A Case for Solutions When Working with the Elderly
The minute she arrived and displayed her beautifully lined and full of expression face on my eyes there was a bond. Immediately I had to check myself. This person in front of me is not my mother. She is the same age as my mother was when she died five years previously, she has the same coloured hair, permed and styled exactly the same; she is the same height and even has the same smile. An overwhelming feeling of love for my own mother swept over me; I missed her so much.
As I allowed Beryl Mackenzie to tell her story I challenged myself to keep track of my own feelings, no transference please. On the surface I knew that this poor lady of 86 years needed to tell her story to somebody who will attempt to appreciate her feelings. Somebody who will share an unconditional positive regard and project a deep empathic understanding. Unfortunately Beryl picked up on the subconscious feeling I was projecting and there in my room was a case of countertransference.
She stated “My dear you are just like the daughter I wished I had – I always imagined she would be just like you. I did however have three incredible sons and they’re all married with children. Actually some of their children have had children of their own. So I am a great grandmother and very very proud of this.”
Mrs Mackenzie (I was compelled to use her formal title because of the values I had inherited from my own mother instilling in me as a child regarding respect of my elders) then launched into the most amazing story of her life which gathered momentum each time I attempted to keep her on track. She said she felt very ‘at ease’ with me and really wanted to tell me everything.
I, as the counsellor, felt quite out of control of this situation. Consideration of the age factor, plus the fact Beryl reminded me of my mother and respect for somebody who has come to counselling to tell her story; all events paid their toll on me. I couldn’t stop her. So I just let her expand on everything that came to her, hoping she would exhaust herself in about 15 minutes.
First she spoke about the loss of her husband twelve months prior and still caught in the process of extreme deep-seated grief, however she did not wish to pause on the emotion of that time, she had so much more she wanted to say. She immediately relayed each son’s story and what their lives were like up to the time of their marriages.
Unfortunately after twenty minutes I had to stop Beryl; I noticed she was becoming quite fatigued. Her voice was weakening and her shoulders appeared more slumped than when she first arrived. I did ask her about her general health and she stated she was on five different medications prescribed through her family doctor and who had also referred her for counselling. She said her doctor told her he didn’t really have too much time to talk with her, that he had a lot of sick people waiting in his surgery.
I decided the best way to pause Beryl would be to suggest a break in our session where I would be able to gather my thoughts on how to continue the session with some control over the outcome and help Beryl reach some goals of which I had no idea at this stage. After I made Beryl a cup of tea and she settled in ready to proceed, I complimented her on her alertness and attitude in recognition of her years to which she made reference quite a few times, how well she is going for her age and her ability to stay healthy.
“We give compliments about things the clients have done that have significance to them in the achievement of their goals.” (Turnell & Hopwood 1994)
I enquired about the types of medication she was on. She said two years prior she suffered a very mild heart attack and was on blood pressure tablets. Her doctor had also prescribed tablets to help her with her anxiety and she did have the first stage of osteoporosis. One of her sons was a Naturopath and wanted to know exactly what she was taking at all times and challenged her with her ‘drugs’, as she stated he called them.
The procedure of the counselling session continues.
Counselling Session – Transcript
(With ‘C’ being Counsellor and ‘B’ being Beryl Mackenzie)
C: Mrs Mackenzie, I am going to interrupt you and I hope you don’t mind. I realise that you have an entire lifetime to tell me about, however, time permitting we will address some of that and more importantly explore the reasons why you have felt the need to come and see me here in my counselling room. I suppose what I’m asking is which area would you like to work on first.
B: Well my dear, when my dear husband of 50 years died I just didn’t know what to do with myself. Dear Wally did everything for me. He drove me to the shops. I never drove a car in my life. My youngest son tried to teach me once, but Wally got so upset in case I had an accident. He loved me so much, did Wally. I never had to work either. Wally always looked after me. He paid all the bills and now when I get something in the mail I send it down to Ben, my eldest son and he takes care of everything for me regarding bills and things.
C: So do all of your sons live away from you Mrs. Mackenzie?
B: Oh yes, they all live down south and this is the problem. They want me to go down there and live near them. I just don’t want to move, I’m scared of travel, I just never go anywhere especially without Wally.
And then B starts to cry. B is offered a tissue at this point which is declined and a small lace handkerchief is gathered out of her purse she is clutching in her frail, yet very worn looking, hands. They are deeply lined and marked with years of work and twisted with arthritis.
My chest tightens and I feel fluttering sensations inside my neck. My own mother used to crochet the edges of handkerchiefs just like this one Beryl had and I had to stay on track with the session. Control of emotions is imperative when working with clients. It would be unfair to our clients to be less than professional.
Respectfully I allow her a few minutes to contain her tears and my emotional stability is challenged. I am wondering if I should refer her, however it would be, I felt, irresponsible of me at this stage to suggest this considering Beryl is able to open up to the first person who has taken the time to really listen to her; as she stated previously.
C: Mrs Mackenzie, have you had a meeting with all of your sons and their wives together so they understand how you feel about travelling and moving to another State?
B: Shakes her head and looks into her lap and slumps.
C: Do you know what their plans are for you when you do move down there to live, has that been worked out yet?
B: You know dear, they all talk too fast, they live fast and I think sometimes I just get in their way. They don’t really want me there; I think they just feel obligated because I’m their mother. I did hear them mention a Retirement Village at one stage but that really frightens me. I’ve been living in my own home for fifty years now and I know the neighbourhood and how to get to the shops and I can walk up to the Church every Sunday and they have a craft group there on Wednesdays. I like my life but I do miss my boys now that Wally has gone and I know he’s not coming back. Beryl starts to cry again.
C: Now Mrs Mackenzie just because your boys talk fast and live fast doesn’t mean you have to. Do you talk with them on the phone? Your sons may know your fears about travelling.
Beryl then proceeded to start to tell me how often she spoke with them on the phone, the content of the conversations and I could feel myself losing control of the session again because I was respectfully allowing her to continue into multiple tangents of her sons’ lives.
“It follows from the person-centred view of psychological disturbance that such disturbance will be continued and reinforced if an individual remains dependent to a large extent on the positive judgement of others for a sense of self-worth” (Mearns & Thorne 1991)
Even though the session started with Person Centred Therapy according to the needs of my elderly client, I decided to adopt the Solution Focused Therapy components of promoting the exception questions with Beryl. ‘The Client is the Expert’ and will finally decide on what she wants through the skills required of a Solution Focused therapist.
‘The counsellor needs to communicate with the client in clear and comprehensible terms. In order to achieve clarity the counsellor matches the client’s language and imagery, provided that the language chosen does not trap the client in her problem situation’ according to O’Connell (1998) ‘the counsellor needs patience, tenacity, warmth, tact and curiosity in order to enter the client’s frame of reference in a respectful, non-intrusive manner.’
C: Mrs Mackenzie, was there ever a time when you felt like you could just hop on a plane and make that flight down to the next State to be with your boys?
B: Oh my dear, yes. I feel sometimes as if I’m twenty and so fit and active and I can do whatever I want to do and then I remember, good grief, I’m 86, you old fool, you can’t do that. I wish I could just fly down there and live with them all together just how it was when they were little and I was their Mum and they followed me because I was so bright and cheery and smart and active and all the things that I’m not now. Oh, I’m so sorry, listen to me. Maybe I’m just losing my marbles, what do you think, dear?
C: Smiling – Imagine if I waved a magic wand and miraculously you were twenty again. What would you see yourself doing Beryl. Is it ok if I call you Beryl?
B: Of course my dear, I realise those days are long gone with titles. Sometimes it is nice to have a little dream. I’d see myself being in more control of my life. I would probably organise a flight down to see my boys once a month or something and have the ability to get myself to the airport. I suppose I see myself as being fit and healthy and without a care in the world. Oh dear, I think inside of my body I am still that twenty year old; except my body reminds me that I’m not.
C: So what would frighten you the most about going and living interstate Beryl?
B: I don’t know, I just don’t know. I think I’m scared of not knowing. Lately I’m scared about everything. This is old age; you know my dear, I think I’m even scared of dying. We can’t live forever I know, can we. I suppose I should be spending more time with my boys. I can’t expect them to always be flying up here to see me. Oh gosh, look at the time, I could sit here forever and talk with you except I’ve got to get home to watch my serials. Can I come and have a talk with you again tomorrow?
C: Well Mrs. Mackenzie, the whole idea of our time together is to help you decide what it is you are going to do with your life now that your sons have suggested a big move. We can work together on some different ideas so that you can come to a decision of what suits you best. Please take into consideration our time here today and you will need to think about these things we have talked about. Then next week when we get together again, we will talk some more about what you would like to do and then we can go from there. How does that sound to you?
As a parting gesture for my client, I offered her a quote from a book:
In Friedan (1993) cited by Hecht (1998) excerpt she urges older people to stop the quest for youth and to embark on a new venture, effectively to redefine (more positively) who they are:
“The problem is not how we can stay young forever, personally… the problem is, first of all, how to break through the cocoon of our illusory youth and risk a new stage of life, where there are no prescribed role models to follow, no guideposts, no rigid rules of visible rewards, to step out into the true existential unknown of these new years of life now open to us, and to find our own terms for living it. (p.33)
As Beryl Mackenzie left my room, a feeling of huge relief swept over me and I realised I had a lot to learn about myself and the containment of my own emotions. Because my own mother had died five years prior, emotional feelings of grief remained with me.
Elderly clients are a reminder of our own destinies. I pondered my own mortality as I reached for the phone to make an immediate appointment with my Supervisor.
Supervision sustains me fortnightly because of the numbers of clients I see; however I have to admit that Beryl Mackenzie has been the most emotionally challenging so far. Her fragility and vulnerability, which were both purely my perceptions, with complete trust in the proceedings left me in a space of similar feelings which only added to the challenge of counselling the elderly.
“Observational research has documented older people not only accommodating or accepting ageism but also as unwitting co-conspirators in its realisation” (Hecht 1998)
Author: Kathleen Casagrande Dip.Prof.Couns., Cert.IV Work. Assess
- Hecht (Ed.), Michael L., (1998). Communication Prejudice. Sage Publications, U.S.A.
- O’Connell, Bill (1998). Solution-Focused Therapy. Sage Publications, London.
- Mearns, Dave & Thorne, Brian (1991). Person-Centred Counselling in Action. Sage Publications, London.
- Turnell, Andrew & Hopwood, Larry (1994, 8 (2), A “Map” for Doing Solution-Focused Brief Therapy, Case Studies in Brief and Family Therapy.