[This blog is part of a series of blogs commissioned by ELDAC to support aged care health professionals and care providers in providing end of life care. You can find more information on the ELDAC website.]
This is the third blog in a series of three blogs about mental health and older adults by Felicity Chapman. Part 1 of this series focuses on working with grief, and part 2 focuses on acceptance and commitment therapy.
Have you ever been in front of an older client and suddenly lost your way? You are not able to see the woods for all the trees of problems and you have a serious case of theoretical hyper-arousal – a deer in headlights. Or if you were dancing it might be akin to being so focused on the routine that you end up falling on the floor! Work with seniors can be like this. Often. The path you imagined going down has been hijacked, the co-morbidities are as numerous as the stars, and your client is looking at you like an exotic plant species – interesting but perhaps a little dangerous. I have found that in times like these I need to lose my interest in the dance routine, and just move to the music. Connect. Be present.
Work with advanced seniors, perhaps more than for any other group of adults, demands an ability to be present first and foremost. It is from this place that everything else can grow – dignity, respect, trust – and then deeper healing. I have had counselling students and colleagues ask me out of worry if they are doing enough and I believe that if you are truly present with your client and interested in them as a person then you are always doing enough.
This emphasis on human connection is not new. It can be found in the revolutionary work of Carl Rogers with his Human Potential Movement and concepts for psychotherapy such as being “person-centred” and having “unconditional positive regard”. He also spoke about being real: “I find it very satisfying when I can be real, when I can be close to whatever it is that is going on in within me … I have learned … that realness, or genuineness, or congruence – whatever term you wish to give it – is a fundamental basis for the best of communication”. 
I agree. I believe that when I am connecting on a fundamentally human level in my work with older adults then I have all I need to create constructive therapeutic encounters. Work with seniors can be fascinatingly complex and unshakeably simple – all at once. It is complex because there are many things to consider as you take in all of the changing variables of environment, presentation, abilities, and possible response pathways. But it is simple in that it can have, at its core, an emphasis on being present in this moment with this person; in a way that penetrates beyond the shell of age or pathology and looks into the soul of the human.
When I first see advanced seniors they are not usually thinking in terms of therapeutic goals – or even of therapy. Because of this I have developed a set of principles that can help professionals in their quest of engaging an older adult and being present with them:
- Dignity: How can you build them up? (Not in a patronising or unauthentic way.)
- Choice: How can you help them feel like they are in control of the process?
- Value: What is it about their conversation that speaks of important values?
- Trust: What opportunities are there to reaffirm their trust in you?
- Permission to talk: How can you comfortably invite them into a conversation?
I remember explaining the process of counselling to one 95-year-old woman after informally engaging her and seeing the look on her face. I reflected back on her scepticism. “What could talking do?” I asked rhetorically. “Exactly!” she exclaimed. But when I referenced the conversation we had just had she admitted to feeling very relieved. She was not able to articulate therapy goals but after an experiential understanding of counselling (via informal engagement) we were able to form them together:
“You’re interested in finding some more relief from your pain?” I asked.
“Yes,” she replied.
“To find a sense of peace about what your life has all been about?” I suggested.
She smiled, teary. “Oh, yes.”
Psychotherapy may not be something sought by your older clients, but by engaging in this way you can open the funnel of possibility wide and make the idea of therapy more palatable. And whenever you feel like you are at a stalemate, you can drop down into informal engagement so doubt or frustration can turn into relaxed curiosity. The senior before you becomes more a person than a client. The context becomes one where you are consulting them more than guiding them. In doing so, therapy can become a process that is highly flexible and truly senior-friendly.
Felicity Chapman is the author of the book Counselling and Psychotherapy with Older People in Care: A Support Guide which includes her Flexicare Model aimed at facilitating interaction with older people unfamiliar with therapeutic goals. [2,3] She is an Accredited Mental Health Social Worker who works in a Primary Health Network funded program supporting the emotional and psychological wellbeing of residents of care homes. She is also a sessional lecturer and member of the South Australian Association of Social Workers Aged Care Practice Group.
- Rogers C. A Way of Being. New York: Houghton Mifflin Co; 1995.
- Chapman F. Undercover agents: innovative psychological model for an advanced senior population (566kb pdf). Poster presented at: 2018 AAG Conference; 2018 Nov 21-23; Melbourne, VIC.
- Chapman F. Counselling and Psychotherapy with Older People in Care: A Support Guide. London: Jessica Kingsley Publishers; 2018.
Felicity Chapman, Mental Health Clinician and Aged Care Specialist