In my many years of clinical work with the elderly, I have come to appreciate that loss is often a major therapeutic issue for many of the residents I work with. I now believe that working with residents’ experience of loss is required to achieve a deep level of healing.
Reflection reveals that while loss is ubiquitous in our lives, in the prime of our adulthood we generally have options with which to mitigate loss. Losing a job can lead to another; the death of a spouse, while traumatic, can be softened by other social opportunities. We can adjust to each unexpected loss by the new options life may present.
With age and infirmity, however, options dwindle, and the effects of loss can be chronic, permanent and deeply troubling.
I view my role in the psychotherapy of the elderly as one of helping them move from an outlook of hopelessness to one of growth and promise. While I cannot change the fact of aging, with its attendant need for greater assistance, or assure the physically disabled a quick resolution of their medical condition, I can help them realize that losses contain the possibility of positive development. They contain within them unexpected opportunity for growth that is capable of mitigating a patient’s despair.
Recognizing opportunity
It was early in my work with patients that I noticed how positive events can arise out of loss. Moreover, these events would not (perhaps could not) have materialized had the patient’s “unfortunate situation” not occurred.
For example, inpatient rehabilitation patient Mrs. S was convinced that her life had been characterized by depression, loneliness and isolation. As I worked with her, though, it became apparent that she had lived a life of self-deprivation, resulting in low self-esteem and an inability to believe she was entitled to anything good. Staff reported that she received many visitors, so I decided to show her some objective evidence.
Together we realized that she had received six visitors during the prior three weeks — neighbors and friends from church. She seemed surprised but could not deny that there were people in her life who cared about her. She agreed with me that she would never have realized how many caring friends she had were she not in need of inpatient physical rehab.
Mrs. S and I spent part of one session talking about the spiritual significance of this realization. Associating her injury and rehabilitation with a possible religious or spiritual significance strengthened her awareness of being looked after.
More often than not, patients and residents have positive re-alignments of their relationships with family and friends that are uniquely facilitated within the context of “loss.” I have come to think of these situations as “blessings in disguise” for many of my residents.
Similarly, Ms. G. had been admitted for rehabilitation following hip replacement and was noted to be quite anxious and not fully committed to her physical therapy. In my work with her, she acknowledged feeling anxious and impatient with the constraints of the rehab setting. Her dependence on a wheelchair further exacerbated her impatience.
Discovering that she was deeply spiritual, I asked her to consider whether there might be some larger meaning for her in her situation, or whether some important teaching was being made available to her. I suggested that since her impatience had been a life-long trait that often placed her in emotionally problematic situations, being in a rehabilitation setting might provide just the right opportunity for her to learn patience and experience greater emotional comfort.
Eventually, Ms. G. came to believe that her injury and treatment were a “gift,” as well as a trial — and she embraced the opportunity to use her situation to improve her patience. Our sessions focused on techniques to help her better manage her impatience, and the work was both more successful and more satisfying because it now came from her own motivation to improve herself. Needless to say, both she and the staff on the unit, as well as her commitment to rehab, benefited from her new understanding.
New perspective
Loss is a defining characteristic of long-term care. Residents have lost their home, their health status and important aspects of their psychosocial world, such as community, hobbies and pets. And yet, long-term care units are full of residents who become involved in deeply connected friendships with fellow residents; who cherish the mutually caring relationships they form with their CNAs and other staff members; whose relationships with their families and significant others actually blossom now that they are freed from the burdens of daily housekeeping and financial concerns; and who focus their attention on new projects or “unfinished business” that they never had time to attend to in the community.
A “blessing in disguise” is a belief that is both spiritually and logically compelling. In our culture, we often hear spiritually-oriented statements such as “it was meant to be,” or “when one door closes, another opens.” Such beliefs are commonplace and express, I think often unconsciously, the wish to believe in a spiritual or higher-level process serving our needs. These beliefs, as a basis for new-found optimism and hopefulness, are a potent force in the healing process, and I cannot over emphasize the therapeutic value of exploring, and bringing into focus, each patient’s spiritual belief system as it relates to his or her ongoing psychotherapeutic process and the birthing of a new, more positive outlook.
Sam Kupietz, Ph.D., is a clinical psychologist with TeamHealth.
