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
What is chronic disease? 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).
What is chronic disease? 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)
Holism • the belief that all aspects of life are interrelated • emotional symptoms can exacerbate physical pain
Overview: Section 1 Social interest & social embeddedness Identifying and using your team Encouragement Exercise 1: Sharing & Listening
Overview: Section 2 Social interest for providers Encouragement vs. sick-role Encouragement & self-efficacy Self-management Exercise 2: Setting Your Goals
Overview: Section 3 Conclusion Q&A and discussion
Overview Who’s here?
Alfred Adler & Adlerian Psychology
• What is social interest?
Social Interest 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.)
Social Interest Encouraged Discouraged High social interest Low social interest Feelings of belonging Feelings of inferiority
Social Interest: Why? 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).
Social Interest: Special Challenges managing social relationships can be made more difficult by illness-related behavioral limitations
Social Interest: cultural context individualism communalism Dominant US culture Some other cultures Independence, self-reliance Emphasis on community Illness is the responsibility of Illness is the responsibility of the individual the community
Caregivers, including partners, family, friends, etc. Healthcare providers Patients Social support Partner or spouse Family Friends Society/Community/Culture
Work with your team Working with your healthcare providers Express your needs Ask questions Repeat instructions received Be candid
Work with your team Working with your social relationships Get support for your goals
Work with your team Working with your social relationships Understand what it is like for them “Two ears and mouth” Reciprocate
Work with your team Working with your social relationships Accept changes in your social system Find ways to make social time
Work with your team 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
Patients & partners as a team If one of you has an illness, both of you have the illness. Make your relationship solid Encourage each other and acknowledge each other’s efforts
Patients & partners as a team 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).
Patients & partners as a team Go to appointments together They learn your limitations They help you remember your questions and experiences They participate and take ownership They provide support and encouragement
Advocate and educate
The aim of encouragement is “to increase an individual’s courage to meet the problems of life (Ansbacher & Ansbacher , 1956, p. 20)”
Social Interest Encouraged Discouraged High social interest Low social interest Feelings of belonging Feelings of inferiority
Encouragement is… 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 THE LANGUAGE OF ENCOURAGEMENT (Evans, 1995, Dreikurs, Grunwald, & Pepper, 1982) Discouragement Encouragement “Here, let me do that for you. “I think you can do it.” “Be careful; it’s dangerous.” “You have what it takes.” “Don’t forget your assignment.” “You’re a hard worker.” “Let me give you some advice.” “What do you think?” “When you’re older, you can help.” “I could use your help.” “I told you to be careful.” “It looks like a problem occurred. What can we do to solve the problem?” Praise Encouragement “I’m proud of you when you do well.” “You put a lot of effort into your work.” “You did better than anyone else in the class.” “You’re a fine person.” “Next time, if you work harder, “I know you did your best.” I know you can get an A instead of a B+.”
SHARING & LISTENING
Exercise 1: 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.
Talkers: What brought you here? 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?
Listeners: Just Listen! Active listening skills Give encouragement Don’t fix, suggest, or advise – for now.
Confidentiality Respect the right to privacy: What is said here, stays here.
Exercise 1: 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.
Talkers: What brought you here? 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?
Exercise 1: Sharing & Listening Great job!
You can use these tips, and/or teach your own healthcare providers. Increase compliance and outcomes through trust.
Social interest for providers 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.
The Sick Role and Illness Behavior A kind of discouragement Feelings of helplessness, inability to contribute or take care of self Soliciting attention for illness behavior
The Sick Role and Illness Behavior A tempting trap Others can contribute We can find other avenues to significance and meaning.
The Sick Role & Encouragement 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
Attitude & Expectations 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
Subjectivity 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
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