Marie Jones is a 73-year-old woman who lost her husband last year after nearly 50 years of marriage. Their complaints are memory problems, loss of appetite and low energy. Mrs. Jones told her doctor that her children think she should move into a seniors’ community, but she is reluctant to give up her home. If Mrs. Jones or someone like her were referred to your practice, would you be willing 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 expectancy has increased dramatically over the past 75 years, and the number of seniors willing to engage in community activities is steadily increasing. The stresses associated with aging such as environmental changes, retirement, losing a partner, and coping with illness are all issues that could be addressed in psychotherapy. However, very few graduate programs offer training opportunities in clinical gerontology.
Even when training is available, ageism may lead some therapists to believe that emotional growth and change in the elderly is limited and therefore not worthy of professional pursuit. Countertransference, which often stems from personal fears of old age or family issues with parents/grandparents, can also discourage people from treating elders. Whether the reasons are personal or professional, treating older adults, if you are prepared, leaves the door wide open to ethical dilemmas and potential wrongdoing.
*Before work begins*
Psychotherapy is an intensive examination of personal values. Understanding your own value system and how it affects your work is the cornerstone of ethical practice. Your beliefs drive the counseling process, even in the most indirect of therapies. As Christians, it is easy to underestimate the importance of values clarification. Loving God, loving our neighbor as ourselves, and believing in the healing power of Christ are all values that come naturally within the Christian pastoral community. But there is tremendous diversity within the body of Christ, so many different understandings of health, healing, pathology and change.
Assessing and articulating your values in the field of gerontology means prayerfully considering difficult questions. For example, what are your beliefs about the end of life? If your client wanted to die by stopping painful medical treatment, how would you decide what to do? Would you decide differently if your customer were 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 take the time to identify your values about the aging process and about older people, you will be better able to see how the thesis affects your work. Being aware, clear and open respects both the therapy process and the individual client. It also helps you avoid many ethics-related pitfalls.
*Common Ethical Dilemmas in Gerontology*
Mrs Jones has now been referred by her GP for a consultation. He’s worried about her memory problems and wants a second opinion. He also believes that Mrs. Jones is isolated and could benefit from having someone to talk to about the relatively recent loss of her spouse. Are you the right recommendation? Even with 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 can all be appropriate components of your treatment plan. As a provider, you must first assess your own level of training and skills. Just as one would not think of treating children without proper training, the same standard applies to gerontological practice. If you feel underqualified, you must turn to legacy resources such as supervision, training, and counseling to support your work. The most ethical decision might be to refer that 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 becoming more and more psychologically sophisticated, there are many older people who believe that counseling is only for the really crazy. They may be more comfortable in a traditional doctor-patient relationship and may not know what to expect from a therapist or from therapy itself. Once you have decided that you have the skills to treat Ms. Jones, she must be fully briefed on the therapy process, including your therapeutic style, fees and billing practices, confidentiality, and the risks and benefits of treatment. She may need additional information about possible referrals, such as psychological testing, grief support groups, or medication counseling. Once Ms. Jones has the information she needs to understand your work with her, she will be better prepared to give informed content. If you have any doubts about her competence to give consent, further investigation is required before beginning treatment of Ms Jones. This is important for the delivery of ethical therapy and for the client’s own safety. If Mrs. Miller doesn’t seem to understand the therapeutic contract, she may have issues outside of the therapy room that need to be addressed quickly. Memory loss or functional limitations do not equate to incompetence, but they can serve as red flags for a comprehensive assessment.
*Release of Information*
They have been seeing Mrs. Jones for about two months when her out-of-state son comes to visit. He is very impressed with the improvements he is seeing in his mother’s mood and self-care, but remains questioning whether his mother should move into a foster care facility. He also believes some of his mother’s problems are related to the physical abuse she endured for most of their married life. He calls and leaves you this information and asks you to call him back without telling his mother that he has called. This telephone message presents you with many problems. First, Mrs. Jones has yet to mention that her husband was abusive. She has portrayed her marriage as happy and stable. Second, Mrs. Jones decided not to sign any information releases for her children because she would worry enough about me that it would only make things worse. Her son found out about her therapy from the GP, who reported to the son that Ms Jones’ memory problems and depression seemed to decrease. With this turn of events, you need to focus on your customer. You don’t have access to Mrs. Jones’ son, much as he would like to help you. Also, you now have important therapeutic information to sensitively discuss with your client. Honesty within therapy requires that you let her know what happened and work with her to create a plan of action.
*Limits of Confidentiality*
When Mrs. Jones found out about her son’s call, she states that her husband was an active alcoholic for most of their marriage. During this time he was physically abusive. His eventually 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 gets so angry that he hits her. 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 a result of the abuse she has experienced. The shame associated with being abused by their children leads many adults to hide the violence, but the stress and trauma is often shown indirectly. It is your responsibility to know the laws in your state regarding confidentiality limits and reporting requirements for suspected elder abuse. This information should be provided to your clients at the start of treatment so that they can decide when and how to share this information with you. Christian online counseling is a good way to get suggestions.
The best way to avoid ethical problems in psychotherapy with any population is to check beforehand. Recognizing the limitations of your education, participating in continuing education, ensuring you have safety nets to support your practice, and staying in touch with colleagues are all important safeguards against ethical violations. As Christian therapists, we are committed to being God’s instruments of healing in a broken world. This requires not only that we practice our profession to the highest ethical standards, but that we continually remain open to the work that God can do through us. Knowledgeable, trained by us and confident clinicians who know their values, strengths and limitations are best equipped to deliver this higher standard of care.
Thanks to Anthony Centore | #ethical #challenges #working #older #adults