents hopeless story,				insignificance and de-humanization because they are
though not necessarily a FACT, becomes one.				impersonal, mechanistic and dismissive. Consequently,
And unfortunately the screaming misery that results				resident losses continually loom larger in consciousness.
becomes the biggest FACT of all!				The train to culture-change is moving faster. Not
Implications For Your Facility:				changing your mental health provider to one who
This insidious waking hypnosis is induced by repetitive				emphasizes strength and success-based approaches
problem-saturated conversations taking place in the				can put you in danger of being perceived as an
facility. THAT IS Right! The CNAs, nurses, therapists,				uncaring dinosaur later. On the other hand,
families, doctors and residents themselves unknowingly				enthusiastically adopting it now can position you as a
collude, by their use of various interactions and words,				forward-looking pioneer who is contributing to the
to create a reality which is catastrophic, demoralizing				historic changes taking place in the long term care
and futile.				industry.

Lapsi

What Mental Health Providers Do Not Tell You about Why Residents in Long Term Care Are So Depressed