When Someone You Love Has Alzheimer's - Part 2

Yesterday my blog article When Someone You Love Has Alzheimer's - Part 1 discussed some basic information about Alzheimer's disease and the Alzheimer's Association as a resource for support and valuable information.  Today I would like to discuss how to navigate family dynamics when family members disagree about elder care issues involving a loved one.

Making Decisions for a Loved One with Alzheimer's:

Making decisions for a loved one who has Alzheimer's can be one of the most difficult things that you and your family will ever have to do.

First of all, to accept that a mother or father (or other relative) who was once an independent and capable person is no longer capable of making decisions for her or himself can be heart wrenching.  But even after you've accepted this, you and other family members might not agree about how to proceed.  This can quickly lead to family conflict and degenerate into warring factions in the family, adding to an already very difficult situation.

The Alzheimer's Association:  Alzheimer's Organization
As I mentioned yesterday, the Alzheimer's Association, can be a wonderful resource for general information, but they can't make personal decisions for you about your loved one.  That's up to you and your family.

Getting a Diagnosis:
As I mentioned yesterday, Alzheimer's can look like other medical conditions.  It's a "rule out" diagnosis and a good place to start is with your family doctor.  Often, your family doctor will refer your loved one to a neurologist.

Important Elder Care Decisions to Make:
Once you have a diagnosis of Alzheimer's and you've obtained basic information from the Alzheimer's Association, it's often helpful to get an objective professional evaluation about your loved one's specific needs:

• Can s/he take care of daily activities of living (e.g., getting dressed, preparing meals, paying bills, etc). 
• Is it safe for your loved one to live alone?
• Is it safe for your loved one to continue to drive?

These are just some of the many questions that need to be addressed.

So, what do you and your family members do after your loved one is diagnosed with Alzheimer's?

Call a Family Meeting:
Rather than going it alone, I recommend calling a family meeting and discussing the important elder care issues that are involved when a family member has Alzheimer's.  Usually, an important decision is whether or not to involve the family member who has Alzheimer's.  A lot will depend on whether he or she is still capable of understanding what's going on.  If not, it might be more confusing than helpful to him or her.

Prepare for the Family Meeting:
Before the meeting, gather your thoughts and write down the main issues that need to be discussed.  You don't need to cover everything in one family meeting and, in fact, it can be overwhelming.  Unless the situation is urgent and you need to make immediate decisions, it might be better to plan a couple of meetings, if possible, so you don't wear yourself and others out by trying to do it all at once.

Stay Calm and Be Patient with Other Family Members:
Although this can be a very emotional time, especially if family members don't agree or if they're in denial about the Alzheimer's diagnosis, try to stay calm so you can listen to your family's concerns.  You might have overcome denial about your loved one's diagnosis, but it might take other family members a little longer to come around.  Try to be patient.

Get an Objective Professional Evaluation:
Once your loved one has been diagnosed with Alzheimer's by a medical doctor, you need to know what are his or her particular needs.  So, it's often very helpful to start with an objective professional evaluation about the particular needs of your loved one who has Alzheimer's.  Having an evaluation often helps families in the decision making process.

Consult with a Geriatric Social Worker:
Geriatric social workers evaluate the needs of a person with Alzheimer's disease.  They are trained to evaluate and make recommendations for the elderly.  You and your family can start by getting information through various geriatric social work websites, including:  http://caremanager.org.

• Make sure that the geriatric social worker you choose is a licensed social worker who is certified in geriatric care.  
• Ask questions when you call about the geriatric social worker's credentials, the fee, and what services s/he provides.  
• Before you go for the consultation, prepare questions in advance so you're organized for the meeting and use the time most effectively.
• The geriatric social worker can't make decisions for you.  He or she can only make recommendations after the evaluation, and then it's up to you and your family to make important elder care decisions.  
• A geriatric social worker can also help you to navigate through the confusing, bureaucratic morass of the health care system, whether your loved one is able to stay at home and get a home health aide or whether s/he needs to be placed in a nursing home.  S/he might also be able to recommend an elder care attorney so you can get a durable power of attorney or handle other legal issues involved.

Take Care of Yourself Throughout this Process:
People who go through this process often don't realize how stressful and frustrating it can be, even when there isn't family conflict about how to proceed.  It's easy to neglect yourself during this time.  So, it's important to take extra good care of yourself by eating well, getting enough sleep, and having emotional support.

You're Not Alone:
When you're faced with these difficult decisions and, possibly, your own conflicting emotions, you can feel very alone.  But, as the population ages, there are thousands of people going through what you're going through now.  You're not alone.  If you're able to attend a support group through the Alzheimer's Association, you could benefit from one of these mutual support groups.

Get One-on-One Emotional Support in Therapy:
Many people find it helpful to get objective emotional support in their own therapy while they're going through this challenging time.  It can be helpful to be in your own therapy to sort out your feelings about what to do.  It's one thing to have an objective recommendation and to know logically what to do, but it's another thing to handle it emotionally.

This is obviously a huge topic, which can't be completely covered in one or two blog posts, but if you're currently going through a difficult time with someone who has Alzheimer's, I hope these blog posts have been helpful. 

About Me

I'm a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit:  Photo Pin

When Someone You Love Has Alzheimer's Disease

One of the most difficult things to deal with in life is to watch someone you love deteriorate over time because of Alzheimer's disease.  Currently, there is no cure for Alzheimer's.  There are medications that can slow the progression of the disease, but they cannot stop it from ravaging the brain.  Since there is no cure, you can feel extremely helpless watching someone you love get worse and not being able to do anything about it.

Alzheimer's is a "rule out" disease, which means that other medical problems must be eliminated first in order for a medical doctor to diagnosis someone with Alzheimer's.  Over time, Alzheimer's causes memory loss, usually starting with short term memory and eventually progressing to long term memory.

In the early stages, it can be hard to detect because it can look like many other medical problems, which is why other disorders and diseases must be ruled out first.  As Alzheimer's progresses, it will eventually affect a person's ability to perform basic tasks, like taking care of themselves.  It will also, in the advanced stage, affect their ability to speak and walk.  People with advanced Alzheimer's often have poor judgment.  It affects mood, so the person often becomes irritable or loses his or her temper.

If you have a loved one that has Alzheimer's, you need emotional support.  Taking care of someone with Alzheimer's can wear you down.  It's painful to watch someone who was a very vibrant and capable person before Alzheimer's, deteriorate.  Your loved one might not even seem to be the same person that you've always known.  He or she might not recognize you and lash out at you.  At those times, you might feel very alone and need help yourself.

The Alzheimer's Association is a wonderful resource.  They provide support to caregivers on so many levels:  emotional as well as educational.  Participating in one of their support groups with other people who have loved ones with Alzheimer's can be very helpful.  Being around others who are going through what you're going through can be a tremendous relief, so you don't feel so alone.

The Alzheimer's Association also provides free meetings to help you with financial and legal questions. Elder care attorneys present legal information that affect people who have spouses, parents or other relatives with Alzheimer's.  In addition, the Alzheimer's Association has a virtual library online so you can educate yourself.

Also, see When Someone You Love Has Alzheimer's Disease - Part 2:  http://psychotherapist-nyc.blogspot.com/2012/09/when-someone-you-love-has-alzheimers_20.html. 

If you have a loved one with Alzheimer's, don't go it alone.  Contact the Alzheimer's Association near you and get support.

To contact the Alzheimer's Association, you can go to their website:  http://Alz.org.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit: Photo Pin

Life After the Divorce

Most people I know, who are newly divorced, tend to speak of their lives in terms of "life before the divorce" and "life after the divorce."  Even when their divorce represents the end of a marriage that was filled with animosity and rage at the end, they still tend to feel some ambivalence about parting from someone they once loved and who once loved them.

Life After Divorce

There are often ambivalent emotions after a divorce
I have a friend who is newly divorced.  At this point, she looks at her life in terms of "before the divorce" and "after the divorce."  While she's mostly relieved to be unattached to her ex, who was cheating on her with many different women and she doesn't miss her ex, she still looks back on the good times they had when they were first married, "He was so charming then.  We were so in love." She was the one who initiated the divorce and, overall, she's glad that she's not with a man who was unfaithful to her.  But, like many people who go through a divorce, I still detect a sense of ambivalence in her voice when she talks about how in love they were when they first got married.

Everyone's experience of divorce is different - New York Times "Modern Love" article
Of course, everyone's experience of getting a divorce is different, whether they were the ones who initiated the divorce or they were the ones who wanted to reconcile or it was a mutual decision.  But I haven't met anyone (at least, not yet) who is having a party or an "unbridled shower,"as they're called in yesterday's Sunday New York Times article by Judith Newman: The Unbridle Shower- Celebrating Divorce not with-a Whimper But a Bang.

I had no idea that, as the New York Times article states, there are high-end party planners who organize parties for people who are divorced or soon to be divorced that are like bridle showers.

The article mentions that there is actually a fireworks company in England that can be hired for these occasions to set off fireworks that spell out "free at last."  Apparently, some people who are getting divorced even list themselves with store registries so their friends can buy them gifts for their "unbridled shower."

And here's another thing I didn't know:   there are divorce party specialists (http://divorcepartysupply.com), according to the article, who will "celebrate your new freedom".

As I was reading the article, I felt myself getting increasingly annoyed with descriptions of devil-horn tiaras, Alice in Wonderland costumes, and "penis pinatas" at these "unbridled showers."  Someone in the article even mentioned that since gay men and lesbians can now get married and, hence, they can get divorced, this might mean even more divorce parties.  Is this something to look forward to?

After I finished reading the article, I wondered: What's making me feel so annoyed?

The conclusion I came to is that there was a frivolous attitude to the article.  This might not have been the writer's intention.  But the way I read it, it sounded like an "out with the old" and "in with the new" attitude in the article, a sort of cast-off-that-old-marriage-and-walk-in-the-sunlight-of-your-new-life kind of attitude.

As a society, are we really so cavalier about our relationships?

I'm certainly not suggesting that people who are newly divorced should spend their days with the sheets pulled over their heads (although, you could understand someone feeling that way initially).  But a divorce party cake with a bride on top holding a knife over the groom's mutilated body?

The important of emotional support after a divorce
I do like the idea of friends and family coming together to be supportive of someone who is getting divorced.  People who are going through a divorce often need a lot of social support.  

There was one person in the article whose friends bought him new kitchen utensils to replace the ones that were kept by his wife after the divorce.  This was obviously a supportive gesture to help this person move into the next stage of his life.  

I also liked that one person received a beautiful piece of sea glass as a gift to symbolize survival and endurance through a difficult time.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Clinical Hypnosis: Learning to Nurture Your Inner Child

Many clients come to therapy because they feel unloved or unworthy of love in their adult lives.  Most of the time, these feelings stem from feeling unloved, neglected or abused as a child.  Clinical hypnosis offers an opportunity to work through this trauma and to also learn to nurture your inner child.  

What is clinical hypnosis?
See my article: What Is Clinical Hypnosis?

We know we can't undo the past
You might wish you had a childhood that was more loving and nurturing, but we know that wishing won't make it so.  But clinical hypnosis (also known as hypnotherapy) offers an opportunity to access that younger part of yourself, as well as your adult self, so that you can nurture yourself now.

Even though we're adults, we still have access to the younger aspects of ourselves
We're aware of this, at times, in our daily lives when we become triggered, as adults, by hurtful situations that we experience now.

For instance, if someone hurts your feelings by saying something unkind to you, it can trigger old, unresolved emotional wounds from when you were a child.  Often, in these situations, you realize that your reaction to these unkind words seems out of proportion to what's been said.  You might even feel overwhelmed by your emotional reaction and wonder, "What's going on?  Why am I having such a strong reaction?"  Often (although not always), this is an indicator that there might be old, unresolved issues that are getting triggered in you.

We can shift our emotional states
We don't always realize it, but we shift our emotional states many times during the course of a normal day.  During the course of any given day, we might shift between feeling like confident adults to rebellious teenagers to vulnerable children.  Now, I'm not talking about multiple personalities.  What I'm referring to is often much more subtle.  It's more than just a shifting mood.  It's an actual shift in our self state.  It's not something we do intentionally most of the time.  We often experience it as "it just happened."

How a skilled hypnotherapist can help
To work through these old, unresolved emotional wounds, a skilled hypnotherapist can help you to access the various self states that are already a part of who you are---including your current "adult self" and your "younger self" in a clinical hypnosis session.  By shifting between these different states, you can experience yourself as an adult nurturing the child part of yourself.  This can be a very healing experience that, with practice, can have long lasting effects.

The child aspect of yourself can still be very much alive and active.  This is true even if you had the best childhood.  The child aspect doesn't only surface because of neglect and abuse.  It also surfaces as the playful and creative part of you.  In fact, I often help people who are stuck creatively to access that part of themselves in hypnotherapy so they can get unstuck.

There's a big difference between hypnotherapists and hypnotists
As I've mentioned many times before, there's a big difference between people who call themselves hypnotists and people who are hypnotherapists.  

The hypnotist often learns various hypnotic techniques, but s/he is not a skilled clinician or trained mental health practitioner.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I work with individual adults and couples, and I have helped many clients to learn to nurturing themselves so they can heal and lead more fulfilling lives.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit: Photo Pin

Balancing Your Needs with Being Responsive to the Needs of Our Loved Ones

How do we balance our own needs with being responsive to our loved ones?  

There are times in life when we choose to put aside something that we want in our lives to focus on our loved ones, whether this involves a child, a spouse or an elderly relative.  This is a part of life and, usually, we do this because we love them and they're important to us.  But this is different from a lifelong pattern of constantly putting others' needs first and sacrificing our own.  

Balancing Your Needs With the Needs of Your Loved Ones

For many people, it can be tricky knowing how to balance their needs with what's being asked of them from family and friends.  When there's a lifelong dynamic of consistently putting others' needs over our own, it can leave us feeling adrift in a sea of doubt and dissatisfaction.

Here are a few short vignettes that are examples of this pattern of putting others' needs first:

Paul:
From the time he was a small boy, Paul always wanted to be an airline pilot, but he knew that his father wanted him to be a doctor.  His father wanted to be a doctor himself when he was younger, but he had to help his parents support  a large family, so he went to work instead of going to medical school.  Paul is painfully aware of his father's family history and the many sacrifices his father made.  He feels too guilty to pursue his dream of becoming an airline pilot, so he becomes a doctor to please his father.  Once in the profession, he's deeply unhappy.  He finds he hates it and he's ill at ease with all the patient contact.  But he remains as doctor because he knows it makes his father proud and happy, and he would feel too guilty disappointing his father.

Susan:
Susan's mother, Mary, has a long history of living beyond her means.  When Mary loses her job, she tells Susan that she wants to stop working, rather than look for other work, and she expects Susan to help support her.  Mary is only in her early 50s, in very good health, and there are no other reasons why she can't look for another job.  She just doesn't want to do it.  Over the years, she's depended on Susan to bail her out financially.  Susan just began building a financial safety net for herself, but she's nowhere near what financial experts recommend of having at least six months to a year of savings in case of an emergency.  Supporting her mother would be a very big financial sacrifice.  Rather than supporting her on an ongoing basis, Susan would rather help her mother in the short term until Mary can find another job.  But Susan doesn't feel comfortable telling her mother this, so she agrees to give her mother a substantial part of her salary every month, which keeps Susan from saving for herself.  She's unhappy with this arrangement, but she feels too guilty and that it would be selfish to speak up for herself.

Alice:
Alice recently joined a neighborhood writing group.  Since she began this supportive group, Alice has become much more confident in her writing and she has been seriously considering submitting her short  stories for publication.  The group members have been encouraging her to do so, and they especially urged her to come to the next meeting where the guest speaker will be an editor from a magazine who might be interested in Alice's stories.  As Alice is about to leave for the group meeting, she gets a last minute call from her sister, Betty, who is in tears about the latest argument she had with her husband.  She tells Alice she is coming over because she needs to talk to her right now.  This is the third time this week that Betty has called in tears to talk about her marriage.  Alice had very much been looking forward all month to attending her group and meeting the magazine editor.  But rather than telling Betty that she could talk to her later, she takes off her coat, resigns herself to missing the meeting, and tells Betty it's okay for her to come over now.

What all of these scenarios have in common is an inability to assert one's self in order to balance one's own needs while still being responsive to loved ones.  Each person is taking on his or her loved one's problems or wishes at a sacrifice to him or herself.  

When Shame is at the Core of the Problem
If shame is at the core of being unable to assert your own needs, it can make these situations even more challenging.  By shame, I mean that, often, people who tend to put others' needs first most of the time feel too ashamed to allow themselves to want things for themselves.  Their family upbringing might have been that it's better to always put other people's needs first.

Tactfully setting boundaries with others is your right.  You might know this, but knowing when to do it might be confusing:  Are you being selfish or are you asserting yourself?  

Always Putting Others' Needs First Can Exhaust and Depress You
A pattern of putting others' needs before your own can leave you feeling depleted and depressed.  It can also cause you to feel resentful of others.  On the one hand, you don't want to feel like you're being selfish but on the other hand, you don't want to neglect your own needs.  It can be hard to know where to draw the line.  But if you don't learn where to drawn the line, your life will go by without the things that you really want for yourself.  There are few things sadder than someone who looks back on his or her life and says, "If only I had pursued my dreams..."

Getting Help in Therapy
When you work with a clinician who has expertise in helping people to balance their needs with being responsive to their loved ones, you learn to discover what you really want, when to assert your needs, and how to do it.  

It's not a matter of the psychotherapist telling you what to do.  It's about you discovering and learning to listen to your core self, who usually knows what's right for you so you can lead a more meaningful and fulfilling life.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I have work with individual adults and couples.  I've helped many clients to overcome obstacles that keep them from leading more fulfilling lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

For a related topic, see my article:  Overcoming Fear of Anger

Learning to Celebrate Your Success in Life

Celebrate Your Success

Setting and accomplishing goals can be challenging. When you succeed at attaining your goals, it's important to acknowledge your hard work and perseverance by celebrating your success. 

Yet, so many people have a hard time recognizing and acknowledging their success.

Feeling Empty Rather than Happy After Accomplishing a Goal
Over the years, so many people have told me that they looked forward to accomplishing a long term goal, but after they succeeded, they felt empty inside.  Rather than feeling happy that they attained a hard-won success, they feel nothing.

For instance, I've known a number of people who work full time and go to college at night.  This can be very challenging.  (I know this from personal experience because I attended college for years at night while I worked full time.)  When it comes time to attend their graduation, many of these same people just don't go.  They make all kinds of excuses for not attending their graduation ceremony, but it's clear they're uncomfortable and they don't know why.

An Inability to Celebrate Success is Often a Deeply-Rooted Problem
Often, this problem of being unable to celebrate success is deeply rooted in earlier problems.  For each person, it will be different.  But an inability to celebrate a success is a real problem that can follow you throughout your life robbing you of the joy you could feel for your accomplishments.

For many people who have been emotionally traumatized in life, they feel a need to be always vigilant for the next bad thing that might happen in their lives.  Letting down their guard to be happy and celebrate a success just doesn't feel like an option for them.  They might not even realize that this is what's keeping them from feeling good.  But, often, when they come to therapy, they realize that they have old emotional wounds to work through.

Getting Help in Therapy
If you're someone who has problems acknowledging and celebrating your successes in life and you haven't been able to overcome this on your own, you owe it to yourself to seek professional help to work through this issue.

Life is short and it brings both joy and sorrow.  If you're only able to feel the sorrow, you're depriving yourself of many happy moments in life.  It's possible to overcome this problem, if you're willing to take the first step to get help to heal.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I work with individual adults and couples.

I have helped many clients to overcome emotional obstacles so they can lead more fulfilling lives.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit: Photo Pin

Fear of Being a Disappointment to Your Therapist

I was talking to a friend recently, and she mentioned to me that she was thinking of leaving therapy because she was afraid she was going to be a disappointment to her therapist.  She's been with this particular psychotherapist for more than a year.  She told me that they have a great rapport, but she was worried because she was considering returning to her ex-husband, and she feared that she would be a great disappointment to her therapist if her therapist heard about it.  So rather than talk to her psychotherapist about it, she was contemplating leaving therapy rather than risk seeing the look of disappointment on her face.

A Common Fear for Clients in Psychotherapy
After we talked about it, my friend, whom I'll call Mary (not her real name) gave me permission to write about this in my blog because it's such a common problem for many people in therapy, especially when they really like their therapists.

Therapy is a place where, ideally, you can talk about anything.  Yet, so many people hesitate to tell their therapists about decisions they're about to make because they fear looking bad in their therapist's eyes.  They become so filled with shame and fear that they'd rather leave therapy prematurely than deal with this issue.

Clients Feel Too Ashamed to Talk to Their Psychotherapist About Certain Topics
When new clients come to me for a consultation in my psychotherapy practice in NYC, I usually ask them what their prior experiences have been in therapy.  It's not unusual to hear that they had a therapist that they really liked, but they left because they felt ashamed about something that they did or were about to do.  Often, it involves going back to an ex or making some other decision that they think will disappoint their therapist.  Often, their abrupt departure from therapy is still a loss for them that has not been worked out.

If clients have been raised by overly critical and shaming family members, this is even more likely to be a problem for them as they imagine that their therapist will think less of them.  Often, this is a projection of old, unresolved emotional wounds.  And, they would rather leave their therapist prematurely than see disappointment in his or her eyes.

Talk to Your Therapist About Your Fears
Since my friend had not left therapy yet (she was only thinking about it at the time), I urged her to talk to her therapist about her fear.  This took a lot of courage on my friend's part.  But, afterwards, she was very glad that she did it because that session affirmed the bonds of their therapeutic relationship.  Rather than seeing disappointment in her eyes, my friend saw caring and compassion.  It was a very healing experience for her to know that her therapist still cared about her regardless of what she was contemplating about her ex.  In fact, my friend realized that she was the one who was judging herself and projecting this onto her therapist.  This realization caused her to stop to explore the issue of reconciling with her ex further without being burdened by guilt or shame.

There's a good article in Psychology Today on how to communicate with your therapist by Ryan Howes, Ph.D. that could be helpful to you: "How to Give Feedback to Your Therapist".

Thinking that you might be a disappointment to your therapist can be a painful experience.  Most skilled clinicians have dealt with this issue before and can help you to navigate through it.  Rather than leaving therapy in haste, I usually urge most people to talk to your therapist about whatever it is you fear will make you a disappointment to him or her.  These are often the best sessions in therapy when they are handled by an experienced licensed clinician.

About Me

I am a licensed NYC psychotherapist, hypnotherapist,  EMDR and Somatic Experiencing therapist. 

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit:  Photo Pin