"I will not work with older adults”, Sally, an early-career psychologist exclaimed during a meeting to discuss further career options. She explained that during a university placement, she spent a few days on an inpatient psychogeriatric rotation. She spoke with heavily medicated inpatients with dementia, depression and other mental health problems. Sally’s rudimentary training in cognitive behaviour treatment (CBT) and acceptance and commitment therapy (ACT) seemed irrelevant to a setting where patients had cognitive confusion, many physical comorbidities, sensory difficulties and who appeared resigned to their impairments. Although the placement lasted only a few days, Sally’s view hardened – psychologists were irrelevant to, and ineffective with, older adults.
Sally’s experience challenges the view of experiential-based learning as an important means for challenging negative stereotypes of a client group. Surely, working with older adults facilitates a better understanding of the population. Not so for Sally. In fact, her attitudes became solidified through the placement. Sally extrapolated her experience in an acute psychogeriatric unit to all settings involving older clients. Despite the heterogeneity within the older adult cohort, Sally’s views about clinical geropsychology were informed by her brief encounter with one type of client group.
Sally was not presented with opportunities to contextualise her experiences within a broader frame of clinical geropsychology. She had little course material to rely on, no training in techniques for late-life mental health conditions, limited understanding of dementia and cognitive impairment, or the aged-care system and no expert supervision. Without supportive infrastructures to develop knowledge on normative ageing, the types of cognitive and psychopathology related to later adulthood, or assessment methods and knowledge of treatment directions for older adults, it is unsurprising that Sally felt unskilled to work in a psychogeriatric setting.
Although Sally’s training and placement experience may appear substandard, sadly, this is, with some exceptions, the norm in Australia (Pachana, Emery, Konnert, Woodhead, & Edelstein, 2010). Students interested in working with older adults rarely have the opportunity to engage in placements that offer a breadth of experiences contextualised by expert supervision, teaching activity and research.
The lack of aged-care mental health training in our professional courses in clinical and counselling psychology is alarming. The number of older adults in Australia will more than double by 2055 (Commonwealth of Australia, 2015). Such growth will be matched by an increase in the prevalence of late-life mental health disorders. With virtually no training courses in clinical geropsychology in Australia and a dearth of clinical supervisors with competencies in this area, we are unprepared.
Where to from here?
In 2009, a group of clinical geropsychologists met in Pikes Peak, USA, to discuss a model of training for psychologists to build capacity for working with older adults (Knight, Karel, Hinrichsen, Qualls, & Duffy, 2009). They established the Pikes Peak Model for Geropsychology Training, which recommended the attitude, knowledge and skill competencies needed to become a competent geropsychologist.
Over the past seven years, Swinburne University of Technology established the Wellbeing Clinic for Older Adults – a research-based innovative outreach program using principles of the Pikes Peak model to train psychology students, and providing a service to older adults living in residential settings (Bhar & Silver, 2014). Postgraduate psychology students (counsellors) completed placements in residential aged-care settings providing counselling, assessment, education and support services to residents, families and staff (Bhar et al., 2015). To support these activities, fortnightly seminars provided knowledge of normative ageing, late-life disorders, assessment methods and treatment models appropriate for older adults. In addition, regular group and individual supervision was provided. Initial results evaluating the training have shown superior growth in counsellor attitudes, knowledge and skill competencies compared to peers not in theprogram.
Other postgraduate training programs incorporating clinical geropsychology training are offered through the University of Queensland and James Cook University. Multidisciplinary courses on aged-care mental health are also available through a variety of other providers such as the University of Tasmania, Flinders University, the University of Wollongong and the University of Melbourne, reflecting a growing awareness of the need for such training in today’s workforce.
With Sally’s experience in mind, training programs in clinical geropsychology may have the best outcomes when placement-based learning is contextualised within a model that actively seeks to cultivate realistic attitudes towards late-life issues, knowledge of a range of late-life presentations and skills to customise treatments for older adults.
Acknowledgements
Acknowledgement is provided to Mr Mark Silver and Dr Deborah Koder for contributing to this article and the ongoing research on the trajectory of clinical geropsychology outcomes for students involved in Swinburne's Wellbeing Clinic for Older Adults.
The author can be contacted at [email protected]