Performing Art Therapy and Geriatrics

The following is  a slideshow presentation about performing arts therapy and geriatrics from Dr. D. Dutta Roy from the Psychology Research Unit at the Indian Statistical Institute in Kolkata.

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Performing Art Therapy in Geriatric Care – Presentation Transcript

1. Performing Art Therapy in Geriatric Care Dr. D. Dutta Roy Psychology Research Unit Indian Statistical Institute, Kolkata – 700108 Web :http://www.isical.ac.in/~ddroy E-mail: ddroy @ isical .ac.in Venue: Paripurnata, 12.11.09 Audience: Senior People
2. What is performing art therapy ?
   • Performing art generally includes dance, music, songs, drama in organized fashion. Besides, painting, sculpturing, Yoga, farming etc. are the performing arts.
   • Performing art therapy is the therapeutic process in which performing art therapist tends to
   • • explore one’s needs, values, crisis in the life cycle;
   • • improvise performing art in such a fashion so that client can understand own needs and can develop coping strategy to overcome the crisis.
   • In performing art, client is not merely receptive but productive and creative. Therefore, the objective of therapist will be to stimulate the client to understand self and socially accepted coping strategies. It develops adaptability within individual.
3. Role of Performing Art therapist
   • Performing art therapist acts as the tool for
   • • Diagnosis
   • • Restoring (condition at control)
   • • Preventing and
   • • Promoting physical, mental, social and spiritual health.
   • It is the process of achieving three layers of consciousness.
4. What happens during PAT ?
   • During performing art, individual travels around different layers of consciousness – the outer, inner and inner core layers.
   • During traveling, individual understands own crisis in life cycle, underlying reasons and sets own coping strategy.
   • It helps individual to find meaning in life, to realize own self and develop high efficacy in cognitive, emotional, psycho motor co-ordination and over all health efficacy.
   • It increases desires for life expectancy.
   • It controls ageing process.
5. CONSCIOUSNESS PARADIGM Outer Layer: -Missing -Anomalies Inner Layer -Vividness -Orderliness -Complexity
   • Inner Core Layer
   • Harmony with Environment
   • Aesthetics
   • Cleanliness
6. A Journey
   • Rabindrasangeet is a journey from outer layer to inner core through inner layer of consciousness.
   • • "Chokher aloy dekhechilem chokher bahire"; (outer layer)
   • • "Antare aaj dekhbo, jakhan alok nahi re" (inner layer)
   • • "Dharay jakhan dao na dhara hriday takhan tomay bhara, ekhon tomar apan aloy tomay chahi re" (innercore layer)
7. Playing in the outer layer
   • “ Ami keboli swapan karechi bapan batase-
   • Tai akashkusum karinu chayan hatashe
   • Chayar matan milay dharani, kul nahi pay ashar tarani,
   • Manaspratima bhasia beray akashe”

   “ Emni karei jay jadi din jak na, Mon ureche uruk na re mele diye ganer pakhna”

8. Mixing with inner core/Saraswat layer
   • “ Amar poran jaha chay tumi tai, tumi tai Go toma chhara ar e jogote mor keho nai, keho nai Go.
   • Tumi sukh jodi nahi pao, jao sukher sondhane jao ami tomare peyechhi hridhoymajhe, ar kichhu nahi chai go.
   • Ami tomar birohe rohibo bileen, tomate koribo baas dhirgho dibos dhirgho rojoni, dirgho borosh-maas.”
9. The Second stage
   • The journey is not very smooth. Lot of ideas are broken, built and rebuilt.
   • • “ Tomay niye khelechilem khelar gharete khelar putul bhenge geche pralayy jhaarete Thak tabe sei kebol khela, hok -na ekhon praner mela- tarer bina bhanglo, hriday-binay gahi re. "
10. Case Study 1: Where all fail, Rabindrasangeet acts
11. Response control of OCD
    • A woman of 52 years old came to me with complaint of OCD to dirt. Patient reported her inability to control washing compulsion. For last 30 years, she regularly went to toilet for washing and cleaning hands. She always closed her hands tightly so that her hands would be completely cleaned. Before visit to me, she was treated by many psychiatrists and one psychologist. No notable changes are noticed except long time sleep.
12. Patient’s behaviour
    • Very inhibitive;
    • Hand clasping tightly;
    • Strong resistance to open clasping;
    • Non-cooperative to participate;
    • Not able to administer any available psychological tests.
13. Analysis of patient
    • Patient is searching for dirt in the outer layer.
    • In the inner layer, dirt is perceived as threatening;
    • Patient wants to move away from inner to inner core layer. For the same, she spends most of the time in worshipping the God and keeping cleanliness.
    • She is not happy with soaping hands as this can not help her to reach at the innercore layer of consciousness.
    • This results approach – avoidance conflict.
    • (Approaching to the soap in order to avoid dirt, again few soaping is not sufficient, so more soaping is required ).
14. Analysis of family
    • Repeated soaping consumes more water;
    • Family assumes that it is unreasonable but patient assumes it as reasonable ;
    • Family member is not aware of consciousness dynamics playing inside the patient.
15. Therpeautic analysis
    • Target: Preventing clasping hands;
    • Consciousness model:
    • • Outer layer : Dirt perception;
    • • Inner layer : Dirt as threat;
    • • Innercore : Feeling of cleanliness;
    • Currently, patient is moving around outer and inner layers only.
    • Therapeautic target: Providing her Feeling of cleanliness.
    • Rabindrasangeet is non-dirt area;
    • Explore the song suitable for feeling of non-dirt area;
16. Session-1
    • In the first session , patient was highly inhibitive to reveal herself. Due to difficulty in rapport establishment. I started singing – "Ananda loke, mangala loke" (moving to spiritual land).
    • Suddenly, she started singing with me in very low voice;
    • I paid my attention to her and started moving the hands keeping with the rhythm and waves of the song loudly. She participated into my hand movement and sang the song loudly.
17. Session-2
    • In the 2nd session after 6 days, the client sang with me same song by standing. She moved her hands above head when she sang " Grahataraka chandra tapana byakula drutabege" (the planets, satellites are moving speedily). It is noted that her hands now completely opened.
18. Session-3
    • In the 3rd sitting, patient reported that she alone practiced two songs
    • • "Ektuku chona lage…." (feeling light touch), and
    • • "Eto din je bosechinu" (waiting for long days) at home. Finally, she sang with me both songs alongwith Ananda loke, danced and she never closed her hands.
    • Termination : Patient herself is able to prevent stopping hand clasping.
19. Searching Principle : Growth of inquisitiveness Feeling of scattered impulses,needs etc. Searching cues Does it give meaningful pattern ? N Y
20. Geriatric assessment
21. Geriatric Disorders
    • Organic Disorders : Dementia, Delirium
    • Psychological Disorders :
    • • Neurotic (Anxiety disorder, Phobic disorder, Conversion reaction, Dissociative Reaction, Obsessive Compulsive disorder, Depression, Hypochondriasis)
    • • Psychotic (Schizophrernia, Manic-Depressive Disorder, Paranoia)
    • • Substance abuse
    • • Sexual disorder
22. History
    • Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren . Warren emphasized that rehabilitation was essential to the care of older people. She developed the concept that merely keeping older people fed until they died was not enough- they needed diagnosis, treatment, care and support . She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.
    • Another "hero" of British Geriatrics is Bernard Isaacs , who described the " giants " of geriatrics: incontinence, immobility, impaired intellect and instability. Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants
23. Geriatric Psychology for the Care givers
    • To understand different principles leading to formation of different symptoms of geriatric disorders.
    • • Biological Paradigms : Brain mapping, Loss or injury
    • • Psychological Paradigms : Psychodynamic, Learning, Cognitive
    • To understand principles of Psychology in order to improve quality of life of the elderlylyly people.
    • • Counseling, Psychotherapy, Individual and community care.
24. BIOLOGICAL PARADIGM
    • BRAIN MAPPING
    • LOSS OF BRAIN FUNCTIONS
25. Brain Mapping
    • Frontal Lobe
    • • How we know what we are doing within our environment ( Consciousness ). How we initiate activity in response to our environment. Judgments we make about what occurs in our daily activities. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose. Involves word associations. Memory for habits and motor activities.
    • Parietal Lobe
    • • Location for visual attention. Location for touch perception. Goal directed voluntary movements. Manipulation of objects. Integration of different senses that allows for understanding a single concept.
    • Occipital Lobe
    • • Vision
    • Temporal Lobe
    • • Hearing ability Memory acquisition Some visual perceptions Categorization of objects.
    • Brain Stem
    • • Breathing Heart Rate Swallowing Reflexes to seeing and hearing ( Startle Response ). Controls sweating, blood pressure, digestion, temperature ( Autonomic Nervous System ). Affects level of alertness. Ability to sleep. Sense of balance ( Vestibular Function ).
    • Cerebellum
    • • Coordination of voluntary movement Balance and equilibrium Some memory for reflex motor acts.
26. Loss of Brain Functions
    • Frontal Lobe
    • • Loss of simple movement of various body parts ( Paralysis ). Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee ( Sequencing ). Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought ( Perseveration ). Inability to focus on task ( Attending ). Mood changes ( Emotionally Labile ). Changes in social behavior. Changes in personality. Difficulty with problem solving. Inablility to express language ( Broca’s Aphasia ).
    • Parietal Lobe
    • • Inability to attend to more than one object at a time. Inability to name an object ( Anomia ). Inability to locate the words for writing ( Agraphia ). Problems with reading ( Alexia ). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics ( Dyscalculia ). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention. Difficulties with eye and hand coordination.
    • Occipital Lobe
    • • Inability to attend to more than one object at a time. Inability to name an object ( Anomia ). Inability to locate the words for writing ( Agraphia ). Problems with reading ( Alexia ). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics ( Dyscalculia ). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention. Difficulties with eye and hand coordination.
    • Temporal Lobe
    • • Difficulty in recognizing faces ( Prosopagnosia ). Difficulty in understanding spoken words ( Wernicke’s Aphasia ). Disturbance with selective attention to what we see and hear. Difficulty with identification of, and verbalization about objects. Short-term memory loss. Interference with long-term memory Increased or decreased interest in sexual behavior. Inability to catagorize objects ( Catagorization ). Right lobe damage can cause persistant talking. Increased aggressive behavior.
27. Comprehensive geriatric assessment
    • Identification : Age, sex, brought in by whom, chief complaint
    • Source of History (include reliability rating) : Patient, caregiver, family, friends Medical records, Previsit questionnaire
    • History of Present Problems/Condition
    • Medications – old medication lists, herbal/alternative medications , Allergies/Adverse Drug Reactions : Name specific medications and characterize specific allergic/adverse drug reaction for each medication
    • Habits : tobacco, recreational drugs
    • Social History : Education, Marital Status/Children, Household members, Activities/Exercise, Travel, Occupational History/Toxin Exposures, Diet, Caffeine, Sexual Activity, Caregiver roles
    • Past Medical History : (ask about previous medical records, old lab/imaging/study reports)
    • Family History : Heart disease, cancer, diabetes, TB, HTN, mental health, Alzheimer’s disease
    • Care Resources : past and present Home Health, Case Management, etc.
    • Personal History : Environment, Reverse developmental milestones
28. • Review of Systems :
    • General : fevers, chills, malaise, fatiguability, night sweats, weight changes
    • Neurologic : syncope, seizures, weakness, paralysis, abnormal sensation/coordination, tremors, memory loss
    • Psychiatric : depression, mood changes, difficulty concentrating, nervousness, tension, suicidal ideation, irritability, sleep disturbances
    • Sensory Functions : visual changes, hearing changes, neuropathy, balance/coordination
    • Motor Functions : gait, falls, ataxia
    • Diet : preferences, restrictions (religious, allergic, disease), vitamins/supplements, caffeine, food/liquid intake diary , "look in fridge test" , who prepares/obtains food
    • Skin : rash/eruption, itching, pigmentation, excessive sweating, nail/hair abnormalities
    • Head : Headaches, dizziness, syncope, severe head injuries, loss of consciousness
    • Eye : visual changes, blurring, diplopia, photophobia, pain, eye medication use, eye trauma, FH of eye disease
    • Ears : hearing loss, pain, discharge, tinnitus, vertigo
    • Nose : sense of smell, obstruction, epistaxis, postnasal drip, sinus pain, rhinorrhea
    • Oral : hoarseness, sore throat, gum bleeding/soreness, tooth abscess/extraction, ulcers, taste changes

    Comprehensive geriatric assessment

29. • Cardiac/Peripheral Vascular : Chest pain, palpitations, dyspnea, orthopnea, edema, claudication, HTN, previous MI, exercise tolerance, previous cardiac studies
    • Pulmonary : pleuritic pain, dypsnea, cyanosis, wheezing, cough/sputum, hemoptysis, TB exposure, previous CXR’s
    • Gastrointestinal : appetite, digestion, dysphagia, heartburn, nausea, vomiting, hematemesis, diarrhea, constipation, stool changes, flatulence, hemorrhoids, hepatitis, jaundice, dark urine, history of ulcers/gallstones/polyps/tumors, previous X-rays
    • Renal/Urinary :dysuria, flank/suprapubic pain, urgency, frequency, nocturia, hematuria, polyuria, hesitancy, dribbling, force of stream changes, STD’s
    • Hematologic : anemia (dizziness/fatigue/dyspnea), easy bruising/bleeding, blood cell abnormalities, transfusions
    • Lymphatic : lymph node enlargement/tenderness
    • Endocrine/Metabolic : thyroid enlargement/pain, heat/cold intolerance, unexplained weight change, diabetes, polydipsia, polyuria, facial/body hair changes, increased hat/glove size, striae
    • Musculoskeletal : joint stiffness, pain, limited ROM, swelling, redness, heat, bone deformity
    • Sexual : libido, intercourse frequency, sexual difficulties, impotence
    • Gynecologic : itching, last Pap smear, menopause age
    • Breasts : pain, tenderness, discharge, lumps, mammograms, self-breast exams

    Comprehensive geriatric assessment

30. Geropsychiatric Mental Status Exam
    • Most of this exam is observed through the interview conversation with patient
    • General Appearance/Behavior: Grooming and hygiene, unusual movements, attitude, psychomotor activity, eye contact
    • Affect: (external range of expression) flat, blunted, labile, full/wide range
    • Mood: (internal emotional tone) dysphoric, euphoric, angry, euthymic, anxious
    • Thought Processes: Language (quality/quantity of speech), tone, associations, speech fluency Note presence of: pressured speech, poverty of speech, blocking, flight of ideas, loosening of associations, tangentiality, Circumstantiality, echolalia, neologisms, clanging, perseveration, ideas of reference
    • Thought Content: note hallucinations, delusions, illusions, derealization, depersonalization, suicidal or homicidal ideation
    • Cognitive: (mostly covered by psychometric tests )level of consciousness, orientation
    • Insight: the patient’s understanding of his or her problems and implications of these problems
    • Judgment: based on history of patient’s decision making abilities
31. Geriatric care by the caregiver
    • I) Social Information II) Caregiver Information III) Patient’s Health IV) Head Injury V) Activities of Daily Living VI) History of Falls VII) Vision VIII) Hearing IX) Dentition X) Bowel/Bladder XI) Sexuality XII) Nutrition XIII) Communication XIV) Usual daily activities (with exercise) XV) Sleeping XVI) Finances XVII) Home Safety Checklist XVIII) Current Medications XIX) Care resources/agencies
32. Geriatric care by Psychologist
33. Counselling VS Psychotherapy
    • Counselling
    • A brief treatment focusing on patient’s current problems.
    • Helping people who have the capacity to cope in most circumstances, who are experiencing temporary difficulties or in a psychosocial transition.
    • Psychotherapy
    • Psychotherapy is more concerned with the resolution of longstanding personal issues and may be either brief or long term.
    • When issues are more symptomatic of something deeper.
34. Why Psychotherapy ?
    • It helps aged to deal with those issues and the emotional problems surrounding them and to understand their behavior on others. In addition to improving interpersonal relations psychotherapy increases self esteem and self confidence, decreases feelings of helplessness and anger and improves the quality of life. Psychotherapy of the aged has the general aim of assisting the old person to have minimal complaints to help him or her make and keep fresh of both sexes, and to have sexual relationship where there is still interest and capacity. Psychotherapy helps relieve tension of biological and cultural origins and helps old persons work and play within the limits of their functional status and as determined by their past training activities and self concept in society.
35. Psychodynamic Paradigm
    • Pathology of elderly people is due to conflict between structures of mind – Id, Ego and Super Ego.
    • Study the pathology in terms of energy processing from Unconscious to conscious through Pre-conscious.
    • Psychosexual stages
    • • Oral, Anal, Phallic,Genital and Latency
    • Study it in terms of Ego-defense mechanisms – Regression, Repression, projection, rationalization, displacement, reaction formation etc.
36. Neo-Freudian
    • ADLER
    • Study abnormal behavior in terms of
    • • one’s failure in striving for perfection,
    • • Organ Inferiority, Psychological inferiority.
    • Defenses
    • • Compensation;
    • • Superiority Complex
    • ERIKSON
    • Abnormality is due to one’s failure in handling crisis of earlier stage.
    • Stage One Oral-Sensory: from birth to one, trust vs. mistrust, feeding;
    • Stage Two Muscular-Anal: 1-3 years, autonomy vs.doubt, toilet training;
    • Stage Three Locomotor: 3-6 years, initiative vs.inadequacy, independence;
    • Stage Four Latency: 6-12 years, industry vs.inferiority, school;
    • Stage Five Adolescence: 12-18 years, identity vs.confusion, peer relationships;
    • Stage Six Young Adulthood: 18-40 years, intimacy vs.isolation, love relationships;
    • Stage Seven Middle Adulthood: 40-65 years, generativity vs.stagnation, parenting;
    • Stage Eight Maturity: 65 years until death, integrity vs.despair, acceptance of one’s life.
37. Psychodynamic Counseling
    • Psychodynamic therapists make genetic links between early childhood experiences and deal patient’s current character structure and symptomatology. The patient’s emotional response to the therapist (transference) and the therapist’s emotional response to the patients (counter transference) are also sources of learning. Key patterns of feeling and behaving from early childhood are repeated or ‘transferred’ on to the people in the patient’s adult life including the therapist.
38. Geriatric care by Performing art therapist
39. Performing art acts as tool for diagnosis and therapy
40. Dance,song and drama make your body fit
41. Social dancing
    • Social dancing increases feeling of generativity and reduces stagnation in life;
    • It reduces feeling of loneliness;
    • It provides social support and care;
    • It encourages life expectancy
    • It contributes to the longevity of the dancers, giving them something to enjoy and focus upon – to live for.
    • it alleviates social isolation and quite literally helps take away the aches and pains associated with older age."

    http://www.worldhealth.net/news/research_shows_that_social_dancing_in_ol/

42. Performing art therapy acts as time machine
    • Through performing art therapy, senior people can realize all levels of consciousness across all the passed ages.
    • Performing art therapy has different forms :
    • • Dance, drama, song and music ;
    • • Drawing, painting, sculpturing ;
    • • Gardening;
    • • Yoga;
    • • Games, Sports;
43. The time machine Experience your bodily changes during laughing (Babyhood) Make others laugh (Childhood) Facilitate your imagination (Adolescence) Self-engagement (Adulthood)
44. Sculpturing
45. Farming and gardening Individualism VS Collectivism
46. Overcoming Ageing by Sports
47. Yoga in group With trainer Couple Yoga is a system
48. Neurological Paradigm
    • The brain produces natural chemical messengers – called neurotransmitters – that send messages from one nerve cell to another. Serotonin is known as the "feel good" neurotransmitter because it plays an important role in the regulation of mood. Low levels of serotonin can cause excessive feelings of sadness and anxiety. Two other important neurotransmitters – dopamine and norepinephrine – also affect mood. When the brain doesn’t produce enough dopamine or norepinephrine, you can feel tired, unmotivated and foggy-headed.
    • Ref: http://www.amoryn.com/howamorynworks.html
49. INTEGRAL PSYCHOLOGY Abnormality is due to arrested and bewildered inner evolution in consciousness. It is the lack of harmonisation of physical, vital, mental and psychic energies
50. Acknowledgment
    • Arpita for dance, Anuradha for song, Avijit for flute – my students of Performing Art Therapy Centre, Rabindra Bharati University.
    • N.B.: Dance and songs are used for receptive and flute is used for productive performing art therapy.
51. You can if they can