In Older Couples, Dr. Paula Hartman-Stein demonstrates her approach to conducting therapy with couples in their later years. Working with older couples involves many issues not common in therapy with younger people, including issues surrounding illness, cognitive impairment, and physical decline, all of which generally cause some stress in marital relationships. Hartman-Stein's approach is to teach couples better ways to cope with the challenges of aging with the resources they have available.
In this session, Dr. Hartman-Stein works with a couple in their early 60s who have become entrenched in negative patterns of interaction. After performing an assessment, she builds rapport with the couple and begins the work of instilling hope.
The basic theoretical approach used in this video is cognitive–behavioral. The goals of therapy are to enhance the couples' functioning together as partners and to increase their overall quality of life. Improving methods of conflict resolution and problem solving within the marital context are also important.
Clients who describe themselves or their spouses as withdrawing from conversation, usual physical activities, or social events are often appropriate clients for this approach. Couples in long-term marriages who consider their relationship as frequently in conflict or who are unable to satisfactorily cope with age-related changes or life circumstances can also benefit from this approach.
Key Concepts
The therapy strives to enhance coping strategies that require adaptation, such as coping with illness, retirement, cognitive changes, caregiving responsibilities toward the spouse, decreased energy, and changes in friendships and family relationships. The behavioral component of the therapy emphasizes increasing overall activity level if there has been
- withdrawal of one or both spouses from general engagement with life
- a decrease of the frequency of pleasant events that the couple enjoys together to offset life hassles
The cognitive component emphasizes changing pessimistic viewpoints to more positive yet realistic appraisals of life circumstances and changes that accompany the later years.
Additional Tools
Dr. Hartman-Stein often uses the Geriatric Depression Scale (Yesavage et al., 1983) as a screening instrument for depression, the Mini-Mental State Exam (Folstein, Folstein, & McHugh, 1975) as a screening tool for cognitive impairment, and the Behavioral Competence Inventory (Hartman-Stein & Reuter, 1996) if functional ability in one of the partners has declined.
Suggested Outcomes
Possible positive outcomes may include an increase in engagement with life activities, improvement in the perception of the quality of the relationship and communication and problem-solving strategies between partners, and remission of depressive symptoms in one or both marital partners.
Paula Hartman-Stein, PhD, is founder of the Center for Healthy Aging, a behavioral health care practice in Kent, Ohio. She received her PhD from Kent State University and additional training through the Geriatric Clinician Development program at Case Western Reserve University. She has a national reputation for excellence as a clinical psychologist, consultant, and public speaker specializing in aging issues.
Her major research interest is in measuring the functional behaviors of older adults at risk for dementia from the perspective of the caregiver.
She is a senior fellow at the Institute for Life-Span Development and Gerontology at the University of Akron and adjunct associate professor in the Department of Psychology at Kent State University. She also is the director of geriatric psychology for Summa Health System in Akron, Ohio.
As of 2004, she was named a fellow in Division 12 of the American Psychological Association (APA) as well as distinguished practitioner by the National Academy of Practice in Psychology. She is past president of APA's Division 12, Section 2, Clinical Geropsychology.
Her work regarding assessment and therapy for older adults has been featured in numerous publications, including her edited book Innovative Behavioral Health Care for Older Adults: A Guidebook for Changing Times. She is also a regular columnist for the newspaper The National Psychologist.
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