Wisdom for Working with Elder Therapy Clients

Nicole Urdang MS, NCC and DHM, Licensed Mental Health Counselor in Buffalo NY

Although people are still people, there are notable differences when working with elders. (When I speak of elders, I’m referring to anyone in the third age, the last third of their life. If you think you’ll live until 90, that’s 60-90.)

Five Tips for Working With Elders

Here are some key tips to provide therapy for this population. These attitudes and behaviors are essential for building therapeutic relationships that work well with elders.

1. Remember, anyone can grow

It is important to remember that everyone, at any age is capable of personal growth. More than that, they may secretly crave psychological, emotional, vocational, volunteer, and social change but erroneously think it’s impossible.

2. Respect

Respect for every person who comes to you is already inherent in the way you work; since elders, like children and teens, often don’t get respect from society at large, paying attention to this aspect of your covenant to help and heal is crucial.

3. Listen Actively and Attentively

Elder therapy clients with their extensive life experience make it even more important to listen. It is possible to connect, understand, and trust by responding with empathy and intelligence. Some people feel they can trust someone even in their later years. Don’t underestimate this gift and its potential importance.

4. Cultivate compassion

It is important to cultivate compassion for all people you meet, at work or out. When you care about others, people can feel it. Our unspoken innermost feelings are unconsciously expressed through body language, tone of voice, and energy. Kindness, whether it’s felt through a smile, attentive listening, or from a meta-message conveyed more subtly. These unspoken feelings are often more powerful and memorable that the overt conversations you had.

5. Bring Your Best

These things are important but you must also bring your A game. To put it another way, be prepared to draw upon all you know about how to live a life that brings joy, meaning, self-compassion and connection.

Common Elder Concerns — And How to Approach Them

It might not be just the day to-day issues someone is looking for help with, but also fractured family relationships and patterns of life they are trying to fix. Perhaps, it’s the deepest question of all: Are you living a fulfilled life? And the corollary: Do I think I have made the world a better one?

Even in the worst case scenario, even if someone brings a laundry list of ways they have hurt others or been overly self-serving, there are still ways for them to make an impact. This is paradoxically because it all starts with being kind to oneself.

This might be difficult to sell, as many people, especially older people, associate self-compassion and selfishness with what they really want. It is impossible to be more wrong. By cultivating self-forgiveness, self-acceptance, and an unerring devotion to one’s own mental, physical, and spiritual health, they create a fuller well from which to draw for others.

Older adults have a treasure trove of memories, some not so beautiful and some quite delightful. Perhaps they have grievances about nursing. They might believe that there is no better time than the past. They might be in deep grief from a variety of losses. If any of these show up, it’s helpful to ask: What’s right in your life right now?

It is likely that older people have experienced a lot of loss. Your job is to help them deal with the emotional trauma of all of those experiences. Being able to let them feel their emotions and being there for them can be so liberating. Remember that grief is a mercurial emotion. It can change from feeling deep sadness to rage. It can also manifest as anxiety, feelings worthlessness, self-hate and loneliness, anger, resentment and guilt.

No matter their age, everyone wants to feel heard and valued. This is especially true for older adults who often feel rejected, insignificant, and invalidated. Your caring attention can be a beacon for their journey.

This Era: The Fight Against Natural Aging

Media pressures on older adults

The American society is currently governed by a pervasive trope. It’s the inchoate, yet very real, competition of who can age the best — defined by who can remain the most vibrant, most engaged, most sexual, most appealing, and most useful.

We love to watch shows such as Grace and FrankieAs funny and compelling as these stories may be, they set an almost impossible standard for older women. After all, it is the culmination of our stars’ resources and the retinue of people at their beck and call, all working to create an illusion.

Living in a death-denying culture is a deeper problem. Trying to stay young forever is a fool’s errand. Life would be meaningless without death. Nothing would feel as precious without impermanence. Denying aging by trying to prolong youth for youth’s sake is an outgrowth of a death-denying culture.

As long as therapists don’t challenge the media’s message that older people, especially women, should look, act, and even feel younger, they are part of the problem. They’re perpetuating unrealistic ideals that most folks can’t attain. This message can be transmitted unconsciously by therapists, and it can hinder the desire to help people find their true self.

That said, challenging the values of someone who adheres to a regimen of Botox, dermabrasion, extreme diets, plastic surgery, and so on is just as unhelpful. Working with clients with different values is the best way to work. You should help them grow and change at their pace and for their goals, not at mine and yours. It’s easy for anyone, including therapists, to project our own values onto others. Your job isn’t to make people look like you, but to help them become their true selves.

Knowing how to work wisely with all kinds of people is part of a therapist’s job, and if you come across someone you feel you can’t help, let them know as soon as you do. Sometimes that can be the most difficult work because it requires self-knowledge as well as the ability to endure the sadness and disappointment that comes with disappointing someone.

What are some areas you should explore in your work with an elderly person?

It’s important to assess your older clients holistically. How are they doing with their sleep, nutrition and diet? What about their daily routines and habits? Where do they find satisfaction, peace, and purpose?

Looking back to the past

Do they want to look back on their lives? Would they be interested in sharing their past with you, or keeping a journal? Is this a source to fulfillment and self-actualization or are they regretting something?

Are they angry at themselves or others? Even if they are dead, it can be very beneficial to work on self-forgiveness as well as forgiveness for others.

Life is cumulative. This is especially true in the case of loss and grief. The majority of older people have a stash of grief. It’s helpful to ask an elder therapy client about their history of losses. I often suggest a timeline that shows the time from their earliest loss to the most recent. This doesn’t just apply to loved ones who have died. It could also include: a pet that has died, a friend moving away, loss of an idea of their life, dealing with natural losses like age and inchoate loss, such as the loss or a dream. This timeline can be used to help someone release long-held regrets and sadness.

The Future and the Present

Are there any fears or concerns they have about the future of their family? What can you do to help them overcome their fears and concerns about the future? You can always ask, “What would help?”

Another question that generates lots and lots of therapeutic fodder is: What are you still interested in doing?

When President Obama was winding down his presidency, his advisers asked him: “Mr. President, do you have a bucket list?” He replied: “Well, I have something that rhymes with bucket list.”

Obama may have the same abilities as older people. Your client might not be looking for a bucket-list, but the other. This is no easy feat. The more successful someone is, the harder it can be for them to let go of the constant lure of one more accomplishment. To help someone age well, it is important to let the ego go. The ego loves accomplishment, checking things off a list, and getting approbation, whether from one’s self or others. There are other parts of everyone, especially older people, that want to be less and more. As society values achievement, it can be extremely helpful and beneficial for your client to help navigate this new terrain. You can look at things that have a subtle, cumulative effect on accomplishment and joy. These could include meditation, yoga or qi gong. As they are a bigger achievement in many ways, they also offer a new challenge of going against all the indoctrination of a lifetime.

A Breath of Fresh, Clean Air

Your open, positive, and optimistic energy can have a profound healing effect on elder therapy clients. The way you attentively listen and care is different from any other relationship they may have had in their life, since one‘s relationship with a therapist, if it is a good match, is a unique and amazing experience.

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© Copyright 2021 GoodTherapy.org. All rights reserved. Nicole Urdang MS., NCC. DHM. Licensed Mental Health Counselor in Buffalo. Permission to publish granted

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