The ethical challenges of working with older adults

The ethical challenges of working with older adults

Marie Jones is a 73-year-old woman who lost her husband last year after nearly 50 years of marriage. Her complaints include memory problems, loss of appetite and low energy. Ms. Jones told her doctor that her children think she should move to a retirement community, but she is reluctant to give up her home. If Ms. Jones or someone like her were referred to your practice, would you be willing to treat her? If you're like many other providers in the helping community, the answer is most likely no. With the end of the 20th century, American society turns gray. Life expectancy has increased dramatically over the past 75 years, and the number of seniors willing to thaw in the community continues to rise. The stresses associated with aging, such as environmental changes, retirement, loss of partners, and dealing with illness, are all issues that could be addressed in psychotherapy. Very few graduate programs offer training opportunities in clinical gerontology.

Even when training is provided, ageism may lead some therapists to assume that emotional growth and change among seniors is limited and therefore not worth pursuing professionally. Countertransference, often based on personal fears of aging or family issues with parents/grandparents, can also prevent people from treating seniors. Whether the reasons are personal or professional, treating older adults, if you are prepared, leaves the door open for ethical dilemmas and potential misconduct.

*Before work begins*

Psychotherapy is an intensive exploration of personal values. Understanding your own value system and its impact on your work is the cornerstone of ethical practice. Their beliefs drive the counseling process, even in non-directive therapies. As Christians, it is easy to underestimate the importance of clarifying values. Loving God, loving our neighbors as ourselves, and believing in the healing power of Christ are all values ​​that seem self-evident in the Christian counseling community. But there is tremendous diversity in the Body of Christ as we will also have many different understandings of health, healing, pathology and change.

To evaluate and articulate your values ​​in the field of gerontology, you must prayerfully consider difficult questions. For example, what do you believe about the end of life? If your client wanted to die by withdrawing painful medical treatment, how would you decide what to do? Would your decision be different if your customer was 65 or 85 years old? Would your behavior put you in conflict with accepted community standards or with government regulations and laws? Values ​​guide us and they guide our customers. Once you have taken the time to identify your values ​​about the aging process and older people, you will be able to better understand how the thesis will impact your work. Being aware, being clear, and being open respects both the therapy process and the individual client. It also helps you avoid many ethical problems.

*Common ethical dilemmas in gerontology*

Ms Jones has now been referred for advice by her GP. He is concerned about her memory problems and wants a second opinion. He also believes Ms. Jones is isolated and could benefit from speaking to someone about the relatively recent loss of her spouse. Are you the appropriate referral? Despite the limited information we have about Ms. Jones, there are many clues that can guide her mental health treatment. Your symptoms may indicate the onset of dementia, but they may also indicate other problems such as depression, uncomplicated bereavement, poor health, or even elder abuse. Psychological assessment, individual therapy, and family therapy may be appropriate parts of your treatment plan. As a provider, you must first evaluate your own training and expertise. Just as you wouldn't think of treating children without proper training, the same standard applies to gerontological practice. If you feel like you're underqualified, you'll need to turn to legacy resources like supervision, training, and consulting to support your work. The most ethical decision might be to refer this client to a colleague and take the time you need to develop your skills.

*Consent to treatment*

Many older adults are unfamiliar with the process, requirements, and expectations of psychotherapy. Although the senior community is becoming increasingly psychologically sophisticated, there are many older people who believe that counseling is only for truly crazy people. They may be more comfortable with a traditional doctor-patient relationship and may not know what to expect from a therapist or from therapy itself. Once you have determined that you have the skills to treat Ms. Jones, she must be fully informed about the therapy process, including your therapy style, your fees and billing practices, your confidentiality, and the risks and benefits of treatment. She may need additional information about possible recommendations such as psychological testing, grief groups, or medication counseling. Once Ms. Jones has the information she needs to understand your work with her, she will be better prepared to provide informed content. If you have any doubts about your ability to consent, further assessment is required before beginning treatment for Ms. Jones. This is important for providing ethical therapy and for the client's own safety. If Ms. Jones does not seem to understand the therapy contract, she may have issues outside of the therapy room that need to be addressed quickly. Memory loss or functional impairment does not equate to incompetence, but it can serve as a red flag for a comprehensive evaluation.

*Release of information*

They have been seeing Mrs. Jones for about two months when her son visits from out of state. He is very impressed with the improvements he sees in his mother's mood and self-care, but continues to question whether his mother should move into a nursing facility. He also believes that some of his mother's problems are related to the physical abuse she suffered throughout most of her married life. He calls and leaves you this information and asks you to return his call without telling his mother that he has made contact. This telephone message presents you with many problems. First, Ms. Jones has yet to mention that her husband was abusive. She portrayed her marriage as happy and stable. Second, Ms. Jones decided not to sign information releases for her children because she was worried enough about me and this would only make things worse. Her son learned about her therapy from his family doctor, who reported to the son that Mrs. Jones' memory problems and depression appeared to be improving. When faced with this turn of events, you need to focus on your customer. They don't have access to Mrs. Jones' son, as much as he wants to be helpful. Additionally, you now have important therapeutic information that needs to be discussed sensitively with your client. Honesty within therapy requires that you let her know what happened and work with her to reach a plan of action.

*Limits of confidentiality*

Upon learning of her sons' call, Mrs. Jones states that her husband was an active alcoholic for most of their marriage. During this time he was physically abusive. His eventual poor health led to his sobriety and they spent the last 10 years of their lives together in a peaceful and relatively happy relationship. Mrs. Jones also reveals that her youngest son, who lives next door, is also an alcoholic and sometimes gets so angry that he is. An essential aspect of ethical gerontological practice is a thorough understanding of elder abuse. It is possible that some of the depression and cognitive problems observed in Ms. Jones are due to the abuse she experienced. The shame associated with abuse by their children causes many adults to hide the violence, but stress and trauma are often shown indirectly. It is your responsibility to know the laws in your state regarding the limits of confidentiality and reporting requirements for suspected elder abuse. This information should be shared with your clients at the beginning of treatment so that they can decide when and how to share this information with you. Online Christian counseling is a good way to get suggestions.

*Finally*

The best way to avoid ethical problems in psychotherapy in any population is prior control. Recognizing the limitations of your training, participating in continuing education, ensuring safety nets are in place to support your practice, and connecting with colleagues are important safeguards against ethical violations. As Christian therapists, we are committed to being God's healing instruments in a broken world. This requires not only that we practice with the highest ethical standards of our profession, but that we continually remain open to the work that God can do through us. We are knowledgeable, trained and confident clinicians who understand their values, strengths and limitations and are best equipped to deliver this higher standard of care.

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