Group Therapy with Older Adults

Discussion: Group Therapy with Older Adults
As the population continues to age, more and more older adults will require therapy for various mental health issues. While the group setting offers many benefits and makes therapy more accessible to those in need of services, this therapeutic approach may not be effective for all clients. For this Discussion, as you examine your own practicum experiences with older adults in group therapy settings, consider strategies to improve the effectiveness of your sessions.

 

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Learning Objectives
Students will:
Analyze group therapy sessions with older adults
Recommend strategies for improving the effectiveness of group therapy sessions for older adults
To prepare:
Review this week’s Learning Resources, and consider the insights provided on group therapy with older adults.
Reflect on your practicum experiences with older adults in group therapy settings. Group Therapy with Older Adults
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.

Chapter 18, “Psychotherapy with Older Adults” (pp. 62–660)
Bonhote, K., Romano-Egan, J., & Cornwell, C. (1999). Altruism and creative expressions in a long-term older adult psychotherapy group. Issues in Mental Health Nursing, 20(6), 603–617. doi:10.1080/016128499248394

Note: Retrieved from Walden Library databases.

Cheston, R., & Jones, R. (2009). A small-scale study comparing the impact of psycho-education and exploratory psychotherapy groups on newcomers to a group for people with dementia. Aging & Mental Health, 13(3), 420–425. doi:10.1080/13607860902879409

Note: Retrieved from Walden Library databases.

Krishna, M., Honagodu, A., Rajendra, R., Sundarachar, R., Lane, S., & Lepping, P. (2013). A systematic review and meta-analysis of group psychotherapy for sub-clinical depression in older adults. International Journal of Geriatric Psychiatry, 28(9), 881–888. doi:10.1002/gps.3905

​A Systematic Review and Meta-analysis of Group Psychotherapy for Sub-clinical Depression in Older Adults by Krishna, M.; Honagodu, A.; Rajendra, R.; Sundarachar, R.; Lane, S.; Lepping, P., in International Journal of Geriatric Psychiatry, Vol. 28/Issue 9. Copyright 2013 by John Wiley & Sons Ltd. Reprinted by permission of John Wiley & Sons Ltd. via the Copyright Clearance Center.

Krishna, M., Jauhari, A., Lepping, P., Turner, J., Crossley, D., & Krishnamoorthy, A. (2011). Is group psychotherapy effective in older adults with depression? A systematic review. International Journal of Geriatric Psychiatry, 26(4), 331–340. doi:10.1002/gps.2546  Group Therapy with Older Adults

Is Group Psychotherapy Effective in Older Adults with Depression? A Systematic Review by Krishna, M.; Jauhari, A.; Lepping, P.; Turner, J.; Crossley, D.; Krishnamoorthy, A., in International Journal of Geriatric Psychiatry, Vol. 26/Issue 4. Copyright 2011 by John Wiley & Sons, Ltd. Reprinted by permission of John Wiley & Sons, Ltd. via the Copyright Clearance Center.

Rice, A. (2015). Common therapeutic factors in bereavement groups. Death Studies, 39(3), 165–172. doi:10.1080/07481187.2014.946627

Note: Retrieved from Walden Library databases.

Wang, C., Tzeng, D., & Chung, W. (2014). The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors. Psychogeriatrics: The Official Journal of the Japanese Psychogeriatric Society, 14(1), 38–46. doi:10.1111/psyg.12037

Note: Retrieved from Walden Library databases.

Watkins, R., Cheston, R., Jones, K., & Gilliard, J. (2006). \'Coming out\' with Alzheimer\'s disease: Changes in awareness during a psychotherapy group for people with dementia. Aging & Mental Health, 10(2), 166–176. doi:10.1080/13607860500312209

Note: Retrieved from Walden Library databases.

Week 10 Discussion: Group Therapy with Older Adults
Reflection on Practicum Experiences with Older Adults
For practicum experiences with older adults in group therapy settings, sometimes there were some challenges like minor cognitive changes for some group members and hence it would become difficult to conduct the therapy for all group members since the recovery rate of members was different. Some older adults without any cognitive complaints would undergo the therapy sessions faster and systematically when compared to older adults cognitive challenges. Sometimes the sessions would be interrupted and this seemed to negatively impact those without cognitive changes because they felt like they were being dragged behind. This would also lead to some participants would be more dominant than others. Moreover, in some cases the cognitive problems such as memory loss would hinder the older adults from grasping the already taught skills and learning conducted during the previous sessions.
Additionally, during group therapy, some older adults would tend to be secretive and were not comfortable in opening up in front of other group members. For instance, during self-introductions, some group members would appear relaxed and voluntarily provide the information. However, when told to talk about their experiences, some would become formal and superficial while some appeared reluctant to participate in further discussions. As Krishna et al (2013) provide, most older adults have difficulty in sharing their feelings with other people. Group Therapy with Older Adults
It is noteworthy that the group therapy for older adults assisted the clients in overcoming their social isolation challenges because the group therapy provided the older adults an opportunity to socialize and meet with their age mates who share similar experiences.

 

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Strategies to Improve the Effectiveness of Group Therapy Sessions
To improve the efficacy of group therapy sessions for the older adults, the therapist should identify the age-specific factors that may be impacting each individual group members such as cognitive impairment, disability, or even lack of independence (Mukhtar et al, 2017). This will allow the therapist to implement certain adaptations in order to accommodate such age-specific factors during the therapy. For instance, in case the therapist identifies that some group members have minor cognitive changes, for example, lower abstraction capacity or higher distractibility, the therapist can slow down the therapy and have numerous pauses and synopses to prompt memory (Krishna et al, 2013). It is also important to hold regular discussions with the group members of tangible illustrations in order to identify any cognitive misrepresentation during therapy.
Another strategy is to use a structured psycho-education approach during therapy sessions. This is because the approach offers a comfortable environment to the elderly during therapy and hence offers practical information (Mukhtar et al, 2017). The aspect of psycho-education also ensures that the group therapy integrates exercises that stimulate the older adults mentally in order to ensure that the mild cognitive impairment common in this population does not interfere with the therapy. In addition, structured sessions should be often used as well as simple tools like notebooks and recorded sessions (Mukhtar et al, 2017).
Thirdly, the efficacy of group therapy among older adults can be increased by providing a chance for a structured socialization with other group members. This will give them an opportunity to open up and share their age-allied challenges and at the same time provide an opportunity to provide and get feedback, as well as positive fortification (Krishna et al, 2013). Therefore, this will help older adults to freely open up and share their feelings with other group members during therapy sessions improving the efficiency and efficacy of the group therapy. Evidence shows that providing an opportunity for group members to have a structured socialization during the group therapy promotes increased compliance, reduced relapse rate, as well as better psychopathological status (Utoyo et al, 2013). Group Therapy with Older Adults
Another strategy is to ensure that information exchange is done with short segments with regular prompting and advance notice of tasks. This is because older adults take a longer time to learn new information. With the therapy progress, the therapist should ensure that clients take a more active role in order to challenge their thoughts and formulate behavioral experiments jointly (Wang, et al, 2014). It is also important to prepare the older adults for future setbacks by bolstering their skills for instance through stimulus control in order to help these clients to be watchful of negative cognitions and to control them any time they experience them because they are inevitable (Wang, et al, 2014).
Use of educational materials during group therapy has been shown to increase therapy efficacy for older adults. Educating clients about the aspect of their mental conditions, for instance how physical symptoms presents, play an important role during the treatment of older adults (Watkins et al, 2006). Prina et al (2014) support the introduction of information during therapy; the information may consist a reading material explaining the significance of the treatment, and how negative moods influence the individual’s condition.
Finally, older adults may have health conditions that may affect therapy sessions and hence it is important for therapists to assess any physical symptoms and if present ensure they are managed effectively. This is because it can be challenging to engage a group member with noticeable physical symptoms unless their complaints and health issues are acknowledged. To ensure the physical symptoms do not significantly interfere with the therapy group sessions, it would be important to ensure that such clients receive suitable treatments and there is close collaboration with their healthcare providers (Utoyo et al, 2013).

References
Krishna, M., Honagodu, A., Rajendra, R., Sundarachar, R., Lane, S., & Lepping, P. (2013). A systematic review and meta-analysis of group psychotherapy for sub-clinical depression in older adults. International Journal of Geriatric Psychiatry. 28(9), 881–888. doi:10.1002/gps.3905
Prina M, Mrioni G, Jones P, Brayne C & Tom D. (2014). Improving access to psychological therapies and older people: Findings from the Eastern Region. Behaviour Research and Therapy. 56(1), 75-81.
Utoyo DB, Jaya ES, Arjadi R, Hanum L, Astri K, et al. (2013) Correction: Preliminary Study on the Effectiveness of Short Group Cognitive Behavioral Therapy (GCBT) on Indonesian Older Adults. PLOS ONE. 8(12): 10.1371/a
Wang, C., Tzeng, D., & Chung, W. (2014). The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors. Psychogeriatrics. The Official Journal of the Japanese Psychogeriatric Society. 14(1), 38–46. doi:10.1111/psyg.12037
Watkins, R., Cheston, R., Jones, K., & Gilliard, J. (2006). \'Coming out\' with Alzheimer\'s disease: Changes in awareness during a psychotherapy group for people with dementia. Aging & Mental Health. 10(2), 166–176. Doi:10.1080/13607860500312209 Group Therapy with Older Adults

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