Kathleen S. Mayers

Damaged Sexual Self-Esteem: A Kind of Disability

Damage to sexual self-esteem can occur readily through interactions with others; name-calling, sexual insults, unsuccessful sexual interactions, sexual victimization, and ones own impulsivity and self-destructiveness in a sexual encounter can affect the individuals sexual self-esteem. In this paper, five cases are provided to clarify the ways in which individuals experience damage to their sexual self-esteem. Some of these cases came under court scrutiny; monetary compensation was ordered by the courts because of extreme damage in some of the cases. Damage to SSE can be extreme, disabling and can significantly detract from the individuals self-view, satisfaction with life, capability to experience pleasure, willingness to interact with others and ability to develop relationships.

Inappropriate Social and Sexual Responses to a Female Student by Male Patients with Dementia and Organic Brain Disorder

This paper focuses on the issues of inappropriate sexual comments and behaviors directed at a female student in a hospital environment. Through a discussion of case reports, the paper explores the difficulties faced by female students addressing sexual responses by patients with dementia. To further complicate the emotional difficulties of students, these issues are typically difficult and uncomfortable to explore in clinical supervision. The paper concludes with some examples of how female students can be supported and prepared to work with this difficult patient population.

Sexual and social concerns of the disabled: A group counseling approach

This paper describes a group designed to offer an opportunity for discussion of sexual and social adjustment for individuals with a variety of chronic physical disabilities. Group organization and topics discussed by the participants are described. Guidelines are provided for facilitation of sexual and social discussion groups for individuals with chronic physical disabilities.

Hope in a geriatric psychiatric state hospital population: Results of a structured interview

Hope is a critically important characteristic in the physically ill patient. The presence of hope is related to recovery from life-threatening medical illnesses, such as cancer; specific strategies are used in individual or group therapy to increase hopeful attitudes. The concept of hope has not yet been fully explored in the geriatric population. Among elderly individuals who have suffered from dementia or major mental illnesses and are hospitalized because of these illnesses, there is little

Specialized services for demented residents in Washington state nursing homes: report of a survey

done regarding the effects of dementia, and studies ofpeople with Alzheimers disease have been particularly prominent in this research. Studies have focused on the disease process itself and how the person, family, and community learn to cope with the disease. When memory and judgement (among other abilities) become impaired, a person becomes more dependent on others to assist in everyday activities and to provide security. The demented individual may experience changes in behavior, which occasionally become management problems for the caregiver. Much has been written

Sexualized components of verbally abusive statements by residents with dementia diagnoses

Staff members were surveyed about their experiences with verbal abuse by residents in a geropsychiatric unit of a psychiatric hospital. They were asked to indicate the nature of the verbal abuse directed toward them and to indicate the worst thing a resident had ever said to them. Perceived sexual practices and preferences were a focus of insult described by many staff. The majority of “worst thing” said to them statements were sexual insults, with name calling using vulgar terminology and vulgar terms referring to male genitalia occurring with highest frequency. Examples of the kinds of abusive statements heard in the geropsychiatric facility are provided. Implications of sexual name calling in the geriatric long term care facility are discussed.

Methods of dealing with agitation, resistiveness and combativeness Results of a survey of Washington state nursing homes

The most troublesome behaviors of nursing home residents include disruptive, resistive and aggressive activities. Such activities usually result in initial efforts to determine if the behavior can be managed or medicated away, and if not, admission to a state hospital may be necessary. At such times, the individual may enter the state hospital system labeled as gravely disabled, a danger to self, or a danger to others. A residents transferfrom a nursinghome or private/community hospital becomes necessary when efforts to manage the individuals problem behaviors are ineffective, or the individual fails to control his behavior, and refrain from troublesome, disruptive, combative or resistive actions. Behaviors that fall into this category include:

Combativeness in the demented patient

Combative responses in patients with dementia diagnoses pose a major management problem for care-takers. Those individuals who display repeated bouts of combativeness and pose a risk of harm to others often cannot be maintained in a nursing home setting or other less restrictive environment. Factors contributing to combative responses in patients with dementia are discussed. Case studies are provided; these offer a means of understanding why the patient hits in specific situations. Recommended management strtegies ae described.

The decision for civil commitment by jury trial and the respondent with a diagnosis of dementia

Difficulty communicating with the moderately to severely demented patient in a civil commitment proceeding is discussed. The patient is not always able to indicate whether s/he wants a jury trial or a hearing by judge (or court commissioner). At times, the manner in which the judge or attorney communicates may contribute to the patient s inability to comprehend. Two cases are provided which demonstrate these difficulties. Suggestions are made to simplify communication in the courtroom and to increase the likelihood that the patient will understand. A brief structured interview is included to facilitate the process of obtaining an indication from the patient as to whether s/he wants a jury trial or a hearing by judge (or court commissioner).