Counseling with Older Adults

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Counseling with Older Adults

• Carl Renold, Ph.D.
• CSUF
• Human Services and Gerontology

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Gerontology

• Although aging begins before birth, most people
  studying gerontology are concerned with change in
  middle age and later life. Then, is gerontology
  only about older people and later life?
  Definitely not. Gerontology is about everybody
  and for everybody. Does it deal with dying
  elderly persons? Yes, but it is also concerned
  about family members who deal with dying parents.
  Does it care about how older people maintain
  healthy life? Yes, but it also examines what
  kinds of earlier behaviors and environments
  affect health in later life. Thus, gerontology
  addresses anything that is related to aging and
  older people.
• About the story of life

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Introduction

• Psychotherapy with older adults has been
  performed, studied, and discussed for the past
  eighty years. Generally, both case studies and
  controlled outcome designs have yielded evidence
  of the efficacy of psychotherapy with older
  adults (Knight, Kelly, Gatz, 1992).
• The literature suggests that older adults are
  responsive to a wide variety of therapeutic
  approaches ( see, for example, Zarit Knight,
  1996). More recent evidence suggests that older
  clients, when given appropriate treatments by
  competent clinicians, improve from
  psychotherapeutic treatment at rates comparable
  to younger adults (Scogin McElreath, 1994).

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Early Gerontology

• The loss-deficit model of aging, which portrays
  the normative course of later life as a series of
  losses and the typical response as depression,
  was an outgrowth of the selected experience of
  practitioners, who generally work with older
  adults who are ill, depressed, or experiencing
  social problems.

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Positive Aging

• Conversely, researchers examining the more
  positive aspects of aging began to adopt
  conceptual and methodological advances from
  lifespan psychology. Lifespan developmental
  psychology is based on sequential designs that
  combine aspects of cross-sectional and
  longitudinal methods to make it possible to
  separate developmental aging effects from

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Lifespan developmental

• cohort differences, which are the ways that
  successive generational groups differ from one
  another, and from time effects, which can be
  related to social influences that affect everyone
  at about the same time or which can be specific
  to changes in the research study itself.

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Maturational Changes with Aging

• Slowing. There are several important cognitive
  changes that occur with aging, one of which is
  cognitive slowing. The slowing that occurs in all
  cognitive tasks where speed of response is a
  factor is considered the most pervasive cognitive
  change in developmental aging ( Salthouse, 1985).
  While reaction time has been sped up in older
  adults through practice, exercise, and other
  interventions, age differences are seldom
  completely eliminated. Salthouse (1985) argued
  that the probable locus of slowing is in the
  central nervous system. With aging, the speed
  with which a signal is conducted through the
  nervous system is slowed. Conduction velocity
  decreases by as much as 30 over the life span,
  with reports of 10-40 decreases on average

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Changes (continued)

• A second cognitive change associated with aging
  occurs in the realm of intelligence. For the
  purposes of this model, it is useful to break up
  intelligence into a two-factor distinction
  proposed by Cattell and elaborated by Horn (see
  Labouvie-Vief, 1985, for a review).

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Fluid Intelligence

• Fluid intelligence, usually measured within the
  field of aging by tasks that involve a speeded or
  timed component, shows clear evidence of change
  with developmental aging . Inferential reasoning,
  (as assessed by questions that ask what comes
  next in a series), is a part of fluid
  intelligence in this sense.

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Crystallized Intelligence

• Crystallized Intelligence, measured by tests
  assessing general fund of information and
  vocabulary, shows little change as a result of
  the aging process until age 70 or later (Schaie,
  1996).

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• Declines in average levels of mental abilities
  after age 70 are observed, but are not universal
  nor global and are difficult to untangle from the
  changes which could be due to early stages of
  dementing illnesses and other illness-related
  declines (Schaie, 1996).

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Mind as Computer

• Rybash, Hoyer Roodin (1986) advanced some
  intriguing notions about the course of cognitive
  development across the adult lifespan. Drawing on
  the information processing "mind as computer"
  metaphor, they argue that increased experience
  can be seen as operating like an "expert system"
  program. With accumulation of experience, older
  adults have a considerable store of knowledge
  about how things are and how things work,
  especially in their individual area of expertise,
  informed by work experience, family experiences,
  and other interpersonal relationships.

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Memory

• Memory is perhaps the most difficult topic in
  the study of cognitive changes in late life. What
  is known about memory now would suggest that
  differences between current younger and older
  adults in memory performance are not large when
  material is meaningful and relevant to the older
  adult and the older adult is motivated to learn
  (Botwinick, 1983 Craik Trehub, 1982 Hultsch
  Dixon, 1990).

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Personality

• The last fifteen years have seen valuable
  research conducted on personality development in
  adulthood and later life. The work of Costa,
  McCrae, and associates in the Baltimore
  Longitudinal Study on Aging (McCrae Costa,
  1984 Costa McCrae, 1988) using self report
  measures of personality and a nomothetic model of
  personality measurement has supported stability
  of personality across the adult lifespan in the
  "Big Five" personality factors
  introversion/extroversion, neuroticism, openness
  to experience, dependability and agreeableness.

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Personality

• These results are strong evidence supporting the
  concept that these personality dimensions are
  stable across years and even decades and that
  these personality factors stay roughly the same
  through much of adulthood and into the early part
  of old age.

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Emotional Development

• Emotional changes over the adult lifespan are a
  topic of considerable importance for
  psychotherapists working with older adults. At
  the psychobiological level, Woodruff (1985) has
  concluded that older adults are more difficult to
  arouse but also have more difficulty returning to
  a state of calm once aroused.
• Recent research has also led to new ways of
  thinking about the importance of emotional
  experience to older adults. Whereas previously
  older adults were thought to become emotionally
  disengaged, Carstensen (1992) has found that
  adults increasingly focus on emotionally close
  relationships as they get older, while casual
  relationships become less important.

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Cohort Differences

• Much of social gerontology could be summarized as
  the discovery that many of the differences
  between the old and the young that society has
  attributed to the aging process are due, in fact,
  to cohort effects. Cohort differences are
  explained by membership in a birth-year- defined
  group that is socialized into certain abilities,
  beliefs, attitudes, and personality dimensions
  that will stay stable as it ages and that
  distinguishes that cohort from others born
  earlier and later. For example, later born
  cohorts in twentieth century America have more
  years of formal schooling than earlier born
  groups.

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Context of Older Adults

• Another source of potential adaptation in
  psychotherapy with older adults is the need to
  understand the distinctive social milieu of older
  adults in the U.S. in the late 20th century. This
  context includes specific environments (age
  segregated housing, age segregated social and
  recreational centers, the aging services network,
  age segregated long-term care, and so on) as well
  as specific rules for older adults (Medicare
  regulations, Older Americans' Act regulations,
  conservatorship law and so forth).

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Disability

• Working with older adults often means working
  with individuals who are chronically and/or
  physically disabled and who are fighting to
  adjust to these problems. Thus, the
  psychotherapist working with older adults will
  often learn a great deal about chronic illnesses
  and their psychological impact, pain and pain
  management, adherence to medical treatment,
  rehabilitation strategies, and assessing
  behavioral signs of medical reactions.

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Diversity

• In the United States, diversity issue is much
  more complex than in other societies where single
  race or ethnicity is the majority of the
  population different from in some formerly
  communist countries in which stratification of
  social class is not as complex as in United
  States and different from countries where gender
  role is much more conservative and traditional.

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Grieving

• Another specific challenge to older adults
  involves working through grief. While loved ones
  die throughout our lives, the experience is more
  common in later life. Older adults seeking help
  for depression frequently have experienced
  several deaths of loved ones in the preceding
  months or years. Grief may be a principal focus
  of therapy when there are multiple losses within
  a short period of time, when there is unresolved
  grief from losses that occurred earlier in life,
  or when the relationship with the deceased was
  problematic for some reason.