Attention and Focus Redirection

Decreased attentional resources, particularly selective attention, or the ability to tune out distracting or extraneous stimuli, also present a challenge (McDowd & Birren, 1990). In particular, older patients' ability to focus on discussions in therapy, to conduct structured tasks, and to answer directive questions is affected by their ability to concentrate on the task at hand. Deficits in attention and focus look very much like tangential thinking in the therapy context. As an example, one therapist in training asked a patient to elaborate on how his dietary restrictions contributed to his depression. As the patient began to explain the current problem, he became distracted by additional information about his eating habits, and within a period of 10 minutes, had shifted from answering the therapist's question to talking about a blender he had bought in 1960. The patient then paused and asked, "I'm sorry, what was your question?" The therapist had been so distracted by the conversation that he no longer remembered! This not uncommon occurrence in therapy with older adults can be more upsetting to patients than being redirected by the therapist. Therapists need to become comfortable with redirection to keep the focus of the therapy on the material/activity at hand (Dick & Gallagher-Thompson, 1996). When it is apparent that patients have difficulty focusing in therapy, the therapist can first point out the process as it occurs in the session, then let them know that he/she may need to redirect them back to the initial question or task.

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