Psychotherapy with older adults. Bob Knight. Sage Publications, California, 1986. No. of pages: 192
1
410 BOOK REVIEWS Psychotherapy with Older Adults. BOB KNIGHT. Sage Pub- lications, California, 1986. No. of pages: 192. Dr Knight is a clinical psychologist, psychoanalytically orientated but working from a ‘social learning model’, who has some unusual and interesting things to say, par- ticularly about the stereotyping of the elderly and myths about old people and their families, and suggests new ways of thinking about ageing. Clinical examples throughout the book illustrate specific topics and prob- lems. For example, in the first chapter on the essentials of gerontology is a clinical example of a first interview in which things ‘went wrong’, for the kind but inexperienced and apprehensive therapist as well as for the patient. Communication between the two broke down, mainly because of unrealistic expectations due to stereotyping, and the patient, a 75-year-old depressed widow, did not return. Knight enlarges on these stereotypes and draws attention to cohort effects. An 80-year-old individual who has lived through two world wars and was not brought up with computers will be different from someone born 50 years later, regardless of age. He com- ments: ‘. . . age is a rather unimportant thing to know about a person’, In Chapter 2, Knight describes the real differences between the elderly and younger individuals in terms of developmental changes (slowing and memory impair- ment for example), cohort differences (awareness of dif- ferent sets of ‘beliefs’ in patient and therapist) and the elderly as a subculture, different but not inferior. He points out that old people may be less rigid than the young and more open to interpretations and, I would add, the pressure of time in some cases actually speeds up the work. Therapy has to be adapted to accommodate these differences and the different intrapsychic tasks in old age. I enjoyed this book and learnt a lot from it but I have some criticisms. British readers will be disappointed that there are so few references to work from their side of the Atlantic. The most notable exception is to Bertrand Russell’s recipe for good spirits and longevity-regular bowel movements. The book ends abruptly, without even a single concluding sentence to draw the work together. And there is no index-a considerable disadvantage. Knight’s ideas about stereotyping and popular mis- conceptions or myths are especially challenging. The work he describes is in general problem-centred and from his social workbase he focuses more on casework than on the psychodynamic side of therapy. He emphasizes the importance of treating the client, not just his or her age. Social workers, geriatricians and psychotherapy researchers, as well as psychotherapists (not only those who work with the elderly), should read this book. RUTH PORTER Hammersmith Hospital, London Helping Older People: A Psychological Approach. CHARLES TWINING.Wiley, Chichester, 1988. No. of pages: 196. Price: E8.95 (paperback). Aimed at a broad spectrum of those working with elderly people, with and without professional qualifications, this book shows the applicability of psychological principles to the range of problems experienced by older people and their families. The topics include cognitive changes in normal ageing and the dementias; emotional adjust- ment in late life, depression, anxiety and psychological treatment approaches; death and bereavement; residen- tial care and quality of life; and family life, including issues relating to caring for an elderly person. Retirement and coping with physical illness and disability in late life are covered in more detail than is often the case and the book is a particularly useful source on these topics. The book claims to use ‘straightforward language’ and generally jargon is avoided or adequately explained. The style of writing is rather conversational, and this has led, at times, to some convoluted passages and lack of precision. However, the book is not at all daunting. Unlike most books by psychologists, references are used sparingly. ‘Exercises’ are employed frequently as a device to help readers reflect on a particular issue and to relate the topic to their own experience and concerns. Each chapter ends with suggestions for further reading, so that particular topics can be pursued in more depth. In my copy, the print was rather faint at times, and a number of misprints had crept through-my favourite was ‘scarer’ for ‘carer’ (p. 11l), just before a section on old age abuse! The ‘psychological approach’ of the title is one that would be shared by many psychologists working with older people. It encourages an understanding of older people as individuals in the context of their network of relationships and their environment, recognizing the con- tinuity within the individual from younger to older per- son, with changes arising from efforts to adapt to changing health and circumstances. The basis of the approach to helping the person is a systematic problem- solving approach, empowering people as much as pos- sible to make choices for themselves and their lives. The final section of the book encourages readers to take a similar approach to their own work, helping them to understand their motivations and attitudes and to set goals for development of their work. Much of the book reads as good, sound ‘common sense’. However, it is possible to discern that the material presented represents the distillation of a vast literature on the relevant topics, and the author is to be congratu- lated for achieving this feat so elegantly. It is a book that would be a useful basic text on courses on caring for elderly people, for staff working both in the com- munity and in residential settings, and is one of the best general introductions to the area at this level. BOB WOODS Institute of Pqchiatry, London
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Transcript of Psychotherapy with older adults. Bob Knight. Sage Publications, California, 1986. No. of pages: 192
410 BOOK REVIEWS
Psychotherapy with Older Adults. BOB KNIGHT. Sage Pub- lications, California, 1986. No. of pages: 192.
Dr Knight is a clinical psychologist, psychoanalytically orientated but working from a ‘social learning model’, who has some unusual and interesting things to say, par- ticularly about the stereotyping of the elderly and myths about old people and their families, and suggests new ways of thinking about ageing. Clinical examples throughout the book illustrate specific topics and prob- lems.
For example, in the first chapter on the essentials of gerontology is a clinical example of a first interview in which things ‘went wrong’, for the kind but inexperienced and apprehensive therapist as well as for the patient. Communication between the two broke down, mainly because of unrealistic expectations due to stereotyping, and the patient, a 75-year-old depressed widow, did not return. Knight enlarges on these stereotypes and draws attention to cohort effects. An 80-year-old individual who has lived through two world wars and was not brought up with computers will be different from someone born 50 years later, regardless of age. He com- ments: ‘. . . age is a rather unimportant thing to know about a person’,
In Chapter 2, Knight describes the real differences between the elderly and younger individuals in terms of developmental changes (slowing and memory impair-
ment for example), cohort differences (awareness of dif- ferent sets of ‘beliefs’ in patient and therapist) and the elderly as a subculture, different but not inferior. He points out that old people may be less rigid than the young and more open to interpretations and, I would add, the pressure of time in some cases actually speeds up the work. Therapy has to be adapted to accommodate these differences and the different intrapsychic tasks in old age.
I enjoyed this book and learnt a lot from it but I have some criticisms. British readers will be disappointed that there are so few references to work from their side of the Atlantic. The most notable exception is to Bertrand Russell’s recipe for good spirits and longevity-regular bowel movements. The book ends abruptly, without even a single concluding sentence to draw the work together. And there is no index-a considerable disadvantage.
Knight’s ideas about stereotyping and popular mis- conceptions or myths are especially challenging. The work he describes is in general problem-centred and from his social workbase he focuses more on casework than on the psychodynamic side of therapy. He emphasizes the importance of treating the client, not just his or her age. Social workers, geriatricians and psychotherapy researchers, as well as psychotherapists (not only those who work with the elderly), should read this book.
RUTH PORTER Hammersmith Hospital, London
Helping Older People: A Psychological Approach. CHARLES TWINING. Wiley, Chichester, 1988. No. of pages: 196. Price: E8.95 (paperback).
Aimed at a broad spectrum of those working with elderly people, with and without professional qualifications, this book shows the applicability of psychological principles to the range of problems experienced by older people and their families. The topics include cognitive changes in normal ageing and the dementias; emotional adjust- ment in late life, depression, anxiety and psychological treatment approaches; death and bereavement; residen- tial care and quality of life; and family life, including issues relating to caring for an elderly person. Retirement and coping with physical illness and disability in late life are covered in more detail than is often the case and the book is a particularly useful source on these topics.
The book claims to use ‘straightforward language’ and generally jargon is avoided or adequately explained. The style of writing is rather conversational, and this has led, a t times, to some convoluted passages and lack of precision. However, the book is not at all daunting. Unlike most books by psychologists, references are used sparingly. ‘Exercises’ are employed frequently as a device to help readers reflect on a particular issue and to relate the topic to their own experience and concerns. Each chapter ends with suggestions for further reading, so that particular topics can be pursued in more depth. In my copy, the print was rather faint a t times, and a number
of misprints had crept through-my favourite was ‘scarer’ for ‘carer’ (p. 11 l), just before a section on old age abuse!
The ‘psychological approach’ of the title is one that would be shared by many psychologists working with older people. It encourages an understanding of older people as individuals in the context of their network of relationships and their environment, recognizing the con- tinuity within the individual from younger to older per- son, with changes arising from efforts to adapt to changing health and circumstances. The basis of the approach to helping the person is a systematic problem- solving approach, empowering people as much as pos- sible to make choices for themselves and their lives. The final section of the book encourages readers to take a similar approach to their own work, helping them to understand their motivations and attitudes and to set goals for development of their work.
Much of the book reads as good, sound ‘common sense’. However, it is possible to discern that the material presented represents the distillation of a vast literature on the relevant topics, and the author is to be congratu- lated for achieving this feat so elegantly. It is a book that would be a useful basic text on courses on caring for elderly people, for staff working both in the com- munity and in residential settings, and is one of the best general introductions to the area at this level.
BOB WOODS Institute of Pqchiatry, London
