Our elder population is growing and is grossly underserved in the arena of mental health.
The APA website and office on aging do a good job of explaining the lopsided demographics of need versus trained practitioners and needs of the population but they don’t convey the experience of working with seniors.
Working as a clinical supervisor training graduate students to work with medical patients in healthcare settings, I spend time discussing my experience with seniors with my students to find that they are not being educated about gerontology as a specialty and cannot name one course offering on the subject offered at their school.
A simple web search illustrates the paucity of programs dedicated to geropsychology. How then do we draw more practitioners into this specialty?
I believe that in order to draw more psychology students and newly licensed psychologists into the field of geropsychology, it is helpful to share my experience in working with seniors for 10+ years. I have done so with my supervision students in informal ways over the years with positive results.
I am pleased to report that some of them have so enjoyed my clinical tales that they have gone on to gerontology training settings. In the hope of some more positive outcomes, I am going to share with the reader some of the insights that I share with my students.
Seniors seek or are referred for mental health treatment for a variety of reasons including depression, anxiety, grief and disability. Often, those seeking therapy are isolated, widowed, struggling with caregiving burdens or feel disconnected from their community after retirement.
This population is characterized by rich, complex personal histories of coping, family life and personal struggles in addition to the challenges of facing personal and familial morbidity and mortality. And, they come into therapy ready to engage in “life review” work or reminiscence therapy which is an extremely meaningful process.
Seniors face the challenges of permanent life changes that threaten their autonomy. In my experience, one of the most prominent concerns is the loss of function and independence. Surrendering one’s driver’s license and moving an elder out of his or her home into an assisted living facility are probably the most emotionally charged losses for seniors.
Other common themes are cognitive and sensory decline, death and dying, and grief about ill and deceased loved ones, including pets. These patients often have outlived their peers and feel disconnected and alone. And they are at various stages of aging and retirement.
My role is typically characterized by offering reality testing, socialization and support to seniors who often feel disenfranchised. Frequently they tell me that I am the only or one of the few people in their lives who sits and listens to their struggles, offers empathy, unconditional acceptance and steps toward resolution.
Often they describe their families as resentful, impatient, intolerant or just too busy to listen, attend to their needs or include them socially.
The interventions that we use with other populations are applicable to seniors. I apply an array of evidence-based strategies such as journaling, CBT, humor therapy, mindfulness, ACT and supportive psychotherapy, adapting them to meet the needs of seniors.
For example, we may spend more time on review of life events and memories than with younger people. And we may slow down the process of teaching them a new coping skill.
Seniors today are a product of a 20th century worldview. We engage in much verbal unravellng of experience and personal stories from last century and also discuss ways to adapt to the 21st century.
They are digital “newbies” which is a bonus in my eyes as they understand the value of interpersonal connection and tend to benefit greatly from our work together. Their generation understands personal responsibility and commitment; they show up for therapy, are goal-directed, do the work and usually enjoy the process.
However, elders vary in their technological skill level. I spend many sessions offering tutorials in smart phone or PC utilization in order to foster more independence.
I especially enjoy sharing the most recent advances in neuroscience with seniors. We have evidence that the brain is neuroplastic across the lifespan. The influx of new information about our brains offer tremendous hope for easing the aging process and offering more fluid, flexible interventions for optimizing the aging brain. And it’s really fun information to share!
I have developed a modest session goal over the years, which usually is well-received. I aim to offer my patients one suggestion or piece of information to take away and mull over until the next session. It focuses us on the experiential and relational elements in therapy.
In this vein, I make it a point to capitalize on their strengths and emphasize a mindful, accepting approach. I enjoy humor and share laughter with seniors in session if they are amenable to it, typically a solid mood booster!
I learned how to work with seniors on the job, sitting with my patients, attending geropsychology seminars, reading the literature and consulting with colleagues. There is a great deal of information about gerontology that I’ll reserve for future blog notes.
My aim was to touch on some key experiential themes that resonate with me as a clinician and hopefully will spark an interest in a reader who is looking for a psychological niche.
I am constantly learning more about this multifaceted, largely unappreciated population group. They tend to be extremely appreciative of our work together and teach me valuable, unexpected lessons every week for which I am eternally grateful.
Wendy Tayer, Ph.D. is a clinical instructor at University of California San Diego’s Department of Psychiatry.