Mental Wellness in Aging Strengths-Based Apporaches Edited by Judah L. Ronch, Ph.D., and Joseph Goldfield, M.S.W.

Excerpted from the Introduction for Mental Wellness in Aging: Strengths-Based Approaches, by Judah L. Ronch and Joseph A. Goldfield.

Copyright © 2003 by Health Professions Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

Introduction

We use the term “mental wellness” to reflect our belief that health and illness are not dichotomously arranged in nature or in life and because people can, at times, in collaboration with knowledgeable helpers, move along the continuum toward optimal wellness at each stage of life by dint of their own efforts. People have more options than to be sick or healthy; they do not have to be sick in order to take advantage of the means to improve wellness. This is an especially important outlook for aging as a process — people can have an array of illnesses as they age and yet enjoy wellness and a good quality of life.

We also think that the old Cartesian mind-body separation is fading from view and that a growing body of evidence in the scientific and lay literatures is correct when it indicates that somato-psychic and psychic-somatic phenomena are mutually influencing and “influenceable.” Damasio’s (1999) writing on the neurological basis of the unity of mind and body, and the postmodern view of illness and the central role of individual experiences of disease on prognoses (Morris, 1998), suggested that mental and physical domains are inseparable and profit from approaches informed by these synergistic views. Feinberg’s (2001) work added another level of richness to the analysis of how “the self” as a unifying, perpetually created, process of the brain, is a lifelong process. He shed important light on the intricate, fluid, lifelong nature in which the holistic nature of mind-body unity are played out in ways seen throughout the human lifespan.

Although we have framed the issue as mental wellness, we are not ignorant of the many infirmities and illnesses that befall people as they age. Our use of the term wellness is not intended to deny the existence of the maladies, frailties, and dependencies that occur in later life. We intend only to bring attention to the entire continuum of experience that is aging and the need to recognize the assets older people bring to the experience of their illness or dependency.

Though the terms wellness or strengths may not appear per se in every chapter, they are included as organizing constructs and philosophical approaches to the subject matter. The absence of illness paradigms or terminology is one aspect of this approach; another is that the authors view aging as a process and an era of development and as the purview both aging people and their helpers, paid and unpaid. The wellness orientation and its theoretical complement, strengths-based appraisal, assessment, and intervention (Butler, Lewis, & Sunderland, 1998; Cohen, 1993; Cohen, Kennedy, & Eisdorfer, 1984; George & Clipp, 1991; Kivnick, 1993; Kivnick & Murray, 2001; Lustbader, 1991; Rowe & Kahn, 1997; Sacks, 1985; Sherman, 1993) are reflected in the use of terms, including skill, resiliency, autonomy, collaboration and historical preferences. It is noteworthy, and perhaps a reflection of how far we have come in the development of approaches that are applicable across the entire lifespan, that the terms wellness and strength can be used in discussions about aging without fanfare as they would be for any other age group.

As pundits ponder the future of aging and of those who will age, the impact of scientific progress on aging as a future achievement — and indeed, the very nature of what it will mean to age — is open to revision. That alone will require us to re-think the essence of the relationship between the helping professions and the aging people they serve. Featherstone (1995) predicted that technology (especially nanotechnology) will prevent the physical decline that has for so long characterized the narratives of old age and thereby expand the opportunities to constantly redefine the self. This, he proposed, will bring about the ability to give meaning in old age through freely chosen self-narratives, rather than through the experience of disability and dependency. If Featherstone is correct, how might that change each of our future plans about our own aging and our future careers as practitioners? The concept of helping aging people may have to undergo radical transformation, even a questioning of whether achieving mental wellness in later life will require therapy and therapists at all?

Strengths-Based Approaches

The strengths-based approaches we have chosen have a number of aspects in common, and we hope the reader will appreciate both the historical evolution and richly diverse applications of theory and practice that have evolved. Though there are real differences evident in the chapters, they share a core of assumptions that are particularly beneficial in work with aging people. These include the following:

1. Client resources: All of these approaches assume that clients enter therapy with many skills, capacities, and resources (personal and environmental). The primary therapeutic endeavor is to elicit and channel appropriate and relevant client skills toward the achievement of the client’s goals. This is in contrast to many pathology-based approaches, which emphasize the necessity of clients having to learn new skills and a new vocabulary in order to resolve their problems.
   
   
2. Collaborative client-helper relationships: In pathology or deficit-based approaches, the relationship between client and helper tends to be hierarchical, with the therapist or other clinician acting as a benevolent expert who has the responsibility of teaching the client new skills and that the helper alone knows what is best for him or her. In contrast, strengths-based approaches emphasize collaborative client-helper relationships in which the client and helper together seek to discover which client capacities will prove useful for developing solutions in line with the goals and outcomes that are important to the client.
   
   
3. Causality and time effectiveness: Whereas deficit or pathology models tend to spend a great deal of time in attempting to understand how unhealthy tendencies develop or maintain themselves, the strengths-based models discussed in this volume give more attention to building on healthy tendencies that already exist within a client’s life. This process allows therapy to be efficient in terms of time as well as of other resources.
   
   
4. Anti-ageist perspective: The aspects just outlined are of special benefit to therapists working with older clients because these processes prevent therapists from limiting the scope of their thinking and actions (in assessing or intervening) in terms of generalizations based on age or diagnostic categories. Therapists are instead able to notice subtle possibilities and abilities in their clients that otherwise might have been missed. The principles of these strengths-based approaches also benefit older clients because these individuals are not forced to take on new roles based on societal myths about the deficits presumed to be intrinsic to aging in order to resolve their problems.