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|Case Study - Page 3|
After we reviewed Steve's assessment, I told him we'd spend the remaining sessions improving skills that he already possessed. For him, as for many clients, this was surprising and not necessarily welcome. He believed he didn't have any memory skills left (the bad news), but he hoped that I'd somehow magically supply those skills to him (the good news). I acknowledged that sometimes it's hard not just to recognize your own abilities, but to do the work required to take advantage of them. In short, remembering no longer would be the automatic process it had been for Steve when he was younger, but now would require conscious effort.
I engaged him in exercises to identify and review the strategies he was currently using to remember sermons, especially sermons that involved learning new material. I challenged him, through some structured handouts, to take time during the upcoming week to jot down "the strategies that you use to remember things," and congratulated him for already taking steps to boost his memory capacity. "Steve, give yourself permission to acknowledge that you're already a memory expert; you just never realized it."
He returned to our third session having completed the assignment, and was pleased to discover that he was already employing many memory aids, like using a checklist to remember the materials he needed from home and keeping a notepad on which he wrote down parishioners' names that were more difficult to remember. We discussed external versus internal aids. Sometimes, for example, external aids are the obvious choice—a container or a place where important items, like wallet and car keys, are automatically deposited to avoid misplacing them, or a checklist as a reminder to take items needed on a trip or to work. Steve's strategy of keeping a notepad to write things down—the name of a parishioner he didn't want to forget, the time of an appointment, an important date to remember—is an excellent use of an external aid. External aids require as much skill to use as internal aids, and practice using external aids—like checklists, reminder notes, and regular locations for important objects—is essential to gain proficiency with them.
In the fourth session, we examined a class of memory device called mnemonics, which would help Steve retrieve information on demand without external aids. Mnemonics link personal or familiar information, such as an object or a location in one's home, with an unfamiliar or to-be-remembered item, such as an item needed at the grocery store. Steve was quick to point out that one way he used this method with names and faces was to remember people as a group according to where they lived (this is a mnemonic known as categorization). He'd created strong memories of the parishioners who lived on his own block by associating unique features of their houses with their first and last names. For example, Ray Leveridge lives in the small house on the corner, with the big garage that he must hand open (or RAYz) with the large handle (or LEVER) on the front of the door. Steve noted that when people came to church regularly and sat in the same pews, it gave him cues for remembering their names. I explained to him that this strategy was actually a well-known mnemonic, called "the method of loci." Mnemonics go by many names, including peg-word, number-consonant, and name-face mnemonic. (The full range of mnemonics can be found on my webpage, http:// www.positiveager.com, with detailed information, including videos on how to use them.) Indeed, Steve was discovering that what he thought were his own home-grown strategies were formally described mnemonic techniques, which we could continue to refine for his personal use.
Like my other clients, Steve found that fixed, session-by-session memory-remediation training ended with his surprised discovery that his own repertoire of skills was sufficient to meet his memory demands. The time and practice are taken up not so much by providing arcane and specialized intervention, as by helping clients consciously and diligently apply what they already know to new situations and challenges.
When people complain about "memory loss," they're probably experiencing something cognitively and emotionally more complex than a simple skills deficit. To provide good memory-remediation training requires not just knowledge of assessment and training strategies, but understanding how the brain works, where memory deficits originate, and—perhaps most important—the connections between cognitive and emotional processing. Steve's description of his problem didn't suggest a disease of the brain, but rather that his anxiety and sense of diminished self-efficacy were making his memory deficits worse. A key part of this therapy was helping him to stay calm in the face of memory slips—not to catastrophize to the worst-case scenario—and reassuring him that he was most likely doing his job well, even with some diminished memory. As often happens, the key to memory training with Steve wasn't coming up with startling new ideas and fancy techniques, but helping him recognize, actualize, and refine his existing skills.