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|Case Study - Page 4|
By Terry Hargrave
As Robert Hill points out in this case study, people have a fair amount of anxiety and fear concerning memory loss. The fact that longevity is increasing in our society guarantees that memory deficits will increase as more and more of us have aging brains. There's little doubt that the prescription that Hill recommends here is on target in terms of being able to assess when a person simply needs to apply more skills and training toward the work of memory versus determining that there's a serious disease. Both assessment and training are essential in dealing with problems of memory, but my main question in this case is this: did Hill lose psychotherapeutic opportunities with Steve because of the psychoeducational process?
I have nothing against psychoeducation and memory improvement, but it seems to me that several psychotherapeutic issues are lost in this vignette. First and foremost, the primary issue that memory loss reminds us of is that we're making adjustments in response to conditions indicating that we're headed toward the end of life. We can't work ourselves out of dying or the anxiety and fear that death signals.
I'm absolutely for positive aging, and there are important and positive ways to engage these fears so as to move an older population toward being generative and connecting in relationships. The way our society and psychotherapy deal with aging is often to try and make sure that we can keep people functioning in middle age. While this is sometimes appropriate, it is also necessary to deal with the real therapeutic questions of aging and memory loss when Steve might not be able to combat the effects of his aging. Helping Steve reckon with those questions would help him in his aging adjustment if he isn't so lucky as to be able to work another 10 years.
My second point centers on Hill's statement that, if Steve had had indications of a serious disease such as Alzheimer's, he'd have suggested referral for in-depth assessment. No doubt this is needed, but serious therapeutic work is called for too, as Steve would have to face the grief and loss of a terminal disease, along with the turmoil of anticipating the loss of a sense of self and recollections and connections with others. Therapeutic work with Steve and his family would go far in easing his emotional pain, guiding the role and care structure for the family and making the most of the memory that remains. We can do much more with these families than simply to refer or train.
Finally, I'd suggest that there's a need to prepare Steve's family for an eventual care-giving role for him. Aging brings on losses, and memory loss is a signal that Steve and the family must start asking questions about care. The fear that compels him to explore his memory loss is the same fear that may keep him quiet on the subject of his eventual needs. Loss signals opportunities for these discussions, and I believe Hill would have done well to use the opportunity to begin this discussion. Steve likely won't require care until he's in his 80s, but talking about and settling these issues is much easier now, when he's 72, than when he's in immediate need of it.
Terry Hargrave has highlighted an important issue that faces all older adults: the phenomenology of irretrievable loss. Although this wasn't the focus of the case, I agree with his assertion that psychotherapy is an excellent arena in which to address this concern.
Because Steve had been a pastor for many years, he'd dealt with issues of irretrievable loss among members of his parish, including the death of family members, the disabilities brought on by chronic disease, and even profound memory deprivation resulting from Alzheimer's. Therefore, his difficulty in accepting his own losses as a consequence of age-related decline was part of our therapy, although it wasn't presented in the case.