Working with the

Elderly and children

with special needs
ATLEY JOE CHACKO
• Honoring diversity in all of its many forms is fundamental to counseling.
• Without such a stance, the welfare of clients is endangered, and the respect and
dignity that should be accorded every person is ignored.
• Negative attitudes toward clients because of their age, sex, sexual
orientation, ethnicity, or spirituality “have been found to influence
counseling processes” for the worse(Miller, Miller, & Stull, 2007)
Counselling with Older
Adults
COUNSELING AGED POPULATIONS
• Development is traditionally defined as any kind of systematic change that is
lifelong and cumulative.
• Multilevel Development: Individuals undergo development on cognitive,
emotional, physical, spiritual, and other levels throughout their lives.
• Expected vs. Accelerated/Delayed Development:
• When development aligns with expected timeframes (e.g., physical growth in
childhood), individuals typically experience minor transitional challenges.
• Accelerated, delayed, or non-event life changes (e.g., never marrying or
having children) can negatively impact well-being.
• Unanticipated Events: Unexpected life events, such as early parental death or job
loss, can be detrimental due to associated trauma and a lack of preparation.
• The aged are defined here as persons over age 65
• Since 1935 and the passage of the Social Security Act, age 65 has been seen as the
beginning of old age or late adulthood.
• Historically, counseling older adults has been a neglected area of the counseling
profession (Muzacz & Akinsulure-Smith, 2013)
• As a group, members of this population receive only 6% of all mental health
services
• This situation stems from the group’s unique developmental concerns, especially
those involving financial, social, and physical losses.
• In the mid-1970s, Blake (1975) and Salisbury (1975) raised counselor awareness
about counseling older adults.
• The landscape of counseling programs and education has evolved significantly,
with a notable increase in courses and standards for working with older populations
 THEORIES OF AGING

Several multidimensional theories of aging exist, considering biological,

psychological, and social factors.
• Erikson's theory emphasizes the importance of developing generativity and ego
integrity in middle and late adulthood.
• Jung believes that spirituality is uniquely explored by those over the age of 40.
• Neugarten identifies three major periods of older adulthood: young-old (65-75), old
(75+), and old-old (85+).
• Aging patterns are unique, with physical and mental activity varying among
these age groups.
• The third phase of life encompasses these three groups of older adulthood.
these three age groups of older adulthood are “collapsed into one group called the
third phase of life” (Richmond & Guindon, 2010, p. 281).
THE THIRD PHASE OF LIFE: OLDER ADULTHOOD

• Old-people have to deal with age based prejudice and expectation at this point.
• Older people often are tagged with uncomplimentary labels such as senile,
absentminded, and helpless
• These negative attitudes and stereotypes - ageism, prevent intimate encounters with
people in different age groups and sometimes lead to outright discrimination .
• Individuals who are growing older, a phenomenon that Friedan (1994) calls “the age
mystique.” frequently deny and dread the process
• Even counselors are not immune to ageist attitudes (Blake, 1982; Maples & Abney,
2006)
NEEDS OF THE AGED

Transition to Senior Citizen Status:

• Older adults face a variety of complex issues during their transition from midlife to
senior citizen status.
• These include changes in physical abilities, social roles, relationships, and
residential relocation.
Potential Identity Crisis
• Many of these changes have the potential to trigger an identity crisis within the
individual.
• The developmental demands on older adults are significant.
Challenges Associated with Aging:
• According to Havighurst, older adults must cope with challenges like :
• the death of friends and spouses,
• reduced physical vigor,
• retirement, increased leisure time,
• developing new social roles,
• dealing with grown children, and
• changing living arrangements.
Gradual and Abrupt Changes:
• Some aging-related changes, like the loss of physical strength, occur gradually.
• While others, such as death, are abrupt.
• Aging is characterized by both positive transitions, like becoming a grandparent,
and negative transitions, like the loss of a spouse or job
Mental Health Concerns:
• Older adults face mental health challenges, including loneliness, physical illness,
retirement, idleness, bereavement, and abuse.
• Depression, anxiety, psychosis, dementia, and suicide are also concerns.
Elder Abuse:
• Domestic elder abuse, including physical abuse, psychological abuse, financial
exploitation, and violation of rights, is a significant issue affecting older adults.
• Alcohol abuse is also prevalent among this population.
COUNSELING THE AGED

Specialized Training Needed:

• Counselors interested in working with older adults often require additional
professional training specific to this specialty.
• Many counselors lack an understanding of older adults and may avoid working with
them
Emerging Roles and Challenges:
• Some older adults face new and unexpected roles in life, such as raising
grandchildren.
• Counseling services may need to address these emerging challenges through
direct outreach interventions, skill training, and support groups.
Investment Syndrome:
• Some counselors may focus on younger individuals, believing they will
contribute more to society, which may lead to a lack of attention to older adults.
• This approach may overlook the potential for change in older adults.
Irrational Fear of Aging:
• There is an irrational fear of aging, and counselors and mental health specialists
may distance themselves from older individuals due to this fear.
Age-Related Problems Misunderstood:
• Problems of older adults may be mistakenly attributed to aging itself rather than
recognized as treatable conditions, such as depression, which have always been a
part of their lives.
These points highlight some of the challenges and reasons why counseling for older
adults may be inadequate or overlooked,
APPROACH TO WORKING SUCCESSFULLY WITH THE
AGED
Treating Older Adults as Adults:
• A successful approach in working with older adults is to treat them with respect and
engage in basic counseling skills.
• This approach encourages older adults to explore their difficulties and adjustment
issues.
Incorporating Logotherapy Principles:
• Incorporating logotherapy principles into counseling can provide a holistic model of
aging that addresses the spiritual dimension of human existence
• Assist older individuals in making meaning in late life.
Modifying Attitudes and Systems:
• Counselors can promote change by modifying societal attitudes and the systems
in which older adults live.
• Changing negative stereotypes and age restrictions is important to encourage
older adults to be themselves.
Practical and Educational Counseling Services:
• Portable and practical counseling services that are educational and focused on
problem-solving are helpful for older adults.
• These services can address specific and immediate problems, such as employment
seeking.
Life-Review Process:
• Structured life-review processes are beneficial for helping older adults integrate
their past and prepare for the future.
Counseling Approaches for Alzheimer's Disease:
• Specific counseling approaches, including Roger's theories, Carkhuff's practical
application, and group counseling based on existential writings, can be
beneficial for older adults dealing with Alzheimer's disease and their family
members.
Cognitive Behavior Therapy and 12-Step Programs:
• Short-term cognitive behavior therapy can help increase rational thinking and
decrease depression in older adults.
• Additionally, 12-step programs and bibliotherapy are successful in addressing
alcohol abuse among older adults.
Popular Group Types for Older Adults:
• Includes reality-oriented groups, remotivation therapy groups, reminiscing
groups, psychotherapy groups, topic-specific groups, and member-specific
groups.
Learning from Older Adults:
• Counselors working with older adults often adopt an open attitude and consider
themselves as students of life, with older adults becoming their teachers.
• This approach facilitates meaningful interactions and the sharing of important
life events.
POPULAR AGED GROUP IN COUNSELING
Reality-Oriented Groups:
• These groups aim to help older individuals who may be confused or disoriented
by orienting them to their surroundings.
• The focus is on enhancing their awareness of the present environment.
Remotivation Therapy Groups:
• These groups are designed to motivate older clients to become more engaged in
both the present and the future.
• The goal is to help them find renewed purpose and motivation.
Psychotherapy Groups:
• These groups are tailored to address specific problems commonly associated with
aging, such as coping with loss or other emotional challenges.
Reminiscing Groups:
• Reminiscing groups conduct life reviews that focus on resolving past issues.
• The purpose is to help members become more personally integrated and find
meaning in their present lives.
Topic-Specific Groups:
• These groups center around specific topics of interest to older adults, such as
health-related discussions or activities related to the arts.
Member-Specific Groups:
• Focus on addressing the unique transition concerns and needs of individual
members.
• This might include issues like hospitalization or dealing with in-law relationships.
 Working with the
children with special
needs
SPECIAL NEEDS

• "Special needs" is a broad term used to describe individuals who require

assistance or accommodations due to a variety of physical, developmental,
intellectual, sensory, or emotional challenges.
• These challenges may be temporary or long-term and can impact an
individual's ability to perform daily activities.
• Special needs can encompass a wide range of conditions and disabilities,
including but not limited to:
1. physical disabled
a) sensory handicapped
b) neuromotor disorders
SPECIAL NEEDS

 Mentally disabled
Due to multiple causes like malnutrition, infectious diseases, down's syndrome,
nuclear radiation effects, brain damage due to injury etc.
 Learning disability
According to Myers and Hammill ( 1976) it can be due to motor activity,
emotionality, perception, attention , memory.
 Communication disability
Persons with speech disorder – stammering, stuttering, flattering etc
 Deficit in social behaviour
Includes maladaptive behaviour, abusive, aggressive, antisocial and social
SPECIAL NEEDS

• Ability is a natural tendency to do something well such as carry out tasks

in daily life (e.g., dress or feed oneself), work at a job/attend school, or be
mobile.
• Disability is an inability or a limitation that prevents a person from
performing some or all of the tasks of daily life, such as taking care of
bodily functions, walking, talking, or being independent of a caretaker.
• Handicap
it is linked to disability but is also distinct from it. It is an observable or
discernible limitation that is made so by the presence of various barriers
 PROMOTING INCLUSIVE EDUCATION AND THE
ROLE OF VARIOUS STAKEHOLDERS
All persons with different disabilities require special education programmes
for their special needs and special abilities.
• Handicapped persons Act was first passed in west and later in India.
However, the act was not been enforced seriously in India due to lack of
legal action .
• Right to Education (RTE) was undertaken by NGOs and voluntary agencies
has been implemented recently.
• Counsellor must guide teachers and train them with different skills for
disabled students in their classroom.
They should conduct workshops to guide and train them for special needs and
teach them some behavioural modification techniques
• Role of parents in bringing them to mainstream is so crucial .
‘ parental association ‘ were developed to initiate, integrate and explore
planned action welfare programmes for their own disabled children and
family members.
• Role of state and government in integrated education programmes has
benefited that no school can refuse admission to disabled child along with
normal children(inclusive education).
 "MODELS OF DISABILITY: UNDERSTANDING
DIFFERENT APPROACHES"
A number of different models for helping people who are disabled have emerged
(Smart & Smart, 2006). There are four that are most prominent.
THE BIOMEDICAL MODEL
• Most popular and closely associated with medical model.
• According to this model, “disabilities are objective conditions that exist in
and of themselves”.
• They are considered deficiencies and residing within an individual who is
totally responsible for the problem.
• This model basically equates disability with pathology. Whereas the model
may work best when dealing with physical disabilities, it is “less useful with
mental and psychiatric disabilities”.
ENVIRONMENTAL AND FUNCTIONAL MODEL
• Its focus is more appropriate for chronic disabilities (i.e., what most disabilities
are).
• In this model, people carry a label with them (i.e., “disabled”).
• The label may lead to some degree of social prejudice and discrimination. Yet,
it also places the blame for disabilities outside the individual.
SOCIOPOLITICAL MODEL
• a.k.a minority model.
• It assumes that persons with disabilities are a minority group rather than
people with pathologies.
• “The hallmarks of this model include: self-definition,
the elimination (or reduction) of the prejudice and discrimination (sometimes
referred to as ‘handicapism’), rejection of medical diagnoses and categories, and
the drive to achieve full equality and civil rights under U.S. law”
PEER COUNSELOR MODEL
• It assumes that people with direct experience with disabilities are best able to
help those who have recently acquired disabilities.
ROLE OF COUNSELOR

In working with clients with disabilities to develop or to restore adjustment, the

role of counselors is to:
• assess the clients’ current level of functioning and environmental situation
that either hinder or enhance functionality.
• After such an assessment is made, counselors use a wide variety of
counseling theories and techniques.
• Virtually all the affective, behavioral, cognitive, and systemic theories of
counseling are employed.
• The actual theories and techniques used are dictated by the skills of
counselors as well as the needs of clients.
DEALING WITH SPECIFIC DISABILITY

There are a number of specific disabilities that counselors work with.

PHYSICAL DISABILITIES
• Physical injuries such as spinal cord damage, mild traumatic brain injury
(MTBI), limb loss, or blindness produce a major loss for an individual and
consequently have a tremendous physical and emotional impact.
• Counseling may involve a blend of therapies (occupational, physical, cognitive),
necessitating client and family cooperation to adapt to the situation.
• Livneh and Evans (1984) point out that clients who have physical disabilities go
through 12 phases of adjustment that may distinguish them from others
• Shock,
• anxiety,
• bargaining,
• denial, mourning,
• depression,
• withdrawal,
• internalized anger,
• externalized aggression,
• acknowledgment,
• acceptance, and
• adjustment/adaptation.
Professionals working with physically disabled individuals have multiple roles and
responsibilities:
• Counselors: They provide counseling services to individuals with physical
disabilities.
• Advocates: They advocate for the rights and needs of disabled individuals,
ensuring they have equal access and opportunities.
• Consultants: They offer expert advice and guidance to help disabled
individuals navigate their challenges effectively.
• Educators: They help disabled individuals develop an internal locus of
control, empowering them to take charge of their lives.
In this comprehensive task, there is a complex relationship among these job
functions.
INTELLECTUAL DISABILITIES’
• Clients with intellectual disabilities include those who have mild to severely
limited cognitive abilities.
• In some cases, counselors’ tasks and techniques may be similar to those
employed with adults or adolescents who have physical disabilities
• Young clients with intellectual deficiencies may require different activities
and services.
• Counselors can help parents of these children in working through their
feelings about having children with intellectual disabilities.
• In the process they help the children as well through promoting positive parental
interactions that encourage maximum development (Huber, 1979).
ADD OR ADHD
• Attention deficit disorder (ADD) and attention deficit/hyperactivity disorder
(ADHD) are disorders that interfere with learning and day-to-day functioning.
• These disabilities have a neurological base and begin in childhood
• Influence the emotional, social, and behavioral adjustment of children, with
more boys than girls impacted.
• ADD and ADHD are found in various forms
• 50% to 80% of children with ADHD continue to have symptoms into adolescence
and some even into adulthood (Wender, 1998).
• ADHD challenges, including distractibility, impulsivity, disorganization, and
interpersonal issues, can persist and worsen with age, impacting one's life span.
• This may lead to increased frustration, anxiety, distress, depression, and
reduced self-esteem.
Strategies for working with individuals with ADD and ADHD have evolved over time,
especially in educational and community contexts.
• Preparing for Postsecondary Education: Counselors assist students with ADHD
in preparing for higher education and vocational opportunities.
• Providing Behavioral Cues: Counselors offer mnemonic cues to help individuals
with ADHD understand and manage their behavior in different situations.
• The SLANT mnemonic is used to assist individuals with learning difficulties in
focusing during classroom lectures:
1. S = "Sit up straight"
2. L = "Lean forward"
3. A = "Activate thinking and Ask questions"
4. N = "Name key information and Nod your head to validate the teacher/speaker"
5. T = "Track the teacher or speaker"
Interventions for children or adolescents with ADHD include, but are not limited to,
a) parent counseling and training,
b) client education,
c) individual and group counseling, and
d) social skills training (Brown, 2000).
Medical treatment may also be necessary
REHABILITATION COUNSELOR

• Rehabilitation counseling, a specialty in the counseling profession, is

particularly focused on serving individuals with disabilities (Parker &
Patterson, 2012).
• Those who specialize as counselors with the disabled must have knowledge of
medical terminology as well as helping skills to be effective.
• Rehabilitation is defined as the reeducation of individuals with disabilities
who have previously lived independent lives.
• Habilitation focuses on educating clients who have been disabled from early
life and have never been self-sufficient
REFERENCES

• Gladding, T.S.(2003) counselling; a comprehensive profession; 7th edition;

Pearson India.