How Nursing Homes Can Eliminate Depression, Anxiety and Behavior Problems- Without More Drugs

By: Dr Mike Shery

Hundreds of nursing home administrators in northern Illinois and elsewhere, have provided their residents with relief from depression and other emotional difficulties without adding more drugs. They do so by making psychotherapy available to their residents through the services of a psychologist practicing independently on staff.

This brief question-and-answer guide provides valuable information to help administrators and nursing supervisors get their residents to benefit from outpatient psychotherapy and counseling.

When should you consider psychotherapy or counseling for a resident?

Psychotherapy is a partnership between a long term care resident and a professional, such as a psychologist. The psychologist is highly trained to help residents understand their feelings in order to assist them in changing their behavior.

According to the National Institute of Mental Health, one-third of adults in the United States experience an emotional or substance abuse problem. Nearly 25 percent of long term care residents suffer at some point from depression or anxiety.

You should consider psychotherapy for your residents under the following circumstances:

When they feel an overwhelming and prolonged sense of sadness or helplessness, or lack hope in their lives.

When their emotional difficulties make it hard for them to function from day to day. For example, when they are unable to concentrate on ADLs or they are too withdrawn.

When their actions are harmful to themselves or to others. For instance, if they resist directions or become overly aggressive.

When they are troubled by emotional difficulties with family members, a spouse or other residents.

What does research show about the effectiveness of psychotherapy?

Research suggests that therapy effectively decreases residents depression and anxiety and related symptoms -- such as pain, fatigue and nausea. Psychotherapy has also been found to increase survival time for heart surgery and cancer patients, and it can have a positive effect on the body's immune system.

Research increasingly supports the idea that emotional and physical health are very closely linked and that therapy can improve an elderly persons overall health status.

There is convincing evidence that most nursing home residents who have at least several sessions of psychotherapy are far better off than untreated residents with emotional difficulties.

One major study showed that 50 percent of patients noticeably improved after eight sessions while 75 percent of individuals in psychotherapy improved by the end of six months.

How do I find a qualified psychologist for my facility?

Selecting a therapist is a highly individual matter.

There are several ways to get referrals to qualified psychologists, including the following:

Talk to existing staff members about recommendations, especially if they, or someone they know, has had a good experience with a particular psychologist.

Many state psychological associations operate referral services which can put you in touch with a psychologist who might be ideal for your facility.

Ask your medical director or nursing supervisor for a referral. Tell them what's important to you in choosing a psychologist, so he or she can make appropriate suggestions.

Inquire at a church or synagogue.

Look in the phone book for the listing of a local mental health association or community mental health centers and check these sources for possible referrals.

Ideally, you will end up with more than one lead. Call and request the opportunity, either by phone or in person, to ask the psychologist some questions about the possibility of doing nursing home work.

You might want to inquire about his or her licensure, approach to psychotherapy and participation in Medicare and other insurance plans. Such a discussion should help you sort through your options and choose someone with whom you believe your residents would interact well.

If a resident begins psychotherapy, how can I help her to gain the most from it?

There are many approaches to outpatient psychotherapy and various formats in which it may occur -- including individual, group and family psychotherapy. Despite the variations, all psychotherapy is a two-way process that works especially well when residents and their therapists communicate openly.

Research has shown that the outcome of psychotherapy is improved when the therapist and resident agree early about what the major problems are and how psychotherapy can help.

Your psychologist and resident will both have a responsibility in establishing and maintaining a good working relationship. Be clear with your psychologist about your residents expectations and the best way to work with them and the facility staff. Psychotherapy works best when the resident or family attends all scheduled sessions and give some forethought to what they should discuss.

How can I evaluate whether therapy is working well in my facility?

When your psychologist begins psychotherapy with a resident, you should be sure clear goals are established. Perhaps your resident needs to overcome feelings of hopelessness associated with depression. Or maybe she should learn to control a fear that disrupts her daily life.

Certain tasks will require more time to accomplish than others; your residents may need to adjust their goals depending on how long the psychological therapy will last.

After a few weeks, it is a good sign if you feel the experience truly is a joint effort between you, the psychologist and the staff so that your residents and psychologist enjoy a good rapport. On the other hand, you should be open with the psychologist if you find yourself feeling confused or lacking direction in how the process is supposed to benefit your residents and help your staff.

There may be times when a psychologist may be nervous, rushed, appear cold and disinterested or does not seem to regard a certain resident positively. Tell him/her if this is the situation, or if you question other aspects of his or her approach.

Residents often feel a wide range of emotions during psychotherapy. Some qualms about psychotherapy residents may have result from difficulty in discussing painful and troubling experiences. When this happens, however, it can actually be a positive sign indicating that the residents are starting to explore their thoughts and behaviors.

You should spend time with the psychologist periodically reviewing his/her progress with your residents (or your concern that they may not be making sufficient headway). Although there are other considerations affecting the duration of anyones psychological treatment, success in reaching the primary goals for the resident should be the major factor in deciding when treatment should end.

Psychotherapy and counseling is not easy. But your residents who are willing to work in close partnership with the psychologist often find relief from their emotional distress and begin to lead more productive and fulfilling lives.

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Dr Shery is in Cary, IL, near Algonquin, Crystal Lake, Marengo and Lake-in-the-Hills. He's an expert geriatric psychologist. Call 1 847 516 0899 and make an appt orlearn more about counseling at: www.nextdayappointment.com

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