Alison Lynn, MSW, LCSW, associate director of social work at the Penn Memory Center (PMC), wrote a 2-part series on how to begin psychotherapy and the benefits of psychotherapy for individuals living with Alzheimer’s disease and related dementias (ADRD) and their family caregivers. As part of the series, Alison collected questions from the PMC community about psychotherapy. Here are Alison’s answers to your questions:
Question: Is therapy confidential?
Answer: Yes, by and large, therapy is covered under HIPAA and is confidential. There are some exceptions to this rule. Your therapist may break confidentiality if:
- You share an imminent plan to seriously hurt yourself or someone else
- You disclose current abuse of a child, older adult, or person with a disability
- They receive a request in the form of a subpoena or court order
Your therapist should explain their privacy policy to you during your first session, and should also provide a copy in writing.
Question: My wife has Alzheimer’s and goes to daycare 4 days a week but except for that I’m her total caregiver. I was speaking to my son and told him I would do anything for just one normal day, then I realized I don’t know what a normal day would be. He suggested I might need a psychotherapist. If so what type would I look for? Thank you.
Answer: First of all, I want to commend the question-asker for staying open to their son’s suggestion, and for seeking support – neither of these things are easy! I would focus on finding a therapist who specializes in working with ADRD caregivers, or at least has a working knowledge of Alzheimer’s Disease. The type of degree they have is less important. If you are a part of the Penn Memory Center, you can always reach out to the social work team (alison.lynn@pennmedicine.upenn.edu) and we can send you some personalized referrals.
Question: What is the most current evidence (peer-reviewed and corroborated) that psychotherapy provides benefit to individuals with MCI? What are the confirmed benefits? Thank you!
Answer: This is a bit tricky to answer since there are so many different types of psychotherapy, all of which have different aims and different potential outcomes. In general, the most commonly confirmed benefit of therapy with this population is a reduction in depressive symptoms. I practice similarly to a well-studied and replicated intervention known as the CORDIAL program, which is an 11-week, manual-based treatment program. CORDIAL combines Cognitive-Behavioral Therapy (CBT), Reminiscence therapy, and cognitive rehabilitation. In a recent larger RCT, a group of folks with MCI and early-stage dementia who participated in CORDIAL experienced more significant and longer-lasting reduction in their depressive symptoms, as compared to the control group (Tonga, et al., 2020).
Question: I’ve been in therapy for a few months now but I don’t feel like it’s helping. What should I do?
Answer: I would first start by bringing this up with your therapist. I know this is hard to do, but they are a professional and should welcome this kind of feedback, as it will only help them provide better care (if they don’t, that’s a major red flag). If I were the therapist, I could then:
- Revisit the goals we set at the beginning of treatment: Are they still relevant? Are they realistic? How will you know when you’ve met them?
- Revisit my modality and technique: What is going well in the work we’re doing together, and what isn’t? If CBT is not helpful, for example, we might decide to choose a different approach.
- Evaluate if I am the best clinician to help you: Sometimes two people just don’t mesh well enough to have a good working relationship – it means nothing negative about either person! You might not feel comfortable enough opening up to me, or I might know of a colleague with more experience in treating your presenting problem.