In Caregiving, Dr. Tim Elliott demonstrates his approach to counseling people who provide care to those in need. Caregiving is an emotionally draining and demanding role, meaning that caregivers often require help in learning to meet their own needs.
In this session, Dr. Elliott works with a 32-year-old single mother of four whose eldest son Joseph has cerebral palsy. He has severe mobility problems, retardation, and is visually impaired and unable to swallow. He is on several medications and a series of physical activities. His mother describes some of her struggles as caregiver, including a suicide attempt following some insensitive medical care. Dr. Elliott counsels her on self-care and ways to find balance in her life.
The social problem-solving model is embedded in classic principles of cognitive–behavioral therapy. It provides an excellent format for understanding and conceptualizing the problems experienced by individuals who provide daily, ongoing assistance to a family member with a severe physical disability. This approach works best within a traditional, empathic, and professional counseling relationship, although the basic elements of the problem-solving model can be taught in psychoeducational groups and brief presentations.
Counselors can best address the personal, phenomenological needs of each family caregiver by providing this training in one-to-one sessions. The flexibility of the approach permits applications in long-distance technologies (e.g., telephone sessions, video-conferencing) and in home-based interactions.
The key to effective problem-solving training resides in the ability of the counselor to help the family caregiver identify and clarify the important problems they face. Rather than assume these problems relate to the care recipient and associated activities, it is essential for the counselor to appreciate the myriad of routine and ongoing issues that families face, generally, and help the caregiver explore the problems that are uniquely and particularly stressful. Caregivers are guided into exploring all facets of these problems, including their emotional reactions and characteristics of the problem that appear to perpetuate it, and reviewing past attempts to address these issues.
Eventually, the major components of problem-solving training are presented in the course of the interaction, including brainstorming of possible options for solving the problem, considering important goals to be achieved in solving the problem and the possible consequences of possible solutions, choosing and implementing a plan, and monitoring the progress of the plan.
Throughout this process the counselor is sensitive to the emotional experience of the caregiver, as negative emotions may represent the more important barriers to effective problem-solving, and a positive orientation toward solving problems should be cultivated. This would include positive emotions, a sense of competency, and a sense of positive rewards.
Typical "caregivers" do not meet stereotypical expectations. Women are most often in caregiver roles, but the number of men is increasing. Generally, these women have prior relationships with the care recipient (e.g., wife, mother) and the quality of the prior relationship will have important implications for the nature of the caregiver–care-recipient relationship.
Caregivers may experience certain problems unique to a particular health condition (e.g., emotional disinhibition following traumatic brain injury, bowel management concerns following tetraplegia with a complete spinal cord lesion) but caregivers differ tremendously in their perceptions and experience of these issues. Moreover, many family members do not identify as a "caregiver" and they may perceive their role as an extension of their role as a parent or spouse. These issues may represent important and ongoing strengths or problems, depending on the nature and quality of these relationships.
Tim Elliott, PhD, holds a joint appointment as professor in the Department of Educational Psychology and the Department of Rural Public Health at Texas A & M University in College Station, TX. He is a fellow of Division 22 (Rehabilitation Psychology), Division 38 (Health Psychology), and Division 17 (Society of Counseling Psychology) of the American Psychological Association and currently serves as editor of the journal Rehabilitation Psychology, having also served as associate editor for the Journal of Clinical Psychology in Medical Settings and the Journal of Social and Clinical Psychology.
He is a member of Society of Behavioral Medicine, the Association for the Advancement of Behavioral Therapy, and the Association of Psychologists in Academic Health Centers. He holds board certification in rehabilitation psychology from the American Board of Professional Psychology.
Beginning with his doctoral studies at the University of Missouri—Columbia, Dr. Elliott has studied cognitive–behavioral mechanisms that influence adjustment among persons who live with chronic health conditions. For the past ten years he has studied the effectiveness of problem-solving training for family members who provide daily assistance to a loved one with a severe disability. His work has received funding from the Centers of Disease Control, the National Institute of Disability Research and Rehabilitation, and the National Institutes of Health.
- D'Zurilla, T. J., & Nezu, A. (1999). Problem-solving therapy (2nd ed.). New York: Springer.
- Elliott, T., & Shewchuk, R. M. (2000). Problem solving therapy for family caregivers of persons with severe physical disabilities. In C. Radnitz (Ed.), Cognitive–behavioral interventions for persons with disabilities (pp. 309-327). Northvale, NJ: Jason Aronson.
- Elliott, T., & Shewchuk, R. (2002). Using the nominal group technique to identify the problems experienced by persons who live with severe physical disability. Journal of Clinical Psychology in Medical Settings, 9, 65-76.
- Houts, P. S., Nezu, A. M., Nezu, C. M., & Bucher, J. A. (1996). The prepared family caregiver: A problem-solving approach to family caregiver education. Patient Education and Counseling, 27, 63-73.
- Sahler, O., Fairclough, D., Phipps, S., Mulhern, R., Dolgin, M., Noll, R., Katz, E., Varni, J. W., Copeland, D., & Butler, D. (2005). Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: Report of a multisite randomized trial. Journal of Consulting and Clinical Psychology, 73, 272-283.
- Nezu, A. M., Nezu, C. M., Felgoise, S. H., McClure, K. S., & Houts, P. S. (2003). Project Genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. Journal of Consulting & Clinical Psychology, 71, 1036-1048.
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