Abstract
This article considers a person-orientated approach to counselling, psychotherapy and rehabilitation for people with a diagnosis of dementia. It draws on the concepts developed by Tom Kitwood (1995) for describing the factors –neuropathology, health, personality, biography, social psychology – that affect the manifestation of dementia, but places more emphasis on personality and biography for the person in the early stages. The social context – or psychology – is the home in these early stages, and the family system is critical. It provides a supportive or negative environment in which the person expresses an experience of cognitive decline. The behaviours seen in dementia are regarded as adaptive responses to the experience of cognitive decline, rather than directly the result of brain pathology. Given this view of the syndrome of dementia being a reactive response to cognitive decline, and to stresses such as giving up driving, the types of interventions that might be offered are discussed. These are grief counselling, non-directive counselling, long-term supportive psychodynamic psychotherapy, cognitive-behavioural therapy and rehabilitation. The human brain has developed over a lifetime of experience, in a variety of psychosocial environments, and so exhibits its own unique coping mechanisms in the face of internal devastation. It is this aspect of dementia – its individual uniqueness and its reflection of a person’s past and present psychosocial context – that this article uses as the basis for suggesting effective treatment strategies.