Called to Flourish Podcast - Gerontological Counseling

0:09Welcome to the Call to Flourish podcast. My name is Thomas Cronquist, and I am your cohost with father Charles Sikorsky, the president of Divine Mercy University. Father Charles, how are you doing today? Great. Looking forward to learning, more and more about this great field of mental health and counseling. Well, today we have doctor Cathy Erwin again, and we're gonna continue talking about, gerontological counseling and all that's involved there, its importance. Doctor Erwin, how are you today? Welcome to the show. Well, I'm doing great. And thank you so much for taking this topic on, to highlight the need for working with our older adults. Well, tell us a little bit more. Let's, kinda revisit where we were in the last podcast, about gerontological counseling, why it's important, what are the, what are the ways that can be done well and and maybe not done so well, and, where we need to go with it.

1:07Well, actually, I started into this by not knowing what I was doing and not doing it well and having to go and figure it out. Very briefly, I have, of course, a master's in counseling as is the program that we teach in here at Divine Mercy and the doctorate in counseling psychology. And I'm a better than average therapist on most days, especially in group work. So I had a friend ask me to come out to an older adult complex and do group work, and I did. And it was a disaster. I was a complete failure because I was doing group work that was really not related to their needs. And so I went looking for how do I do this thing. I only found two authors on the subject, doctor Robert Butler, who was really considered one of the key figures in gerontological counseling, who was an MD, and doctor Irene Burnside, a nurse practitioner.

1:52Those are the only two works that existed at that time. So I had to learn by doing a good way sometime, and that came to be one of my group techniques for aging adults books. I was the third in the field to do this. Now, blessedly, there are a lot more because I didn't understand aging cohorts at all, Tom. Have you heard those terms, aging cohorts? No. I haven't. Nobody else is either. So you are not alone. And here's how I like to explain it. Think high school. Remember when you were a freshman, you thought you were cool? The seniors did not think you were cool at all. And then when you got to be a senior, you knew why freshmen weren't cool. You were in the same place doing something similar, but, basically, you didn't have everything in common.

2:40And that's what I learned about older adults. The cohorts of older adults, those who are sixties, seventies, eighties, nineties, and above are just like the cohorts of high school. And so those who are in their sixties have one interest in music and art and books and TV and movies, and they'll very quickly tell you, if they did me, that's my mother's music he brought for 80 year old people, not 60 year old people. And that is something nobody taught me in either of my master's or my doctoral degrees, and I think we're missing that boat too often, in our profession. What kind of, particular needs do you see with the with the elderly, counseling the elderly? How are they, in what ways are they distinct?

3:29Well, actually, they're just an older version of us. And the the needs, however, do vary by some people who are in their older ages will have more physical issues to deal with. Some will have more cognitive issues to deal with. But there's a broad assumption that if you are, quote, old, whatever you think old is and as one of my clients used to say, I don't know what old is, but it's older than me, and I think that's how most folks feel, then there's a presumption that being older means being inefficient, incompetent, and less valuable. And, yes, it's even in our churches, they are treated that way. That's sad. Yeah. So you see this would you how you broke it down sixties, seventies, eighties, and nineties.

4:15Are those sort of the every ten years you would make these distinctions, or or how would you how do you go about getting a feel for the room, so to speak, in in these different age groups? Well, the importance of age cohorts is just as I gave the example of high school. What would be of an interest to a high school freshman would not necessarily be of interest to a high school senior or not quite in the same way. And so if we just lump everybody who's over 60 into one category of old people and, frankly, before I learned this, I did that too. I'm guilty. There isn't one category because by age cohorts, there are interest, interest in music, interest in even look at worship. Look how worship has changed in the years of people who are now 60 and those who are now 80 or 90.

5:02Even that is is is a variation for them. Obviously, the gospel hasn't changed. The message hasn't changed, but styles have changed. And so they become interested in that which is familiar. And don't we all do that anyway at any age? So we have to think about how can we minister to people, how can we counsel people, and be attentive to their ages just as we are in younger ages. We may work with a teenager. We may work with a college student. They are of a different age generation in terms of age cohorts, maybe not a large difference, but there's definitely a difference. I'm wondering, how is how important is it for family to have contact with the elderly? How is that how does that affect their, their mental status, their their emotional, condition?

5:59I my my wife and I, we took care of my my mother when she was, older, and she lived with us for eight years. And, since we did not put her into an assisted living, and we saw that interaction with the family was very seemed very, very helpful at times. Do you see that too, in your in your counseling? Well, with older adults, and that's what we generally refer to in the term as older adults is, you know, these are just people with a lot of life experience. They still have interest. They still want to be with friends. They wanna be with their own age group sometime. Not I mean, family's wonderful. Yes. But remember, our friends are our age group, and their friends are gonna start to die out, unfortunately, or perhaps move away.

6:47So where can we find other types of age cohort interest? A really easy one is a lot of areas have a program called neighborly senior services. And with neighborly senior services, there's a congregate dining at in many cities, not smaller ones, but sometimes larger cities, then maybe some smaller. I'm not sure. And that gives them an opportunity to go and do congregate dining. They have lunch. They have a program. They have people to talk with. And my question is, why don't we do more of that in our churches? Why do we leave that to the world? We may have a senior adult program, but it doesn't have to just be we're all gonna sit down and do a craft or go on a trip. Let's have a regular dining experience.

7:32Let's have just a get together and make our churches a place of welcome for them for more than just the service. Loneliness can be one of the problems that people face as they get older. And, what are some of the what are some of the more you know, you mentioned and I don't know if this is part of it too, but, you know, the how the world kinda devalues people who are as they get older, they think they're all the same. Maybe they're, you know, they're retired and there's a lack of a sense of purpose. What are some of the why do people wanna go and get involved in counseling groups and group therapy? What are some of the main reasons? Are they the same as for younger people or they're kinda you see more frequency of of different kinds of issues that they bring up?

8:15Well, we often divide that into community dwelling elders and, assisted living or other living community elders. Community dwelling elders actually have the greater propensity for depression, if you look at the statistics, than do those living in a congregate facility. They're isolated. Sometimes it may be an older couple. One person is taking care of the other. They may no longer be able to drive, which, of course, limits their socialization, and their friends start to die. The one who is left at the end and my mother-in-law went through that. She when her third of there was a girl the girlfriend group of four that did everything together when they were younger on into the older ages, and then she was the survivor.

9:00And she didn't want to to to do anything else because her group was gone. And we tried really hard to get her to meet new friends, which is another thing that sometimes happens with the older old, eighties and nineties, is they don't want to meet new friends because they know they're gonna lose those friends, and it's only a matter of time. You see that a lot in elder care homes where people become very retreating or very reclusive. They just they they just know that the friendship is not gonna last. But we have to keep trying. We can't give up. What degree would a would a faith perspective help? Right? Because Mhmm. You think about it, and I'm sure this is not so easy when you're in that situation, but, it's it's not that it the real point is these friendships will last.

9:46Right? It's not just about this world. When you're you're making eternal friendships and maybe supporting each other in this very difficult time. Is that something you can help a person in that situation? Absolutely. Now there are some elder care homes that are faith based, and so they would have more activities that are faith centered. But, typically, what you see is they rotate. Every Sunday, a pastor will come in, a priest will come in, someone else will come in, and there might be a brief service, but then the folks just leave. So, you know, my encouragement to every church is if if you are if if you're a priest or your pastor is coming in to do a service, bring some other people with you.

10:27Stay afterwards and chat. Don't just do your service and walk out, because it just they need that connection, and faith connection means showing that they are valued. And so many older adults, especially those who have outlived their partners, maybe sometimes outlived their children, no longer feel that they have value even in God's eyes, and that's heartbreaking. One of the things that, we dealt with when we were taking care of my mother was she would become upset because as time went on, she was able to do less and less, and she and she needed more and more. It was almost as though she was becoming a child again in certain ways. Mhmm. Yes. And what are the ways maybe you can deal with that kind of I'm not sure if it's pride or if it's just panic or what is it, but, not responding well to the fact that you become more and more dependent as you get older.

11:21Well, I have never seen anybody who likes the idea of becoming more dependent regardless of age. And when it is age related and that individual is not cognitively impaired, then he or she knows fully well it's only gonna get worse. So the question is, what can we do? And I suggest this to families. What kind of of tasks can this person do to feel valued in the in the home? And maybe it's folding laundry. Maybe it's, you know, sitting down with listening to the children read if they have reading to do when they come home. Give a sense of purpose. And now that's a lot harder to do in an elder care home because there are so many people to take care of at once. But just realize we all want a sense of purpose.

12:09That doesn't stop because you get older. Your ability to fulfill that person purpose stops, and that is so frustrating. And I and that is what I have seen as a significant part of depression. Yes. Older adults can be clinically depressed. I've had this argument with psychiatrists so many times. They say, well, they're old. Sure. They're depressed. Okay. And, you know, that's about the time I I found this one particular one and said, okay. Let me give you these I have a client, woman, 40 years old. Here's the symptoms. What do you think? Well, we need to treat this. We need to do that. And I go, oh, excuse me. I misspoke. She's 72. Oh, well, that's different. We don't need to treat. I go, excuse me.

12:49Excuse me. The symptoms are the same. Why do you not want to care about treating a person 72 when you cared when you thought they were 42? And so we have some of that ageism feeling, in the medical and the counseling community, and it breaks my heart. We've gotta get out of that. What are some of the there's a great you you mentioned purpose in the sense of purpose. Mhmm. So what what are some good helpful strategies with with folks to to work with oh, we don't know older people. And, you know, they kinda feel like, well, I'm ready I'm ready to go to you know, I'm ready. I you know, I'm so you know, I I I'm ready to move on. And Mhmm. How do we get them, though, to see that there is purpose even in simple things or maybe, strategy that help that?

13:37Well, first of all, think about what is possible to do. What is physically possible? A person who may not be able to walk is not gonna be able to do some of the things another person will. Maybe it's, you know again, it's it's simple tasks. It can also be and that's was the basis of my group techniques for aging adults, is having some groups that have a therapeutic basis but also draw out things like my modalities for spirituality, for life review, for having my older group develop the some of the writing, talk about favorite memories, and then give that to their families as something special. And for an older adult at home, we have the perfect opportunity, my goodness, even on our cell phones, is to sit down and ask your grandparent, you know, what was some of the favorite traditions when you were growing up at Christmas?

14:30What was your what was the most important first faith tradition that you participated in? You know, think about these things and tell that story. Older adults enjoy reminiscing or remembering the story, and it's it's a treasure that so many of us didn't have when our grandparents passed years before we had that ability. This is a true treasure. We need to treat it like a treasure and not just, oh, well, grandma's talking about the same old thing again. Yes. She is. But, you know, I have young clients who do that too. One of the things that we saw taking care of my mother is, the importance of letting her know or seeing that she's still important to the family. Mhmm. Yes. You might not be able to fold clothes or do whatever, wash dishes or whatever, you know, small task might be available, but just giving her the sense that she is an important part of the family.

15:27And, you said listening to her life experiences, but also maybe asking for advice at times. You talked about how they have a wealth of experience Yes. Asking for advice. Now you might not take their advice, you know, but at least you listen and you weigh it. And they get the sense that they get the sense that you're listening to them. How important is that? Well, it's as important to them as it is to any of us because one thing that we know is that, at least in most cultural context, when you are listened to, you are considered valuable. And so if we fail to listen or we wanna, oh, yeah, mom. I heard that story before. Yeah. We know what happens. When we don't listen to people, we devalue them.

16:12And, yes, there's gonna be repetition. That happens. But listening is so important, and I can't tell you how many nuggets of wisdom I have gained from listening to my older adult clients, really more than I imagined. I sometimes feel like they give me more than I give them, and I think that's but in family, it's harder, again, because it's easier to get frustrated. Well, mom, you I I've heard that story since I was, you know, 20 years old. And, you know, patience. It it is so important and so valuable and so therapeutic, frankly. Yeah. Listening is important. Right? And, I would guess, would it also be helpful for younger people when when they are, you know, benefiting from that wisdom and advice that they tell them, hey.

17:00I'm so glad you told me that. That's very helpful, you know, or or I didn't understand, some of the things about our family history. Now that that's I'm so glad you you did that. So Yes. That they can understand that they do have a purpose and that they are, you know, certainly contributing to everybody and really passing on that wisdom is such a great to be a vocation, you could say. Somewhere, our culture changed for the worst. In in generations past, older adults were valued, and listening to them was valued. And the grandchildren respected and honored them, And we don't do that anymore. Our culture has changed to say, well, if you're old and you can't do certain things, then your value as a human is less.

17:49And that leads us down to a real slippery slope that that we need to talk about more in our faith tradition. There's a lot of attention on abortion, and I'm not saying that that's not a good idea. But there's that other side of life, and that's euthanasia. And when we devalue any group of people, then society can do what it wants to do. And there are other countries where euthanasia is legal. This discussion comes up in our nation periodically, and that is a devalue to me, a severe devaluation of human life. And I really wish that we'd get more concerned about that. Because as life goes longer and people live longer with conditions like dementia and Parkinson's and others, there are families who get frustrated and say, nah.

18:39You know, they're just not really useful. Not to mention those that have nefarious intents. They want grandma's money. That's an issue that I I just wish our faith community would get more concerned about. It's a great point you make because, usually, you know, all seems to me, all the pro lifers and Chris were, oh, yeah. We're all we're we're against euthanasia. But it's kinda like we throw it in there. Yeah. Conception to natural death. And then we kinda don't always, we think more about the front end, which which is critically important. But at the same time, when we do a disservice to the entire cause of life and we sort of discount Mhmm. The importance of protecting life at the final stages, where we're almost kind of agreeing with the secular mentality, well, these people aren't worth it anymore.

19:29So we sort of put them on the side. And That is a serious issue. And, you know, we're we're there in my family. I my husband has dementia. It's difficult, and it's getting more difficult. But all you know, God decides these things. We don't get to decide them, and all life has value. The value is different because the ability to participate in life is different. And so we we work with that, and it is challenging. I've taught families about dementia for years, and now, literally, I'm living it. So and by the way, those of you who are listening, just because I know a lot about this doesn't make it easier, in case you wondered. In fact, sometimes it might be harder because I know too much. But this is the one thing I do know, and I knew this when I was writing about it and when I've been working with staff about it, because you value is there where you find it, but it's only there if you try to find it.

20:24And it's going to be different, and the person that you're with is gonna is going to lose some skills over time and be frustrated. And you have to do what I tell my counseling students. Tell your face. Don't let your face show frustration. Don't let your face show disappointment because even people in dementia who lose words don't lose the idea of seeing how you look. So when you look at them with disgust and frustration, they pick up on that really easily. So tell your face and just remember that but for the grace of God, someday, that might be you. How do you want somebody to treat you? That's what I tell tell caregiving families. How would you want this if you were on the other side? I think the answer might be different.

21:09And, yes, it's hard. That's why caregiver groups are important. Seems like one of the cultural pressures today that, you talked about how culture has changed. Mhmm. We've become so mobile, and we don't we don't generally speaking, we don't stay in one place for long periods of time. We're moving. Families are moving, changing jobs. And to, and it it's it's a pressure to kind of break up families. Those that can't keep up don't come. My my, my father-in-law worked for one company for forty years up in New York, Upstate New York. He was a chemist for Xerox. And, who does that anymore? You know? And they can build there's an extended family built around him that grew up around him. But most of us are on the move, and it's it's it's more of a challenge, I think, to bring extended family with you.

22:09So what what could be other cultures don't, you know, other cultures not all all cultures have the same mobility, problems or challenges. How how how do you deal with that? I mean, that's the way our culture is today. How do you how does that affect the the the, the elderly? Well, it is very difficult, because families are not living down the street from each other like they formally did or wanting to maybe everybody moves over to grandma's house to help take care of grandma. That's not common today. And so I've talked about before with family groups is that there are sometimes caregivers who are on the scene, and there can you can still be a distance caregiver. Now that sounds like an oxymoron at first, but there are times when family members live elsewhere because they are their jobs, they're in the military.

22:59Whatever the reason is, they can't be in the same place. They can't pick up and move. But there's a lot of there's a lot more services now in many communities, caregiving services, visiting services, and an underutilized resource for families is the area agency on aging. Every major metropolitan area has a headquarters on area agency on aging. It may not be in your immediate city, but look for the nearest large city. There are so many services available through area agency on aging that you can get for your older adult who's living with you even. But, definitely, you can help to arrange, those sorts of services and others if you are a distance caregiver. And at times, Tom, that's the way it has to be because people are either deployed.

23:47They're they have jobs elsewhere. They're going to school elsewhere. It's it's just, people are not all staying down the street from each other anymore. It's not the way we live. One of the challenges we faced dealing with my mother is, to get some of that care you might be referring to was expensive. And, are there different groups that are maybe volunteer or, less expensive? Some of them are just out of many people's price range. Well, it act it depends on a number of factors. Area agency on aging does serve a lot of needs regardless of income, and the income would be considered that of the older adult, not necessarily that family. Now if you're talking about moving into a facility, then that that could go in either direction, the individual's income or the family support income.

24:40But caregiving at home, it you can also bring in just those people that you need to help. But for a while, for the last couple of years, actually, I've had a a a bath aid come in and assist for my husband, and which he would come in, you know, once a week and help us with that. So sometimes if you think about, okay. What specific task do I need assistance with by someone else, and which ones can we do ourselves as a family? And then you can get down to a level of participation that that is not as expensive potentially. So sometimes we can't necessarily do it all. We're we're well meaning, but some things are out of skill. Some things are out of my skill. That's why I bring in people people to to assist.

25:26And there are there are some subsidies in their different communities. You can also check with the Alzheimer's Association, people, who are caregivers for an individual with who's diagnosed with dementia. That is an underutilized resource. Can't do it all right ourselves. Kinda related to this. It sounds like there are a lot of things we could do at the church level. Yes. And I just wanted to say, you know, and I think obviously the leadership, the pastors and the priests need to be have a role in that, but I would throw a challenge out, you know, pastors and priests can't do it all either. You know, if you're Mhmm. If if this issue is on your heart, why not try and start something at your church and and say, hey.

26:13Get a little group of people together of of, church goers or parishioners and and go to the pastor and and talk to them about it. Because I find that when when you have a group that's willing to take responsibility for it, it's very easy to say yes to it. Right? If you're not if if we're waiting for the church the leadership to do everything. There's some really simple things, and I'm so glad that that you're championing that idea, father Charles. There are simple things you can do within the church. One of the things that I've seen a number of groups do and I've discussed with them is, you know, in some churches, there is, maybe there's a nursery for the children or a playroom for the children so that the parents can attend mass or service.

26:58And that's great, but nobody thinks about what about some older adults? Some people with dementia will shout out. They will make noises. They will fidget, and it's difficult for their family to really focus on worship. So it would be easy during maybe one service. There only has to be one service even if there's multiple. One service, one mass. You have a group of people who are willing to volunteer to do crafts or games or music with the older adults who have dementia while their family members can attend mass or service and not have to worry about that. Really just focus on worship. We're talking about giving a couple of hours a week, and you have no idea. So many caregiving families drop out of church, not because they're dropping out of church, but they know if they bring their person to mass or to service, who knows what might happen?

27:50There might be an outburst. There might be a shout. Never know what's gonna happen. And so they don't come, and they lose that. Oh, goodness. No. You know as a as a priest how much families need spiritual strength at this time. This simple thing of literally caregiving, doing an activity with a group for a couple of hours on Sunday, that would be that would be a almost a miracle to many families. And I think every church could do that if the members would just make that commitment. Doctor. Irwin, we have just a few minutes here left in this podcast. And I wanted to ask you, in your experience, you're you are in the counseling program here at Divine Mercy University. Could you summarize what the perspective is or maybe the different perspective of your, your class or the counseling program here at Divine Mercy University, maybe, versus other programs you've seen?

28:44Well, other programs I've taught in for that matter. Well, of course, we are faith based, but I believe even even as a value added to being faith based is that we we have a faculty who are highly steeped in their professional abilities. And then when you when you add faith to it, to me, that's like the secret sauce. That just takes it to a whole different level because we, as humans, are mind, body, and spirit. And when counselors only deal with the mind and the body, you've got an entire segment of a human that is not being attended properly. And putting them together is, I have found as a professional counselor, the most powerful way to help people when you bring God into the equation. It's very good.

29:32Now if someone has a a a follow-up question for you, how might they contact you? I think you gave your email address in our earlier Absolutely. Can you give me that? I would be happy to. It's kerwin@divinemercy.edu. And I would love to hear from any of our podcast listeners. Happy to recommend any resources. And if you're interested in learning more about gerontological counseling, I'd be happy to give you some direction and ideas about that. Well, doctor Erwin, I'd like to thank you very much again for this very interesting, talk. And, I hope people will follow-up with you and, and you'll be able to help them. And I look forward to talking with you again, in future podcasts and, just wish you a wonderful day and, and I look forward to talking with you again soon.

30:23Thank you, Tom. Bobby Charles. Good. Good to be with you.