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