Question

In each of the following situations, develop a tentative plan for the client. List the various services you believe each person needs initially. Include in your plan for each client both formal and generic services, and where appropriate, use social supports and support groups. Suggest other services the person might use later once the case is stabilized. Think about how you can involve others close to the per- son and how you will involve the client in planning.

You are called by the daughter of an elderly woman who lives alone. The daugh- ter lives in another city and is concerned because her mother does not drive and has seemed unhappy and listless on the phone. The daughter expresses concern that her mother seems lonely and is perhaps depressed. The daughter does not know her mother’s neighbors and calls you instead at the Office of Aging. She has told her mother she is going to call your agency for help, and the mother had no objection to that.

Answer 1

Old age or older adulthood or senior citizenhood commences from 65 years of age. This phase is marked by physical disability or immobility, dementia, financial problems, loss of spouses, loneliness and other problems. Occurrence of symptoms of depression (like feelings of sadness, loss of interest or pleasure in activities once enjoyed, sleep disturbances or sleeping too much, reduced energy or heightened fatigue, etc ) is thus inevitable in old age.

The elderly woman, who seems unhappy, listless and depressed is in need of psychological help and support. For depressed elderly lacking social support, 'Interpersonal Psychotherapy' (IPT) has prooved be a fruitful and an effective solution. It is a structured and time-limited therapy for depression.

In the initial phase of the therapy, the depressive symptoms are identified. The elderly then receives psycho-education about depression. The interpersonal context of the patient is analyzed and the depressive symptoms are connected to recent interpersonal events or situations. In the above mentioned case, the elderly woman's daughter lives in another city and the neighbourhood of the elderly remains unidentified.

Then four possible areas of treatment are distinguished for selection and treatment. These areas are complicated grief, interpersonal conflict, role-transition and interpersonal deficit. One of the problem areas is thus selected. In the above mentioned case, light has been thrown upon interpersonal deficit. The nature of the affecting interpersonal event is studied and emotions parallel to the event are analyzed. The client then receives support in considering and initiating possible solutions to the problem.

Interpersonal therapy is based on the assumption that as the person overcomes one problem area, its results will be generalized to other areas, thus uprooting the problem in all possible ways. The last sessions of the therapy are focused upon evaluation of the therapy and due attention on the prevention of relapses. Prevention of relapses will stop depression to win over the elderly, after the treatment.

Other possible treatment methods for depressed elderly are Cognitive-Behavioral Therapy (CBT) and Problem-Solving Treatment (PST). CBT usually involves efforts to change thinking patterns and behavioral patterns, as it assumes that the underpinnings of psychological problems are, in part, wrong or unhelpful ways of thinking and learned patterns of unhelpful behavior. It also assumes that people with psychological problems can learn effective coping ways, thus, overcoming problems and becoming more efficient in their lives. PST is based on the assumption that symptoms of psychopathology are repercussions of ineffective or maladaptive coping. It involves psychoeducation, interactive problem-solving exercises and motivational home assignments to overcome distress.

As far as social support and persistence of stability in the elderly woman is concerned in the above mentioned case, the daughter of the elderly woman can start living with her old mother. This might help the elderly in initiating conversations and be involved, raher than being alone and withdrawn. As far as the neighbourhood is concerned, aged people in the elderly's social setting can be identified. Social interactions among old people can help them to vent their emotions and also drive away loneliness, unhappiness and depression.