Defense Date

4-1-2005

Graduation Date

2005

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Clinical Psychology

School

McAnulty College and Graduate School of Liberal Arts

Committee Chair

Roger Brooke

Committee Member

Constance Fischer

Committee Member

Paul Nussbaum

Keywords

Alzheimer's, Erikson, existential-phenomenology, geriatrics, gerotranscendence, Kitwood, rementing, therapy for dementia

Abstract

Objective: The standard paradigm of research into dementia of the Alzheimer's type (DAT) has yielded little in the way of effective patient treatment. Recent neuroscientific advances into the understanding of implicit memory have opened up new possibilities of patient care. The ontology developed within the existentialphenomenological (EP) tradition provided the best foundation for further research in this direction, toward restoring moderately impaired DAT patients to Erikson's last normative stage of development, gerotranscendence. Drawing from the EP tradition, the idea of continuity was developed for this research. Continuity is composed of four domains: postural modality, discourse, and the patient's focal relationships to the environment and others within it. It was hypothesized that there would be a partial restoration of functioning through these four domains when the patient engaged with a cherished object. Method: Five subjects were recruited from a pool of previously diagnosed patients with moderate DAT living in a nursing home. Some neuropsychological testing was conducted to provide a baseline of cognitive functioning. Each participant was interviewed at least twice about some cherished object in his or her room, yielding at least three episodes of continuity, which were then analyzed within and across participants. Results: It was found that an alignment between the object and the patient's postural modality, as well as other domain alignments, supported various insights, including those that encouraged gerotranscendence. The power of the object to effect this alignment depended on its confluence with the rest of the immediate environment. Each subject was shown to have a spatial signature, an alignment of domains that best facilitated gerotranscendence. A therapeutic object was designed for each participant based on this signature, and a working vocabulary for a therapy based on continuity was developed that melded the standard paradigm with the EP tradition. Conclusion: It was concluded that gerotranscendence was possible for moderately impaired DAT patients, and that the idea of continuity could be used to elaborate a therapy to achieve that end, primarily by means of therapeutic objects.

Format

PDF

Language

English

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