We must remember the benefit in addressing a wider swath of the population in need of mental health
Raven Cross
Week 11 Initial Post
COLLAPSE
Week 11
Initial Post
Loss of support in older adults can increase the risk of depression and incidence of suicide. Consequently, change can bring with it an emotional state that can be both positive and negative. The group that I have been working with for the past 4 weeks is a group that is coping with loss and grief of a spouse. Complicated grief is a difficulty in accepting and reconciling a death. People with complicated grief often use avoidance strategies, such as detachment. The inability to process a loved one’s death can lead to “a negative effect on nutrition, quality of life, job performance and family and social interactions” (Nickrand & Brock, 2017,). Group therapy has been seen to “restore a healthy grief process” (Supiano, Luptak, Andersen, & Haynes, 2016).
Stages of the Group
The stages of group formation are based on the development of the internal relations of the group members. Forming of the group can occur when new members enter the group and get to know each other. The members of the group are welcoming to new members and are approaching each individual’s thoughts in a cohesive approach. Storming can be identified within this group as conflict among group members usually due to differences of opinions or beliefs. The members of this group can discuss their feelings as well as exchange solutions to other members. Norming then occurs when group members have attended group sessions for a lengthy period. The last stage is performing; members of the group are benefiting from therapy. Group members have formed a bond with one another while remaining open to new group members. Each member has identified the stages of grief and allowed each person to express their independent stage openly.
Resistance or Issues
Issues that can be identified within the group are members of the group wanting to over talk other members, or members wish to discuss individuals by name that are not part of the group. Group therapy immerses individuals in an environment where members are asked to face loss, disappointment, and anger; this includes both losses experienced in their personal lives as well as losses they will inevitably experience in group. (p. 574)
Resistance in the group primarily comes from group members that are new. For example, one of the members of the group stated that just because she attends group, doesn’t mean that she will not miss her dead husband. The facilitator asks the group member to express why she feels that way and reflects to the group to identify if they thought the same when they were new to the group. As the group bonds the changes in attachment may provide individuals with the emotional support that is needed. The attachments with others will provide a safe place for relieving anxiety and give a secure space to explore who they are without the deceased (Paine et al, 2017).
Challenges That May Occur Working with Groups
Intragroup conflicts can be a challenge when working with groups. Not everyone shares the same beliefs. Complicated grief is under diagnosed in older adults, therefore it is a factor affecting mental health and functioning from being undertreated (Supiano & Luptak, 2013). Acknowledging the conflict is the first step in resolving it. Ignoring conflicts within a group will only aggravate the situation. As a facilitator one must treat conflicts as they arise as issues to be resolved, avoiding placing blame. To ensure the psychotherapeutic process, one must understand what attributes might affect adult psychotherapy and this requires an understanding of individual, family, collective, and systemic issues within older adults (Wheeler, 2014). Group therapy works for this population because it brings together those facing similar difficulties who have been feeling isolated (Paine et al., 2017).
References
Nickrand, H.L., & Brock, C.M. (2017). Culinary Grief Therapy: Cooking for One Series. Journal of Palliative Medicine, 20(2), 181-183. doi:10.1089/jpm.2016.0123
Paine, D. R., Moon, S. H., Langford, R., Patel, S., Hollingsworth, A., Sandage, S. J., Bronstein, M., Salimi, B. (2017). Group therapy for loss: Attachment, intersubjectivity, and healing. International Journal of Group Psychotherapy, 67(4), 565-589. doi:10.1080/00207284.2016.1278172.
Supiano, K.P., & Luptak, M. (2013). Complicated Grief in Older Adults: A Randomized Controlled Trial of Complicated Grief Group Therapy. The Gerontologist, 54(5), 840-856. doi:10.1093/geront/gnt076.
Supiano, K.P., Luptak, M., Andersen, T., Haynes, L. (2016). Transforming the Meaning of Loss: Complicated Grief Group Therapy with Bereaved Dementia Caregivers. The Gerontologist, 56(3), 433-434. doi:10.1093/geront/gnw162.1726.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to
guide for evidence-based practice. New York, NY: Springer.
cheryl taunt
Group Therapy with Older Adults
COLLAPSE
In my clinical setting, there are not specific groups for older adults, however, there are a few of these individuals that participate in the mental health intensive outpatient (MH IOP) groups. For two of them, we make special accommodations. Each group participant is asked to complete a daily checklist that gauges symptoms of depression, anxiety, and suicidality, asks about medication compliance and side-effects, and completes a brief assessment about sleep, appetite, self-esteem, stressors, etc. During this quarter, I was charged with completing these checklists 1:1 with the older adults to ensure they understood what was being asked and also to ensure identification of issues that might otherwise be missed. When tailoring group therapy sessions to the specific needs of older adults, or even ensuring that these sessions are elder-inclusive, consideration must be paid to decreasing feelings of powerless related to life changes and assisting in coping with loss and/or changes in function (Bonhote, Romano-Egan, & Cornwell, 1999).
Description of Group/Techniques
MH IOP utilizes DBT skills in a CBT setting to teach skills that assist participants in better managing emotions, behaviors, and thinking patterns. The four themes of DBT, around which each session is centered, are mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Through skills training, individuals are empowered to change maladaptive, self-defeating behaviors and also to accept that which cannot be changed (Canadian Agency for Drugs and Technologies in Health [CADTH], 2010). The groups function by way of collaboration between therapists and practitioners/prescribers. Support is a cornerstone of the sessions, each member encouraged to share goals, challenges, and victories. Mutual sharing can be as beneficial in the learning process as the therapist-delivered content. The therapist must encourage sharing from the older adult that might feel hesitant to do so in a younger environment. Although aging is typically fraught with social and emotional losses and physical/functional declines, the value these individuals hold by way of possessing a rich history of experiences should be capitalized upon during group therapy (Bonhote, Romano-Egan, & Cornwell, 1999).
Individuals move in and out of the groups, remaining as long as insurance will allow or they feel equipped to independently utilize newly-acquired skills to more effectively address relationships, stressors, and situations. Due to the continuous ebb and flow of new and departing group participants, it is difficult to maintain stages of therapy which would include stabilization, identification, problem-solving, and fulfillment. These facets must be woven into the weekly sessions. It is important to recognize older adults might not as easily transition between these stages and might require more therapist intervention.
Challenges/Issues
The therapist must be cognizant of a few challenges associated with older adults in the group psychotherapy setting. One of these, as previously mentioned, is the hesitancy of the older adult to share-experiences, challenges, stressors, etc. Care should be taken to ensure these individuals feel comfortable and not rushed when sharing. During the pandemic, some therapies have transitioned to a technology-heavy hybrid format that might alienate older adults. These individuals might not be as well-versed in the technologies utilized, or might not even possess the hardware necessary to participate. Efforts to remain inclusive and ensure continued participation and no resultant drop-out, should be made.
Adaptations to therapy with the older adult center around differences in context, cohorts, and challenges (American Psychological Association [APA], 2020). Contextual differences involve settings in which these individuals live. Unlike younger clients, older adults might live at home requiring assistance, or in settings such as long-term or retirement communities. Cohort differences imply the unique skills, values, and life experiences these individuals possess. And finally, challenges of later life require specific knowledge and therapeutic skills because of the problems they represent for clients (APA). Some modifications suggested for accommodating the unique needs of the older adult in therapy include: learning about the individual, providing for sufficient time in the session, creating a therapeutic, trusting partnership between therapist and client, adjusting communication style if necessary (larger font in handouts or memory aids, for example), accommodating learning styles, and adapting to evolving needs or concerns (Toner & Shadden, 2002).
Several studies in this week’s media, specific to older adults with depressive symptoms, demonstrate the positive benefits (versus wait-list individuals) that can be realized when these individuals participate in group psychotherapy (Wang, Tzang, & Chung, 2014; Krishna, Honagodu, Rajendra, Sundarachar, Lane, & Lepping, 2013; Krishna, Jauhari, Lepping, Turner, Crossley, & Krishnamoorthy, 2011). Some studies do show that individual therapy might be preferable to group therapy (Cox & D’Oyley, 2011), we must remember the benefit in addressing a wider swath of the population in need of mental health services via group formats. In addition, group formats provide the additional benefits of social interaction and, often, lower costs (Cox & D’Oyley). As disorders such as depression are widely un-recognized in this population (Krishna, Jauhari, Lepping, Turner, Crossley, & Krishnamoorthy, 2011), simply chalked up as an expected aspect of getting older, we must ensure those willing to participate in group psychotherapy gain as much as possible from the experience. The therapist must be aware of their own biases, as well as the challenges and benefits associated with having these individuals in group and tailor sessions accordingly.
References
American Psychological Association. (2020). Psychotherapy & older adults. Retrieved from
https://www.apa.org/pi/aging/resources/guides/psychotherapy
Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expression in
a long-term older adult psychotherapy group. Issues in Mental Health Nursing, 20, 603-
617. Retrieved from the Walden library database.
Canadian Agency for Drugs and Technologies in Health. (2010). Dialectical behavior therapy
in adolescents for suicide prevention: Systematic review of clinical-effectiveness. CADTH
Technology Overview, 1(1), e 0104. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411135/
Cox, D., & D’Oyley, H. (2011). Cognitive-behavioral therapy with older adults. BC Medical
Journal, 53(7), 348-352. Retrieved from
https://bcmj.org/articles/cognitive-behavioral-therapy-older-adults
Krishna, M., Jauhari, A., Lepping, P., Turner, J., Crossley, D., & Krishnamoorthy, A. (2011).
Is group psychotherapy effective in older adults with depression? A systematic review.
International Journal of Geriatric Psychiatry, 28(9), 881-888. Retrieved from the Walden
library database.
Toner, M.A., & Shadden, B.B. (2002). Counseling challenges: Working with older clients and
caregivers. Contemporary Issues in Communication Science and Disorders, 29, 68-78.
Retrieved from
cheryl taunt
Group Therapy with Older Adults
COLLAPSE
In my clinical setting, there are not specific groups for older adults, however, there are a few of these individuals that participate in the mental health intensive outpatient (MH IOP) groups. For two of them, we make special accommodations. Each group participant is asked to complete a daily checklist that gauges symptoms of depression, anxiety, and suicidality, asks about medication compliance and side-effects, and completes a brief assessment about sleep, appetite, self-esteem, stressors, etc. During this quarter, I was charged with completing these checklists 1:1 with the older adults to ensure they understood what was being asked and also to ensure identification of issues that might otherwise be missed. When tailoring group therapy sessions to the specific needs of older adults, or even ensuring that these sessions are elder-inclusive, consideration must be paid to decreasing feelings of powerless related to life changes and assisting in coping with loss and/or changes in function (Bonhote, Romano-Egan, & Cornwell, 1999).
Description of Group/Techniques
MH IOP utilizes DBT skills in a CBT setting to teach skills that assist participants in better managing emotions, behaviors, and thinking patterns. The four themes of DBT, around which each session is centered, are mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. Through skills training, individuals are empowered to change maladaptive, self-defeating behaviors and also to accept that which cannot be changed (Canadian Agency for Drugs and Technologies in Health [CADTH], 2010). The groups function by way of collaboration between therapists and practitioners/prescribers. Support is a cornerstone of the sessions, each member encouraged to share goals, challenges, and victories. Mutual sharing can be as beneficial in the learning process as the therapist-delivered content. The therapist must encourage sharing from the older adult that might feel hesitant to do so in a younger environment. Although aging is typically fraught with social and emotional losses and physical/functional declines, the value these individuals hold by way of possessing a rich history of experiences should be capitalized upon during group therapy (Bonhote, Romano-Egan, & Cornwell, 1999).
Individuals move in and out of the groups, remaining as long as insurance will allow or they feel equipped to independently utilize newly-acquired skills to more effectively address relationships, stressors, and situations. Due to the continuous ebb and flow of new and departing group participants, it is difficult to maintain stages of therapy which would include stabilization, identification, problem-solving, and fulfillment. These facets must be woven into the weekly sessions. It is important to recognize older adults might not as easily transition between these stages and might require more therapist intervention.
Challenges/Issues
The therapist must be cognizant of a few challenges associated with older adults in the group psychotherapy setting. One of these, as previously mentioned, is the hesitancy of the older adult to share-experiences, challenges, stressors, etc. Care should be taken to ensure these individuals feel comfortable and not rushed when sharing. During the pandemic, some therapies have transitioned to a technology-heavy hybrid format that might alienate older adults. These individuals might not be as well-versed in the technologies utilized, or might not even possess the hardware necessary to participate. Efforts to remain inclusive and ensure continued participation and no resultant drop-out, should be made.
Adaptations to therapy with the older adult center around differences in context, cohorts, and challenges (American Psychological Association [APA], 2020). Contextual differences involve settings in which these individuals live. Unlike younger clients, older adults might live at home requiring assistance, or in settings such as long-term or retirement communities. Cohort differences imply the unique skills, values, and life experiences these individuals possess. And finally, challenges of later life require specific knowledge and therapeutic skills because of the problems they represent for clients (APA). Some modifications suggested for accommodating the unique needs of the older adult in therapy include: learning about the individual, providing for sufficient time in the session, creating a therapeutic, trusting partnership between therapist and client, adjusting communication style if necessary (larger font in handouts or memory aids, for example), accommodating learning styles, and adapting to evolving needs or concerns (Toner & Shadden, 2002).
Several studies in this week’s media, specific to older adults with depressive symptoms, demonstrate the positive benefits (versus wait-list individuals) that can be realized when these individuals participate in group psychotherapy (Wang, Tzang, & Chung, 2014; Krishna, Honagodu, Rajendra, Sundarachar, Lane, & Lepping, 2013; Krishna, Jauhari, Lepping, Turner, Crossley, & Krishnamoorthy, 2011). Some studies do show that individual therapy might be preferable to group therapy (Cox & D’Oyley, 2011), we must remember the benefit in addressing a wider swath of the population in need of mental health services via group formats. In addition, group formats provide the additional benefits of social interaction and, often, lower costs (Cox & D’Oyley). As disorders such as depression are widely un-recognized in this population (Krishna, Jauhari, Lepping, Turner, Crossley, & Krishnamoorthy, 2011), simply chalked up as an expected aspect of getting older, we must ensure those willing to participate in group psychotherapy gain as much as possible from the experience. The therapist must be aware of their own biases, as well as the challenges and benefits associated with having these individuals in group and tailor sessions accordingly.
References
American Psychological Association. (2020). Psychotherapy & older adults. Retrieved from
https://www.apa.org/pi/aging/resources/guides/psychotherapy
Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expression in
a long-term older adult psychotherapy group. Issues in Mental Health Nursing, 20, 603-
617. Retrieved from the Walden library database.
Canadian Agency for Drugs and Technologies in Health. (2010). Dialectical behavior therapy
in adolescents for suicide prevention: Systematic review of clinical-effectiveness. CADTH
Technology Overview, 1(1), e 0104. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411135/
Cox, D., & D’Oyley, H. (2011). Cognitive-behavioral therapy with older adults. BC Medical
Journal, 53(7), 348-352. Retrieved from
https://bcmj.org/articles/cognitive-behavioral-therapy-older-adults
Krishna, M., Jauhari, A., Lepping, P., Turner, J., Crossley, D., & Krishnamoorthy, A. (2011).
Is group psychotherapy effective in older adults with depression? A systematic review.
International Journal of Geriatric Psychiatry, 28(9), 881-888. Retrieved from the Walden
library database.
Toner, M.A., & Shadden, B.B. (2002). Counseling challenges: Working with older clients and
caregivers. Contemporary Issues in Communication Science and Disorders, 29, 68-78.
Retrieved from
http://www.asha.org/uploadedFiles/asha/publications/cicsd/2002SCounselingChallenges.pdf
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