(2019) highlighted the distinction between cohort and age. Meaning that someone my age in the 1970s will have experienced life very differently from me, just as my young adulthood was different to those of the trainees we work with. So, whilst there is that ‘same generation identification’ we discussed, which can help, we agreed we need to be cautious about our assumptions. Curtis and Dixon also note that some social differences are intrinsic and relatively static whilst others can change and are controllable. Yet age is constantly increasing. And, as a colleague once put it, birthdays keep happening without our permission and against our will! John: Certainly so. It is obvious that, at the later stages of the life cycle, death and dying become much more real as a possibility. Younger people sometimes act as if they are immortal so take high and dangerous risks. What we have found from our work is that the closer to death that older age betokens so the latent ‘death anxieties’ over decades begin to surface. It reminds me of that TV programme that ‘miraculously’ folds away the sea to reveal the wrecks and hulks lying on the seabed. It’s all done with the technology of computer graphics. But I do think it’s a useful comparison for how our minds can reproduce the same process through reminiscence, as Freud maintained decades ago. Melanie: We have also talked about the issue of time and its relationship to the lifecycle. I’ve wondered if some older adults might have a different relationship to help and to hope, depending on their experiences and the chronicity of their difficulties. For example, I’m always conscious that hypothetical, future- oriented questions have a different meaning when people have shorter futures. John: I have noticed the understanding and beliefs about the ‘marriage contract’ that couples make in their 20s or 30s have shifted by the time they are in their 80s and into the ‘golden wedding’ era of celebrations. Melanie: That makes me think of a conversation I had with Hugh Jenkins (2006) about his idea of asking couples about their ‘invisible’ marriage contracts on the blank back of the real one. He meant the unsaid assumptions we bring


34


into relationships: expectations that both one’s partner and oneself may be unaware of – such as how the partner might compensate for aspects of our personalities or make up for painful previous experiences. John: There’s a couple we saw as a team over a number of sessions. The man was increasingly self-neglectful and cognitively impaired and shuff led into the session. They had had a very sparky, jousting, intellectual relationship based on humour and a questioning view of the world. His wife, who was very sharp and feisty, said about session four, “The marriage vows say that we should love each other in sickness and health until death parts us. It doesn’t say if he stops loving and caring for himself, which he does, you should therefore love him in spite of that!” In the following session he was more verbal and she calmer, more resigned and less agitated about their situation. We didn’t quite know what had changed and she just said, “I have come to accept him the way he is. It is better”. Melanie: I wonder what their ‘invisible contracts’ might have been and how your involvement seemed to help him be more present and her more accepting. I quite agree that, at later stages of the life cycle, issues of mortality are much more present and so is the reality of ‘cognitive impairment’ or ‘dementia’: both can generate a great deal of fear. In my experience, although some professionals and families question the inclusion of people with ‘cognitive impairment’ in therapy, I have rarely found it more appropriate to meet the family separately from the person with dementia (although sometimes it has proved impossible, for practical reasons, to include them). But this question can be an important and tricky one when joining with families if they feel strongly the person with dementia should not be part of the sessions. John: For me, thinking systemically is thinking inclusively. This may be difficult and unbearable at first for the practitioner, but families do take their cues from us and how we practise. Sal Minuchin (Minuchin & Fishman, 1981) always stressed the importance of therapeutic leadership. Role-playing potentially difficult scenarios where cognitive or perceptual differences are huge is really important to do. It is real,


experiential and gives us the ‘live feel’ of practice which texts can’t give, though these have their place in the learning continuum too. Melanie: Can you say a bit more John? It sounds really interesting. John: Well, when I was training in the early 80s, Minuchin came to talk to us trainees on the Tavistock Sheldon Family Therapy training. He said he had just written a play sequel to Ibsen’s A Doll’s House in which the wife, Norah, having broken free from the oppressive conventions of her marriage, in which she had no rights nor recognition as a free-thinking person, willingly returned to her husband! I had taught a course at the University of Kent on using works of drama to teach family interactive process, so this was very ‘conjoint’ with my own thinking, though dramatically and ethically wrong by short-changing Norah’s assertion to be her own person. It was a violation of what Ibsen was saying! It confirmed my view, however, that drama is the ‘foundation stone’ of family therapy because it teaches us about dialogue and action – the action of relational interaction. Norah ‘finds her voice’ through her family interactions. It sounds as if this is what you are reaching out for too? Melanie: I hadn’t thought about it quite in that way before but yes. Talking of ‘finding a voice through family interactions’, I’m sure you have faced the dilemma as a therapist when the person with dementia finds it hard to have a voice and protective family members sometimes speak for them? This can challenge one’s neutrality. I’ve found Webb-Peploe and Fredman’s (2015) paper regarding systemic empathy, based on their work with people with intellectual disabilities, one of those I return to frequently. It gives useful ideas relevant to working with people with dementia and their families. About how to include and to hear all voices in the family and address the difficulty of maintaining a balanced alliance when family members have different and sometimes opposing views. You need to consider respectful ways of ensuring all are heard and that the person with dementia is involved right from the start. I find you also need to make some changes to the sessions. What changes have you found useful?


Context 169, June 2020


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


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52