Effective Nursing Home Psychotherapy: Blending Skill And Heart By Tom Medlar, LMHC on 2/23/23 - 5:37 AM

“My mother literally made gin in the bathtub; it was part of how she made money. She also had men ‘guests’ in the apartment, and unfortunately, she didn’t always protect me from them.” Daphne remarked as she spoke of her childhood in Brooklyn, New York.

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Daphne was now 84 and resided in a nursing facility. She used a wheelchair, and spoke in a raspy voice due to polyps on her vocal cords. As a result, she would not sing one note, since she knew it would never again sound like it had when she was younger. But she would laugh, and she would share her stories, and she was always curiously asking about the stories of other people, even mine.

On Her Own Terms

We often sat for psychotherapy in a small TV room in her unit. The room was about 8 feet wide by 10 feet long; just space for a loveseat, one chair, her wide wheelchair, a small TV on the wall, and a window looking out at the woods behind the facility.

During one session Daphne was speaking about the ironic balance of shyness and confidence of a performer. “How about you, you seem calm, but do you feel shy or do you feel confident?” she asked. I explained that when I was younger, I went to acting school, partly because someone wrongly suggested to me that taking up acting was a way to overcome shyness. Daphne laughed, and asked, “Well, so how did that work out, anyway?”

Daphne had a regal quality, along with her charmingly refreshing genuineness. Her issues in therapy were related to acceptance of aging and reduced functional independence, tolerance of the loss of her singing voice, and easing of suffering due to abuses experienced in her childhood. Daphne was intolerant of anything phony. She’d seen too much in her life, and seen through the disguises of so many persons. I could not have “played the part of a therapist” with Daphne — hiding behind a veneer of neutrality — my choice was to meet her on the terms she expected of authentic sharing, or nothing.

She roared with laughter as I told of the nausea and fear I’d experienced before a stage performance, and my delighted excitement during the performance. That pattern continued with each show — dread in anticipation, and elation while acting — and no, I certainly never got over being shy, I explained, as she threw her head back and laughed.

“So, why did you give it up?” she asked. I did not think it would be a successful, or tolerable, career — I could hardly tolerate putting myself through those ups and downs, so I went back to school to get a master’s degree to practice psychotherapy. “Well, didn’t you still have those same ups and downs in your new career?” she asked with her bright and penetrating gaze.

Actually, I would sometimes give talks or make presentations at professional conferences, and would experience the same nauseating apprehension, and then the same enthusiastic enjoyment while at the podium. ”Of course, I knew it!” she laughingly stated. “Let me explain to you why that happens,” she said.

Personality and Talent

“That’s the difference between personality and talent. Your shyness and your anxiety about putting yourself in the spotlight, that’s personality. But the joy and enthusiasm you felt when performing, in one way or the other, is talent. Talent and personality are not the same thing, but so many performers harm themselves because they never understand the difference.” Daphne wisely explained.

Daphne used examples of famous performers who confused their personality with their talent, and who got caught up in the projections of fans who thought that their personality ought to match their talent, and who developed problems because they could not, and should not, blend the two things that were categorically different.

Sometimes in psychotherapy, my clients are vulnerable and in need of guidance, strict boundaries, and a straightforward application of therapeutic techniques. In nursing facilities, I sometimes work with residents who have diagnosed mental disorders, and who need formal and conventional psychotherapy. Yet sometimes the residents I see in therapy don’t have a psychiatric disorder, but may instead wrestle with real-life problems such as illness or loss, and who may benefit from a less formal educational and supportive approach.

Daphne was of the latter; wise and resilient, she lived vibrantly, even when she was less able to function on her own. Her wisdom, her humor, and her curiosity about the lives of others were key strengths, and they found a place in our therapeutic conversations.  

File under: A Day in the Life of a Therapist, Musings and Reflections