Psychology in a Case of an Elderly Experiencing Depression - Essay Example

The study focuses on the field of psychology as a science that deals with social care. The study tackles the application of theoretical perspectives of psychology in a case of an elderly experiencing depression. It then focuses on the Psychodynamic approach, as a method of counseling in assisting the elderly coping with adjustments in life and experiencing depression. The study expounds on the different elements of the psychoanalysis theory, and the method in which sessions are executed in a psychodynamic approach of counsel. It concludes with the concept of psychotherapy, with its significance during a person’s recovery state- to achieve optimal health and well being. Introduction Suicide and depression are considered as the most considerable concerns that home health clinicians handle in terms of caring for the elderly, most especially those that are homebound (Taylor, Peplau & Sears 2006, p. 342). Frank is an 85 year old male individual who used to serve the army. He is now retired and he had been assessed to be at risk for depression and suicide as caused by his wife’s recent passing. The case study presents how Frank’s suicide tendencies had been reduced through proper counseling, by the utilization of the Psychodynamic approach. Major depression is one of the factors that lead to suicide, regardless of age or gender. The age of the elderly ranging from 65 and older account for 18% of suicide rates. In most cases, the progression of depression is overlooked, thus it is left untreated among the geriatrics (Taylor 2006, p.29). The following are considered the most common factors that lead to suicide: previous history of depression or depressive disorder; past suicide attempts; fear of death; bereavement; polypharmacy; illnesses; experiencing severe pain; substance abuse; and isolation (Gross 2005, p. 108). Healthcare clinicians or providers must strictly be coherent with the manifestation of sign and symptoms pertaining to depression among older adults (Smith, Nolen-Hoeksema & Frederickson 2003, p. 63). There are various tools that can be utilized to evaluate an individual’s state of depression, such as the screening tool in the form of a Patient Health Questionnaire-2, an assessment tool or the Patient Health Questionnaire-9, or simply making use of the Geriatric Depression Scale (Swann and Seyle 2005, p.164). Case Study Frank is an 85 year old male war veteran who had been admitted in a Home Based Primary Care in September of 2009. He lives in Ohio, solely with his Labrador retriever who had been under his care for 10 years. Frank and his wife moved to Ohio from Florida, after retiring from serving the army for almost 25 years. Their reason for moving was that Frank’s wife was in need of medical attention due to her chronic condition. His wife suffered from Alzheimer’s disease. Though Frank wanted to help his wife recover, he had a difficult time adjusting and coping with the fact that his wife must now be taken care of in a nursing home. Frank was severely affected by his wife’s condition. He used to cry during visits when his wife could no longer recognize him. It pained him at instances when his wife thinks of him as another person, instead of her husband. He became depressed over the fact that he vowed never to put his wife in a nursing home, but he was left with no choice. He was bearing guilt in his heart the whole time his wife was under therapy at the nursing home. He wanted the best for his wife, but she required more care than he can provide. After a month of being placed at the nursing home, Frank’s wife died. When Frank’s wife passed away, he had set up a memorial in his apartment by decorating a table with two artificially lighted candles beside his wife’s picture. He also placed his wife’s possessions on her side of the bed, which he never dared touch. Frank and his wife never had children; they only had the dog with them. He had no one to lean on while mourning as he was the only one alive out of 3 siblings. The only support he can turn to was his niece and her family, who had recently moved. When his niece used to live nearby, she would visit Frank and his wife and help them with their needs. Upon moving to another home, she was no longer able to offer the level of monitoring and assistance she used to provide. With the death of his wife and the moving of his niece, Frank felt alone. Frank was tended to by an HBPC care team that comprises of a registered nurse, who serves as the primary care provider, a social worker, a registered dietician and an occupational therapist. They visit Frank regularly to provide care he needs. After several months of therapy, the social worker advised the RN that she had found out that Frank is attempting to commit suicide on Christmas Eve. The social worker also advised the care team that Frank would deny his suicidal tendencies because he has a gun in his possession. Thus implying that upon his confession, the police would be notified and he would be admitted involuntarily for precautionary measures. Frank had also manifested signs that led the care team to presume that he had decided on killing himself on Christmas. The followings signs are as follows: bereavement caused by deceased wife; living alone with no immediate family to turn to; depression due to grieving and the holiday season; substance abuse; presence of chronic pain due to hematuria; and polypharmacy. In addition, having access to lethal means of suicide such as armaments or a huge stock of medication increase the chances of suicide completion. Since Frank lives by himself, there is a small chance that he would be found and resuscitated upon attempting to end his life. Franks was initially screened by his supervising RN the following questions to validate his state of depression. The questions are dependent on how Frank has felt during the previous two weeks if he had felt depressed or he is no longer interested with his usual activities. The result of Frank’s PHQ-2 core was three, which indicated a positive screen for depression. The health care team then decided to process a counseling session to help Frank through his dilemma. The key aspects of the counseling sessions aimed to reduce Frank’s depression and to protect him from suicide. The counsel therapy included the premise of religious beliefs of prohibiting suicide, and to promote life satisfaction and a sense of responsibility to others. The positive therapeutic relationship aims to strengthen social support. Through counsel, Frank was asked to agree not to harm himself. The Importance of Psychology in Social Care Personnel whose career focus on care and counsel interact with people as necessitated in their line of work. The key goal in effective care and counsel professions is to promote and encourage good health and well-being (Latane 1981, p.351). They abide by the common definition of health in promoting the core value of having representing a state of complete mental, physical and social wellbeing. Health does not only imply of a person not having any kinds of diseases or infirmity (Gross 2005, p. 112). There are various ways in which psychological theories can benefit developments in the health and social care setting. One of which is it could help health care workers to value the variation between peoples’ understandings and needs in order to be able to guarantee that the individual care offered is optimal and most fitting (Aronson, Timothy, Wilson, & Akert 2004, p. 52). It is also helpful in providing better insights regarding the process of communication in determining means of developing the correlation between therapy and work, with the aid of inter-agency and inter-professional perspective. It also aids in determining factors that can affect how people handle and manage circumstances involving chronic and severe illness, pain and loss, as well as the anxieties encountered in life (Lacan 1977, p. 96). Health and social care workers can help those individuals in coping and reducing the potential risk of acquiring illnesses related to stress. It also assists in providing information pertaining to a person's influence towards one's lifestyle and certain motivations regarding health related behaviours. In addition, the application of evidence-based interventions in developing the health and well being of people, in helping them modify their lifestyles (Semin & Smith 2002, p. 386). This concept had been developed through the context of the biopsychosocial health model that focuses on the composite interface between a person’s physiological system to one’s biological aspects, psychological processes, as well as other factors that affects a person’s life development such as one’ social and cultural background (Brehm, Kassin, & Fein 2005, p. 264). Psychodynamic psychology Patients in need of counsel are aided in retrieving the memories in order to resolve the inhibited thoughts to release difficulties or traumatic memories. This type of approach therapy also has its concerns, wherein other psychologists believe it brings about false memories (Glass 2008, p. 1588). A patient undergoes a case study, which is considered as an in-depth analysis of an individual. A subject's life and history is assessed and analyzed in order to identify patterns and causes for the individual's behaviour. The premise of this approach is that by careful examination of one case, it can be applied in a general context. On the contrary, such cases are highly subjective, thus the difficulty in identifying such patterns in a larger population (Bishop & Lane 2003, p. 10). There are certain factors that affect an individual's pattern in a psychodynamic approach. An individual's conscious mind encompasses a person's awareness, which involves an individual's capacity of mental processing through thinking and talking. Human beings have developed an innate ability to protect their egos against anxiety, which is referred to as a defense mechanism (Glass 2008, Eysenck and Keane 2005, p. 8). This process is supposed to protect the mind from emotions and thoughts that are difficult for the conscious mind to adapt and deal with. This factor usually involves a person's capability to block or set aside unwanted thoughts from entering the conscious mind. An individual's unconscious realm is the venue in which feelings, urges, thoughts and memories reside, independent of the conscious awareness (Gable and Haidt 2005, p. 105). Factors that are contained in a person's unconscious mind are mostly unpleasant, which usually delves on negative emotions such as pain and anxiety (Starcevic 2003, p. 280). The concept of psychodynamic psychology implies that the unconscious influences an individual's behaviour and experiences (Antaki, Barnes & Leduar 2005, p. 629). Psychotherapy is the process of interaction between a health care worker and a patient in order to produce changes that range from a less adaptive to a more adaptive state of the patient's thoughts, emotions and behaviours. It is a process of counseling that stresses on helping an individual solves problems (Barwick 2008, p. 246). Method of Psychodynamic Psychotherapy The method of the psychodynamic approach is processed through an individual's weekly consultations with a health care worker, wherein the patient is necessitated to communicate everything one perceives and thinks of, without hesitation (Antaki et al 2005, p. 632). Those who or ­emotionally unstable or in need of more attention could have sessions twice or thrice a week. This process involves both participants to sit facing each other. This mode of communication is referred to as free association. The health care worker utilizes the technique of talking as opposed to the psychoanalysis process of silence, in order to encourage the patient to communicate freely. The treatment is strongly interactive and involves two individuals, who emphasize the motivation of unconscious actions and interpretation of dreams. The sessions may last from 1 to 12 for brief psychotherapy treatment, and 20 sessions to years if needed (Hoffer & Youngren 2005, p. 1489). Interventions Treatment for the elderly who manifest suicidal tendencies is best dealt with an interdisciplinary approach aimed at decreasing risk factors and increasing protective factors. The health care team then decided to increase the frequency of home visits. Through the psychodynamic approach, they have opened a more positive relationship with Frank through daily counsel in order to observe and monitor his behavior. Along with the counsel therapy, the RN kept Frank busy in decorating and planning the group’s small dinner for Christmas. He was also given an assignment, to be in charge of the punch bowl. Apart from that, a volunteer from the facility was also asked to bond and spend time with Frank daily. The volunteer wasn’t with Frank the whole time, but he visits on a daily basis so that Frank can have someone to talk to. They maintained a good and trusting relationship and they bond quite frequently. The RN also made it a point to monitor Frank’s vital signs and to address his pain issues. He was assisted with proper compliance in taking medications, including proper intake of antidepressants. The occupational therapist did his duty at Frank’s home in order to maintain safe evaluation. He also ensured that Frank would be provided the necessary equipment he needs. On the other hand, the social worker met with Frank in order to assist him with his financial concerns and to contact family members. Frank also went through nutritional counseling with the dietitian so that his weight and nutritional intake is properly monitored. As part of Frank’s therapy, he was asked to make a verbal contract with his healthcare group that he would not harm himself as long as his dog was still alive. Frank saw no harm in the deal and he cared for his dog, which is why he agreed. Frank also went through bereavement counseling with an inpatient hospice, where he was able to share and relieve his emotions and frustrations, including his guilt for putting his wife in a nursing home. The therapy session was processed in a personal setting, as Frank was hard of hearing and he won’t be able to connect to the person he’s talking to through a phone call. During therapy, he was also advised and encouraged abstinence from alcohol. When Christmas was fast approaching, Frank continued to manifest symptoms of depression, but he was strictly monitored by the health care staff. By the first week of December, Frank had surrendered three loaded guns from his apartments and handed it over to his RN, saying that he no longer trusts himself with the guns around. This was an improvement in Frank’s mood and mental state. The Key Aspect of Psychological Change Guidance can only be achieved wholly if the person seeking it would be willing to cooperate. Another individual can provide assistance, but progress can only be measured if the patient requiring it would help himself as well. The first step of the process is to acknowledge and understand the present symptoms, as achieved by the context of awareness. Behavioural change cannot be processed through awareness alone. In order to bring about psychological change, an individual must be accountable for the inhibited thoughts, in order to feel the need to act upon it (Barwick 2008, p. 246). Case Analysis A case about geriatrics encompasses social care through a psychodynamic approach, as supported by Erik Erikson's Stages of Development Theory. Erikson believed that culture has a considerable influence on one's behaviour, and one's development is highly determined by the interaction of an individual's body, mind and cultural influences (Sneed, Whitbourne & Culang 2006, p. 151). His theory had categorized a person's life into eight stages, from birth upon death. The premise of Erikson's theory is simple: the world grows larger as we grow, and failure is cumulative. The latter insinuates that individuals who have gone through complicated and unpleasant experiences during the initial stages of life would be unable to manage later stages as compared to those who have gone through the earlier stages smoothly (Scibilia et al 2009, p. 406). A child who has not been attended to at a young age would have difficulty in establishing human contact as he grows. The last stage of Erikson's theory is referred to as Late Adulthood, which ranges from age 55 to a person's mortality. The ego development outcome on this stage focuses on integrity versus despair, in which the basic strength learned is wisdom. The concept behind this stage is that individuals go through life in preparation of the middle adulthood stage, wherein the last stage's purpose is to recover (Sneed, Whitbourne & Culang 2006, p. 156). This implies that as people grow old, they have a tendency to look back and reflect on their lives with the feeling of happiness and contentment. The feeling of fulfillment takes place as an individual reflects the deep sense of the meaning in one's life and how they have lived their purpose. Erikson calls this sense of elation as integrity (Leventhal, Weinman, Elaine & Leventhal 2008, p. 451). A person's strength is derived from wisdom upon knowing that the world is vast, slowly detaching themselves from the concern in which has troubled them their entire life, thus learning to accept death and the culmination and the completion of their lives (Scibilia, Mcnulty, Baxter, Miller, Dine & Frese 2009, p. 411). On the contrary, there are adults who have reached the last stage in despair, due to their past experiences and failures. They do not feel the sense of enlightenment nor elation, as they perceive death as they aren't ready for the final culmination. They fear that time is catching up on them and they have yet to fulfill, or even find their purpose in life (Scibilia et al 2009, p. 414). Traditional psychotherapeutic interventions that can be utilized in dealing with geriatrics is through supportive psychotherapy that involves a group session and a family therapy. One method is through insight oriented psychotherapy, which can help decrease a specific symptom in older individuals (Kaplan & Sadock 2008, p. 1540). This type of therapy is advisable for those who have an inclination towards narcissistic gratification, as such notions tend to backfire in cases of depression where an individual realizes that his life had been a series of failure and since he is already in the last stage of life, he no longer has the chance to redeem himself (Marks, Murray, Evans, Willig, Woodall & Sykes 2006, p. 56). Counsel approaches usually focus on common age-related issues regarding the elderly's need to adapt to recurrent and diverse losses, such as death of loved ones. It also encompasses their inability to adapt well to new roles they must adjust to, such as transitioning to retirement or being incapable of performing tasks they used to do. The most important counseling subject is the acceptance of mortality (Kaplan & Sadock 2008, p. 1549). Conclusion Through the Psychodynamic approach, Frank was able to connect and adjust well with his therapy. He survived the Christmas season, even Valentine’s Day. He still manifested symptoms of depression but he was able to manage it through the efforts of his health care group. In spite of continuous treatment, Frank suffered from frequent hematuria and developed chronic abdominal pain. The progress of his illness was evident, as he got weaker. As his disease advanced, he became more depressed, but he was able to shun suicidal thoughts. 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Taylor, SE, Peplau, LA & Sears, DO, 2006, Social psychology (12th edn). Pearson Prentice-Hall, Upper Saddle River, NJ, pp. 341-345. Read More