ELDERLY COUNSELING:

THE UNDERSTANDING, AND PRACTICE IN MALAYSIA

BY NURUL AINI BINTI MUDAYAT

MASTERS OF COUNSELING PGB110006

UNIVERSITY OF MALAYA

INTRODUCTION

• BACKGROUND OF STUDY

• PROBLEM STATEMENT

• RATIONAL OF STUDY

• RESEARCH OBJECTIVE

• RESEARCH QUESTION

BACKGROUND OF STUDY

• Demographic data indicate that the population of adults ages 65 and older is growing at an increasing rate. By 2030, there will be about 70 million elderly, more than twice their number in 1997. People 65 and older are projected to represent 13% of population in the year 2000 but will be 20% by 2030 (Administration on Aging, 1998).

• As the number of elderly in the population continues to grow, counsellors will increasingly be faced with meeting the needs of elderly and their families.

• With a growing population of older adults who will seek psychological services to address the needs of older adults, a need to understand and give light to older adults’ experiences of the counselling process is very important (Foster, Kreider, & Waugh, 2009; Gellis, Sherman, & Lawrance, 2003; Hillman, Stricker, & Zweig, 1997; Hillman & Stricker, 1998; Qualls et al. 2002).

PROBLEM STATEMENT

• For many young counsellors, providing counselling for persons of elderly with diverse ethnic and racial backgrounds is a challenge. Not only do counsellors have to apply good counselling skills to the session but they also have to be aware of personal biases and be sensitive to issues of cultural diversity (Sue, Arredondo, & McDavis, 1992).

• Increased numbers of older people and a continued lengthening of the life span signal the need to expand counselling services to a population often overlooked--the older adult. While the elderly for 25 percent of the national total spent on health care, they are underrepresented in receiving psychological aid. Older adults are healthier and better educated than ever before, concerned about the quality of life as well as the length of it.

SIGNIFICANT OF STUDY

• Counselors - better understand and improve their service

• Readers - can enrich the readers understanding

• Other researcher - guide to other researchers where they want to know more

RESEARCH OBJECTIVE

• The following are the research objectives: – To understand general opinion regarding

counselling with elderly

– To review multicultural competence in elderly counselling

– To study process of engaging in elderly counselling

– To evaluate counsellor practice in elderly counselling

– To study strategies and recommendations in elderly counselling

RESEARCH QUESTION

• The following are the research question:

– What is general opinion regarding counselling with elderly?

– What type of multicultural competence in elderly counselling?

– How the process of engaging in elderly counselling?

– How to evaluate counsellor practice in elderly counselling?

– What strategies and recommendations in elderly counselling?

LITERATURE REVIEW

• CURRENT STATUS OF PRACTICE WITH ELDERLY

IN COUNSELLING PSYCHOLOGY

• MULTICULTURAL COMPETENT

COUNSELLING

CURRENT STATUS OF PRACTICE WITH ELDERLY IN COUNSELLING PSYCHOLOGY • Counselling psychology focuses on life-span

development and helping clients identify, develop, and access personal and social resources while addressing emotional, social, vocational, educational, health-related, developmental and organizational concerns (Lopez et al., 2006).

• Counselling psychology is calling for more research on clinical work with elderly and is attempting to address the needs of a diverse older population. Hinrichsen (2006) and Hays (1996, 2001), for example, offer valuable suggestions for practice with culturally diverse elderly, and particularly, strategies for counselling cultural minority older clients.

MULTICULTURAL COMPETENT COUNSELLING

• Sue and colleagues (1998) have developed a model of multicultural competent counselling to help guide psychologists in developing their counselling competencies. The model consists of 3 dimensions of counsellor competence: awareness, knowledge, and skill.

METHODOLOGY

• RESPONDENTS

• PROCEDURE

• INSTRUMENTS

RESPONDENTS

REGISTERED COUNSELLOR

Chinese Christian

Male 30+ years

old

Oikos counseling

ELDERLY CLIENT

Malay Muslim

Male 63 years

old

Royal retired

Security guard

PROCEDURE

Identification Selection &

Making Contact

Interview Transcription

INSTRUMENTS

QUALITATIVE METHOD

SEMI-STRUCTURED INTERVIEW

INSTRUMENTS REGISTERED COUNSELOR

Personal and professional backgrounds

General opinions regarding elderly counselling in Malaysia.

Multicultural counselling concepts in elderly counselling

Multicultural competence in elderly counselling

Work experience in elderly counselling

Process of engaging with diversity especially in elderly counselling

Evaluation practice in counselling with elderly

Strategies and recommendations in elderly counselling in Malaysia.

ELDERLY

Personal and professional backgrounds

General opinions regarding elderly counselling in Malaysia.

Strategies and recommendations in elderly

counselling in Malaysia.

RESULT AND DISCUSSION

• GENERAL OPINION REGARDING COUNSELLING WITH OLDER ADULT

• AREAS OF CONCERN OF OLDER ADULTS

• MULTICULTURAL COMPETENCE IN OLDER ADULT COUNSELLING

• PROCESS OF ENGAGING IN OLDER ADULT COUNSELLING

• EVALUATE PRACTICE IN OLDER ADULT COUNSELLING

• STRATEGIES AND RECOMMENDATIONS IN OLDER ADULT COUNSELLING

GENERAL OPINION REGARDING COUNSELLING WITH ELDERLY

“Elderly counselling is counselling for people who are 60 years old above. They are usually retired from their career.” (Respondent 1: Line 43)

• The terms “elderly” and “older adult” do not have the same meaning in all societies, so their definitions are somewhat arbitrary. In most developed countries the terms are related to retirement age (65 or thereabouts).

AREAS OF CONCERN OF ELDERLY

Elderly with grief and lose

• “Usually a client who came to attend the counselling sessions has a problem with grief and loses. In which the husband or wife died. In addition, the children leave them for their own families after get married. Clients who come usually want their problems solved.” (Respondent 1: Line 87)

Elderly with retirement or job transition

• “Usually these elderly has retired. If they have no financial problem, then no problem. But if they have financial problems should be looking for other income. The main problem is the income or financial. If there are pension its okay. If there is no pension they have to work. EPF money must use the right way. In addition is to the work transition and retirement.” (Respondent 2: Line 56)

MULTICULTURAL COMPETENCE IN ELDERLY COUNSELLING

Awareness

• “We should empathy for the elderly emotionally and attitudes. In addition, we should have an understanding of the needs of the elderly.” (Respondent 1: Line 192)

Knowledge/Understanding

• “Counsellors must have knowledge. Good at taking care. They must have the knowledge to know the people problem. There must be a level of perfection. Not everyone can give counselling. Who are attend in counselling usually have a problem. And those who are come usually can involve in counselling process.” (Respondent 2: Line 32)

Skills

• “We must have good skills and technique for counselling sessions with the elderly. With good skills, sessions will work more comfortably.” (Respondent 1: Line 198)

PROCESS OF ENGAGING IN ELDERLY COUNSELLING

Pre-Session

Preparation for Counselling

• “Firstly, try to communicate with family members. We can ask about background and problem. Usually, the families are refers clients to counsellors because they think their parents considered problematic. Clients also come with the family.” (Respondent 1: Line 106)

PROCESS OF ENGAGING IN ELDERLY COUNSELLING cont…

During Session

Early Stages of Counselling

• “We use a sand tray for building rapport between counsellor and client. In the box there is sand and miniatures. Client will select the miniatures which have been prepared in the cupboard in the counselling room. Client will create a situation or condition. Client decides what they want to do. On That process, counsellor will communicate and explore client problem.” (Respondent 1: Line 120)

Sand Tray Therapy Techniques

• “An intervention strategy is the sand tray therapy. It is very interesting because the process of building a relationship is to use a sand tray. It is also very suitable in use for clients that are difficult to share.” (Respondent 1: Line 130)

PROCESS OF ENGAGING IN ELDERLY COUNSELLING cont…

Post-Session

Engaging older adult with family counselling

• “After the counselling session usually I will conduct discussions with the family. In addition, I also do family counselling. This is important for children to be more understanding and empathy for their parents. Usually I will continue with the next session when needed.” (Respondent 1: Line 148)

EVALUATE PRACTICE IN ELDERLY COUNSELLING

Study case Discussion Feed back

• “Usually, I make a case study and discussion with the doctor, therapy and other counsellors such as my colleagues, supervisors and guardian of elderly in old folks home. I also have to make consultation with the client's family. Sometime I get feedback from family members about the client.” (Respondent 1: Line 175)

STRATEGIES AND RECOMMENDATIONS IN ELDERLY COUNSELLING

Humanistic Psychotherapy

• “For the counselling session with the elderly, counsellor must accept a client without conditions (unconditional positive regard). As an elderly they also wanted to share the problem. Counsellors also need empathy to understand the client's physical condition, especially declining hearing and vision. Counsellors need to be patient with the stubbornness of elderly clients and by using appropriate approach.” (Respondent 1: Line 53)

Empathy

• “We should empathy for the elderly emotionally and attitudes. In addition, we should have an understanding of the needs of the elderly.” (Respondent 1: Line 192) “Empathy was very-very important to understand their feeling.” (Respondent 1: Line 204)

CONCLUSION

• IMPLICATIONS

• LIMITATION

• SUGGESTIONS

• CONCLUSION

LIMITATION

Sample: 2 respondents. Data

cannot be generalized.

Both respondent are male. No opinion from

female perspective.

IMPLICATION & RECOMMENDATION

Implications and Recommendations for Future Research

• The focus of this study was to capture the stories of people who had been in counselling. Future research that captures the narratives of older adults who are unwilling to attend counselling may shed additional light on the perceptions and beliefs older adults hold about psychological counselling.

• As this study only addressed young counsellor and elderly client experiences, further research could explore the issue from elderly counsellor perspectives. For instance, in a follow up study, the counsellors of these participants could be interviewed to compare the narratives of the young counsellor, elderly client and older counsellor. The contrast and comparison could highlight important converging and diverging experiences of the young counsellor, elderly client and older counsellor that may shed light on ways to adjust the practices of counselling to better meet the needs of older clients.

• This study can be extended with a counsellor who has worked in public service who has run sessions with the elderly. In addition, this study also can be extended to the elderly who have never conducted a counselling session. This study also needs to be done with the female counsellors and older women to get more information.

IMPLICATION & RECOMMENDATION Implications and Recommendations for Practice and Training

• Overall, this study demonstrates that psychological counsellors can serve as advocates for older adults. Psychological counsellors can engage in advocacy to address unjust social conditions that are exacerbated by additional factors such as ageism, poverty, and classism amongst older adults.

• With a growing population of older adults, geropsychological training will need to be integrated into all counselling psychology training programs.

• Many training programs do not actively train psychological counsellors on conducting individual assessments using multiple sources, such as family and friends. Obtaining information from multiple perspectives may help psychological counsellors gain a fuller picture of the clients’ situations while also demonstrating a flexibility and willingness to give clients a voice in determining the course of their treatment.

CONCLUSION

• Counselling the elderly most often requires a holistic approach--consistent with lifestyle counselling

• Counsellors should treat older clients with respect: emphasizing their strengths, not weaknesses; developing independence while diminishing dependence and; encouraging decision making and action taking

• Counsellors who chose to work with the elderly population must have significant knowledge of their specific issues, experiences, and concerns.

• Counselling services with the elderly need to be introduced and highlighted in order to the elderly know that there are counselling services for them.

REFERENCE

• Gott, M. (2005). Sexuality, sexual health, and aging. Berkshire: Open University Press.

• Hinrichsen, G. A. (2006). Why multicultural issues matter for practitioners working with older adults. Professional Psychology: Research and Practice, 37, 29-35.

• Qualls, S. H., Segal, D. L., Norman, S., Niederehe, G., & Gallagher-Thompson, D. (2002). Psychologists in practice with older adults: Current patterns, sources of training, and need for continuining education. Professional Psychology: Research and Practice, 33, 435-442.

• Rainsford, C. (2002). Counselling older adults. Reviews in Clinical Gerontology, 12, 159-164.

• Ryan, E. B., & Butler, R. N. (1996). Communication, aging, and health: toward understanding health provider relationships with older clients. Health Communication, 8, 191-197.

• Schaie, K. W. (1993). Ageist language in psychological research. American Psychologist, 48, 49-51.

• Sue, D.W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790-821.

• Sue, D.W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790-821.

Q & A