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COUNSELING OLDER PATIENTS.
Term Paper ID:29673
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Issues involved in geriatric counseling and therapy.... More...
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Paper Abstract:
Issues involved in geriatric counseling and therapy. Implications of a growing elderly population regarding psychiatric, medical and other types of care. Defines and discusses effects of ageism in the workplace and family unit. Incorrect assumptions of ageism. Therapy issue of countertransference and transference. Special psychiatric problems such as dementia. Assessment and interventions.
Paper Introduction:
Older Adults in Counseling and Therapy
Introduction
Today, life expectancy in the United States is over 75 years – a fact that has created a substantial and growing population of the “elderly” who will require a significant amount of medical, psychiatric, and other types of care over time. Butler, Lewis, and Sunderland (1998) noted that a “demographic revolution” is underway in the United States in which members of the so-called “baby boomer” generation entering the period after age 65 will eventually comprise about 20 percent of the national population. Older individuals, male and female, wealthy and poor, urban and rural, will consume a disproportionate level of care resources in the coming decades.
This “demographic revolution” demands that counselors and therapists de
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Avoiding countertransference is necessary andcan be helpful to the therapist in confronting his or her own concernsregarding the aging process. It is important to recognize that the older individual needs amultidisciplinary assessment in which a number of professionals pool theirknowledge and expertise to construct as complete profile of thepsychiatric, physical, social, financial, and other problems of the olderclient as is possible. Attributions of individual traits, behaviors, needs, orother issues addressed in the context of counseling can distort the processitself. For therapists working with geriatric patients, assessment andevaluation procedures and tools are important elements in the avoidance ofcountertransference. It is all too often assumed that any psychiatricsyndromes that arise in later life are secondary to the problems of agingitself. Ageism begins in childhood,according to Butler, et al (1998), and represents in part an attempt byyounger people to shield themselves from the recognition that they, too,will eventually age and confront the inevitability of death and physicaldecline. 2 8). In transference, as the classlectures and discussions demonstrated, clients often come to regard theircounselor or therapist as an authority figure or another or loved or hatedfigure from the past. Often, clients will transfer their previousattitudes toward significant others in their lives to the therapist. Process becomes more important than content in this therapist/clientrelationship. Warmthand empathy without condescension are essential aspects of the therapist'sbehavior and attitudes. Butler, et al (1998)reported that the American Psychiatric Association estimates that between15 and 25 percent of all individuals over the arbitrary age of 65 sufferfrom symptoms of mental illness. Realistic treatment goals should be set viaconsultation with the client and other caregivers. Older Adults in Counseling and TherapyIntroduction Today, life expectancy in the United States is over 75 years - a factthat has created a substantial and growing population of the "elderly" whowill require a significant amount of medical, psychiatric, and other typesof care over time. Mood disturbances such as depression are of particular significancebecause the depressed individual also experiences sleep disturbance,appetite and weight changes, decreased concentration, feelings of fatigueor loss of energy, psychomotor disturbances, and recurrent thoughts ofdeath (Butler, et al, 1998). Doing so can increase the fear of theolder adult and jeopardize the development of the kind of rapport needed inthe therapeutic relationship. Ageism is a construct that functions to"pigeonhole" people in much the same manner as sexism and racism; inessence, ageism is a way of thinking about the elderly that marginalizesthem, demeans them, and isolates them. A thorough assessment as described above can help atherapist to overcome any preconceptions or stereotypes that he or she maypossess regarding the aged. Geriatric assessment is a multidisciplinaryevaluation in which the multiple problems of older persons are identified,described, and explained. Ageism also assumes, incorrectly, that the process of aging isinvariably associated with a decline in mental and physical competencies.It can and does provide a rationalized excuse for forcing older workers toretire. Ageism also encompasses theassumption, common even among counselors and other caregivers, that olderindividuals have lost much of the capacity for self-management and self-care that characterizes younger individuals. The field of geriatric counseling is anincreasingly important practice focus because of the aging of the Americanpopulation. For the older individual it may very well be that this type of mentalillness (i.e., depression) exacerbates physiological anomalies or healthproblems. This "demographic revolution" demands that counselors and therapistsdevelop effective intervention strategies for assisting older clients incoping with the myriad issues that confront the elderly. Because this is the case, older patients, including those inresidential or institutional facilities who are known to have psychiatricsyndromes tend to be undertreated. Central to the therapeutic relationship, regardless of the age,gender, or ethnicity of the client and therapist, are the processes of bothtransference and countertransference. Love and protectiveness may vie with hate and revenge. Anxiety of an acute or chronic nature, substanceabuse engendered by over-medication, depression, difficulties withactivities of daily life (ADLs), and social isolation are among theseproblems. Dementia is one of the most frequently observed forms of mentalillness in older patients. ReferenceButler, R.N., Lewis, M.I., & Sunderland, T. Mood disorders, including major depressive disorder, bipolardisorder, and dysthymic disorder are also observed in older individuals, asare the various somatoform and personality disorders. This brief essaywill address some of the key issues related to this process, includingageism itself, counter transference and transference issues in counseling,psychiatric problems including dementia, assessment techniques, and "bestpractice" interventions.Ageism Ageism is a general term that encapsulates the prejudices andstereotypes that are applied to older people purely on the basis of theirage (Butler, et al, 1998). When therapists working with elderlyclients allow negative attitudes to intervene, therapy cannot besuccessful. Assisting the olderperson who has lost a loved one, for example, may involve addressing issuesof guilt and atonement as well as the client's personal fears regardingillness or death. Such assessments fulfill preventive and screeningfunctions as well as diagnostic functions. In the workplace and in the family unit, olderindividuals (i.e., those over age 65, which is an admittedly arbitrarycutoff for defining the "elderly") are often dismissed as unable to makeadequate contributions to the group. This may occurin the older person as a consequence of multiple losses within a close timeperiod or as a reaction to certain extreme stresses. What is essential in designing any intervention for the olderclient, as was discussed in class, is pinpointing what is threatening theclient and what they are reacting to. Medical as well as psychiatric assessment andthe taking of a complete case history combine to assist the therapist indeveloping an effective intervention plan.Interventions Interventions designed to meet the needs of older clients can rangefrom pharmaceutical treatment to psychotherapy and environmental therapy,other somatic therapies, cognitive and behavioral therapies, reality-orientation, remotivation, and rehabilitation programs, to assistance withADLs. Psychiatric Problems, Dementia Older individuals may present for treatment with any one of a numberof psychiatric problems. (1998). Butler, et al (1998) pointed out that some agedclients may stimulate therapists' fears about his or her own old age,arouse the therapist's conflicts about relationships with parental figures,or suggest to the therapist that intervention is wasted effort because theolder client may be nearing death. The older individual is as worthy of intervention as anyother client.Assessments Older clients should be as thoroughly assessed or evaluated as anyother particular population. It is far more likely that older individualsexperience psychiatric problems as a consequence of legitimate fear ofbeing alone, a sense of social isolation, a feeling of worthlessness, andany number of other anxiety-producing sociocultural or familial situations. The goal of intervention, whatever form itmight take, is to contain any paranoid, anxious, or other self-damagingreaction that the older client has to his or her problems. Of those older people with mentaldisorders, depression appears to be the most common primary diagnosis. Moving from a thorough assessment of the client's needto a multidisciplinary set of interventions offered in an empathetic andcaring manner is essential. Process may be defined as dealing with or addressing theunderlying verbal or nonverbal feelings expressed by the client. Transference allows thetherapist to identify a pattern of the unconscious problems that the clientis experiencing and can therefore be valuable in facilitating thetherapeutic process. Aging and Mental Health: Positive Psychosocial and Biomedical Approaches. What emerges from this discussion is the recognition that the olderindividual is entitled to caring, supportive, and non-prejudicial servicefrom a counselor. Boston: Allyn and Bacon. The effects of ageism are numerous and potentially debilitating.Ageism can constitute the societal sacrifice of older people for the sakeof younger people. Dementia and the various psychoses, according to discussions inclass and lectures, represent a break in the ability to manage theactivities of daily living and a lack of reality testing. In any event, interventions that are successful witholder clients are those that are framed to meet specific needs and resultin positive improvements in mood, affect, outlook, and functioning.Conclusion This brief essay has presented some of the issues involved incounseling older patients. Ageism takes this a step further. The counselor should be careful not to argue with the client orattempt to impose his or her version of what is or is not the truth aboutthe problem as the client sees it. Mental health personnel not only have to deal with leftover feelings from their perceptions of older persons, but they must also be aware of negative cultural attitudes toward older persons (p. Dismissing theseproblems as an artifact of the aging process or declining health status isinappropriate. It is fallacious to assume that the physical health problems thatemerge as individuals age invariably give rise to psychiatric disorders(Butler, et al, 1998). Older adults may experience all of the neuroses and psychosesthat are found in younger patients, including schizophrenia and paranoiddisorders manifested by delusions, hallucinations, disorganized speech,grossly disorganized or catatonic behavior, or negative symptoms (Butler,et al, 1998). Countertransference may be more difficult in the context of dealingwith older clients. The older client may display an overwhelming desire to please theanalyst, or may also display resentment and hatred even though the analysthas done nothing to provoke such emotions. While it is certainly true that there are oftenorganic explanations for psychoses suffered by older individuals, it isalso true that the vast majority of older individuals suffering frompsychiatric syndromes do not have mental problems as a result ofphysiological conditions. The resources and strengths of the individualare identified, service needs assessed, and a coordinated care plandeveloped in order to focus interventions (Butler, et al, 1998). In the United States, federal legislation has been enacted toprevent age discrimination in the workplace, but many older workers stillfind that they are devalued and passed over for promotions or otherbenefits simply because of negative assumptions regarding their age and itsputative impact upon performance (Butler, et al, 1998) In the context of counseling and therapy, ageism can negativelyimpact upon the capacity of professional caregivers to work effectivelywith clients. Butler, Lewis, and Sunderland (1998) noted that a"demographic revolution" is underway in the United States in which membersof the so-called "baby boomer" generation entering the period after age 65will eventually comprise about 2 percent of the national population.Older individuals, male and female, wealthy and poor, urban and rural, willconsume a disproportionate level of care resources in the coming decades. For mental health caregivers, serving the older clientnecessitates coming to terms with one's own fears and anxieties regardingthe aging process (Butler, et al, 1998).Countertransference and Transference In providing services to the older client, a counselor must be awareof the issues associated with both transference and countertransference.Countertransference is described by Butler, et al (1998) as follows: Countertransference in the classic sense occurs when mental Health personnel find themselves perceiving and reacting to older persons in ways that are inappropriate and reminiscent of previous patterns of relating to parents, siblings, and other key childhood figures. In other words, therapists must avoid negative countertransferencebased on ageism as well as an unconscious overidentification with olderpeople. In other words, the therapist or counselor working with the olderindividual must recognize that these individuals will manifest many of thesame presenting problems exhibited by younger clients. It is likely that members of the caregiving professions willdevote even more time to research on the best practices for treating thispopulation effectively. Certainly, the therapist working with older patients mustrecognize that simply being elderly does not mean that an individual'scapacity for enjoying life, making a meaningful contribution to family andsociety, or participating competently in problem resolution cannot occur. A related goalis addressing the underlying problem and ensuring that interventionsdesigned to ameliorate or eliminate that problem are forthcoming.
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