Discernment Leads to Humble Deferral

I’ve had the profound privilege for the past 15 years of learning under the mentorship of Penny Garner, founder of The Contented Dementia Trust in England and the SPECAL® Method. (pronounced “speckle”). I’ve also studied many other person-centered care models over the years and ultimately view them all through the lens of the SPECAL method because SPECAL gives us such a simple, clear understanding of what it might feel like not to know what you’ve just said or done only moments before. SPECAL helps us realize that we all experience life by matching to information which is already stored in our memory. People with dementia are no different. If someone with dementia is matching how they feel today at a social gathering with the feeling they had while teaching a history class 40 years ago, they are telling us that match helps them make sense of the situation in a way that gives them confidence to know how to act or what to say. SPECAL helps us discover that the condescending, patronizing terms which imply deception (e.g., “white lies,” “therapeutic lying,” “fiblets,” etc.) are completely unnecessary when attempting to avoid contradiction with a person experiencing dementia.

As mentioned in a previous blog, when we intentionally observe our loved one living with dementia and discern how facts are increasingly failing to store coherently or sequentially, and how they need to match to old facts in order to cope, it informs how we can best respond. When we strive to care well, our discernment leads to humble deferral.

SPECAL treats dementia as a simple disability which can be positively managed. It proposes:

After diagnosis, for the purposes of managing the condition, dementia is best understood as the random, intermittent, and increasing inability to store the facts of what has just occurred in one’s life, while continuing to store feelings in the same way as usual.

Regardless of diagnosis (reason for dementia); regardless of dementia progression; regardless of the presence of other dementia symptoms often considered unrelated to memory, this simple understanding explains how SPECAL counter-intuitive principles prevent people experiencing dementia from being tripped up.

SPECAL likens dementia to other physical disabilities to make the point:

If someone lost a limb, we’d find it cruel to refuse them accommodation with a prosthesis or crutch.

With SPECAL, we realize that when someone has lost “a limb” in their memory system, we are equally cruel when we refuse to make accommodations in how we communicate. When we have the ability to accept the crutch they are choosing to use, and we refuse to do so, we trip them up. In fact, when we don’t learn from the expert to use their chosen crutch ourselves in our communication with them, we risk causing trauma. By listening to the expert (the person who is coping with the disability of recent facts failing to store), following their lead, we can prevent new trauma caused by common sense communication from entering in their lives.

Listening to the expert means we even discern that they may not always need a crutch, so first we have to spot when and how they are using their crutch. That is where we avoid both over-accommodating by doing too much and under- accommodating by knocking away the crutch they are choosing to use.

At Dementia Together, we love sharing an approach that promotes lifelong well-being by providing highly practical strategies which care partners can use to avoid disturbing the sense the person with dementia is making based on facts that are (or are not) currently storing. Care partners who use SPECAL boost the dignity of a person with dementia by incorporating the SPECAL general principles (including “listen to the expert!”) along with the specific individualized historical facts the person living with dementia is matching to in order to make sense of what is happening in their life.

Contact us by email, help@dementiatogether.org, or check out our website, dementiatogether.org, if you’d like to learn more.

– Cyndy Luzinski, Executive Director at Dementia Together