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Music Therapist From Virginia, United States

About Cindie: Cindie L. Wolfe, BS, BMus, MT-BC, EMT-B
Masters of Music Therapy candidate
Board Certified Music Therapist
Neurologic Music Therapist
BS Physics. Engineer. Problem Solver.

1 Activity

3 Comment

Cindie 9th Apr 2020 Music Therapist


Hilma, you mention she has a diagnosis of somataform disorder and ask if CBT will help. Yes, Cognitive Behavioral Therapy can help with this. However, somataform disorder isn't about attention seeking. The person suffers from very real physical symptoms. It's just that even though a physical cause may be present, the level of distress is excessive and disproportionate. It is accompanied by persistent thoughts or anxiety about their health, which could cause the person to talk about it but that wouldn't have anything to do with some of the comments you related. You have described some of the symptoms of histrionic personality disorder but would need to have her evaluated to see if that or any other diagnosable mental health issue is involved.

The attention seeking behavior could have a wide variety of causes. It could be relatively recent behavior, perhaps related to being in care such as reduced autonomy / insecurity / powerlessness or feeling abandoned. The behavior could be lifelong and related to childhood experiences. Or something else. If you can figure out the reason for the behavior that will help you figure out how to meet her needs and reduce the behavior.

You could try:
Ignore inappropriate behaviors without ignoring her: Continue with the group activity without acknowledging inappropriate behavior. Do give her the same opportunities to participate as others. Thank her for appropriate responses. Schedule time each day, or shift, for someone to spend a few minutes focused on her. Try to make it the same person, roughly the same time (or associated with a specific daily activity) each day so she can trust she will get attention. There may be people she especially wants approval from. Consider adding Noncontingent Reinforcement. This has been proven to be an effective intervention for attention-seeking behaviors like screaming. This procedure involves providing reinforcement, such as attention from staff via verbal praise or high fives on a fixed schedule (every 15 minutes, every hour) --or-- at random, completely independent of the behavior. For example, staff would provide social praise every hour.

Include your plan of action in the nursing plan and get care staff on board.
Cindie 3rd Apr 2020 Music Therapist

Using Music With Older Adults During Covid-19

A new activity has been posted by a Golden Carers member: Using Music With Older Adults During Covid-19
Cindie 3rd Apr 2020 Music Therapist


Hilma, I have a list of strategies for you at the bottom of this post.
Any idea why they do this? Dementia, don't understand / remember social norms, unaware of behavior, impulse control, faster / higher cognitive functioning than the others, not challenged enough, being knowledgeable has something to do with their identity, used to being or wants to be a leader, attention seeking or needs acknowledgement or human connection, wants to matter to someone / be important in some way, other?

All behaviors have a reason. Looking at behaviors as an opportunity to uncover & meet needs provides more benefits for patients and staff alike rather than trying to extinguish problematic behaviors. Consider with the treatment team how this behavior might be related to other behaviors, the patient's current and past experiences, their environment, their impairments, and needs.

Some strategies:
1. "Let's hear from someone who hasn't given an answer yet." -- When I try this and it isn't working, I might say it again while gesturing toward a section of participants who haven't answered.
2. "I want to give everyone time to think about this, so I'm going to ask you (plural you) to wait before answering." (be sure to make eye contact with the person, but not only them)
3. "Fred, I think you know the answer to this. I'd like to see if someone else knows it, so I'd like you to wait before answering."
4. "Fred, you're a fast thinker! (you could make a comment or ask a question related to their career or hobby like, That must have come in handy when you worked as a ....) Not everyone thinks as fast as you do. Would you wait to answer so some of the others have time to think through the question?" -- Give 'Fred' a way to be part of the solution.
5. Speak with 'Fred' privately.
6. Find something else for 'Fred' to do that uses a skill or interest he has. Maybe he can ask some of the questions.
7. "Fred, this doesn't seem like much of a challenge for you. So, ...." Give him a challenge - to wait, to write down the answer w/his non-dominant hand instead of verbal answer, answer in Morse code or another language, ... be creative.
8. Seat him in a different spot. In the back, front (he might feel like he has more access to you yet the others might not hear his answers), to the side?
9. If other things aren't working, I might combine #1 and #8 and just nod (or quietly thank) at 'Fred' or ignore him (depending on the reason for the behavior) while making eye contact with others and continue to look to them for answers.