Supportive psychotherapy in dementia

Dementia care is quite rightly the focus of much attention. Guidance on the treatment and care of people with dementia has recently been jointly agreed by the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence (National Collaborating Centre for Mental Health, 2006). This recommends as a key priority for implementation that ‘Carers of people with dementia who experience psychological distress and negative psychological impact should be offered psychological therapy’ (p. 9). The care of people with dementia has changed considerably over a relatively short period of time. Managing dementia has become a complex process: it is perhaps not an exaggeration to liken it to a sophisticated art. Advances in science have added useful pharmaco­ logical weapons, and there is a small but growing evidence base for non­pharmacological interventions. Unfortunately however, the emphasis is far too often one of exclusion. Access to antidementia drugs is under threat, psychological services are restricted and resources are often constrained by annual ‘cost improvement’ cycles. It is therefore imperative to identify, understand and utilise cost effective evidence­based interventions. Although it is widely recognised and accepted that non­pharmacological interventions should always be considered as a first­line approach, there appears to be a distinct lack of enthusiasm for increasing the use of psychological treatments in dementia care (Douglas et al, 2004). Public opinion on the value of psychotherapy for elderly people is disheartening. When 414 indivi­ duals (aged 17–81 years) were asked their opinion on psychotherapy for elderly people, participants of all ages were strongly biased against psychotherapy for older adults and felt that the benefits that clients could derive from it decreased steadily with increasing age (Zivian et al, 1994). Murphy (2000) drew attention to the poor provision of psychotherapy services for older adults in the UK. Her study found overwhelming evidence of an ageist approach. She felt that all professionals should ‘hold in mind’ this group of people and should be educated about the availability and applicability of the psychotherapies for older individuals. Garner (2002) reported that, although older peo­ ple are less likely to be referred for psychological interventions, perhaps because they rarely have criti­ cal social or work roles so treatment to keep them functioning is not a priority, there is no evidence that these treatments are less effective in an older age group. Hepple (2004) has written a very useful overview of psychotherapies with older people, again drawing attention to the slow development in this area and suggesting possible reasons. He reviewed the evidence base, which suggests that cognitive– behavioural therapy, interpersonal therapy, cognitive analytic therapy, and psychodynamic and systemic approaches can help in a range of psychiatric problems in older people, including dementia. Supportive psychotherapy in dementia