People with elderly parents met in five eight-week counseling groups to make decisions about the extent of responsibility they could comfortably assume for their parents and to work toward reaching a stage of filial maturity. Some issues were common to all groups — dependence, fear of one's own aging, relationships with siblings, communication. Results indicate that this informal, supportive modality is effective in helping adult children make decisions and act upon them.

Short-term Counseling Groups for People with Elderly Parents1 Carol Popky Hausman, PhD2

102

The Gerontologist

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

before. As their parents age, people frequently face increasing responsibility for them, particuself-reliance are so highly valued, young adults larly if the parent is suffering from a disease or and the middle-aged leave their elderly parents disability. The decision about the extent of rebehind and alone. York and Caslyn (1977) call sponsibility a person will assume for his/her this the "myth of uninvolvement." Actually, parent's welfare is a difficult one. It is important young people do not abdicate their responsibil- that adult children be given opportunities to ity toward their parents. A well-known study explore their feelings about responsibilities and (Shanas, 1960) found that 36% of older people limits, as well as to learn about alternatives, in America who had children lived with them;3 before a time of crisis. Whether a parent is instian additional 24% lived within walking dis- tutionalized, lives in the adult child's home, or tance; and an additional 25% lived less than a lives out-of-town, involved and caring adult day's drive away. Other studies have found that children often find themselves in the unexpected families provide the main support — financial, and unfamiliar role of decision-maker and careemotional or recreational — to their aging mem- taker. bers. For example, Brody (1970) reported that For example, the choice of a service setting for at least 80% of older people depend mainly on elderly people is largely made by family memtheir families, with community services supple- bers, usually with, but sometimes without, the menting rather than substituting for family sup- concurrence of the old person. Hausman (1976), port. Both Brody (1970) and Butler (1975) report in a study of family members of nursing home that institutions are disproportionately used by patients and geriatric day-care center participeople who have no children. And those people pants, found that some family member was who, for one reason or another, do have parents involved in the placement decision two-thirds in institutions, do not ignore them. Most families of the time. Brody and Cummer (1967) report call, visit, and attend to their parents frequently, that at least one adult child was present at the often at great personal sacrifice. Even appropri- initial nursing home interview 70% of the time. ate institutional placements often trouble the Egerman (1966) found that the success or failure families deeply (Butler, 1975; Silverstone & of placement is determined by the attitudes of Hyman, 1976). The norm is overwhelmingly one adult children. of involvement. Under the auspices of the Community PsychiBecause of the lengthening average life span, atric Clinic of Montgomery County, Maryland, more people have elderly parents than ever the author has conducted short-term groups for adult children who need help in making parental decisions that are comfortable for them, for their nuclear families, and for their parents. So far, 'The groups described in this paper were conducted under the auspices of Project Family Outreach, Community Psychiatric Clinic, Montgomery Co., MD. five groups have been held. Although each 'Coordinator, Services to the Elderly, Mount Vernon Ctr. for Community Mental Health, 8119 Holland Road, Alexandria, VA 22306. group has been unique, there are some issues The 1970 U.S. Census report (PC (2)-4A,4B) indicated that 17% of the elderly that are common to all of them. This article live in multigenerational households. It is a prevalent, but mistaken, idea that in our society, in which mobility, independence and

children may have to provide those very same kinds of supports to disabled or ailing parents. (This is not to imply that a role reversal takes place, for, despite what may appear to be childlike behavior, no one ever becomes a child a second time.)

describes the groups, defines the major issues, and indicates some of the ways in which the group members have worked toward resolution. Group Composition

Three Major Goals The goals of all the groups have been: (a) to find a balance between responsibility to one's self, one's nuclear family, and one's parents; (2) to make specific decisions about the extent of, and limits of, the members' duties and obligations to their parents, and what the attendant behavior should be; and (3) to learn to deal with one's parents in a mature way, leaving behind the conflicts, rebellions and unresolved issues from childhood and adolescence that so often interfere with objective evaluations of needs and provision of real help. The third goal is perhaps the most important, for it involves the accomplishment of one of the developmental tasks of the middle years, the resolution of what Blenkner has so aptly termed the "filial crisis" (Blenkner, 1965). To resolve the filial crisis and arrive at a stage of filial maturity, one must recognize what one must do and what one cannot do, as well as accept the fact that parents may no longer be able to provide the kinds of supports for which their children looked to them in the past. Indeed, the

Vol. 19, No. 1,1979

Informal and Supportive Atmosphere

The groups met weekly for eight sessions of 1V2-hours duration. The atmosphere was informal and permissive. Interventions were mainly limited to reminders to stay with the group's task, clarifications of misunderstandings, prevention of monopolizing, interpretations and summaries. Didactic material was occasionally presented to correct factual misconceptions, particularly about diseases and disabilities, to present relevant statistics, or to offer information on community facilities. Group cohesiveness developed quickly in all the groups. In the first session, long self-introductions took place, with other members being encouraged to ask questions and to interact freely during the introductions. Almost immediately, common problems, fears and goals were recognized. In realizing the extent of their own interest in what others had to say, members expressed relief in finding a place where they could talk about a subject which they felt uncomfortable discussing elsewhere. Usually during the first session someone tried to offer quick "easy" solutions to pressing, long-standing problems. It was important for the leader to intervene when this occurred to keep members from being pushed into the uncomfortable role of help-rejector. Group cohesiveness, according to Yalom (1970), "results in better group attendance, greater participation of members, greater influenceability of the members, and many other effects." Early cohesiveness, developing from early intermember identification, facilitated a sense of trust which, in turn, encouraged honesty and receptiveness to ideas and suggestions. There was invariably a high level of involvement. Concerns articulated in the first session were often common to several members. In later sessions, people whose concerns differed in substance often found that the feelings behind the concerns were the same. During the third session, the leader asked each member to select another member and summarize that person's major reason for joining

103

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

Group size ranged from six to 15 members. Forty-eight people attended the five groups — 39 female and nine male. The age range was 26 to 70, and the median age was 52. The living circumstances of the 57 elderly parents discussed varied widely. Fifteen lived in the homes of the group members: seven were in nursing homes; thirteen lived in their own homes in the same geographic area as the group members; and 22 lived out-of-town. Participants learned about the groups in various ways. The group leader sent letters to several physicians, nursing home administrators, and social service agencies in the community asking them to inform appropriate clients about the groups. Notices were placed in local newspapers. Some people attended because they had friends who had benefited from attending earlier groups. Three people signed up a second time. The leader telephoned each potential participant to explain the goals and procedures of the groups. A si id ing-scale fee, ranging from no fee to twenty-five dollars, was charged.

Issues Common to All Groups

The issue of unpreparedness for a suddenly assumed burden of care generally arises early in the life of the group. Although the age range of members has been wide in each group, and therefore the members are in different stages of life themselves, virtually none of them had spent a great deal of time planning for the part they would play in their parents' old age. Many of them came to the group to try to undo or cope with a burden which had been assumed too hastily during a crisis; others came because they anticipated a crisis. All of them had looked forward to the kinds of freedom that middle age often brings — freedom from child care, from rushing home to make the family's dinner, from financial worries, freedom to be able to do what they wanted to do when they wanted to do it without having to consider the needs of a lot of other people. None of them expected the burden to fall on them from the other end as soon as, or before, the children left home. Much of the group's time is spent discussing the issue of the indignities of old age. This generally leads to expressions of fear about the

members' own aging and to concerns about death. Typical questions which arise are: Are we going to be like them? Will we do this to our children? How much of this or that disease or disability is hereditary? Members with disabled parents are often convinced that they will suffer the same disability at the same age. Having a wide age span within the groups is very useful in helping them learn that different people age at different rates. For example, in one group a 30-year-old woman was worried that everyone her father's age (particularly she herself), would be as disabled as he. He was 66. As the group was trying to tell her that that was not necessarily so, a 70-year-old member rushed in and apologized for being late — the tennis tournament in which she had been participating ran overtime! Nothing the group could have said to the young member could have been quite so convincing. A closely related issue is that of dependence. Since most of the group members were in the most powerful stage of their lives vocationally and financially, it was especially difficult for them to imagine losing any of that independence and yet retain self-esteem. The issue of sibling relationships arose frequently. Those who had no siblings were able to relate to this issue because they usually had a relative who stood in place of a sibling for purposes of elderly parent responsibility. Many members were experiencing resentment toward siblings whom they perceived as not bearing their share of the burden for sick or disabled parents. Often, the caretaker child, who gave so much time and attention to the parent, was also the one who received the bulk of the parent's anger and criticism, while the absent sibling received the praise. On the absent one's infrequent visits, he/she saw only the sunny side of a difficult parent's disposition. Similarly, the grandchildren who accommodated to having a sick grandparent in the house often made sacrifices like giving up their rooms and doing without loud music and late-night guests, only to suffer criticism and complaining, while they constantly heard their out-of-town cousins praised. Underlying the current sibling resentments was residual sibling rivalry from childhood. Some people who had arrangements with siblings for shared parental responsibilities were unable to share, resulting in interference during their sibling's turn. The issue of helping a parent through a stage of grief was covered at some length. The group

104

The Gerontologist

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

the group. In this exercise, people discovered whether they had been understood clearly or whether they needed to clarify their problems further both for themselves and for the group. Most expressed surprise and gratitude upon hearing the insights and understanding of others. Frequent comments were, "You really heard me," and "You said it better than I could." Because of the assurance that they had been heard and understood, most members became available for guidance. The leader encouraged them to present suggestions to others in behavioral terms, in small, easy steps that were likely to be successful. For example, the group instructed one woman to visit a variety of senior residences because of her negative stereotyping of all of them. Another, who rarely left her demanding mother's bedside, was urged to spend an evening out each week with her husband. The group helped her rehearse assertive approaches to inform her mother of her new plans. Feedback was sought at sessions following those at which behavioral suggestions had been made. Members spontaneously reinforced behavioral change. The participants used the final sessions to summarize for themselves and others what they had gained from the group and what work remained to be done.

Evaluation Instrument Administered A general evaluation questionnaire was distributed at the last meeting of each group, to be filled in anonymously. Members were asked about their initial expectations from the group, and whether those expectations had been met. Most members stated that they had joined the group either for help in resolving a specific problem, to acquire new knowledge and information, or for help in improving relationships. Almost all reported that their expectations had been met well, that their concerns were discussed quite thoroughly, and that they found the topics interesting and valuable. A large number expressed surprise at the extent to which topics they had not anticipated were dealt with — particularly feelings about their own aging, guilt feelings, death, and encouraging independence. When asked to check the benefits people may get out of a group such as this, the two items most frequently chosen were: "I was able to share with people who had concerns similar to mine," and "I was able to evaluate and change some of my own attitudes and beliefs." More than half the respondents said that they would join a similar group again, and all said they would recommend a similar group to

Vol. 19, No. 1,1979

others. (Many actually did so — some of the later groups were partly composed of acquaintances of earlier members.) Frequently, comments were added to the questionnaires: "I was overwhelmed at the kind of support a group such as this can give;" "After the first session I immediately felt better both physically and in my mental attitude and felt that there would be a way to solve the problem confronting me;" "The group meant a great deal to me at a very difficult time in my life;" "I was able to use what I learned almost immediately." Ways in Which the Members Grew In discussion, more than on the evaluation form, members expressed their feelings about ways in which they had grown. Learning about successful aging and what can be done about it, both for themselves and their parents, was high on the list of specific positive benefits. They welcomed information about correlates of successful aging — exercise, intimate relationships, planful daily living. Information about community facilities was also welcomed. One member had never heard of geriatric day care at the first session, and at the last session she reported that her mother was successfully enrolled at a local center. The group members learned from each other about the kinds of parent-child relationships that do and do not work when living in multigenerational households. Those people who had unsuccessful relationships with their parents during most of their lives found that, unless they were to radically alter their modes of communication, living together only exaccerbates the worst in the relationship. The opposite, of course, is also true — that a healthy relationship based on affection, open communication, and mutual generosity is one which can grow and flourish in a multigenerational living arrangement. In either case, group members warned against hasty decisions, because they are difficult to undo. This was particularly poignant when grief work was left unfinished. Members helped each other realize that, if time heals wounds, it does so slowly when the wound is the loss of a spouse with whom one has lived for half a century. Adjustment to that loss can often only be accomplished successfully when other major adjustments are not required simultaneously. When loss of a long-time residence, a familiar area, and the company of old friends

105

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

members who had "protected" their parents by moving them away from their homes immediately after a difficult loss, generally expressed sorrow at having done so, unintentionally compounding the loss. The value of grieving at one's own pace and in one's own place was emphasized by those who had been able to allow it. This led to further discussions about the necessity of closely examining actions which may appear to be altruistic but which may turn out to be in the parents' best interest. The self-centeredness of older parents was a subject that arose often. Members described their parents as selfish, demanding, inconsiderate, and, perhaps hardest of all, uninterested in the activities and accomplishments of their own children and grandchildren, who were formerly the main focus of their interest. Communication — with parents, other relatives, parents' doctors, nursing home personnel — was another major problem. The need to communicate without complaining, to be assertive without being aggressive, to state needs without accusations, was expressed at nearly every session.

and bored there. The group found a successful solution — enlisting the children to perform the role of secretary to the grandmother who was also worried about falling behind in her correspondence. This gave the children something useful to do, took away their discomfort, and gave the grandmother their presence. Three parents died while groups were in progress, forcing all the members to confront the issue of both their own and their parents' mortality. The groups were invaluable in helping members help their parents die well. One daughter's dilemma consisted of having a doctor who wanted to hospitalize her 96-year-old father during his last weeks, and a father who wanted to die in his own home with a bottle of bourbon next to his bed. The group gave the daughter the courage to follow her natural inclination, to stand up to the doctor, and to grant her father's wish. Many members were able to hear their parents' concerns about death for the first time and to talk with them about it, rather than denying it by repeating the familiar, easy, "Don't be silly, you have a long life ahead of you." Learning to be more in touch with their parents' feelings was a primary benefit from the group. So many members were frustrated by repetition of discussions and arguments which only led to worsening relationships. The groups helped them get to the feel ings behind the words, to break noncommunication patterns, to stop trying to reason with people who had lost the ability to reason, and to find the level where communication could take place. This often meant starting to give up lifetime hopes and dreams; it often meant leaving old conflicts behind; but it also meant a new kind of gratification, a step toward resolution of the filial crisis, and freedom to give the kind of affectional support most needed by the parent and most rewarding to the adult child. One member, whose institutionalized mother was suffering from chronic organic brain syndrome, provides a moving illustration of this point. At her too frequent visits to the nursing home the daughter had continued to try to get her mother to recognize her, badgeri ng her to the point where both she and her mother would yell in frustration as the visits ended. At the end of the seventh group session, she quietly reported: I went to visit my mother after our meeting last week. She didn't know me, of course. I sat there and just held her hand, and I looked at my mother and this woman is at peace. Really. When I sat there and just held her hand, I had a feeling of peace too. She is

106

The Gerontologist

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

occur at the same time, grief can be intensified. Because of this, members were encouraged to help their parents stay in a familiar, comfortable place if at all possible after the death of a spouse. They were also encouraged to talk with their parents about their losses, rather than either distracting them or engaging in denial. People in the groups learned to try not to make decisions for people who are capable of making them for themselves. They learned to respect their parents' need for independence as long as it is safely possible. Many members began examining decisions which they had offered as being made for their parents' benefit but which were really made to ease their own burdens or guilt. One woman, whose parents live across the country, kept trying to convince her mother to hire someone to care for her disabled father, rather than care for him herself. The mother was able to discuss the situation rationally and state quite clearly that she was doing what she chose to do. The daughter told the group, "My mother doesn't complain but she should." It took several sessions, including a temporary drop-out in frustration, for this woman to begin respecting her mother's right to continue behaving in a way she had behaved for 47 years! On the other hand, some members who themselves were administering constant care to ailing parents admitted resenting it and feeling trapped. The group convinced them of the necessity to set limits, both for their own and their parents' benefit. Twenty-four-hour care, especially when given unwillingly, cannot be of the best quality. Rather, availability at specific, scheduled times, which both the caretaker and the care-recipient can count on, gives a sense of security to both parties and often raises the quality of care considerably. Group members discussed how to give their parents a chance to remain parents — to maintain as much of this role as possible. In place of necessarily decreasing instrumental tasks, they learned how to supply increasingly affectional tasks. They began asking their parents for recipes, childcare advice, family history. What began as a somewhat manipulative suggestion from the group often became the basis for a new kind of valuing of parents' contributions. During the course of one group, one of the members was caught between a hospitalized mother who begged her to bring the grandchildren to visit, and children who refused to go to the hospital because they felt uncomfortable

being taken care of. Whatever world she's living in, quate for the majority of members; those who she is not suffering and she's clean and not in any want more time join succeeding groups. pain. It was a completely relaxed feeling. She is not hurting. References Blenkner, M. Social work and family relationships in later life with some thoughts on filial maturity. In E. Shanas & G. Streib (Eds.), Social structure and the family: Generational relations. Prentice-Hall, Englewood Cliffs, NJ, 1965. Brody, E., & Gummer, B. Aged applicants and nonapplicants to a voluntary home: An exploratory comparison. Gerontologist, 1967, 7, 234-243. Brody, E. The etiquette of filial behavior. Aging and Human Development, 1970, 1, 70-84. Butler, R. Why survive: Beingold in America. Harper & Row, New York, 1975. Egerman, L. Attitudes of adult children toward parents and parents' problems. Geriatrics, 1966, 21, 217-222. Hausman, C. Geriatric day care and long-term institutionalization: A comparison of attitudes and feelings of family members identified as responsible (Doctoral dissertation, Univ. of Maryland, 1976). Dissertation Abstracts International, 1977,38/2, 960-B. (University Microfilms No. 77-16370). Shanas, E. Family responsibility and the health of older people. Journal of Gerontology, 1960, 15, 408-411. Silverstone, B., & Hyman, H. You and your aging parent. Pantheon, New York, 1976. Yalom, I. The theory and practice of group psychotherapy. Basic Books, New York, 1970. York, J., & Caslyn, R. Family involvement in nursing homes. Gerontologist, 1977, 17, 500-505.

GERONTOLOGICAL PSYCHOLOGIST The Dept. of Psychology at Oakland University (located in the Detroit metropolitan area) invites applications for a one-year appointment as Visiting Assistant or Associate Professor starting August 15, 1979. The position requires teaching of undergraduate and master's level courses in the psychology of adulthood and aging and coordination of field experience for students in agencies serving the elderly. Requires PhD in Psychology of Human Development with specialization in aging. Salary negotiable on the basis of qualifications and experience. Research activity will receive support. Send vita and names of three references to Harold Zepelin, PhD, Dept. of Psychology, Oakland University, Rochester, Ml 48063. Affirmative Action/Equal Opportunity Employer

Vol. 19, No. 1, 1979

107

Downloaded from http://gerontologist.oxfordjournals.org/ at University of Arizona on June 7, 2016

Recommendations The effectiveness of the groups described in this paper prompts the recommendation that the short-term, time-limited, task-oriented format is appropriate for helping people who have concerns and problems about their elderly parents. Te opportunity for immediate expression of common concerns at the initial session, and the clear expression of the group's objectives, help to develop the cohesiveness that accounts for high involvement and attendance. Groups which include men and women, and which have between nine and 12 members, are the most active, have a wider variety of situations and points of view, and are not too large to prevent discussion by all who choose to participate. A sliding-scale fee makes it possible for people of all socioeconomic backgrounds to participate, thus increasing the variety of ideas and suggestions. The pressure of some fee, rather than no fee, probably contributes to the high attendance rate. Eight IVi-hour sessions is ade-

Short-term counseling groups for people with elderly parents.

People with elderly parents met in five eight-week counseling groups to make decisions about the extent of responsibility they could comfortably assum...
680KB Sizes 0 Downloads 0 Views