It is interesting that whenever someone asks me what population I work with, and I mention older adults, in my experiences the first thing many people then ask about has something to do with memory loss or dementia. It seems as though there is a widespread association between older individuals and memory loss. I have also encountered individuals who often assume that all of my clients have Alzheimer’s disease. In addition, in my experiences many people seem to then conclude that individuals with such memory loss, Alzheimer’s disease or other forms of dementia could not benefit from counseling. There is some truth in the connection between getting older and the onset of memory loss. Alzheimer’s disease, also, is a disease that is rapidly growing within our population and a cause that is near to my heart when it comes to volunteering and advocating. However I wanted to take some time in this blog to share my experiences with clients who do have memory loss, as well as client’s living with Alzheimer’s disease; experiences which demonstrate the positive impact counseling can have even with various levels of memory impairment.
Simply because an individual may suffer from some kind of memory impairment does not mean they do not face other challenges in life which cause them to deal with feelings of sadness, anxiety, or difficulty adjusting to new obstacles. The thing that has stayed with me the most throughout my short time working with older adults living with various forms of memory loss is that while discussed content, people, and events can be forgotten over time and even from day to day, feeling are forever strong and present. In my growth as I counselor, I have found these feeling to be an unbelievably powerful tool. I have had some heartbreaking moments as well in which the individual is left with feelings of sadness, anxiety or other uncomfortable emotions; however, they have no content to understand why they are feeling this way. It is important to remember that this is with clients living with more advanced memory loss; however nonetheless it provides a great example of the power of implicit feelings even in younger individuals with intact memories. If an older individual can reach a stage of memory loss that leaves him/her with little to no understanding of where they come from, who they are, or even aspects of the world around them, it is unbelievable that feelings of sadness, worry, anger, happiness, and even joy can persevere until that individual’s last breath. It is my belief that such lasting emotion alone demonstrates the possible benefits of counseling with individuals living with memory loss. The therapeutic tools and strategies utilized must be adapted and shaped to best work with memory loss. This is where the power of implicit feelings comes into play.
In my experiences counseling individual’s with various levels of memory loss, I have found another tool in the use of long term memories. The majority of clients I worked with living with memory loss often retain many of their long term memories from decades ago. Such long term memories have become a valuable tool for me as a framework for sessions with individuals with memory loss. It seems like a simple concept in theory, but in practice can be more difficult to implement. I have developed a method for structuring my sessions with individuals with memory loss to allow feelings of sadness, anxiety, or anger to be explored early on in our session. It is interesting because some may think that if the individual forgets content and short term memories then how can they work through such sadness, anxiety or anger if he/she does not recall where those emotions stem from? This was a question I struggled with as I started working with memory loss. It was difficult to navigate through such sadness, anxiety or anger especially because confusion would also set in when the individual did not understand why they felt such uncomfortable emotions. In my opinion, confusion is the most challenging emotion because it breeds fear. As a young counselor, to be witness to such life shaking fear in the voices and eyes of these older adults left me at a loss on many occasions. I found myself putting myself in their shoes, trying to imagine the utter confusion and fear of slowly losing the memory of each day and with time losing the concept of your loved ones and even the very person you are.
Sitting with various levels of this confusion and fear forced me to work on strategies for leaving these clients with some aspect of who they are. This is where long term memories became an invaluable tool. When the older adult was confused by their feelings of sadness, anxiety or anger, I would collaborate with him/her to remember salient long term memories for which they dealt with similar feelings. In doing this the clients seemed to feel relief to “know,” as if for a while it all made sense again as we relived those important memories. The structure of such sessions provided time to explore parallel feelings of sadness, anxiety or anger from the past with their present emotions. I then work to shift the reliving of more challenging long term memories to associated times of happiness or joy. This too continues to be a challenge in which I work to best find methods for smooth transitions. However, there is one particular strategy I have found very helpful in transitions from more challenging past times to more joyous memories. As I get to know the deeper person, I have found that relationships with individuals often push emotions to the more intense ends of emotion spectrums. At times I have tried to bring up an individual who is strongly connected to the feeling of joy with that particular client. Often times, no matter what memories they are recalling, this individual has some association. In making this transition of reliving memories, I am working to leave my clients with a positive feeling. It is my goal that due to the possibility that they do not remember a single bit of the content for which we discussed during our time together, the power of implicit feelings will allow them to be left with feelings of joy for a time being.
I have many other thoughts on working with memory loss, as well as specific examples for which I will share in future blogs. I believe that the power of implicit feelings is an important concept not only with memory loss, but with any population of clients. Clients with memory loss act as a prime example of the power of such implicit feelings, but such feelings and reliving of memories can provide useful tools for clients of any age or presentation. I would love to hear your own thoughts, idea, or experiences with such thoughts! My email is firstname.lastname@example.org Thanks for your time in reading!!
Lee Kehoe is a counselor working with the older adult population. It is her passion to serve the older adult population through counseling, research, and advocacy efforts, with the hope of raising awareness to the growing needs of older adults and their families.