How a Gerontologist Therapist Can Help
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Gerontologists Are Experts in the Field of Aging
While all psychotherapists receive education and training in counseling psychology, gerontologist-therapists have extensive additional training, education and experience with the myriad of complex issues encountered by people and families in midlife and older years. Some of these issues include:
- Constantly changing physical health situations and their impact on mental health
- The compounded side effects of multiple prescription medications; when to refer to MD’s
- Challenges in advocating effectively for attentive care and follow-up from MD’s and aides
- Changing living environments, such as downsizing living spaces, exploring housing alternatives, moving closer to adult children, bringing in caregivers to your home
- Increased necessity and emphasis on safety and fall prevention
- Adjustment to decreasing independence
- Transitioning to a deeper inner life, rethinking identity, purpose and meaning
- Exploration of the existential questions of life
- Life review and reminiscence, finding new meaning and purpose
- Adjustment to the increased time necessary for self care maintenance
- Transitioning roles and identities within families and our society
- Ageism – how to effectively understand it and advocate for yourself and others
- Building an effective and competent support circle
- Learning and practicing effective communication skills
Gerontologists stay current with latest developments linking physical and mental health challenges in older age, safety techniques and resources, societal influences and resources, advocacy news and the best local senior services and care providers. In order to effectively advocate for, educate on behalf of and serve older clients as a psychotherapist, simply knowing the basics of psychology is not enough.
ANSWER: As we grow older, our losses accumulate, so education about the effects of cumulative loss, grief and mourning are common themes that are explored and supported.
Depression and anxiety are referred to as the “common colds” of mental health and aging. Often people have tried to “white knuckle” it alone through these conditions until they decide to turn to a mental health professional. Then cognitive-behavioral therapy, including mindfulness meditation and relaxation techniques, are introduced and practiced in order to decrease conditions such as anxiety, stress and loneliness. A trusting relationship with a nonjudgmental, compassionate and competent gero-psychotherapist can result in a safe and warm environment in which each client can feel safe enough to be vulnerable, explore concerns and find her own answers.
More specifics common in older years are coping with chronic pain and illness, working through changing relationship roles within families and in society, managing long term care financial planning, adjusting to retirement and other lifestyle changes, learning new communication skills, repairing relationships with adult children and siblings, reviewing one’s life and legacy, rethinking our identities in older years, and more.
Older life offers rich opportunities for deeper self-knowledge, expanded creativity, renewed spirituality, a greater appreciation of life’s beauty and Mystery, and moments of transcendence. Working with a seasoned and kind gerontologist-therapist can result in people tuning more consciously into these potential blessings. Clients are encouraged to recall and share life stories, finding meaning and healing along the way. In this process of remembering and expressing verbally, clients review and gain new appreciation for their many life-honed personal strengths and resiliency. As renowned psychologist Joan Erikson put it, they get in touch with their “indomitable core”.
See: “How Therapy Can Help in the Golden Years” – an illuminating article from the New York Times.
Q: How does psychotherapy work?
ANSWER: “How Does Psychotherapy Work?” is a helpful summary written by Dr Scott Sullender, licensed psychologist and Associate Professor of Pastoral Counseling at the San Francisco Theological Center. How Does Psychotherapy Work?
You can click on the link above to read the whole article and/or read the first few paragraphs below:
“It is hard for some people, particularly those who tend to be pragmatic, hard headed and no nonsense folks, to understand how psychotherapy works. The fact is—it does work! Let’s reflect for a moment on how and why it works, so that your expectations for therapy are clear and reasonable.
Psychotherapy works because a therapist provides us with a safe place. First, you are safe physically, safe from danger, abuse and/or manipulation. The professional parameters that surround the profession of psychotherapy are important ingredients in helping the process work.
Secondly, you are safe psychologically and emotionally. You need not fear being judged, evaluated, discounted or ridiculed. We live in a very competitive, judgmental culture (and sometimes come from families that have similar characteristics), where we are constantly evaluated based on our wealth, appearance or accomplishments. Therapy works because we have a safe place in our week to let down and be who we really are.
Psychotherapy works because in this safe place we are able to be deeply honest. You can say things that you normally would not reveal about your deepest feelings, thoughts, fears, hopes, hurts and dreams. If there is anything that you have not talked about openly, that you have kept hidden from others, perhaps even from yourself, this is your time and place to share. Talking about painful, embarrassing or frightening material is not easy, but generally the talking process helps us out of our anguish by both venting and gaining alternative perspectives on our hurt.
Psychotherapy works because we are regular and faithful in our attendance in therapy. Some people are inclined to quit therapy when it gets hard, or seems unproductive or when they do not achieve results soon enough. Give it some time. As the regularity of therapy starts to become a pattern in your week or month, you will start to plan your next sessions. You will look forward to those sessions, because you have been working on things in between sessions. Indeed, some people believe that the most important work in therapy is done in between therapy sessions.”
ANSWER: Therapy sessions are typically 50 minutes long. Sometimes clients request longer sessions depending on what they are experiencing at any given time. Family therapy sessions can be scheduled for longer time periods, too, due to increased complexity and number of people involved.
Weekly appointments provide the best opportunity for effective progress towards relief from the most immediate concerns. Once things have stabilized, for some people that’s enough. Other people choose to proceed with deeper psychological exploration and ongoing supportive psychotherapy.
Q: Can I trust my therapist with what I say?
ANSWER: Confidentiality and trust are the cornerstones of successful therapy. A therapist is bound by law not to break client-therapist confidentiality. The exceptions are if the client is determined to be a serious threat to himself/herself or others; if the therapist has reasonable suspicion that the client is a victim of any kind of elder abuse; or if the client gives the therapist express written permission to talk with an identified individual about specified topics.
Having a safe, confidential and trusting relationship with a nonjudgmental, competent and compassionate counselor who is outside of the client’s personal and family spheres – and therefore objective – is the primary reason why most people come to and benefit from therapy.
ANSWER: I do not accept Medicare. I am an out-of-network provider for insurance companies. I provide clients with the invoices and billing records (“superbills”) necessary for out of network reimbursement from their health plans. Some health plans reimburse clients up to 50% of monthly therapy fees when pursuing reimbursement for therapy provided by a therapist outside of their provider network. It’s wise to double-check your mental health coverage benefits prior to starting therapy.
For many individuals, mental health services are tax-deductible – check with your accountant to make sure this is true for you.
There are pros and cons to using insurance benefits for mental health services. Health plans require periodic documentation from the therapist and a severe mental health diagnosis. This diagnosis can be seen as a “pre-existing condition” which can impact your insurance costs and coverage. Many people like to pursue therapy for personal growth and relationship reasons and don’t actually have a mental health diagnosis. These clients often will choose to pay for therapy on a fee for service basis.
I do maintain one or two low fee client openings. If these are full, I will refer to nonprofit or county agencies in Marin who specialize in offering low cost therapy groups or individual sessions.
ANSWER: Reminiscence Therapy is an active way of eliciting memories and storytelling from older people. This kind of exercise can also be referred to as “life review”. It is an important part of our healthy developmental tasks in older age. Here is an excellent summary written by Harvard MD Dr. Michael Craig Miller:
Remembering As a Form of Therapy – Why Reminiscing Can Be Therapeutic
Memory looms large in our understanding of mental health and mental illness. For some people, remembering painful events, like abuse or the death of a loved one, causes suffering. But as we age, remembering too little becomes the problem for many of us. A simple form of therapy can be helpful when memory begins to fail. And, as an additional benefit, it can help with mood problems.
What is Reminiscence Therapy?
Reminiscence therapy uses prompts, such as photos, music or familiar items from the past, to encourage the patient to talk about earlier memories. It’s generally offered to people in their later years who have mood or memory problems, or need help dealing with the difficulties that come along with aging.
Since the late 1990s, partially controlled studies have shown that this treatment has a small but significant positive effect on mood, self-care, the ability to communicate and well-being. In some cases, this therapy improves intellectual functioning.
The History of Reminiscence as Therapy
The idea that reminiscing could be therapeutic was first proposed in the 1960s. Robert Butler, a prominent psychiatrist who specialized in geriatric medicine, coined the term “life review.” He proposed what many now take as a given: When approaching death, people find it helpful to put their lives in perspective. In an earlier decade, talking about distant memories was thought of as “living in the past” and therefore a problem.
The idea behind reminiscence therapy is consistent with the theories of adult psychological development that were being proposed around the same period by another famed professional, the psychologist Erik Erikson. Erikson thought that for the greater part of adulthood, we are challenged to find creative, meaningful work in order to avoid feeling stuck.
Then, in the final phase of life, we may try to review where we have been and what we have accomplished in the hope that we can feel good about our lives. Reminiscence therapy, which incorporates both Dr. Butler’s insights into life review and Dr. Erikson’s theory of psychological development, may help a person achieve that goal.