START: Strategies for Relatives

Session 8:

What works? Using skills and

strategies in the future

Copyright 2018 Gill Livingston and Penny Rapaport. Licensed under CC BY-NC-ND

4.0

For permission requests, write to the publisher addressed “Attention:

Permissions Coordinator” at the address below:

UCL Division of

Psychiatry 6/F Maple

House

149 Tottenham

Court road London

W1T 7NF

United Kingdom

This manual was adapted from original (Dolores Gallagher-Thompson and

colleagues, Stanford University School of Medicine, 2002) by University College

London Division of Psychiatry in 2008, with kind permission of the author. This

is the revised second edition of the manual, created in 2018.

Plan for today’s session

2nd Edition

Session 8

3

Putting it all together

p. 4

What works? Pleasant events

p. 5

What works? Managing behaviours and making a plan

p. 6

What works? Challenging unhelpful thoughts

p. 7

What works? Assertive communication

p. 8

What works? Communicating with your relative

p. 9

What works? Planning for the future

p. 10

What works? Relaxation

p. 11

Keeping it going – Making a plan

p. 12

Summary

p. 17

Putting it all together

2nd Edition

Session 8

4

• Today we are going to do a recap of the previous sessions and bring together

what works for you, both old and new strategies. We will use this to make a

plan so that you can keep using START in the future.

What works? Pleasant events

2nd Edition

Session 8

5

• Last week we discussed the importance of pleasant events for both you and

your relative (session 7, page 5) and the impact that doing more for yourself

can have on your mood.

• Did you try out any pleasant events over the past week?

• How did you feel during and after the pleasant activities?

• What got in the way of doing more pleasant events?

• What might help you overcome these obstacles in the future?

Summary: What worked best?

What works? Managing behaviours and making a plan

2nd Edition

Session 8

6

• In the first three sessions we discussed trigger-behaviour-reaction patterns for

your relative.

• Recording in detail what is happening can help understand what is causing

difficulties and help us to find different strategies and ways to react.

• Remember, there is always a cause for behaviours but your relative is not doing

it on purpose.

• Have you been able to use this approach to behaviours? If so, did you find it

helpful?

Summary: What worked best?

What works? Challenging unhelpful thoughts

2nd Edition

Session 8

7

• In session four (page 7) we discussed how learning to change the unhelpful

thoughts we have in stressful situations can help us to feel less sad and

frustrated.

• We discussed three steps to challenging unhelpful thoughts:

1. Stop and identify your current thoughts.

2. Challenge and replace your unhelpful thoughts with more helpful ones.

3. Pay attention to how you feel now.

• Shall we talk about how you found challenging unhelpful thoughts?

Summary: What worked best?

What works? Assertive communication

2nd Edition

Session 8

8

• In session five we looked at different ways to communicate. This included assertive

communication when and how to use these skills when asking for help from others.

• Have you used assertive communication skills? If so, how did it go?

• What effects have you noticed?

• What made it easier to try out these communication skills?

Summary: What worked best?

What works? Communicating with your relative

2nd Edition

Session 8

9

• In session five we also looked at how memory problems can affect your relative’s

communication.

• We looked at some techniques to help improve communication with them and

included helpful tips.

• Have you used these techniques? If so, what was helpful?

• What effects have you noticed?

• What made it easier to try out these techniques?

Summary: What worked best?

What works? Planning for the future

2nd Edition

Session 8

10

• In session six we discussed planning for the future and the issues that this can

raise. We talked about how making decisions can be difficult but that planning

before a crisis can be helpful. We discussed some of the most common concerns

including:

Options for care

Managing the physical health of someone with dementia

Legal issues

Have you had a chance to think about or have these discussions with your relative or

other family members? If so, have you found this helpful?

Summary: What worked best?

What works? Relaxation

2nd Edition

Session 8

11

• Each week we have practiced a different relaxation technique for you and/or your

relative to use. These included:

1. Signal breath

2. Focused breathing

3. Physical grounding

4. Guided imagery: Meadow and stream

5. Meditation

6. Guided imagery: Ocean escape

7. Stretching

You can listen to these managing stress exercises any time on your CDs or

smartphones.

• Let’s talk about how you found the relaxation exercises. Which did you find

most helpful?

Summary: What worked best?

Keeping it going: Making a plan

2nd Edition

Session 8

12

• We know from experience that making changes and keeping them going is

difficult. Some changes work and others will not. Try not to be too discouraged.

• Some of the reasons it can be difficult include:

o The advice and strategies are not relevant to you.

o It is tricky to get the hang of some of the strategies.

o It is hard to break established patterns.

• Here are some suggestions to help you keep going!

o Make use of the manual to remind yourself what you learnt in sessions.

o Using record forms to notice patterns, especially when there is a new

problem.

o Remember small changes can make a big difference over time, so keep

trying things out and practicing.

2nd Edition

Session 8

13

• Based upon what you have said works best and has been most

useful, l am going to make a list of skills/techniques/strategies that you

intend to keep using in the future:

Action plan: Skills, techniques and strategies for the future

1.

2.

3

4.

5.

6.

7.

8.

2nd Edition

Session 8

14

Managing Stress 8:

Choose

your

favourite

relaxation

Guided

Imagery -

Meadow &

Stream

(Session 4, p.

15)

Stretching

(Session 7, p.

13)

Physical Grounding

(Session 3, p. 12)

Signal Breath

(Session 1, p.

15)

Focused Breathing

(Session 2, p.

17)

Guided

Imagery -

Ocean Escape

(Session 6, p.

18)

Meditation

(Session 5, p.

15)

Stress Rating Before Exercise

2nd Edition

Session 8

15

First, please rate your level of stress or tension right now, before we practice your

favourite relaxation technique.

5 = Terribly tense 4 = Really tense 3 = Moderately tense 2 = Slightly tense 1 = Not at all tense

On a scale of 1 to 5, how would you rate your tension?

Tension Rating After Exercise

2nd Edition

Session 8

16

How would you rate your tension level now, after trying your favourite relaxation

technique?

5 = Terribly tense 4 = Really tense 3 = Moderately tense 2 = Slightly tense 1 = Not at all tense

Q! Now, please rate your tension or stress level from 1 to 5

Summary

Session 8 2nd Edition 17

Copies of Record Forms: Behaviour Record

2nd Edition Session 8 18

Day Morning/Afternoon/

Night

Who was

there?

Trigger Behaviour Reaction What strategy did you

try?

What happened?

Communication Record

2nd Edition Session 8 19

Situation

What I said or did?

How did it turn out?

How did I feel?

Pleasant Events Record

2nd Edition Session 8 20

Day

What did you try?

How did it go?

How was your mood?

Events for you Events for you and your relative

Rating (1-10)

Thought Record

2nd Edition Session 8 21

What was happening?

What were you thinking?

How did you feel?

An alternative response would be…

How do you feel now?