| Marie Jones is a 73-year-old woman who lost her | | | | therapy Itself. Once you have decided you have the |
| husband last year after almost 50 years of marriage. | | | | skills to treat Mrs. Jones, she must be fully informed |
| Her complaints are memory problems, poor appetite, | | | | about the process of therapy, including your |
| and low energy. Mrs. Jones told her physician that her | | | | therapeutic style, fees and billing practices, |
| children think she should move into a retirement | | | | confidentiality, and the risks and benefits of treatment. |
| community, but she is hesitant to give up her home. If | | | | She may need additional information about potential |
| Mrs. Jones or someone like her was referred to your | | | | recommendations such as psychological testing, |
| practice, would you be prepared to treat her? If you | | | | bereavement groups, or a medication consultation. |
| are like many other providers in the helping community, | | | | Once Mrs. Jones is given the information she needs to |
| the answer is most likely no. As the 20th century | | | | understand your work with her, she will then be better |
| draws to a close American society is graying. Life | | | | prepared to give informed content. If you have any |
| expectancies have increased dramatically during the | | | | doubts about her competence to give consent, further |
| past 75 years, and the number of community dew | | | | evaluation will be needed before you begin treating |
| willing seniors is steadily rising. The stressful associated | | | | Mrs. Jones. This is Important for the provision of |
| with aging, such as environmental changes, retirement, | | | | ethically sound therapy and for the clients own safety. |
| loss of partners, and coping with Illnesses are all issues | | | | If Mrs. Jones does not appear to understand the |
| that could be addressed in psychotherapy. Yet very | | | | therapeutic contract, she may have problems outside |
| few graduate programs offer training opportunities in | | | | the therapy room that need to be quickly addressed. |
| clinical gerontology. | | | | Memory loss or decreases in functioning do not equal |
| Even when training is available, ageism may lead some | | | | incompetence, but they can serve as red flags for a |
| therapists to assume that emotional growth and | | | | comprehensive assessment. |
| change among seniors is limited, and therefore not | | | | *Release of Information* |
| worth professional pursuit. Counter transference, often | | | | You have been meeting with Mrs. Jones for about |
| based on personal fears of aging or family issues with | | | | two months when her son comes to visit from |
| parents/grandparents, can also pull people away from | | | | another state. He is very impressed with the |
| treating seniors. Whether the reasons are personal or | | | | Improvements he sees in his mother's mood and |
| professional, treating older adults when you are I'll | | | | self-care but continues to wonder whether his mother |
| prepared leaves the door wide open for ethical | | | | should move into a care facility. He also believes that |
| dilemmas and potential malpractice. | | | | some of his mother's problems relate to the physical |
| *Before the Work Begins* | | | | abuse she endured during most of her married life. He |
| Psychotherapy is an intensive exploration of personal | | | | calls and leaves you this information and asks that you |
| values. Understanding your own value system and | | | | return his call without telling his mother he has been in |
| how it Impacts your work is the cornerstone of ethical | | | | touch. This phone message presents many problems |
| practice. Your beliefs drive the counseling process | | | | for you. First, Mrs. Jones has yet to mention that her |
| forward, even in the most non directive of therapies. | | | | husband was abusive. She has presented her |
| As Christians, it is easy to underestimate the | | | | marriage as happy and stable. Second, Mrs. Jones |
| Importance of values clarification. Loving God, loving | | | | decided not to sign releases of information for her |
| our neighbors as ourselves, and believing in the healing | | | | children, because they worry enough about me and |
| power of Christ are all values that would appear to be | | | | this would just make it worse. Her son learned about |
| self-evident within the Christian counseling community. | | | | her therapy from the family physician, who reported to |
| But there is tremendous diversity within the Body of | | | | the son that Mrs. Jones memory problems and |
| Christ as we will as many different understandings of | | | | depression seemed to be decreasing. When faced |
| health, healing, pathology, and change. | | | | with this turn of events, you must remain focused on |
| Assessing and articulating your values in the field of | | | | your client. You do not have access to Mrs. Jones son, |
| gerontology will involve prayerfully considering difficult | | | | as much as he would like to be helpful. In addition, you |
| questions. For example, what are your beliefs | | | | now have Important therapeutic information that must |
| regarding the ending of life? If your client wanted to die | | | | be sensitively addressed with your client. Honesty |
| by stopping painful medical treatment, how would you | | | | within the therapy demands that you let her know |
| decide what to do? Would your decision be different if | | | | what has happened and work with her to reach a plan |
| your client was 65 or 85? Would your behavior place | | | | of action. |
| you in conflict with accepted community standards of | | | | *Limits of Confidentiality* |
| practice or with state regulations and laws? Values | | | | When told about her sons call, Mrs. Jones states that |
| guide us, and they guide our clients. Once you have | | | | her husband had been an active alcoholic for most of |
| taken the time to identify your values about the aging | | | | their marriage. During that time, he was physically |
| process and about older persons, you will be better | | | | abusive. His eventual failing health led to his sobriety, |
| able to see how thesis will Impact your work. Being | | | | and they spent the last 10 years of their lives together |
| aware, being clear, and being open respects both the | | | | in a peaceful and relatively happy relationship. Mrs. |
| process of therapy and the individual client. It also helps | | | | Jones also reveals that her youngest son, who lives |
| you steer clear of many ethics-related pitfalls. | | | | next door, is also an alcoholic and sometimes |
| *Common Ethical Dilemmas in Gerontology* | | | | becomes so angry that he hIt's her. An essential |
| Mrs. Jones has now been referred for counseling by | | | | aspect of ethically sound gerontological practice is |
| her family physician. He is concerned about her | | | | having a thorough understanding of elder abuse. It is |
| memory problems and wants a second opinion. He | | | | possible that some of the depression and cognitive |
| also thinks that Mrs. Jones is isolated and could benefit | | | | problems observed in Mrs. Jones could be attributed to |
| from talking to someone about the relatively recent | | | | the abuse she has been experiencing. The shame |
| loss of her spouse. Are you the appropriate referral? | | | | associated with being abused by their children leads |
| Even with the limited information we have about Mrs. | | | | many adults to keep the violence hidden, but the stress |
| Jones, there are many clues that can direct her mental | | | | and trauma are often exhibited indirectly. It is your |
| health treatment. Her complaints may indicate the | | | | responsibility to know the laws in your state regarding |
| onset of a dementia, but they can also suggest other | | | | the limits of confidentiality and the reporting |
| problems, such as depression, uncomplicated | | | | requirements for suspected elder abuse. This |
| bereavement, failing health, or even elder abuse. | | | | information should be shared with your clients when |
| Psychological assessment, individual therapy, and family | | | | treatment begins, so they have the power to decide |
| therapy may all be appropriate parts of her treatment | | | | when and how to share this information with you. |
| plan. As a provider, you must first evaluate your own | | | | Online Christian Counseling is a nice way to get |
| level of training and expertise. Just as you would not | | | | suggestions. |
| think of treating children without adequate training, the | | | | *In Closing* |
| same standard applies to gerontological practice. If you | | | | The best way to avoid ethical problems in |
| feel that you are under trained, you will need to access | | | | psychotherapy with any population is antecedent |
| old_resources such as supervision, continuing | | | | control. Recognizing the limits of your training, |
| education, and consultation to assist your work. The | | | | participating in continuing education, making sure you |
| most ethical decision may be to refer this client to a | | | | have safety nets in place to assist your practice, and |
| colleague and take the time you need to develop your | | | | staying in touch with colleagues are all Important |
| skills. | | | | safeguards against ethical violations. As Christian |
| *Consent to Treatment* | | | | therapists, we have made a commitment to be Gods |
| Many older adults are unfamiliar with the process, | | | | instruments of healing in a broken world. This demands |
| demands, and expectations of psychotherapy. | | | | not only that we practice with the highest ethical |
| Although the senior community is rapidly becoming | | | | standards of our profession, but that we constantly |
| more psychologically sophisticated, there are many | | | | remain open to the work that God can do through us. |
| older persons who believe that counseling is only for | | | | Knowledgeable, we will-trained, and self-aware |
| really crazy people. They may be more comfortable | | | | clinicians who know their values, strengths, and limits |
| with a traditional doctor/ patient relationship and may | | | | are going to be best equipped to meet this higher |
| not know what to expect from a therapist or from | | | | standard of care. |