NCE STUDY – Counseling Older Adults

(((I am currently studying for a licensure exam & completing an internship.  This blog post is intended as a study exercise.)))

QUESTION: “How can you develop sensitivity to culturally diverse older adults?”


The first idea that comes to mind, as a result of everything I’ve learned in this course, is the idea of working developing a working knowledge base. This means having a knowledge of various theories and as well as current research.   Admittedly this is not enough in and of itself. Nonetheless having a basis of knowledge to begin assessing and contextualizing client experiences can help provide essential insights to guide the counselor through the therapy process.


The second idea I’ve learned from this course is the idea of learning through direct contact within those communities we hope to serve within. Naturally, you can only so much about human beings, and relevant interpersonal skills through reading and study.


There is one final insight relevant to this question and it comes from two sources. The first insight comes from the following quote in our Hays textbook:

“Eclecticism in psychotherapy can take two general terms. The first involves an integration of diverse theories into one transtheoretical mode. The second, known as technical eclecticism, describes the increasingly common practice of systematically  choosing and using a wide range of interventions and procedures.” (Hays, 2008, p176-177)”

alongside this notion of being somewhat flexible and using a “doing-what-works” method there is another resource I found particularly helpful from my research for our paper assignment for the Latino community. In this research titled “Counseling a Hispanic/Latino Client – Mr. X” by Delgado-Romero (2001), there is an excellent example of case conceptualization. This paper did a good job of showing how using relevant knowledge alongside directly assessed information to form a basic conceptualization of the case. This would be useful as an ongoing hypothesis testing process in a “doing-what-work” approach.

QUESTION: “What are some unique issues faced by these older adults?”


As per our readings, initial obvious issues associated with this community include physical and cognitive decline, caregiver stress, grief and bereavement, and intergenerational stress (associated with variations in acculturation and familial culure gaps), (Hays & Iwasama, 2006).  When taking time to contextualize these developmental changes, I found it helpful to look at Erickson’s lifespan Development theory which discusses Ego Integrity vs. Despair. The key developmental issue at this age occurs as one “comes to terms with life’s successes, failures, and missed, missed opportunities and realizes the dignity of own life” (Broderick & Blewitt, 2010, p10). It must be noted in mentioning factors associated with aging, that it is important to note both positive elements associated with maturity, alongside the above factors.


In a resource titled, “Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults” is information on unique influences associated with one’s cohort, (Knight & Poon, 2008).Defined as a birth-year dependent group of individuals born within a 7 to 10 year period” (Knight & Poon, 2008), one’s cohort influences a variety of factors. In addition to the obvious influences of key historical events during one’s developmental years, other less obvious factors exist. For example, a person’s immediate sociohistorical context influences the cognitive abilities most relevantly adaptive to that environment. Additionally, differences along measures of personality are seen to coincide within different cohort groups. Influenced by sociocultural factors, and norms influencing behavior for example personality measures such as extraversion/interversion vary by cohort, (Knight & Poon.) Factors such as these influence the general maturation issues as they are experienced by the client.


Finally, culture also complicates the issue of understanding the general issues associated with the maturation process.   Variations in beliefs and norms, as well as views of illness and help seeking behaviors are obvious key factors, (Hays & Iwasama, 2006). When digging deeper, and understanding the influence of culture it is important to understand the clients experiences of acculturation and enculturation. The problem is further complicated by the need to contextualize this alongside the any potential intergenerational conflicts associated with familial cultural gaps.

QUESTION: “What does research suggest as effective techniques in working with older adults?”  

Our textbook makes a point to mention that while CBT is found to be effective within this community, certain adaptations need to be made. Firstly as per the previously mentioned insights it will be essential to adapt CBT to how older ethnic adults learn and recall information, (Hays & Iwasama, 2006). Secondly, taking time to build a rapport and carefully assess the client will require the case conceptualization / eclectic approach mentioned earlier, (Hays, 2008; Delgado-Romero, 2001). The most convenient example of this is in our assigned readings in which the counselor’s method of assessing affect, shifted in focus to account for generational and cultural differences.


Broderick, P.C. & Blewitt P. (2010). The Life Span: Human Development for Helping Professionals. 3rd Ed. New Jersey: Pearson.
Delgado-Romero, E.A. (2001). Counseling a Hispanic/Latino Client – Mr. X. Journal of Mental Health Counseling. 23(3). 207-221.
Hays, P. (2008). Addressing cultural complexities in practice. (2nd Ed.) Washington, D.C.:  American Psychological Association
Hays, P., & Iwasama, G.Y. (2006). Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, & Supervision. Washington, D.C.: American Psychological Association
Knight, B.G. & Poon, C.Y.M. (2008) Contextual Adult Life Span Theory for Adapting Psychotherapy with Older Adults Journal of Rational-Emotive Behavioral Therapy. 26:232–249


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