Forward-looking long term care administrators have long pondered how to eliminate the dejection and malaise that infests their facilities. They have heard about culture-change and tried various solutions: staff wearing regular clothes, pleasant bird cages, providing more resident options and meetings about communication skills with the staff.



However, nothing seems able to generate the meaningful changes needed for a pleasant and more optimistic environment.

How Do You Transform Long Term Care from Being A Festering Incubator of Malaise and Hopelessness to Becoming an Uplifting Gallery to Resident Achievement and Accomplishment?

I have practiced clinical psychology for 30 years and treated hundreds of elderly patients for depression and anxiety. I have concluded that insidious communication patterns within long term care facilities themselves are often at fault.

These, combined with the out-dated techniques used by the mental health providers they use, inadvertently create the conditions which cause residents to be even more depressed and dejected.

There is a growing concern that the only mental health care residents often get is from geriatric psychiatrists who often miss the feelings they experience about their plight. Just write a prescription, maybe tell them how their thinking processes are distorted, check in occasionally and see you later.

The use of medication is often the only treatment a resident receives, even though the research literature clearly and consistently emphasizes that it must be combined with psychotherapy to achieve optimal outcome.

However, many psychologists use pathology-driven psychotherapy in their treatments. They build and expand on the problems and repeated complaints of the resident thereby encouraging their impact on his/her awareness. They often contribute to the lack of significance and de-humanization residents feel because their approaches are often too impersonal, mechanistic and dismissive. Consequently, resident losses continually loom larger in consciousness.

They generate impersonal case histories, which fail to illuminate each individual's experience in the struggle to survive illness. Residents, too, increasingly complain about this crisis of having no meaning-nothing to live for.

This underscores the need for a cutting-edge mental health program that addresses meaning obtained by the resident from his/her travails and his/her strengths and successes, no matter how small. This dignifies him/her. After all, that is what culture-change is all about!

What Most Mental Health Providers Do Not Know about How Residents in Long Term Care Become So Depressed

Conventional mental health providers miss the point that the resident makes sense of his/her world by creating a coherent facility persona by subconsciously crafting a particular story and role for him/her in it. We have all seen the abandoned residents, betrayed residents, and the ostracized residents. When we see no objective verification, we conclude that they are the result of internal dramas that the residents are really feeling and living which have been created by inadvertent, though insidious, hypnotic processes taking place in the facility itself.

Just like the stage hypnotists subject really feels like and becomes a barking dog, the facility resident becomes and feels like a victim drowning in his/her own tragedy. Therefore, the residents hopeless story, though not necessarily a FACT, becomes one.

And unfortunately the screaming misery that results becomes the biggest FACT of all!

Implications For Your Facility:

This insidious waking hypnosis is induced by repetitive problem-saturated conversations taking place in the facility. THAT IS Right! The CNAs, nurses, therapists, families, doctors and residents themselves unknowingly collude, by their use of various interactions and words, to create a reality which is catastrophic, demoralizing and futile.

We undergo waking hypnosis all the time e.g. in the theatre when an endearing character dies we may cry and feel hopeless; if our parents continually told us how stupid we were, we may grow up actually feeling stupid. THE SAME SITUATION can be perceived differently by different people based on the story of themselves that was internalized by repetitive pervasive conversations.

One person is treated for cancer and describes the therapeutic experience as miserable and the worst time in my life. Another describes it as just a difficult challenge.

Both had almost identical experiences and walked away with vastly different interpretations, stories and feelings. We learn thru repetition. Repeated suggestions and conversational themes associated with emotionally charged experiences are powerful in crafting a certain role for a resident in a particular story.

The residents internalized story can change over time because it is contingent on the type of consistent interactions in which s/he is engaged. Interactions or conversations need not be verbal, but are often composed of nonverbal components. A nurse who is gruff in manner is sending the suggestion that the resident is a pain or perhaps inept. Every interaction with a resident should be seen as resulting over time in a better or worse outcome for the residents felt sense of self.

Strength-Embedded Psychotherapy starts to treat resident depression and anxiety by using asset mining, a method of sensitively, yet tenaciously, unearthing any improvements, large or small, that can be credited to the resident. Then s/he implements the skillful use of conscious conversation: manifesting attention, imbuing constructive meaning and significance to resident suffering and replacing problem-saturated conversations with strength and progress saturated ones.

These techniques are reinforced by the long term care staff and are used over time with repetition and consistency. The therapist then incorporates them deftly in the residents internalized story, occasionally over his/her objections, so that the new plot can be internalized and eventually changed from one starring resident victimization to one showcasing mastery.

Throughout the process, the resident will often tenaciously attempt to revert to saturating conversations with problems and references to victimization. The resident craves continuity of the problem-saturated story which s/he has internalized.

After all s/he has depended upon it, often at great emotional cost, for a consistent sense of identity. However, with consistency and over time, the new trance starts to take effect with the resident experiencing him/herself as masterful and potent, rather than miserable and hopeless.

Compare SEP-strength-embedded psychotherapy with the usual pathology-focused techniques of most mental health providers. Talk to a resident for 15 minutes; just write a prescription and follow-up occasionally. If you are a psychologist, tell them how their thinking processes are distorted. Then over-use empathy to the point that the resident is repeating the same miseries and complaints over and over to the point that they loom ever larger in consciousness.

These pathology-driven treatments continue to infest long term care with dire results. They build on the problems of the resident and build their impact on his/her awareness. They often contribute to their insignificance and de-humanization because they are impersonal, mechanistic and dismissive. Consequently, resident losses continually loom larger in consciousness.

The train to culture-change is moving faster. Not changing your mental health provider to one who emphasizes strength and success-based approaches can put you in danger of being perceived as an uncaring dinosaur later. On the other hand, enthusiastically adopting it now can position you as a forward-looking pioneer who is contributing to the historic changes taking place in the long term care industry.