View article

DISCUSSION

The problems of the ‘young’geriatric patient and his family are complex. Long-term care geriatric wards are primarily designed for the more frail and deteriorated. Whilst the family visit offers contact with a more personalized and stimulating environment, in Mr A’s case vi&s were stereotyped and characterized by discord. The goal of intervention was to restructure family interaction during visits. partly by ensuring that Mr A had stimulating experiences to talk about and partly by showing Mrs A how to prompt her husband to realistic adaptive behaviour. This entailed showing Mrs A that there were ways of responding to her husbands complaints other than by scoiding, arguing or telling him he would soon be home. Several factors probably underlie the family’s increased satisfaction. Apart from the demand characteristics of the therapeutic changes in the situation, Mr A’s increased programme of activities legitimized his wife’s reduced frequency of visiting and allowed her to shape a more independent life. Furthermore, construing reminiscence as a therapeutic tool allowed her to prepare for the visit and control its content. The stroke patient illustrates what Eastman (1976) has called ‘double strength* learned helplessness. He is exposed not only to inescapable aversive stimuli (discomfort, hospitalization), but also, through reduced capacity, is likely to find goal seeking behaviour unsuccessful. even if reinforcers are present. Ferster. quoted by Eastman, points out that such an individual may spend so much time engaged in avoidance and escape behaviour that goal seeking behaviour is never initiated. Mr A’s withdrawal and complaining …