Social_Work_with_Mentalhealth

Therapeutic Communication for Elderly Victims eruption of Mount Merapi Yogyakarta in Living Everyday Life During Evacuation Shelter by: Tukino *) Background Mount Merapi is located in Sleman District of Yogyakarta Special Province is one of the most active volcanoes in the world, which is periodically ready to spew lava down the slope and the surrounding land. The disasters of Merapi eruption or re-occurred on October 26, 2010 caused great numbers of casualties as well as properties. Data from the National Disaster Management Agency (BNPB) until October 29, 2010, there were 37 people dead and 46 injured beasu of hot clouds. In addition, on November 5, 2010 eruption caused a much stronger burst of volcanic materials with as high as 6.5 km from the summit of Merapi, and the gusts of hot clouds as far as 14 miles to the south. The hot cloud flowed along the Gendol river where there were many inhabitants. This second eruption caused great damage along the path of Gendol river and cause more deaths. Based on data Pusdalops BNPB on November 27, 2010, eruption of Mount Merapi has caused loss of life as many as 242 people died at the Yogyakarta Special Region, and 97 people died in Central Java. Beside causing deaths, the eruption of mount Merapi has made in thousands of houses damaged. It is recorded 2636 housing units were severely damaged and uninhabitable, 156 houses were damaged and 632 houses suffered minor damage, thus the overall 3424 houses in the area of Yogyakarta which suffered from the impact of damaging eruption. Meanwhile in the region of Central Java province, it is recorded a total of 3705 houses were damaged, with the distribution of 551 houses were severely damaged, 950 houses were damaged and 2204 houses were slightly damaged. Residents who survived from the eruption of mount Merapi included the elderly people now are still living in the refugee camps known as "shelter", which are in the shelter of Plosokerep of Pelemsari village and the shelter of Kuwang of Kinahrejo village in Sleman district. It has been more than a year the elderly are living in refugee shelters with various limited facilities. They occupy a refugee shelter with clothes, possessions, and potluck meal, makes a chance to meet their basic needs becomes very limited. With limited fulfillment of basic needs, it is also followed by the limitations of other needs. In addition, most elderly also experience traumatic conditions due to eruption of Merapi, which is seen as a devastating event, that is concerned with life and death, which may still leave traumatic experience and psychological effect on the resident’s mood, such as loss or death of family members as victims of the eruption of Merapi. This paper is based on the author's experience when doing the practice field with team of the psychosocial assistance on November 23 to 26, 2011, which had followed the training of psychosocial assistance for the victims of natural disasters organized by the Directorate of Social Protection of Victims of Natural Disasters of Social Affairs Ministry of the Republic of Indonesia. The paper reveals: (1) the health conditions of the elderly during the evacuation shelter, (2) the psychological problems, (3) the relationship with the environment, (4) the therapeutic communication strategies to overcome problems of the elderly during staying at the evacuation shelter. A social worker or facilitator who works with the elderly should have a professional communication skills and intention to heal the client. The communication skill is called therapeutic communication, ie consciously planned communication, aiming and activities are focused on healing the clients. Therapeutic communication is a process in which the facilitator therapeutic consciously influences a client or helps clients to understand better about the problems through verbal or nonverbal communication. Therapeutic communication involves the use of specific strategies which encourage clients to express feelings and ideas, communicate acceptance and respect (Mosby's Medical Dictionary, 8th edition, 2009). Therapeutic Communication Implementation Of Elderly In Shelter Displacement Therapeutic communication skills be come very important for the most of professions. A social worker or facilitator while communicating with others will reflect his own personality. If he communicates positively with others, then he will get the same kind of response. Psychosocial assistance activities for the elderly in the perspective of therapeutic communication consists of four phases, namely, pre-interaction phase, orientation phase, working phase, and termination phases. Each phase of therapeutic communication reflects the job description of a social worker (Purwanto, 1994) 1. Pre-interaction phase At this pre-interaction phase, the facilitator to explores feelings, fantasies and fears if later he meets elderly clients in evacuation shelters, whether he will be well accepted by the elderly, if there are no language problems, or so. Thus a facilitator should analyze the professional strengths and weaknesses of himself. Through facilitator team meeting on November, 23, 2011 in Yogyakarta, intensive discussions were carried out for mutual opening up of the strengths and weaknesses of each facilitator. Then collecting data of elderly clients, and planned the first meeting with clients. In this case the escort team coordinated with Social Services Special Province of Yogyakarta, which had previously conducted a preliminary contact with the shelter manager. 2. The orientation phase This phase includes the introduction of the client, communication or a contract agreement with the clients (verbal contract), as well as the determination of the orientation program. This activity took place on November 24, 2011 on two evacuation shelter locations, namely at the Kuwang shelter and Plosokerep.. a. Contacts and Contracts Psychosocial team has 11 personnels, and divided into 5 groups, each of them then spread to the elderly residence either in Kuwang shelters or in Plosokerep shelter. In the contact phase, it began with the introduction of each team's assistant with elderly clients, and present of the objectives of the activities performed. There was no constraint in terms of language because of advanced age in the shelter could speak Indonesian. Communication techniques that are used as the basis for the creation of conditions: ✓ speaks clearly to the client, not in a hurry, and tone of voice can be heard by the elderly client ✓ eye contact with a pleasant facial expression ✓ positive regard ✓ listened attentively ✓ be friendly, empathetic and genuine ✓ body position and proportionate distance when talking elderly ✓ Alpha The elderly could receive the arrival of the escort team with friendly welcome intimacy, they even felt happy to meet and talk with their facilitators. In such an intimacy, then the contract between the facilitator with clients to help solving the problem which was oral contract, had been made, because a written contract was less possible to be done in an informal situation. b. Identification of the problems and the needs of the clients Within the framework of the orientation program, then after setting the limits of relation through contact and contract activity, the facilitator identified issues of older clients, reviewing what was expected from the communication that would be shared between the facilitators and elderly clients. The facilitator duties in this phase is to build client trust, acceptance and open communication, and explore thoughts, feelings and actions of the clients. Thus the facilitator could identify the problems and the needs of the clients. In this process the facilitator used a structured interview technique using an instrument that had been developed before, and made ​​observations on a limited basis to clients and their social environment in evacuation shelters. Communication techniques used at this stage are: ✓ all the techniques used when making initial contacts and contracts ✓ encouragement simple, and rephrasing ✓ reflective respond ✓ clarification (clarifying the client's message) ✓ interpretation (interpreting the information obtained from clients) ✓ providing information ✓ emphasizing the client's strengths The results of the identification of the problems and the needs of the clients or referred to psychosocial assessment at both shelters can be described below, and in this paper the authors took a sample of two elderly to each shelter. KAlpha ▪ Kuwang Shelter ➢ Client "Wi" Clients "Wi", female, 70 years old, was quite healthy, but mentally he suffered from a psychological disorder, that she could accept the fact that her three grandchildren had died as victims of Merapi eruption. At the time of assistance, clients "Wi" had no desire to see the tomb of her grandchildren and did not want to return to his native village, because she felt cheated by angry family members who said that her grandchildren were still alive when a disaster occured, and informed that the three grandchildren were located in Purwosari. After two months of eruption, the client "Wi" found out that all three of her grandchildren had died. As a result of psychological problems experienced, the client "Wi" be come quietly and cried at her stay shelter,and rarely hung out with other fellow refugees. Alpha ➢ Client "WW" Clients "WW", male, 90 years old, was a widower with an elementary level of education. Physically, client "WW" had a problem with a swollen right leg 'and frequent cramps, frequent coughing due to heavy smoking, as well as heartburn that was felt for a year. In connection with the disaster, the client "WW" was able to accept reality and tried to forget it. Psychologically client "WW" felt boredom because he did not work, whereas previously he was actively worked as a farmer and a sand seeker. He also had problem with sleeping and meals appetite. Socially, client "WW" had good relation with neighbors and social environment. ▪ Plosokerep Shelter ➢ Client "AS." Clients "AS", female, 65 years old, was in quite healthy physical condition even he used to have problem with kidneys, and also had lump in his intestine, and difficulty in sleeping. He was psychologically able to accept the situation happened, and had good social relations with fellow elderly and went well with the surrounding environment.Alpha ➢ Client "Bu" Clients "Bu",female, 93 years old, was a widow. Physically, she appeared to have rheumatic that made her difficult to walk, hypertension and osteoporosis. Mentally, clients "Bu" still felt sadness due to a missing grandson and daughter at the time of eruption, was also often bothered with bad dreams associated with the eruption. In social relations, clients "Bu" did not have a problem, she often visited her neighbors. Based on data obtained from the elderly clients in the shelter, it can be formulated some of the problems experienced by the elderly during the displacement, namely: • physical: the body part were often cramps, rheumatism, often felt dizzy, eye /vision and hearing were less clear, high blood pressure, poor appetite. • psychological: post traumatic stress disorder (PTSD), speaking in a high tense similar to anger. • social, avoiding situations, places or people that were reminiscent of a catastrophic event, received less attention from family, irritable and easily involved in conflict with others. While it is concerned with the needs of the elderly during their stay in the shelter camps include; needs nutritious food, shelter, health care and social needs in contact with other people Alpha c. Determination of intervention program Once the facilitators is completed to identify problems and needs of elderly clients, in the evening November 24, 2011, the team arranged discussion and preparation for activities program based on the results of studies in the field. Some programs successfully prepared by the team as an assistant in the intervention plan in facilitator activities for the elderly in the shelter were as follows. ▪ Alpha ▪ The Intervention Used Model The model used in the intervention plan for the elderly client is a model of psychoanalysis, which is a healing model for elderly individuals associated with emotional problems, individual problems and deep depressed personality. ▪ Alpha ▪ Intervention Techniques Intervention techniques that can be used in accordance with the model of psychoanalysis, among others: ✓ Support therapy, which involves the provision of support to potential supporters, in this case, peers or neighbors who are also elderly to provide support to another elderly who experienced psychosocial problems, such as feelings of sadness for the loss of family members due to catastrophic eruption Merapi. ✓ Life review therapy: Reminiscence Life review therapy is a technique of intervention in a way reflects the life experience of the elderly and then solve it, organize it and integrate it in the recent life. Life review therapy reflects all life experiences either pleasant or unpleasant. In the case of elderly who are depressed due to the disaster, the facilitator can use part of the life review therapy which is reminscence techniques so that the elderly can remaind pleasant experience of his life. So far, this technique can also increase the confidence of the elderly. ✓ Counseling Provided counseling services to help the elderly understand the problem and find the solution. In this case, counseling is a process of interpersonal communication between the client and the facilitator to improve client understanding and skills to find the problem, especially socio-emotional problems, such as post traumatic stress disorder issues. 3. Phase of Work In this phase of work, the facilitator expand the interaction and the functional factors of the therapeutic communication to assist elderly clients to solve the problem and develop a cooperative relationship. The facilitator duty in the phase of this work is to explore the stressors that occurs on the client appropriately. Facilitator also needs to encourage the development of client self-awareness and the use of constructive coping mechanisms. The entire communication techniques used in the orientation phase as mentioned in the previous section, is also used in the working phase. Within the framework of therapeutic communication, the facilitators that had been developed previously implemented in the practice of facilitator that took place on 25 and 26 November 2011. The location of implementation of interventions was tailored to the technique, where the support life therapy an the life review therapy held in groups and took place in one of the elderly house, while the counseling conducted at each elderly house. Alpha a. Trust building Intervention activities aimed at helping the elderly, especially in dealing with psychosocial problems. In the application, this method started by building trust between the facilitator and the elderly, containing of 10 people, by making game; "head, shoulders, nose" and sang along. Through the game ice breaking occurs between the facilitator and the elderly. b. Life review therapy The implementation of life review therapy is to evoke the spirit of life and confidence of the elderly by telling their life experiences before their peers and facilitators. In this activity the facilitator used part of the life review therapy that is reminscence technique, thus the elderly can look back on pleasant post experiences. Before the application of reminscence techniques, the session begins with a mild game of activities, namely, the elderly were asked to stand at where they were, and facing the right direction. Then they raised both hands, and put both hands on one’s shoulders in front of them, and each at them was asked to massage them. After a while they were asked to return ground and took turns massaging. All participants were simultaneously enthusiastic taking part in the game laughter in the fun. Then the facilitator asked participants to look back on his life experiences, especially the things that made their live fun and they now perceived their lives meaningful. The facilitator asked each participant in turn to tell a good life experience. In Plosokerep shelter, the first opportunity to appear was "Mbah Putri" (wife of the late Mbah Maridjan) to tell the most memorable experiences of her life, followed later by other participants. In this technique at least the elderly could increase their self confidence when they were brave enough to perform to tell experiences their lives. Alpha c. Support therapy The next activity, the facilitator implemented the use of technical support in a group therapy. Through this technique, the elderly who experienced psychosocial problems received support from other elderly in solving the problem. This was possible because the clients and the fellow elderly already had known each other. d. Counseling Individual counseling services performed by each of the facilitator to the elderly at home where he lived. Counseling was done mainly to help the elderly improve their ability to face unpleasant conditions during their stay at the the refugee shelter. 4. Termination phase Termination phase is a phase of mental preparation to make conclusions about the planning assistance activities that have been done and maintain the relation limits specified. The facilitators review back on the implementation of assistance and the results achieved, such as to know the physical, psychological, and social impacts of elderly clients who become assistance partners, and the implementation assistance in the implementation of therapeutic communication. One fact that the implementation of the assistance was limited by the time that only lasted 4 days, certainly did not achieve maximum results in helping the elderly cope with their psychosocial problems during their stay in the shelter camps. But at least through therapeutic communication made ​​by the facilitator, elderly clients can express their feelings. Discussion The application of methods and techniques in the practice of caring for the elderly is needed, but with the absence of therapeutic communication between the client's and the facilitator, the expected change of the clients will not possibly happen. Therapeutic relationship between clients and facilitators is cooperative relationship that is characterized by the exchange of behaviors, feelings, thoughts and experiences in fostering therapeutic intimate relationship. Elderly client therapeutic relationship and the facilitator started with facilitator empathy attitude about the real conditions faced by the elderly. In this case the facilitators concerned, open mind and heart, being neutral, did not get carried away, did not judge, got into the world of the elderly experience during their stay in the shelter camps. Positive regard is the first step to do for the facilitator, such as the belief that elderly clients are valuable persons and treat them with respect, regardless their appearance, behavior, and the circumstances of their lives. Further personal warmth shown by the facilitators as a friendly personal in communication with the elderly, and the nature of the genuineness of the facilitators by showing the authenticity of which arose spontaneously (not artificial) when communicating with the elderly. These four basic conditions in therapeutic communication were still maintained by the facilitators when applying some intervention techniques that essentially helps the elderly in living more meaningful lives during their stay in the shelter camps. They acquired new knowledge about themselves, their motives, feelings, reactions and attitudes. They would get more extensive knowledge about their behavior and its impact on others, they would learn more about the significant others in their lives. Through the process of therapeutic communication between the facilitators and the elderly, at least the client "Wi" was able to express feelings of distress, she obtained a room for mental catharsis and could converse with the facilitator as newly person she know. The fact that during the time assistance "Wi" still could not accept the fact that all three of her grandchildren died as victims of the eruption of Mount Merapi, and did not want to visit the tomb of her grandchildren, this would require considerable time. Religion became an alternative approach for clients 'Wi' to accept of the destiny from God. This is similar to he client "Bu" who still felt the sadness of losing one grandchild and daughter who were the victims of Merapi eruption, but at the implementation of facilitator, clients "Bu" laughed cheerfully when she was involved in the dynamics group by, and of course the conversation that occured between the client "Bu" and the facilitator is another form of positive behavior evident of "Bu". Meanwhile, the client "AS." and "WW" who relatively did not have psychological problems, through the process they gained new experiences, especially in training of memory and thinking power which in fact was slowed, but they also got the excitement and could express their feelings to others. ________Alpha Bibliography sources: Adi Fahrudin. (2000). Gerontologi dan perkhidmatan sosial kepada warga tua. Laporan Penyelidikan. Kota Kinabalu: Universiti Malaysia Sabah. Berger, L.Peter & Luckmann, Thomas.1966. The Social Construction of Reality. A Treatise in the Sociology of Knowledge. 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Illionis : Mc Graw-Hill Companies, Inc Hargie, D.W. Owen.1997. The Handbook of Communication Skills. Second edition. New York : Routledge Littlejohn, Stephen W.1996. Theories of Human Communication. Edisi ke-5. Belmont, California : Wadsworth Satriawan. 2003. Profesionalitas Pekerja Sosial dalam Tinjauan Komunikasi Kemanusiaan (Karya tulis di lingkungan intern Perpustakaan BBPPKS Bandung ________ *) Tukino, was born in Ciamis, December 13, 1959. graduated in Padjadjaran University (Unpad)-Department of Social Welfare, 1985, Master in developmental psychology, Unpad, 2000, doctor in communication science, Unpad, 2008. The author is a lecturer at the Bandung College of Social Welfare (STKS), and is active in the Center for Disaster and Refugee Studies (Puskasi), and the Center for the Elderly studies. Alpha