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The role of the fear-of-loss-of-control marker within the accounts of people affected by dementia about their illness: implications for psychotherapy
Author/s: Richard Cheston 
Year:  2015 Issue: 37 Language: English 
Pages:  21 Pg. 45-65 FullText PDF:  181 KB
DOI:  10.3280/QPC2015-037003
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One way research can explore the psychological and social factors underlying the awareness of people affected by dementia about their illness is by intensive examination of the process of psychological change as it occurs both within psychotherapy and in ordinary life. The assimilation model describes a series of stages through which clients’ problematic experiences are hypothesized to progress during successful psychotherapy. Markers of assimilation stages are recognizable types of events in psychotherapy discourse that are linked to those stages and which may be useful both clinically and in research. This paper describes how the "fear-of-losing-control" marker may operate in the accounts of people affected by dementia. Analysis of examples of the fear-of-loss-of-control marker suggests that it is associated with avoidance of referring to dementia by name (referred to here as the Voldemort phenomena), the experiences of shame and fears of the loss of self, for instance expressed as concerns about becoming mad. Implications for dementia care and for post-diagnostic therapy are considered.
Keywords: Dementia, Alzheimer’s illness, psychotherapy, assimilation, loss of control

  1. Alzheimer’s Disease International (2012). World Alzheimer Report 2012. London: Alzheimer’s Disease International.
  2. Betts N., Cheston R. (2011). From warding off to working through: helping people facing a diagnosis of dementia to change their relationship with their memory problems. PSIGE Newsletter, 118: 34-42.
  3. Cheston R. (1996). Stories and metaphors: talking about the past in a psychotherapy group for people with dementia. Ageing and Society, 16: 579-602.
  4. Cheston R. (1998). Psychotherapy and dementia: a review of the literature. British Journal of Medical Psychology, 71: 211-231.
  5. Cheston R. (2013). Dementia as a problematic experience: using the Assimilation Model as a framework for psychotherapeutic work with people with dementia. Neurodisability and Psychotherapy, 1, 1: 70-95.
  6. Cheston R., Jones R. (2009). A small-scale study comparing the impact of psycho-education and exploratory psychotherapy groups on newcomers to a group for people with dementia. Aging and Mental Health, 13, 3: 410-425.
  7. Cheston R., Jones K., Gilliard J. (2003). Group Psychotherapy and People with Dementia. Aging and Mental Health, 7, 6: 452-461.
  8. Cheston R, Jones K., Gilliard J. (2004). “Falling into a hole”: narrative and emotional change in a psychotherapy group for people with dementia. Dementia: the International Journal of Social Research and Policy, 3, 1: 95-103.
  9. Gee J. (1986). Units in the production of narrative. Discourse processes, 9: 391-422.
  10. Gee J. (1991). A linguistic approach to narrative. Journal of Narrative and Life History, 1: 15-39.
  11. Gergen K., Kaye J. (1992). Beyond narrative in the negotiation of therapeutic meaning. In: McNamee S., Gergen K., editors, Therapy as Social Construction. London: Sage.
  12. Gilbert P. (1988). Shame and Guilt. Changes, 6: 50-53.
  13. Gilbert P. (1997). The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. British Journal of Medical Psychology, 70: 113-147.
  14. Gilbert P. (2000). The relationship of shame, social anxiety and depression: the role of the evolution of social rank. Clinical Psychology and Psychotherapy, 7: 174-189.
  15. Gilbert P., Andrews B. (1998). Shame: interpersonal behaviour, psychopathology and culture. Oxford: Oxford University Press.
  16. Guss R. et al. (2014). Clinical Psychology in the Early Stage Dementia Care Pathway. London: The British Psychological Society.
  17. Hermans H., Kempen H. (1992). The dialogical self: beyond individualism and rationalism. American Psychologist, 47: 23-33.
  18. Honos-Webb L., Stiles W. (1998). Reformulation of Assimilation analysis in terms of voices. Psychotherapy, 35, 1: 23-33.
  19. Honos-Webb L., Surko M., Stiles W.B. (1998). Manual for rating assimilation in psychotherapy: February 1998 version. Unpublished manuscript. Department of Psychology, Miami University, Oxford, Ohio.
  20. Honos-Webb L., Lani J.A., Stiles W.B. (1999). Discovering markers of assimilation stages: The fear of losing control marker. Journal of Clinical Psychology, 55: 1441-1452.
  21. Honos-Webb L., Surko M., Stiles W., Greenberg L. (1999). Assimilation of voices in psychotherapy: the case of Jan. Journal of Counselling Psychology, 46: 448-460.
  22. Kessler E., Bowen C.E., Baer M., Froelich L., Wahl H. (2012). Dementia worry: a psychological examination of an unexplored phenomenon. European Journal of Ageing, 9, 4: 275-284.
  23. Lishman E., Cheston R., Smithson J. (2014). The Paradox of Dementia: meaning making before and after receiving a diagnosis of dementia. Dementia: the International Journal of Social Research and Policy, published on line 27/2/14., DOI: 10.1177/147130121452078
  24. Logsdon R., Pike K.C., McCurry S.M., Hunter P., Maher J, Snyder L., Teri L. (2010). Early-Stage Memory Loss Support Groups: Outcomes from a Randomized Controlled Clinical Trial. Journal of Gerontology: B Psychological Science and Social Sciences, November; 65B, 6: 691-697.
  25. Mair M. (1989). Between psychology and psychotherapy: A poetics of experience. London: Taylor & Frances/Routledge.
  26. Marshall A., Spreadbury J., Cheston R., Coleman P., Ballinger C., Mullee M., Pritchard J., Russell C., Bartlett E. (2015). A Pilot Randomised Control trial to compare changes in quality of life for participants with early diagnosis dementia who attend a “Living Well with Dementia” group compared to waiting list control. Aging and Mental Health, 19,6: 526-535., DOI: 10.1080/13607863.2014.95452
  27. Newman D., Beail N. (2002). Monitoring change in psychotherapy with people with intellectual disabilities. The application of the Assimilation of Problematic Experiences Scale. Journal of Applied Research in Intellectual Disabilities, 15: 48-60.
  28. Sims D., McCrum T. (2012). Measuring the benefits. Journal of Dementia Care, 20, 4: 20-22.
  29. Stiles W. (2001). Assimilation of Problematic Experiences. Psychotherapy, 38, 4: 462-465.
  30. Stiles W., Meshot C., Anderson T., Sloan W. (1992). Assimilation of problematic experiences: The case of John Jones. Psychotherapy Research, 2: 81-101.
  31. Stiles W. (1999). Signs and Voices in Psychotherapy. Psychotherapy Research, 9, 1: 1-21.
  32. Stiles W., Honos-Webb L., Lani J. (1999). Some functions of narrative in the assimilation of Problematic experiences. Journal of Clinical Psychology, 55, 10: 1213-1226.
  33. Stiles W.B. (2001). Assimilation of problematic experiences. Psychotherapy, 38: 462-465.
  34. Varvin S., Stiles W. B. (1999). Emergence of severe traumatic experiences: An assimilation analysis of psychoanalytic therapy with a political refugee. Psychotherapy Research, 9: 381-404.
  35. Watkins B., Cheston R., Jones K., Gilliard J. (2006). “Coming out with Alzheimer’s disease”: changes in insight during a psychotherapy group for people with dementia, Aging and Mental Health, 10, 2: 1-11.

Richard Cheston, in "QUADERNI DI PSICOTERAPIA COGNITIVA" 37/2015, pp. 45-65, DOI:10.3280/QPC2015-037003


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