Their Caregivers, and Health Care Providers Sherry L.M. Merriam - - PowerPoint PPT Presentation
Power Tools for People with Chronic Illness, Their Caregivers, and Health Care Providers Sherry L.M. Merriam Adler Graduate School In Partial Fulfillment of the Requirements for the Degree of Master of Arts in Adlerian Counseling and
Power Tools for People with Chronic Illness, Their Caregivers, and Health Care Providers
Sherry L.M. Merriam Adler Graduate School
In Partial Fulfillment of the Requirements for the Degree of Master of Arts in Adlerian Counseling and Psychotherapy
illnesses that are prolonged do not resolve spontaneously are rarely cured completely and may involve some type of long-term disability that
is irreversible.
(National Center for Chronic Disease Prevention and
Health Promotion, 2000).
The health problem can be stabilized and controlled,
but the affected individual cannot expect to return to the level of health enjoyed before the onset of the illness.
(National Center for Chronic Disease Prevention and
Health Promotion, 2000)
all aspects of life are interrelated
symptoms can exacerbate physical pain
Social interest & social embeddedness Identifying and using your team Encouragement Exercise 1: Sharing & Listening
Social interest for providers Encouragement vs. sick-role Encouragement & self-efficacy Self-management Exercise 2: Setting Your Goals
Conclusion Q&A and discussion
Who’s here?
Sense of belonging “To see with the eyes of
another, to hear with the ears of another, to feel with the heart of another” (Ansbacher, H. L., & Ansbacher, R. R. [Eds.], 1956.)
Encouraged Discouraged
High social interest Feelings of belonging Low social interest Feelings of inferiority
access to social support increases the
likelihood of positive outcomes when dealing with health issues (Cohen, 1988; Gentry & Kobasa, 1984).
lack of social support is predictive of
long-term disability (Johansson & Lindberg, 2000).
The adequacy of social support and the quality of the
relationship between patient and health care provider affect your confidence, and therefore your ability to achieve positive outcomes (Sperry, Lewis, Carlson and Englar- Carlson, 2005).
managing social
relationships can be made more difficult by illness-related behavioral limitations
individualism communalism
Dominant US culture Independence, self-reliance Illness is the responsibility of
the individual
Some other cultures Emphasis on community Illness is the responsibility of
the community
Caregivers, including partners, family, friends, etc. Healthcare providers Patients Social support
Partner or spouse Family Friends Society/Community/Culture
Working with your healthcare providers
Express your needs Ask questions Repeat instructions received Be candid
Working with your social relationships
Get support for your goals
Working with your social relationships
Understand what it is like for them “Two ears and mouth” Reciprocate
Working with your social relationships
Accept changes in your social system Find ways to make social time
Working with your social relationships
Getting the help we need, not the help they think we
need.
Communication
Be direct Ask for what you need Avoid being passive or manipulative
If one of you has an illness, both
Make your relationship solid Encourage each other and
acknowledge each other’s efforts
Treatment is a joint effort
family support is an important component in recovery
(Roback, 1984; Turk & Kearns, 1985, Friedman & DiMatteo, 1989)
The family’s success in adapting to the challenges of the
disease may have a major affect on the individual’s success with self-treatment (Hendrick, 1985).
Go to appointments together
They learn your limitations They help you remember your
questions and experiences
They participate and take
They provide support and
encouragement
Encouraged Discouraged
High social interest Feelings of belonging Low social interest Feelings of inferiority
positive feedback that focuses primarily on effort or
improvement rather than outcomes.
not praise, reward, or language used to gain
compliance (Evans, 1989).
THE LANGUAGE OF ENCOURAGEMENT (Evans, 1995, Dreikurs, Grunwald, & Pepper, 1982) Encouragement “I think you can do it.” “You have what it takes.” “You’re a hard worker.” “What do you think?” “I could use your help.” “It looks like a problem occurred. What can we do to solve the problem?” Discouragement “Here, let me do that for you. “Be careful; it’s dangerous.” “Don’t forget your assignment.” “Let me give you some advice.” “When you’re older, you can help.” “I told you to be careful.” Encouragement “You put a lot of effort into your work.” “You’re a fine person.” “I know you did your best.” Praise “I’m proud of you when you do well.” “You did better than anyone else in the class.” “Next time, if you work harder, I know you can get an A instead of a B+.”
SHARING & LISTENING
You will choose a partner, preferably someone you do
not know.
If you don’t have a partner, you will raise your hand. You will each get five minutes to share your story.
People with illness or disability: What are you dealing
with? How does it interfere with your daily life? What challenges have you already overcome?
Caregivers: Who are you caring for? How do you help
them? How does it interfere with your daily life? What challenges have you already overcome?
Healthcare providers: What kind of health care do you
provide? What challenges do you face? What have you already overcome?
Active listening skills Give encouragement Don’t fix, suggest, or advise – for now.
Respect the right to privacy: What is said here, stays here.
You will choose a partner, preferably someone you do
not know.
If you don’t have a partner, you will raise your hand. You will each get five minutes to share your story.
People with illness or disability: What are you dealing
with? How does it interfere with your daily life? What challenges have you already overcome?
Caregivers: who are you caring for? How do you help
them? How does it interfere with your daily life? What challenges have you already overcome?
Healthcare providers: what kind of health care do you
provide? What challenges do you face? What have you already overcome?
You can use these tips, and/or teach your own healthcare providers. Increase compliance and outcomes through trust.
Use your patient’s learning style. Make sure your patient is able to listen and learn. Instead of talking at a patient, engage them. Resistance is a misalignment of goals. Build relationships with other providers for case
management.
Help your patients build social interest using the
principles we have discussed.
A kind of
discouragement
Feelings of helplessness,
inability to contribute or take care of self
Soliciting attention for
illness behavior
A tempting trap Others can contribute We can find other avenues to significance and
meaning.
Caregivers
Encouragement Support without reinforcing sick-role behavior
Healthcare providers
Avoid recommending excessive tests and treatments
People with illness
Ask your team for encouragement Develop your communication, problem-solving,
relationship skills
Manage your expectations– Is it good enough? Don’t sweat the small stuff The Serenity Prayer
God, grant me the serenity to accept the things I cannot
change,
The courage to change the things I can, And the wisdom to know the difference.
Focus on managing the problem, instead of on having
the problem
Reality is as you perceive it. You can choose your thoughts and emotions. Determine your own meanings Establish the new normal Use patience and a sense of humor
Self-efficacy: a person’s belief that they
can handle the challenges that life throws at them (Bandura, 1977; 1997).
Related to the feeling of control (Sperry,
et al., 2005).
If you feel like you can do it, you are
more likely to achieve it than if you feel like you cannot (Ajzen, 1988; Bandura, 1977)
higher self-efficacy less disability, less pain, better
Romano, 1994; Turk, 1996; Silverman, 2001; Turk & Feldman, 2000; Gatchel & Turk, 1999).
higher efficacy decreases stress, and lower stress is
better for your body. (Sperry, et al., 2005).
Count your resources/blessings Have “the courage to be imperfect” (Dreikurs, cited in
Terner, Pew, and Aird, 1978).
Exercise power over what you think and feel
Manage your Self-talk: those messages we go through in
Remember your achievements Practice gratitude
Before your appointment
Write down your questions And your comments or concerns Document your symptoms Update your list of medications
At your healthcare office, note:
The date and provider’s name The professional opinions The treatment plan The answers to your questions
Have someone fill it in for you, if needed
Flareup: when your illness or pain returns or worsens
A difficult, but necessary, time to make decisions
Protocol: a guideline for treatment
You write it when you are healthier, so you can use it
when you need it.
Increase your feelings of control and self-efficacy
(Sperry, et al., 2005).
Fully investing yourself in problem solving, welcoming
challenge and change, gives you more power to cope and achieve positive outcomes (Kobasa, Maddi, & Courington, 1981).
Negative cycle Positive cycle
I feel bad physically I can’t do anything about it I feel bad emotionally
I feel bad physically
I take positive steps
I feel better physically
Be an active participant in managing your life and
relationships
Take charge of personal issues like job dissatisfaction,
substance abuse, relationship problems, depression or anxiety
People in psychological pain express more physical pain
(LaFountain, 2011).
Facing the things in life that you do not want to will
change your pain (B. A. Schumacher, personal communication, September 27, 2012).
Look after your health
Engage in health prevention Change health risk behaviors such as smoking, high
cholesterol diet, and lack of exercise
Be an active participant in your healthcare
Everything you have
to give up, replace it with something else.
Focus on what you
can do, instead of what you can’t do.
Be creative in your
problem-solving.
stress and the way people cope with stress play
important roles in health outcomes
sometimes we deny or avoid stress, but this isn’t the
same as coping.
getting enough sleep Stress itself has negative physiological effects, even for
healthy people.
relaxation, mindfulness, meditation, breath control,
yoga, tai chi, etc.
helpful for stress management and relaxation, for a
sense of empowerment, and finding communities that provide social support and encouragement.
there are plenty of resources out there
SETTING YOUR GOALS
You will work with your partner again. If you don’t have a partner, you will raise your hand. You get five minutes to work on each set of goals. You will take turns
Share three or more changes you want to make, from
all the ideas we talked about
Write them down in your notes If you wrote more than three, put a * by the three most
urgent or important
What obstacles do you anticipate getting in the way?
How can you overcome them?
Brainstorm with your partner
If needed, help your partner brainstorm goals for their
list
Suggest resources Just lend a hand; you don’t have to have all the answers Encourage your partner, verbally and in writing
Talkers Listeners
Share 3+ changes you want to
If you wrote more than three,
* the three most urgent or important
What obstacles do you
anticipate getting in the way?
How can you overcome them? Brainstorm with your partner If needed, help your partner
brainstorm goals for their list
Suggest resources Just lend a hand; you don’t
have to have all the answers
Encourage your partner,
verbally and in writing
Review Further Resources Q&A Discussion
Social interest & social embeddedness Identifying and using your team Encouragement Exercise 1: Sharing & Listening
Social interest for providers Encouragement vs. sick-role Encouragement & self-efficacy Self-management Exercise 2: Setting Your Goals
health-focused counseling and/or health-focused
psychotherapy
When you get stuck on issues
for patients and caregivers
Living with Pain: A New Approach to the Management of
Chronic Pain, by Richard L. Reilly, D.O.
The Pain Survival Guide: How to Reclaim Your Life, by
Dennis W. Turk, PhD, and Frits Winter, PhD
Explain Pain, by David Butler and Dr. Lorimer Moseley Living a Healthy Life with Chronic Conditions: Self-
Management of Heart Disease, Arthritis, Diabetes, Asthma, Bronchitis, Emphysema and Others, by Lorig, et al.
You Can Heal Your Life, by Louise L. Hay (see also her other
works)
for healthcare professionals:
Patient Education for Common Chronic Diseases: Chronic
Disease Patient Education Manual
Health Promotion and Health Counseling: Effective
Counseling and Psychotherapeutic Strategies, by Sperry, Lewis, Carlson, & Engler-Carlson
for everyone
Difficult Conversations: How to Discuss What Matters Most,
by Douglas Stone, et al.
Making Good Use of Illness: an Adlerian Approach to Chronic
Illness, by Louise Giroux (out of print, hard to find)
online tool to deal with pain, by the Penny George Institute
for Health and Healing: www.allinahealth.org/georgeinstitute
Family Caregiver Alliance, National Center on Caregiving –
caregiver.org
join a support group, and/or find a website about your
illness
Alzheimer’s/dementia caregivers: www.alz.org/mnnd North American Society of Adlerian Psychology:
http://www.alfredadler.org/alfred-adler
chronic pain programs in the Twin Cities Other?
Ajzen, I. (1988). Attitudes, personality and behavior. Chicago: Dorsey Press.
Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1956). The individual psychology of Alfred
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Bulletin, 84, 191-215.
Bandura, A. (1997). Self-efficacy. New York: Freeman.
Cohen, S. (1988). Psychosocial models of the role of social support in the etiology of physical disease. Health Psychology, 7, 269-297.
Dreikurs, R., Grunwald, B., & Pepper, F. (1982). Maintaining sanity in the classroom. New York: Harper & Row.
Evans, T. (1989). The art of encouragement. Athens, GA: University of Georgia, Center for Continuing Education.
Evans, T. (1995). The encouraging teacher. In G.M. Gazda, F. Asbury, M. Blazer, W. Childers, & R. Wallers (Eds.), Human relations development (5th ed.), 261—69. Boston: Allyn & Bacon.
Friedman, H. S., & Booth-Kewley, S. (1987). The disease-prone personality: A meta- analytic review of the construct. American Psychologist, 42, 539-555.
Friedman, H. S., & DiMatteo, M. R. (1989). Health psychology. Englewood Cliffs, NJ: Prentice-Hall.
Gatchel, R., & Turk, D. (1999). Psychological factors in pain: Critical perspectives. New York: Guilford.
Gentry, W. D., & Kobasa, S. C. O. (1984). Social and psychological resources mediating stress illness relationships in humans. In W. D. Gentry (Ed.), Handbook of behavioral medicine (pp. 87-116). New York: Guilford.
Hendrick, S. S. (1985). Behavioral medicine approaches to diabetes mellitus. In N. Schneiderman & J. T. Tapp (Eds.), Behavioral medicine: The biopsychosocial approach (pp. 509-531). Hillsdale, NJ: Erlbaum.
Jensen, M. P., Turner, J. A., & Romano, J. M. (1994). What is the maximum number of levels needed in pain intensity measurement? Pain, 58, 387-392.
Johansson, E ., & Lindberg, P. (2000). Low back pain patients in primary care: Subgroups based on the Multidimensional Pain Inventory. International Journal of Behavioral Medicine, 7, 340-352.
Kobasa, S. C., Maddi, S. R., & Courington, S. (1981). Personality and constitution as mediators in the stress-illness relationship. Journal of Health and Social Behavior, 22, 368-378.
LaFountain, R. M. (2011). Psychological and physical pain: Two sides of the same coin. Paper presented at the meeting of North American Society of Adlerian Psychology, Victoria, British Columbia, Canada.
National Center for Chronic Disease Prevention and Health Promotion (2000). Chronic diseases and their risk factors: The nation’s leading causes of death, 1999. Washington, DC: Author.
Roback, H. B. (Ed.). (1984). Helping patients and their families cope with medical
Silverman, J. T. (2001). Catastrophizing and coping with chronic pain. Dissertation Abstracts International, 61(9-B), 0419-4217.
Sperry, L., Lewis, J. A., Carlson, J., & Englar-Carlson, M. (2005). Health promotion and health counseling: Effective counseling and psychotherapeutic strategies. Boston: Pearson/Allyn & Bacon.
Turk, D. (1996). Psychological aspects of chronic pain and disability. Journal of Musculoskeletal Pain, 4, 145-153.
Turk, D., & Feldman, C. (2000). A cognitive-behavioral approach to symptom management and palliative care: Augmenting somatic interventions. In H. Chochinov &
York: Oxford University Press.
Turk, D. C., & Kerns, R. D. (Eds.). (1985). Health, illness, and families: A lifespan
Terner, J. R., Pew, W. L., & Aird, R. A. (1978). The courage to be imperfect: The life and work of Rudolf Dreikurs. New York: Hawthorn Books.
“In the depths of winter I finally learned that there is within me an invincible summer.” – Albert Camus
Thank you all for participating, and gratitude also to: Marina Bluvshtein, PhD Daniel A. Haugen, PhD Trish Fitzgibbons Anderson, MA Rebecca K. Facer, MSW, LICSW Patrick Robinson, MA & the AGS Alumni Association The staff at the Adler Graduate School My Tai Chi family at Normandale Community College Michael Merriam My colleagues, family, and friends