Staffs' interpretation of the experience behind vocally disruptive behavior in severely demented patients and their feelings about it. An explorative study.

This study illuminates the experience behind the vocally disruptive behavior in demented patients and their caregivers' reactions to it. Because of the communicative disturbances of the patients, caregivers were asked to act as their vicarious informants. Projective identification, transference, and countertransference were supposed to take place between the patients and their caregivers. Thus, a psychological framework was used. Seventeen experienced caregivers were interviewed after listening to tape-recordings of two patients exhibiting vocally disruptive behavior. Analysis revealed that caregivers regarded anxiety as the most common experience behind the behavior. Seven categories of explanations were obtained: anxiety over abandonment, dissolution, loss of autonomy, threats to integrity, an expression of bodily needs, reactions to disturbing environment, and automatic behavior. Caregivers wished to understand and help but felt powerless and insufficient. The results stress the importance of finding ways of interpreting severely demented patients exhibiting vocally disruptive behavior. The importance of supervision to support the caregiver in the extremely burdensome situation is also elucidated.