The Delicate Balance Case Studies in Counseling and Care Management for Older Adults Edited by Berit Ingersoll-Dayton, Ph.D., and Ruth Campbell, M.S.W.

Excerpted from the Preface for The Delicate Balance: Case Studies in Counseling and Care Management for Older Adults by Berit Ingersoll-Dayton and Ruth Campbell.

Copyright © 2001 by Health Professions Press, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Preface

The case examples in this book augment the theoretical coursework of students and the clinical experience of gerontological practitioners. The illustrations include men and women from different ethnic groups across a variety of therapeutic settings and important therapeutic issues such as the blurring of roles (e.g., from professional helper to surrogate family member) that occurs when working with clients over a long period of time, how sensitive and confidential matters are handled when working with older people in the context of their families and formal systems, and how one respects older clients’ strengths and their reluctance to engage in therapy.

The chapters represent the experiences of different practitioners, so the voices of many applied gerontologists are heard; however, a common set of analytic threads runs throughout the book. In each chapter, the author or authors provide a summary of their intervention and then analyze the therapeutic process using a set analytic framework. Each case is analyzed with respect to six themes:

1. Demonstration of respect for the client
2. Use of the client’s strengths
3. Blurred boundaries 
4. Changes in the therapeutic relationship over time
5. Benefits and difficulties of the therapeutic relationship for the client and therapist
6. Words of wisdom

The development of a therapeutic relationship over time is a complex process that necessitates growth on the part of the therapist as well as the client. In this book, we are fortunate to hear directly from practitioners about the ways in which they dealt with their own frustrations and the ways in which, in retrospect, they would approach the relationship differently. We have deliberately chosen cases that represented significant challenges to the practitioners involved. In these cases, readers learn how the practitioners creatively tried to address these challenges, often using multiple interventions. Sometimes the outcomes of the therapy are mixed. The chapters illustrate the great variety in individual responses to therapeutic interventions. Some older clients grow, thrive, and make positive changes in their lives despite significant physical  and psychological problems; others make few changes but maintain stability through professional support; and still others do not seem to benefit from these interventions. We thought it important to show the variety of responses that most gerontological practitioners are likely to experience.

Although the case examples are based on actual cases, we have been respectful of the clients’ confidentiality by making case illustrations a composite of several cases and/or by changing any identifying information. As they were preparing their chapters, the contributors were provided with guidelines for disguising case material that included changing names, locations, physical problems, and other identifying information.

The Delicate Balance is organized in relation to three levels of intervention used with older clients: working with individuals and couples, working with groups, and working with families and systems. After highlighting the importance of the six themes in Chapter 1, attention turns to the three levels of intervention. Chapters 2–6 illustrate individual and marital therapy as well as care management with older clients. Some of the interventions are conducted in home settings whereas others take place in the office. Chapters 7–10 discuss different kinds of group therapy including a cognitive therapy group, an exploring the meaning of life group, a writing group, and an intergenerational memory group. Chapters 11–14 illustrate therapy and care management with family members of the older clients and other larger systems. These systems include work with professionals in other agencies on behalf of older clients in the community. At the end of each intervention chapter, a brief review is included of additional resources that provide information on theory, research, and practice for individuals who are interested in pursuing the chapter’s issues in greater depth. Chapter 15 draws upon the six themes to provide suggestions for negotiating the delicate balance between counseling and care management with older adults.