Living well with dementia groups: changes in participant and therapist verbal behaviour

ABSTRACT

Objectives: This paper reports two related analyses of verbal material from seven Living Well with Dementia groups: the first examines changes in the verbal behaviours of participants across the course of the sessions in all seven groups; while the second contrasts therapist behaviour in two groups.

Methods: In the first analysis, recordings of three sessions from each group were transcribed and participant descriptions of dementia were analysed using the Markers of Assimilation of Problematic Experiences of Dementia (MAPED) rating procedure. In the second analysis, therapist behaviour in weeks 2 and 8 from two groups (F and G) was analysed using the Hill Counsellor Verbal response rating scale. Inter-rater reliabilities for the two sets of ratings were ‘good’ and ‘very good’, respectively.

Results: For the MAPED ratings, a five by four contingency table was analysed using chi-squared, which indicated a highly significant change in assimilation. There were significant higher levels of level 1 and 2 markers in the first two sessions and level 4 for sessions 5 and 6. Facilitators used significantly more direct guidance and information giving behaviour in the second session at Location F compared to Location G.

Conclusions: The results suggest that important changes occurred in the way that dementia was described across the seven LivDem groups: this includes both reductions in the avoidance of direct references to dementia after the first two sessions, as well as an increase in ‘insight’ statements. Directive facilitator behaviour may be associated with poorer outcomes.

KEYWORDS:

• Alzheimer's disease
• psychotherapy
• awareness
• insight
• dementia

Acknowledgments

We would like to thank all of the participants and their families for participating in this research. The project team would also like to thank the group facilitators (Kathy Chapman-Hill, Jackie Shearing, Lorraine Conduit, Rachel Crane, Angela Lynch, Kate Wilson, Rebecca Burke, Heather Baldwin, Rachel Woodward, Alison Moren, Sue Ward, Helen Williams, Debbie Bolton, Emma Reed, Susan Ryan and Nicki Short) as well as the project steering group members including Professor Clive Holmes, Elizabeth Bartlett and David Higgenbottom. In addition Lauren Gatting, Andrea Hirons and Saskia Boisevin assisted in the analysis of material.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Available on request from the first author.

2. http://www.controlled-trials.com/ISRCTN25079950/.

3. REC Number 11/SC/0363, approval dated 18 November 2011, protocol amendments accepted on 28 June 2012 and 23 August 2012.

4. The MAPED coding frame is attached to this paper as a supplementary material or is available on request from the first author.

5. http://graphpad.com/quickcalcs/kappa2/.

Additional information

Funding

This work was supported by a grant from the National Institute of Health Research, Research for Patient Benefit funding stream [grant number PB-PG-0610-22005].