The Ethical Challenges of Working with Older Adults

The Ethical Challenges of Working with Older Adults

She has presented her marriage as happy and stable. Second, Mrs. Jones decided not to sign releases of information for her children, because they worry enough about me and this would just make it worse.Her son learned about her therapy from the family physician, who reported to the son that Mrs. Jones memory problems and depression seemed to be decreasing. When faced with this turn of events, you must remain focused on your client. You do not have access to Mrs. Jones son, as much as he would like to be helpful. In addition, you now have important therapeutic information that must be sensitively addressed with your client. Honesty within the therapy demands that you let her know what has happened and work with her to reach a plan of action.

Limits of Confidentiality

When told about her sons call, Mrs. Jones states that her husband had been an active alcoholic for most of their marriage. During that time, he was physically abusive. His eventual failing health led to his sobriety, and they spent the last 10 years of their lives together in a peaceful and relatively happy relationship. Mrs. Jones also reveals that her youngest son, who lives next door, is also an alcoholic and sometimes becomes so angry that he hits her. An essential aspect of ethically sound gerontological practice is having a thorough understanding of elder abuse. It is possible that some of the depression and cognitive problems observed in Mrs. Jones could be attributed to the abuse she has been experiencing. The shame associated with being abused by their children leads many adults to keep the violence hidden, but the stress and trauma are often exhibited indirectly. It is your responsibility to know the laws in your state regarding the limits of confidentiality and the reporting requirements for suspected elder abuse. This information should be shared with your clients when treatment begins, so they have the power to decide when and how to share this information with you.

In Closing

The best way to avoid ethical problems in psychotherapy with any population is antecedent control. Recognizing the limits of your training, participating in continuing education, making sure you have safety nets in place to assist your practice, and staying in touch with colleagues are all important safeguards against ethical violations. As Christian therapists, we have made a commitment to be Gods instruments of healing in a broken world. This demands not only that we practice with the highest ethical standards of our profession, but that we constantly remain open to the work that God can do through us. Knowledgeable, well-trained, and self-aware clinicians who know their values, strengths, and limits are going to be best equipped to meet this higher standard of care.

Susan L. Lichtman, Ph.D., is in private practice in Bangor, Maine. Dr. Lichtman provides psychotherapy to adults with emphases in gerontology and coping with chronic illnesses such as HIV disease and cancer.

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