The Ethical Challenges of Working With Older Adults

Marie Jones is a 73-year-old woman who lost her husband last year after almost 50 years of marriage. Her complaints are memory problems, poor appetite, and low energy. Mrs. Jones told her physician that her children think she should move into a retirement community, but she is hesitant to give up her home. If Mrs. Jones or someone like her was referred to your practice, would you be prepared to treat her? If you are like many other providers in the helping community, the answer is most likely no. As the 20th century draws to a close American society is graying. Life expectancies have increased dramatically during the past 75 years, and the number of community dew willing seniors is steadily rising. The stressful associated with aging, such as environmental changes, retirement, loss of partners, and coping with Illnesses are all issues that could be addressed in psychotherapy. Yet very few graduate programs offer training opportunities in clinical gerontology.

Even when training is available, ageism may lead some therapists to assume that emotional growth and change among seniors is limited, and therefore not worth professional pursuit. Counter transference, often based on personal fears of aging or family issues with parents/grandparents, can also pull people away from treating seniors. Whether the reasons are personal or professional, treating older adults when you are I’ll prepared leaves the door wide open for ethical dilemmas and potential malpractice.

*Before the Work Begins*
Psychotherapy is an intensive exploration of personal values. Understanding your own value system and how it Impacts your work is the cornerstone of ethical practice. Your beliefs drive the counseling process forward, even in the most non directive of therapies. As Christians, it is easy to underestimate the Importance of values clarification. Loving God, loving our neighbors as ourselves, and believing in the healing power of Christ are all values that would appear to be self-evident within the Christian counseling community. But there is tremendous diversity within the Body of Christ as we will as many different understandings of health, healing, pathology, and change.

Assessing and articulating your values in the field of gerontology will involve prayerfully considering difficult questions. For example, what are your beliefs regarding the ending of life? If your client wanted to die by stopping painful medical treatment, how would you decide what to do? Would your decision be different if your client was 65 or 85? Would your behavior place you in conflict with accepted community standards of practice or with state regulations and laws? Values guide us, and they guide our clients. Once you have taken the time to identify your values about the aging process and about older persons, you will be better able to see how thesis will Impact your work. Being aware, being clear, and being open respects both the process of therapy and the individual client. It also helps you steer clear of many ethics-related pitfalls.

*Common Ethical Dilemmas in Gerontology*
Mrs. Jones has now been referred for counseling by her family physician. He is concerned about her memory problems and wants a second opinion. He also thinks that Mrs. Jones is isolated and could benefit from talking to someone about the relatively recent loss of her spouse. Are you the appropriate referral? Even with the limited information we have about Mrs. Jones, there are many clues that can direct her mental health treatment. Her complaints may indicate the onset of a dementia, but they can also suggest other problems, such as depression, uncomplicated bereavement, failing health, or even elder abuse. Psychological assessment, individual therapy, and family therapy may all be appropriate parts of her treatment plan. As a provider, you must first evaluate your own level of training and expertise. Just as you would not think of treating children without adequate training, the same standard applies to gerontological practice. If you feel that you are under trained, you will need to access old_resources such as supervision, continuing education, and consultation to assist your work. The most ethical decision may 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, demands, and expectations of psychotherapy. Although the senior community is rapidly becoming more psychologically sophisticated, there are many older persons who believe that counseling is only for really 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 decided you have the skills to treat Mrs. Jones, she must be fully informed about the process of therapy, including your therapeutic style, fees and billing practices, confidentiality, and the risks and benefits of treatment. She may need additional information about potential recommendations such as psychological testing, bereavement groups, or a medication consultation. Once Mrs. Jones is given the information she needs to understand your work with her, she will then be better prepared to give informed content. If you have any doubts about her competence to give consent, further evaluation will be needed before you begin treating Mrs. Jones. This is Important for the provision of ethically sound therapy and for the clients own safety. If Mrs. Jones does not appear to understand the therapeutic contract, she may have problems outside the therapy room that need to be quickly addressed. Memory loss or decreases in functioning do not equal incompetence, but they can serve as red flags for a comprehensive assessment.

*Release of Information*
You have been meeting with Mrs. Jones for about two months when her son comes to visit from another state. He is very impressed with the Improvements he sees in his mother’s mood and self-care but continues to wonder whether his mother should move into a care facility. He also believes that some of his mother’s problems relate to the physical abuse she endured during most of her married life. He calls and leaves you this information and asks that you return his call without telling his mother he has been in touch. This phone message presents many problems for you. First, Mrs. Jones has yet to mention that her husband was abusive. She has presented her marriage as happy and stable. Second, Mrs. Jones decided not to sign releases of information for her children, because they worry enough about me and this would just make it worse. Her son learned about her therapy from the family physician, who reported to the son that Mrs. Jones memory problems and depression seemed to be decreasing. When faced with this turn of events, you must remain focused on your client. You do not have access to Mrs. Jones son, as much as he would like to be helpful. In addition, you now have Important therapeutic information that must be sensitively addressed with your client. Honesty within the therapy demands that you let her know what has happened and work with her to reach a plan of action.

*Limits of Confidentiality*
When told about her sons call, Mrs. Jones states that her husband had been an active alcoholic for most of their marriage. During that time, he was physically abusive. His eventual failing 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 becomes so angry that he hIt’s her. An essential aspect of ethically sound gerontological practice is having a thorough understanding of elder abuse. It is possible that some of the depression and cognitive problems observed in Mrs. Jones could be attributed to the abuse she has been experiencing. The shame associated with being abused by their children leads many adults to keep the violence hidden, but the stress and trauma are often exhibited indirectly. It is your responsibility to know the laws in your state regarding the limits of confidentiality and the reporting requirements for suspected elder abuse. This information should be shared with your clients when treatment begins, so they have the power to decide when and how to share this information with you. Online Christian Counseling is a nice way to get suggestions.

*In Closing*
The best way to avoid ethical problems in psychotherapy with any population is antecedent control. Recognizing the limits of your training, participating in continuing education, making sure you have safety nets in place to assist your practice, and staying in touch with colleagues are all Important safeguards against ethical violations. As Christian therapists, we have made a commitment to be Gods instruments of healing in a broken world. This demands not only that we practice with the highest ethical standards of our profession, but that we constantly remain open to the work that God can do through us. Knowledgeable, we will-trained, and self-aware clinicians who know their values, strengths, and limits are going to be best equipped to meet this higher standard of care. 老年服务 顔脱毛