by Nicole Urdang, MS, NCC, DHM, Licensed Mental Health Counselor in Buffalo, NY

Wisdom for Working with Elder Therapy Clients

While it is true that people are people, there are some noteworthy differences in working with elders. (When I speak of elders, I’m referring to anyone in the third age, the last third of their life. If you think you’ll live until 90, that’s 60-90.)

5 Tips for Working with Elders

Here are some important tips for providing therapy to people in this population. These mindsets and behaviors are key to developing healthy, fruitful therapeutic relationships with elders.

1. Remember That Anyone Can Grow

The most important thing to remember is that anyone, at any age, is capable of personal evolution. More than that, they may secretly crave psychological, emotional, vocational, volunteer, and social change but erroneously think it’s impossible.

2. Offer Respect

Respect for every person who comes to you is already inherent in the way you work; since elders, like children and teens, often don’t get respect from society at large, paying attention to this aspect of your covenant to help and heal is crucial.

3. Listen Actively and Attentively

When it comes to elder therapy clients, with their wealth of life experience, careful listening is even more important. Responding with empathy and intelligence to what has been said creates an opportunity for connection, understanding, and trust. Some people, even in their late years, have never felt they could trust somebody. Don’t underestimate this gift and its potential importance.

4. Cultivate Compassion

As with all who cross your path, whether at work or outside it, cultivating compassion is key. People can actually feel when you genuinely care about them. We all unconsciously express our unspoken innermost feelings through tone of voice, body language, and energy. Kindness, whether it’s felt through a smile, attentive listening, or from a meta-message conveyed more subtly. Yet, those unspoken feelings are often far more potent and memorable than the overt conversation you had.

5. Bring Your Best

As much as these things matter, bringing your A-game is essential. What I mean by that is be ready to call upon everything you have learned about what it takes to navigate a life, to enhance joy, meaning, self-compassion, and connection.

Common Elder Concerns — And How to Approach Them

It may not only be the day-to-day issues that someone wants help with, but fractured family relationships, or patterns of a lifetime they would finally like to address. Perhaps, it’s the deepest question of all: Have I led a meaningful life? And its corollary: Have I made the world a better place?

Even, in the worst-case scenario, where someone comes in with a laundry list of how they have harmed people or been inordinately self-serving or stingy, there is still always a way for them to make a positive difference. Paradoxically, that starts with being kinder to themselves.

This may be a hard sell as many people, especially older folks, equate self-compassion with selfishness, the exact opposite of what they think they want to cultivate. Nothing could be further from the truth. By cultivating self-forgiveness, self-acceptance, and an unerring devotion to one’s own mental, physical, and spiritual health, they create a fuller well from which to draw for others.

Older people have a warehouse full of memories, not all of them pretty and delightful. Perhaps they are nursing grievances? Maybe they think nothing can ever be as good as a time gone by. They might be frozen in grief over a multitude of losses. If any of these show up, it’s helpful to ask: What’s right in your life right now?

As for grief, you can be sure older people have accrued a fair number of losses. Helping them navigate the emotional detritus of all those experiences is a big part of your job. Making it safe for them to feel all their feelings and supporting them through that process can be truly beautiful and liberating. Remember, grief is mercurial, a perennial shapeshifter that can go from feeling deep sadness to rage. It can manifest as any other emotion, including anxiety, feelings of worthlessness, self-hate, loneliness, anger, resentment, and guilt.

Everyone, no matter what their age, wants to feel heard, respected, and validated. This is especially true for older people who often feel invisible, unwanted, and invalidated. Your caring attention and connection can be a beacon for the rest of their journey.

Specific Pressures of This Era: The Fight Against Natural Aging

Media pressures on older adults

There is an insidious trope running through American society right now. It’s the inchoate, yet very real, competition of who can age the best — defined by who can remain the most vibrant, most engaged, most sexual, most appealing, and most useful.

When we watch shows like Grace and Frankie, as amusing and compelling as they may be, they set up an almost unattainable high bar for older women. After all, it is the culmination of our stars’ resources and the retinue of people at their beck and call, all working to create an illusion.

A far deeper part of our societal problem is living in our death-denying culture. Trying to stay young forever is a fool’s errand. Without death, life would have no meaning. Without impermanence, nothing would feel as precious. Denying aging by trying to prolong youth for youth’s sake is an outgrowth of a death-denying culture.

As long as therapists don’t challenge the media’s message that older people, especially women, should look, act, and even feel younger, they are part of the problem. They’re perpetuating unrealistic ideals that most folks can’t attain. Therapists can sometimes unconsciously convey this message and it can sabotage the desire to help people become their most authentic self.

That said, challenging the values of someone who adheres to a regimen of Botox, dermabrasion, extreme diets, plastic surgery, and so on is just as unhelpful. The best way to work with clients whose values might be different from yours is to help them grow and change at their speed and for their aims, not at your speed and with your goals for them. It’s easy for anyone, including therapists, to project our own values onto others. Your job is not to make people your clones but to help them blossom into their true selves.

Knowing how to work wisely with all kinds of people is part of a therapist’s job, and if you come across someone you feel you can’t help, let them know as soon as you do. Sometimes, that can be the hardest work of all, as it requires self-knowledge and the ability to withstand the difficulty sadness that comes with disappointing somebody.

Specific Areas to Explore in Your Work with an Older Person

It’s important to assess your older clients holistically. How are their sleep, nutrition, diet, social life, spiritual connection, time in nature, daily habits, and routines? Where are they finding satisfaction, peace, and meaning?

Looking to the Past

Are they interested in looking back over their life? Would they like to journal or talk to you about various aspects of their past? If they are, is this a source of fulfillment and self-actualization, regrets, or a combination of both?

Are they harboring anger at themself or others? Exploring self-forgiveness and forgiveness of others, even if they are no longer alive, can be very beneficial.

Life is cumulative. This is especially true of grief and loss. Most older people have a storehouse of grief. It’s helpful to ask an elder therapy client about their history of losses. I often suggest a timeline from their earliest recollection of a loss to the most recent one. This is not just limited to loved ones who are gone, but may include: a pet that died, a friend who moved away, loss of an image of how their life might be, dealing with the natural losses of age, and inchoate losses, like loss of a dream. By going through this timeline, carefully and slowly, you can help someone unburden long-held sadness and regret.

Considering the Present and the Future

Do they have fears or concerns about the future? If so, how can you help them allay those anxieties? You can always ask: What would help?

There is another question that generates lots of therapeutic fodder: Is there anything you would still like to do?

When President Obama was winding down his presidency, his advisers asked him: “Mr. President, do you have a bucket list?” He replied: “Well, I have something that rhymes with bucket list.”

Older people may have what Obama has. Your client may not be looking for a bucket list, but the other one. This is no mean feat, because the more accomplished someone has been in their life, the more difficult it can be to relinquish the perennial lure of one more achievement. Part of helping somebody age well is allowing the ego to take a back seat. The ego loves accomplishment, checking things off a list, and getting approbation, whether from one’s self or others. Yet, there are other parts inside everyone, especially elders, that may want the peace that comes from doing less and mindfully experiencing more. Since society applauds achievement, helping your client navigate this new territory can be incredibly supportive and beneficial. You can reframe things that may ultimately have a more subtle, cumulative effect of accomplishment and joy, like meditation, yoga, qi gong, tai chi, hobbies, reading, etc. as a bigger accomplishment in many ways as they offer a new challenge of going against the indoctrination of a lifetime; namely, that your worth is determined by what you do.

Being a Breath of Fresh Air

Last but not least, your open, cheerful, and generally optimistic energy with elder therapy clients can have a profoundly healing effect. The way you attentively listen and care is different from any other relationship they may have had in their life, since one‘s relationship with a therapist, if it is a good match, is a unique and amazing experience.

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© Copyright 2021 GoodTherapy.org. All rights reserved. Permission to publish granted by Nicole Urdang, MS, NCC, DHM, Licensed Mental Health Counselor in Buffalo, NY

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