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ForwardThe Traumatizing Loss of Dignity in Dementia
Abstract:
Dementia in a loved one such as parent or spouse is a fairly common trauma in the elderly demographic, notably for those age sixty and older. Most families can point to a current or former family member who has or had Alzheimer’s disease or one of the other forms of dementia. Alzheimer’s disease accounts for approximately 60 to 80% of persons diagnosed with dementia. Other forms of dementia include Frontotemporal, Lewy Body, Vascular, and Parkinsonian types.
It is often traumatizing to witness and participate in a loved one’s loss of dignity due to their gradual erosion of cognitive function and later of the ability to control bodily functions. For the patients themselves, the trauma of such losses induces dissociation which compounds the growing cognitive deficits. The patients’ eventual loss of the ability to care for their own most basic needs (such as feeding and toileting), even if they accept it, is often humiliating to the point of being traumatic. Having to handle bladder and fecal incontinence of the person with dementia by family members can be traumatic for both. Beliefs in a just world, belief that the world is an orderly, predictable and just place, for patient as well as caregivers, are shattered. Often the denial is three-fold: in the patients themselves, in the caregivers, and in the medical profession. Too often the pain and fear of witnessing a patient’s extreme cognitive decline can lead to emotional distancing on the part of medical professionals and others, which causes more shaming of the patient and more loss of dignity. Years can go by with inadequate treatment or without the support that could enhance the quality of life of the patient and family. Institutional care even in the best facilities will sometimes mean the patient is neglected, perhaps left soiled or with painful bedsores. Add to this trauma the challenges in obtaining a definitive diagnosis and appropriate treatment, locating meaningful support and assistance in caring for the loved one, and securing safe and kind placement when home care is no longer feasible or practical. The cost and management of such care, whether at home or in a facility, can be overwhelming. Caregivers often face legal, financial and medical catastrophes, some of which can linger long after death.
The presenters, both clinical psychologists and trauma specialists, lost their husbands to Alzheimer’s disease in 2020 and 2022. The frustrations of managing the medical system, getting the right help and getting their husbands to accept the need for that help as well as their new limitations, were challenging, often to the point of being overwhelming.
Potential to Distress: No
This recorded conference session was originally presented as part of a live conference in April 2024.
Target Audience
Those seeking to participate in this webinar must be licensed mental health professionals (psychiatrists, psychologists, clinical social workers, mental health counselors, accredited psychotherapists, etc.). ISSTD staff will audit license information prior to the start of the course and may request additional documentation for your license.
We do accept students enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation. Students must submit proof of student status such as a transcript or registration record. For those who have completed their degree and are currently in the pre-licensure stage practicing under the license of another clinician, you must provide the name and license information for the person you are working with. Documentation should be sent to ISSTD staff at [email protected] before registering.
This webinar content is at the beginning/introductory level.
Learning Objectives
Learning Objectives:
- Identify the predominant symptoms of dementia in order to be aware of the difference between normal aging, mild cognitive impairment, and dementia
- Explore obstacles to persons with dementia and their loved ones obtaining treatment and end of life care with dignity
- Address their own emotional responses to dementia as it relates to their professional and personal situations
- Recognize that dealing with the course of dementia and death can be traumatic for patient, family and clinician alike
- Learn resources in general, and how to obtain them locally, for dealing with the needs of the individual and family struggling with dementia
Course summary
- 1.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Shielagh Shusta-Hochberg, PhD
Dr Shielagh Shusta-Hochberg, an ISSTD fellow since 2015 and member since 1997, earned her PhD in Clinical Psychology from Adelphi University”s Derner Institute. She was assistant professor of psychiatry at Mt. Sinai Hospital in New York City and maintained a Manhattan private practice for many years. She is in private practice in Naples, Florida, working with anxiety, trauma, dementia and bereavement. She is a certified End-of-Life-Doula and in 2020 lost her husband to Alzheimer’s disease. Publications: 2017 Volume 18, Reviewers for the Treatment Guidelines, Journal of Trauma and Dissociation,18:5, 735-735. Dr Shusta-Hochberg is among the reviewers for this publication. 2013 Howell, E. F., and Shusta-Hochberg, S. R., eds. Revised Curriculum for the Standard Course of the Psychotherapy Training Program for Treatment of the Dissociative Disorders, ISSTD, McLean, VA. 2006 Shusta-Hochberg, S. R.. “The complex relationship between obsessive compulsive disorder and the dissociative disorders.” ISSTD News, 24(4), 6-8. 2004 Shusta-Hochberg, S. R.. “Therapeutic hazards of treating child alters as real children in dissociative identity disorder.” Journal of Trauma and Dissociation, 5(1), 13-27. Originally presented to ISSD Conference in Baltimore, MD as “Fixed illusions: Confronting the reification of child alters in dissociative identity disorder.” 2003 Shusta-Hochberg, S. R.. “Impact of the World Trade Center disaster on a Manhattan psychotherapy practice,” Journal of Trauma Practice, 2(1), 1-16. 1999 Shusta, S.R. “Successful treatment of refractory obsessive-compulsive disorder,” American Journal of Psychotherapy, 53(3), 377-391. Recent presentations: 2024 “The Aging Therapist Treating an Aging Caseload” on March 15, 2024 at the 42nd Annual Conference of the International Society for the Study of Trauma and Dissociation (ISSTD) held in Boston, MA (USA) with co-presenter Peter Maves, PhD. 2023 “The Traumatizing Loss of Dignity with Dementia” on March 23, 2023 at the 41st Annual Conference of the ISSTD held in Frisco, TX (USA) with co-presenter Elizabeth Howell, PhD.
Elizabeth F. Howell, PhD
Dr. Elizabeth Howell has been a member for 28 years. She is on the faculty of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis; faculty and supervisor for Manhattan Institute for Psychoanalysis Program in Trauma Studies; past Co-Director and Faculty, International Society for the Study of Trauma and Dissociation (ISSTD) Professional Training Program on Dissociative Disorders, and on the Editorial Board of the Journal of Trauma and Dissociation. In addition to over forty professional articles, her books include: Trauma and Dissociation Informed Psychotherapy: Relational Healing and the Therapeutic Connection; The Dissociative Mind; Understanding and Treating Dissociative Identity Disorder: A Relational Approach; The Dissociative Mind in Psychoanalysis: Understanding and Working with Trauma, (Howell & Itzkowitz), Psychoanalysts, Psychologists & Psychiatrists Discuss Psychopathy and Human Evil (Itzkowitz & Howell), and Women and Mental Health, (Howell & Bayes). Her (2014) article “Ferenczi’s concept of identification with the aggressor: . American Journal of Psychoanalysis.74:1, pp. 48-59.,” has received over 7,000 reads. A Fellow of ISSTD, she is the recipient of the Cornelia Wilber Award, the Lifetime Achievement Award, and Print Media award for her books, The Dissociative Mind, Understanding and Treating DID, and the Dissociative Mind in Psychoanalysis (coedited with Sheldon Itzkowitz). She is a Gradiva Award Nominee for her 2021 book, Trauma and Dissociation Informed Psychotherapy, and for The Dissociative Mind in Psychoanalysis Also with Dr. Itzkowitz she received the Author’s Recognition Award from the National Institute for the Psychotherapies (NIP). She has lectured for various institutes in New York City as well as nationally and internationally--most recently in Madrid on Differentiating Dissociative Identity Disorder from Schizophrenia” and “Integration in the Dissociated Self-States Model/ Healing Fragmentation in the Therapeutic Connection.” She is in private practice in New York City, where she works with clients, does consultations, and runs consultation and study groups.
Available Credit
- 1.50 APAThe International Society for the Study of Trauma and Dissociation is approved by the American Psychological Association to sponsor continuing education for psychologists. The International Society for the Study of Trauma and Dissociation maintains responsibility for this program and its content.
- 1.50 ASWB ACEThe International Society for the Study of Trauma and Dissociation (ISSTD), #1744, is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 08/20/2024 – 08/20/2027. Social workers completing this course receive 1.50 continuing education credits.
- 1.50 ISSTD Certificate ProgramThis program is eligible for 1.50 credits in the ISSTD Certificate Program. No certificate of completion is generated for this type of credit.
Price
"Your Price" above reflects your final price based on your membership status and career level.
- ISSTD defines a student as those enrolled in a program of study leading to a degree or certification in the mental health field and who have an interest in trauma and dissociation.
- ISSTD defines an emerging professional as mental health professionals who have completed an advanced degree and are in the first three years of their career (or first three years after graduation for researchers).
- If you do not fall into one of the above categories please register as Professional/Retired.
These prices are for Tier I countries. For a list of countries by Tier click here. If you are located in a country that falls into Tier II-VI please contact ISSTD at [email protected] to receive the appropriate discount code.
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