Counselling for Older Adults Experiencing Homelessness
by Andrea Koenigstorfer
The importance of mental health care for the elderly has been recognised in recent years. In the 2006 census, people aged 65+ made up 11% of the population – by 2041 this will have increased to 22% (Centre for Ageing Research and Development in Ireland, 2011). Elderly clients accessing counselling services often present with issues around loss and loneliness – they can be isolated from family members and have poor social networks. They also have a high likelihood of health problems and disabilities, which often result in a loss of independence. In this context older adults often struggle between the wish to be cared for versus the need to be in control of their lives. These circumstances result in older clients presenting with symptoms of social distress, involving worthlessness, inadequacy, fear of abandonment, anger and vulnerability. Counselling can help these clients come to terms with loss, negative emotions, feeling a lack of meaning, reminiscence, failing health and death.
Older adults affected by homelessness are more likely than their younger counterparts to present with mental health issues (O’Connell, 2005). Their needs in this context are often more complex than those of older adults in the general population, in that they may also include alcohol or drug use, traumatic incidents in the past and limited opportunities for meaningful activities (Walsh, 2013). Living without a home can be especially challenging in later life, making older adults’ need to access housing particularly urgent. Older adults affected by homelessness also have unique needs regarding safety. They may have encountered violence on the streets or in shelters and are considered more at risk than their younger counterparts because of their poor health and because they could be seen as easy targets.
The assessment of mental health issues for older people, whether they are experiencing homelessness or not, can often be difficult, mainly due to the perception of these problems as an unavoidable consequence of ageing rather than a treatable problem (Crome & Bloor, 2005a; Crome & Bloor, 2005b). Also, due to the stigma in society, older people often do not report problems around their mental health. This frequently results in a focus on pharmacological treatment and an ‘encouragement’ to ‘go out and socialise more’. Mobility or hearing problems, as well as faltering concentration or memory issues, can make it difficult for counsellors to engage with, and retain older clients (Toner & Shadden, 2002). Older clients often also lack an understanding of what counselling is and have difficulties sharing problems with a stranger. The fact that they are often suffering from financial difficulties tends to affect their access to treatment.
The counselling process with older clients mainly involves dealing with the above-mentioned losses and meaning making. At the Dublin Simon Community Sure Steps Counselling Service, we help clients provide a narrative of their lives, not just a mere description of the facts but rather of the role they played in it. This helps them find new meaning and a renewed purpose in life and enables them to find acceptance and an ability to live in the present. What is important is to stress the individual’s independence, in spite of their physical or emotional circumstances, and to not let them become infantilised, which they could experience in shelters or nursing homes. This is essential for them to maintain their self-esteem.
Clients who are homeless and have a history of trauma can often feel unsafe, therefore the counselling process needs to work towards rebuilding their physical and emotional safety and a sense of control over their lives (Hopper, Bassuk, & Olivet, 2010). We support our clients in identifying and highlighting their own strengths and developing coping skills to further develop their own resiliency.
What we find useful with older clients is to adapt the counselling process to the needs of this client group and each client individually. This may involve additional reminders for appointments or adapting the session length to a client’s physical and mental capacity on a particular day.
For many clients, learning to trust their counsellor is a first step towards rebuilding trust with others (Shallcross, 2010). The importance of our work lies in recognising and accepting our clients as human beings – or in other words, simply listening to them tell their story. A lack of validation is a common theme among clients in general, but in particular those affected by homelessness. They feel judged, they feel nobody listens to them, nobody cares about them. They feel powerless, dirty and a sense of shame that is overwhelming. It is essential for us as counsellors to change this paradigm, build a relationship with them and improve their experience within ‘the system’. We accomplish this by listening non-judgementally, validating a client’s experiences and building a relationship of trust.
What we know is that change is possible even at an advanced age. People who are elderly can also benefit from psychotherapeutic intervention (Toner & Shadden, 2002). They are generally eager to reflect on their past and naturally tend to sum up their lives. Working with older adults on anxieties related to loss and bereavement may raise emotional issues for therapists as they are consistently confronted with fears about their own mortality. In the homeless sector, we also often experience a sense of helplessness and frustration in view of our own limitations to facilitate change. What is important is to find the value in what we are doing and appreciate that success might not come in huge leaps and bounds. Accepting this truth is essential. In creating a different environment and experience for the client we often may just be planting a seed. This is all we have control over.
The Dublin Simon Community Sure Steps Counselling Service was established in 2012 and is currently providing psychological support to an average of 70 clients per month presenting with a wide variety of issues. The range of services encompasses one-to-one counselling, weekly drop-in clinics, in-reach and outreach crisis intervention, and a counsellor-led emotional wellbeing group programme. As a trauma-informed counselling service our counsellors are aware of the traumatic experiences of our clients and incorporate an understanding of their trauma into our work.
Andrea Koenigstorfer is an IACP and BACP accredited Counsellor and Psychotherapist working with the Dublin Simon Sure Steps Counselling Service.
Centre for Ageing Research and Development in Ireland (2011). Ageing and intellectual disability research brief. Belfast: Centre for Ageing Research and Development in Ireland.
Crome, I., & Bloor, R. (2005a). Older substance misusers still deserve better services – an update (Part 1). Reviews in Clinical Gerontology, 15, 125–133.
Crome, I., & Bloor, R. (2005b). Older substance misusers still deserve better services – an update (Part 2). Reviews in Clinical Gerontology, 15, 255–262.
Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma- informed care in homelessness services settings. The Open Health Services and Policy Journal, 3, 80-100.
O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville: National Health Care for the Homeless Council, Inc.
Shallcross, L. (2010). Putting a human face on homelessness. Retrieved 20 February 2016 from http://ct.counseling.org/2010/01/putting-a-human-face-on- homelessness/
Toner, M. A., & Shadden, B. B. (2002). Counseling challenges: Working with older clients and caregivers. Contemporary Issues in Communication Science and Disorders, 29, 68–78.
Walsh, K. (2013). Homelessness, ageing and dying. Simon Communities of Ireland. Retrieved 19 May 2016 from http://www.simon.ie/ HomelessnessAgeingandDying/#/1/