the journal of the b c psycholo gical a sso ciation

Volume 3 • issue 2 • sprin g 2014 • agin g

BC PsyChologist

EDITOR IN CHIEFTed Altar, Ph.D., R. Psych.

AssIsTANT EDITORMarian Scholtmeijer, Ph.D.

PUBLIsHERRick Gambrel, B.Comm., LLB.

ART DIRECTOR Inkyung (Inky) Kang

ExECUTIvE DIRECTORRick Gambrel, B.Comm., LLB.

ADmINIsTRATIvE DIRECTOREric Chu

ExECUTIvE AssIsTANT Rukshana Hassanali

BOARD OF DIRECTORsPRESIDENT

Ted Altar, Ph.D., R. Psych.

VICE-PRESIDENT

Don Hutcheon, Ed.D., R. Psych.

TREASURER

Marilyn Chotem, Ed.D., R. Psych.

DIRECTORS

Michael Mandrusiak, Psy.D., R.Psych.

Douglas Cave, MSW, RSW, Ph.D.,

R. Psych., MA, AMP, MCFP.

Yuk Shuen (Sandra) Wong, Ph.D., R. Psych.

Murray Ferguson, Psych.D., R. Psych.

mIssION sTATEmENT

The British Columbia Psychological Association provides leadership for the advancement and promotion of the profession and science of psychology in the service of our membership and the people of British Columbia.

sUBmIssION DEADLINEsDecember 1 | March 1 | June 1 | September 1

PUBLICATION DATEsJanuary 15 | April 15 | July 15 | October 15

ADvERTIsING RATEsMembers and affiliates enjoy discounted rates. For more information about print and web advertising options, please contact us at: communications@psychologists.bc.ca CONTACT Us#402–1177 West Broadway, Vancouver BC V6H 1G3 604.730.0501 | www.psychologists.bc.ca info@psychologists.bc.ca

ADvERTIsING POLICYThe publication of any notice of events, or advertisement, is neither an endorsement of the advertiser, nor of the products or services advertised. The BCPA is not responsible for any claim(s) made in an advertisement or advertisements mailed with this issue. Advertisers may not, without prior consent, incorporate in a subsequent advertisement, the fact that a product or service had been advertised in the BCPA publication. The acceptability of an advertisement for publication is based upon legal, social, professional, and ethical consideration. BCPA reserves the right to unilaterally reject, omit, or cancel advertising. To view our full advertising policy please visit: www.psychologists.bc.ca DIsCLAImERThe opinions expressed in this publication are those of the authors, and they do not necessarily reflect the views of the BC Psychologist or its editors, nor of the BC Psychological Association, its Board of Directors, or its employees.

Canada Post Publications Mail #40882588

COPYRIGHT 2014 © BC PSYCHOLOGICAL ASSOCIATION

BC PsyChologist

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contents

Letter from the President

Letter from the Executive Director

BCPA News

Invitation LetterPiece of Mind Exhibition Opening Night

Meaning Therapy Workshop Registration Form

Features

Factors Contributing to Healthy AgingDr. Paul Pearce & Yuk Shuen (Sandra) Wong, Ph.D., R. Psych.

AgingMarilyn Chotem, Ed.D., R. Psych.

Positive Aging in CanadaPaul T. P. Wong, Ph.D., C. Psych.

Psychotherapy for EldersTed Altar, Ph.D., R. Psych.

Metacommunication in Organizations — Four Principles to Keep in MindDonald Hutcheon, Ed.D., C. Psychol (UK)., R. Psych.

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4 Spring 2014

Dear colleagues anD frienDs,

Every February, as you may know, is Psychology Month. This was

originally started by the Canadian Psychological Association in February

of 2005 and BCPA has been involved every year. The purpose is to try

to generate local or grassroots events and activities to help raise the

awareness of our fellow British Columbians about our role as psychologists

and the role of psychology itself in bettering the lives of all.

All Psychologists are encouraged to do what they can to help their

communities understand the value and benefits of our work. We want

ultimately to increase support for psychological services, psychological

research, and psychological education and training. This promotion is of

course best achieved by us as psychologists, who know psychology and its

historical development best, and can best explain its great contributions to

knowledge and health, and its current benefits for all British Columbians.

Some things that BCPA has done and which we can all help do as

well in our own communities, include, organizing a Public Lecture/Seminar

or Workshop or panel discussion, having an information Session or board

at your clinic or office, showing a film, writing a newspaper or newsletter

article, participating in a letter-writing campaign, asking your library to

create a “Psychology Display”, and so on.

On behalf of BCPA, Dr. Patrick Myers generously gave a free

presentation about the two primary requirements of a successful long

term relationship and two life skills required to navigate a couple’s journey

through life. Dr. Kenneth Cole also graciously presented a free lecture on

February 12 at the Central Library in Vancouver on the “Top 10 Strategies

for Supporting Persons with Autism Spectrum Disorder”. Finally, let

us also thank Dr. Merv Gilbert for doing a workshop on February 20 on

Creating a Psychologically Healthy Workplace: Strategies for Employees

and Employers. As you may know, Dr. Gilbert also chairs the BCPA

Healthy Workplace Committee. This series of free workshops for the

public were promoted through the Vancouver Public Library and all of their

branches. BCPA also sent out mail announcements to over two hundred

sites (hospitals, clinics, schools, neighbourhood houses etc.). Of course,

you may have also seen our regular e-blasts to members, but we also send

e-blasts to various health associations, community groups and businesses

(about 150). In addition, we have utilized event websites like “Vancouver

is Awesome” and “eventbrite”. BCPA was also present on March 1 at the

2014 Diversity Health Fair.

In former years we did ads in the movie theatres but this year

we have a very tight budget and it was determined that we could not

afford ads for this year. We must, finally thank the many participants

who attended, on February 28, the BCPA workshop by Dr. Joel Paris, “The

Intelligent Clinician’s Guide to DSM-5”. I believe that this was the most

well attended workshop that we have had in many years. Thank you again

for your support.

This issue of our Journal on older persons applies to us all, young

included, since we must age. Projections by Statistics Canada (2006)

teD altar, ph . D. , r. psych .

The President of the BC Psychological

Association. Contact for the Board of

Directors at board@psychologists.bc.ca

letter from the President

BC pSyChologiSt 5

referencesBrown, R.L. (2011). Economic security in an aging Canadian Population. SEDAP Research Program, McMaster U. Available online at: http://socserv.mcmaster.ca/sedap/p/sedap268.pdfRobson, W.P. (2001). Aging populations and the workforce: Challenges for employers. Final draft paper for the Working Group on Business and the Challenge of Aging in the Western World. British-North American Committee. Available online at: http://www.cdhowe.org/pdf/bnac_aging_workingpaper_3.pdf

indicate that by 2031 senior Canadians will comprise one

quarter of the total population. Unfortunately, there have

been magnified projections about how the aging population

will put undue pressure on our health care and social

security systems. Some have proclaimed that the potential

increase in costs will be unaffordable and that this pressure

may amount to more than fifty percent of Canada’s GDP

(Robson 2001). With such claims of economic disaster,

older adults are to be burdened with yet another worry for

their golden years. Should none of us should retire until

necessary due to failing health? Postponing retirement

would be more viable for occupations that don't require

physical strength and endurance, like occupations in the

field of psychology. What the public does not often hear in

this debate is that the projected dependency ratio of Canada

of both youth and older persons will be no greater than it

was in sixties and even in 1971, when the dependency ratio

was 90 people dependent on government services to every

100 people of working age. The future dependency ratio in

2056 will reach a peak of 85. Of course, the argument is that

older persons will consume more social service and health

care costs than children and youth. This does not apply to all

persons over 65 and in fact those 75 and older will only grow

from 5.8% in 2001 to 6.7% in 2015. Were we to even assume

that persons over 65 consume half of health care costs, the

increase would only be 1.1% of expenditures as a percent

of GPD. Given future economic growth at just a moderate

level, Canada can easily afford the aging population without

raising the age of retirement (Brown, 2011).

Regardless of the arguments in the literature,

hardly a week goes by without another article in the

media about the pending health care cost crisis (see

for example, The Globe and Mail, 2010). Normally,

these commentaries are couched in a context of

population aging.

In particular, we know that population aging per se

accounts for very little of the increase in health care

costs in the recent past and it will not be the key

driving force over the next three decades (Evans et

al, 2001). This myth that population aging is the key

factor in rising health care costs is used by those

who seek more funding for their part of the system.

It is a convenient factor since the system has no

control over it (“it is not our fault”). McIntyre et

al. (2003) projected real growth in health care

costs of 2.6% per annum made up of 0.9% for

increased per capita consumption/service levels,

0.9% for general population growth, and 0.8%

attributable to population aging. (Brown, 2011,

p. 28)

Whether or not you agree that we are headed

for an economic problem, we can all agree that if

Governments are serious about reducing health care

costs, then Psychology will play a vital role in that

endeavour. The real increased costs to health care will not

be due to an aging population alone. In fact the greater

proportion of costs are coming from the increased use of

services by all age groups. We are seeing medical health

professionals more frequently, undergoing more tests

and procedures, and receiving more prescriptions. What

cannot be ignored is that it is relatively healthy adults of

all ages that are driving up costs. The high costs of ever

more sophisticated interventions and the more frequent

use of prescription drugs has and will continue to drive

up costs more than the increase in the dependency

ratio of older persons. Psychological treatments for

depression and many anxiety disorders can be more

cost effective than medications. Health psychology

reduces costs in terms of promoting drug-free methods

of stress management and in developing motivational

programs that work in helping people adopt healthier

life style changes. Those psychologists with training in

psychopharmacology and who have prescription rights

have been shown to reduce reliance on medications since

the right to prescribe is also the right to un-prescribe.

The current incentive system for physicians is to

prescribe, but psychologists with both capabilities — of

prescribing and treating through psychotherapy — can

better determine when psychotherapy is to be employed

with or without psychotropic medications.

The aging population is not something to fear

or lament. It is another opportunity for psychologists

to make their contributions and show both the public

and government that real savings are to be achieved

by consideration of the holistic approach of the

biopsychosocial model.

Respectfully,

Dr. Ted Altar, President

6 Spring 2014

rick gamb rel , b . co mm . , llb .

The Executive Director of the BC

Psychological Association. Contact:

rick.gambrel@psychologists.bc.ca

letter from the Executive Director

a s i write this we are just past the halfway mark in our

membership year, which runs from September 1st to August 31st.

I can report that, to date, BCPA has been enjoying a very

successful 2013 – 2014.

Memberships have been renewed at historically high rates, and

we have welcomed a number of new members into the BCPA family. Both

existing and new members alike have told us that they value the benefits

of membership, including:

• exclusive discounts on liability insurance

• access to group health, dental, and disability insurance plans

• a subscription to our quarterly journal, The BC Psychologist

• networking with colleagues through our members-only Email Forum

• discounts on goods and services through BCPA Club Rewards

• supporting BCPA advocacy efforts with the public, industry and the

government

• exclusive discounts on our BCPA continuing education events

As announced earlier, one of our liability insurance providers

has changed to BMS Insurance. They advise us that they will be offering,

upon renewal in June, better coverage for a smaller premium. BCPA was

involved in bringing these changes to our members.

The last issue of the BC Psychologist was the first issue that

was sent to each of our provincial Members of the Legislative Assembly,

bringing the BCPA right to the door of our elected representatives.

Our advocacy efforts continue, with meetings this year with

industry, elected representatives and other provincial national and

international psychological associations, to advance the cause of the

psychological well-being of our citizens. As an example, this January,

BCPA took a leading role at the annual meeting of the Council of

Professional Associations of Psychologists in Ottawa, where issues of

national importance to the profession were discussed.

For Psychology Month this February, BCPA was one of the

most active provincial associations in the country. We offered series of

three public lectures at the Vancouver Public Library Main Branch on the

following topics:

• Relationship Life Skills – Dr. Patrick Myers

• Strategies for Supporting Persons with Autism Spectrum Disorder – Dr.

Kenneth Cole

• Creating a Psychologically Healthy Workplace: Strategies for

Employees and Employers – Dr. Merv Gilbert

BC pSyChologiSt 7

In addition, our association completed a mail out campaign to

raise awareness of psychological services and our referral service to over

230 medical clinics, libraries, universities, colleges and neighbourhood

houses throughout the entire province of British Columbia.

As well, during Psychology month, BCPA staff and member

volunteers attended the extremely well attended Diversity Health Fair,

interacting with hundreds of members of the public and letting them

know how psychologists may assist them.

This coming May BCPA will be repeating the highly successful

Piece of Mind — an art exhibition showcasing pieces of work that answer

the question: What does psychological health mean to you? Piece of Mind

aims to inspire members of the community, through artistic expression,

to live psychologically healthy lifestyles by adopting healthy coping

skills. Submissions will be available for public viewing with the hopes of

facilitating a platform that will transfer these pieces of art into pieces of

individual inspiration and motivation. The call for submissions has gone

out to individuals and hundreds of organizations across the province. We

invite you to join us for the opening night on May 8 at the Vancouver

Public Library Main Branch, or to take in the exhibition at the Library from

then until the end of May.

I am pleased to report that our workshop “The Intelligent

Clinicians Guide to DSM–5”, conducted by Dr. Joel Paris, was by far the

best attended workshop in this association’s history, with close to 200

registrants. We thank you for your many positive comments about the

workshop.

Remember to attend our next workshop, “Meaning Therapy”

conducted by Dr. Paul Wong, at the University Golf Club on April 25. At

the time of writing this, there were still spaces available.

In June, at the CPA convention in Vancouver, I will be leading

a group of lawyers and psychologists in a pre-convention workshop on

Psychologists and the Law.

And, as always, BCPA continues to offer regular ethics salons to

our members in Vancouver, Victoria, Surrey and other locations.

My thanks to the board, volunteers and the talented, passionate

and very hard-working BCPA staff for all of their tremendous work. And

thank you to you, the members. Without you BCPA could not achieve the

success that it has this year.

Rick Gambrel, B.Comm., LLB.

Executive Director

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8 Spring 2014

BcPA News

UPCOMING WORKSHOP

me anin g ther apy: a ne w par aDig m o f

integ r atin g he alin g with pers o nal

g row th

Presented by Dr. Paul T. P. Wong

Friday April 25th, 2014 @ University Golf Club

Please see page 25 or visit www.psychologists.bc.ca for

more information and registration.

PIECE OF MIND

o penin g nig ht @ m oat ar t gallery

(Vancouver Public Library, 350 West Georgia Street)

Thursday May 8th, 2014 from 7pm to 9pm

SUBMIT ARTICLES

want to write fo r us? We are always looking

for writers for the BC Psychologist or the BCPA blog.

The theme for the upcoming Summer 2014 issue is:

Parenting & Families. The Summer edition is sent out

to all Registered Psychologists in BC — do not miss this

occasion to reach them all! For further details, contact us

at: communications@psychologists.bc.ca

CONTACT US

we pub lish n otice s regarding retirement,

awards, and deaths of members. Please keep us informed

about your career and life milestones. If you want a

notice to be included in the publication (approximately

100 words) contact us at: info@psychologists.bc.ca

SOCIAL MEDIA

join us o nline!

www.psychologists.bc.ca/blog

www.youtube.com/bcpsychologists

www.twitter.com/bcpsychologists

www.facebook.com/bcpsychologists

Advertising Inquriesco nnec t with b c psych o lo gists!

• PRInT (BC PSYCHOLOGIST)• WEB POSTInG (30 DAyS)• E–BLAST (EVERY FRIDAY)

b cpa www.psychologists.bc.ca

402 - 1177 West Broadway Vancouver, BC V6H 1G3

ph o ne 604-730-0501 fa x 604-730-0502

email communications@psychologists.bc.ca

UPCOMING THEMES

summer 2014 • Parenting & families

fall 2014 • Future of Psychology

winter 2015 • Depression

BC pSyChologiSt 9

Piece of Mind Opening Night

piece o f minD e xhibitio n o penin g nig ht

@ m oat ar t gallery (350 w. g eo rgia)

thursDay may 8 t h, 2014 (7pm – 9pm)

D e ar b cpa memb ers ,

Again this year, on May 8, 2014, at 7:00 p.m., at the Vancouver Public

Library Moat Art Gallery, BCPA presents its second Annual Piece of

Mind Art Exhibit opening night. You are invited to attend.

Piece of Mind asks the question of artists,

“What does psychological health mean to you?”

Last year, the art answering that question was beautiful, moving and

thought provoking. On opening night, in addition to the art, there will

be a chance to meet and talk to the artists, meet and talk to your BCPA

executive, and be a part of a panel discussion session with artists and

psychologists about psychological health.

Both the opening night gala and the exhibit (running until the end of

May at the Vancouver Public Library Moat Art Gallery) are free to attend.

Last year, Piece of Mind was a great success in engaging the community

in discussing psychological health and this year’s exhibit promises to be

even bigger and a more rewarding experience.

Piece of Mind is an initiative of the BC Psychological Association’s

Community Engagement Committee.

We hope that you will attend.

For more information and to RSVP, please go to mypieceofmind.ca.

Rick Gambrel, B.Comm., LLB.

Executive Director BCPA

piece o f minD is an

initiatiVe o f the co mmunit y

en gag ement co mmit tee (cec)

o f the b ritish co lumbia

psych o lo gical a ss o ciatio n .

The aim of the project is to inspire the

community through artistic expression

to live a psychologically healthy

lifestyle. We are inviting individuals

to submit pieces of art to express what

psychological health means to them.

Prizes include tuition, art supplies and a

one month art exhibition in the Moat Art

Gallery at the Vancouver Public Library.

email info@mypieceofmind.ca

Visit http://mypieceofmind.ca

PIECE OF MIND

you’re invited to

Moat art Gallery350 West GeorGia street

o p e n i n g n i g h t@

piece of mindexhibition

7PM-9PM thursday May 8mypieceofmind.ca | info@mypieceofmind.ca

10 Spring 2014

BC pSyChologiSt 11

D r. paul pe arce

Dr. Paul Pearce has served as a pastor, educator and

administrator. He recently retired from being the

Executive Director of Beulah Garden Homes, which

provides affordable housing for older adults in East

Vancouver. He currently is involved in establishing and

directing the Centre for Healthy Aging Transitions located

at the Carey Institute on the UBC campus.

y uk shuen (sanD r a) wo n g, ph . D. , r. psych .

Dr. Sandra Yuk Shuen Wong is a registered psychologist

serving in Vancouver and Richmond.

Factors contributing to Healthy

intro D u c tio n

There are currently a growing number of resources and

strategies for healthy aging being promoted by those

within the health care professions, other community

care agencies and the business sector concerned with the

emerging demographic of older adults (55+). The growth

in this demographic is unprecedented and will continue to

influence all sectors of society over the next few decades.

The expectation of another third of life for those in their

mid-50s is creating new challenges and opportunities for

this generation. This expectation arises because people

arrive at this time of life with better health and education,

and more options for accessing community support services

and personal resources, resulting from planning over the

years. Healthy aging results from a number of factors being

developed and held in a balance.

There are five factors, in particular, which will

influence the health and life fulfillment of those entering

the older adult years.

1. the Vo catio nal fac to r

There are several issues that will have to be resolved

as a person anticipates moving from the middle adult

years when daily commitments to work and family have

provided the framework for meaningful activities and

use of time. What is the purpose of aging and how can

someone live meaningfully in the changing roles no

longer defined by daily work and family commitments as

a parent with children at home? Realigning priorities and

commitments, while staying motivated and interested with

a meaningful use of time, can be a daunting and sometimes

discouraging experience. The importance of still being

needed and making a contribution to the future, family

and community is an important factor to be resolving.

The U.S. Centers for Disease Control and Prevention have

recently been reporting that suicide rates among middle

aged Americans have risen sharply in the past decade. One

of the explanations being suggested for this finding is that

those in their 50’s and 60’s are struggling with realigning

life expectations for the future.

2 . the wellne ss fac to r

Being responsible for personal wellness and health

care is a factor contributing to healthy aging. There is

an expectation for longer life expectancies as medical

research continues to seek responses to the many

diseases related to aging. The continuing developments

in the medical and health care sciences and professions

are also raising a new awareness and generating a better

informed approach to personal health and wellness.

Again, a number of questions converge as a person makes

the transition into the later years of life. What are the

consequences of living longer? How does one anticipate

and plan for the inevitable diminishment of health?

There is a growing realization that personal wellness

will be realized when a person is approaching his or

her life in a holistic way. Wellness includes a balanced

understanding of relational support systems (e.g., family,

community), psychological integrity and environmental

satisfaction (e.g., adequate housing and home life). It can

be a time in life when there could be a spiritual openness

to exploring and developing a knowledgeable approach

and understanding to the ultimate questions resulting

from a growing awareness of one’s mortality. There also

should be attention given to the resolving of “end of life”

preparations for self and the significant others entrusted

with fulfilling these expectations.

3 . the s o cial fac to r

The social factor is concerned with the significant — other

relationships, friendships and community connections

providing a feeling of personal security and wellness for

the individual. There is recognition by community leaders

and homecare providers that the social consequences of

loneliness and isolation for many living in Canada’s busy

and culturally diverse cities can have a significant impact

on the quality of life for older adults. In today’s highly

mobile world, family members are not as easily available

for regular contact with aging parents to provide the care

and reassurance needed. There are increasing concerns

around affordability issues for housing and other daily

12 Spring 2014

necessities. Often such factors result in a person’s having

to relocate at a time of life when it is more difficult to

establish new supportive relationships. People need a

social context of both giving and receiving stimulation

and support in relationship with others to stay healthy.

How will older adults feel they belong and are making

a contribution in an age when ageism means that they

are sometimes ignored or experience prejudice? There

are often concerns around who will be the primary care

partners for those who can no longer care for themselves

as government funding for needed services declines.

Answers for these and other questions are going to be

more difficult, as the number of older adults continues

to grow into a significant minority (majority in some

communities).

4 . the re s o urce s fac to r

The resources factor involves the awareness and

appreciation of the cumulative value of a person’s life

experience, career fulfillment and achievements, personal

integrity, supportive relationships and an adequate

financial plan to sustain one’s basic living needs and

expectations. For many, there will need to be assurances

that there will be financial stability often resulting in

some intentional shifts in one’s lifestyle. Concerns

around finding affordable and trustworthy counsel for

management of personal affairs will be a growing need for

many who have not required such advice up to this time

of life. The resources factor needs to be expanded beyond

just financial planning and implementation, which seems

to be the focus for many. There will need to be a deeper

appreciation for the other “personal equity” resources

(beyond financial) people bring to the later years of their

lives, which can be appreciated by themselves and those

around them. The possibilities are many for encouraging

and challenging this unprecedented wave of maturing

people to become viewed as elders and not just the

“elderly”. They have been living resourceful and engaged

lives and will want to continue to make a meaningful

contribution to their families and communities. They

could be developing mentoring and counselling

relationships informed by their own life experiences,

career and professional insights gained through their

full-time working years and their personal passions and

interests as they plan for their futures.

5 . the spiritual fac to r

American author, marriage and family counsellor, Michael

Gurian says in his book THE WONDER OF AGING — A

New Approach to Embracing Life After Fifty (ATRIA

Books, 2013) that the post 50’s time of life provides us

with second chances to make adjustments to enhance our

lives. Regarding spirituality he suggests that

...making peace with our bodies’ gradual

vulnerabilities as we age is a spiritual act, a second

chance at becoming spiritual in the way we may

not have had the time to become before. Even

if we were good at practicing our religion before,

knowing all the rote elements of it, we might

now become better at practicing spirituality, for

now we can “get” what the masters have always

been trying to teach — Self, Soul, Identity, Grace,

Service. If we enter a time of making spirituality a

part of our lifetime of second chances, we can stop

spending a great deal of our second half of life in

low-grade sadness, depression, anger, even rage

at what is happening to our bodies (our souls), but

instead see how miraculous the life of the soul is

as it flows and adjusts within even our illnesses.

(p.242)

Aging allows a person the opportunity to discern that beliefs,

worldviews and the possibility of post-life dimensions for

continuous being can be important and life enhancing. Are

the changes I am experiencing (will experience) confusing

and discouraging or a time to more deeply understand and

embrace the possibility of a newly informed faith paradigm

for resolving many of life’s mysteries and unanswerable

questions? How do others, communities of faith and other

culturally informed resources, open the possibilities for

a more deeply informed faith and a more mature time of

spiritual formation?

The value of exploring and embracing the mysteries of life’s

ultimate questions can be a helpful and a maturing activity

in the later years of life as a result of being aware of the

spiritual factor.

co n clusio n

The coming decades will present an unprecedented time of

challenge and opportunity as governments, community care

agencies, faith communities, other voluntary organizations

and the business sector respond to the growing presence

and influence of the aging “boomer” demographic. There

will be increasing needs and possibilities for rethinking how

greater cooperation can be achieved for all who are trying

to assure a safer and healthier environment for the aging.

Identifying and recognizing how human and financial

resources can be deployed in an effective and sustainable

way will require some ongoing dialogue with those in

communities who are already engaged in providing services

to address the factors outlined above. It will be important

to have a balanced and an holistic approach for achieving an

environment which can encourage a global commitment to

healthy aging. All ages will benefit when a commitment is

shared around the value of caring for the aging. These five

factors and others will require attention as new networks

emerge to develop strategies for effective action.

BC pSyChologiSt 13

marily n ch otem , eD. D. , r. psych .

Dr. Marilyn Chotem has been practicing psychology

in BC since 1979. She has worked in addictions,

community mental health, eating disorders, a hospital

psychiatric unit, and has had a private practice on the

North Shore since 1992. www.marilynchotem.com

rememb er the m oVie Harold and

Maude ? Harold was the adolescent guy from a materially

privileged family absent of warm connections who sought

death as a relief. Maude was an elderly woman who was

wealthy in her simplicity and zest for life. She broke

the rules of aging and society. The movie challenged

stereotypes on aging, showed that age was a matter of

outlook, and exposed the potential emptiness of material

aspirations.

Life is a process of gradual changes, not discrete

units with visible markers at the end. Sure, there are

milestones and achievements, but they aren’t magical

transformations. They are markers. I have many times had

naïve assumptions about aging fall flat in the face of reality.

I thought when I turned 18 I would be an adult with freedom

and maturity. I thought when I graduated from university,

someone would offer me a job. When I was single, I thought

marriage was a promise of love and security. And, I thought

brain neuroplasticity stopped at 65. I also thought that older

people with lengthy marriages didn’t divorce. Our conscious

and unconscious scripts about aging are tempered by reality.

In my younger days, I saw possibilities, not

barriers. Whatever I set my mind to, within reason, I

aimed to do. But as vision falters, memory that was like a

container becomes more like a sieve, new learning is more

work and takes longer, pushing leads to injuries rather

than accomplishments, wrinkles carve deeper into one’s

face, and past possibilities are less realistic. It is a time

of adjusting to new realities. An attitude of acceptance

can make the difference between healthy and unhealthy

adjustments to emerging limitations. Practice with

adjusting to changes should lead to greater resilience and a

more proactive engagement with life. I laugh now about the

words and names I can’t find; I move at a slower pace, and

achievements are less important than peace of mind.

In actuality, age offers no immunity to emotional

distress or psychopathology. Our developmental histories

and personalities travel with us through life. Psychotherapy

can be as useful to the aging and elderly as to the young

adult. Both are adjusting to life transitions. Psychotherapy

Aging can help people address their losses and the meaning of

those losses for the individual. With the life expectancy

increasing and the population of seniors bulging,

psychologists will provide a valuable role in the quality of

life for the elderly in the decades to come, if not longer.

Last night over dinner, a 78-year-old friend said,

“Aging is not for the faint of heart.” He was struggling

with pain, mobility problems, loss of loved ones, and

social isolation affecting his mood. He had only stopped

his career 3 years ago. The workplace social network

was gone, as was the structure and sense of purpose

and esteem work had provided him. Without external

demands to direct us, the arbitrariness of choices can lead

to apathy. Without the esteem of colleagues, our harsh

self-talk has no opposition. Erik Erikson believed that

development continues throughout life. We need purpose

and connections, as much as our minds and bodies need

activity and challenges. As for Maude of Harold and

Maude, every day is a gift of time to embrace since we

don’t know when the clock will stop. There are things to

discover, and infinite choices for learning, purpose and

connections. Aging can be vibrantly alive if we proactively

engage with life.

Long ago, I met a career woman in her late 40s

who had counselled numerous college females to pursue

careers, as she had pursued her own career. She regretted

her choice and her advice because, as she said, “a career

doesn’t rub your back at night.” Other people have said

that at the end of life, it is not for our achievements

that people remember us; it is for the relationships we

nurtured. Aging, like death, is part of life. Psychologists’

skills of motivational interviewing and talk therapy may

be very important to the emerging population of seniors.

We may help older clients adjust to their losses and find

the attitude that time is a gift. We may also help them

come to peace with buried secrets or unresolved issues.

Most of all, we have the skills to help others understand

that outlook is a choice.

Marilyn Chotem, Ed.D., R.Psych. #773

I’m growing fonder of my staff;

I’m growing dimmer in the eyes;

I’m growing fainter in my laugh;

I’m growing deeper in my sighs;

I’m growing careless of my dress;

I’m growing frugal of my gold;

I’m growing wise; I’m growing, — yes, —

I’m growing old.

John Godfrey Saxe, (1816 – 1887) “I’m Growing Old”.

An American poet who best known for his paraphrase of

the Indian parable “The Blind Men and the Elephant”.

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16 Spring 2014

paul t. p. wo n g,

ph . D. , c . psych .

Dr. Paul T. P. Wong is Professor

Emeritus of Trinity Westerns University.

He is well known for his research on

Positive Aging, Personal Meaning,

and Positive Psychology. He has been

a registered clinical psychologist in

Ontario for more than 30 years.

He will present the BCPA workshop:

“Meaning Therapy” on April 25th, 2014.

alth o u g h su cce ssful agin g

me ans Different thin gs to Different peo ple ,

there is some consensus that we need to shift the emphasis from

the medical model and physical components of aging to psychological

and spiritual components, and from a disease model to a growth model.

According to a lifespan developmental approach to aging, one can continue

to grow in wisdom and spirituality even in advanced stages of aging.

american m o D el s o f su cce ssful agin g

In the past two decades, numerous gerontological studies

have investigated successful aging (e.g., Rowe & Kahn, 1998; Schulz

& Heckhausen, 1996). These models differ in their definition of what

constitutes success, but “the prevailing view is that successful aging

requires consideration of multiple criteria and multiple adaptive patterns”

(Reker & Wong, 2012).

Rowe and Kahn (1998) debunk the myth that aging has to be

accompanied by illness and loss of cognitive functions and emphasize the

importance of a positive attitude and healthy life style. Older persons can

maintain their zest for living and remain productive members of society.

Successful aging is characterized by low risk of disease and disability, high

mental and physical function, and active engagement with life.

George Vaillant (2002) emphasizes the positive psychology

of aging — how to live a happy life in old age. The Harvard Study is the

world’s longest continuous study of aging and health. The main finding

is that college education is a better predictor of health and happiness

than money, social prestige, etc. Uncontrollable factors, such as genetics,

parent’s social class, and family cohesion, are no longer important by age

70. Controllable factors become more important. These include engaging

in altruistic behavior, staying physically healthy, pursuing education,

staying creative and playful, and using mature or adaptive coping.

“Successful aging means giving to others joyously whenever one is able,

receiving from others gratefully whenever one needs it, and being greedy

enough to develop one’s own self in between.”

canaDian m o D el s o f su cce ssful agin g

Canadian researchers on successful aging have a more existential

and spiritual emphasis than their American counterparts. For example,

Mark Novak (1985) focuses on personal responsibility and the quest for

meaning within the biological and social-economic constraints that often

accompany old age: “A good old age ...comes about when, given a basic

income, reasonable health, good self-esteem and a little energy, a person

sets out to discover a meaningful life for him — or herself.” (p. 273)

Wong (1989) and Reker (2000) stress the psychological and

spiritual dimensions of aging. According to Wong and Reker, successful

aging is not primarily conditional on physical conditions — we have aged

successfully, if we feel satisfied that we have become what we were meant

to be, accomplished most of our life tasks, contributed to society and

Positive Aging in canada

BC pSyChologiSt 17

referencesNovak, M. (1985). Successful Aging: the myths, realities and future of aging in Canada. New York: Penguin Books.Reker, G. T. (2000). Theoretical perspective, dimensions, and measurement of existential meaning. In G. T. Reker & K. Chamberlain (Eds.), Exploring existential meaning: Optimizing human development across the life span (pp 39 – 58). Thousand Oaks, CA: Sage Publications.Reker, G. T. (2002). Prospective predictors of successful aging in community-residing and institutionalized Canadian elderly. Aging International, 27, 42 – 64.Reker, G. T., & Wong, P. T. P. (2012). Personal meaning in life and psychosocial adaptation in the later years. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed., pp. 433 – 456). New York, NY: Routledge. Rowe, J. W., & Kahn, R. L. (1998). Successful Aging. New York: Random House.Schulz, R., & Heckhausen, J. (1996). A life span model of successful aging. American Psychologist, 51, 702 – 714.Vaillant, G. (2002). Aging well: Surprising guideposts to a happier life from the landmark Harvard study of adult development. New York: Little, Brown, and Company.Wong, P. T. P. (1989). Personal meaning and successful aging. Canadian Psychology, 30, 516 – 525.

future generations, and kept our faith in spite of difficulties

and disappointments. Therefore, successful aging is

attainable by anyone, regardless of their physical conditions.

After reviewing the theories and empirical findings

on the role of meaning in successful aging, Wong (1989)

introduces four meaning-enhancing strategies that are

especially relevant to the elderly; namely, reminiscence,

commitment, optimism, and religiosity. He concludes,

At present, most of the societal resources have

been directed to meeting the physical, social and

economic needs of the elderly. While these efforts

are essential, one must not overlook personal

meaning as an important dimension of health and

life satisfaction. Prolonging life without providing

any meaning for existence is not the best answer

to the challenge of aging. Greater research efforts

are needed to provide a firm scientific basis for

the application of personal meaning as a means of

promoting successful aging. (p. 522)

In the mid-1980s, Wong and Reker launched a

longitudinal study on the profile and processes of successful

aging in institutionalized and community-residing older

adults that came to be known as the Ontario Successful

Aging Project (OSAP). For more details on these findings,

the reader is referred to Reker (2002) and Reker & Wong

(2012). Here are some major findings that are relevant to

meaning and spirituality.

In this study, participants were classified as either

Successful or Unsuccessful agers based on ratings on

mental, physical health and adjustment. Successful and

Unsuccessful agers did not differ significantly in terms of

gender or income. However, Successful agers had more

resources than Unsuccessful agers. More specifically, they

differed in the following major resources:

• Social resources (social contacts and marital status)

• Cognitive resources (college education and intelligence)

• Spiritual resources (religious activity and personal

meaning)

• Psychological resources (optimism, commitment, self-

reliance)

Successful agers scored higher in both subjective

and objective outcome measures. These measures include:

Health outcomes as measured by a nurse, physical

symptoms as reported by participants, psychopathology,

depression and perceived well-being. There are different

predictors of physical and mental health. For physical

health outcomes, the significant predictors are perceived

control, perceived income, commitment to personal

projects, social contacts and intelligence. For mental

health, the significant predictors are: personal meaning,

religious activity, social contacts and marital status.

Consistent with Vaillant (2002), Successful agers

use more adaptive, mature ways of coping. Our study

shows that employed successful agers more often used

the following types of coping, which are important for

problems that cannot be controlled or resolved personally:

• Situational coping (Problem-focused)

• Existential coping (Meaning and Acceptance)

• Religious coping (Beliefs and Activities)

• Self-Restructuring (Cognitive and Behavioral)

• Social support (Instrumental and Emotional support)

Based on all the research on successful aging,

Wong recommends the following ten commandments of

successful aging:

1. Cultivate internal and external resources.

2. Embrace religion or spirituality.

3. Stay engaged with life and commit to personal

projects.

4. Receive college education and be a lifelong learner.

5. Develop mental capacity and exercise your brain.

6. Get married & stay connected with family and friends.

7. Be optimistic and confident.

8. Pursue a healthy lifestyle.

9. Be reflective and flexible in coping.

10. Expand yourself in every way — turn inward, upward,

forward and outward.

18 Spring 2014

No one is free of some discrimination and

certainly if we are fortunate to live a long life we will

have to cope with the prejudices of ageism. Compared

to research on sexism and racism, there is a surprising

paucity of research on ageism. One convenience sample

of 1,501 Canadians (Revera Report, 2012) found that

fifty-one percent of respondents agreed that ageism is

the most tolerated social prejudice, more than gender

(20%) or even raced-based (15%) discrimination (Revera

Report, 2012). The majority of seniors (63%) reported that

they have been treated unfairly or differently due to their

age. We see an elder limping and we assume a chronic

condition or an injury that will take much longer to heal

than if we saw the same limp in a younger person, yet

older adults have injuries that heal quickly and youth can

incur a permanent disability from accidents. Maybe the

stereotype that our profession has had to overcome is that

of older adults not being as responsive to or as suitable for

psychotherapy as young or middle-aged people. In 1905,

when he was forty-nine, Freud wrote that people over

fifty were not treatable:

The age of the patient also plays a part in the

selection for the psychoanalytic treatment.

Persons near or over the age of fifty lack, on the

one hand, the plasticity of the psychic processes

upon which the therapy depends — old people

are no longer educable — and on the other hand,

the material which has to be elaborated, and

the duration of the treatment is immensely

increased. (Freud 1905).

Unfortunately, this myth about age continued

for many decades and still lingers in a perception that

the aged would not be as interested in or as amenable

to psychotherapy. In fact, crystallized intelligence

involving a life-long accumulation of learning and

culture is maintained and increases during adulthood

and is less dependent on physiological functioning than

is fluid intelligence (see Dixon & Cohen, 2003). The

famous Seattle longitudinal-sequential study by William

Schaie (1995) showed that cohort effects were being

teD altar, ph . D. , r. psych .

The President of the BC Psychological Association. Contact for the Board of Directors at board@psychologists.bc.ca

confounded with actual longitudinal changes. What was

found was that although our quickness with numbers

starts to decline in our thirties, word fluency in the forties,

inductive reasoning in the fifties, and word meaning in

the sixties, these declines don’t become significant until

some time after seventy. But these specific functions as

measured in isolation don’t take into account the actual

performance with real world demands where older persons

can compensate with post-formal cognition and practical

intelligence. While episodic memory declines such that 80%

of adults in their 20’s will do better than adults in their 70’s,

age differences on semantic memory and implicit memory

tests are usually absent (Fleischman & Gabrieli, 1998). While

access to remembered information may be slower among

older learners, the same knowledge structures or associative

networks remain intact, unless ravaged by severe illness or

brain injury.

neither fifty, as Freud thought, nor seventy, as

some of us may still believe, is an absolute limit since many

such older adults are able to use their stores of crystallized

knowledge and pragmatic skills to compensate and continue

learning as effectively as younger adults. There are multiple

directions of age-related change and older persons can

compensate by investing more time and effort at a skill,

substituting more enduring component skills for those

skills that may decline, and optimizing by selecting what

is most achievable, or simply by adopting more realistic

criterion of success. Most of the obvious significant declines

in learning and memory occur about five years before one’s

death (Hess, 2005) due to declining health and attendant

compromises of neurological functioning. Maintaining good

health offsets early cognitive declines. Exercise and healthy

eating benefits all age groups. What is important to know

is that there is great individual variability such that some

individuals in their seventies showed no decline in practical

cognition.

In terms of personality, we may actually continue

to improve in some fundamental ways. Conscientiousness

and agreeableness increase with age and stays at its highest

point beyond age sixty. Extraversion declines only slightly

“ the wiser minD m o urns le ss fo r what ag e take s away than what it le aVe s b ehinD.”

fro m THe FounTain: a ConversaTion by WilliaM WordsWorTH

BC pSyChologiSt 19

but neuroticism continues to abate past sixty (Srivastava,

2003). Rates of severe depression reach their peak in the

early twenties and become lowest for those 65 and older.

Findings like these have changed the outlook of gerontology

to the current positive view of the increasing longevity and

quality of life as the “third age” (Baltes & Smith, 2003)

Although a less rigid outlook has been advanced

about aging, there are the inevitable changes of aging

that make for an increasing loss of one’s former physical

robustness and endurance along with a slowing of the

mechanics of cognition (e.g., speed of processing). After

85 — the ‘fourth age’ — declines become more prevalent

and more inevitable because the limits of compensation

have been reached physically and cognitively. Illness, prior

educational levels, life circumstances, and terminal changes

are associated with declines in many older people but not

all to the same degree, and again there are wide differences

between individuals.

Another myth of aging is the assumption that

with age comes increasing wisdom but in fact there is no

correlation between age and wisdom (Baltes & Staudinger,

2000). We may always lack wisdom or have it at any adult

age. This applies to psychologists as well and therefore we

need to remain humble, informed and up-to-date on the

empirical facts that serve to contradict the stereotypes of

age, since stereotype threat internalized by older clients

may also partly account for some declines in cognitive

ability or a reduced effort in trying.

psych other apy fo r elD ers

Psychotherapy research for the two most common

complaints of depression and anxiety has demonstrated

that good psychotherapy outcomes occur for both adults

and elderly clients (Laidlaw). This is not to say that the

context of these disorders will be the same for all age

groups. Depression and anxiety in the elderly client more

frequently has a biopsychosocial aetiology referring to a late

age context of multiple losses and increased social isolation.

Life span developmental psychology has helped

greatly in increasing our understanding of the changes and

stabilities of growing old. If one lives to sixty-five, one can

then expect the average lifespan for an individual in Canada

to be eighty-five (Chappell & Hollander, 2013). We know

that the percentage of persons sixty-five and older in the

population will increase from 14.1% in 2010 to 24.9% in

2050.

When assessing and treating an elder adult,

questions about what to address can be less clear than

with a younger adult. Do you first focus on the symptoms

of an apparent depression or on their coping with a health

issue, their grief over a recent or long standing loss

of friends and family, their acceptance of a change in

role and social status, possible social isolation, or their

adjustment to changes in their relationship with the

world? A helpful and necessary place to begin would be

to review the updated APA Guidelines for Psychological

Practice with Older Adults (adopted by the APA Council

of Representatives in August of 2013) and other related

guidelines. Also, there are now many more books

available on working with older adults (Qualls & Knight,

2006; Scogin & Shah, 2012; Sorocco & Lauderdale, 2011;

Vacha-Hasse et al., 2011).

s o me ba sic co nsiD er atio ns fo r wo rkin g

with o lD er clients

1. Respect older adults as adults. To use baby-talk

or such intonation with any adult is insulting and

the same applies to older persons. Even those with

dementia may become irritable when they hear a

patronizing tone. Even though one may mean well,

such a tone is not helpful. An adult remains an adult

even if he or she suffers from cognitive loss.

2. Make accommodations for physical limitations. Due

to visual acuity decreasing with age, particularly in

low light, make sure that your office is well-lit and

that you book older clients during the mid-day so

that they can travel when traffic is minimal and the

sunlight is good. Avoid surfaces in your office with

glare like high gloss flooring finishes. Because one’s

sense of balance decreases, make sure that there are

railings on both sides of a stairwell to your office, that

there are no unnecessary obstacles in your office, and

that there are no slippery services or slippery carpets.

3. Speak slower and always clearly. While slowing of

psychomotor speed or reaction time is one of the

most inevitable changes of aging, a key reason for

this slowing is actually due to slower decision speed

and processing speed, particularly in situations that

involve ambiguous information. Given a reduced

speed of processing, it may be necessary to talk more

slowly and be clear in enunciation. Shorter sentences

are always better than long-winded sentences and

this generally applies to all clients. Approximately

one in three people between the ages of sixty-five

and seventy-four experience some hearing loss

and nearly half of those older than seventy-five

do have difficulty hearing (nIDCD, 2013). Always

face the person since part of our disambiguation of

another’s voice depends on viewing the speaker’s

lip movements. The McGurk effect demonstrates

20 Spring 2014

how we all use such visual cues and these become

more important as one's hearing become less

sensitive. Difficulty understanding speech may not

only be embarrassing but can be very isolating when

it becomes hard to hear conversation. Errors in

understanding can also be dangerous when mistakes

in hearing result in not understanding medical advice

or not hearing various auditory alarms.

4. Provide and Elicit Summaries and ensure handouts

are in a readable font. It is always good to provide

verbal summaries with clients and this can be

especially needed for some older persons. Also,

written summaries or handouts need to be in large

print. Asking clients to verbalize their progress and

what they have found most helpful or useful from

the last session provides useful information for the

psychologist to know not only what has been learned

and applied but what yet needs to be reinforced and

further practiced. If the client is having difficulty

remembering, then the psychologist can mention a

couple of key points and ask again which was deemed

most useful.

As we get older the percentage of us with serious

vision problems or blindness increases. One in eleven

Canadians aged sixty-five or older must live with

vision loss and this increases to one in eight for those

Canadians aged seventy-five or older (CnIB, 2013). It

is therefore a naive assumption that everyone will be

able to readily read printed materials and one needs

to know what size of font a client is capable of reading.

now that every office has a laser printer, there is

little excuse not to print off one's client handouts to

match an individual's comfort zone of visual acuity.

One may also find that providing a binder or folder for

handouts, exercises and summaries can be very much

appreciated.

5. Be sensitive towards, and knowledgeable of,

cohort differences. Just as we are required to be

informed about gender and racial differences and

sensitivities, so too we need to be informed about

cohort differences. There is no easy way to be versed

in the sub-culture and differing socio-historical

experiences of cohorts but knowing and being versed

on some basic history is certainly a good place to start.

Someone once said that if one only reads psychology

texts, as wonderful as they may well be, one will still

not be a good psychologist. One needs to also be more

widely read and cultured.

People are profoundly influenced by their

socio-historical environment. The greater education

and historical events of the 1950’s and 1960’s (Baby

Boom Generation) politicized an influential minority

regarding racial and economic inequalities. The

generation of the seventies became less engaged in

social activism and more inwardly directed towards

self-fulfillment and personal success. Of course, such

generalities are not that helpful. What is helpful are the

details of the key events, the specific personages and

specific cultural or material consumptions of choice.

Concepts of masculinity and femininity, for instance,

have undergone many generational changes, as have

changes in religiosity, community values, degrees

of social solidarity and alienation, ideas of personal

self-care, and the increasing individualization of

entertainments, hobbies and life styles.

6. Use Examples. A good therapist makes things concrete

with vivid examples, memorable demonstrations, or

analogies. ACT therapy and Impact therapy, as well

as Cognitive Therapy are good sources for increasing

one’s stock of illustrations and examples. Of course,

one needs to always be very sparing of citing one’s own

personal examples as this is overused by the novice

therapist and too often diverts attention from the client.

Role playing is also useful in making more vivid and in

practicing certain skills of coping, communication with

another, assertion with civility, and so on.

Asking clients to complete some exercises at home

is risking embarrassment for the client should they

forget or be unable to complete the homework. One

approach is to simply start some of the homework in

session.

7. Encourage note-taking or recording. Very often we

may cover too much ground in a session although due

to years of familiarity for the psychologist it may not

seem as if much was covered. Providing a notepad or

suggesting to clients that they are always welcome to

record their session can certainly serve as an aid to

memory. Recording is less distracting than note-taking,

but note-taking can be more concise and focused on

what a client finds is most helpful.

8. Be sensitive to issues of loss and acceptance.

Older adults will have experienced more losses and

disappointments than younger clients. Along with

attending more funerals, there may be a greater history

of traumatic experiences and life disappointments. In

addition, older adults will be faced with a progressive

diminishment of personal strengths, competencies,

social status and personal future. Approximately 35%

of Canadians age sixty-five to seventy-four will have

to cope with some disability and this increases to 55%

BC pSyChologiSt 21

of those over seventy-five (Stats Canada, 2008). While

limitations among working adults are mostly for pain,

mobility limitations become prevalent with age. Hence,

23% of Canadians age sixty-five to seventy-four have

mobility limitations, and this increases to 41% for those

age seventy-five to eighty-four, and increases again

to 61% for those age eighty-five and older (ibid, 2008).

Older adults must adjust to and accept such limitations

and also reconcile with past mistakes which a shortened

future prevents from replacing with compensating

successes.

Here is where an individual’s vulnerabilities are

not to be exploited and great care must be shown in

respecting how an older adult comes to terms with

the narrowing of their world. Imposing one’s own

solutions can be a deep insult or a form of exploitation

of another’s vulnerability. It is not our role to convert,

proselytize or recruit for our metaphysical point of

view. It is rather our turn to validate by listening

and affirming the client’s perspective on his or her

life story and its end. To the extent that there are

obvious cognitive distortions, and unfair or inaccurate

statements of fact that are making for distress or

dysfunction, then we may intervene with the humbling

knowledge that we may fall short in comparison with

the lived life that older adults possess.

9. Be aware of phenomenological differences. While

severe depression is less frequent among older adults,

it is also experienced or expressed differently. For

instance, the core symptom of sadness may be referred

to by younger adults as being “down” but older adults

may instead talk about feeling “helpless” or “tired”.

Apathy may be stronger or more apparent with older

depressed adults, and staying in bed and not wanting

to get up and do things more common. The reduction

in physical activity among older adults certainly

aggravates their depression. In addition, the social

stigma of being retired can also contribute to the older

adult’s dysphoria. As Simone de Beauvoir wrote,

Society cares about the individual only in so

far as he is profitable. The young know this.

Their anxiety as they enter in upon social life

matches the anguish of the old as they are

excluded from it. (Simone de Beauvoir, 1973,

p. 807)

A weak appetite and insomnia may be symptoms

of depression or age-related changes or reflect

health problems, medication side effects, metabolic

changes, and so on. Also, loss of health, stress

from relocation, fear of losing independence

and few social supports, or isolation makes for

anxiety being more prevalent among older adults,

particularly women.

10. Be aware of possible differences between what

is normal and what becomes a disorder. Certain

normal changes of aging on their own do not

constitute a disorder but will be a valid complaint.

For instance, sleep often becomes lighter with

age and more time is spent in stage 1 and 2 sleep

while less time occurs in the slower wave sleep of

stages 3 and 4. The overall duration is decreased

and sleep disturbances become more frequent. The

circadian cycle changes such that both sleep onset

and awakening are earlier than desired, sometimes

by several hours. Napping and light contamination

also affect sleep patterns and older adults may have

to adjust. When these differences reach the level at

which an older adult is not obtaining the sleep they

need, then treatment is needed.

It is unfortunate that sleep disturbed older

adults are more likely than any other age group to be

prescribed benzodiazepine hypnotics (Stewart, 2006).

Besides the potential adverse effects, tolerance and

addiction, it turns out that the effect size compared

to the placebo response is small and of questionable

value (Huedo-Medina, 2012). A psychological

and evidence-based approach that could be more

frequently offered would be a cognitive behavioural

treatment that would involve sleep-restriction-

compression, sleep hygiene education, relaxation

training and cognitive therapy. Stimulus control

therapy could also be considered, but further research

is needed to move it beyond a partially supported

treatment to that of an evidence-based treatment

(Dillon, H.R., Wetzler, R.G., & Lichstein, K.L. (2012).

11. Become versed in cognitive retraining and other

rehabilitative methods for older adults. Cognition

is indeed a complex assembly of mental skills

and functions that include attention, perception,

comprehension, learning, remembering, problem-

solving, reasoning, and applied judgement. The field

of cognitive rehabilitation (Raprente & Herrmann,

2003) is a growing and an important area of practical

knowledge in working with both older and younger

adults who are exhibiting some cognitive impairment

from either accidents or illness. For those older adults

experiencing cognitive difficulties or declines, it can

be helpful to instruct on how to use various strategies

for compensating. For example, basic memory

strategies like association, imagery, chunking,

22 Spring 2014

rehearsal, attention-concentration, the method

of loci, face-naming and name learning have been

shown to be helpful with both older adults and adults

in the early stages of dementia (Rebok, 2012). Other

methods like teaching task breakdowns, moving from

the simple to the complex, moving from the concrete

to the abstract, using double or triple digit number

groupings to increase digit span, and using imagery

and space retrieval methods for memory (where

the time between retrieval attempts is gradually

increased) are just some of the many techniques

that may be effective, although further research is

needed to better establish their efficacy. It needs to

be remembered that older adults already have learned

or developed various idiosyncratic approaches,

some of which may well be effective. Resistance to

learning new strategies needs to be respected. They

may find that the method of loci may seem strange

and impractical to them and one should then offer

alternative methods that are less threatening or

effortful.

referencesAmerican Psychological Association (2014). Guidelines for Psychological Practice with Older Adults. Amer. Psychologist, 69(1), p. 34 – 65. Baltes, P. B. & Smith, J. (2003). New frontiers in the future of aging: From successful aging of the young old to the dilemmas of the fourth age. Gerontology, 49, 123 – 35.Baltes, P.B., & Staudinger, U.M. (1993). Wisdom: A meta-heuristic (pragmatic) to orchestrate mind and virtue toward excellence. American Psychologist, 55, 122 – 136.Chappell, N. & Hollander, M. (2013). Aging in Canada. Oxford.CNIB (2013). Fast Facts about Vision Loss. Found at http://www.cnib.ca/en/about/media/vision-loss/Pages/default.aspxDillon, H.R., Wetzler, R.G., & Lichstein, K.L. (2012). Evidence-based treatments for insomnia in older adults. In Scogin & Shah (ed.), Making Evidence-Based Psychological Treatments Work with Older Adults. APA.Dixon, R.A. & Cohen, A. (2003). Cognitive development in Adulthood. In Lerner et. al., Handbook of Psychology, v. 6, 443 – 61, N.Y., John Wiley & Sons. De Beauvioir, Simone (1973), The Coming of Age. Warner (originally published in 1970 in French by Gallimard)Fleischman, D.A. & Gabrieli, T.E. (1998). Repetition priming in normal aging and Alzheimer’s disease: A Review of findings and theories. Psychology and Aging, 13, 88 – 119.Evans, S. (2004). A survey of the provision of psychological treatments to older adults in the NHS, Psychiatric Bulletin, 28, 411 – 14.Hess, T.M. (2005). Memory and aging in context. Psych. Bull., 131 (3), 383 – 406Huedo-Medina, T.B. Kirsch, I., Middlemass,J., Klonizakis, M., Siriwardena, A. (2012). Effectiveness of non-Benzodiazepine Hypnotics in Treatment of Adult Insomnia. BMJ, 345, e8343Freud, Sigmond (1905). On Psychotherapy. Reprinted (1953 – 1974) in the Standard Edition of the Complete Works of Sigmund Freud (trans. & ed. J. Strachey), vol. Also can be found at http://www.bartleby.com/280/8.htmlNational Institute on Deafness and other Communication Disorders (NIDCD, 2013). Hearing loss and older adults. Publication No. 13–4913. Found at http://www.nidcd.nih.gov/health/hearing/pages/older.aspxParente, R. & Herrman, D. (2003). Retraining Cognition: Techniques and Applications (2nd ed). Pro Ed.Qualls, S. & Knight, B. (2006). Psychotherapy for Depression in Older Adults (Ed.). Wilely.Rebok, G.W., et al. (2012). Evidence-based psychological treatments for improving memory function among older adults. In Scogin & Shah (ed.), Making Evidence-Based Psychological Treatments Work with Older Adults. APA.The Revera report on ageism: A look at gender differences. (2012). Published by the International Federation on Aging. Found at http://www.ageismore.com/Revera/media/Revera/Content/Revera-Report_Gender-Differences.pdfSchaie, K.W. (1994). The course of adult intellectual development. Amer. Psyc., 49, 304 – 13.Schaie, K.W. (1995). Intellectual development in adulthood. The Seattle longitudinal study. New York: Cambridge U. Pr.Scogin, F. & Shah, A. (2012). Making Evidence-Based Psychological Treatments Work with Older Adults. APA.Skinner, B .F. (1983). Origins of a behaviorist. Psychology Today, 22 – 33Sorocco, K. & Lauderdale, S. (2011). Cognitive Behavior Therapy with Older Adults: Innovations across Care Settings. Springer Srivastava, J.S., et al. (2003). Development of personality in early and middle adulthood: Set like plaster or persistent change? J. of personality and Social Psych., 84, 1041 – 53.Statistics Canada (2006) Population Projections for Canada, Provinces and Territories 2005 – 2031. Cat No 91–520–XIE. Statistics Canada (2008). Participation and Activity Limitation Survey: An Analytic Report. Cat No 89–628–XIE no. 2.Stewart, R. et al. (2006). Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep, 29, 1391 – 97.Vacha-Haase, T., Wester, S. & Christianson, H. (2011). Psychotherapy with Older Men. Routledge

co n clusio n

The above few suggestions for the most part may be

obvious considerations to the experienced psychologist,

but it is surprising how many therapists forget or ignore

some basic practicalities. Working with older adults

requires that we update and maintain our general

knowledge about older adult development, review our

attitudes about such developments, and always upgrade

our competence in assessing and treating older adults.

Working with adults whose future self is comparatively

short involves a respect for a lived life that had different

challenges and opportunities than the lives of those

who are younger. A longer life is a life with likely more

successes and more failures, a life belonging to a person

who had to navigate in a socio-historical world of

different events, hardships and constraints.

“ o lD ag e anD the we ar o f time te ach man y thin gs .”

s o ph o cle s , T yro. fr ag . 586

BC pSyChologiSt 23

o rganiz atio nal “s crip ts”, the me ta

co mmunicatio n o f the o rganiz atio n , are writ ten

oVer time by lo n g -term employ ee s anD are usually

co DifieD. By learning to understand the message behind the message

between co-workers; management; union officials, you will learn the

metacommunication of the organization. There are four principal features

to keep in mind which have been identified by Kets de Vries and Miller

(1987) and which I have expanded upon below.

a . thematic unit y

Organizational events should be interpreted in one interconnected,

cohesive observation. A communality amongst the organization’s global

themes occurring throughout the first weeks/months that you work in this

new environment should become increasingly apparent. Conceptually, a

unity or theme of organizational protocol begins to present itself which

allows the following extrapolation. Can I envisage myself working within

the organization’s operational boundaries? Do I like the organization’s

style of problem solving, doing business, risk taking, liberalism/

conservatism? All of this information should be absorbed, certainly by the

end of a probation period (e.g., six months). If not, “get the hell out of

Dodge” as the expression goes because you’re probably in an enmeshed

or disengaged infrastructure, which diminishes by varying degrees the

transparency of communication within the organization. Obviously, this is

not good.

b . pat tern matchin g

When involved in organizational diatribes between departments, units and

collegial relationships, people tend to seek out a fit between the current

event and past events in an attempt to make things meaningful, looking

for patterns of repetition. “Pattern matching” or interpreting the present

dynamic(s) in terms of past events, causes us to re-live past events and

react as we did at a previous time. Unfortunately what was an appropriate

reaction in the past is often no longer effective. Please beware of making

this generalization which can be a grave mistake! Rather, carefully assess

the current problem to reduce the tendency of impulsive, “knee-jerk”

responses based on and influenced by previous, habituated behaviour. you

will save yourself a lot of problems and heart ache.

c . psych o lo gical urg en cy

You should, with practice, be able to understand the dynamics of the

issue being addressed and the “text” of the most pressing problem(s) to

be solved. Begin by prioritizing the problem and look for the flip-side

of the problem, which is usually the answer to the problem in broad

strokes. Subsequently, compartmentalize the problem by breaking

down its components and assessing, then prioritizing which aspect of

D o nalD hutcheo n , eD. D. ,

c . psych o l(uk). , r. psych .

Vice-President of the BC

Psychological Association.

Metacommunication in Organizations

4 principles to Keep in Mind

(a)

(b)

(c)

(d)

24 Spring 2014

p ost s crip t

As I was writing this article it occurred to me to look through

some older texts (i.e., Malone & Petersen 1974) regarding

increasing your effectiveness in handling politics and

promoting your reputation/success within an organization.

You’ve probably heard some of this information before, but

it doesn’t hurt to be redundant for your benefit.

Build a positive political image: Simply this: consistent

good work and the appropriate use of your ability

usually “wins the day”. How so? Increase the frequency

of contact and interest in others; know people by name

and give them credit or recognition to acknowledge

their work and personal achievement; show tact,

sensitivity and respect for other people and your

contacts with them;

Deal with political realities: Organizational politics are

realities we have to deal with! Be wary of cliques and if

you join one, don’t be surprised if anything you disclose

is not perceived as confidential and is discussed in open

forum. Expect fairly consistent action and support

among the members within a clique. If one member is

opposed to an idea or program, the others are apt to be

against it as well. Please be careful and be aware of this

one looming its big rotund, ugly head;

Prevent political breeding grounds: Avoid using

the same source as your informal channel of

communication. This is a big “no no,” as that person

comes to depend on the power of their informal

“expert” role as your confidant, which in turn can

work against you with a “falling out” in times of

distress and political action. The information you

seek or have disclosed to that person in the past may

be misrepresented to save someone’s job, career,

whatever and leave you “hanging out to dry” and lastly;

Sidestep political schemes and power plays: Challenge

the temptation of listening to gossip and keep in mind

the alternative of refusing to listen. Explore issues and

differences between people openly and impartially.

Avoid the tendency to “carry tales” or listen to

unverified rumours. Stay focused on work objectives

and avoid entanglement with conflicting factions and

schemers. Colleagues respect “apoliticals”; it’s that

simple.

Following these rules will help you stay on top of the

game. With luck and hard work, much success in all future

endeavours and your careers!

the problem you can successfully address. Attempt to

solve the problem after you’ve determined its degree of

difficulty from your perception of it on a “most weak to

most difficult” continuum. As you answer each aspect

of the problem, this should increase your confidence

to continue. From this beginning and the success you

achieve in solving aspects of the problem, you will

begin to understand the problem’s overall psychological

urgency vis-à-vis its overall impact on the organization.

Often what we perceive as overwhelming and stressful

upon “first blush” changes after a few attempts to

problem solve. Specifically, when anxiety dissipates there

is greater acceptance of the “dignity of risk”, of actually

risking a confrontation with the problem at hand. With

practice, this problem solving approach should become a

comfortable option for addressing most dilemmas faced

by you in your role within the new organization.

D. multiple fun c tio n

Organizational theme(s) can have serious meanings

depending on how you interpret them and from which

points of view (i.e., defensive processes; key dynamics;

interpersonal relationships, their patterns and their effect

on the organization etc.). These issues may also be played

out simultaneously or concurrently and at individual,

management and organizational levels of the political

ecosystem. If you hadn’t guessed, thematic evaluation

can be complex. Learn to prioritize the organization

theme you’ve encountered regarding ongoing work

“widgets” you’ve been assigned to lessen the chance of

error. With time, this skill set will improve.

By now it should be obvious to YOU, the

stakeholder of your mental health, that becoming familiar

with these rules of interpretation is vital! Learning the

basic organizational themes and patterns of the dynamics

of these themes played out at your workplace will

allow you to interpret them quickly. With practice, the

significance of issues that initially seem meaningless

or chaotic, can be interpreted at their proper level of

importance. Have confidence. you will become adept at

learning the organization’s themes of communication and

your ability to interpret them will become second nature

with practice.

referencesKets de Vries, M and D. Miller (1987). Inside the troubled organization: Unstable at the top. The New American Library of Canada Limited.Malone, R.L ., and Petersen, D.J (1974). The effective manager’s desk book: Improving results through people. Parker Publishing Company Inc.

Meaning Therapy :A new paradigm of integrating healing with personal growthpresenteD by D R. PAUL wO N G

Friday April 25th, 20149:00AM – 4:00PM @ University Golf Club5185 University Boulevard Vancouver, BC V6T 1X5

Continuing Education Credits: 6

About the WorkshopMeaning Therapy (MT) introduces a new paradigm of integrative therapy that treats the whole person, rather than mere cognitions or behaviours. It is integrative, holistic, and evidence-based with the positive psychology of meaning as its central organizing construct. As an extension of logotherapy, it will pay special attention to the existential and spiritual issues that underlie most personal issues and predicaments. MT will integrate existential psychology with CBT, narrative therapy, cross-cultural psychology, and positive psychotherapy.

MT aims to restore human dignity and promote mental health in an increasingly dehumanizing and toxic culture dominated by materialism, consumerism, and cut-throat competition. Psychologists will learn how to use meaning-based interventions to address major clinical issues, such as depression, anxiety, and to empower their clients to live a purposeful and value-driven life.

MT helps clients discover their true selves and hidden inner resources by switching from a self-focus to a meaning focus. It shows how a radical change in worldview and belief systems can transform a person’s life from the inside out.

Learning Objectives• How to contrast the new meaning paradigm with

the traditional paradigm of psychotherapy• How to heal the worst and bring out the best in

people’s lives through meaning• How to employ a coherent conceptual framework

with meaning as the central organizing construct in integrating a variety of therapeutic modalities

• How to use innovative positive interventions, such as PURE and ABCDE, to restore hope, meaning, and passion for living, regardless of circumstances

About the Presenter — Dr. Paul T. P. WongPaul T. P. Wong, PhD, CPsych, has been a professor and clinician for more than three decades. His meaning therapy has gained world-wide recognition. He is the President of the International Network on Personal Meaning, and International Society for Existential Psychology and Psychotherapy. He is

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also Editor of the International Journal of Existential Psychology and Psychotherapy. He has been invited all over the world to give workshops on Meaning Therapy. His lectures are known for his passion and humour.

How to register for this workshopMail this form to: BC Psychological Association • 402 – 1177 West Broadway Vancouver, BC V6H 1G3Fax this form to 604 – 730 – 0502• Go online: • http://psychologists.bc.ca/civicrm/event/info?reset=1&id=110

cancellation policy: cancellations must be received in writing by april 15th, 2014. a 20% administration fee will be deducted from all refunds. no refunds will be given after april 15th, 2014.

Go Green: http://tripplanning.translink.ca/

GST # 899967350. All prices are in CDN funds.Please include a cheque for the correct amont, not post-dated, and made out to “BCPA” or “BC Psychological Association”. If you prefer paying by credit card, please register online.Workshop fee includes handouts, morning & afternoon coffee, and lunch. Free Parking is available. Participant information is protected under the BC Personal Information Act.

Regular Registration (March 4th – April 20th, 2014)

q Regular Price $270.90 (incl. GST)

q BCPA Members / Affiliates $197.40 (incl. GST)

Meal Requirements

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26 Spring 2014

BC pSyChologiSt 27

Bc Psychological AssociationSince 1938, the BC Psychological Association (BCPA) has

represented psychologists in British Columbia. It is a

voluntary body and is committed to advancing psychology

and the psychological well-being of all British Columbians.

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