An article by Mag. Mariana A. Rodríguez,
Graduate Professor in (Argentina)
Human aging is a vital process related to the passage of time and begins with the beginning of each subject’s life. Although it is important to note that old age is not synonymous with disease and that it is necessary to include the healthy aspects of it, when thinking about new ways of living and getting sick, it is noticed that more and more professionals must training in the new bio-psycho-social problems to intervene in the different demands of the elderly subjects and their families in the field of health. Within the field of Aging Sciences, professional practices are emerging such as Therapeutic Accompaniment devices for dependent or semi-dependent subjects.
There are currently diseases that still do not have a cure, such as dementiasand especially from the links It is from where you can intervene to offer quality of life and alleviate mental suffering of those who suffer. Depending on the signs and symptoms that manifest in the affected subjects, the significant losses who suffer are the following:
- Losses identity: desubjectivation and disintegration of ego functions, disintegration of thought functions: from symbolic-abstract functions to concrete thought, functional deterioration and progressive loss of autonomy.
- Losses intersubjective: loss of roles in the links, loss of links.
- Losses social: loss of social roles, isolation and social abandonment while the problem is made invisible.
Now, are they Therapeutic Companions (AT) caregivers of people with dementia? What is the role that the spouses demand? What functions do children assign to Therapeutic Companions? What do the treating professionals indicate? When the legal discourse is present through different cases, what do they specifically request?
Pulice (2016) notices a very interesting phenomenon when he postulates that the multiplicity of discourses “It is the propitious ground for the loss” (1st part). In many cases, the word of the affected subject remains unheard in the network of discourses and their desire invisible. What he wants? Do you suffer? What does he suffer from? Pulice (2016) states it as “tangle of demands and silences” (1st part).
In the case of people affected by dementia, there is a prejudice that they do not understand or are not aware of their desubjectification and loss of cognitive functions.
In the particular case of the people affected by dementia there is a prejudice that they do not understand or are not aware of its desubjectivation and loss of cognitive functions. Conversely, in the early stages of the disease and up to the moderate phases, subjects can account for and be aware of changes that they begin to experience and the losses that they entail. The appearance of dementia beyond the differences that can be located in each person based on their uniqueness, produces a disruption in the fabric of senses that the subject constructs of himself. These disruptions, sometimes slower and others more abrupt, affect the position of the subject and require duels and identity reworkings.
Luis Hornstein (2011) expresses that “Self-esteem is the report that one makes about oneself”, that report refers to a self-assessment. (p.28). People with dementias during a long period of the disease retain that self-assessment function and for many it is very frustrating to find their difficulties and their deficits. Recognize the affected subject as a subject of desireis in many cases, to intervene to uncatch it from the “tangle” discursive and intersubjective and build with the / the Therapeutic Accompanying a different scene in the theater of his life.
mental suffering
We know that a diagnosis of dementia can be traumatic for the affected individual and for their spouse and family members. He psychic suffering appears in its singular dimension and in its bond dimension. From the Therapeutic Accompaniment device, it is important to locate those who suffer, build hypotheses about those sufferings and implement interventions. Both the people affected and those who are “care partners” they suffer progressive losses in different areas of their lives and must face very painful duels. Each person based on their uniqueness and their story will display different modes of psychic functioning in the face of said losses, transformations and mourning.
When the mental suffering cannot be dealt with, due to excess and/or lack of mental resources on the part of the person affected and/or their spouse, children or close relatives, it is important notify and intervene from different interviews with the children, with the spouse, with relatives, with the treating professionals, with gerontological assistants, with geriatric directors, with curators, etc., to prevent further suffering and acceleration of deterioration in the affected personin order to redefine TA objectives and intervene in their sense, to give rise to the demands of the affected subject and accommodate the anxieties of the spouses and family members who begin to mobilize for the interventions.
In the specific case of spouses, the predominant factors of psychological suffering include singular phenomena such as ambivalence, anger, anger, guilt and a feeling of debt, and in the linking dimension, the modification of the exchanges that historically shaped homeostasis of link functioning.
The exchanges guide the interaction within the links and they are establishing the subjective positions and the distribution of roles. If a couple bond supports a dominant logic of operation, how does the disabling chronic illness of a member modify that logic? Does this disease break into the system and modify the functionings and give rise to new alternative functionings? What are the effects of the disease on the balance achieved by the different positions of the members of the bond and how is this loss of balance related to the suffering of both spouses?
Anguish and ambivalence that are not put into words or processed, are acted on or affect the body:
- in mistreatment towards the person affected and towards the ATS,
- in carelessness and lack of supervision exposing the affected subject to risk situations for himself and for third parties,
- in the emotional and physical discomfort of ATs,
- in the abrupt interruptions of the AT,
- in compulsive institutionalizations due to lack of resources to cope with the trauma of the situation,
- not to institutionalize when there are institutionalization criteria,
- in illness and/or death of the spouse, among others.
Initial objectives of Therapeutic Accompaniments
Examples of objectives proposed at the beginning of an AT Device.
The first goal is build a bond of trust with the accompanied and intervene to promote a linking framework that houses the subject, their problems and their desire. At a later stage you can add targets that focus on the Accompaniment of the subject according to the case. Examples:
Accompany to:
- Manage paperwork, medical appointments or other daily tasks.
- Physical activity and/or walks.
- Participate in recreational activities such as walks and outings.
- Develop cognitive stimulation activities to slow cognitive decline.
- Carry out activities that encourage socialization and the construction of networks.
- Integrate into stimulation proposals to enhance conserved functions and enable neuroplasticity.
- Others.
These may be initial objectives that arise as requests from spouses, family members or treating professionals. Now, the inescapable question: which of all these possible objectives of an AT device can account for the desire of the subject affected by dementia?
To redefine the objectives of a TA, it is necessary to carry out a evaluation of the diagnosis of the affected subject, its possibilities and limitationsevaluate the historical functioning of the bonds, and in relation to the current bonding modalities, investigate the positions adopted by spouses and family members.
Said diagnostic process carried out by the Therapeutic Companions together with the treating professionals, makes it possible to intervene to facilitate referral processes for spouses and/or relatives to psychotherapy spaces, to support groups on these specific problems or other devices in the field of mental health.
Finally, another dimension of loss is unfolding with the Therapeutic Companions, since the desubjectification of the subject and the destructuring of their cognitive functions are determining that the links and encounters are from different points of connection and contact. These processes require the periodic redefinition and adjustment of objectives. The subject, his limitations and his wishes are transformed in the process and the AT Device must be flexible to accompany this dynamic.
Bibliography:
Finkelsztein C. and Matusevich D. (2012) Psychogeriatrics: Theoretical Framework. In Clinical Psychogeriatry. From Hospital Editions. Finkelsztein and Matusevich Publishers. Italian Hospital of Buenos Aires. Teaching and Research Department. University Institute. Buenos Aires.
Hornstein, L (2011) Self-esteem and Identity. Narcissism and Social Values. Fund of Economic Culture. Buenos Aires.
Lifac, S. (1987) Narcissism, Old Age and Psychoanalysis. Third Annual Meeting. Place and Function of the Analyst. Argentine Association of Group Psychology and Psychotherapy. Buenos Aires, Argentina.
Lifac, S. (sn) The Conjugal Bond in the Third Age. Library «Pichon-Rivière» Argentine Association of Group Psychology and Psychotherapy: Sheets
Pulice, G. (2016) «Therapeutic Accompaniment, transfer and direction of the cure» (1st part) La PlazAT Digital Magazine No. 2 October 2017. Clinical Pathways / Ethics and Technique Section. https://www.facebook.com/La-Plaza-AT-214680679024829/
Sarasola D. Demey I. and Rojas G. (2016) Alzheimer’s disease: an epidemic of the 21st century. In (Ed.) P. Bagnati Alzheimer’s disease and other dementias. Handbook for the family. Chap. 1 Editorial Polemos Buenos Aires Argentina
About the author
Mariana Rodriguez is Master in Psychoanalysis (National University of La Matanza in agreement with the Argentine School of Psychotherapy Association for Graduates Argentina) and in psychogerontology (Maimónides University. Argentina); Postgraduate in Applied Psychogeriatrics (University Institute of the Italian Hospital School of Medicine), and graduate in Psychology. (National University of Mar del Plata).
currently is Clinical Psychologist and Psychogerontologist at Hogar San Martin (Residence for the elderly of the Government of the City of Buenos Aires) and teacher Graduate at the Maimonides University in the Specialization and Master’s Degrees in Psychogerontology, Group and Family Psychotherapy 2. Second Year. Director: Dr. G. Zarebski.
Is Psychotherapist of the Assistance Team for Older Adults. Rascovsky Center. Association of the Argentine School of Psychotherapy for Graduates….