Turning the Puzzle Pieces to a Personal Challenge

Turning the Puzzle Pieces to a Personal Challenge post page

Online Dementia Journal

By Online Dementia JournalJuly 17th, 2018

Turning the Puzzle Pieces to a Personal Challenge

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by Deb LeBlanc,

PAC Mentor and Consultant


The role of a PAC Consultant is to help care partners and PLwD (People Living with Dementia) to be good detectives about situations. As a PAC Consultant, I typically use Teepa’s 6 Pieces of the Puzzle tool when I work with care partners and people living with dementia as we consider challenging situations. The puzzle pieces help us to gather information in organized, manageable pieces, and to ensure that we can consider the whole picture. I find it is a scaffold that helps keep me, as a consultant, in a Sapphire GEMS state.

Recently, I have been dealing with my own challenging situation. Knowing how powerful the pieces of the puzzle can be, I decided to use them to turn the detective work inward. The following is my journey through each of the six pieces of the puzzle. I hope that this helps illustrate the power available in a tool like this for challenging situations.

Teepa’s Six Pieces of the Puzzle

The Three Intrinsic Factors:

1.  The Person

We always start with the person and not a diagnosis or problem. This is a tough place to start when you are considering yourself. How often do we sit and consider our life stories, our personality traits, and our core values? When I consider my current situation, there are a few things that have stood out for me. I highly value being able to juggle multiple roles (wife, mom, worker, etc.) with a high level of competence. I have difficulty asking for assistance and I have a core belief that asking for help is a sign of weakness. I should be able to do everything. I am very good at minimizing any difficulties I may be having and soldiering on with a stiff upper lip based on the values of my upbringing. I am also a natural caregiver who believes that I am “okay” as long as everyone else’s needs are looked after. Being a strong introvert lets me know I need to have a huge sense of control and I also need to recharge away from people in a quiet place.

2.  Wellness, Health & Fitness

Stress: This is a big consideration for me. Not just stress but my coping mechanisms. Have I been meditating regularly? Have I been playing music and singing? Have I been getting outside for walks? Have I been connecting with close friends? How is my sleep? Am I eating well most of the time (or is my diet mostly chocolate and coffee)? Am I taking my medications? Am I taking breaks from working and maintaining a balance?

I am lucky that I am physically quite healthy, but I also have warning signs when I am not looking after my wellness. They include headaches, sleep difficulties, and frequent colds/illnesses.

I am a person who has lived for the past 25 years with a diagnosis of major depressive disorder and generalized anxiety disorder that is generally well managed. My current challenge is that I am experiencing a relapse of my symptoms that has severely impacted my level of function. My treatment team has determined that a medication change is required in my treatment. This is an added challenge because a medication change is a difficult and stressful process that often includes unpleasant side effects.

3.  Brain Change

I am most fortunate that I am not dealing, currently, with a diagnosis of dementia. So, how does brain change fit into my situation? This is where I consider the GEMS states. Everyone has a brain and within each of us, we fluctuate between different GEMS states depending on many different factors.

Right now, as I am struggling with this relapse, I find myself mostly in a Diamond state. I prefer familiar environments and actively avoid new situations and activities. I struggle greatly with last minute changes to plans. I find my short-term memory significantly decreased and it is hard to integrate new information. My family also reminds me that I often repeat myself. The worst part of this for me is that I cannot make decisions, no matter how small. (I have actually skipped lunch rather than try to decide what to eat).

I can have Sapphire moments. I find they currently require a great deal of effort and concentration. This leaves me exhausted if I do not give myself the care and time to recover.

I also have many Emerald moments. These tend to fall into two categories. One is around language. There are times when I struggle with my vocabulary and finding words. I also shut down when there is a lot of conversation or discussions are about deeper topics such as family finances and dreaded taxes. The other example of emerald state for me is difficulty with basic activities of daily living. On really difficult days, I need cuing and help with motivation to get in the shower or to get out of my pajamas. Some days I cannot even get out of bed.

The Three Extrinsic Factors

4.  People, Stakeholders, Us

This piece is about the team. I am extremely fortunate. My primary support is my husband and my family. I also have a fantastic informal support group of great friends and co-workers. I am learning to reach out and ask for assistance more frequently. I find this hard, but my team wants to help and support me, they just need me to tell them what would be helpful (even if it is to send me a bunch of funny Facebook posts). I have friends and family who I can call any time, day or night.

I am also blessed to have a fantastic medical and treatment team. I have 100% trust in my primary medical care partner and I know that I can call her anytime during the day. I also have community resources and emergency resources that are available 24/7.

In the past, I tried to cope on my own and it was a disaster. It has taken years to build this support system, but they have literally saved my life.

5.  Environment

What environment works best for me at this moment? I typically find that a quiet and calm environment is best. Crowded and loud situations are often the biggest triggers for an anxiety attack for me. Can I avoid these environments all the time? The answer is no. We recently had a big family holiday weekend. I had multiple large family gatherings. This required planning. How could I build in quiet time? (Noise cancelling earphones are the best). I was also able to let everyone know that there may be times when I would disappear to a quieter room by myself, to recharge.

6.  Time Use

Although last, this is often the most predictive puzzle piece for my difficult situations. We have four major areas where we spend our time. Productivity gives life meaning and value (for me this centers around work but also includes being the CEO of my family). Leisure is joyful, fun, preferred activities. Wellness & Self-care are activities to take care of the body, the brain and personal needs. Restorative activities are time to recharge such as sleep and quiet time to care for the mind and spirit.

For me, this puzzle piece is all about balance. When the balance is gone, I stop functioning. Am I working too much? Have I practiced my music? Have I been exercising? Have I been meditating? I can guarantee that the beginning of every relapse of symptoms I’ve ever experienced has started when I have been unaware (or simply ignored) a prolonged imbalance in my time use.

As I look at the six pieces of the puzzle for my current situation, I realize that the three extrinsic pieces are much easier to change. Although, any changes need to be based on the information in the three intrinsic pieces. I determined that there were a few options to help me recover faster but that I could not successfully address all six pieces at once. My first focus has been reaching out for help to regain some balance in my life. I have refocused on regaining my health through improved self-care so that I can successfully return to the important activities in my life.

This was an unusual situation where I acted as both the person with a challenge and, also, as my own PAC Consultant. It was an experience for me to see this PAC tool from both sides. However, it is the exact process I would use as a PAC consultant to help someone else with a challenging situation. We would work through the puzzle pieces with a goal of finding some courses of action that could be possible first steps and choosing a first step to try towards a solution.

If you have a challenging situation and are interested in exploring it using Teepa’s six Pieces of the Puzzle, I urge you to reach out to a PAC Consultant. You can also find additional information regarding the puzzle pieces and other excellent tools in the resource Creative Solutions to Challenging Situations DVD and Workbook Combo.

View Deb’s bio here.


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