Tag Archives: Attachment

Aged Care at Christmas – New Year

Posted on by

Living in an aged care residence at this time of year brings home the realities of life. Too many of our residents do not have any visitors and the aloneness they feel can be crushing. Many feel abandoned by their families. Many have unhappy visits from family members that they find difficult to transact pleasantly despite their hopes for a “happy family” experience. And it should be said, some of our residents do indeed have pleasant and fulfilling experiences of being with family who come and take them home for a day or two to share in their lives and celebrations.

This time of year brings home the stark reality of the lack of satisfying and nourishing attachments for many of our elders who have been dislocated and isolated from their families, some for years. This creates a deadening effect for some as they defend against the pain of not being loved in their old age. For others they rail against it and become angry and upset with those nearest to them – the care staff and fellow residents, pushing away the very people who are there to care for them.

We need infinite patience and a caring mind to see the opportunity in this period of the year. This is an opportunity to see the aloneness and isolation and break it down with a quiet (perhaps brief but regular) warm visit and friendly conversation that establishes or sustains the rapport you have with the elder.

If the person has cognitive impairment they will likely be living with a constant threat of isolation and aloneness and a sense of struggling to make good sense of what is happening and feel competent to handle it. We can step in and provide a support to their desire for competence by helping them finish the sentence, patiently listening, or even just sitting quietly for a few moments and smiling and not blaming them for their angry outburst but trying to find an explanation. Its not complex but it seems to be difficult to do these simple things consistently.

So there it is. My wish for 2012 is that you find at least one moment this year to give another person comfort in their isolation and aloneness and support in their desire to feel competent once again.

best wishes

Bernie

Attachment in care

Posted on by

Attachment is the bond of affection and care that characterises most of our close relationships as human beings and can be seen in many animals.

John Bowlby, the British psychoanalyst who is regarded as the father of attachment theory suggested that attachment is a phenomenon that is active throughout the life cycle from infancy to old age.

Attachment figures are the caregivers who provide a safe haven and secure base from which infants and then we as adults move out to form our own lives and establish intimate attachment relationships. As adults we also internalise the capacity to form secure attachments so that the attachment figure does not have to be in the room with us but we can still feel loved and safe.

Some people however do not internalise secure attachments. Rather they internalise insecure, anxious attachments or avoid attachments altogether in their lives.

Ainsworth who is regarded as the mother of attachment theory, identified three styles of attachment that I have just referred to: Secure, Anxious/ ambivalent and Avoidant. These continue into adulthood and are present in parenting or caregiving styles of parents and others involved in close relationships with others.

Caregiving is an attachment experience in which we act as attachment figures to people who are dependent on us to provide food, affection and safety. This is particularly true for people living with cognitive impairment who are unable to process life experience in the way they previous have done and who engage with the world of social relationships in a way that is reminiscent of their previous attachment styles.

So we see dependent behaviour, asking for mother or father, wanting to go home, asking what they can do next, calling out, sexualising contact, and being clingy as attachment behaviour of proximity seeking, a behaviour that is a hallmark sign of attachment.

However, such proximity seeking is not the only sign that an attachment is active. We also see angry outbursts, pushing the attachment figure away, attacking, as the reaction to an attachment need not being  met by the desired caregiver. Then if the attachment figure does not respond for long enough the person gives up and disengages. This is often the reaction we see by people living with dementia who are left for long periods without stimulation or not interacted with, not spoken to, not noticed, or simply ignored by passing staff.

Attachment behaviour in dementia is a common experience and the explanation for much ‘disturbed’ or ‘challenging’ behaviour.

Where have you noticed attachment behaviour in the people you care for?

You are attachment figures

Posted on by

Goodbye GrandpaAttachment has been studied with children and more recently with adults. However, it is only now being considered in relation to the relationship between caregivers and people living with dementia.

Whether you are a paid or unpaid caregiver for someone living with dementia you have an effect on the person, emotionally, psychologically. Because of the cognitive changes that cause such loss of confidence and increased confusion, the person with dementia often feels emotionally upset, lost, confused, angry, abandoned, forgotten. So they are more likely to sense themselves they way they did when they were younger, much younger – like 3-8 years old. They are not children but they can feel like they used to and this is where attachment comes in.

You know yourself how easy it is to be thrown back into younger emotional territory by the actions of other people or your own actions that cause you to feel the way you used to when you were younger. Its much the same for the person with dementia.

So you become their attachment figure in this emotional landscape. You are important from an emotional point of view because you become a provider of safety and security, predictability. They rely on you, look to you for guidance about what to do next, where to go, how to feel.

I some ways you are a “mother” or “father” figure to the person.

In a future blog I will talk about the ways in which disturbed behaviour can be understood as attachment behaviour.

Enhanced by Zemanta