It often feels like an uphill battle to be attending graduate school, working, sifting through large amounts of data about practicum (and then internship) placements, and weighing options all at the same time. As a graduate counseling student, there are recurrent moments of panic and thoughts of What am I going to do? Where should I apply? and the unavoidable, multifaceted What if … ?
As someone who has advised graduate students, supervised future counselors throughout their clinical training process, and practiced for over a decade myself, I try to break this process down into questions such as: What do you hope to achieve? What interests you? What type of work do you see yourself doing when you graduate? These questions illicit responses that span from the specific (e.g., “I want to work with kids who are struggling with an addiction”) to the more general (e.g., “I want to get experience doing actual therapy”).
Many clinical training directors will tell you that what we less frequently hear is counseling students who say they want experience working with older adults. When I suggest that this is a growing field with extremely diverse opportunities — from setting (hospital, community, private) to format (individual, family, group) — what I often get in return is a perplexed look, a head shake, and a facial expression that seems to suggest anxiety. This is accompanied by a statement to the effect of, “I’m just not comfortable counseling an old person. What could I possibly say to them that they haven’t already heard?”
Uncertain about the uncertainty
The reasons behind this uncertainty are not simple. First of all, what does being an “old person” or “geriatric” even mean? Society most often measures these constructs in terms of years. According to the World Health Organization, the beginning of “old age” typically hovers somewhere between 60 to 65 years old, coinciding with average retirement age in many cultures. But even this age range is slowly shifting upward as we live longer and healthier lives. According to the U.S. Census Bureau, in 2017, 15.6% of the U.S. population was 65 or older. By 2030, this number is estimated to grow to 25% of the population. The Stanford Center on Longevity estimates that 10,000 Americans turn 60 every day.
Given the many opportunities to enhance their clinical skills with such a large and diverse population, how can we understand the hesitation that counseling graduate students may show toward working in organizations that aim to provide services to those over 65? Is the hesitation connected to an internal fear of the unknown — growing older themselves or thinking about loved ones aging and not being ready to face those prospects? Or does it involve assumptions made about people based on age? In speaking with students and fellow counseling supervisors, I think it has to do with a combination of those two reasons.
We all get nervous about working with unknowns, of course. Applied to this situation, the origins of this uneasiness seem obvious: Graduate students have all experienced being children before, but few of them have experienced being old. When a shared reference point is not available, assumptions are all too often generated from stereotypes. The same holds true with words such as “old,” “geriatric” and “elderly.” The problem is that the almost automatic images associated with these descriptors — and with presumptions about fragility, sickness, and resistance to change — are not appropriately reflective of older adults in general.
Given the inevitability of aging and the astounding need for more counselors with geriatric training and experience, I often wonder what we can do to challenge such inhibitions and encourage more students to pursue opportunities to work with older adults.
It is vital to this discussion to debunk age-related myths. This involves challenging the veracity of automatic links and images that students may generate related to the mental and physical well-being of aging adults.
One way to accomplish this is by discussing the basic statistical concept that the variability of differences within a group is much greater than the variability between groups. Said another way, it is more likely that a graduate counseling student will have more in common with an older person than it is for a group of older adults to have a lot in common with each other. This concept should already be a learning objective that is core to any multicultural counseling class. Ensuring that graduate counseling classes that focus on matters of diversity also include exploration of what aging does and does not mean could go a long way toward breaking down uncertainty that is based in incorrect automatic images and assumptions rather than in reality.
Scientific and technological breakthroughs mean that what once seemed to be inevitable byproducts of the aging process are no longer homogeneously applicable. Here are two examples of myths with associated reality checks:
Myth: Old people are fragile and are probably ill.
Reality: Some diseases, infections and conditions that were not understood or treatable 50 years ago are now completely preventable or treatable at any age. The National Institute on Aging states that the average age of onset of many chronic illnesses (for example, arthritis and heart disease) has increased incrementally by 10 years over the past 80 years. This means that people are staying healthier for longer and have freer will to control environmental factors that can facilitate good health.
Myth: Old people are set in their ways and don’t want to change.
Reality: Personality characteristics usually remain stable over time. Someone who was generally resistant to change over the course of his or her life is likely to remain resistant to change. However, the converse is also true: Someone who generally welcomed change over the course of his or her life is likely to continue to welcome change.
Normalizing the fear of the unknown, identifying experiences that may affect this, challenging the rationality of assumptions around aging, and having frank discussions about the universality of “experience” are all pivotal to encouraging graduate students to work with an aging population.
By “universality,” we are not just referring to the inevitability that, with luck, we will all get older. Rather, it refers to the reality that we are all subject to similar challenges and emotions that can arise at any point in our lives. For example, relationship difficulties, depression, anxiety, trauma, illness and loss are life challenges that a 5-, 25- or 75-year-old can face. Therefore, a 5-, 25- or 75-year-old could benefit from treatment.
Erik Erikson recognized this lifelong process of continuous development, growth and reflection through the “integrity versus despair” stage in his theory of psychosocial development. According to Erikson, around age 65, individuals begin to profoundly reflect on the meaning in their life thus far. Someone who is able to find this meaning and look back on life with few regrets moves toward integrity. If, on the other hand, individuals feel they have wasted their time and are full of regret, they will be more prone to despair. Meeting the developmental needs of older adults as they negotiate this critical phase elucidates a common clinical issue that both current and future counselors will always face: perception of meaning in life.
We want our counselors-in-training to mature in their reflective capacity skills and to strive to understand internal variables that they may bring into sessions. By the time they are in the classroom with us, most graduate students have had the experience of seeing loved ones age, and those who have not could be anxious about the certain reality of having this experience at some point in the future. This gives counselor educators and supervisors the opportunity to explore with students how their reactions to these inevitable realities are collective in nature and how they are shared by many people, regardless of age. A counselor-in-training with good reflective capacity can harness the associated emotions and funnel them into an invaluable therapeutic tool: empathy.
Recommendations and tips
As mentioned earlier, the diverse options for working with older adults better enables us to match student interests with appropriate placements. I had a student who was interested in getting clinical experience with family therapy and older adults in hospital settings. The student was able to find a placement in a hospital working with families in which one of its members had been newly diagnosed with Alzheimer’s disease. Another student had strong interest in getting experience working with addictions. The student was able to find a placement at a methadone clinic and was assigned a good caseload of older clients who were in recovery. My point is to communicate to students that the variety of placements available for working with older adults mirrors the diversity of today’s older adult population.
The passage of time inevitably brings change and, with that, different challenges and fluctuations. As counselor educators and supervisors of future practitioners, it is our responsibility to challenge and prepare graduate students to tackle these issues. Whether it’s a student seeking guidance or a person seeking counseling, assisting in increasing their reflective capacity, adaptation or coping with these challenges and changes is core to what we do as educators and practitioners. Regardless of how old the person sitting in our office or classroom is, engaged learning can happen in countless forms, as can growth through stepping out of one’s comfort zone.
Neha Pandit is an assistant professor at Robert Morris University, working mainly in the master’s counseling psychology program. She also has more than 15 years of clinical experience and is currently working at a practice in Wexford, Pennsylvania. Contact her at email@example.com.
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