Counselling people with dementia

Counselling people with dementia is in its infancy. There is plenty of counselling available for carers, and support available for people with dementia, but there still seems to be a feeling that people with dementia cannot benefit from counselling properly so called. But is this true?

As counsellors we believe that all people should be treated, and be aware that they are being treated, with the dignity that their human nature demands; that is especially important for those groups of people whose human dignity has been, or is being, denied: people with dementia form one of those groups. Counselling is a way to free a person to recognise that dignity in themselves and so inevitably (according to Carl Rogers, the founder of person-centred counselling) grow in the capacity to recognise it in others.

If there is one phrase that sums up counselling, it would be that famous one which originates with the Danish philosopher Kierkegaard and was picked up by Carl Rogers, “to become the self one truly is”. We hear over and over again from people with dementia that they have lost themselves or they are losing themselves; and so many of their carers say some such thing as “I have already lost my mother, although she is still alive”. Dramatic things to say? Yes, indeed – but the other place where not dissimilar things are said is in the counselling room. I know that “something” has happened when a client says “I want my self back”; I know they are on the road to becoming the self they truly are.

That is the core of counselling. On the way we may incidentally find life easier, grow in self-esteem, manage our anger, our shyness, our fear. We may find a new place in our lives for the beloved person who has died. We may learn to diminish or live with our dissociation, our post-traumatic stress, our voices. All these things, I firmly believe (and so far observation bears that out) stem from discovering, re-discovering perhaps, the self that we truly are.

One of my clients said “Certainty is more comfortable, but doubt is more real”. There is no certainty for the person with dementia. As Karl Marx put it, “All that is solid melts into air”: the things that once defined them; the memories which – perhaps – make them who they are. But do they? Another client commented that there are two ways of looking at identity or self: one is that we are the sum total of our experiences, and the other is that we are who we are at this instant. That client was inclined to think that for them, at least, the second was more accurate. And if that can be so, then there should be no reason why diminished cognitive abilities or diminished memory should preclude discovery of self.

People sometimes say that counselling cannot possibly help a person with dementia, as they “won’t remember what has happened from one session to the next”. Well, true, if you regard counselling as something basically cognitive, depending on building, by cognition and by memory, on previous sessions. But that is only one way of seeing it; to a person-centred counsellor, counselling is fundamentally, essentially, relational. It was Tom Kitwood, the first to make a serious study of counselling people with dementia, who put it best:

Although people who have dementia are greatly disadvantaged, there are some respects in which they may be more open than others to therapeutic change… There are several different theories about how therapeutic change occurs. One highly respected view attaches relatively little weight to cognition, and regards the whole process as fundamentally relational… During the course of therapy a special kind of relationship is formed, one which is far more tolerant, accepting and stable than is common in ordinary life; for some people it is the first time ever that they have been acknowledged truly as a person.

There is nothing more powerful than being acknowledged truly as a person. It is effective for all kinds of clients: it is no less effective for the person with dementia.