educational programs
MENTAL ILLNESS AND AGING:
DIFFICULT BEHAVIORS THAT CHALLENGE PROFESSIONALS
January 24, 2008, 8:30 AM to 4:30 PM
Patients/clients who exhibit “difficult” behaviors often do not get the mental health care they need. Substance abuse, denial, personality and anxiety disorders, acting-out, risk-taking behaviors often render the patient/client unable to fully utilize mental health services and can leave clinicians feeling frustrated about how to help. This program will bring together leaders in the field of geriatric mental health to discuss how to work with patients/clients who present in more challenging ways. In addition to offering a deeper understanding of the internal world of these patients/clients, presenters will discuss how the clinician’s feelings and reactions to these behaviors (countertransference) also contribute to difficulties in treatment. Attendees will learn about how and why patients/clients use challenging behaviors to manage their feelings, what these behaviors may tell us about the patient’s/client’s needs, and how clinicians can manage their own feelings while working with these patients/clients.
MORNING PLENARY SESSION, 8:30 AM TO NOON
Moderator: Tessa ten Tusscher, PhD, Vice President, Clinical
Services, Institute on Aging
Working With the Difficult, Resistant Older
Client and Suicide Ideation in Older Adults
Older adults
resist our well intentioned efforts to help them through a variety of
methods. They may resist our attempts to correct or alter their behavior
through anger or aggressive behavior. They may fear being stereotyped,
misinterpreted, over-intellectualized, or controlled by the professional
helper. This fear or anger may manifest in suicidal ideation or crisis.
Our challenge is to integrate best practice approaches into our compassionate
and caring responses.
— Patrick Arbore, EdD, Director,
Center for Elderly Suicide Prevention and Grief-Related Services, Institute
on Aging
What Makes the Difficult Client so Difficult?
Difficult clients are those who evoke in us a sense of helplessness,
hopelessness, inadequacy and rage; all the feelings they are feeling.
Core concepts of the “difficult personality” will be introduced,
as will the frequently occurring events in older age that are likely to
exaggerate clinical symptoms, especially anxiety and depression.
—
Erlene Rosowsky, PsyD, Assistant Clinical Professor of
Psychology, Department of Psychiatry, Harvard Medical School
Out of Your Mind? Memory and Mood Disorders
in Older Adults
Is it possible to influence our mind
and mood as we age? Are memory loss and depression unavoidable with living
long? This presentation will address these important questions, and look
at recent advances in maintaining brain fitness.
— Moira
Fordyce, MD, Clinical Professor of Medicine, Stanford University
School of Medicine
Alcohol and Drug Problems in Older Adults
Alcohol and drug abuse among older adults is a problem of increasing
concern to health service providers. Yet relatively little is known about
the extent of alcohol and drug abuse or its effective treatment in older
populations. This presentation will examine what we know about the prevalence
of alcohol and drug abuse among older adults, factors affecting changes
in alcohol and drug use as people get older, and outcomes of older adults
in chemical dependency treatment.
— Derek Satre,
PhD, Assistant Adjunct Professor, Department of Psychiatry, University
of California San Francisco; Adjunct Investigator, Kaiser Permanente Division
of Research
LUNCHEON ROUNDTABLES, NOON TO 1:00 PM
AFTERNOON WORKSHOPS, 1:15 TO 2:45 PM
** Working With the Difficult, Angry, Older
Adult
Working with difficult older adults can add a great deal of pressure to
professional helpers. When difficult people experience stressful situations,
they often act out their feelings through anger and aggressive behaviors.
Pushing, hitting, cursing, manipulating, biting, and screaming are just
some of the ways in which difficult people vent their distress. According
to Greenspan (2003) an inability to express and experience grief, fear
and despair in a healthy manner can lead to depression, anxiety, addiction,
irrational violence, and psychic numbing. In this workshop we will examine
the causes of difficult behavior in older adults. We will also explore
ways in which the professional helper can cope effectively with someone
who is “acting out.”
— Patrick Arbore, EdD, Director,
Center for Elderly Suicide Prevention and Grief-Related Services, Institute
on Aging
** Personality Disorders in Older Adults: Diagnosis
and Treatment
This workshop will explore personality disorders in older adults and the
difficulties they present for diagnosis and treatment. Research findings
will be discussed, as will the affects of aging and how they might be
anticipated to respond to challenges in older age. A conceptual model
will be presented offering a way to understand these most difficult clients
and which can inform the selection among treatment options.
— Erlene Rosowsky, PsyD,
Assistant Clinical Professor of Psychology, Department of Psychiatry,
Harvard Medical School
** Addressing Addictive Behaviors in Older Adults:
New Research Developments and Innovations
Alcohol and drug abuse among older adults can be especially challenging
for providers to manage. Similarly, addressing nicotine dependence among
patients who have been smoking for many years can seem like a daunting
task. Fortunately, it is never too late to treat these problems—in
fact, substance abuse treatment outcomes in older adults are often better
than those of younger adults. In this workshop, the presenters will discuss
clinical strategies for reducing harmful substance use among older adults.
The presenters will review findings from recent outcome studies, and share
suggestions for working with patients.
— Derek
Satre, PhD, Assistant Adjunct Professor, Department of Psychiatry,
University of California San Francisco; Adjunct Investigator, Kaiser Permanente
Division of Research; and Eva M. Schmitt, MSW, PhD, Associate
Director, Program Evaluations, Institute on Aging Research Center
** Releasing the Dragon: Helping Elders Express
Their Feelings Metaphorically Using the Expressive Arts
Behavioral problems with elders are often a symptom of underlying anger,
frustration, fear and anxiety that they are looking for a way to express.
Constant requests to stop, curtail and repress this energy often increase
the anger, rather than making it go away. The dragon grows taller. In
this workshop, the presenter will share creative ways to invite the emotion
to be expressed, metaphorically and energetically, providing a positive
way to release pent up feelings.
— Nina “Anin” Utigaard, MFT, REAT, Clinical
Director, Pacific Institute; Founding Executive Co-Chair, International
Expressive Arts Therapy Association
AFTERNOON WORKSHOPS, 3:00 TO 4:30 PM
** Anxiety Disorders in Older Adults
This workshop will present an overview of what is known about anxiety
disorders in older adults. Special considerations, such as medical conditions,
medications, and late life existential issues as they contribute to anxiety
will be discussed. Treatments, as well as barriers to treatment, will
be addressed.
— Erlene Rosowsky, PsyD, Assistant Clinical Professor
of Psychology, Department of Psychiatry, Harvard Medical School
** Dangerous Behavior: Assessment, Intervention
and Treatment of Suicide Ideation in Older Adults
Older adults have the highest rates of suicide of any age population.
Depression, alcohol abuse, dependence, isolation, chronic physical illness,
anxiety and bereavement are significant suicide risk factors. One of the
most difficult challenges that professional helpers and families face
with older adults is chronic suicidal ideation. The goal of a suicide
assessment is not to predict suicide, but to place a person along a risk
continuum, to appreciate the bases for the suicidality, and to allow for
a more informed intervention (Jacobs, Brewer and Klein-Benheim, 1999).
How to respond to a suicidal crisis is a common problem. The professional
helper can feel anxious upon hearing about a person’s suicidal intent
and communication can be blocked. Suicidal people are very sensitive to
the underlying feelings of the helper. Countertransference issues will
be explored.
— Patrick
Arbore, EdD, Director, Center for Elderly Suicide Prevention
and Grief-Related Services, Institute on Aging
** Helping Families Cope With Mental Illness
When adult children have to make plans for the care of an elderly parent
with a history of mental illness, the decision-making process is much
harder. Problems of protectiveness, alienation, triangulation and over-responsibility
all play a role. In this workshop, we will look at the dynamics involved
and things to keep in mind in working with caregivers under these circumstances.
— Donna Schempp, LCSW, Program Director, Family
Caregiver Alliance
** Delirious, Demented, Depressed? How to Tell
the Difference and What to Do About It
This session will describe symptoms and signs of delirium (acute confusion),
dementia (chronic confusion) and depression (one of the most under-diagnosed
conditions in older adults). The differences, similarities and overlaps
among these conditions, as well as the difficulties in diagnosis and management
will be explored. Features of "masked" depression will be presented
and depression and apathy in the demented patient will be explored.
— Moira
Fordyce, MD, Clinical Professor of Medicine, Stanford University
School of Medicine
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