Marie Jones is a 73-year-old woman who lost her husband last year after nearly 50 years of marriage. Her complaints are memory problems, lack of appetite and low energy. Mrs. Jones told her doctor that her children think she should move to a retirement community, but she is hesitant to leave her home. If Ms. Jones or someone like her was referred to her practice, would he be prepared to treat her? If you’re like many other providers in the support community, the answer is most likely no. As the 20th century draws to a close, American society is graying. Life expectancy has increased dramatically over the past 75 years, and the number of spray-willing seniors in the community is steadily increasing. Stressors associated with aging, such as environmental changes, retirement, loss of partners, and coping with illness, are issues that could be addressed in psychotherapy. However, very few graduate programs offer training opportunities in clinical gerontology.

Even when training is available, ageism may lead some therapists to assume that emotional growth and change among older people is limited and therefore not worth pursuing professionally. Countertransference, often based on personal fears of aging or family problems with parents/grandparents, can also turn people away from treating older people. Whether the reasons are personal or professional, treating older adults when you’re ready leaves the door open to ethical dilemmas and potential malpractice.

*before work begins*

Psychotherapy is an intensive exploration of personal values. Understanding your own value system and how it impacts your work is the cornerstone of ethical practice. Your beliefs drive the counseling process, even in the least directive therapies. As Christians, it is easy to underestimate the importance of values ​​clarification. Loving God, loving our neighbor as ourselves, and believing in the healing power of Christ are values ​​that seem evident within the Christian counseling community. But there is tremendous diversity within the Body of Christ, as we will have many different interpretations of health, healing, pathology, and change.

Assessing and articulating your values ​​in the field of gerontology will involve prayerfully considering difficult questions. For example, what are your beliefs regarding the end of life? If your client wanted to die while interrupting painful medical treatment, how would you decide what to do? Would your decision be different if your client was 65 or 85? Would your behavior put you in conflict with accepted community standards of practice or state laws and regulations? Values ​​guide us, and they guide our clients. Once you have taken the time to identify your values ​​about the aging process and about older people, you can better see how the thesis will affect your work. Being aware, being clear, and being open respects both the therapy process and the individual client. It also helps you steer clear of many ethics-related pitfalls.

*Common Ethical Dilemmas in Gerontology*

Ms Jones has now been referred for advice by her family doctor. He is concerned about her memory problems and wants a second opinion. He also thinks that Mrs. Jones is isolated and could benefit from talking to someone about the relatively recent loss of her spouse. Are you the right reference? Even with the limited information we have on Ms. Jones, there are many clues that may guide her mental health treatment. Her complaints may indicate the onset of dementia, but they may also suggest other problems, such as depression, uncomplicated grief, health problems, or even elder abuse. Psychological evaluation, individual therapy, and family therapy may be appropriate parts of her treatment plan. As a provider, you must first assess her own level of training and experience. Just as you would not think of treating children without proper training, the same standard applies to gerontology practice. If you feel you don’t have the right training, you’ll need to tap into old-fashioned resources like supervision, continuing education, and consultation to help you in your work. The most ethical decision may be to refer this client to a colleague and take the time you need to develop her skills.

*Consent for Treatment*

Many older adults are not familiar with the process, demands, and expectations of psychotherapy. Although the senior community is rapidly becoming more psychologically sophisticated, there are many seniors who believe that counseling is only for really crazy people. They may be more comfortable with a traditional doctor/patient relationship and may not know what to expect from a therapist or from therapy itself. Once you have decided that you have the skills to treat Ms. Jones, you should be fully informed about the therapy process, including her therapeutic style, fees and billing practices, confidentiality, and the risks and benefits of treatment. . She may need additional information about possible recommendations, such as psychological testing, grief groups, or a medication consultation. Once Ms. Jones receives the information she needs to understand her work with her, then she will be better equipped to provide informed content. If you have any doubts about her competence to consent, further evaluation will be necessary before you begin to treat Ms. Jones. This is important for ethically sound therapy delivery and for clients’ own safety. If Ms. Jones doesn’t seem to understand the therapy contract, she may have issues outside of the therapy room that need to be addressed quickly. Memory loss or decreased functioning do not equate to incompetence, but may serve as red flags for a comprehensive evaluation.

*Release of information*

You’ve been meeting with Mrs. Jones for about two months when her son comes to visit from out of state. He is very impressed with the improvements he sees in her mother’s mood and self-care, but continues to wonder if her mother should move into a care facility. He also believes that some of her mother’s problems relate to the physical abuse she endured for most of her married life. She calls you and leaves you this information and asks you to call her back without telling her mother that she has been in contact. This phone message presents many problems for you. First, Ms. Jones has yet to mention that her husband was abusive. She has presented her marriage as happy and stable. Second, Mrs. Jones chose not to sign releases for her children, because they care enough about me that this would only make things worse. Her son learned of her therapy from the family doctor, who informed the son that Ms. Jones’s memory problems and depression seemed to be abating. Faced with this turn of events, she must remain focused on her client. You don’t have access to Mrs. Jones Jr., much as she’d like to be helpful. Also, you now have important therapeutic information that needs to be discussed delicately with your client. Honesty in therapy requires that you let her know what has happened and work with her to come up with a plan of action.

*Limits of Confidentiality*

When told about her son’s call, Mrs. Jones claims that her husband had been an active alcoholic for most of their marriage. During that time, he was physically abusive. The eventual decline in his 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 to her, is also an alcoholic and sometimes gets 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 Ms. Jones could be attributed to the abuse she has been experiencing. The shame associated with her child’s abuse leads many adults to keep the violence hidden, but stress and trauma are often on display indirectly. It is her responsibility to know the laws in her state regarding the limits of confidentiality and the requirements for reporting 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. Online Christian counseling is a good way to get suggestions.

*In conclusion*

The best way to avoid ethical problems in psychotherapy with any population is a background check. Recognizing the limits of your training, participating in continuing education, making sure you have safety nets to help your practice, and staying in touch with your colleagues are all important safeguards against ethical violations. As Christian therapists, we are committed to being God’s healing instruments in a broken world. This requires not only that we practice to the highest ethical standards of our profession, but that we remain constantly open to the work that God can do through us. Well-informed, trained, and self-aware physicians who know your values, strengths, and limits will be better equipped to meet this higher standard of care.