Gallagher-Thompson / Bilbrey / Qualls Family Caregiver Distress

1. Auflage 2023
ISBN: 978-1-61334-517-7
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 100 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

Get the science on helping reduce stress in family caregivers of people with dementia:

Details the best tools for assessment and explores evidence-based approaches
Reflects on diversity, equity, and inclusion
Includes downloadable handouts

Guidance for supporting family caregivers on maintaining positive mental health
This is the first book that takes a “deep dive” to answer the questions that mental health providers encounter when working with family caregivers. Just what are the unique issues family caregivers face? How does this impact their mental health? What can providers do to help?

Based on research and clinical experiences of the authors, this volume in our Advances in Psychotherapy series focuses on examining the specific issues that caregivers of people with Alzheimer’s disease or other forms of dementia face. Practitioners learn about the best tools for assessment and which evidence-based interventions help reduce caregiver distress – including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness and multicomponent intervention programs.
Resources in the appendix include a caretaker intake interview, and the book is interspersed with clinical vignettes that highlight issues of diversity, equity, and inclusion – making this is an essential text for mental health providers from a variety of disciplines including psychology, psychiatry, nursing, social work, marriage and family counseling, as well as trainees in these disciplines.

Zielgruppe

Clinical psychologists, geropsychologists, psychiatrists, psychotherapists, family practitioners, and marriage and family counselors, as well as trainees.

Autoren/Hrsg.

Gallagher-Thompson, Dolores

Bilbrey, Ann Choryan

Qualls, Sara Honn

Ghatak, Rita

Trivedi, Ranak

Waelde, Lynn C.

Lynn,

Fachgebiete

• Sozialwissenschaften Soziologie | Soziale Arbeit Soziale Arbeit/Sozialpädagogik Soziale Arbeit/Sozialpädagogik: Kranken-, Alten- und Behindertenhilfe
• Sozialwissenschaften Psychologie Psychologie / Allgemeines & Theorie Psychologie: Sachbuch, Ratgeber
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Pflege Fachpflege
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie

Leseproben

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Theories and Models
2.1  Stress and Coping Model
Several theoretical models have shaped this field, starting with Lazarus and Folkman (1984) who recognized that it is not the situation or event itself that causes stress, but rather how it is appraised and responded to. If a person thinks they have the resources to cope with the challenges they face, their perceived stress will generally be low. Those who perceive their coping resources to be overwhelmed and think they are unable to rise to the occasion will experience significant stress. This model was applied to caregiving by Pearlin and colleagues (1990), who added the relevance of background factors (e.g., socioeconomic status, education), and the context within which caregiving takes place (e.g., available support networks). They made a key distinction between primary and secondary stressors which is important since primary stressors typically increase (worsen) over time, whereas secondary stressors can often be addressed with appropriate interventions. Primary stressors are the functional limitations of the person being cared for (e.g., their cognitive and functional status; how much help they need in everyday life). Secondary stressors occur when caregivers have multiple roles (e.g., worker, spouse, adult child, and/or parent) that may be in conflict with one another. For example, caregivers in the sandwich generation care for their own children as well as one or more aging parents and have competing demands from all for time, money, energy, and emotional engagement. Employed caregivers have issues with absenteeism, unavailability for travel, or for complex projects. Many reduce work hours or leave the workforce entirely as dementia progresses. Caregivers may also experience psychological strain from their own self-doubt about being able to continue in the role as long as it takes, negative feelings such as guilt at not doing enough, frustration with being unable to manage time and tasks effectively or a sense of loss as they observe their loved one’s decline over time. These secondary stressors add an additional layer of complexity to an already challenging situation. Pearlin’s approach highlights the need to evaluate multiple outcomes (because caregiving is a multifaceted experience) as well as the role of two key mediators: caregivers’ ability to employ adaptive coping skills to deal with intra- and interpersonal stressful behaviors, and skills to develop strong social support network systems that can have major positive influences on how this dynamic situation plays out. |15|2.2  Sociocultural Model
Increasing attention to the diversity of the US population has led to development of a sociocultural caregiving model by Knight and Sayegh (2010) highlighting the contributions of cultural values, beliefs, and practices to caregiving stress and related outcomes. This model also notes the importance of coping styles and social support, both of which are heavily influenced by one’s cultural identification (see Figure 3). Earlier, Aranda and Knight (1997) observed measurable differences in how caregivers respond to primary and secondary stressors, based on their cultural identification. For example, those who hold the strong Asian cultural value of filial piety (Bedford & Yeh, 2019) often have a collectivistic coping style that involves relying on family rather than oneself for problem-solving. Those whose values and actions are consistent with their cultural identity may experience fewer negative outcomes. Cultural values and extent of acculturation, or the degree of assimilation into the host culture, influence what kinds of social supports are identified and utilized. For example, some Latino caregivers incorporate traditional healing methods so their support system may include practitioners skilled in massage and herbal remedies, in addition to family and traditionally trained medical providers. Using these supports may have a positive impact on caregiver functioning by reducing perceived burden. Figure 3 also illustrates that behavioral problems in and of themselves, which are so typical in middle stage dementia, may not have a direct path to caregiver distress, but are mediated by coping styles and social supports reflecting the individual’s values and cultural identity. There is no doubt that culture counts when it comes to caregiving. Culturally rooted views about causes of dementia, how it can be treated, and |16|what role various family members and/or friends play in providing care are all relevant to understanding the needs of the caregiver as well as the kinds of interventions likely to be effective (Yeo et al., 2019). Although it can be challenging to be aware of important ethnocultural nuances, an attitude of cultural humility is an essential component of effective assessment and treatment (Hook et al., 2017). When clinicians are culturally humble, they respect the perspectives, values, and identities of others, while being aware of their own, without assuming that their own perspectives and values are superior. Cultural humility in the context of caregiver intervention involves self-reflection about the nature of the clinician’s own multiple and intersecting identities and how they may be similar or different from the client’s. It also involves considering the impact of the differential of power and privilege between clinician and caregiver and how that may affect the working relationship. In this context, cultural humility takes the form of learning about the caregiver and their cultural context to avoid stereotypes. The culturally humble clinician is inquisitive about cultural issues and will creatively employ that information in both assessment and intervention. Research is underway to understand how dimensions of diversity other than race/ethnicity and cultural background influence caregiving for PLWD. Gender and sexual orientation, urban versus rural differences, religious/spiritual beliefs and practices, and disparities in health equity – as well as the intersectionality of these issues – all may affect caregivers’ mental and physical health (e.g., C. Liu et al., 2021; Yeo et al., 2019). 2.3  Trajectory of Illness Model
Each of the above-described models provides valuable pieces of the puzzle, but do not address how caregiving itself changes over time, often referred to as the trajectory of caregiving. Caregivers’ experience is profoundly affected by stage of the care recipient’s illness. Demands typically increase as dementia progresses and care recipient’s needs become more intense, so both positive and negative impacts of caregiving change, too, along with the caregiver’s internal and external resources. Multiple interactions occur with health care systems that also change over time. As health crises and hospitalizations of care recipients increase, care needs take up more time, energy, and resources of the caregiver. Table 1 depicts the multifaceted and dynamic nature of this process (Gallagher-Thompson et al., 2020). This model emphasizes the importance of recognizing and working with transitions between stages of disease progression and highlights the fact that progression is not linear. Focal points for intervention loop back onto one another throughout this process. These transitions represent times of confusion when formerly effective care structures no longer work, leading the care recipient to experience health interruptions from dementia-related complications or other comorbid conditions. For caregivers, these are times of increased stress; some initiate their own help-seeking at these points. Early stage Transition Middle stage Transition Late stage ...