Examples – Helping Aging Parents

l Will and Marilyn had married late and had kids even later. With their kids

entering adolescence, they were confronted with the possibility of becoming

caregivers for Marilyn’s widowed mother after she fell, breaking her hip.

l Sarah has been a frequent volunteer for years, ever since retiring from the

school district. But her health has been failing recently and she’s not sure how

much longer she can live alone. She doesn’t want to live in a retirement home, but the last thing she wants to do is disrupt her children’s lives.

l Edward is a widower and has cancer that has spread to his liver. His children have A expressed concern over his living conditions, believing that he has not been caring for himself properly.

Definitions and Key Thoughts for Helping Aging Parents

l Aging is a natural process. The rate at which people age varies widely according

to many factors such as family history, emotional attitude, chronic medical conditions, and lifestyle.

l Although the risk of disability and illness increases with age, poor health is not an inevitable consequence of aging. Persons with healthy lifestyles that include regular exercise, balanced diet, and no tobacco use have half the risk for disability than those with less healthy lifestyles.

l Caring for aging parents can be gratifying, but that depends on a lot of complex issues, such as your own health, whether you are still raising children, financial resources, and emotional resilience. Even though being a caregiver is laudable, it is not necessarily the wisest decision if there are other options.

l The “sandwich years” is a phrase referring to middle-aged people who are

still raising children and are also caring for their parents. They are “sandwiched”

between these two generations, and it can feel like a vice grip or a well-coordinated

dance.

l As people age, their idiosyncrasies tend to become more pronounced. Easygoing

people may continue to be laid back, but those who were uptight at a

younger age may become more anxious or paranoid as they age.

l Persons entering their later years experience many transitions and endure many losses such as retirement; moving from parenthood to grandparenthood; lessened physical abilities, strength, and energy; the deaths of friends and peers; lowered social status; a tighter financial budget; and the loss of a

spouse.

Boston Therapy Assessment Interview

As you talk to the aging person or a family member, remember that aging and caregiving take many forms. Try not to project your own values. The older person may value independence far more than you would think is healthy, or the family member might be convinced that anyone older than 65 can’t be independent. Listen first, then gently respond as necessary.

Boston Therapy Assesment: Rule Outs

Medical:

Q1 If the elderly person is confused, has he or she been ill? Is there a chance of

depression, dehydration, other medical problems, or poor nutrition? (Several

medical conditions and depression can mimic the symptoms of dementia,

so always be sure that medical problems and depression have been ruled

out by professionals before making any assumptions about a person’s ability

to live independently.)

Emotional:

Q2 Is the older person lonely/depressed? (Simple loneliness can prompt a person

to reach out for help, sometimes acting needier than he or she truly is.)

General Counseling Therapy Questions

Q3 What level of care do you think you (or your loved one) need?

Q4 What are your (or your loved one’s) financial resources?

Q5 What medical issues are there? Are these terminal? Chronic? Permanent

but not debilitating? Degenerative and progressive? (Clearly, if a medical

condition is temporary, the future plans will be very different than if it is

terminal, progressive, or chronic.)

Q6 How do you feel emotionally about the possibility of needing to get more

care (give care to a loved one)?

Q7 What family members are available to help?

Q8 Is the aging person in danger?

Dangerous conditions would include:

– memory loss that leads to accidental fires, wandering, or destructive behavior;

– medical conditions that require constant supervision or that contribute to sudden loss of stability or consciousness;

– a residence that is deteriorated, unhealthy, or structurally too demanding

(e.g., too many stairs);

– an emotional state that could lead to extreme despondency or psychosis

(distorted thinking, such as paranoia).

Wise Counsel

When counseling, or providing therapy to, a caregiver, impress upon the person the complexity of issues

related to aging and the wealth of resources for caregivers and for the elderly.

Encourage the person to gather all the facts (from doctors, other family members,

neighbors, etc.). The goal is to find out how the aging person has been doing and

whether there are critical concerns.

Assess whether there is any possibility of physical or financial elder abuse or

neglect.

l Financial abuse occurs when friends or family members take financial resources

from an older person for their own benefit. This is a particular risk

when the older person is confused and no longer controlling his or her

own finances. Financial Abuse tends to increase during times of economic recession (Boston, MA is not immune to this). 

l Elder neglect occurs when a spouse or live-in family member deliberately

neglects the needs of the older person for food, clothing, shelter, a clean environment,

and protection from extremes of temperature. Sometimes, this

occurs inadvertently when a previously healthy spouse becomes confused

or sick and is no longer able to provide a safe environment for a vulnerable

spouse.

l Elder abuse is physical violence directed at an older person. This could be a

form of domestic violence that has been ongoing for years but the victim is

now over 65. Or, it could be abuse of an older person by a caregiver who is

a family member or a stranger.

Action Steps  –Boston, MA Therapy Tips

For older persons:

Poor health and the loss of independence are not the inevitable consequences of

growing older. To preserve health and independence, older persons should consider

the following strategies:

l Early detection of diseases. Screening to detect diseases early, when they

are most treatable, saves many lives. Older adults should be encouraged to participate in recommended screenings.

l Healthy lifestyle. A healthy lifestyle is more influential than one’s genes in

helping older people avoid the decline traditionally associated with aging.

l Immunizations. Flu shots, pneumonia vaccines, and other important immunizations

reduce a person’s risk for hospitalization and death from illness.

l Preventing injuries. Falling is the most common cause of injury with older

adults. More than one-third of adults 65 and over fall each year, and of

those, 20–30 percent suffer moderate to severe injuries that reduce mobility

and independence, says the CDC. Remove tripping hazards in the home

and install grab bars in key areas, like bathrooms. These simple measures

will significantly reduce an older person’s chance of falling.

l Programs to help adapt and self-management. Consider finding programs

to teach older Americans self-management techniques. These programs

help older adults cope with and manage the transitions of their later years.

1. Rank the Need

l Have the caregiver and the elderly person rank needs in order of importance.

Begin to brainstorm with the elderly person how those needs

can be met with minimal upheaval. Most of the time, the choice is not

between living alone or moving to a nursing home. There are dozens of

options in between, including:

– Non-medical home care for cleaning, meals, or home maintenance

– Meals on Wheels and similar programs for delivery of meals

– Help at home during key hours for things like bathing and dressing

– Adult daycare during daytime hours for those who have family members with them at other times

– Seniors housing complexes (apartment complexes with some extra supports available that are offered at a lower price for needy older persons)

– Shared housing with a younger person (who is not a family member)

– Retirement home living (that often relieves an older person of loneliness

or the need to make meals, maintain a home, and so on)

– Catered/sheltered care or assisted living (situations that provide meals,

some medication reminders, transportation to stores, and other support

services)

– Care in a private group home (where 2–6 older people might be cared for

by a couple who make caregiving their full-time job)

2. Consider the Effects

l Consider the effect of any changes in lifestyle on all family members,

not just the older one. A change in location, for example, will not just

affect the older person but also any family members who are going to

be involved.

l Attempt to keep upheaval to a minimum, especially if family life for

caregivers is already tense or demanding. (Adding a family member requiring

24-hour care to a household with teenagers or a special-needs

child, for example, might not be the best idea.)

3. Consider All Options

l Enumerate all the options and then give all of them much prayerful

consideration.

l Enlist several people—both in and outside the family—to pray about

the possibilities.

4. Give them something to live for

l Hobbies, prayers, purpose of any sort, giving and receiving love.

5. Develop Schedules

l A sense of stability and structure gives confidence to everyday life.

Thrive Boston Therapy provides help for Families dealing with difficult issues. To speak with someone from our team, call: 617-395-5806.

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Mark A. Yarhouse and James N. Sells

Inter Varsity Press, 2008

Written for students, therapists, and pastors, the textbook Family Therapies is designed to provide intelligent content about psychotherapy topics, while not losing readers with less clinical inclinations. The book accomplishes this goal.

Students reading the textbook will receive an ample review of major family therapy models, while counselors will benefit from the more nuanced clinical insights of the authors, such as the “respect commitment,” a concept that can be implemented during times of family stress or crisis. According to the authors: 

The respect commitment is a pledge to not provoke secondary crisis through acts or attitudes that are known to cause additional pain for other family members. For example, a family member might sooth their pain by stopping at a sports bar after work and watching a NASCAR race and drinking a beer, or walking alone in the woods [for two hours] before coming home…Or an adolescent might choose to spend $400 of his or her money saved for college on clothes or stereo equipment—impulsively, without consultation with a parent. The respect commitment says that for the time being each member will respect others by not engaging in behaviors that are within your “individual right” but are also known to be potentially incendiary (p. 320).

Ideas like this one are scattered throughout the text like so many chocolate espresso beans in my trail mix. And like those beans, they have helped me to think sharply about new techniques that could work with current clients, and brainstorm new ways of approaching therapy with future ones.

While a textbook by definition, it is conversational enough to read straight through. Granted, 500 pages will take you a while, so you may want to start with the family therapy models in which you have interest. The text surveys major family therapy models including:

·         Bowenian Family Therapy

·         Strategic Family Therapy

·         Structural Family Therapy

·         Psychodynamic Family Therapy

·         Contextual Family Therapy

·         Experiential Family Therapy

·         Solution-Focused Family Therapy

·         Cognitive-Behavioral Family Therapy

·         Narrative Family Therapy

In the second half of the book, Yarhouse and Sells take a topic-based approach and address a selection of family therapy issues including crisis and trauma, marital conflict, and substance abuse.

Bottom Line

This is not a ground breaking study, a Yalom page-turner, or a self-improvement must-read. But it is an unusually well written textbook. It’s a good choice if you’re a therapist or counseling pastor looking for a serious guide to Christian family therapy.  

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The article is titled “Parenting During Difficult Financial Times” and addressed steps parents can take to keep relationship with their kids strong when the family if expereincing above-normal financial stress. 

Here is an excerpt from the published article: 
“Kids cost money. School clothes, cell phones, video games, baseball, girl scouts, daycare, music lessons, karate, field trips, birthday gifts, 5 meals a day, braces, contacts, car insurance, and the list goes on.

If you’re feeling the pinch of the rising cost of parenting and a tighter budget, you’re not alone….”

Click here to read the complete article on this therapy blog: http://thriveboston.com/counseling/parenting-during-difficult-financial-times-boston-child-therapy-and-parenting-information/

Click here to read the article on the Wicked Local Parents website: http://www.wickedlocalparents.com/content/parentingduringdifficultfinancialtimes

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To make a report, call The Department of Children and Families (DCF) Hotline anytime of the day or night at 800-792-5200. Follow their instructions.

 Child Abuse/Neglect Warning Signs

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Kids cost money. School clothes, cell phones, video games, baseball, girl scouts, daycare, music lessons, karate, field trips, birthday gifts, 5 meals a day, braces, contacts, car insurance, and the list goes on.

If you’re feeling the pinch of the rising cost of parenting and a tighter budget, you’re not alone. Parents today face a financial balancing act that may bring feelings that range from guilt to panic. Many say that they are unable to meet the financial “demands” of their kids. “It’s not about greed,” one Boston-based parent says, “I worry that if my kid has less, she will have limited opportunity to pursue her dreams, her happiness, and might struggle socially with other kids at school.”

Today, the question on parents’ minds is “how do we maximize our children’s chances at success without driving the family budget into the ground?” Here’s how you can start…

Build Your Relationship with Your Kids

The average kids receives approximately 2000 commands a day: wake up, get dressed, eat your breakfast, get your shoes, put on your shoes, tie your shoes, get your coat, and hurry up. While many of these commands are necessary, they also stress and can harm the parent-child relationship. During stressful times, good parents can become “bad bosses” by, without realizing it, INCREASING the amount of demands they give.

I often advise parents to spend some time one-on-one with their kids every day (as little as 20 minutes) when they give no commands—let’s call it “free time.” During “free time,” the child chooses and directs an interactive activity to do with their parent (anything except TV). The parent can participate, comment, encourage, and respond to their child–but not give a single command. This is remarkably difficult for most parents, many give commands without noticing it (i.e., Bella, pass me that Lego!). While challenging, mastering the skill of “free time” will counter some of the relationship stress caused from the 2000 commands a day, and help to strengthen the parent-child relationship.

Talk about Money

The budget needs to change. While unpleasant, this can be a learning opportunity for your child if he or she is brought into the discussion (Note: the child’s age and maturity will determine how much they can be included).

First, stress to your child the things that WILL NOT change. You still love them, they are safe, everyone is healthy, etc. Then, tell your child in a way he/she will understand that there is less money, and what that means for the family. Include them in some of the decisions that affect them. This will feel more fair to them then hearing a series of “No, no, nos” when they ask for things.

Next, give them the opportunity to brainstorm solutions with regard to the gap between what they want, and what the family can afford. Even a younger child can begin to prioritize—“football camp, not Nintendo.” An older child might get a part-time job to pay for some desired luxuries. Your kids might come up with creative ways to get the goods they want, such as go online where things you were paying for, retail, may be available at a discount.

Parenting Success!

As a therapist, I sometimes hear a client say, “Growing up I had everything, except for my parents.” This client is always worse off than the client that says “We didn’t have much but we had each other.” Remember, parenting is not about “stuff” – it is your relationship that equips your kids with what they need to be successful in life.

Author:

Dr. Anthony Centore is Founder of, and Therapist at, Thrive Boston Counseling in Cambridge, MA. Visit: www.ThriveBoston.com

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