Cultural Aspects of Aging and Psychotherapy, Essay Example

The caregiver I interviewed was an experienced professional, a man who rose through the ranks to become supervisor of an institution for elderly care, including end-of-life care. A warm, compassionate man, Mr. Joseph (pseudonym), said he always wanted to work in a field where he could help others. In part because of his own family background and upbringing, which involved a very close extended family, in college Mr. Joseph finally determined that he would become a caregiver. He has been in the field for twenty-five years, and says that he has never regretted his decision to work with the elderly, including those facing end-of-life issues. His answers to my questions were both informative, and full of a great deal of practical wisdom.

A good career development theory that describes Mr. Joseph’s career path is the Theory of Work Adjustment (TWA), which is quite solidly rooted in the tradition of psychology emphasizing individual differences (Dawis, 2005, p. 4). This tradition emphasizes the variability of individual psychological temperament: how people differ from each other in endless, unique ways that cannot be entirely captured by upbringing or environment (p. 4). In other words, the TWA is a trait theory, one that emphasizes innate characteristics, such as Mr. Joseph’s amiable, personable disposition. Indeed, I base this in no small part on the fact that when I asked him about how he was as a boy, Mr. Joseph explained that he was, on balance, a rather kind-hearted and nurturing lad. He explained that he’s always loved people, and although this was doubtless influenced by his environment too, he gave me the impression of being someone with precisely the right kind of traits to be a caregiver. The TWA is also a person-environment fit (P-E fit) theory, as well as a P-E interaction theory (p. 4). Following this model, Mr. Joseph was just the right kind of person to be molded by his family environment, and to interact with his family environment in such a way, that he was an ideal and quite logical candidate for work with the elderly as a caregiver (p. 4).

I asked Mr. Joseph about how he takes into account age, culture, family structure, and the like. Here, he gave me a number of answers. First of all, he explained that he tries to spend time with his patients and their family members, and observe how they interact. This allows him to learn a lot just by watching and listening. Secondly, he tries to ask tactful questions about family beliefs, practices, arrangements and the like, in order to try to elicit feedback from clients and family members about what they would like. He said that he’s learned different cultures have different styles of communication, and for some cultures direct communication is not necessarily preferred. He used the terms “high context” and “low context” to describe how cultures prefer to communicate, terms he said come from anthropology and the social sciences: people in “high context” cultures rely not so much on the actual words that are said, but rather more on the subtext. He gave examples such as tone, body language, and the outright implications of words: simply put, in some cultures, what is actually said may only be a small part of the actual communication. On the other hand, people in “low-context” cultures, such as ‘mainstream’ Americans, are more direct, and rely much more on what is actually said. Through diligent and patient observation, and some important friendships with people of other cultures, Mr. Joseph has learned a great deal about how to communicate cross-culturally.

Mr. Joseph said that there are a lot of challenges associated with working with individuals in these stages of life. He explained that not all elderly folks face the end of their lives with dignity and grace. “You need to realize,” he told me, “that not everyone turns into a wise and kindly grandfatherly or grandmotherly figure. Different people have lived different lives, and it shows.” He said that although most of his patients are wonderful people in their own right, he has had no insignificant number who were bitter, unpleasant, or depressed, or presenting some combination of these and other dispositions. Others are fine people, but they are in a lot of pain, and/or are coping with tremendous personal losses, and this is always difficult to see. According to him, this is simply part of the territory: working with the elderly is not always fun or wonderful.

On the other hand, he was very clear that overall, it is a very rewarding line of work. The majority of his patients, he explained, are perfectly decent people, and some of them are absolute saints. He said he’s found that some people seem to reach a watershed in the aging process where they accept how they’ve lived their life, including the mistakes as well as the triumphs, the grief and the pain that they have experienced as well as the joy, and it’s actually a rather inspiring thing to see. And although he cautioned against stereotyping, he said that many of them are indeed very wise and insightful people: they’ve seen more and done more than most of the population, and Mr. Joseph said he finds a lot of the concerns of modern consumerist culture to be very shallow as a result of the perspective he’s gained working with the elderly.

Mr. Joseph said he uses a combination process of observing behavior and looking for actual physical signs of abuse to detect any incidents of elder abuse. Abusers and victims, he explained, tend to show certain predictable behaviors, and the characteristics of a bruise can tell one a great deal. All in all, Mr. Joseph’s responses were very insightful, and he helped me to realize the importance of finding a line of work one is passionate about. “There’s no feeling more wonderful, than to realize you’re helping people,” he said. For me, it was a significant tie-in for my own line of work, since I really have a heart for helping married couples and families.

In my family, caring for the elderly has been a bit of a tricky proposition. My grandparents on my father’s side took care of themselves until very near the end, when they finally assented to an assisted-living arrangement. On my mother’s side, my grandparents are still going strong, and they’ve made it very clear that they are fiercely independent, so I foresee some significant battles in the next five to ten years. When my father’s parents died (within a year of each other), there was some grieving, but on the whole it was rather

There are plenty of cultural differences in caring for elders and dealing with death. Cultures differ profoundly in their attitudes about aging, especially with the influence of modernity: for example, a study in a Columbian peasant village found that although the elderly are not accorded prestige, they are still integrated fully into the working of family and community (Dein & Huline-Dickens, 1997, p. 114). By contrast, in Britain, becoming an elder usually involves retirement, and caring for the elderly is increasingly seen as a burden (p. 114). Cultural factors profoundly impact the degree to which caregivers cope with caring for the elderly: for example, Roth, Haley, Owen, Clay, and Goode (2001) found that African-American caregivers did better than Euro-American caregivers in caring for patients with dementia, consistent with previous research that African-American families are particularly capable of coping with caring for family members who have dementia (pp. 428-431).

Still, general themes in cross-cultural caring for the elderly include having to find ways to incorporate the elderly into society in a way that takes account of their frailty; the process of making arrangements for the disposition of any property (which may occur before or after death), and then funerary and mourning practices. By understanding cross-cultural patterns with regards to caring for the elderly and dealing with end-of-life issues, I will be much better prepared to serve clients of diverse cultural backgrounds. This will facilitate the degree to which I can help people, no matter their cultural background, resolve their issues and go on to live happier, healthier, and generally more fulfilling lives.

References

Dawis, R. V. (2005). The Minnesota theory of work adjustment. In S. D. Brown & R. W. Lent (Eds.), Career development and counseling: Putting theory and research to work (pp. 3-23). Hoboken, NJ: John Wiley & Sons.

Dein, S., & Huline-Dickens, S. (1997). Cultural aspects of aging and psychotherapy. Aging & Mental Health, 1(2), pp. 112-120. Retrieved from http://search.ebscohost.com/

Roth, D. L., Haley, W. E., Owen, J. E., Clay, O. J., & Goode, K. T. (2001). Latent growth models of the longitudinal effects of dementia caregiving: A comparison of African-American and White family caregivers. Psychology and Aging, 16(3), pp. 427-436. DOI: 10.1037/0882-7974.16.3.427