Group therapy
For some patients group support, often in the setting of a day hospital,
is a good means of meeting and working through problems including
dependency needs. It is often less intense than one to one therapy, and
less likely to lead to regression. Groups can help some older people with
social functioning, especially those who have been isolated. Some special
difficulties with group therapy in the elderly include deafness and
somnolence. Avoiding meeting after heavy meals; using comfortable but
supportive chairs; a well ventilated room; and a minimum of extraneous
noise, help to keep everyone awake and able to hear. Meetings should
not run for longer than half an hour.
Dobson & Culhane (1991) describe a therapeutic group run for older
women. They emphasise the importance of having a clear purpose for a
group and considering selection criteria carefully. In the early stages,
rules such as not talking while others do, and valuing others’ contributions,
helped to harness good intentions. Finances, losses and reminiscences
were powerful themes. The group ended after plenty of notice had been
given, and a photograph taken on the penultimate session. The leader’s
responsibilities are defined in Box 17.3.
Family therapy
Most informal carers are close family members, and the problems shown
by an older family member may reflect family pathology. Family therapy
remains primarily associated with helping children, but there are now a number of established examples of its application to older people
(Brubaker, 1985). The adaptations required are relatively minor, although
they include all the general rules for involving older people in
psychological treatments (Box 17.1). There may be problems with
communication, for example deafness or poor vision, which can
compound the effects of ageing in reducing information processing
capacity. The overall effect is to make demanding tasks such as therapy
very difficult. Physical or mental illness can be used to scapegoat the
older person. Conversely, symptoms of physical illness can be accentuated
or become an important vehicle for the older person’s status and power
(West & Spinks, 1988) (Box 17.4)