Chapter

Clinical supervision for psychotherapy with older adults

Bob G. Knight

in Casebook of clinical geropsychology

Published on behalf of Oxford University Press

Published in print September 2010 | ISBN: 9780199583553
Published online February 2013 | e-ISBN: 9780191754678 | DOI: http://dx.doi.org/10.1093/med/9780199583553.003.0007
Clinical supervision for psychotherapy with older adults

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In this chapter, I have focused mainly on common elements across supervision experiences in teaching psychotherapists to work with older adults. These shared themes have included common errors in assessment and case formulation, including those related to positive stereotypes of aging and positive attachment to older clients. Relationship issues including cohort competency, cultural competency, focus on the older adult as the real client, and handling comments on one's relative youth are also important and frequent issues in supervision in professional geropsychology. Finally, therapists new to working with older clients often experience difficulties interrupting clients and keeping them on topic, confronting older clients, and terminating the therapy relationship.

Working with clients who are further along in the life cycle than oneself is personally challenging in ways that can lead to considerable professional and personal growth. As noted by Qualls et al. (1995, p. 125), “The clinician's beliefs about his or her own future, aging, and death create a relationship dynamic with the older client that is ripe with countertransference possibilities.” They list potential themes of relationship problems that can arise for the supervisee, including: (a) feeling overwhelmed by the client's multiple problems and the need to gain knowledge from other health disciplines; (b) anxiety about the need to collaborate with de facto interdisciplinary teams caring for an older client; (c) blaming others in the client's support system for not caring enough as the therapist sees herself as “the good child” in the system; (d) resisting taking on unfamiliar roles like case management; and (e) handling issues related to death and grief. These are not only the bane of young professionals; the middle-aged and older therapist can be even more vulnerable to identification with the client and wanting the client to handle issues in the way that the therapist would.

The goal of clinical supervision is to assure that the therapy remains the client's therapy. Good geropsychological supervision is essential to having active therapy that is focused on the older client's issues. Nonetheless, through supervision on such cases therapists also learn important lessons about the nature of therapy and about their own aging: future, present, or recent past.

Chapter.  6915 words. 

Subjects: Psychiatry ; Geriatric Medicine

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