AL psychotherapist won’t take on 79 y/o mom as a patient for talk therapy, sound right?
Very disappointed as mom wants to talk to someone about the lunacies she believes really happened/happening. We’ve told her to hang on as we seek out a therapist. Because mom’s attention span is short, inability to sometimes answer basic questions and being contradictive therapist said she’d not benefit from talk therapy. As a therapist there are goals set and she felt no path could be established for mom and justify insurance billing. She suggested maybe hiring a “companion” to spend time w/her and be a listening partner. Mom has also just been diagnosed w/a rare terminal form of leukemia, yet I’m more concerned with her mental health management. How to help mom have someone to share her horrors with, without family having to shoulder (delusions are explicit and include our deceased father)?
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But maybe others will have different input
You have really had to take the oars for your Mother & steer her to safety. It's a lot.
So many folk want their parent to WANT talk therapy - your Mom does but doesn't 'qualify'. That seems very unfair.
I know nothing of the billing/ insurance but I feel for you in this situation.
I could see the benefit of a 'companion' aide.. but, it would need to be the right person. Someone with REAL listening skills - not some distracted person nodding vacantly & checking the time.
Do you have a local Cancer or Leukaemia Organisation? Would they have ideas?
I am reluctant to add it, but if Hospice was appropriate, they may have ideas or resources too.
Another thought is , are these lunacies new ? Is she on any new meds ? Has she been tested for a UTI ? ( A UTI can cause behavior , mental changes in elderly ). How is her mental illness being treated by the doctor , any meds ? , maybe a med change is needed to calm her .
Goals are required in order to bill insurance , much like it is to be approved to be a candidate for PT etc. People are also refused PT , OT , rehab if it is not felt progress would be made or goals would be met .
Find some companion who can listen to Mom and agree with whatever she says . Perhaps someone who is experienced with people with dementia .
It is unfortunate that she’s not a candidate for talk therapy . At least the therapist gave an alternative to try by suggesting a companion , Mom just wants , needs to vent , and be validated to calm her .
You would probably like something ‘therapy’ to disillusion M about “the lunacies she believes really happened/happening”. However it sounds like M is not a candidate for getting better. That’s why no goals can be set. If M has dementia or any other mental problems, you probably need to accept that you are going to hear a lot of ‘lunacies’ before she dies. It’s very common.
If M needs/wants to talk about her delusions, think about what response she needs/ would like. Does she simply need to talk herself? What would she want the hearer to say back? How could you find someone to listen and respond in a way that would soothe M? This may be the best way forward, if you can accept that M is NOT going to get these delusions out of her mind.
Yes, it is talking, but it isn't aimless. It's conducted by a trained counsellor, or a psychotherapist (most often, the former).
Talk therapies have helped me immeasurably. I have had both CBT and generic counselling.
Talking therapies wouldn't be appropriate for someone in Plumhead's mother's condition. Severe hallucinations require anti-psychotic drugs, not counselling.
The delusions along with the short-term attention (memory?) and aggressive behaviour point to cognitive decline, which cannot be fixed, nor can it be helped by counselling.
A counsellor couldn't go against their training and validate the delusions of a client/patient, so talking therapy could actually make the mother feel worse.
It's not the same as the delusions of a mentally ill person who is capable of getting better. Plumhead's mother will not be able to apply reasoning and will not respond well to her delusions being challenged. Instead, she needs reassurance and to be made comfortable. She needs medication.
You listed your question under Alzheimer's and Dementia... so, going just by what you describe she certainly seems like she may have it. If so, I am doubtful that talk therapy would be any benefit at all to her, especially if she doesn't retain it. For talk therapy to benefit, one has to be able to retain AND properly process what is being discussed. Dementia robs people of their reason and logic, their empathy, their filters, their sense of time and place, their self-awareness, and more. This is why so many people with dementia require medication to help them through depression, anxiety, agitation, aggression. They can no longer bring their own selves to a place of acceptance, contentedness or peace. They need meds to achieve this, and it doesn't always work -- but should be tried. The last thing that she should be doing is sharing her horrors continually. She needs her mind lead to safe and less stressful places, even if it seems she doesn't wish to go there.
My Aunt with advanced dementia often had dark thoughts and delusions. It made her very stressed and agitated. We had her only movies (mostly oldies or animated) that had very little dark content. And it didn't take much to reach the "dark" threshold for her. She couldn't watch the news or any shows that were violent or negative.
The best thing we can do for our LOs with dementia is to protect them, make decisions in their best interests and keep them calm. I'm sorry she's going through this plus damnable leukemia. If she doesn't have a diagnosis for cognitive and memory impairment, or has never been tested, I'd do this straight away. You may be able to discuss meds for her mental health with her primary doctor. I wish you peace in your hearts on this journey.
I have spoken to a Licensed Clininical Social Worker who said she has had patients in SNFs so you might find one. Aunt is not willing to communicate for the most part but if she were, I would pursue.
People with mental illness often have group sessions in psych hospitals. Might be helpful in assessing calming meds etc.
If she has the "inability to sometimes answer basic questions" how in the world do you think a professional therapist could possibly help her?
You must be realistic now and understand that your moms brain is broken in more ways than one and that therapy in the common way we think of it, just won't help your mom.
I would instead with your moms recent terminal cancer diagnosis, bring hospice on board, and perhaps let the hospice social worker talk with her.
Hospice will be extra sets of eyes on her in her AL, and will be able to provide any needed medications to help with her hallucinations.
And all of hospices care is covered 100% under your moms Medicare.
Mom did not realize he was a psychotherapist. He just told her he checks in to see how residents are doing. Mom assumed he was a nurse. Unfortunately , another staff member mentioned how “ nice the psychologist is “ right after he left Mom’s room . From then on Mom refused to talk to him stating “ I’m not crazy “. I was upset she wouldn’t do talk therapy anymore , it helped Mom’s mood , and it helped my visits be better .
Agree , Hospice on board would be a great resource . As you said a social worker could be the sounding board for the mother etc .
"And I am considering palliative/hospice, tho mom is not a fan, as dad had hospice and she thinks they caused him to pass, even tho I’ve explained their purpose many times. Everyday is a new situation and we’re jumping to try to help alleviate all that ails her (not enough space on this page!), and guess we need to make peace we can’t solve everything for her…tortured mind being the worst of it."
You cannot keep reexplaining things to someone with dementia and memory impairment -- you will exhaust yourself emotionally and physically. Also, people with dementia have trouble dealing with pain, identifying what's happening with their bodies, and being realistic about solutions. It is 100% unproductive and you need to economize on where your energies are spent because you are now in a marathon, not a sprint.
Teepa Snow has an excellent video series on YouTube. I learned so much from them, especially how dementia changes our LOs and great strategies that will help you have more peaceful and productive interactions with your Mom.
Talk therapy is for someone who can work towards getting better; that isn't the case for a person experiencing cognitive decline, who is incapable of applying reasoning, and cannot retain information.
I'm really sorry, but I think that the therapist was correct. It isn't just about money and insurance, but the fact that this wouldn't benefit your mum in any way. In fact, it could make her feel worse because she wouldn't feel heard or understood by the therapist who couldn't, in good conscience (or code of practice), validate your mum's delusions.
I think that the advice you were given is good. Take it. And speak to your mum's doctor about medication to help with the hallucinations (not lunacies), as well as her low mood and aggression.
If mom has cognitive failure she likely would not benefit from oncology. Have you looked into hospice?