Psychotherapy with Older Adults

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Bob G. Knight

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    Acknowledgments

    Jim Brace-Thompson, my editor at Sage Publications, initiated the idea that it was time to begin working on a third edition of this volume. He has been patient and supportive throughout the process, particularly during delays imposed by other professional demands, including grant administration and my becoming Director of Clinical Training in the University of Southern California Psychology Department. It is a running theme in our conversations that an oddity of our professional lives is that we typically meet at conventions all over the United States and Canada, even though we live in neighboring towns in Southern California. Claudia Hoffman and Catherine Chilton guided the book through the postproduction and copyediting phases with considerable skill, patience, and grace.

    The intellectual and professional influences on me have multiplied and grown so much over the years that any listing is sure to be incomplete and therefore to delete some who should have been included. Margaret Gatz is a long-term colleague and has continued to influence my thinking about psychotherapy with older adults, especially when we coteach the course on that topic at USC. My students and clinical supervisees at USC constantly teach me as they learn from me. Sara Qualls of the University of Colorado at Colorado Springs, in many conversations at conventions, has stimulated my thinking about doing and teaching psychotherapy. Michael Duffy of Texas A&M has challenged me often to examine in new ways what I have said and written, and he was a key influence on my decision to include the chapter on psychotherapy with persons with dementia. David Powers and Lynn Snow also provided encouragement and inspiration for the chapter on dementia.

    Several British geropsychologists have become strong influences on my thinking about this book and about psychotherapy with older adults, including Murna Downs, Mary Gilhooly, Fiona Goudie, Ken Laidlaw, and Bob Woods. Carolien Lammers helped to frame for me the distinction between approaches to psychotherapy rooted in life span developmental psychology and its concern with normal aging and those approaches that are more purely clinical and therefore rooted in the psychopathology of aging. This distinction highlights differences between national approaches to the topic as well as differences between training models within nations.

    Lucio Bizzini at the University of Geneva Hospitals challenged me to think more about the distinction between healthy aging and frailty in later life and influenced changes in this edition. Inger Hilde Nordhus and her colleagues at the University of Bergen (Norway) were among the first to encourage me to think beyond the boundaries of the United States with regard to psychotherapy and aging, and they also provide a good model for theoretical integration of psychodynamic and cognitive behavioral approaches with older adults.

    And, of course, thanks to all of the older adults who shared their lives with me or with the trainees that I've supervised (and so with me via recording of their therapy sessions). Their active participation in, and resistance to, the therapeutic process is the foundation upon which this book rests.

    Preface

    The knowledge base for psychotherapy with older adults continues to grow and to refine the image of later life that can inform and guide clinical work with older adults. Since the second edition of this book went to press in 1995, a number of books and handbooks related to this topic have appeared, and the pace of research both in clinical geropsychology and in the basic science of life span developmental psychology has increased. One goal of this revised edition is to incorporate these new findings, both in updating information and in revising the contextual, cohort-based, maturity, specific-challenge (CCMSC) model in some respects.

    There are two new chapters in this volume. In several conversations with other clinical geropsychologists since the second edition appeared, I have been asked why I have not addressed working with clients who have dementing illnesses. When Sage asked me to work on this revision, the reviewers that they contacted also mentioned the lack of coverage of psychotherapy with persons with dementia in earlier editions. It is one marker of the changing attitudes toward psychological interventions with persons with dementia that this would be a consensus request at present. A chapter on working with persons at various levels of cognitive impairment appears in this edition.

    The second chapter also covers an omission that occurred to me shortly after the publication of the second edition. Although I have been professionally involved in services to caregivers since 1980, helped to organize one chapter of the Alzheimer's Association, and have been faculty director of the Los Angeles Caregiver Resource Center since 1989, the earlier editions of this book have not specifically covered psychological interventions with caregivers of the frail elderly. Clearly, caregiving is one of the specific challenges of later life and so deserves the new chapter devoted to it in this volume.

    Another change in this volume is the incorporation of some of the case material from Older Adults in Psychotherapy (Sage, 1992). The integration of these case examples in abbreviated form into the discussion of psychotherapy is intended to enrich and provide concrete examples of the points covered in this discussion of changes in psychotherapy when working with older adults.

    As with the previous editions, this volume continues to draw upon findings in life span developmental psychology and in scientific gerontology to explore how psychotherapy needs to be adapted for work with older adults. In general, the answers to this question are rooted more in differences among cohorts born at different points in time, in differences between the social contexts of older and younger adults in our society, and in the distinctive challenges of later life rather than in aging as a developmental process.

    This distinction between aging itself and other influences on older adults' thinking and behavior is sometimes salient and sometimes subtle, but it is always important in the accurate understanding of what it means to be an older person. As is explored in this volume, the distinction is important for both therapist and client.

    Working with older adults is a challenging and often touching experience. The problems faced by older clients often cut across the typical boundaries between medicine, psychology, and social services. Working with members of earlier born cohorts expands our awareness of human diversity and of the scope of societal change over successive decades. Working within the sometimes distinctive social contexts of older adults teaches us what we as a society do to the elderly as well as for them. For myself, the field of psychotherapy with older adults has been rewarding both intrinsically and extrinsically I hope you find it so as well.

    Bob G.Knight
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    About the Author

    Bob G. Knight, Ph.D., is the Merle H. Bensinger Professor of Gerontology, Psychology, and Counseling Psychology at the University of Southern California. At USC's Andrus Gerontology Center, he serves as Director of the Tingstad Older Adult Counseling Center and Faculty Director of the Los Angeles Caregiver Resource Center; in the Department of Psychology, he is Director of Clinical Training (2002). His research interests include caregiving, emotion and aging, and mental health policy and aging, and he has published extensively in mental health and aging, including Outreach with the Elderly (1989) and Older Adults in Psychotherapy: Case Histories (Sage, 1992). He is Senior Editor of Mental Health Services for Older Adults: Implications for Training and Practice in Geropsychology (1995) and a coeditor of A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-Stage Context (1996). He has been active in various professional organizations relating to psychology and aging: He served as President of Section II, Division 12 (Clinical Geropsychology) of the American Psychological Association in 1997 and as President (2003–2004) of APA Division 20 (Adult Development and Aging), as well as Chair of the APA Committee on Aging in 2001. He received his Ph.D. in clinical psychology from Indiana University, Bloomington. His professional experience in working with older adults began while he was working at the Urban League of Madison County (Indiana), where he organized and served as first President of the Madison County Council on Aging in 1973.


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