Category Archives: Uncategorized

The Vacuum Caused by Dementia

 

Recently I was at an event where a guest with Frontal Temporal Dementia was present. This is a brilliant man who has had the disease for over four years and is now left with a rapidly progressing, debilitating disease. The guests knew he had dementia although not necessarily the type. As is often the case, most people when thinking of dementia, were expecting Alzheimer’s Disease and seeing someone similarly afflicted. Many of the people were actually relieved to see how well he is functioning. This conclusion was based on the fact that he knew their names and was very sociable. The fact that he is incapable of speaking even the briefest of sentences or expressing himself verbally was not factored into their assessment. Frontal Temporal Dementia presents differently from Alzheimers. The person doesn’t become withdrawn. They lose all inhibitions – it does, after all, affect the temporal lobe – are unable to find words, and lose their muscle strength.

This is just one of the many isolating experiences caretakers for people with dementia, any kind of dementia, face: the gap between their reality and other people’s perspectives.

Friends who have relatives with dementia have described how after encountering friends or neighbors on the street, people will remark that the person with dementia seems to ‘be not that bad’. They base that on the fact that the person has been able to nod at appropriate times or cover for their lack of understanding in other ways. The caretaker however, knows that person can no longer watch or comprehend a television program and is incontinent, a very different perspective. It’s often these disconnects in reality that make the caretaker feel isolated. They are seeing the ravages of dementia up close while the fleeting glance can appear very different to those who are ill-informed or see a glimpse of it. Whatever the kind of dementia, it’s an isolating experience living with someone who has dementia.

A friend of mine who has a sister with early onset Alzheimer’s pointed out another aspect of dementia: unlike other debilitating and fatal diseases, those with dementia cannot express their wishes which creates a conflict-causing vacuum. I have seen this up close and it is a difficult situation. A person gets dementia and, even if he/she has clearly planned and expressed his/her wishes, family members and friends ‘know’ what the person would want. (If they haven not planned for the future, the situation is worse.) She hears, “I know she would want…” all the time, whether the person actually has some insight or not. Although every one may be well-meaning, the assumed desires of the patient may put the family members in conflict over the care of their relative. In my friend’s case, she has the power of attorney but needs to consider the desires of her young adult nephews and, in this case, her sister’s interfering ex-husband. In cases where adult siblings do not agree on the care and wishes of their parent, disagreements can fray relationships and leave the disabled parent without the care and services they need while the children argue about it. There are so many sensitive decisions to be made: taking away the driver’s license, insuring the person’s safety, getting an aide, deciding on the right living situation, getting the finances in order. These decisions all require a united family or at least one that is in agreement on important issues.

Advanced planning and expressing one’s desires about care are so important but often an avoided conversation. Caring for a person with dementia is stressful enough. A facilitated conversation might ease the way for moving ahead and getting the person with dementia the needed care. It is best to fill that vacuum with consensus.

Gail Goodman

 

 

 

 

Why I Should Have Chosen Mediation

My friend, let’s call her Cathy, has had a difficult relationship with her widowed father for a while now. She is part of an informal, blended family. Her father lives in a nearby city and is not married, but has been living with a woman for several years. The father lives in the woman’s house, spends summers at her summer house, is close with her daughter’s family, and overall has slipped comfortably into his significant other’s life. Cathy has been devastated. According to Cathy, her father’s girlfriend, let’s call her Mrs. X, has made no attempt to draw Cathy and her nuclear family into this extended, blended family. Instead of her traditional family holiday celebrations, the whole new family is included in holiday traditions that they would not normally celebrate, since they are not all the same religion. For Cathy, this has created a lot of resentment towards her father. Doesn’t he see what’s happening? Doesn’t he see that she’s left out. Why doesn’t he stick up for her? She and her father had some awful blowout fights and can hardly say a civil word to each other. The tension has gone so far as to effect Cathy’s brother and his family. Last year, I suggested to Cathy that she consider mediation so they can learn to listen and speak to one another  and come out with a plan to go forward. Instead, she convinced her father to try therapy with her, and each committed to two months. Her father didn’t make it past the fourth session.

Last week I sat down to ask her why she didn’t chose mediation. Interestingly enough, her answers were based on a misunderstanding of mediation and the process. Where as a friend did I go wrong?? I think we both made assumptions without ever clarifying the options. She went to therapy because she needed to get some of the old hurts and pain her father had caused dealt with and discussed, even though he has alway opposed doing that. Her therapist thought that this could work for them. It didn’t. Her father didn’t believe in therapy to begin with. Her father has a stereotypical view of therapy and who needs therapy and it doesn’t include him. This was not a realistic method for him to resolve any problems. His biases were already in place. She didn’t go to mediation because she didn’t think she would have the opportunity to communicate her pain and hurt he has caused her.

Now I explained the mediation process. How we interview each of them beforehand to find out their perception of the issues and then schedule one open-ended session where the issues are discussed in a non-confrontational way and hopefully, agreements are reached and the parties are able to talk to one another after they leave. Emotions come out, and there is room for it in the process, but we, as mediators, are going to keep the parties talking and focused on the issues they have identified. Cathy had an immediate problem: she and her father were losing their relationship. We insure the parties speak and listen to one another, and actually hear one another. Mediation is a problem oriented process.  It helps people resolve their conflicts, focusing on the problem at hand, and gives the parties a means to move ahead. Cathy would have been able to communicate her emotions and hurt, but in the end she and her father would have learned how to talk and listen effectively , be considerate of each other, and avoid ‘pushing each other’s buttons’.

Without asking, Cathy said, “we should have gone to mediation.” So, what were the selling points that indicated this was the better route? A la Letterman, let’s start with:

  • Number 4. Her father would have been more open to a process that wasn’t a therapeutic framework. Given his original biases, he was less likely to function well in that context.
  • Number 3: Although it was important for her to have her father hear her hurt and what the issues were for them, it would have taken them far longer than the time allotted, and possible, for them to really get into and resolve the roots of some of their problems.
  • Number 2 is the realization that she would have gotten skills that she could use when future problems arose. Her pain and emotions would be part of the session but the emphasis would have been on how they could go forward, which was the immediate problem for her.
  • And what she consider as the all important Number 1 is the ability to resolve the problems in one session. She left frustrated every time the therapy session ended and nothing was resolved. Whatever momentum they achieved, was lost when the time was up. She feels the opportunity to work through in one long session might have been a key point in helping them work through their issues productively.

Next time, I will try to be as clear with my friends as I am in my formal presentations.

Why Mediation Matters by Ruth Weinreb

I graduated law school 28 years ago and was looking forward to a career in litigation. I had taken classes in evidence, civil procedure and trial advocacy and was excited about litigating my first trial. After a short period of time, I was handling my own trials, loving it. I enjoyed the details of putting together the evidence, preparing the witnesses and sparring with my opponent. I even enjoyed writing the briefs. But after 28 years of litigation experience, 28 years of parties waiting three years for a final Order, and 28 years of parties not receiving a full remedy, I realized that mediation offered more than a viable alternative to litigation. Continue reading Why Mediation Matters by Ruth Weinreb

Parent/Teen Mediation: Why Kids Return to the Table by Gail Goodman

I enjoy mediating with teens and parents. The cases are sometimes referred by social services or probation, or sometimes a school counselor or social worker will recommend trying mediation. Initially I made the assumption that any young person coming in who has been referred by an official agency, some under the threat that this was the last chance before being taken out of the home, would come in intending to comply with the terms. This is not always the case.

After greeting the parents and teen, I explain the mediation process and the ground rules and tell them that there is a commitment to attend a one hour session for 4 consecutive weeks. The parents generally agree but the teen will usually, and sullenly, only agree to see how it goes. There are no guarantees except for the first session. Yet at the end of all those first sessions, they all agree to come back; that’s a 100% retention rate. This isn’t to say that every mediation resolved all the conflicts or necessarily ended ‘successfully’, but just having everyone return every week was something of a victory. What made them agree? What changed their attitude? Here’s what I got from some of the feedback and my observations. Continue reading Parent/Teen Mediation: Why Kids Return to the Table by Gail Goodman