Using SPECAL: A Case Study
Dementia is not a normal part of aging, but sadly, it is becoming more prevalent. There are 50 million people worldwide living with dementia, and 850 000 in the UK.
As a carer, it is inevitable that some of your clients will be living with dementia and to care for someone with dementia can be very challenging, as well as very rewarding. At The Good Care Group, we are privileged to be taught the SPECAL method of communication and are each given a copy of Oliver James’ excellent book on how to use the SPECAL method, “Contented Dementia”.
However, even with the training and having the book by your side, it can be daunting when faced with a particularly challenging situation and have to start remembering what to do, especially as each person is different and each situation is different and unique to that person.
I recently had a very interesting and quite delightful experience in what many would class a very challenging situation and I would like to share my experience here. Let's call the client Dee. Dee is a charming, funny, intelligent lady who lives with advanced dementia. Most of the time she is delightful and I enjoyed my time with her. However, she has two triggers and when in the grip of these two triggers she can seem quite terrifying, that is if you forget about the principles of SPECAL and allow yourself to feel afraid.
Let's remind ourselves of the three golden rules of the SPECAL method:
1. Never ask direct questions
2. Do not contradict
3. Learn from the expert, ie, the client
Dee’s two triggers were dirt and carers. She hated dirt and she was very independent, believing herself to live alone and not needing anyone's help. Once I picked up on the two main triggers, ie, learnt from the expert, it all became a lot easier to support her when she was enraged and to help her back into the green zone (I don't use the word 'enraged’ lightly).
When Dee was reminded of my presence on getting up in the morning she would become angry, telling me to go and ask when I was leaving. I would apologise profusely for the ridiculous misunderstanding at the office that had once again sent someone to her so unnecessarily (agreeing with her and using her words and the energy of her words) and tell her I was leaving after breakfast. If it was after breakfast, I would change the time to after lunch or the following day. Once she saw I was on her side and that we were in the same club (read the book again!), she would quickly become calmer and we would then be able to continue with the daily routine.
The other trigger was dirt. Dee would sometimes come into the carers’ bedroom and pull everything out of the drawers and throw things on the floor declaring how dirty and disgusting the room was. Instead of seeing this as an act of hostility towards me, I realised that there were things in the room that belonged to other carers and things she did not recognise and that she had a deep desire to tidy up and restore order to HER room. Never forget that we are guests in someone else's home and they may not like seeing our things.
I would agree that the room was disgusting and that I'd never seen anything like it. Together we would lament about how young girls today just had no idea of how to clean. I would bring bags for her to put all the 'rubbish’ in and 'throw it out’ (just moved it to a wardrobe in another room). I would give her dusters and together we would clean the room. At one point she got so annoyed that I had been forced to live in such a ‘dirty’ room that she cleared a drawer for my things!
After a short period of intense cleaning and throwing out rubbish and discovering what a kindred spirit I was, Dee would calm down and we would even be able to have a joke about it.
By jumping into her world and becoming a trusted ally against the perceived enemy, Dee was able to see me as a friend, as someone who shared her values, her likes, and more importantly, her deep dislikes. This was invaluable in soothing her and bringing her from intense anger to relief and peace relatively quickly.
My advice is to read the book, and when you are in the reality of a situation that requires soothing with SPECAL, jump into the person's world with gusto and enjoy the ride. It isn't always easy, and sometimes you may have a few false starts trying to figure out the right phrases to use. However, the right phrases are actually there already - listen to the words the person uses and mirror those words back. For example, when Dee would say, 'I hate dirt’, I would say 'Me too, I can't stand dirt, Dee’. Listen with love and compassion and if all your efforts fail at a specific time, withdraw for a little while, give the person space to cool down, and come back and try again.
Using SPECAL does work; it takes a bit of practice and the most important thing is to really inhabit the other person's world. Feel what they feel, see the situation as they see it and convey to them your solidarity. A person who is exhibiting 'challenging’ behaviour is a person who is in pain, either emotionally or physically, and a person who is experiencing high levels of fear and confusion. By walking with them in a spirit of compassion and solidarity it is usually possible to soothe that pain, even if just for a little while.