The first is a powerful new psychotherapy, which provides the treating psychologist with powerful new interventions to eliminate residents’ depression, anxiety and pervasive feelings of futility. It is called SEP… Strength-Embedded Psychotherapy. It is packed with powerful, but little-known psychological tools, designed to encourage your resident to become more aware, or “conscious,” of his/her strengths, progress and successes.

It is a consciousness-raising technique that uses a treasure chest of innovative, next-generation interventions that are skillfully crafted for each resident, including: writing, counseling, problem-solving, cognitive restructuring, audiotapes, videotapes, letters, awards, story- telling and drama exercises. They are designed so that the resident is not able to just remember, but to actually re-live or “revivify” those aspects of his/her life which highlight his/her heroism, flexibility and resilience.

SEE…The Strength-Embedded Environment

The second component is The Strength-Embedded Environment. The typical nursing home environment often triggers hopelessness and futility…

Q. How Does the Resident Come to View Him/Herself As Hopeless?

A. By succumbing to the symptom-embedded environmentof the nursing home.

I began to understand that nursing home residents make sense of their world by subconsciously crafting a particular story, often a tragedy, and a role or persona for themselves in it. We have all seen the “hopeless residents,” “betrayed residents,” and the “all-suffering residents.” These tragic and subconsciously assumed roles are the result of painful life situations that needed context. So the resident subconsciously creates an internal drama that s/he really feels and then lives-out.

The themes for these dramas have been subconsciously shaped by insidious hypnotic processes taking place in your facility itself. Just like the stage hypnotist’s subject really feels like and “becomes a barking dog,” your facility resident “becomes” and feels like “a hopeless victim” or “a victim drowning in futility.” Therefore, the resident’s hopeless story, though not necessarily a FACT, is perceived and actually lived-out as such.

Repetitive Problem-Saturated Conversations are Invisible Culprits. They Relentlessly Shape Your Residents’ Consciousness So That Their Losses and Symptoms Are Always “In Their Face!”

These problem-saturated conversations take place in your facility EVERY DAY. They generate a little-known and insidious “invisible hypnosis” that infects your entire facility with a pervasive and depressive malaise.

The CNAs, nurses, therapists, family, doctors and residents themselves unknowingly collude in the creation of an environment that triggers a constant “in your face” awareness of deficiencies in your residents. They unknowingly do this by their pervasive use of conversations that are suggestive of resident symptoms, dependence and incompetence. They create a “reality” for residents  which is catastrophic, demoralizing and futile.

We undergo waking hypnosis all the time e.g. in the theatre when an endearing character dies we may cry and feel hopeless. During our childhood, if our parents continually told us how stupid we were, we may grow-up feeling stupid.

We know that THE SAME SITUATION can be perceived differently by different people based on the story of themselves they have internalized from the way others have treated them. One person is treated for cancer and describes the therapeutic experience as miserable and “the worst time in my life.” Another describes it as “a difficult challenge that strengthened me.”

Both had almost identical experiences and walked away with vastly different interpretations, stories and feelings. We learn thru repetition. Repeated suggestions and conversational themes associated with emotionally charged experiences are powerful. They create a certain internalized role for the resident that, in turn, creates hopelessness and dejection.

The resident’s perceived story can change over time because it is contingent on the type of consistent interactions in which s/he is engaged. Interactions or “conversation” need not be verbal, but are often nonverbal. A nurse who is gruff in manner is sending the suggestion that the resident is a “pain” or perhaps “inept.” Every interaction with a resident should be seen as resulting over time in a better or worse outcome for the resident’s felt sense of self.

SEP… Strength-Embedded Psychotherapy

This is a revolutionary form of psychotherapy and it is usually implemented by a psychologist or social worker who treat your residents individually or in groups.

SEP views residents as giving meaning to events by subconsciously creating stories and images which explain their experience-true or false, good or bad. Their malaise, fear or depression is seen as resulting from these “internalized” stories that that have been consistently told over time.

The resident’s perceived story is subconscious and contributes to his/her internalized role or identity…and… the resulting despondency, agitation or hopelessness. However, this internalized story and identity can change because they are contingent on the type of consistent interactions in which s/he has been most recently immersed over time.

These “subconsciously created autobiographies” or narratives are inadvertently co-written by family and staff, through their conversations with the resident, and can have a life changing impact. Our psychotherapist addresses these malignant stories and carefully, skillfully and very subtly re-writes them with the inadvertent cooperation of the resident.

Through the skillful use of conscious conversation, these new stories become embedded with strengths by the therapist and, over time, they become part of a resident’s new “internalized” and “strength-infused” story. This new strength-embedded story then produces a new strength-embedded identity.

This new identity, carefully co-created by the therapist, triggers a pervasive awareness of the potency, competence and achievements that were re-lived and highlighted from the resident’s past or present.

It is designed so that with systematically applied repetition and consistency, residents for the very first time, will start to perceive the victories and strengths that were skillfully highlighted by their therapist, as actually defining of his/her identity, rather than their symptoms and infirmities. The losses begin to fade into the background of awareness, to be seen as more incidental… though still unfortunate and painful…and, perhaps, only an inevitable part of aging over which one has little control.

WHAT A SHIFT!  The resident used to view him/herself as just a “hopeless and despondent loser,” resulting in feelings of despondency and malaise. However, after pervasive and systematic embedding with strengths by the treating psychologist, s/he now perceives herself more as “resilient and heroic.” S/he knows that, like others, s/he has to deal with the often inevitable, physical and lifestyle losses that accompany advanced age and over which she has little control.

For any resident, there are many issues that could be highlighted by a therapist... Does the therapist highlight the strengths…or…like most…the weaknesses? What is highlighted contributes to the shaping of the resident’s “internalized plot,” with all the feelings and behaviors that go with it.

The story of one resident eloping from a facility in the direction a busy street is a case in point. The therapist could have purposely highlighted many aspects.

 What do you think of the choice made about what to highlight by this psychologist…what effect did it have…?

The elopement was initially reported as an apparent suicide attempt. Such banner headlines gave way to his father's frustrated and anguished account of his son's “poor response to the facility’s patchy and inconsistent care.”

Later, while interviewing the resident, the psychologist subtly re-wrote her father’s malignant story. The new plot was embedded with strength and was reinforced by the extraction of significant meaning from the elopement, saying:

"Please tell me about the experience of being old, sick and confined to a nursing home. She deferred to her doctor’s diagnosis in the progress notes. The psychologist said that often we get descriptions of mental state from doctors who can only express their observations in a clinical way, with little consideration for the patient's soul. “I bet your elopement had a message in it about your life right now,” the psychologist said. “What do you think that might be?” he queried.