Psychotherapy for the elderly
By nitsasbi, Sep 17 2014 07:30AM
Self-esteem is often a major theme during psychotherapy with elderly patients. The therapist is put into a position of trying to understand how the patient attempts to maintain self esteem in the wake of biopsychosocial losses associated with aging and to build upon existing coping strategies that the patient has accrued over a lifetime.
The elderly suffer multiple actual losses of spouses, friends, roles and independence and these may occur alongside the fear of anticipated future losses.
There is also the increased dependency and anticipation and fear of dependency and physical illness. The process of psychotherapy can offer the elderly a safe and trusting relationship in which to examine all frightening feelings. The experience of therapy furthermore offers the elderly person the opportunity to respond to these frightening feelings in a manner that is life enhancing rather than stagnating.
In old age, impending death becomes a reality that can no longer be denied and facing this can be a challenge. Death-related anxiety appears to be more a part of early adult life than of old age because, for elderly individuals,pain and suffering related to death are more of a concern than the fear of death itself.
For any therapist - working with an elderly person - can be anxiety-provoking because of the possible physical problems, dementing illness, apparent helplessness and loneliness and the dependency that the elderly person may have. Overidentification with the patient's problems can also invoke feelings of pity in the therapist, which can block accurate empathy and realistic exploration of the possibilities of change.
A tailored, flexible approach that considers the elderly patient's unique needs and an approach that takes into account specific developmental tasks and challenges associated with aging appears to benefit elderly patients.
By nitsasbi, Jun 23 2014 01:11AM
Loss is inevitable.
When we think of loss we think of death, specifically the death of people we love. Death in this context confounds us with its timing and its apparent disregard for our feelings around finality. But we lose not only through death, but also by leaving and being left, by growing and changing and letting go and moving on.
Throughout our life we grow by giving up. We give up some of our deepest attachments to others and even certain cherished part of ourselves.
The only mystery is that we expect it to be otherwise.
Loss in any form gives rise to anxiety, most notably when the loss is thought to be temporary. But when loss is permanent, anxiety can give way to depression too. "No one ever told me that grief felt so much like fear", reads the first sentence of A Grief Observed, C.S. Lewis's account of his feelings after his wife's death.
Today we seem to prefer the word depression over sadness and melancholy. Perhaps the latter Greek form sounds more clinical and serious or maybe depression is the name of a unique disease and justifies the use of anti-depressants today. For the purposes of this blog, I will speak in today's terms, namely anxiety and depression.
It is true that we recoil from any activity that causes pain and this might suggest that there is nothing natural about psychic pain either. This explains, in part, why some people develop strategies that protect and defend against pain:
Emotional detachment is one such example. We cannot lose someone/something we care for if we don't care. A rock, after all, feels no pain and an island never cries
Another defense against loss may be the compulsive need to take care of others. Instead of aching, we help those who ache
A third defense is premature independence. We claim our autonomy too soon and ensure our survival does not depend on the help or love of anyone
When the poet Edgar Allen Poe's mother died when he was three years old, he was left overnight with his sitter and the corpse until a family friend found them. In his work, Poe returns repeatedly to the image of the blank stare of the dead, cadavers and ghostly women. Poe's literary attempts to describe death over and over, from every conceivable angle, suggests that his depression did not end.
If, however, we are able to follow the mourning process, the loss and the pain will grow less and we will realize that life still has something to offer. Aging can offer us wisdom, changes can bring renewal, letting up can usher in forgivemess and letting go helps us forego endless amounts of heartache.
A Focus on Generalized Anxiety Disorder
By nitsasbi, Apr 3 2014 01:16AM
Worry is Central to the problem of GAD:
Most people who worry appear to be in two minds about it. On the one hand, they believe worry is a beneficial thing in that it helps them cope, but on the other hand they believe it is harmful and uncontrollable. If this is you, ask yourself some of the following questions:-
-- How easy is it for you to stop worrying if you are constantly in two minds about it?
-- If worrying is harmful, how can you also believe that it helps you cope?
-- Have you ever considered that worry might not be useful or harmful, but that it is neither useful nor harmful?
Worriers often discover that their behaviours are not effective in managing their anxiety:
In therapy, the above act of discovery allows the therapist to ask a number of important questions, such as:-
-- What happens to your worry if you have to do something important like answer the telephone? Does it stay uncontrollable or can it be switched on and off?
-- If worry is uncontrollable, how do you manage to get to sleep?
Worry is a coping strategy in response to stress and negative thoughts:
Worry is not equivalent to stress. It is a response to stress. There is limited evidence that psychological stress is directly damaging. The book "The Truth about Stress" (Patmore, 2006) is an excellent resource for those who wish to explore the stress myth further.
There is something significant about the patterns of thinking as seen in GAD. It has a repetitive, brooding quality that is difficult to bring under control.
Focusing on the content of thoughts is only a small feature of cognition and might even be of limited importance. We must also address the tendency to worry or ruminate, which leads to sustained thinking about danger and a persistence of symptoms.
Let me know your thoughts ...
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