Trauma at the End of Life: Somatic Experiencing and Other
Touch-Based Treatments for Neurocognitive Changes
We are all temporarily able minded...
Alzheimer’s Disorder (Forgetting):
The primary presenting problem for is often poor
memory and forgetfulness. In middle stages: reductions
in the ability to conceptualize, organized expressive and
receptive speech, and motor planning. In late stages:
behavioral difficulties, agitation, delusions, and halluci-
Psychological Reactions: To the individual it can
feel like a deadly disease that has no cure and will
inevitably rob them of everything they have. People
can often feel angry at having to go through the cogni-
tive changes; they may feel betrayed, and questions of
existential value can surface.
Transference Issues in Therapy: Clinicians often
feel as if their work is futile due to the client’s progres-
sive decline. Efforts to help the client and/or family can
often seem like failure. Clinicians finding the exis-
tential meaning in each moment of life can help.
Parkinson’s Disease (PD), Parkinsonian Disease
Dementia (PD-D), Lewy Body Dementia (LBD):
These disorders are likely a spectrum of disorders
affecting the sub-cortical movement, motivational
and affective centers of the brain All of these dis-
orders present with tremors, slowing of movement,
difficulty initiating movement, difficulty with bal-
ance and cognitive slowing. LBD can mimic Al-
zheimer’s and have visual/ auditory hallucinations.
Psychological Reactions: Depression is common
in all forms of basilar dementia disorders. Individu-
als who experience these disorders can face social
stigmas. Individuals with LBD particularly experi-
ence paranoia and difficulty distinguishing dreams
Transference Issues in Therapy: The feeling of
sitting with depression can be very heavy, especially
when the depression is associated with dementia. Cli-
nicians can feel confused and hopeless. For individu-
als with LBD the clinician needs to be able to flexibly
work with the client in multiple and fluid realities.
Vascular Dementias (VAD): These disorders are highly
heterogeneous. They reflect damage to the brain from
multiple classes of ischemic attacks, including burst
blood vessels, occlusions and aneurisms. They tend to
follow a step-wise loss of cognitive abilities.
Psychological Reactions: This disorder often has a sud-
den onset. The suddenness and the severe consequences
of the cognitive changes can impact the family and indi-
vidual as a traumatic loss.
Transference Issues in Therapy: Reactions to VAD are
diverse. Sudden changes over time can be destabilizing
to the counseling process. Facing one’s own fragility of
mind can help the clinician support their client and family
to integrate the experience.
(Changes in Self):
FTD most likely not one dis-
order but a group of related
disorders. There are two
main initial presentations a.
The loss of language ability
and b. Behavioral
disinhabition. The later individual can look and act anti-
social, lack social awareness and neglect hygiene. Over
the course of the changes both groups begin to develop
symptoms of the other group.
Language Loss: People can limit the scope of their social
life due to fear that they cannot communicate effectively
Behavior disinhabition: People can ruin their reputation
with impulsive, unethical actions, display lack of insight,
appear cold, rigid and impersonal.
Transference Issues in Therapy: Transference Issues
in Therapy: Initially clinicians can feel powerless to com-
municate without words. Impulsive behaviors often make
it necessary for the clinician to manage his/her frustration
with the client and to be very clear with boundary setting
while holding space for compassionate understanding.
1. Individuals can still learn and
change their emotions, psycho-
logical reactions even with out
memories of distinct events.
2. Working with the autonomic
nervous system can help both
the practitioner and the client
return to rest after stress.
3. Evoking one positive emotion
increases how quickly a person
returns to rest after stress.
4. Signs of Rest: Stomach
Gurgles, Deep Breath, Jaw
relaxes, Hands relax.
Effects of Touch Treatment
1. Reduced Cortisol
2. Increased Dopamine
3. Increased Serotonin
4. Increased Oxytocin
5. Increased Sleep
6. Decreased Substance P
7. Reduced Blood Pressure
8. Reduced Pulse Rate
9. Reduced Agitation
10. Reduced Pacing
Ethical Use of Touch
1. Always obtain informed consent.
2. Have a clear objective for the
3. Respect a clients changing
4. Obtain appropriate training,
consultation and supervision
Use of Touch - Treatment Planing For Elders
1. Obtain and Use Appropriate Informed Consent Protocol
A. Obtain neuropsychological evaluation.
B. Identify patient/caregiver goals and current coping strategies
(some challenges simply need to be accepted, some need be
adapted to, and some corrected).
C. Assess motivation and beliefs about healing/health.
D. Assess the level of insight the client displays about the
3. Identify Touch Therapy Appropriate Goals: a) as an adjunct treat-
ment for mood disorders, b) to reduce cortisol secretion and behavioral
disruptions, c) to reduce anxiety, d) to reduce aggression, e) to support
de-escalation if the individual becomes agitated, f) for pain reduction, g)
to increase social support, h) to increase meaning and emotional commu-
nication and i) increase sleep.
4. Identify Touch Techniques: Self-regulation, Co-regulation and De-
5. Regularly assess and evaluate the outcomes of intervention.
Self-regulation techniques teach an individual to use touch to sooth
anxiety or agitation. Self-touch (e.g., self-massage, tapping, pushing
feet into ground, and self-squeezing), contact with an animal (e.g.,
house pet, health advocate animal, therapy animal), or seeking contact
with care provider (e.g., hand holding, asking for contact).
Co-regulation techniques are techniques that a therapist, family mem-
bers or care providers can use to provide desensitization to triggers and
containment (e.g., providing listening, containing, or supportive touch;
evoking a relaxation response; activating prefrontal emotional regula-
tion areas to come online.
De-escalation techniques can be used to reduce agitation and anxiety
and increase positive mood (e.g., supportive touch on back, hand hold-
ing, asking to squeeze the care provider’s hand, mirroring movements,
allowing the person to take your arm and lead you).
Ableism and Disabilities
Religious/moral model: This model
views disability as a moral failing.
Medical model: Views disability as an
illness or deformity to be fixed.
Disability rights model: Recognizes
differences and notes that social sys-
tems hold biases that can impede the
ability of the individual to adapt.