Question

Please could you describe the principles of counselling in the elderly?

Answer

Counselling needs to be divided into that which can be provided by carers, nurses and doctors without a specialist knowledge in counselling, and psychotherapy and that which requires a psychotherapist. It can be given to a single patient at a time or to groups and families. For depressive disorders, brief psychotherapy is often combined with an antidepressant drug and with social measures. Individual therapy is generally suitable for specific problems that can be the focus of short term treatment. It may also be ideal for those who could be treated in a group but who would feel awkward there because of shyness or the nature of their problems, and it is also chosen for patients with more complex psychopathology.

The common factors in psychotherapy are listening and talking, release of emotion, giving information, providing a rationale, restoration of morale, suggestion, guidance and advice, and the therapeutic relationship. Counselling is based on these general factors. The central feature in counselling is the relationship between the counsellor and the person counselled, the relative importance of giving information, allowing the release of emotion, and thinking afresh about the situation. In counselling to relieve distress, it may be more important to listen rather than give information and to provide an opportunity for emotional release and discussing ways of coping with problems.

Bereavement counselling focuses on working through the stages of grief. It combines an opportunity for emotional release, information about the normal course of grieving, and advice about the practical problems of living without the deceased person.

With problem solving counselling, the patient is helped to identify and list problems that are causing distress, consider what practical courses of action might solve or reduce each problem, select one problem and try out the course of action that appears most feasible and likely to succeed, and to review the results of the attempt to solve the problem.

Finally, the elderly will benefit from psychotherapy and counselling, but the principle may be that affective symptoms should be adequately treated first. At the least, if psychotherapy is being considered for depressive illnesses, it will usually be more effective if combined with antidepressants.

It may be also that an older person may not be able to stand a prolonged session, and fatigue and faltering concentration need to be looked for, and the session shortened if present. One needs to also be aware of cognitive problems, deafness, and the difference in age between therapist and patient, which may take the form of a child (therapist) to client relationship. There is some suggestion in the literature that a group session is better than an individual session in older people.