Coping with Aging in Ourselves and Group Members: Continuing to be Effective Group Therapists With Older Adults Dr. Ken Schwartz CGPA, Sunday Night Teleconference Seminars on Group Therapy
Seminar Objectives 1. Identify techniques and approaches that facilitate symptom relief in group therapy with older adults who are depressed and/or medically ill. 2. Appraise one’s personal feelings with respect to issues of aging and illness and its impact on work with this population. Page 2
Older Adults • A complex population to treat • Trying to cope with medical and mental health issues and other losses • Age range: Baby boomers to centenarians. • Maintain their self-esteem, dignity, hope, usefulness and engagement as opposed to ending up despairing, bitter, hopeless and preoccupied with problems. Page 3
An Old Fable • “A deeply religious man believes sooner or later he will win the lottery to pay off debts…” • Week after week passes…and he prays • Finally, he cries out “Lord, why have you not yet responded? I have such hope and faith.” Then he sees the skies part and hears a booming voice – “Max, meet me half way, buy a ticket.” Page 4
Message • Dealing with and adapting to complex medical and/or mental health issues both requires having hope and the capacity to take some form of action (a risk), thereby increasing the individual’s (and therapist’s) sense of self-efficacy and personal effectiveness. (Leszcz, 2009) Page 5
Why Integrated Group Therapy • In the frail and depressed elderly, loneliness and lack of social integration often present and are profound risk factors in depression. • Group therapy provides opportunities to grieve losses, re-engage with interests and relationships, and to acquire new skills. • Experience of relatedness results from members’ own actions (how they relate and what they say). • Feelings of dependence may be reduced and feelings of personal competence may be increased, which is particularly important in light of the likelihood of future losses. Page 6
Therapeutic Mechanisms 1) Altruism: • Members help one another, simultaneously raising self-esteem for both the receiver and the provider of support Page 7
Therapeutic Mechanisms 2) Installation of Hope: • When realistic, allows patients to see alternatives and solve problems (Nemeth & Whittington, 2012) and is tied to one’s (and therapist’s) sense of self -esteem and effectiveness. • “Groups are wonderful for demonstrating learning and teaching hope is possible when others are adapting with courage and dignity to worsening illness, because they illuminate all stages of (physical or depression) illness”. (Leszcz, 2005) Page 8
Existential Considerations • The elderly’s awareness of the limits imposed by aging, loss, decline focuses attention on existential issues regarding death, meaning in life, and personal responsibility. • Therapy should support exploration of these concerns with a view to facilitating meaningful engagement with life. • The event of death obviously ends life, but the idea of death can vitalize life by focusing attention on both reducing regrets of things undone or unsaid and living life before time runs out. Page 9
Themes 1. Loss and mourning – maintaining continuity of self in light of new life circumstances 2. Dignity – maintaining self-esteem and pride in an often dehumanizing medical health system (“Nobody has the time to talk to me”) 3. Conflictual relationships with adult children (role-reversal, or not receiving enough) – maintaining and/or rebuilding relationships Page 10
• What can groups and/or individual therapy do to help members optimally master what they can and accept what they cannot – managing expectations? Page 11
Three Ways of Coping with Stress A) Emotion-Based Coping • Much coping is directed toward managing feelings of anxiety, fear and dread and toward restoration of self-esteem and interpersonal relationships and acceptance of situations. 1. Social support of group promotes direct engagement with challenge of illness and its treatment. Page 12
Three Ways of Coping with Stress (continued) 2. Encourage individuals to speak the unspeakable, rather than engage in maladaptive denial (elephant in the room). • Mature groups provide a hopeful and more sharing environment where culture is: “I help you and in so doing you benefit and I benefit as well because my own self of effectiveness is bolstered by my being a benefit to you. • But keep in mind, feelings need to be effectively processed and worked through. (“We all have feelings…It’s how we handle feelings.) • Otherwise , it could be made worse by the experiences of others. “Coming here makes me feel worse as worry all week about others”. Unfortunately, looking outward versus self-reflection (Folkman & Lazarus, 1980) Page 13
B) Problem-Based Coping • (Situations in which the person thinks something constructive can be done, or that are appraised as requiring more information favor problem-based coping) • Awareness of personal health and change of lifestyle leads to focus on practicalities. • Address what needs to be addressing • Don’t minimize importance of reducing stress through education, learning how to speak to health care workers, relaxation, exercise. • “Doctor – one more question, it’s a few minutes of your time but for me it’s not waiting and worrying for an entire month.” Page 14
C) Meaning-Based Coping • It’s not just what aging (or illness or life) does; it’s also what older adults do with aging (or illness or life). (Atchley, 1979) • Although unable to control circumstances, one is able to effect one’s attitude (or illness or life) • Illness forces us to confront our limitations and boundaries in life. Page 15
C) Meaning-Based Coping (continued) • Opportunity to make use of existential confrontation with illness and death to reflect and determine what is truly important and make choices accordingly. • Say it or do it now before it is too late. • Use illness as a thrust to realign relationships in ways that were not accomplished before and may have been associated with guilt. • Keep in mind, “you know, you don’t have to wait to say goodbye, you can express your love and appreciation for people right now, everyday .” – so we end up less alone and isolated. • “It’s not just what aging (or illness or life does to us, it’s also what we do with ….” Page 16
Conclusion: What Therapy Can Do! • To help members live life the best and for as long as they can rather than to fear death or to stop living before death occurs (engage vs. escape), by • Trying to help patients “get on with living” and control/self -efficacy in their lives wherever possible, despite illness and decline. Page 17
Reflective Questions for Group Therapists of All Ages and Experience 1. How would you compare your feelings about working with older (or ill) adults to your feelings about working with younger adults? Do such feelings lead you to experience discomfort regarding your own aging or aging of family members (e.g. parents/grandparents)? 2. How do you anticipate that your feelings might change as you age if you continue working with older adults in group, or are you too uncomfortable now to work in the future with individuals who are ill, older, or disabled? (Except primarily to prescribe meds, not psychotherapy) Page 18
Thank you! kschwartz@baycrest.org Page 19
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