First of all, don’t feel like you are all alone. From the beginning of time, men have had a hard time asking for help or admitting that they aren’t fully competent to handle difficult situations. I am a man and I have had that difficulty for many years. Although I now am pretty good about asking for help, it took a long time for me to get here and a lot of patience on the part of my family and my counselors.

The best thing to do is to call and talk with me yourself and discuss the situation, keeping in mind that you should only tell me as much as you think your husband would be comfortable telling someone else in confidence. It would be a serious mistake to contact me in secret or plan on having a conversation with me that you would not eventually share with your husband. As difficult as that may sound to you now, in the long run it will really work out much better if you call me to discuss your situation only after you are clear that you can have the discussion and eventually tell your husband about it. For example, you may decide at the time not to tell me something because that would be going over a line that would be unacceptable to your husband. That is perfectly all right, for the time being. A lot of what we talk about in counseling has to do with being clear and honest in communicating important issues while respecting the privacy of family members and helping to establish clear boundaries and limits in family relationships.

After you and I have had a conversation, if you feel comfortable with me over the telephone, having a discussion with your husband about calling for a counseling session will be much easier because you will genuinely be able to say that I am a person that he can talk to.

Although it was your wife who had stroke, the whole family is living through the experience. Your wife was the most severely affected, but everybody who is in relationship with her has been affected as well. Everybody needs to heal and establish good quality of life. Ignoring this problem will not make it go away.

Family dissolution is much more likely after a severe disability has affected a spouse. This is especially important because we know that the rehabilitation of the person who has experienced the disability is most successful when the family is intact and supportive.

This situation must be approached on an interdisciplinary basis, with your physician, therapists, and counselor working together in harmony. This also needs to have a focus on goals and future plans that were abandoned when the stroke happened. Many of these can be resurrected and integrated into your wife’s rehabilitation program and the family’s future.

This is a wonderful opportunity. You can do a lot to help.

First, your supportive presence is helpful. This is a new and usually frightening experience to the person who begins to experience dementia. The type and extent of dementia is important to understand, and this is based on what the person reports to any careful listener. You don’t need to be able to diagnose, but you can help develop the diagnosis by providing good information to the diagnoser. This is often difficult to obtain unless the history-taker has developed rapport. You already have rapport; use it.

Next, look at the other issues contributing to cognitive dysfunction. Quite often, the cognitive problems are made worse by factors such as depression, hypertension, diabetes, poor nutrition, alcohol use, mixed medications, and stress. Help your loved one find a resource who can parse out the various contributors to the cognitive problems. For example, treating depression can substantially improve cognitive function in the presence of dementia.

The next thing to do is begin an ongoing dialogue. Gently probe into the person’s ability to handle normal activities. Start paying attention to the safety issues that will become apparent as the dementia progresses. The main issues in determining whether the person will require structured care is safety in the kitchen.

The best team to assemble when working with a person who is beginning to experience dementia is a physician who specializes in geriatrics; an occupational therapist who works with people with stroke, dementia, or brain injury; and a psychologist or counselor familiar with adjustment to aging. Enrolling the family is crucial and will help to minimize the effects of the dementia, because stress is deleterious. If you are a counselor, physician, or occupational therapist, the Montreal Cognitive Assessment is an excellent (and free) instrument. It is available in 50 languages.

The management of chronic pain is very difficult, but not impossible. Notice that I did not say, “Getting rid of chronic pain is very difficult, but not impossible”. By the time most people with chronic pain come to me, I cannot help them get rid of their pain. Instead, what I focus on is reestablishing quality-of-life. Pain has become a part of your life but should not run your life or control you.

I work with my clients who have chronic pain to learn to “negotiate” with their symptoms and develop strategies to realize their goals in spite of their pain. Although I will be happy to work with your physician to facilitate his or her medical management of your chronic pain, I don’t want to hold out false hope that chronic pain can be cured. What I can hold out is genuine hope that quality-of-life can be restored. I have many successful clients, including a few who have allowed me to videotape their experience, whose stories I will be happy to share with you. Don’t give up.

Mind altering substance abuse is rampant in young people in our society. Notice that I use the word “abuse” rather than “use”. This is because chemicals such as alcohol can be used responsibly by adults, but the use of alcohol and other mind altering chemicals should always be treated as abuse with children and adolescents because it affects their developing brains and puts them at serious risk of injury or death. A substantial proportion of my brain injured clients are young people who were driving under the influence.

Although I have had considerable experience working with young people who are abusing mind altering substances, I prefer to refer families to several excellent resources in our community. There are very good counselors and treatment programs available and there is a strong 12-step community for young people here in the greater St. Louis area.

I would be happy to talk with you on the telephone about your situation and, based on what we discuss, provide you with a referral to one of these excellent local resources.

One approach that might be useful is Career Exploration. Through both interview and testing, we identify your aptitudes, interests, and values. We would also use the Goaling Process (GP), a structured interview with homework for you that will help you to prioritize your goals as the first step in your career development.

GP is a simple but very effective method to help you achieve clarity about the relative value of the things that are important to you that a career can actualize. I developed GP about 25 years ago, and use it with myself and my family and clients and have trained thousands of professionals to use it with their clients. Career Exploration usually requires three interview sessions and may be benefited by testing, which I can provide.

I have more than 100 tests of various types in my library, several of which can be useful in Career Exploration. At the first interview session, we can determine whether or not testing is necessary or will be useful.

We recommend:

Drury Plaza Hotel Chesterfield
355 Chesterfield Center East
Chesterfield, Missouri, 63017
Phone: 636-532-3300
Fax: 636-733-0554

From St. Louis:
Travel west on Highway 64/40 past Interstate 270 into the Chesterfield Valley, exiting at Long Road. Go south one-half mile, and look for the blue two-story building on the left, just past the railroad tracks.

From Lambert Airport:
Travel west on Interstate 70 for 4 miles before taking Interstate 270 South 8 miles to Highway 64/40 and turning west, continuing into the Chesterfield Valley, exiting at Long Road. Go south one-half mile, and look for the blue two-story building on the left, just past the railroad tracks.