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Facility-visiting psychologists

September 13, 2009
by Kathleen Mears
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Over the years, counseling and psychotherapy have been available at this facility. I wondered if patients in semi-private rooms were allowed enough privacy during their sessions. Though residents with dementia might not notice the lack of privacy, other residents certainly would. I would think they would prefer seeing a counselor or psychotherapist without their roommate present.

Counselors and psychologists walk throughout the facility chatting here and there with residents. I usually wonder if each resident they speak with is a patient. I can imagine that some are former patients or that the counselor or psychologist is just being friendly. But I wish there were a private place for the psychologist to see the patients who can come to him/her.

I know in a rehabilitation setting it is not uncommon to see a psychologist in your room. But those sessions are usually quite private. Since counseling and psychotherapy provide a way for residents to talk about their deepest feelings, I do not know if a resident would feel comfortable discussing them with other residents, staff, and visitors within earshot.

Residents have little control over their sessions. Appointments are not made. The psychologist usually visits the facility on the same day each week. But if there is a change, and the counselor or psychologist does not visit on the scheduled day, residents usually do not know anything about it.

Those residents who can understand should be told how long their counseling or psychotherapy sessions will be each week and how many they can have before their insurance stops paying. Residents also need to know when their weekly sessions will be shortened. Then, they will not feel the therapist no longer has enough time for them. Also, it would be preferable if sessions were phased out rather than ended abruptly.

Finally, residents need some sort of choice of a psychotherapist. Then, if a resident does not feel comfortable with the visiting therapist, there is another option.

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Comments

Hi Kathleen,

Thanks for writing about psychological services in long term care and bringing more attention to the mental health needs of residents. As a nursing home psychologist, I'd like to address some of the concerns you raised.

I agree that privacy is often lacking in the nursing home environment, and other residents and staff see me and my colleagues approaching our patients, but that's true of every service offered, and I'm not sure there's a way around it. Every effort is made to hold psychotherapy sessions in a private space, and if a roommate is there, the curtain is drawn and the session will only proceed if it's okay with the patient. It would be great if the psychologists had a room available in the facility for private sessions. If the residents felt strongly about having a dedicated psychotherapy office, that could be an issue to discuss in Resident Council Meetings, as the residents are in the best position to advocate for it.

As for brief conversations in the hallway, I like to say hello to many people, former patients and not, and I'd never reveal to another resident whether or not someone else has been in treatment. If I told people's secrets in the "small town" atmosphere of the nursing home, everyone would quickly find out I was a gossip and no one would tell me anything!

I try to see people on the same day of the week, let them know if I need to make a change, work around their rehab and activity schedules, and discuss with them their progress in treatment and when and how to discontinue services.

If the conditions I described aren't present in your nursing home, or those of your readers, it might be something to discuss with the Director of Social Work, who usually works very closely with the psychologists to address the mental health concerns of the residents.

Eleanor Feldman Barbera, PhD
http://mybetternursinghome.blogspot.com

Kathleen Mears

www.ltlmagazine.com/blog/kathleen-mears

Kathleen Mears has been a nursing home resident in Ohio for 20 years. She is an incomplete...