In an article written for the Journal of Counseling & Development in 2006, titled “Baby Boomers Mature and Gerontological Counseling Comes of Age,” Mary Maples and Paul Abney suggested that professional counseling would become more complex as the baby boomers continued to age. They said that the increasing number of older adults would create a greater need for professional counselors who possessed the expertise and skills to work with that population, and particularly those older adults who reside in nursing homes or long-term care facilities.
I have had the pleasure and privilege of working with members of this population as a counselor for more than a year. My venture at the nursing facility began as part of a requirement in my doctoral program to choose a specialty area in which to practice counseling. I have always had an affinity for older students as a teacher, and this afforded me the opportunity to work with older adults in this phase of my profession. After a few weeks of individual and group counseling with the geriatric patients, I knew that my specialty had found me.
As I made my rounds through the hallways and entered into patient rooms at their request, several counseling interventions emerged that I was able to use effectively with individual patients. The interventions, which I am developing as an integrated model of “personal activities” for counseling adults in nursing homes, were equally effective with groups. These techniques provide clinical flexibility and may be used for clients’ general wellness or to address specific problems such as dementia, depression or problems associated with terminal illness.
Music Matters allows me to use my passion as a gospel singer to reach out to the residents and engage them in song. Life Journey helps clients to open up and review the paths they have traveled through life. Story Time increases client concentration, communication and well-being in a group reading activity.
I started singing during my adolescent years. I always listened to my mother singing with her beautiful high-pitched voice, and she let me sing along at an early age. My voice was a combination of soprano, alto and tenor. Little did I know that I would need all of those pitches to delight my clients and make a difference at the nursing facility.
I had been working with the elderly residents for several weeks and was enjoying every visit, every client, every interaction, but none so much as when I started singing with them. Carrying music in my toolbox allows me to use my gift as a gospel singer to reach out to clients, touch their memories and engage them with musical selections.
It started with me singing a few songs to clients who seemed depressed. This evolved into a “sing-along with Georgia” activity and ended with me singing with them rather than to them. Now, whenever I visit the nursing facility, the residents ask me to sing, whether it is during a group session or individually with a client who just needs to hear a melody.
Although I am a gospel singer, song selections can range from “Amazing Grace” to “Old MacDonald Had a Farm.” One resident loves to sing “R-E-S-P-E-C-T” right along with me, and afterward, she tells me what a great singer she was in her day. This opens the door to conversations within the group and leads to more meaningful interactive communication among the residents.
Thus, this activity is much more than just singing for fun. After every song, we pause to reminisce and discuss the thoughts that a particular song brings to mind. Clients who fail to respond at any other time will start moving their lips, clapping their hands or tapping their feet to the tune. One of the clients will sometimes ask to lead a song and I, along with the other residents, will sing backup, taking everybody back to another place and time.
Singing together often opens the door to discuss contemporary issues that may be of concern to the residents such as money, health or family problems. After singing “Amazing Grace,” one of the residents wanted to talk about loved ones she had lost, which in turn revealed her concern about her own health and thoughts of death. The other members of the group entered the conversation, demonstrating that there is a calming and healing power in knowing others share your concerns.
Before we know it, the time for the group is up, and the clients are asking, “When will you come again?” During time, regardless of their ills or ailments, they experience a period of rejuvenation and, often, peace.
Sometimes the help given to a resident is provided on an individual basis. When you are asked to talk to an individual in a nursing home, the approach has to be respectful and carefully planned because you will be entering into an older person’s home. Even though it is a nursing facility, for the resident, it is home. Almost all of the residents have a huge array of pictures. Sometimes these photos are hanging on the wall or sitting on the dresser; other times, they are gathering dust in a drawer.
The activity starts with my entering a room respectfully and thanking the client for allowing me to come into his or her home. I then talk about the weather outside, the program on TV or some other insignificant observation. While standing there, I ask about one of the pictures, such as, “Who is this pretty little girl?” or “Tell me about this handsome gentleman.” That is all it takes for the journey to begin.
During our session, clients are encouraged to share the story behind their pictures. The clients start by identifying the individuals in each picture and telling stories about them. The clients are often surprised at the things they remember. They may start laughing or crying as they share their story. They are sometimes sad and, occasionally, they get mad. Even though the process is sometimes painful, it allows me to grasp an additional piece of the client’s life and to gain insight without appearing to pry or be “nosy.”
With those clients who don’t have pictures in their room, the Life Journey technique can still be engaged in through guided conversation and without calling attention to the lack of photographs. I ask these clients to tell me about their childhood, family members or hobbies, looking for something they would like to share that might start a conversation.
It is often surprising how much conversation and enjoyment are generated as the older adult takes a stroll down memory lane and tells bits and pieces of his or her life story. During the conversation, the counselor is gently guiding the journey, listening attentively and searching for those nuggets of information that can be used to benefit the client and add to his or her quality of life. Nuggets of information shared in the life journey, such as abuse, trauma, fear of dying, loneliness and feelings of neglect, are golden because they help the counselor to process the event with the client and gain information about issues that may be troubling. Once the client shares this information — without feeling pressured or intimidated — the counselor-client relationship begins. The counselor can then embark on the journey with the client, letting the individual know that he or she is not alone.
Another technique that is beneficial is a group reading activity that I call Story Time. Many of the residents had fulfilling lives and successful careers prior to entering the nursing home. They were members of community and church organizations and attended various retreats and events. Story Time is a good way to bring a group together and encourage conversation among residents who don’t always interact with one another or have a lot to say.
The counselor must read clearly, with emotion and with volume, to ensure that everyone can hear and understand the story. Many of the clients may at one time have been enthusiastic readers, belonged to book clubs or had magazine subscriptions that were abandoned when they had to leave their homes and enter the nursing home. Much of this information can be elicited during the conversations. Many of the residents are delighted to come to a book reading at which they may be served tea and cookies, listen to a short story or article, and then spend time talking about what that story means.
The selection of a book should be based on the members of the group and their collective interests. The book should invoke thought pictures that encourage the residents to tap into and then talk about their memories. Articles from favorite magazines are also good for bringing back memories, in part because they provide a visual aid. Asking the residents for suggestions about reading material has garnered enlightening information and led to unique reading selections.
Each reading is followed by a discussion of the chosen book or article. I have been most successful with stories that featured a distinct beginning, middle and ending. The answers to the questions or the thoughts to be explored should be projected throughout the reading so that most of the group will understand and be able to answer the questions. A major benefit of Story Time is that it connects the residents socially and emotionally. It allows them to participate in an activity that encourages good conversation and brings back pleasant memories.
Music Matters, Life Journey and Story Time are effective integrated intervention techniques that I have developed in working with geriatric patients, especially those who reside in nursing homes. I have found the techniques to be positive interactive tools that engage the clients, involve the families and open up lines of communication in the therapeutic process.
Georgia A. Ellis is a licensed professional clinical counselor and the regional enrollment director at Lindsey Wilson College in Kentucky. She is also in the doctoral program at Argosy University in Nashville, Tennessee. Contact her at firstname.lastname@example.org.