the journal of the b c psycholo gical a sso ciation
Volume 3 • issue 2 • sprin g 2014 • agin g
BC PsyChologist
EDITOR IN CHIEFTed Altar, Ph.D., R. Psych.
AssIsTANT EDITORMarian Scholtmeijer, Ph.D.
PUBLIsHERRick Gambrel, B.Comm., LLB.
ART DIRECTOR Inkyung (Inky) Kang
ExECUTIvE DIRECTORRick Gambrel, B.Comm., LLB.
ADmINIsTRATIvE DIRECTOREric Chu
ExECUTIvE AssIsTANT Rukshana Hassanali
BOARD OF DIRECTORsPRESIDENT
Ted Altar, Ph.D., R. Psych.
VICE-PRESIDENT
Don Hutcheon, Ed.D., R. Psych.
TREASURER
Marilyn Chotem, Ed.D., R. Psych.
DIRECTORS
Michael Mandrusiak, Psy.D., R.Psych.
Douglas Cave, MSW, RSW, Ph.D.,
R. Psych., MA, AMP, MCFP.
Yuk Shuen (Sandra) Wong, Ph.D., R. Psych.
Murray Ferguson, Psych.D., R. Psych.
mIssION sTATEmENT
The British Columbia Psychological Association provides leadership for the advancement and promotion of the profession and science of psychology in the service of our membership and the people of British Columbia.
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ADvERTIsING POLICYThe publication of any notice of events, or advertisement, is neither an endorsement of the advertiser, nor of the products or services advertised. The BCPA is not responsible for any claim(s) made in an advertisement or advertisements mailed with this issue. Advertisers may not, without prior consent, incorporate in a subsequent advertisement, the fact that a product or service had been advertised in the BCPA publication. The acceptability of an advertisement for publication is based upon legal, social, professional, and ethical consideration. BCPA reserves the right to unilaterally reject, omit, or cancel advertising. To view our full advertising policy please visit: www.psychologists.bc.ca DIsCLAImERThe opinions expressed in this publication are those of the authors, and they do not necessarily reflect the views of the BC Psychologist or its editors, nor of the BC Psychological Association, its Board of Directors, or its employees.
Canada Post Publications Mail #40882588
COPYRIGHT 2014 © BC PSYCHOLOGICAL ASSOCIATION
BC PsyChologist
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contents
Letter from the President
Letter from the Executive Director
BCPA News
Invitation LetterPiece of Mind Exhibition Opening Night
Meaning Therapy Workshop Registration Form
Features
Factors Contributing to Healthy AgingDr. Paul Pearce & Yuk Shuen (Sandra) Wong, Ph.D., R. Psych.
AgingMarilyn Chotem, Ed.D., R. Psych.
Positive Aging in CanadaPaul T. P. Wong, Ph.D., C. Psych.
Psychotherapy for EldersTed Altar, Ph.D., R. Psych.
Metacommunication in Organizations — Four Principles to Keep in MindDonald Hutcheon, Ed.D., C. Psychol (UK)., R. Psych.
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4 Spring 2014
Dear colleagues anD frienDs,
Every February, as you may know, is Psychology Month. This was
originally started by the Canadian Psychological Association in February
of 2005 and BCPA has been involved every year. The purpose is to try
to generate local or grassroots events and activities to help raise the
awareness of our fellow British Columbians about our role as psychologists
and the role of psychology itself in bettering the lives of all.
All Psychologists are encouraged to do what they can to help their
communities understand the value and benefits of our work. We want
ultimately to increase support for psychological services, psychological
research, and psychological education and training. This promotion is of
course best achieved by us as psychologists, who know psychology and its
historical development best, and can best explain its great contributions to
knowledge and health, and its current benefits for all British Columbians.
Some things that BCPA has done and which we can all help do as
well in our own communities, include, organizing a Public Lecture/Seminar
or Workshop or panel discussion, having an information Session or board
at your clinic or office, showing a film, writing a newspaper or newsletter
article, participating in a letter-writing campaign, asking your library to
create a “Psychology Display”, and so on.
On behalf of BCPA, Dr. Patrick Myers generously gave a free
presentation about the two primary requirements of a successful long
term relationship and two life skills required to navigate a couple’s journey
through life. Dr. Kenneth Cole also graciously presented a free lecture on
February 12 at the Central Library in Vancouver on the “Top 10 Strategies
for Supporting Persons with Autism Spectrum Disorder”. Finally, let
us also thank Dr. Merv Gilbert for doing a workshop on February 20 on
Creating a Psychologically Healthy Workplace: Strategies for Employees
and Employers. As you may know, Dr. Gilbert also chairs the BCPA
Healthy Workplace Committee. This series of free workshops for the
public were promoted through the Vancouver Public Library and all of their
branches. BCPA also sent out mail announcements to over two hundred
sites (hospitals, clinics, schools, neighbourhood houses etc.). Of course,
you may have also seen our regular e-blasts to members, but we also send
e-blasts to various health associations, community groups and businesses
(about 150). In addition, we have utilized event websites like “Vancouver
is Awesome” and “eventbrite”. BCPA was also present on March 1 at the
2014 Diversity Health Fair.
In former years we did ads in the movie theatres but this year
we have a very tight budget and it was determined that we could not
afford ads for this year. We must, finally thank the many participants
who attended, on February 28, the BCPA workshop by Dr. Joel Paris, “The
Intelligent Clinician’s Guide to DSM-5”. I believe that this was the most
well attended workshop that we have had in many years. Thank you again
for your support.
This issue of our Journal on older persons applies to us all, young
included, since we must age. Projections by Statistics Canada (2006)
teD altar, ph . D. , r. psych .
The President of the BC Psychological
Association. Contact for the Board of
Directors at [email protected]
letter from the President
BC pSyChologiSt 5
referencesBrown, R.L. (2011). Economic security in an aging Canadian Population. SEDAP Research Program, McMaster U. Available online at: http://socserv.mcmaster.ca/sedap/p/sedap268.pdfRobson, W.P. (2001). Aging populations and the workforce: Challenges for employers. Final draft paper for the Working Group on Business and the Challenge of Aging in the Western World. British-North American Committee. Available online at: http://www.cdhowe.org/pdf/bnac_aging_workingpaper_3.pdf
indicate that by 2031 senior Canadians will comprise one
quarter of the total population. Unfortunately, there have
been magnified projections about how the aging population
will put undue pressure on our health care and social
security systems. Some have proclaimed that the potential
increase in costs will be unaffordable and that this pressure
may amount to more than fifty percent of Canada’s GDP
(Robson 2001). With such claims of economic disaster,
older adults are to be burdened with yet another worry for
their golden years. Should none of us should retire until
necessary due to failing health? Postponing retirement
would be more viable for occupations that don't require
physical strength and endurance, like occupations in the
field of psychology. What the public does not often hear in
this debate is that the projected dependency ratio of Canada
of both youth and older persons will be no greater than it
was in sixties and even in 1971, when the dependency ratio
was 90 people dependent on government services to every
100 people of working age. The future dependency ratio in
2056 will reach a peak of 85. Of course, the argument is that
older persons will consume more social service and health
care costs than children and youth. This does not apply to all
persons over 65 and in fact those 75 and older will only grow
from 5.8% in 2001 to 6.7% in 2015. Were we to even assume
that persons over 65 consume half of health care costs, the
increase would only be 1.1% of expenditures as a percent
of GPD. Given future economic growth at just a moderate
level, Canada can easily afford the aging population without
raising the age of retirement (Brown, 2011).
Regardless of the arguments in the literature,
hardly a week goes by without another article in the
media about the pending health care cost crisis (see
for example, The Globe and Mail, 2010). Normally,
these commentaries are couched in a context of
population aging.
In particular, we know that population aging per se
accounts for very little of the increase in health care
costs in the recent past and it will not be the key
driving force over the next three decades (Evans et
al, 2001). This myth that population aging is the key
factor in rising health care costs is used by those
who seek more funding for their part of the system.
It is a convenient factor since the system has no
control over it (“it is not our fault”). McIntyre et
al. (2003) projected real growth in health care
costs of 2.6% per annum made up of 0.9% for
increased per capita consumption/service levels,
0.9% for general population growth, and 0.8%
attributable to population aging. (Brown, 2011,
p. 28)
Whether or not you agree that we are headed
for an economic problem, we can all agree that if
Governments are serious about reducing health care
costs, then Psychology will play a vital role in that
endeavour. The real increased costs to health care will not
be due to an aging population alone. In fact the greater
proportion of costs are coming from the increased use of
services by all age groups. We are seeing medical health
professionals more frequently, undergoing more tests
and procedures, and receiving more prescriptions. What
cannot be ignored is that it is relatively healthy adults of
all ages that are driving up costs. The high costs of ever
more sophisticated interventions and the more frequent
use of prescription drugs has and will continue to drive
up costs more than the increase in the dependency
ratio of older persons. Psychological treatments for
depression and many anxiety disorders can be more
cost effective than medications. Health psychology
reduces costs in terms of promoting drug-free methods
of stress management and in developing motivational
programs that work in helping people adopt healthier
life style changes. Those psychologists with training in
psychopharmacology and who have prescription rights
have been shown to reduce reliance on medications since
the right to prescribe is also the right to un-prescribe.
The current incentive system for physicians is to
prescribe, but psychologists with both capabilities — of
prescribing and treating through psychotherapy — can
better determine when psychotherapy is to be employed
with or without psychotropic medications.
The aging population is not something to fear
or lament. It is another opportunity for psychologists
to make their contributions and show both the public
and government that real savings are to be achieved
by consideration of the holistic approach of the
biopsychosocial model.
Respectfully,
Dr. Ted Altar, President
6 Spring 2014
rick gamb rel , b . co mm . , llb .
The Executive Director of the BC
Psychological Association. Contact:
letter from the Executive Director
a s i write this we are just past the halfway mark in our
membership year, which runs from September 1st to August 31st.
I can report that, to date, BCPA has been enjoying a very
successful 2013 – 2014.
Memberships have been renewed at historically high rates, and
we have welcomed a number of new members into the BCPA family. Both
existing and new members alike have told us that they value the benefits
of membership, including:
• exclusive discounts on liability insurance
• access to group health, dental, and disability insurance plans
• a subscription to our quarterly journal, The BC Psychologist
• networking with colleagues through our members-only Email Forum
• discounts on goods and services through BCPA Club Rewards
• supporting BCPA advocacy efforts with the public, industry and the
government
• exclusive discounts on our BCPA continuing education events
As announced earlier, one of our liability insurance providers
has changed to BMS Insurance. They advise us that they will be offering,
upon renewal in June, better coverage for a smaller premium. BCPA was
involved in bringing these changes to our members.
The last issue of the BC Psychologist was the first issue that
was sent to each of our provincial Members of the Legislative Assembly,
bringing the BCPA right to the door of our elected representatives.
Our advocacy efforts continue, with meetings this year with
industry, elected representatives and other provincial national and
international psychological associations, to advance the cause of the
psychological well-being of our citizens. As an example, this January,
BCPA took a leading role at the annual meeting of the Council of
Professional Associations of Psychologists in Ottawa, where issues of
national importance to the profession were discussed.
For Psychology Month this February, BCPA was one of the
most active provincial associations in the country. We offered series of
three public lectures at the Vancouver Public Library Main Branch on the
following topics:
• Relationship Life Skills – Dr. Patrick Myers
• Strategies for Supporting Persons with Autism Spectrum Disorder – Dr.
Kenneth Cole
• Creating a Psychologically Healthy Workplace: Strategies for
Employees and Employers – Dr. Merv Gilbert
BC pSyChologiSt 7
In addition, our association completed a mail out campaign to
raise awareness of psychological services and our referral service to over
230 medical clinics, libraries, universities, colleges and neighbourhood
houses throughout the entire province of British Columbia.
As well, during Psychology month, BCPA staff and member
volunteers attended the extremely well attended Diversity Health Fair,
interacting with hundreds of members of the public and letting them
know how psychologists may assist them.
This coming May BCPA will be repeating the highly successful
Piece of Mind — an art exhibition showcasing pieces of work that answer
the question: What does psychological health mean to you? Piece of Mind
aims to inspire members of the community, through artistic expression,
to live psychologically healthy lifestyles by adopting healthy coping
skills. Submissions will be available for public viewing with the hopes of
facilitating a platform that will transfer these pieces of art into pieces of
individual inspiration and motivation. The call for submissions has gone
out to individuals and hundreds of organizations across the province. We
invite you to join us for the opening night on May 8 at the Vancouver
Public Library Main Branch, or to take in the exhibition at the Library from
then until the end of May.
I am pleased to report that our workshop “The Intelligent
Clinicians Guide to DSM–5”, conducted by Dr. Joel Paris, was by far the
best attended workshop in this association’s history, with close to 200
registrants. We thank you for your many positive comments about the
workshop.
Remember to attend our next workshop, “Meaning Therapy”
conducted by Dr. Paul Wong, at the University Golf Club on April 25. At
the time of writing this, there were still spaces available.
In June, at the CPA convention in Vancouver, I will be leading
a group of lawyers and psychologists in a pre-convention workshop on
Psychologists and the Law.
And, as always, BCPA continues to offer regular ethics salons to
our members in Vancouver, Victoria, Surrey and other locations.
My thanks to the board, volunteers and the talented, passionate
and very hard-working BCPA staff for all of their tremendous work. And
thank you to you, the members. Without you BCPA could not achieve the
success that it has this year.
Rick Gambrel, B.Comm., LLB.
Executive Director
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8 Spring 2014
BcPA News
UPCOMING WORKSHOP
me anin g ther apy: a ne w par aDig m o f
integ r atin g he alin g with pers o nal
g row th
Presented by Dr. Paul T. P. Wong
Friday April 25th, 2014 @ University Golf Club
Please see page 25 or visit www.psychologists.bc.ca for
more information and registration.
PIECE OF MIND
o penin g nig ht @ m oat ar t gallery
(Vancouver Public Library, 350 West Georgia Street)
Thursday May 8th, 2014 from 7pm to 9pm
SUBMIT ARTICLES
want to write fo r us? We are always looking
for writers for the BC Psychologist or the BCPA blog.
The theme for the upcoming Summer 2014 issue is:
Parenting & Families. The Summer edition is sent out
to all Registered Psychologists in BC — do not miss this
occasion to reach them all! For further details, contact us
CONTACT US
we pub lish n otice s regarding retirement,
awards, and deaths of members. Please keep us informed
about your career and life milestones. If you want a
notice to be included in the publication (approximately
100 words) contact us at: [email protected]
SOCIAL MEDIA
join us o nline!
www.psychologists.bc.ca/blog
www.youtube.com/bcpsychologists
www.twitter.com/bcpsychologists
www.facebook.com/bcpsychologists
Advertising Inquriesco nnec t with b c psych o lo gists!
• PRInT (BC PSYCHOLOGIST)• WEB POSTInG (30 DAyS)• E–BLAST (EVERY FRIDAY)
b cpa www.psychologists.bc.ca
402 - 1177 West Broadway Vancouver, BC V6H 1G3
ph o ne 604-730-0501 fa x 604-730-0502
email [email protected]
UPCOMING THEMES
summer 2014 • Parenting & families
fall 2014 • Future of Psychology
winter 2015 • Depression
BC pSyChologiSt 9
Piece of Mind Opening Night
piece o f minD e xhibitio n o penin g nig ht
@ m oat ar t gallery (350 w. g eo rgia)
thursDay may 8 t h, 2014 (7pm – 9pm)
D e ar b cpa memb ers ,
Again this year, on May 8, 2014, at 7:00 p.m., at the Vancouver Public
Library Moat Art Gallery, BCPA presents its second Annual Piece of
Mind Art Exhibit opening night. You are invited to attend.
Piece of Mind asks the question of artists,
“What does psychological health mean to you?”
Last year, the art answering that question was beautiful, moving and
thought provoking. On opening night, in addition to the art, there will
be a chance to meet and talk to the artists, meet and talk to your BCPA
executive, and be a part of a panel discussion session with artists and
psychologists about psychological health.
Both the opening night gala and the exhibit (running until the end of
May at the Vancouver Public Library Moat Art Gallery) are free to attend.
Last year, Piece of Mind was a great success in engaging the community
in discussing psychological health and this year’s exhibit promises to be
even bigger and a more rewarding experience.
Piece of Mind is an initiative of the BC Psychological Association’s
Community Engagement Committee.
We hope that you will attend.
For more information and to RSVP, please go to mypieceofmind.ca.
Rick Gambrel, B.Comm., LLB.
Executive Director BCPA
piece o f minD is an
initiatiVe o f the co mmunit y
en gag ement co mmit tee (cec)
o f the b ritish co lumbia
psych o lo gical a ss o ciatio n .
The aim of the project is to inspire the
community through artistic expression
to live a psychologically healthy
lifestyle. We are inviting individuals
to submit pieces of art to express what
psychological health means to them.
Prizes include tuition, art supplies and a
one month art exhibition in the Moat Art
Gallery at the Vancouver Public Library.
email [email protected]
Visit http://mypieceofmind.ca
PIECE OF MIND
you’re invited to
Moat art Gallery350 West GeorGia street
o p e n i n g n i g h t@
piece of mindexhibition
7PM-9PM thursday May 8mypieceofmind.ca | [email protected]
10 Spring 2014
BC pSyChologiSt 11
D r. paul pe arce
Dr. Paul Pearce has served as a pastor, educator and
administrator. He recently retired from being the
Executive Director of Beulah Garden Homes, which
provides affordable housing for older adults in East
Vancouver. He currently is involved in establishing and
directing the Centre for Healthy Aging Transitions located
at the Carey Institute on the UBC campus.
y uk shuen (sanD r a) wo n g, ph . D. , r. psych .
Dr. Sandra Yuk Shuen Wong is a registered psychologist
serving in Vancouver and Richmond.
Factors contributing to Healthy
intro D u c tio n
There are currently a growing number of resources and
strategies for healthy aging being promoted by those
within the health care professions, other community
care agencies and the business sector concerned with the
emerging demographic of older adults (55+). The growth
in this demographic is unprecedented and will continue to
influence all sectors of society over the next few decades.
The expectation of another third of life for those in their
mid-50s is creating new challenges and opportunities for
this generation. This expectation arises because people
arrive at this time of life with better health and education,
and more options for accessing community support services
and personal resources, resulting from planning over the
years. Healthy aging results from a number of factors being
developed and held in a balance.
There are five factors, in particular, which will
influence the health and life fulfillment of those entering
the older adult years.
1. the Vo catio nal fac to r
There are several issues that will have to be resolved
as a person anticipates moving from the middle adult
years when daily commitments to work and family have
provided the framework for meaningful activities and
use of time. What is the purpose of aging and how can
someone live meaningfully in the changing roles no
longer defined by daily work and family commitments as
a parent with children at home? Realigning priorities and
commitments, while staying motivated and interested with
a meaningful use of time, can be a daunting and sometimes
discouraging experience. The importance of still being
needed and making a contribution to the future, family
and community is an important factor to be resolving.
The U.S. Centers for Disease Control and Prevention have
recently been reporting that suicide rates among middle
aged Americans have risen sharply in the past decade. One
of the explanations being suggested for this finding is that
those in their 50’s and 60’s are struggling with realigning
life expectations for the future.
2 . the wellne ss fac to r
Being responsible for personal wellness and health
care is a factor contributing to healthy aging. There is
an expectation for longer life expectancies as medical
research continues to seek responses to the many
diseases related to aging. The continuing developments
in the medical and health care sciences and professions
are also raising a new awareness and generating a better
informed approach to personal health and wellness.
Again, a number of questions converge as a person makes
the transition into the later years of life. What are the
consequences of living longer? How does one anticipate
and plan for the inevitable diminishment of health?
There is a growing realization that personal wellness
will be realized when a person is approaching his or
her life in a holistic way. Wellness includes a balanced
understanding of relational support systems (e.g., family,
community), psychological integrity and environmental
satisfaction (e.g., adequate housing and home life). It can
be a time in life when there could be a spiritual openness
to exploring and developing a knowledgeable approach
and understanding to the ultimate questions resulting
from a growing awareness of one’s mortality. There also
should be attention given to the resolving of “end of life”
preparations for self and the significant others entrusted
with fulfilling these expectations.
3 . the s o cial fac to r
The social factor is concerned with the significant — other
relationships, friendships and community connections
providing a feeling of personal security and wellness for
the individual. There is recognition by community leaders
and homecare providers that the social consequences of
loneliness and isolation for many living in Canada’s busy
and culturally diverse cities can have a significant impact
on the quality of life for older adults. In today’s highly
mobile world, family members are not as easily available
for regular contact with aging parents to provide the care
and reassurance needed. There are increasing concerns
around affordability issues for housing and other daily
12 Spring 2014
necessities. Often such factors result in a person’s having
to relocate at a time of life when it is more difficult to
establish new supportive relationships. People need a
social context of both giving and receiving stimulation
and support in relationship with others to stay healthy.
How will older adults feel they belong and are making
a contribution in an age when ageism means that they
are sometimes ignored or experience prejudice? There
are often concerns around who will be the primary care
partners for those who can no longer care for themselves
as government funding for needed services declines.
Answers for these and other questions are going to be
more difficult, as the number of older adults continues
to grow into a significant minority (majority in some
communities).
4 . the re s o urce s fac to r
The resources factor involves the awareness and
appreciation of the cumulative value of a person’s life
experience, career fulfillment and achievements, personal
integrity, supportive relationships and an adequate
financial plan to sustain one’s basic living needs and
expectations. For many, there will need to be assurances
that there will be financial stability often resulting in
some intentional shifts in one’s lifestyle. Concerns
around finding affordable and trustworthy counsel for
management of personal affairs will be a growing need for
many who have not required such advice up to this time
of life. The resources factor needs to be expanded beyond
just financial planning and implementation, which seems
to be the focus for many. There will need to be a deeper
appreciation for the other “personal equity” resources
(beyond financial) people bring to the later years of their
lives, which can be appreciated by themselves and those
around them. The possibilities are many for encouraging
and challenging this unprecedented wave of maturing
people to become viewed as elders and not just the
“elderly”. They have been living resourceful and engaged
lives and will want to continue to make a meaningful
contribution to their families and communities. They
could be developing mentoring and counselling
relationships informed by their own life experiences,
career and professional insights gained through their
full-time working years and their personal passions and
interests as they plan for their futures.
5 . the spiritual fac to r
American author, marriage and family counsellor, Michael
Gurian says in his book THE WONDER OF AGING — A
New Approach to Embracing Life After Fifty (ATRIA
Books, 2013) that the post 50’s time of life provides us
with second chances to make adjustments to enhance our
lives. Regarding spirituality he suggests that
...making peace with our bodies’ gradual
vulnerabilities as we age is a spiritual act, a second
chance at becoming spiritual in the way we may
not have had the time to become before. Even
if we were good at practicing our religion before,
knowing all the rote elements of it, we might
now become better at practicing spirituality, for
now we can “get” what the masters have always
been trying to teach — Self, Soul, Identity, Grace,
Service. If we enter a time of making spirituality a
part of our lifetime of second chances, we can stop
spending a great deal of our second half of life in
low-grade sadness, depression, anger, even rage
at what is happening to our bodies (our souls), but
instead see how miraculous the life of the soul is
as it flows and adjusts within even our illnesses.
(p.242)
Aging allows a person the opportunity to discern that beliefs,
worldviews and the possibility of post-life dimensions for
continuous being can be important and life enhancing. Are
the changes I am experiencing (will experience) confusing
and discouraging or a time to more deeply understand and
embrace the possibility of a newly informed faith paradigm
for resolving many of life’s mysteries and unanswerable
questions? How do others, communities of faith and other
culturally informed resources, open the possibilities for
a more deeply informed faith and a more mature time of
spiritual formation?
The value of exploring and embracing the mysteries of life’s
ultimate questions can be a helpful and a maturing activity
in the later years of life as a result of being aware of the
spiritual factor.
co n clusio n
The coming decades will present an unprecedented time of
challenge and opportunity as governments, community care
agencies, faith communities, other voluntary organizations
and the business sector respond to the growing presence
and influence of the aging “boomer” demographic. There
will be increasing needs and possibilities for rethinking how
greater cooperation can be achieved for all who are trying
to assure a safer and healthier environment for the aging.
Identifying and recognizing how human and financial
resources can be deployed in an effective and sustainable
way will require some ongoing dialogue with those in
communities who are already engaged in providing services
to address the factors outlined above. It will be important
to have a balanced and an holistic approach for achieving an
environment which can encourage a global commitment to
healthy aging. All ages will benefit when a commitment is
shared around the value of caring for the aging. These five
factors and others will require attention as new networks
emerge to develop strategies for effective action.
BC pSyChologiSt 13
marily n ch otem , eD. D. , r. psych .
Dr. Marilyn Chotem has been practicing psychology
in BC since 1979. She has worked in addictions,
community mental health, eating disorders, a hospital
psychiatric unit, and has had a private practice on the
North Shore since 1992. www.marilynchotem.com
rememb er the m oVie Harold and
Maude ? Harold was the adolescent guy from a materially
privileged family absent of warm connections who sought
death as a relief. Maude was an elderly woman who was
wealthy in her simplicity and zest for life. She broke
the rules of aging and society. The movie challenged
stereotypes on aging, showed that age was a matter of
outlook, and exposed the potential emptiness of material
aspirations.
Life is a process of gradual changes, not discrete
units with visible markers at the end. Sure, there are
milestones and achievements, but they aren’t magical
transformations. They are markers. I have many times had
naïve assumptions about aging fall flat in the face of reality.
I thought when I turned 18 I would be an adult with freedom
and maturity. I thought when I graduated from university,
someone would offer me a job. When I was single, I thought
marriage was a promise of love and security. And, I thought
brain neuroplasticity stopped at 65. I also thought that older
people with lengthy marriages didn’t divorce. Our conscious
and unconscious scripts about aging are tempered by reality.
In my younger days, I saw possibilities, not
barriers. Whatever I set my mind to, within reason, I
aimed to do. But as vision falters, memory that was like a
container becomes more like a sieve, new learning is more
work and takes longer, pushing leads to injuries rather
than accomplishments, wrinkles carve deeper into one’s
face, and past possibilities are less realistic. It is a time
of adjusting to new realities. An attitude of acceptance
can make the difference between healthy and unhealthy
adjustments to emerging limitations. Practice with
adjusting to changes should lead to greater resilience and a
more proactive engagement with life. I laugh now about the
words and names I can’t find; I move at a slower pace, and
achievements are less important than peace of mind.
In actuality, age offers no immunity to emotional
distress or psychopathology. Our developmental histories
and personalities travel with us through life. Psychotherapy
can be as useful to the aging and elderly as to the young
adult. Both are adjusting to life transitions. Psychotherapy
Aging can help people address their losses and the meaning of
those losses for the individual. With the life expectancy
increasing and the population of seniors bulging,
psychologists will provide a valuable role in the quality of
life for the elderly in the decades to come, if not longer.
Last night over dinner, a 78-year-old friend said,
“Aging is not for the faint of heart.” He was struggling
with pain, mobility problems, loss of loved ones, and
social isolation affecting his mood. He had only stopped
his career 3 years ago. The workplace social network
was gone, as was the structure and sense of purpose
and esteem work had provided him. Without external
demands to direct us, the arbitrariness of choices can lead
to apathy. Without the esteem of colleagues, our harsh
self-talk has no opposition. Erik Erikson believed that
development continues throughout life. We need purpose
and connections, as much as our minds and bodies need
activity and challenges. As for Maude of Harold and
Maude, every day is a gift of time to embrace since we
don’t know when the clock will stop. There are things to
discover, and infinite choices for learning, purpose and
connections. Aging can be vibrantly alive if we proactively
engage with life.
Long ago, I met a career woman in her late 40s
who had counselled numerous college females to pursue
careers, as she had pursued her own career. She regretted
her choice and her advice because, as she said, “a career
doesn’t rub your back at night.” Other people have said
that at the end of life, it is not for our achievements
that people remember us; it is for the relationships we
nurtured. Aging, like death, is part of life. Psychologists’
skills of motivational interviewing and talk therapy may
be very important to the emerging population of seniors.
We may help older clients adjust to their losses and find
the attitude that time is a gift. We may also help them
come to peace with buried secrets or unresolved issues.
Most of all, we have the skills to help others understand
that outlook is a choice.
Marilyn Chotem, Ed.D., R.Psych. #773
I’m growing fonder of my staff;
I’m growing dimmer in the eyes;
I’m growing fainter in my laugh;
I’m growing deeper in my sighs;
I’m growing careless of my dress;
I’m growing frugal of my gold;
I’m growing wise; I’m growing, — yes, —
I’m growing old.
John Godfrey Saxe, (1816 – 1887) “I’m Growing Old”.
An American poet who best known for his paraphrase of
the Indian parable “The Blind Men and the Elephant”.
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16 Spring 2014
paul t. p. wo n g,
ph . D. , c . psych .
Dr. Paul T. P. Wong is Professor
Emeritus of Trinity Westerns University.
He is well known for his research on
Positive Aging, Personal Meaning,
and Positive Psychology. He has been
a registered clinical psychologist in
Ontario for more than 30 years.
He will present the BCPA workshop:
“Meaning Therapy” on April 25th, 2014.
alth o u g h su cce ssful agin g
me ans Different thin gs to Different peo ple ,
there is some consensus that we need to shift the emphasis from
the medical model and physical components of aging to psychological
and spiritual components, and from a disease model to a growth model.
According to a lifespan developmental approach to aging, one can continue
to grow in wisdom and spirituality even in advanced stages of aging.
american m o D el s o f su cce ssful agin g
In the past two decades, numerous gerontological studies
have investigated successful aging (e.g., Rowe & Kahn, 1998; Schulz
& Heckhausen, 1996). These models differ in their definition of what
constitutes success, but “the prevailing view is that successful aging
requires consideration of multiple criteria and multiple adaptive patterns”
(Reker & Wong, 2012).
Rowe and Kahn (1998) debunk the myth that aging has to be
accompanied by illness and loss of cognitive functions and emphasize the
importance of a positive attitude and healthy life style. Older persons can
maintain their zest for living and remain productive members of society.
Successful aging is characterized by low risk of disease and disability, high
mental and physical function, and active engagement with life.
George Vaillant (2002) emphasizes the positive psychology
of aging — how to live a happy life in old age. The Harvard Study is the
world’s longest continuous study of aging and health. The main finding
is that college education is a better predictor of health and happiness
than money, social prestige, etc. Uncontrollable factors, such as genetics,
parent’s social class, and family cohesion, are no longer important by age
70. Controllable factors become more important. These include engaging
in altruistic behavior, staying physically healthy, pursuing education,
staying creative and playful, and using mature or adaptive coping.
“Successful aging means giving to others joyously whenever one is able,
receiving from others gratefully whenever one needs it, and being greedy
enough to develop one’s own self in between.”
canaDian m o D el s o f su cce ssful agin g
Canadian researchers on successful aging have a more existential
and spiritual emphasis than their American counterparts. For example,
Mark Novak (1985) focuses on personal responsibility and the quest for
meaning within the biological and social-economic constraints that often
accompany old age: “A good old age ...comes about when, given a basic
income, reasonable health, good self-esteem and a little energy, a person
sets out to discover a meaningful life for him — or herself.” (p. 273)
Wong (1989) and Reker (2000) stress the psychological and
spiritual dimensions of aging. According to Wong and Reker, successful
aging is not primarily conditional on physical conditions — we have aged
successfully, if we feel satisfied that we have become what we were meant
to be, accomplished most of our life tasks, contributed to society and
Positive Aging in canada
BC pSyChologiSt 17
referencesNovak, M. (1985). Successful Aging: the myths, realities and future of aging in Canada. New York: Penguin Books.Reker, G. T. (2000). Theoretical perspective, dimensions, and measurement of existential meaning. In G. T. Reker & K. Chamberlain (Eds.), Exploring existential meaning: Optimizing human development across the life span (pp 39 – 58). Thousand Oaks, CA: Sage Publications.Reker, G. T. (2002). Prospective predictors of successful aging in community-residing and institutionalized Canadian elderly. Aging International, 27, 42 – 64.Reker, G. T., & Wong, P. T. P. (2012). Personal meaning in life and psychosocial adaptation in the later years. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed., pp. 433 – 456). New York, NY: Routledge. Rowe, J. W., & Kahn, R. L. (1998). Successful Aging. New York: Random House.Schulz, R., & Heckhausen, J. (1996). A life span model of successful aging. American Psychologist, 51, 702 – 714.Vaillant, G. (2002). Aging well: Surprising guideposts to a happier life from the landmark Harvard study of adult development. New York: Little, Brown, and Company.Wong, P. T. P. (1989). Personal meaning and successful aging. Canadian Psychology, 30, 516 – 525.
future generations, and kept our faith in spite of difficulties
and disappointments. Therefore, successful aging is
attainable by anyone, regardless of their physical conditions.
After reviewing the theories and empirical findings
on the role of meaning in successful aging, Wong (1989)
introduces four meaning-enhancing strategies that are
especially relevant to the elderly; namely, reminiscence,
commitment, optimism, and religiosity. He concludes,
At present, most of the societal resources have
been directed to meeting the physical, social and
economic needs of the elderly. While these efforts
are essential, one must not overlook personal
meaning as an important dimension of health and
life satisfaction. Prolonging life without providing
any meaning for existence is not the best answer
to the challenge of aging. Greater research efforts
are needed to provide a firm scientific basis for
the application of personal meaning as a means of
promoting successful aging. (p. 522)
In the mid-1980s, Wong and Reker launched a
longitudinal study on the profile and processes of successful
aging in institutionalized and community-residing older
adults that came to be known as the Ontario Successful
Aging Project (OSAP). For more details on these findings,
the reader is referred to Reker (2002) and Reker & Wong
(2012). Here are some major findings that are relevant to
meaning and spirituality.
In this study, participants were classified as either
Successful or Unsuccessful agers based on ratings on
mental, physical health and adjustment. Successful and
Unsuccessful agers did not differ significantly in terms of
gender or income. However, Successful agers had more
resources than Unsuccessful agers. More specifically, they
differed in the following major resources:
• Social resources (social contacts and marital status)
• Cognitive resources (college education and intelligence)
• Spiritual resources (religious activity and personal
meaning)
• Psychological resources (optimism, commitment, self-
reliance)
Successful agers scored higher in both subjective
and objective outcome measures. These measures include:
Health outcomes as measured by a nurse, physical
symptoms as reported by participants, psychopathology,
depression and perceived well-being. There are different
predictors of physical and mental health. For physical
health outcomes, the significant predictors are perceived
control, perceived income, commitment to personal
projects, social contacts and intelligence. For mental
health, the significant predictors are: personal meaning,
religious activity, social contacts and marital status.
Consistent with Vaillant (2002), Successful agers
use more adaptive, mature ways of coping. Our study
shows that employed successful agers more often used
the following types of coping, which are important for
problems that cannot be controlled or resolved personally:
• Situational coping (Problem-focused)
• Existential coping (Meaning and Acceptance)
• Religious coping (Beliefs and Activities)
• Self-Restructuring (Cognitive and Behavioral)
• Social support (Instrumental and Emotional support)
Based on all the research on successful aging,
Wong recommends the following ten commandments of
successful aging:
1. Cultivate internal and external resources.
2. Embrace religion or spirituality.
3. Stay engaged with life and commit to personal
projects.
4. Receive college education and be a lifelong learner.
5. Develop mental capacity and exercise your brain.
6. Get married & stay connected with family and friends.
7. Be optimistic and confident.
8. Pursue a healthy lifestyle.
9. Be reflective and flexible in coping.
10. Expand yourself in every way — turn inward, upward,
forward and outward.
18 Spring 2014
No one is free of some discrimination and
certainly if we are fortunate to live a long life we will
have to cope with the prejudices of ageism. Compared
to research on sexism and racism, there is a surprising
paucity of research on ageism. One convenience sample
of 1,501 Canadians (Revera Report, 2012) found that
fifty-one percent of respondents agreed that ageism is
the most tolerated social prejudice, more than gender
(20%) or even raced-based (15%) discrimination (Revera
Report, 2012). The majority of seniors (63%) reported that
they have been treated unfairly or differently due to their
age. We see an elder limping and we assume a chronic
condition or an injury that will take much longer to heal
than if we saw the same limp in a younger person, yet
older adults have injuries that heal quickly and youth can
incur a permanent disability from accidents. Maybe the
stereotype that our profession has had to overcome is that
of older adults not being as responsive to or as suitable for
psychotherapy as young or middle-aged people. In 1905,
when he was forty-nine, Freud wrote that people over
fifty were not treatable:
The age of the patient also plays a part in the
selection for the psychoanalytic treatment.
Persons near or over the age of fifty lack, on the
one hand, the plasticity of the psychic processes
upon which the therapy depends — old people
are no longer educable — and on the other hand,
the material which has to be elaborated, and
the duration of the treatment is immensely
increased. (Freud 1905).
Unfortunately, this myth about age continued
for many decades and still lingers in a perception that
the aged would not be as interested in or as amenable
to psychotherapy. In fact, crystallized intelligence
involving a life-long accumulation of learning and
culture is maintained and increases during adulthood
and is less dependent on physiological functioning than
is fluid intelligence (see Dixon & Cohen, 2003). The
famous Seattle longitudinal-sequential study by William
Schaie (1995) showed that cohort effects were being
teD altar, ph . D. , r. psych .
The President of the BC Psychological Association. Contact for the Board of Directors at [email protected]
confounded with actual longitudinal changes. What was
found was that although our quickness with numbers
starts to decline in our thirties, word fluency in the forties,
inductive reasoning in the fifties, and word meaning in
the sixties, these declines don’t become significant until
some time after seventy. But these specific functions as
measured in isolation don’t take into account the actual
performance with real world demands where older persons
can compensate with post-formal cognition and practical
intelligence. While episodic memory declines such that 80%
of adults in their 20’s will do better than adults in their 70’s,
age differences on semantic memory and implicit memory
tests are usually absent (Fleischman & Gabrieli, 1998). While
access to remembered information may be slower among
older learners, the same knowledge structures or associative
networks remain intact, unless ravaged by severe illness or
brain injury.
neither fifty, as Freud thought, nor seventy, as
some of us may still believe, is an absolute limit since many
such older adults are able to use their stores of crystallized
knowledge and pragmatic skills to compensate and continue
learning as effectively as younger adults. There are multiple
directions of age-related change and older persons can
compensate by investing more time and effort at a skill,
substituting more enduring component skills for those
skills that may decline, and optimizing by selecting what
is most achievable, or simply by adopting more realistic
criterion of success. Most of the obvious significant declines
in learning and memory occur about five years before one’s
death (Hess, 2005) due to declining health and attendant
compromises of neurological functioning. Maintaining good
health offsets early cognitive declines. Exercise and healthy
eating benefits all age groups. What is important to know
is that there is great individual variability such that some
individuals in their seventies showed no decline in practical
cognition.
In terms of personality, we may actually continue
to improve in some fundamental ways. Conscientiousness
and agreeableness increase with age and stays at its highest
point beyond age sixty. Extraversion declines only slightly
“ the wiser minD m o urns le ss fo r what ag e take s away than what it le aVe s b ehinD.”
fro m THe FounTain: a ConversaTion by WilliaM WordsWorTH
BC pSyChologiSt 19
but neuroticism continues to abate past sixty (Srivastava,
2003). Rates of severe depression reach their peak in the
early twenties and become lowest for those 65 and older.
Findings like these have changed the outlook of gerontology
to the current positive view of the increasing longevity and
quality of life as the “third age” (Baltes & Smith, 2003)
Although a less rigid outlook has been advanced
about aging, there are the inevitable changes of aging
that make for an increasing loss of one’s former physical
robustness and endurance along with a slowing of the
mechanics of cognition (e.g., speed of processing). After
85 — the ‘fourth age’ — declines become more prevalent
and more inevitable because the limits of compensation
have been reached physically and cognitively. Illness, prior
educational levels, life circumstances, and terminal changes
are associated with declines in many older people but not
all to the same degree, and again there are wide differences
between individuals.
Another myth of aging is the assumption that
with age comes increasing wisdom but in fact there is no
correlation between age and wisdom (Baltes & Staudinger,
2000). We may always lack wisdom or have it at any adult
age. This applies to psychologists as well and therefore we
need to remain humble, informed and up-to-date on the
empirical facts that serve to contradict the stereotypes of
age, since stereotype threat internalized by older clients
may also partly account for some declines in cognitive
ability or a reduced effort in trying.
psych other apy fo r elD ers
Psychotherapy research for the two most common
complaints of depression and anxiety has demonstrated
that good psychotherapy outcomes occur for both adults
and elderly clients (Laidlaw). This is not to say that the
context of these disorders will be the same for all age
groups. Depression and anxiety in the elderly client more
frequently has a biopsychosocial aetiology referring to a late
age context of multiple losses and increased social isolation.
Life span developmental psychology has helped
greatly in increasing our understanding of the changes and
stabilities of growing old. If one lives to sixty-five, one can
then expect the average lifespan for an individual in Canada
to be eighty-five (Chappell & Hollander, 2013). We know
that the percentage of persons sixty-five and older in the
population will increase from 14.1% in 2010 to 24.9% in
2050.
When assessing and treating an elder adult,
questions about what to address can be less clear than
with a younger adult. Do you first focus on the symptoms
of an apparent depression or on their coping with a health
issue, their grief over a recent or long standing loss
of friends and family, their acceptance of a change in
role and social status, possible social isolation, or their
adjustment to changes in their relationship with the
world? A helpful and necessary place to begin would be
to review the updated APA Guidelines for Psychological
Practice with Older Adults (adopted by the APA Council
of Representatives in August of 2013) and other related
guidelines. Also, there are now many more books
available on working with older adults (Qualls & Knight,
2006; Scogin & Shah, 2012; Sorocco & Lauderdale, 2011;
Vacha-Hasse et al., 2011).
s o me ba sic co nsiD er atio ns fo r wo rkin g
with o lD er clients
1. Respect older adults as adults. To use baby-talk
or such intonation with any adult is insulting and
the same applies to older persons. Even those with
dementia may become irritable when they hear a
patronizing tone. Even though one may mean well,
such a tone is not helpful. An adult remains an adult
even if he or she suffers from cognitive loss.
2. Make accommodations for physical limitations. Due
to visual acuity decreasing with age, particularly in
low light, make sure that your office is well-lit and
that you book older clients during the mid-day so
that they can travel when traffic is minimal and the
sunlight is good. Avoid surfaces in your office with
glare like high gloss flooring finishes. Because one’s
sense of balance decreases, make sure that there are
railings on both sides of a stairwell to your office, that
there are no unnecessary obstacles in your office, and
that there are no slippery services or slippery carpets.
3. Speak slower and always clearly. While slowing of
psychomotor speed or reaction time is one of the
most inevitable changes of aging, a key reason for
this slowing is actually due to slower decision speed
and processing speed, particularly in situations that
involve ambiguous information. Given a reduced
speed of processing, it may be necessary to talk more
slowly and be clear in enunciation. Shorter sentences
are always better than long-winded sentences and
this generally applies to all clients. Approximately
one in three people between the ages of sixty-five
and seventy-four experience some hearing loss
and nearly half of those older than seventy-five
do have difficulty hearing (nIDCD, 2013). Always
face the person since part of our disambiguation of
another’s voice depends on viewing the speaker’s
lip movements. The McGurk effect demonstrates
20 Spring 2014
how we all use such visual cues and these become
more important as one's hearing become less
sensitive. Difficulty understanding speech may not
only be embarrassing but can be very isolating when
it becomes hard to hear conversation. Errors in
understanding can also be dangerous when mistakes
in hearing result in not understanding medical advice
or not hearing various auditory alarms.
4. Provide and Elicit Summaries and ensure handouts
are in a readable font. It is always good to provide
verbal summaries with clients and this can be
especially needed for some older persons. Also,
written summaries or handouts need to be in large
print. Asking clients to verbalize their progress and
what they have found most helpful or useful from
the last session provides useful information for the
psychologist to know not only what has been learned
and applied but what yet needs to be reinforced and
further practiced. If the client is having difficulty
remembering, then the psychologist can mention a
couple of key points and ask again which was deemed
most useful.
As we get older the percentage of us with serious
vision problems or blindness increases. One in eleven
Canadians aged sixty-five or older must live with
vision loss and this increases to one in eight for those
Canadians aged seventy-five or older (CnIB, 2013). It
is therefore a naive assumption that everyone will be
able to readily read printed materials and one needs
to know what size of font a client is capable of reading.
now that every office has a laser printer, there is
little excuse not to print off one's client handouts to
match an individual's comfort zone of visual acuity.
One may also find that providing a binder or folder for
handouts, exercises and summaries can be very much
appreciated.
5. Be sensitive towards, and knowledgeable of,
cohort differences. Just as we are required to be
informed about gender and racial differences and
sensitivities, so too we need to be informed about
cohort differences. There is no easy way to be versed
in the sub-culture and differing socio-historical
experiences of cohorts but knowing and being versed
on some basic history is certainly a good place to start.
Someone once said that if one only reads psychology
texts, as wonderful as they may well be, one will still
not be a good psychologist. One needs to also be more
widely read and cultured.
People are profoundly influenced by their
socio-historical environment. The greater education
and historical events of the 1950’s and 1960’s (Baby
Boom Generation) politicized an influential minority
regarding racial and economic inequalities. The
generation of the seventies became less engaged in
social activism and more inwardly directed towards
self-fulfillment and personal success. Of course, such
generalities are not that helpful. What is helpful are the
details of the key events, the specific personages and
specific cultural or material consumptions of choice.
Concepts of masculinity and femininity, for instance,
have undergone many generational changes, as have
changes in religiosity, community values, degrees
of social solidarity and alienation, ideas of personal
self-care, and the increasing individualization of
entertainments, hobbies and life styles.
6. Use Examples. A good therapist makes things concrete
with vivid examples, memorable demonstrations, or
analogies. ACT therapy and Impact therapy, as well
as Cognitive Therapy are good sources for increasing
one’s stock of illustrations and examples. Of course,
one needs to always be very sparing of citing one’s own
personal examples as this is overused by the novice
therapist and too often diverts attention from the client.
Role playing is also useful in making more vivid and in
practicing certain skills of coping, communication with
another, assertion with civility, and so on.
Asking clients to complete some exercises at home
is risking embarrassment for the client should they
forget or be unable to complete the homework. One
approach is to simply start some of the homework in
session.
7. Encourage note-taking or recording. Very often we
may cover too much ground in a session although due
to years of familiarity for the psychologist it may not
seem as if much was covered. Providing a notepad or
suggesting to clients that they are always welcome to
record their session can certainly serve as an aid to
memory. Recording is less distracting than note-taking,
but note-taking can be more concise and focused on
what a client finds is most helpful.
8. Be sensitive to issues of loss and acceptance.
Older adults will have experienced more losses and
disappointments than younger clients. Along with
attending more funerals, there may be a greater history
of traumatic experiences and life disappointments. In
addition, older adults will be faced with a progressive
diminishment of personal strengths, competencies,
social status and personal future. Approximately 35%
of Canadians age sixty-five to seventy-four will have
to cope with some disability and this increases to 55%
BC pSyChologiSt 21
of those over seventy-five (Stats Canada, 2008). While
limitations among working adults are mostly for pain,
mobility limitations become prevalent with age. Hence,
23% of Canadians age sixty-five to seventy-four have
mobility limitations, and this increases to 41% for those
age seventy-five to eighty-four, and increases again
to 61% for those age eighty-five and older (ibid, 2008).
Older adults must adjust to and accept such limitations
and also reconcile with past mistakes which a shortened
future prevents from replacing with compensating
successes.
Here is where an individual’s vulnerabilities are
not to be exploited and great care must be shown in
respecting how an older adult comes to terms with
the narrowing of their world. Imposing one’s own
solutions can be a deep insult or a form of exploitation
of another’s vulnerability. It is not our role to convert,
proselytize or recruit for our metaphysical point of
view. It is rather our turn to validate by listening
and affirming the client’s perspective on his or her
life story and its end. To the extent that there are
obvious cognitive distortions, and unfair or inaccurate
statements of fact that are making for distress or
dysfunction, then we may intervene with the humbling
knowledge that we may fall short in comparison with
the lived life that older adults possess.
9. Be aware of phenomenological differences. While
severe depression is less frequent among older adults,
it is also experienced or expressed differently. For
instance, the core symptom of sadness may be referred
to by younger adults as being “down” but older adults
may instead talk about feeling “helpless” or “tired”.
Apathy may be stronger or more apparent with older
depressed adults, and staying in bed and not wanting
to get up and do things more common. The reduction
in physical activity among older adults certainly
aggravates their depression. In addition, the social
stigma of being retired can also contribute to the older
adult’s dysphoria. As Simone de Beauvoir wrote,
Society cares about the individual only in so
far as he is profitable. The young know this.
Their anxiety as they enter in upon social life
matches the anguish of the old as they are
excluded from it. (Simone de Beauvoir, 1973,
p. 807)
A weak appetite and insomnia may be symptoms
of depression or age-related changes or reflect
health problems, medication side effects, metabolic
changes, and so on. Also, loss of health, stress
from relocation, fear of losing independence
and few social supports, or isolation makes for
anxiety being more prevalent among older adults,
particularly women.
10. Be aware of possible differences between what
is normal and what becomes a disorder. Certain
normal changes of aging on their own do not
constitute a disorder but will be a valid complaint.
For instance, sleep often becomes lighter with
age and more time is spent in stage 1 and 2 sleep
while less time occurs in the slower wave sleep of
stages 3 and 4. The overall duration is decreased
and sleep disturbances become more frequent. The
circadian cycle changes such that both sleep onset
and awakening are earlier than desired, sometimes
by several hours. Napping and light contamination
also affect sleep patterns and older adults may have
to adjust. When these differences reach the level at
which an older adult is not obtaining the sleep they
need, then treatment is needed.
It is unfortunate that sleep disturbed older
adults are more likely than any other age group to be
prescribed benzodiazepine hypnotics (Stewart, 2006).
Besides the potential adverse effects, tolerance and
addiction, it turns out that the effect size compared
to the placebo response is small and of questionable
value (Huedo-Medina, 2012). A psychological
and evidence-based approach that could be more
frequently offered would be a cognitive behavioural
treatment that would involve sleep-restriction-
compression, sleep hygiene education, relaxation
training and cognitive therapy. Stimulus control
therapy could also be considered, but further research
is needed to move it beyond a partially supported
treatment to that of an evidence-based treatment
(Dillon, H.R., Wetzler, R.G., & Lichstein, K.L. (2012).
11. Become versed in cognitive retraining and other
rehabilitative methods for older adults. Cognition
is indeed a complex assembly of mental skills
and functions that include attention, perception,
comprehension, learning, remembering, problem-
solving, reasoning, and applied judgement. The field
of cognitive rehabilitation (Raprente & Herrmann,
2003) is a growing and an important area of practical
knowledge in working with both older and younger
adults who are exhibiting some cognitive impairment
from either accidents or illness. For those older adults
experiencing cognitive difficulties or declines, it can
be helpful to instruct on how to use various strategies
for compensating. For example, basic memory
strategies like association, imagery, chunking,
22 Spring 2014
rehearsal, attention-concentration, the method
of loci, face-naming and name learning have been
shown to be helpful with both older adults and adults
in the early stages of dementia (Rebok, 2012). Other
methods like teaching task breakdowns, moving from
the simple to the complex, moving from the concrete
to the abstract, using double or triple digit number
groupings to increase digit span, and using imagery
and space retrieval methods for memory (where
the time between retrieval attempts is gradually
increased) are just some of the many techniques
that may be effective, although further research is
needed to better establish their efficacy. It needs to
be remembered that older adults already have learned
or developed various idiosyncratic approaches,
some of which may well be effective. Resistance to
learning new strategies needs to be respected. They
may find that the method of loci may seem strange
and impractical to them and one should then offer
alternative methods that are less threatening or
effortful.
referencesAmerican Psychological Association (2014). Guidelines for Psychological Practice with Older Adults. Amer. Psychologist, 69(1), p. 34 – 65. Baltes, P. B. & Smith, J. (2003). New frontiers in the future of aging: From successful aging of the young old to the dilemmas of the fourth age. Gerontology, 49, 123 – 35.Baltes, P.B., & Staudinger, U.M. (1993). Wisdom: A meta-heuristic (pragmatic) to orchestrate mind and virtue toward excellence. American Psychologist, 55, 122 – 136.Chappell, N. & Hollander, M. (2013). Aging in Canada. Oxford.CNIB (2013). Fast Facts about Vision Loss. Found at http://www.cnib.ca/en/about/media/vision-loss/Pages/default.aspxDillon, H.R., Wetzler, R.G., & Lichstein, K.L. (2012). Evidence-based treatments for insomnia in older adults. In Scogin & Shah (ed.), Making Evidence-Based Psychological Treatments Work with Older Adults. APA.Dixon, R.A. & Cohen, A. (2003). Cognitive development in Adulthood. In Lerner et. al., Handbook of Psychology, v. 6, 443 – 61, N.Y., John Wiley & Sons. De Beauvioir, Simone (1973), The Coming of Age. Warner (originally published in 1970 in French by Gallimard)Fleischman, D.A. & Gabrieli, T.E. (1998). Repetition priming in normal aging and Alzheimer’s disease: A Review of findings and theories. Psychology and Aging, 13, 88 – 119.Evans, S. (2004). A survey of the provision of psychological treatments to older adults in the NHS, Psychiatric Bulletin, 28, 411 – 14.Hess, T.M. (2005). Memory and aging in context. Psych. Bull., 131 (3), 383 – 406Huedo-Medina, T.B. Kirsch, I., Middlemass,J., Klonizakis, M., Siriwardena, A. (2012). Effectiveness of non-Benzodiazepine Hypnotics in Treatment of Adult Insomnia. BMJ, 345, e8343Freud, Sigmond (1905). On Psychotherapy. Reprinted (1953 – 1974) in the Standard Edition of the Complete Works of Sigmund Freud (trans. & ed. J. Strachey), vol. Also can be found at http://www.bartleby.com/280/8.htmlNational Institute on Deafness and other Communication Disorders (NIDCD, 2013). Hearing loss and older adults. Publication No. 13–4913. Found at http://www.nidcd.nih.gov/health/hearing/pages/older.aspxParente, R. & Herrman, D. (2003). Retraining Cognition: Techniques and Applications (2nd ed). Pro Ed.Qualls, S. & Knight, B. (2006). Psychotherapy for Depression in Older Adults (Ed.). Wilely.Rebok, G.W., et al. (2012). Evidence-based psychological treatments for improving memory function among older adults. In Scogin & Shah (ed.), Making Evidence-Based Psychological Treatments Work with Older Adults. APA.The Revera report on ageism: A look at gender differences. (2012). Published by the International Federation on Aging. Found at http://www.ageismore.com/Revera/media/Revera/Content/Revera-Report_Gender-Differences.pdfSchaie, K.W. (1994). The course of adult intellectual development. Amer. Psyc., 49, 304 – 13.Schaie, K.W. (1995). Intellectual development in adulthood. The Seattle longitudinal study. New York: Cambridge U. Pr.Scogin, F. & Shah, A. (2012). Making Evidence-Based Psychological Treatments Work with Older Adults. APA.Skinner, B .F. (1983). Origins of a behaviorist. Psychology Today, 22 – 33Sorocco, K. & Lauderdale, S. (2011). Cognitive Behavior Therapy with Older Adults: Innovations across Care Settings. Springer Srivastava, J.S., et al. (2003). Development of personality in early and middle adulthood: Set like plaster or persistent change? J. of personality and Social Psych., 84, 1041 – 53.Statistics Canada (2006) Population Projections for Canada, Provinces and Territories 2005 – 2031. Cat No 91–520–XIE. Statistics Canada (2008). Participation and Activity Limitation Survey: An Analytic Report. Cat No 89–628–XIE no. 2.Stewart, R. et al. (2006). Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep, 29, 1391 – 97.Vacha-Haase, T., Wester, S. & Christianson, H. (2011). Psychotherapy with Older Men. Routledge
co n clusio n
The above few suggestions for the most part may be
obvious considerations to the experienced psychologist,
but it is surprising how many therapists forget or ignore
some basic practicalities. Working with older adults
requires that we update and maintain our general
knowledge about older adult development, review our
attitudes about such developments, and always upgrade
our competence in assessing and treating older adults.
Working with adults whose future self is comparatively
short involves a respect for a lived life that had different
challenges and opportunities than the lives of those
who are younger. A longer life is a life with likely more
successes and more failures, a life belonging to a person
who had to navigate in a socio-historical world of
different events, hardships and constraints.
“ o lD ag e anD the we ar o f time te ach man y thin gs .”
s o ph o cle s , T yro. fr ag . 586
BC pSyChologiSt 23
o rganiz atio nal “s crip ts”, the me ta
co mmunicatio n o f the o rganiz atio n , are writ ten
oVer time by lo n g -term employ ee s anD are usually
co DifieD. By learning to understand the message behind the message
between co-workers; management; union officials, you will learn the
metacommunication of the organization. There are four principal features
to keep in mind which have been identified by Kets de Vries and Miller
(1987) and which I have expanded upon below.
a . thematic unit y
Organizational events should be interpreted in one interconnected,
cohesive observation. A communality amongst the organization’s global
themes occurring throughout the first weeks/months that you work in this
new environment should become increasingly apparent. Conceptually, a
unity or theme of organizational protocol begins to present itself which
allows the following extrapolation. Can I envisage myself working within
the organization’s operational boundaries? Do I like the organization’s
style of problem solving, doing business, risk taking, liberalism/
conservatism? All of this information should be absorbed, certainly by the
end of a probation period (e.g., six months). If not, “get the hell out of
Dodge” as the expression goes because you’re probably in an enmeshed
or disengaged infrastructure, which diminishes by varying degrees the
transparency of communication within the organization. Obviously, this is
not good.
b . pat tern matchin g
When involved in organizational diatribes between departments, units and
collegial relationships, people tend to seek out a fit between the current
event and past events in an attempt to make things meaningful, looking
for patterns of repetition. “Pattern matching” or interpreting the present
dynamic(s) in terms of past events, causes us to re-live past events and
react as we did at a previous time. Unfortunately what was an appropriate
reaction in the past is often no longer effective. Please beware of making
this generalization which can be a grave mistake! Rather, carefully assess
the current problem to reduce the tendency of impulsive, “knee-jerk”
responses based on and influenced by previous, habituated behaviour. you
will save yourself a lot of problems and heart ache.
c . psych o lo gical urg en cy
You should, with practice, be able to understand the dynamics of the
issue being addressed and the “text” of the most pressing problem(s) to
be solved. Begin by prioritizing the problem and look for the flip-side
of the problem, which is usually the answer to the problem in broad
strokes. Subsequently, compartmentalize the problem by breaking
down its components and assessing, then prioritizing which aspect of
D o nalD hutcheo n , eD. D. ,
c . psych o l(uk). , r. psych .
Vice-President of the BC
Psychological Association.
Metacommunication in Organizations
4 principles to Keep in Mind
(a)
(b)
(c)
(d)
24 Spring 2014
p ost s crip t
As I was writing this article it occurred to me to look through
some older texts (i.e., Malone & Petersen 1974) regarding
increasing your effectiveness in handling politics and
promoting your reputation/success within an organization.
You’ve probably heard some of this information before, but
it doesn’t hurt to be redundant for your benefit.
Build a positive political image: Simply this: consistent
good work and the appropriate use of your ability
usually “wins the day”. How so? Increase the frequency
of contact and interest in others; know people by name
and give them credit or recognition to acknowledge
their work and personal achievement; show tact,
sensitivity and respect for other people and your
contacts with them;
Deal with political realities: Organizational politics are
realities we have to deal with! Be wary of cliques and if
you join one, don’t be surprised if anything you disclose
is not perceived as confidential and is discussed in open
forum. Expect fairly consistent action and support
among the members within a clique. If one member is
opposed to an idea or program, the others are apt to be
against it as well. Please be careful and be aware of this
one looming its big rotund, ugly head;
Prevent political breeding grounds: Avoid using
the same source as your informal channel of
communication. This is a big “no no,” as that person
comes to depend on the power of their informal
“expert” role as your confidant, which in turn can
work against you with a “falling out” in times of
distress and political action. The information you
seek or have disclosed to that person in the past may
be misrepresented to save someone’s job, career,
whatever and leave you “hanging out to dry” and lastly;
Sidestep political schemes and power plays: Challenge
the temptation of listening to gossip and keep in mind
the alternative of refusing to listen. Explore issues and
differences between people openly and impartially.
Avoid the tendency to “carry tales” or listen to
unverified rumours. Stay focused on work objectives
and avoid entanglement with conflicting factions and
schemers. Colleagues respect “apoliticals”; it’s that
simple.
Following these rules will help you stay on top of the
game. With luck and hard work, much success in all future
endeavours and your careers!
the problem you can successfully address. Attempt to
solve the problem after you’ve determined its degree of
difficulty from your perception of it on a “most weak to
most difficult” continuum. As you answer each aspect
of the problem, this should increase your confidence
to continue. From this beginning and the success you
achieve in solving aspects of the problem, you will
begin to understand the problem’s overall psychological
urgency vis-à-vis its overall impact on the organization.
Often what we perceive as overwhelming and stressful
upon “first blush” changes after a few attempts to
problem solve. Specifically, when anxiety dissipates there
is greater acceptance of the “dignity of risk”, of actually
risking a confrontation with the problem at hand. With
practice, this problem solving approach should become a
comfortable option for addressing most dilemmas faced
by you in your role within the new organization.
D. multiple fun c tio n
Organizational theme(s) can have serious meanings
depending on how you interpret them and from which
points of view (i.e., defensive processes; key dynamics;
interpersonal relationships, their patterns and their effect
on the organization etc.). These issues may also be played
out simultaneously or concurrently and at individual,
management and organizational levels of the political
ecosystem. If you hadn’t guessed, thematic evaluation
can be complex. Learn to prioritize the organization
theme you’ve encountered regarding ongoing work
“widgets” you’ve been assigned to lessen the chance of
error. With time, this skill set will improve.
By now it should be obvious to YOU, the
stakeholder of your mental health, that becoming familiar
with these rules of interpretation is vital! Learning the
basic organizational themes and patterns of the dynamics
of these themes played out at your workplace will
allow you to interpret them quickly. With practice, the
significance of issues that initially seem meaningless
or chaotic, can be interpreted at their proper level of
importance. Have confidence. you will become adept at
learning the organization’s themes of communication and
your ability to interpret them will become second nature
with practice.
referencesKets de Vries, M and D. Miller (1987). Inside the troubled organization: Unstable at the top. The New American Library of Canada Limited.Malone, R.L ., and Petersen, D.J (1974). The effective manager’s desk book: Improving results through people. Parker Publishing Company Inc.
Meaning Therapy :A new paradigm of integrating healing with personal growthpresenteD by D R. PAUL wO N G
Friday April 25th, 20149:00AM – 4:00PM @ University Golf Club5185 University Boulevard Vancouver, BC V6T 1X5
Continuing Education Credits: 6
About the WorkshopMeaning Therapy (MT) introduces a new paradigm of integrative therapy that treats the whole person, rather than mere cognitions or behaviours. It is integrative, holistic, and evidence-based with the positive psychology of meaning as its central organizing construct. As an extension of logotherapy, it will pay special attention to the existential and spiritual issues that underlie most personal issues and predicaments. MT will integrate existential psychology with CBT, narrative therapy, cross-cultural psychology, and positive psychotherapy.
MT aims to restore human dignity and promote mental health in an increasingly dehumanizing and toxic culture dominated by materialism, consumerism, and cut-throat competition. Psychologists will learn how to use meaning-based interventions to address major clinical issues, such as depression, anxiety, and to empower their clients to live a purposeful and value-driven life.
MT helps clients discover their true selves and hidden inner resources by switching from a self-focus to a meaning focus. It shows how a radical change in worldview and belief systems can transform a person’s life from the inside out.
Learning Objectives• How to contrast the new meaning paradigm with
the traditional paradigm of psychotherapy• How to heal the worst and bring out the best in
people’s lives through meaning• How to employ a coherent conceptual framework
with meaning as the central organizing construct in integrating a variety of therapeutic modalities
• How to use innovative positive interventions, such as PURE and ABCDE, to restore hope, meaning, and passion for living, regardless of circumstances
About the Presenter — Dr. Paul T. P. WongPaul T. P. Wong, PhD, CPsych, has been a professor and clinician for more than three decades. His meaning therapy has gained world-wide recognition. He is the President of the International Network on Personal Meaning, and International Society for Existential Psychology and Psychotherapy. He is
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also Editor of the International Journal of Existential Psychology and Psychotherapy. He has been invited all over the world to give workshops on Meaning Therapy. His lectures are known for his passion and humour.
How to register for this workshopMail this form to: BC Psychological Association • 402 – 1177 West Broadway Vancouver, BC V6H 1G3Fax this form to 604 – 730 – 0502• Go online: • http://psychologists.bc.ca/civicrm/event/info?reset=1&id=110
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Regular Registration (March 4th – April 20th, 2014)
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