Helping Relationships With Older Adults. Adelle M. Williams

been stated by Bortz (1990):

      Aging is a self-fulfilling prophecy. If we dread growing old, thinking it is a time of forgetfulness, and physical deterioration, then it is likely to be just that. On the other hand, if we expect to be full of energy and anticipate that their lives will be rich with more adventures and insights, then that is the likely reality. We prescribe what we are to become. (p. 55)

      Three key concepts anchor the development and implementation of promoting successful aging work. The first concept assumes that older people can prescribe their future and that counselors can effectively help them with this process. The second concept assumes that although general knowledge of developmental stages and sociocultural background is helpful in formulating working or guiding hypotheses, it is no substitute for developing a comprehensive understanding of the client. Third, each person uniquely interacts with and creates his or her own environment. Different cultures might have distinct views on the aging process, but individuals vary in their awareness and interpretation of these views. It is likely, however, that almost all people have concerns regarding aging and can be helped to age more successfully. Guided Practice Exercise 3.9 provides the opportunity to examine cross-cultural aging, which will be valuable in understanding older clients who seek counseling services.

      Guided Practice Exercise 3.9

      Individuals from various cultures experience aging differently. It may be welcomed or viewed with disdain. Identify two older adults from different ethnicities and examine their views of aging, the ways older persons are treated in their society, and their use of professionals for personal problems. Share the similarities and differences with your colleagues. Are you surprised by your findings?

      Optimizing the Vision for Aging

      At varying levels of consciousness, people imagine what it means to grow older. These imaginings need to be evaluated in terms of their accuracy and whether they represent how the person wants to age. Discussion, art therapy, relevant print and audiovisual materials, and interviewing are ways of making older people more conscious of their own thoughts and feelings about aging, expanding their notions as to what is possible, and then enlightening them on what they could be doing to achieve it. Gerontological counselors should take some of the following concerns into account when working with older adults. These concerns include losing their health, their ability to care for themselves, and their mental capacity; running out of money; finding meaning in older age; managing loss and grief; navigating sex and impotency; and sustaining marriage in the later years.

      A key element is helping people realize what later life will be is highly contingent on current practices. Neugarten (1971) said, “Most of us have a half-conscious and irrational fear that one day we will find ourselves old, as if suddenly we will fall off a cliff, and that what we will be then has little to do with what we are now” (p. 45). Appreciating this—and after the investigation and evaluation of current wellness levels and practices in the areas of physical health, emotions, nutrition, play, spirituality, finances, family, and friends—clients should have an expanded vision of possibilities for successful aging and should know what wellness practices will help them have greater control over their future. People need to be empowered to prescribe a life course that best fits who they are and who they want to become. A sense of being in control is essential. Guided Practice Exercise 3.10 encourages counselors to examine their strengths and weaknesses as they relate to working with older clients. Developing the right knowledge, skills, and attitudes is critical to effectively provide services to an elderly client population.

      Guided Practice Exercise 3.10

      You have been trained to provide counseling services to clients from young adulthood through middle age. Your knowledge of older adults comes primarily from your experiences with your grandparents and their friends. You are now expected to provide counseling services to an older clientele (65+). How would you prepare yourself to work with this client population? Do you believe you can use the same strategies and interventions you have used previously with these older clients?

      Change will occur as people control their lives and work to implement and optimize their vision for successful aging. It will also occur because living and aging means that the body changes, friends and relatives die, and many aspects of community and society are transformed. It is imperative to provide older adults with conceptual models and coping skills for handling change. These strategies should help them deal with the uncomfortable feelings that often accompany change and thus make them more effective with their change efforts. Competent counselors are already knowledgeable in these areas and need only to target their professional abilities to the area of promoting successful aging.

      Attributes of Successful Practitioners

      Counseling is a unique profession requiring a particular set of qualities. In order to be successful, all counselors need to have the following qualities: comfort with ambiguity, empathy, good boundaries, and belief in the capacity for change (LoFrisco, 2012). Counselors cannot always clearly see the results of their work and must learn to be comfortable in situations where they won’t have all of the facts. They must also have a particular kind of empathy and balance it with accountability. A good counselor holds clients accountable for their actions. Counseling is a profession that has a higher risk for burnout, therefore counselors with good boundaries understand their limitations, know where their responsibility for the change process ends and where the client’s begins, and establish policies and procedures and apply them consistently. Lastly, good counselors believe that people can and do change and provide optimism and hope when there is none. They are realistic about the change process and are able to help clients set attainable goals (LoFrisco, 2012).

      General Attributes Needed for Success

      The qualities and actions of effective therapists, based on theory, policy, and research evidence, can guide others toward continual improvement. Various therapists delivering different treatments in various contexts will emphasize some of these important qualities more than others (Wampold, 2011). Effective therapists have a sophisticated set of interpersonal skills. Clients of effective therapists feel understood, trust their therapist, and believe the therapist can help them. Effective therapists form working alliance with a broad range of clients and provide an acceptable and adaptive explanation for the client’s distress. They provide a treatment plan that is consistent with the explanation provided to the client. The therapist is influential, persuasive, and convincing and continually monitors client progress in an authentic way. Additionally, this therapist is flexible, adjusting therapy if resistance to the treatment is apparent or the client is not making adequate progress. Difficult material in therapy is not avoided but is used therapeutically, and the therapist communicates hope and optimism.

      Effective therapists are aware of the client’s characteristics and context. They are aware of their personal psychological process and do not inject their own material into the therapy process unless such actions are deliberate and therapeutic. The effective therapist is also aware of the best research evidence related to the particular client in terms of treatment, problems, and social context and understands the biological, social, and psychological bases of the disorder or problem experienced by the patient. The effective therapist typically achieves expected or more than expected progress with his or her clients (Wampold, 2011). Finally, the effective therapist seeks to continually improve his or her skills and knowledge.

      Attributes Needed for Success With Older Adults

      Older Americans are not easily categorized. Their needs and preferences are varied and becoming more so. There are a number of personal attributes (Spar & LaRue, 1997) that practitioners should either amplify or adopt for success with older adults. Such attributes include the following:

       Comfort with broad-based rather than narrowly focused interventions

       Appreciation for the social factors in older people’s health and well-being

       Remaining an activist in the face of degenerative or terminal disease

       Patience for the time required and complexity encountered