Parenting Our Elderly Parents
In Parenting Our Elderly Parents, Dr. Patricia J. Pitta demonstrates her approach to working with clients who are in the position of caretaker for their aging parents. Therapy with these clients is challenging, as it involves the family system, parental relationships, changing power dynamics between parents and children, and coping with cognitive and physical decline in loved ones.
Goals in this type of therapy include helping to realign power in relationships, identifying and resolving intergenerational conflicts, and helping caregivers to get support for themselves.
In this session, Dr. Pitta helps a man who is taking care of his elderly mother to set boundaries, cope with his mother's decline, and to seek out resources for support.
Before working with a family, it is essential to understand how the family functions in terms of its overall anxiety levels, levels of differentiation, degree of emotional cut-offs, fusion, intergenerational family processes of relating, and areas of conflict. These processes occurring between younger and older family members are building blocks to ensure healthy and balanced attachments. Information about family functions can be attained through the interview process by the creation of a genogram.
It is important to identify types of adult children that are caregivers (overresponsible, distant, warring for the gold). It is also important to note the types of elderly people (cooperative and independent, cooperative and dependent, uncooperative and unnecessarily dependent, uncooperative, significantly organically compromised and cooperative, significantly organically compromised and uncooperative).
Once the therapist has evaluated the system and the functioning of the individuals within the system (as explained in the preceding paragraphs), it is imperative for both the adult caregiver and the elderly parent or relative to work on the following:
- identifying intergenerational roles and conflict
- redefining responsibilities
- identifying and realigning power
- identifying defenses that contribute to misperceptions about family roles and individual responsibilities and members' actions
- enabling members of the family to feel together so they can grieve, mourn, and heal while taking care of individual responsibilities
- negotiating toxic issues
- re-parenting the caregivers; empowering them to nurture selves and draw boundaries
- de-triangulating the caregiver from dysfunctional system
- identifying relationship options and help for caregivers and elderly people
- rejoining siblings
- rejoining caregivers and elderly in a more functional manner
Goals and Techniques for Therapists
The primary goal in this approach is to support and enable the caregiver to have the most responsible role possible toward the elderly person. The caregiver must work toward maintaining a quality of life and relationship and monitoring his or her own amount of stress and pressure, enabling the caregiver to have or maintain a healthy quality of life.
Some techniques to free the overresponsible caretakers are
- to bring in distant siblings
- to allow the overresponsible caregiver to take a more appropriate role with the older adults
- to look for other relatives to make relationship options for them
- to get outside help and assistance
- to allow yourself to mourn
- to celebrate what you have now with the elderly person that is positive and what you had in the past, tell each other stories that you both enjoy about your lives together, and ask advice and gather the wisdom
In This Video
It becomes apparent in the video that the adult son who is experiencing many transitions in life (loss of marriage, loss of daughters, loss of marital home, living with elderly mother, and being assigned as caretaker) is under a great deal of stress. It is fortunate that he has a girlfriend who is supportive to his many losses, jobs, and stresses.
It is essential in this session to enable the adult son to realize that he needs
- to set realistic boundaries between himself and his mother
- to more realistically face his mother's failings both physically and emotionally
- to get help for himself emotionally (his needs to be able to grieve; work on guilt, worry, and the function that each serves; getting in touch with his power and dealing with mother's manipulation), and to learn practical and emotional skills of care taking (e.g., group—which he appeared to be in agreement)
- to enable him to start thinking about self-nurturing (e.g., private time, exercise, relaxation skills)
The adult son (caregiver) should be able to set realistic goals for himself and his mother, detoxify the guilt he feels around the commitment to mother, set boundaries, and grieve the loss of his marriage—particularly with his daughters who will energize him so that he can try to develop a new relationship with them. It is important that he give himself enough mental and physical space so that there will be time to nurture the new relationship with his girlfriend while being productive at work.
Patricia J. Pitta, PhD, ABPP, received her doctorate from Fordham University in New York. She is currently an adjunct professor at St. John's University and in private practice in Manhasset, New York. Dr. Pitta developed the theory of integrative healing family therapy as applied to children, adolescents, couples, and families dealing with issues throughout the life cycle.
She is a diplomate of the Board of Family Psychology, a fellow of the Board of the Academy of Family Psychology, past president of the Academy of Family Psychology, and past president of the Long Island Association of Marriage and Family Therapy. Dr. Pitta is author and coauthor of numerous articles, books, and other publications and also gives professional presentations and interviews for television, magazines, and newspapers.
- Armstrong, M. J., & Goldstein, K. S. (1990). Friendship support patterns of older American women. Journal of Aging Studies, 4, 391–404.
- Belsky, J. (l997). Growing old in families. In I. Deitch & C. Howell (Eds.), Counseling the aging and their families: The family psychology and counseling series. Alexandria, VA: American Counseling Association.
- Berman, R., & Shulman, B. (2001). How to survive your aging parents. Chicago: Surrey Books.
- Brok, A. (l997). Parent and adult child: Unresolved issues of individuation. In I. Deitch & C. Howell (Eds.), Counseling the aging and their families: The family psychology and counseling series. Alexandria, VA: American Counseling Association.
- Chisholm, J. (l999). Sandwich generation. Journal of Social Distress and the Homeless, 8 (3), 177–191.
- Deitch, I. (l997). When golden pond it tainted: Domestic violence and the elderly. In I. Deitch & C. Howell (Eds.), Counseling the aging and their families: The family psychology and counseling series. Alexandria, VA: American Counseling Association.
- Doka, K. (l997). The effects of parental illness and loss on adult children. In I. Deitch & C. Howell (Eds.), Counseling the aging and their families: The family psychology and counseling series. Alexandria, VA: American Counseling Association.
- George, L., & Gwyther, L. (l986). Caregiver well-being a multidimensional examination of family caregivers of demented adults. The Gerontologist, 26, 253–265.
- Goldstein, M. (l990). The role of mutual support groups and family therapy for caregivers of demented elderly. Journal of Geriatric Psychiatry, 23 (2), 117–128.
- Hamon, R., & Blieszner, R. (l990). Filial responsibility expectations among adult child-older parent pairs. Journal of Gerontology, 45, 110–112.
- Pitta, P. (l996, Summer). Psychodynamic and systemic integration theory: Application to the individual. Psychotherapy Bulletin, 31(3).
- Pitta, P. (l996, Fall). Marital therapy: A search for the self and each other-a systemic psychodynamic integrated approach. Psychotherapy Bulletin, 31 (4). (American Psychological Association, Division 29 newsletter)
- Pitta, P. (l996, Summer). Family therapy treatment issues: Family therapy integration. Independent Practitioner, 6 (3). (American Psychological Association, Division 42 newsletter)
- Pitta, P. (l996, Fall/Winter). Psychodynamic-systemic integration in family therapy. Family matters. (New York: Association of Marriage and Family Therapy newsletter)
- Pitta, P. (l997, Winter). Marital therapy. A systemic psychodynamic integrated approach: A case study. Psychotherapy Bulletin, 32 (1). (American Psychological Association, Division 29 newsletter)
- Pitta, P. (l999). Marital therapy. Practice information clearinghouse of knowledge. Washington, DC: American Psychological Association, Division 42.
- Pitta, P. (2002, Summer). Integrative healing family therapy: A therapy of choice for the adolescent centered family. Family Psychologist, 18 (3). (American Psychological Association, Division 43 newsletter)
- Troll, L. E. (l994). Family connectedness of old women: Attachments in later life. In B. F. Turner & L. E. Troll (Eds.), Women growing older (pp. 141–169). Thousand Oaks, CA: Sage.
- Assisted Living Decisions in Psychotherapy
- Family Therapy With Patients Having Physical Health Problems
Susan H. McDaniel
- Individual Therapy From a Family Systems Perspective
Florence W. Kaslow
- Interpersonal Psychotherapy for Older Adults With Depression
Gregory A. Hinrichsen
- Treating Alzheimer's Disease Through Caregiver Family Therapy
Sara Honn Qualls
- Casebook for Integrating Family Therapy: An Ecosystemic Approach
Edited by Susan H. McDaniel, Don-David Lusterman, and Carol L. Philpot
- Clinical Geropsychology
Edited by Inger Hilde Nordhus, Gary R. VandenBos, Stig Berg, and Pia Fromholt
- Emerging Issues in Mental Health and Aging
Edited by Margaret Gatz
- Interpersonal Psychotherapy for Depressed Older Adults
Gregory A. Hinrichsen and Kathleen F. Clougherty
- Integrating Family Therapy: Handbook of Family Psychology and Systems Theory
Edited by Richard H. Mikesell, Don-David Lusterman, and Susan H. McDaniel
- A Guide to Psychotherapy and Aging: Effective Clinical Interventions in a Life-Stage Context
Edited by Steven H. Zarit and Bob G. Knight
- Mental Health Services for Older Adults: Implications for Training and Practice in Geropsychology
Edited by Bob G. Knight, Linda Teri, Paul Wohlford, and John Santos
- Psychology and the Aging Revolution: How We Adapt to Longer Life
Edited by Sara Honn Qualls and Norman Abeles