A SOLUTION FOCUSED SUPPORT GROUP FOR CAREGIVERS OF STROKE SURVIVORS

1. A SOLUTION FOCUSED SUPPORT GROUP FOR CAREGIVERS OF STROKE SURVIVORS A presentation for the Canadian Counselling and Psychotherapy Association Conference, Calgary, Alberta. May 25, 2012. Rhea Plosker, Athabasca University M.C. Student Dr. Jeff Chang, R. Pysch

2. The Importance of Stroke Caregiver Support • In 2002, over 2,000,000 Canadian family members and friends were providing informal caregiving support for seniors •  In 2007, the number increased to over 2,750,000. • 20% of people over the age of 45 care for a senior • Stroke is the leading cause of disability in Canada and the stroke risk doubles every 10 years after age 55 • A stroke is a sudden loss of brain function. It is caused by the interruption of flow of blood to the brain or the rupture of blood vessels in the brain. The impacts of stroke vary widely depending on what part of the brain was impacted. A Canadian has a stroke every 10 minutes!!!!!! 300,000 Canadians are stroke survivors. 75% of those people live with some level of disability.

3. What do caregivers need? • A review of 117 studies of caregivers of stroke survivors found common themes of lived experience: • Loss of self • Changing roles and relationships • Pride • Love • Guilt • Balancing care for the stroke survivor with other life roles and self-care • Having no idea of what the future holds • Constructing a view of the future • The review provided strong support for caregiver interventions based on the transactional model of stress, treating coping challenges as an imbalance between demands and available resources. • Caregivers, particularly in today’s environment of scarce health care resources, benefit from recognizing and maximizing their available resources, as they have little control over demands placed upon them.

4. Moving Forward: A Therapeutic Group Providence Healthcare, a Toronto rehabilitation hospital, recognized the unique needs of caregivers of stroke survivors and supported developing a solution-focused caregiver support group, called Moving Forward. Moving Forward: A Caregiver Support Group Was Created To Create a slice of time and space in a patient-centered world to focus on caregivers and their needs Provide opportunities for networking and peer support from other caregivers Deliver psychosocial interventions to build coping strategies and a personal toolkit of resources “ Constructing a view of the future”

5. Why a solution-focused group? Solution Focused Brief Therapy was founded in the 1980s by Insoo Kim Berg, Steve de Shazer, with colleagues at the Brief Family Therapy Center in Milwaukee. If I focus on the problem, the problem increases. If I focus on the answer, the answer increases. -Big Book of Alcoholics Anonymous  Typical Solution Focused interaction Typical medical model of health interaction • Focus on pathology including symptoms, disabilities,and risks • Focus on when the problem occurs and how to treat it • Health care provider is the expert and sets goals • Answers constrained by the system • Brief • Focus on available resources, strengths and “what’s better” • Focus on exceptions when the problem is absent or not as bad • The person is the expert and sets their own goals • Answers based on attainable goals • Brief

6. Group Structure-What Worked In keeping with Solution Focused Therapy’s focus on “what works”, the structure of the group was modified quite significantly from the original plan, and will continue to be modified, based on attendee input.

7. The Power of Solution Focused Conversations Reframing Focuses on the people, not the stroke. “Please introduce yourself by telling us your best quality and the best quality of the loved one you are caring for.” • Goal-Setting Questions • Articulate hope • “Let’s suppose that when we walk out that door at the end of week 4, or even today, this group has been helpful to you in some way. What is the first small thing you will notice that would let you know it has been helpful?” Acceptance of reality Sense of community Balance between my needs and family needs Stubborn Strong Committed Sense of humour Cooperative Loyal Accepting Tolerant Dedicated Compassionate Self-control Deeply loving Trying their best Breathe better Inspiration and renewed mission Advocacy ideas New resources Increased peace

8. Challenges

9. Doing What Works: The Wisdom of the Group Chinese Proverb Experience is a hard teacher because she gives the test first, the lesson afterward. • Meditate • Find a mission • Look forward-stroke is not the end • Get out of bed and live life • Love • Get stronger • Make a decision • Pray and have faith • Assume your normal routine • Meet with friends • Eat healthy meals • Learn new skills • Remember to breathe • Learn more about stroke • Focus on one day at a time • Let things go • Understand the fears of the stroke survivor to help you cope • Smile and hug • Walk • Use positive self-talk • Plan, prioritize, organize • Enjoy nature • Rest • Know your limits and work • within them

10. Acknowledgements and Thanks Moving Forward: A Support Group for Caregivers of Stroke Survivors was developed and delivered with the support, guidance, and input of the Providence Healthcare social work team, who dedicated a tremendous amount of time in support of providing this service to caregivers. Special acknowledgements to Joanne Avery, Mirela Tudosa Cappella, Laura Derry, Anne Keown and Andrea Rodrigues, who were so willing to dedicate their time to advise and assist on developing materials, recruiting attendees and co-facilitating the group sessions.

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