Designing a counseling approach - Assignment Example

?Psych Final Project Order 569576 Design a counseling approach using your counseling specialty My client is Sophia, a 78-year-old woman who served asa caregiver for her husband, Frank, for the last ten years of his life. Frank passed away a month ago at the age of 90 from Alzheimer’s Disease. They had been married for 60 years at the time of Frank’s death. Sophia’s son lives a three-hour plane ride away from her, but speaks to her frequently on the phone. When Frank’s illness took a turn for the worse two years ago, Sophia got a home health aide to come in and help her with Frank. Because of that extra help, Sophia was able to go to the senior center and participate in exercise classes for seniors. She has made a few friends in her exercise class, but has been unable to spend much time with them while taking care of Frank. She also has friends in the neighborhood where she has lived and attended church for most of her married life. Many of her and Frank’s friends have also died, and the few that are left Sophia only sees infrequently since Frank’s condition worsened. She has come to the clinic because her doctor suggested she should to get counseling for depression and grief. The human development theory that relates to Sophia’s problem is feminist gerontology. While the name may initially turn some people off, there are aspects of the theory that apply directly to Sophia and her treatment. Obviously, the theory applies to Sophia who is elderly and a woman. Toni Calasanti explains that “a focus on intersecting inequalities is critical to understanding those experiences of aging and that feminist gerontology is uniquely able to offer scholars a lens through which to view these intersections” (Calasanti, 2009, p. 471). Feminist gerontology focuses on the intersections of cultures and/or lifestyles in elderly people. For instance, Sophia is now a widow living alone with no family nearby. This puts her in the category of being vulnerable. She is also African-American and supported only by social security and a small pension that Frank had. These aspects identify her as minority and low-income. Luckily, her son, Albert, a young physician in an inner city hospital, can afford to send her money on occasion. Sophia is a little overweight and has type 2 diabetes, but is relatively healthy otherwise. So, she has many intersecting cultural and lifestyle aspects to her life. One advantageous part of being an older female at this point in history is that usually older women have developed friends and contacts in the community over the years. This is because they did most of the housekeeping through their married years. Having community connections may help in later life. “For instance, women’s immersion in the work of daily life, including kin keeping, provide them resources in later life that men may not enjoy at that stage. Not only do such networks offer social support in old age; for those with fewer material resources, such networks may also ensure a decent quality of life. Because men are not responsible for domestic life, they often access social networks through their wives. Thus, some men can be highly dependent on their wives for social and material resources, and men who are not married often have smaller networks” (Calasanti, 2009, p. 473). This was proven when the church sent over people to help Sophia periodically during the years of Frank’s illness. The counseling theory that relates to Sophia’s problem is cognitive-behavioral therapy, an important part of the psychology of aging. Another type of therapy that may be helpful for Sophia is reminiscence and life review therapy. “Studies tested a range of therapeutic models, two approaches being the most widely researched; cognitive-behavioural and related therapies . . .and reminiscence and life review therapy” (Fillit & Butler, 2009, p. 287). Sophia may benefit from a structured review of her life to point out that it has been fulfilling, but Sophia’s issues would most likely be better addressed with the cognitive-behavioral therapy. For clients in later life, the issues of sexuality, maturation and cohort apply, but in a different way than they do in younger life. John Blando cautions counselors “to anticipate more complex and subtle emotions when working with clients in later life” (Blando, 2011, p. 132). By age 78, Sophia has a stable personality, even though she may demonstrate it through more nuanced emotions. For instance, she seems serene and happy for a woman whose husband of 60 years has just died. However, she says she is depressed. This can be explained in a couple of different ways. One explanation lies in the fact that most elderly people have learned to control their emotions, and after a lifetime of experiencing both good and bad, no longer feel emotions in the extreme way that younger people do. Sophia may feel that she is depressed because what she was accustomed to doing for 10 years—caring for her ill husband—is no longer required. The other reason Sophia may not seem to be taking her husband’s death too hard is that he has been ill for a decade. Alzheimer’s only has one outcome for the time being and Sophia has known that the inevitable would someday come to pass. “Individuals who acknowledge this significant marker may be more likely to take responsibility for ‘putting their house in order.’ Such understanding can transform passive acceptance into an adaptive, robust, and active response to frailty, improving psychological health and quality of life and enabling appropriate care” (Fillit & Butler, 2009, p. 350). When Frank started to show signs of dementia, Sophia realized then that her emotionally close relationship with him would soon end, and it did. While she continues to miss him, she has not depended on him for companionship for a long time. Blando feels that in a situation such as Sophia’s that a counselor should focus on the stability in Sophia’s maturation process, her cohort relationships, and her grieving process. Maturation has to do with the biological processes that take place in the human body as it ages. Sophia already has type 2 diabetes, but she controls it with diet and took an active step toward losing weight by joining a senior’s exercise group. Since joining the group two years ago, she has lost 20 pounds. She visits her doctor regularly and sticks pretty closely to the diet her doctor suggested. What may be a greater worry for a new widow like Sophia is illness caused by stress. However, counseling her to get plenty of sleep, perhaps even prescribing a mild sleeping aid, stick with her diet and continue to get the recommended exercise should keep her physically healthy. Yet there is still the worry of her mental health since she has just lost her long time spouse and also her role as caregiver. Howard Fillit and Robert Butler believe that such an abrupt change in the routine of daily life added to the grief may cause some adjustment issues. “Any psychotherapy provided should address the particular issues of the frailty identity crisis, which may be a critical contributor to the depression, perhaps understood in the context of an ‘adjustment reaction.’ Older persons suffering from a frailty identity crisis may benefit from cognitive behavioral therapy, although more research is needed to refine this approach for frail individuals” (Fillit & Butler, 2009, p. 350). Sophia may not yet be considered frail, but much of her life as she knew it has abruptly altered and, at her age, frailty could become an issue. As the brain ages, intelligence changes and some parts work faster while other parts lose their efficiency. One part, the crystallized intelligence, is that part of the human intellect that remembers events from the past. Alzheimer’s victims will often retain at least a portion of that much longer than they will the fluid memory, which seems to change after age 70 even if a person does not develop full-blown dementia. With dementia patients the crystallized memory will deteriorate, but the patient may retain some memories from their earlier life and confuse them with present circumstance. So far, Sophia has not shown any signs of dementia, but she is nearing the age when it often begins. However, it is still important to remember that “decrease in working memory suggests that counselors should decrease the speed and complexity of language used in clinical activities with older adults and encourage the use of mnemonic aids as compensatory tools . . .to ensure that clinical material is meaningful and relevant and that the older adult client remains motivated” (Blando, 2011, p. 132). For Sophia to gain anything through counseling, what the counselor has to say must motivate her because she has only a small handful of friends to fulfill her human need for companionship. This might lead a counselor to suggest group counseling for Sophia and others like her who have few social contacts and would benefit from more, but a study done in the United Kingdom seems to say differently. “Evidence indicates that individual counselling is popular among older clients and that this may be their favoured treatment modality. The predilection for group treatments in nursing homes may reflect the preferences of therapists, researchers and service providers rather than older clients” (Hill & Brettle, 2006, p. 292). In a clinical setting, it would be more feasible to counsel a client like Sophia one-on-one, but there is still the issue of her cohort context to contend with. One therapy that would help Sophia and others in one action is peer counseling where Sophia would volunteer her time as a sympathetic ear and advise-giver to people in her age group who may be facing some of the same issues she has already experienced. This may help fill the gap that was made in Sophia’s life when her husband died. A study done in China by Amy P.Y. Ho looked at seniors doing peer counseling as a way to motivate themselves. Sophia, having just gone through the ordeal of care giving for her husband with Alzheimer’s may have a unique perspective to offer to other people who are facing the same challenges. Ho says, “Peer counsellors, a substantial lay resource, provided informal social support (instrumental, emotional and informational) to the elderly and modelled positive coping skills. In other words, the peer counselling program is a means to creating a more supportive environment for the depressed elderly in time of distress.” (Ho, 2007, p. 70). But it is not just beneficial to the person seeking counsel, but also to the peer counselor who may find it soothing to recount how she went about caring for her husband. Peer counseling seems like an ideal therapy for Sophia because it would allow her to fill the gap in her life, provide her with an opportunity to socialize, and she will not have to come up with money to pay for extensive counseling sessions. Others will also benefit from Sophia’s knowledge and benevolence. References Blando, J. (2011). Counseling Older Adults. New York City: Taylor & Francis, LLc. Calasanti, T. (2009). Theorizing Female Gerontolgy, Sexuality, and Beyond: An Intersectional Approach. In V. L. Bengtson, D. Gans, N. M. Putney, & M. Silverstein (Eds.), Handbook of Theories of Aging (2nd ed., pp. 471-485). New York City: Springer Publishing. Fillit, H., & Butler, R. N. (2009). The Frailty Identity Crisis. Journal of American Geriatrics Society , 57, 348-352. Hill, A., & Brettle, A. (2006). Counsellng Older People: What Can We Learn from Research Evidence? Journal of Social Work Practice , 20 (3), 281-297. Ho, A. P. (2007). A peer counselling program for the elderly with depression living in the community. Aging & Mental Health , 11 (1), 69-74. Read More