Making Art with Amy, A Patient in a Long-term Geriatric Care Center with Alzheimer's Disease.
Amy's Condition and Background
The patient described in this article is a 90 year old female. She is white, born in the United States, but of eastern European background. She was the oldest of three children, and both of her siblings are deceased. She was raised in a middle class family in New York city. She is college educated at the associates’ degree level in the fine arts. She was born in New York. The patient was trained in the fine arts during her college years and kept up her own identity by her artwork. The patient consistently produced artwork throughout her life and received many awards for her work in many art shows. The patient also taught art to children and adult education groups in various locations throughout the United States. The patient is presently diagnosed with Alzheimer’s disease, which is in late-mid level stage when I started seeing her, and has various health issues that may, or may not, impact on the symptoms of her Alzheimer’s disease, including a history of strokes, a broken hip and general dementia. Up until a recent stroke, the patient has been able to “cover” her Alzheimer’s symptoms by speaking rather coherently, “covering” for herself by continuing dialogue in a way that sounded like she was making sensible dialogue, but was really filled with a lot of gaps and forgetfulness of both concepts of the conversation and actual words to say. A subsequent stroke has deteriorated her condition to the point where coherent speaking is getting more difficult for her.
Presenting Problem and Treatment Focus
Amy was diagnosed, when I first met with her, as a late mid stage Alzheimer’s patient. She was having more and more cognitive gaps, and forgetting proper word usage. During a preliminary art therapy session this author had with the patient, it was noticed by the therapist that the patient was unable due to deterioration of motor skills, to actively do artwork. The patient would do the same thing verbally by repeating the same story over with slight detail changes. The patient was trying to “cover” for her Alzheimer’s condition both in her artwork and her verbal interactions. She could not risk appearing confused or weak to me, the art therapist. Only very briefly, at the very beginning of treatment was the patient able to draw on her own, and then these sessions wouldn’t last more than five minutes due to confusion by the patient. Then even this level of independent participation slipped away. The author (and therapist) was desperately (the patient engendered that in me) looking for a way to engage her.
Amy was diagnosed, when I first met with her, as a late mid stage Alzheimer’s patient. She was having more and more cognitive gaps, and forgetting proper word usage. During a preliminary art therapy session this author had with the patient, it was noticed by the therapist that the patient was unable due to deterioration of motor skills, to actively do artwork. The patient would do the same thing verbally by repeating the same story over with slight detail changes. The patient was trying to “cover” for her Alzheimer’s condition both in her artwork and her verbal interactions. She could not risk appearing confused or weak to me, the art therapist. Only very briefly, at the very beginning of treatment was the patient able to draw on her own, and then these sessions wouldn’t last more than five minutes due to confusion by the patient. Then even this level of independent participation slipped away. The author (and therapist) was desperately (the patient engendered that in me) looking for a way to engage her.
I would use both art therapy and verbal interactions with Amy. The limited goals are still possible while Amy still has enough cognitive skills to:
a) Feel better about themselves, and forgive themselves for any past wrongs
b) Feel bolder about addressing family conflict with the therapist.
c) Remember relationships in the past that were affirming to her.
a) Feel better about themselves, and forgive themselves for any past wrongs
b) Feel bolder about addressing family conflict with the therapist.
c) Remember relationships in the past that were affirming to her.
The treatment plan and focus was to use and do art included the following:
access the patient's remaining memories, enhance her self esteem, and build an "in the moment" therapeutic relationship with the client.
access the patient's remaining memories, enhance her self esteem, and build an "in the moment" therapeutic relationship with the client.
The Goals and Interventions Used, the Treatment Process, and Outcome
Throughout treatment, Amy would call me her “student”. At first, I found this aggravating, and would correct her, but decided in the end to just “go with it”, as to not stop the flow of the conversation, and since my client would forget my correction in a few minutes anyway. The patient would, due to her condition, often forget she was ill, and due to her family’s wishes, didn’t have clear knowledge of her own suffering from Alzheimer’s, or if she did would forget it quickly. Trying to maintain as much “reality contact" as much as possible.
Throughout treatment, Amy would call me her “student”. At first, I found this aggravating, and would correct her, but decided in the end to just “go with it”, as to not stop the flow of the conversation, and since my client would forget my correction in a few minutes anyway. The patient would, due to her condition, often forget she was ill, and due to her family’s wishes, didn’t have clear knowledge of her own suffering from Alzheimer’s, or if she did would forget it quickly. Trying to maintain as much “reality contact" as much as possible.
A session would begin with a verbal discussion of what we wanted to do today, and would be based on agreement from both the therapist and the patient, as per the client centered approach I preferred. We would then begin working, with me being her “hands” and following her directions on how to proceed with an art project. Putting Amy at the center of statements and questions, allowed her to process her own feelings and gave her back some feeling of control that she had lost due to her illness. The interpersonal process gives Amy a feeling of still mattering, despite being locked in a facility and having diminishing abilities. During these sessions Amy would often use them for verbal and not just creative discharge. She would talk about her family, marriage, etc., prompted by my process questions and statements. She would talk exceedingly of her triumphs as an artist and art teacher. Interestingly, after active art making sessions the patient would usually take on wide ranging topics, such as the death of her husband, and memories of living in different communities around the United States. I had to remind my self that the goals with Amy had to be limited, compared with high cognitive level functioning patients, and I had to be satisfied as her therapist with “small” steps and goals, such as a long forgotten memory recovered from her childhood, due to putting Amy at the center of the therapeutic process. I was constantly asking myself, during my sessions:
1)What does the client want from others?
2)What does the client expect from others?
3)What is the clients’ experience of self in relationship with others, the sense of being disconnected or burdensome?
4)What are the conflicting affective states that typically result?
2)What does the client expect from others?
3)What is the clients’ experience of self in relationship with others, the sense of being disconnected or burdensome?
4)What are the conflicting affective states that typically result?
At the end, these strategies worked and Amy and I enjoyed a fruitful therapeutic relationship, where memories were temporarily restored and self-confidence and capability returned for a limited time. My goals in working with Amy were met.
This article, as all content on this website, is copyrighted 2007-2008, by Rita Klachkin, RBHK Fine Arts, and cannot be reproduced in any form without permission from the author.
