The Whitworths of Arizona, bringing science to you in everyday language.

Friday, January 22, 2016

Negotiating a Truce

Blogger Eric Barker (Barking Up the Wrong Tree) says we all need to know how to persuade people. He asked the NYPD hostage negotiators about how they do it. As I read his blog, I found a lot of similarities between a hostage situation and dealing with a PwLBD who is acting out. In both cases, emotions, not rational thinking, rule. We are also fans of Teepa Snow with her "Positive Approach" and of our own local dementia expert, Geri Hall, who has been working with dementia caregivers for well over 40 years. Here are the four NYPD "secrets" from Eric adapted to address caregiver situations with some similar statements from our own gurus.

1. Know their hooks and buttons. Hooks are things your loved one likes. Caregivers often have a head start here because you usually have a good idea of these already. But to find out what is important at this moment,

  • Listen without judging. Take the time to understand not just the words, but the emotions behind the words. Listening means you are validating the person, not necessarily the story. Teepa also suggests you get on their level, and use eye contact.
  • Show interest. The NYPD suggests that when a hostage holder makes "crazy talk", the negotiator say something like this: "Oh, that's really fascinating. I never heard it in quite that way before. Help me to understand. How did you come up with that?" Teepa Snow suggests that you ask person who is hallucinating to "tell me more" and ask specific questions about color, etc. Both examples show you are involved with the conversation.
  • Suspend your ego. Put your own needs, wants, and opinions aside. Don't interrupt or try to correct, which will be perceived as judgmental. No-one likes to be judged, thus it will escalate the situation. This doesn't mean that you have to agree. It only means that you don't express your disagreement. Geri reminds us that they can't hear your concerns right now anyway. They are much to focused on their own issues and their own view of them.

2. Focus on the future. The PwLBD will likely be talking about the that were perceived as painful. Once your loved one feels you are listening, try to turn the conversation to the here and now, and to the immediate future. Geri puts it this way: "Agree, apologize, promise to fix." The "agree" gets you on their side. The "apologize" maintains their dignity. Do it even if you aren't in the wrong! Just do it. Then the "promise to fix" puts you both into the future. Be careful not to make promises you can't deliver. Promise to "work at fixing" or "checking it out" rather than delivering the whole thing. Teepa suggests that you ask for their help in fixing the problem. Ask what do they think can be done.

3. Model the behavior you want. In this case, be calm and soothing. However, Teepa Snow suggests that first, you agree with the PwLBD, matching their level of anger and voicing what they might not have been able to say. THEN, take some deep breaths and get them to take deep breaths with you. And THEN, go into the calm, soothing routine. Trying to calm someone who doesn't feel you are "there" for them is often futile. When they feel you are "on their side" they don't have to be so angry and can allow themselves to take those deep calming breaths and relax.

4. Slow it down. Each step of this process should take a lot of time. You would probably like to just get it over with! But moving too fast leads to pressure and intensifies emotional decision making vs. rational decision making. This is true for anyone under stress. Add the difficulty that a PwLBD has with thinking in general and this is greatly increased.

  • As the PwLBD begins to calm down, slow your own responses even more. Make sure you are both on the same page. A small spark could start the acting-out all over again!
  • Be very clear about what is going to happen next. Make sure the PwLBD is happy with this and doesn't feel pressured. "OK, let's go to dinner and then I'll talk to the nurse about your purse. Are you all right with that?"

View some of Teepa Snows wonderful videos:

Read Eric Barkers fascinating blog:

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a physician's advice.

1 comment:

  1. Great suggestions. A very interesting analogy to hostage negotiations. Probably not dissimilar in many instances. And the shortening to "Agree, apologize, promise to fix." is great as a mantra for so many LBD-related interactions. Thanks for the great ideas!