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Therapy for the life-cycle: an older adult

Group analysis must continually adjust to changing social realities, policies, and priorities, as they affect different population groups. In this way, group analysis has a useful role to play across the lifespan. Consider the case of older adults. Smaller families and considerably longer lives mean that there have been dramatic shifts in the generational balance; commentators refer to a "revolution in longevity, radically challenging both the fatalism traditionally associated with aging as well as the social myths that consign the 'elderly' to certain positions and characteristics (Kirkwood, 1999). Giddens (1998) quips that with improved healthcare and conditions, the elderly are becoming younger. In Everybody's Business (CSIP, 2005), a document designed to guide health policy and service provision for older adults, the rhetoric is clear, that older adults are a valued resource in society, who should be assisted to remain as independent as is feasible, with or without the panoply of assistive technologies and support. Successive government reports and guidelines emphasise ideas of "social inclusion" and "recovery", enabling older adults, in this context, to continue to lead full and purposeful lives in their communities (Social Exclusion Unit, 2004). In his conclusion to a report, the then mental health "Tsar", Louis Appleby (2007) states, "Public expectation, technological advances and an ageing population are driving change in mental health care, just as they are in every other medical speciality" (p. 10). Whilst "active citizenship", "independence", and "life-long learning" are laudable aims, a host of anxieties, real and imagined deprivations, chance circumstances, and bodily limitations frequently intercede to make their realisation problematic. Adaptation to growing old is not simply a matter of the "internal world" per se, the world most emphasised in psychoanalytic accounts (e.g., Quinodoz, 2009), but of changing norms and practices associated with the modern cultivation of self.

Grace's life

Grace (mid-sixties on joining) joined a group which included a wide age range and felt conspicuous as the significantly oldest member. A core fear on joining was that she would not find a place because others would see her as "past it". Hudson (2005) comments on a common perception and prejudice that "change is no longer worth it or possible for older people" (p. 1). There was a risk that Grace might "carry" negative group representations concerning age, reconfirming a fear that she would once more become a burden to others. This mirrored a preoccupation about her place in society, as unproductive, unwanted, and psychologically redundant. Grace worried about "complaining" and becoming a "bitter old lady". In this way, there was a kind of homology of society/group, group/society.

Grace suffered considerable childhood adversity and disruption. Her mother had mental illness, with hospitalisations, and her father was said to be "kind, but undemonstrative". Nursing a disturbed mother and caring for siblings were themes that rapidly entered the life of the group, with others both enjoying her care-giving, "maternal" sensitivity whilst challenging her gravitation towards the caring role. Grace could be thought of as a "cork-child" (McDougall, 1986), whose psychic duty was to hold a would-be, should-be container (the mother/ the group) together. The fear, were she not to perform, was that the container would explode. Care-giving provided reassurance and was a source of life-long self-esteem. However, this psychological view was not an altogether satisfactory explanation, and possibly reductive, since Grace was also culturally presenting aspects of "her times", when patterns of intra-family caring were more normative, particularly for females. She had lived through the war and austerity years and her parents had lived though two world wars and experienced real poverty. The idea of "talking out" problems was far from easy, as she had been brought up to identify with "keeping things in" and, when group members challenged her reliance on "caring for", they implicitly challenged an organising principle of an internalised culture. Their pleas that Grace "be more selfish" and "put herself first" were understandable acts of encouragement by significantly younger people, raised during times influenced by markedly different values and regulative ideals;[1] indeed, in an unhelpful group polarity, Grace accused the younger people of being part of the "self-regarding, me-generation", whilst she was accused of being "old-fashioned". Nevertheless, Grace found some of the challenges helpful, as well as limited; caring could be a burden, but it was also a long-established, crafted ability. This kind of interactional tension and exchange is precisely how group analysis can be effective, with Grace "taking on" some of the group members' challenges whilst also challenging pre-reflective views held by others.

Experiences of job redundancy were another focus, for Grace and others. In her work career, she was displaced by a younger, more energetic "entrepreneur", leaving her on the sidelines. Increasing losses reduced the prospects of support outside. It was hard for Grace not to sink into an "internal society" which conspired to deny her the right to a purposeful life—and not to sink into a negative group role in which she would embody such a position. Grace faced the formidable task of rebuilding and countering feelings of inner destruction; the fact that acquired patterns meant that it was hard to be seen to complain or to burden others, made the task considerably more difficult. Group analysis, based on an ethic of communication, did not sit easily with this and, not surprisingly, there were periods during which Grace wanted to "give up", on the group and sometimes on life.

Reflections

At times—perhaps always (Schermer, 2006)—group analysis acts as a spiritual resource, within which existential crisis and depletion is addressed; "defences" often fail through lifelong wear and tear. The clinical material illustrates the role that group analysis might play in sensitising ourselves to the changing life positions, transitions, and thresholds associated with the fact of living longer lives. There is a particular story here, that of Grace, but also a universal theme; after all, the younger members had future lives, prospects, and fantasies of being old(er). How does anyone manage adjustment to changing culture and mores over time, or construct a non-work identity after one's working life, and so on? Significantly, Grace's struggle to keep going inspired the younger members, some of whom were tempted to seek destructive shortcuts or anti-growth solutions to their dilemmas; perhaps she lent them spiritual resources.

An ethics of communication, of dialogical optimism, grounds group analytic operations; talking and taking, giving and receiving, seeing self-in-other and other-in-self, are core to its practice. This, like other social-moral expectations of living actively and fully, can be a source of real pressure, whilst constituting the very norm through which it is supposed to work. In a psychologised society, a "psy complex" as it was, there seems no alternative to "working on ourselves" (Rose, 1992). We have seen that Grace did not readily "take" to such confessional group values, even though she felt she had "nowhere else" to turn. In this way, group analysis offered no easy resolutions or consolations, but through a sometimes co-operative and sometimes agonistic exploration, some growth and reconciliation, albeit it with much sadness, was possible. A painful aspect of any therapy, and one certainly true of group analysis, is how clients figure out their realistic limitations, at whatever stage in life, and appreciate and actualize their assets.

  • [1] The notion of a regulative ideal refers to an idea that cannot be realised, but is regulative in so far as it guides or mediates behaviour; regulative ideals inspire, mobilise, and serve as yardsticks to measure progress. Ideals, of whatever nature, have a shadow side, in what they repress or in the alternatives they exclude, those negatives or anti-ideals in a given society.
 
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