Growing old disgracefully and working with the disgracefully old: Signifi cant landmarks in the ‘unexplored territory’ of older adulthood


Melanie Shepherd and John Hills


John: Well, Melanie, do you want to start this or shall I? And anyway, where do we begin? We are both systemic psychotherapists working with older adults and I guess we can say we are both in that age-bracket ourselves. Melanie: Yes – I’m in my late 50s but certainly feel older and older every day! My partner is older than me so I have the opportunity to see things through his eyes too. I was thinking about ‘joining’ in the context of how we have collaborated: being invited to co-write this article as strangers, we have got to know each other on the phone and I was welcomed to your family therapy clinic one day. Were I still working for the NHS, I would have reciprocated. We are from different professional backgrounds and age cohorts and seem to have different approaches to writing papers – so, in some ways, this mirrors the joining process we go through with our clients. John: ‘Vive la difference!’ as the French have been known to say! A worthy mantra, I have always thought, for the ethos of systemic thinking and practice. Melanie: We have debated, haven’t we, how much of what we have discussed relates to joining in particular rather than working with older adults in general? I wonder if this ref lects the question regarding whether joining is seen as the initial process of connecting with the client or family or whether the concept is wider and includes engagement and the ongoing therapeutic alliance throughout therapy (Lee et al., 2018). John: I think you’re right to differentiate ‘joining’ from ‘engagement’. ‘Joining’


Context 169, June 2020


implies the act of connecting with a group or club – like a foster child ‘joins’ a family, or we might ‘join’ the local gym. ‘Engagement’ does suggest something much more specific and ‘reducing the human difference’ between one’s own background and subjective ‘life experience’ and that of the members of the family we are hoping to ‘join’. You have also ‘f lagged up’ both the challenges of working with an older adult age group (especially when you are not ‘of it yourself ’) and engaging the particular person or the family. That’s the limitation of the French rallying cry, it seems to me. It’s just a celebratory cry, not an invitation to roll up your psychological sleeves and get down to some work. Melanie: Certain themes have emerged as we have talked. But I wonder if we have seen them similarly or would have come up with different ones alone or in conversation with other people. For me, I would say they have clustered around age, cohort, time and mortality; joining with families affected by ‘cognitive impairment’ and ‘dementia’; and viewing older adulthood as a different ‘culture’. John: Yes, I think you’re absolutely right about these themes coming up through conversation with each other. This is a confirmation, I guess, about the power and value of ‘open dialogue’ as a relational process. I assume that, when it comes to our theme of ‘joining’ and ‘engagement’, it is arguably less difficult for us to connect with this age group than perhaps younger trainees or colleagues. Some trainees and therapists can be the same age as our clients’


grandchildren or children. Retiring by 65 means that many of us older therapists do not get to work with the ‘older adult’ cohort, which I think is a great pity and loss of experience. I think we agree there is more of an immediate same-generation ‘identification’ both from us to clients and clients to us the older we get as practitioners. This does, I think, cut across any role perceptions and anxieties they may have about our power to place fear-inducing ‘labels’ on them like ‘cognitive impairment’, ‘early onset of senile dementia’. We both know there is a ragbag of ‘identity devastators’ like those in the mental health ‘armamentarium’. They may be helpful describers for us, but to their recipients they can be deeply troubling to hear, unless they have their implications explained. Melanie: I certainly feel more comfortable working with older adults than I did when newly qualified and I suspect my older clients might too. I recall my nervousness as my supervisor observed me seeing my first ever client, when training as a psychologist: she was over 65. I ran out of things to ask her, ended the session early and, not surprisingly, the client asked to see someone with more life experience! We’ve both noticed though, that young therapists can surprise older adult clients by how insightful they are despite the age gap. It has struck me that the age span of older adults being 40 years plus is almost as broad as the working age group, so over 65s include a wide spectrum of cohorts. I found it interesting how Curtis and Dixon


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Growing old disgracefully and working with the disgracefully old


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