power tools for people with chronic illness, their ... presentation 2012.… · power tools for...

Power Tools for People with Chronic Illness,

Their Caregivers, and Health Care Providers

Sherry L.M. Merriam

Adler Graduate School

In Partial Fulfillment of the Requirements for

the Degree of Master of Arts in

Adlerian Counseling and Psychotherapy

What is chronic disease? illnesses that are prolonged

do not resolve spontaneously

are rarely cured completely

and may involve some type of long-term disability that is irreversible.

(National Center for Chronic Disease Prevention and Health Promotion, 2000).

What is chronic disease? The health problem can be stabilized and controlled,

but the affected individual cannot expect to return to the level of health enjoyed before the onset of the illness.

(National Center for Chronic Disease Prevention and Health Promotion, 2000)

Holism • the belief that

all aspects of life are interrelated

• emotional symptoms can exacerbate physical pain

Overview: Section 1 Social interest & social embeddedness

Identifying and using your team

Encouragement

Exercise 1: Sharing & Listening

Overview: Section 2 Social interest for providers

Encouragement vs. sick-role

Encouragement & self-efficacy

Self-management

Exercise 2: Setting Your Goals

Overview: Section 3 Conclusion

Q&A and discussion

Overview Who’s here?

Alfred Adler &

Adlerian

Psychology

• What is social interest?

Social Interest Sense of belonging

“To see with the eyes of another, to hear with the ears of another, to feel with the heart of another” (Ansbacher, H. L., & Ansbacher, R. R. [Eds.], 1956.)

Social Interest Encouraged Discouraged

High social interest

Feelings of belonging

Low social interest

Feelings of inferiority

Social Interest: Why? access to social support increases the

likelihood of positive outcomes when dealing with health issues (Cohen, 1988; Gentry & Kobasa, 1984).

lack of social support is predictive of long-term disability (Johansson & Lindberg, 2000).

The adequacy of social support and the quality of the relationship between patient and health care provider affect your confidence, and therefore your ability to achieve positive outcomes (Sperry, Lewis, Carlson and Englar-Carlson, 2005).

Social Interest: Special Challenges managing social

relationships can be made more difficult by illness-related behavioral limitations

Social Interest: cultural context individualism communalism

Dominant US culture

Independence, self-reliance

Illness is the responsibility of the individual

Some other cultures

Emphasis on community

Illness is the responsibility of the community

Caregivers, including partners, family, friends, etc.

Healthcare providers

Patients

Social support Partner or spouse

Family

Friends

Society/Community/Culture

Work with your team Working with your healthcare providers

Express your needs

Ask questions

Repeat instructions received

Be candid

Work with your team Working with your social relationships

Get support for your goals

Work with your team Working with your social relationships

Understand what it is like for them

“Two ears and mouth”

Reciprocate

Work with your team Working with your social relationships

Accept changes in your social system

Find ways to make social time

Work with your team Working with your social relationships

Getting the help we need, not the help they think we need.

Communication

Be direct

Ask for what you need

Avoid being passive or manipulative

Patients & partners as a team If one of you has an illness, both

of you have the illness.

Make your relationship solid

Encourage each other and acknowledge each other’s efforts

Patients & partners as a team Treatment is a joint effort

family support is an important component in recovery (Roback, 1984; Turk & Kearns, 1985, Friedman & DiMatteo, 1989)

The family’s success in adapting to the challenges of the disease may have a major affect on the individual’s success with self-treatment (Hendrick, 1985).

Patients & partners as a team Go to appointments together

They learn your limitations

They help you remember your questions and experiences

They participate and take ownership

They provide support and encouragement

Advocate and educate

The aim of encouragement is “to increase an individual’s courage to meet the problems of life (Ansbacher & Ansbacher, 1956, p. 20)”

Social Interest Encouraged Discouraged

High social interest

Feelings of belonging

Low social interest

Feelings of inferiority

Encouragement is… positive feedback that focuses primarily on effort or

improvement rather than outcomes.

not praise, reward, or language used to gain compliance (Evans, 1989).

The language of encouragement

THE LANGUAGE OF ENCOURAGEMENT

(Evans, 1995, Dreikurs, Grunwald, & Pepper, 1982)

Encouragement

“I think you can do it.”

“You have what it takes.”

“You’re a hard worker.”

“What do you think?”

“I could use your help.”

“It looks like a problem occurred.

What can we do to solve the problem?”

Discouragement

“Here, let me do that for you.

“Be careful; it’s dangerous.”

“Don’t forget your assignment.”

“Let me give you some advice.”

“When you’re older, you can help.”

“I told you to be careful.”

Encouragement

“You put a lot of effort into your work.”

“You’re a fine person.”

“I know you did your best.”

Praise

“I’m proud of you when you do well.”

“You did better than anyone else in the class.”

“Next time, if you work harder,

I know you can get an A instead of a B+.”

SHARING & LISTENING

Exercise 1: Sharing & Listening You will choose a partner, preferably someone you do

not know.

If you don’t have a partner, you will raise your hand.

You will each get five minutes to share your story.

Talkers: What brought you here? People with illness or disability: What are you dealing

with? How does it interfere with your daily life? What challenges have you already overcome?

Caregivers: Who are you caring for? How do you help them? How does it interfere with your daily life? What challenges have you already overcome?

Healthcare providers: What kind of health care do you provide? What challenges do you face? What have you already overcome?

Listeners: Just Listen! Active listening skills

Give encouragement

Don’t fix, suggest, or advise – for now.

Confidentiality Respect the right to privacy: What is said here, stays here.

Exercise 1: Sharing & Listening You will choose a partner, preferably someone you do

not know.

If you don’t have a partner, you will raise your hand.

You will each get five minutes to share your story.

Talkers: What brought you here? People with illness or disability: What are you dealing

with? How does it interfere with your daily life? What challenges have you already overcome?

Caregivers: who are you caring for? How do you help them? How does it interfere with your daily life? What challenges have you already overcome?

Healthcare providers: what kind of health care do you provide? What challenges do you face? What have you already overcome?

Exercise 1: Sharing & Listening

Great job!

You can use these tips, and/or teach your own healthcare providers.

Increase compliance and outcomes through trust.

Social interest for providers Use your patient’s learning style.

Make sure your patient is able to listen and learn.

Instead of talking at a patient, engage them.

Resistance is a misalignment of goals.

Build relationships with other providers for case management.

Help your patients build social interest using the principles we have discussed.

The Sick Role and Illness Behavior A kind of

discouragement

Feelings of helplessness, inability to contribute or take care of self

Soliciting attention for illness behavior

The Sick Role and Illness Behavior A tempting trap

Others can contribute

We can find other avenues to significance and meaning.

The Sick Role & Encouragement Caregivers

Encouragement

Support without reinforcing sick-role behavior

Healthcare providers

Avoid recommending excessive tests and treatments

People with illness

Ask your team for encouragement

Develop your communication, problem-solving, relationship skills

Attitude & Expectations Manage your expectations– Is it good enough?

Don’t sweat the small stuff

The Serenity Prayer

God, grant me the serenity to accept the things I cannot change,

The courage to change the things I can,

And the wisdom to know the difference.

Focus on managing the problem, instead of on having the problem

Subjectivity Reality is as you perceive it.

You can choose your thoughts and emotions.

Determine your own meanings

Establish the new normal

Use patience and a sense of humor

Encouragement & Self-Efficacy Self-efficacy: a person’s belief that they

can handle the challenges that life throws at them (Bandura, 1977; 1997).

Related to the feeling of control (Sperry, et al., 2005).

If you feel like you can do it, you are more likely to achieve it than if you feel like you cannot (Ajzen, 1988; Bandura, 1977)

Encouragement & Self-Efficacy higher self-efficacy less disability, less pain, better

outcomes, and better functioning (Jensen, Turner, & Romano, 1994; Turk, 1996; Silverman, 2001; Turk & Feldman, 2000; Gatchel & Turk, 1999).

higher efficacy decreases stress, and lower stress is better for your body. (Sperry, et al., 2005).

Encouragement & Self-Efficacy: How? Count your resources/blessings

Have “the courage to be imperfect” (Dreikurs, cited in Terner, Pew, and Aird, 1978).

Exercise power over what you think and feel

Manage your Self-talk: those messages we go through in our heads

Remember your achievements

Practice gratitude

& Managing Your Illness

Personal Healthcare Journal

Personal Healthcare Journal Before your appointment

Write down your questions

And your comments or concerns

Document your symptoms

Update your list of medications

Personal Healthcare Journal At your healthcare office, note:

The date and provider’s name

The professional opinions

The treatment plan

The answers to your questions

Have someone fill it in for you, if needed

Flareup Protocol Flareup: when your illness or pain returns or worsens

A difficult, but necessary, time to make decisions

Protocol: a guideline for treatment

You write it when you are healthier, so you can use it when you need it.

Being Proactive: Why? Increase your feelings of control and self-efficacy

(Sperry, et al., 2005).

Fully investing yourself in problem solving, welcoming challenge and change, gives you more power to cope and achieve positive outcomes (Kobasa, Maddi, & Courington, 1981).

Being Proactive: Why? Negative cycle Positive cycle

I feel bad physically

I can’t do anything about it

I feel bad emotionally

I feel bad physically

I take positive steps

I feel better physically

Being Proactive: How? Be an active participant in managing your life and

relationships

Take charge of personal issues like job dissatisfaction, substance abuse, relationship problems, depression or anxiety

People in psychological pain express more physical pain (LaFountain, 2011).

Facing the things in life that you do not want to will change your pain (B. A. Schumacher, personal communication, September 27, 2012).

Being Proactive: How? Look after your health

Engage in health prevention

Change health risk behaviors such as smoking, high cholesterol diet, and lack of exercise

Be an active participant in your healthcare

Being Proactive: How? Everything you have

to give up, replace it with something else.

Focus on what you can do, instead of what you can’t do.

Be creative in your problem-solving.

Improve your coping skills stress and the way people cope with stress play

important roles in health outcomes

sometimes we deny or avoid stress, but this isn’t the same as coping.

getting enough sleep

Stress itself has negative physiological effects, even for healthy people.

Improve your coping skills relaxation, mindfulness, meditation, breath control,

yoga, tai chi, etc.

helpful for stress management and relaxation, for a sense of empowerment, and finding communities that provide social support and encouragement.

there are plenty of resources out there

SETTING YOUR GOALS

Exercise 2: Setting Your Goals You will work with your partner again.

If you don’t have a partner, you will raise your hand.

You get five minutes to work on each set of goals.

You will take turns

Talkers Share three or more changes you want to make, from

all the ideas we talked about

Write them down in your notes

If you wrote more than three, put a * by the three most urgent or important

What obstacles do you anticipate getting in the way?

How can you overcome them?

Brainstorm with your partner

Listeners If needed, help your partner brainstorm goals for their

list

Suggest resources

Just lend a hand; you don’t have to have all the answers

Encourage your partner, verbally and in writing

Exercise 2: Setting Your Goals Talkers Listeners

Share 3+ changes you want to make. Write them down.

If you wrote more than three, * the three most urgent or important

What obstacles do you anticipate getting in the way?

How can you overcome them?

Brainstorm with your partner

If needed, help your partner brainstorm goals for their list

Suggest resources

Just lend a hand; you don’t have to have all the answers

Encourage your partner, verbally and in writing

Exercise 2: Setting Your Goals

Great job!

Review

Further Resources

Q&A

Discussion

Review: Section 1 Social interest & social embeddedness

Identifying and using your team

Encouragement

Exercise 1: Sharing & Listening

Review: Section 2 Social interest for providers

Encouragement vs. sick-role

Encouragement & self-efficacy

Self-management

Exercise 2: Setting Your Goals

Further Resources health-focused counseling and/or health-focused

psychotherapy

When you get stuck on issues

Further Resources: Books for patients and caregivers

Living with Pain: A New Approach to the Management of Chronic Pain, by Richard L. Reilly, D.O.

The Pain Survival Guide: How to Reclaim Your Life, by Dennis W. Turk, PhD, and Frits Winter, PhD

Explain Pain, by David Butler and Dr. Lorimer Moseley

Living a Healthy Life with Chronic Conditions: Self-Management of Heart Disease, Arthritis, Diabetes, Asthma, Bronchitis, Emphysema and Others, by Lorig, et al.

You Can Heal Your Life, by Louise L. Hay (see also her other works)

Further Resources: Books for healthcare professionals:

Patient Education for Common Chronic Diseases: Chronic Disease Patient Education Manual

Health Promotion and Health Counseling: Effective Counseling and Psychotherapeutic Strategies, by Sperry, Lewis, Carlson, & Engler-Carlson

for everyone

Difficult Conversations: How to Discuss What Matters Most, by Douglas Stone, et al.

Making Good Use of Illness: an Adlerian Approach to Chronic Illness, by Louise Giroux (out of print, hard to find)

Further Resources online tool to deal with pain, by the Penny George Institute

for Health and Healing: www.allinahealth.org/georgeinstitute

Family Caregiver Alliance, National Center on Caregiving – caregiver.org

join a support group, and/or find a website about your illness

Alzheimer’s/dementia caregivers: www.alz.org/mnnd North American Society of Adlerian Psychology:

http://www.alfredadler.org/alfred-adler chronic pain programs in the Twin Cities Other?

References Ajzen, I. (1988). Attitudes, personality and behavior. Chicago: Dorsey Press.

Ansbacher, H. L., & Ansbacher, R. R. (Eds.). (1956). The individual psychology of Alfred Adler. New York: HarperPerennial.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Bulletin, 84, 191-215.

Bandura, A. (1997). Self-efficacy. New York: Freeman.

Cohen, S. (1988). Psychosocial models of the role of social support in the etiology of physical disease. Health Psychology, 7, 269-297.

Dreikurs, R., Grunwald, B., & Pepper, F. (1982). Maintaining sanity in the classroom. New York: Harper & Row.

Evans, T. (1989). The art of encouragement. Athens, GA: University of Georgia, Center for Continuing Education.

Evans, T. (1995). The encouraging teacher. In G.M. Gazda, F. Asbury, M. Blazer, W. Childers, & R. Wallers (Eds.), Human relations development (5th ed.), 261—69. Boston: Allyn & Bacon.

References Friedman, H. S., & Booth-Kewley, S. (1987). The disease-prone personality: A meta-

analytic review of the construct. American Psychologist, 42, 539-555.

Friedman, H. S., & DiMatteo, M. R. (1989). Health psychology. Englewood Cliffs, NJ: Prentice-Hall.

Gatchel, R., & Turk, D. (1999). Psychological factors in pain: Critical perspectives. New York: Guilford.

Gentry, W. D., & Kobasa, S. C. O. (1984). Social and psychological resources mediating stress illness relationships in humans. In W. D. Gentry (Ed.), Handbook of behavioral medicine (pp. 87-116). New York: Guilford.

Hendrick, S. S. (1985). Behavioral medicine approaches to diabetes mellitus. In N. Schneiderman & J. T. Tapp (Eds.), Behavioral medicine: The biopsychosocial approach (pp. 509-531). Hillsdale, NJ: Erlbaum.

Jensen, M. P., Turner, J. A., & Romano, J. M. (1994). What is the maximum number of levels needed in pain intensity measurement? Pain, 58, 387-392.

Johansson, E ., & Lindberg, P. (2000). Low back pain patients in primary care: Subgroups based on the Multidimensional Pain Inventory. International Journal of Behavioral Medicine, 7, 340-352.

References Kobasa, S. C., Maddi, S. R., & Courington, S. (1981). Personality and constitution as

mediators in the stress-illness relationship. Journal of Health and Social Behavior, 22, 368-378.

LaFountain, R. M. (2011). Psychological and physical pain: Two sides of the same coin. Paper presented at the meeting of North American Society of Adlerian Psychology, Victoria, British Columbia, Canada.

National Center for Chronic Disease Prevention and Health Promotion (2000). Chronic diseases and their risk factors: The nation’s leading causes of death, 1999. Washington, DC: Author.

Roback, H. B. (Ed.). (1984). Helping patients and their families cope with medical problems. San Francisco: Jossey-Bass.

Silverman, J. T. (2001). Catastrophizing and coping with chronic pain. Dissertation Abstracts International, 61(9-B), 0419-4217.

Sperry, L., Lewis, J. A., Carlson, J., & Englar-Carlson, M. (2005). Health promotion and health counseling: Effective counseling and psychotherapeutic strategies. Boston: Pearson/Allyn & Bacon.

References Turk, D. (1996). Psychological aspects of chronic pain and disability. Journal of

Musculoskeletal Pain, 4, 145-153.

Turk, D., & Feldman, C. (2000). A cognitive-behavioral approach to symptom management and palliative care: Augmenting somatic interventions. In H. Chochinov & W. Breitbart (Eds.), Handbook of psychiatry in palliative medicine (pp. 223-239). New York: Oxford University Press.

Turk, D. C., & Kerns, R. D. (Eds.). (1985). Health, illness, and families: A lifespan perspective. New York: Wiley.

Terner, J. R., Pew, W. L., & Aird, R. A. (1978). The courage to be imperfect: The life and work of Rudolf Dreikurs. New York: Hawthorn Books.

“In the depths of winter I finally learned that there is within me an invincible summer.” – Albert Camus

Thank you all for participating, and gratitude also to:

Marina Bluvshtein, PhD

Daniel A. Haugen, PhD

Trish Fitzgibbons Anderson, MA

Rebecca K. Facer, MSW, LICSW

Patrick Robinson, MA & the AGS Alumni Association

The staff at the Adler Graduate School

My Tai Chi family at Normandale Community College

Michael Merriam

My colleagues, family, and friends