Introduction
The current paper is dedicated to the research related to the case of Martin, an older adult who faces a variety of challenges in his life. Martin was diagnosed with a mild form of dementia which causes him to forget certain important events. Due to his condition, he was unable to deliver on his responsibilities related to caring for his daughter’s children. As a result, his daughter stopped talking to him and refused to let him spend time with his grandchildren, which led to Martin’s depression and anxiety. From the perspective of Erikson’s Theory of Identity Development, Martin is failing to achieve integrity, his age-specific milestone, and is experiencing despair. Therefore, the therapy required in the case of Martin must focus on the reduction of the depressive symptoms and helping Martin to attain integrity in his life. Several interventions were discovered to be relevant to the case in question, and the existing research indicates their effectiveness. Thus, Martin’s challenges can be resolved with the help of several therapeutic approaches, including Psychodynamic, Cognitive Behavioral, and Interpersonal therapies, as well as the selective optimization with compensation process.
Martin’s Challenges and Primary Issues
Based on Martin’s story, there are several developmental challenges which he encounters and which can be explained by the existing theories and scientific research. One of the main issues Martin faces is his cognitive decline which is common during his age, and his diagnosis may indicate the onset of dementia and even Alzheimer’s disease, his mother’s health problem (Broderick & Blewitt, 2020). Martin’s condition led to the conflict with his daughter, with whom he nevertheless is not trying to build a relationship again. Research shows that during late adulthood, people tend to experience a significant decline in traits such as extraversion, agreeableness, and conscientiousness, which can explain Martin’s refusal to reconcile with Maria (Griffin et al., 2015). From the perspective of the theory of Baltes and colleagues, Martin underwent the three-stage process of selection, optimization, and compensation when he made spending time with Maria’s sons his main goal (Broderick & Blewitt, 2020). Thus, Martin successfully overcame the loss of his wife because he managed to switch his focus from his hobbies such as golf and gardening to caring for his grandchildren. Yet, now he lost the ability to achieve his goal because of the conflict.
Martin’s case can be explored from the perspective of Erikson’s Theory of Identity Development. According to the theory, late adulthood is the eighth stage of psychosocial development, the goal of which is integrity and satisfaction with life’s events; otherwise, they may face despair (Broderick & Blewitt, 2020). In the case of Martin, he is clearly not satisfied with his relationship with the family and loss of cognitive capacity, which leads to a failure to achieve the stage’s goal. It is clear that Maria’s behavior has a considerable impact on the development of Martin. Maria’s attitude towards her father is stereotypical because she thinks that he has become insane because of his age.
Evidence-Based Intervention Strategies
As mentioned above, Martin’s life has to be viewed from the perspective of Erikson’s Theory of Identity Development which explains the importance of meeting age-related goals during different stages. Since Martin is considered to be in his early adulthood, his current focus must be a reflection on the life experiences and gaining satisfaction from the events he encountered. Yet, Martin cannot achieve the goal because he lost his only passion in life, namely, spending time with the grandchildren, and his cognitive ability is declining. Moreover, the conflict with his daughter and the subsequent loneliness make him experience depression and anxiety, but he is unwilling to reconcile with Maria.
Taking into consideration the existing challenges encountered by Martin, there are several evidence-based interventions which can be implemented as part of a comprehensive therapeutic approach. The first segment of the treatment will involve utilizing Psychodynamic Therapy, which will be targeted at helping Martin cope with the existing stress in the form of the inability to spend time with grandchildren. Research indicates that Psychodynamic Therapy, despite not being a common approach for helping elderly people, has demonstrated positive results in cases with older adults (Choudhury et al., 2020). The particular method most relevant in the case of Martin is the life review therapy which implies reflecting on Martin’s current conflict with his daughter.
During the life review sessions, the therapist will help Martin understand the cause of the relationship problem and will assist him in finding the right solution. Since Martin is unwilling to reconcile with his daughter, the therapist must try to persuade him to restart the communication with Maria through a discussion about the reunion’s benefits. As mentioned above, Martin’s refusal to restore the relationship is common for people of his age. As recent studies indicate, life review therapy can significantly contribute to the well-being of older adults and reduce symptoms of hopelessness in them (Lan et al., 2017). Martin experiences depressive symptoms since he lacks communication with his family, and the life review therapy will assist him in overcoming the conflict, which stops him from restoring his bond with the daughter and grandchildren.
Martin exhibits a considerable deficit in the developmental domain, namely, in terms of his cognitive functioning. Despite the fact that currently, he has only a mild form of dementia, the fact that his mother died of Alzheimer’s disease makes it possible to assume that his condition may worsen. Moreover, the anxiety Martin experiences due to his loss of communication with the family, which is evidenced by his thoughts about failing as a father and grandfather, may aggravate severe dementia. In order to manage his symptoms and condition, cognitive behavioral therapy can be introduced. According to studies, such an approach to treatment yields positive results in the cases concerning older individuals with mild dementia and manages to reduce their level of anxiety (Tay et al., 2019). Thus, cognitive behavioral therapy can be a reliable solution to the developmental problem of Martin.
The actual cognitive behavioral therapy method used in the case of Martin may involve helping him accept the reality of living with his condition. Namely, the therapist can encourage Martin to recognize his cognitive decline as an inevitable symptom of old age and not experience any anxiety related to it. Additionally, the therapist needs to help Martin improve his confidence level assist him in finding possible ways to avoid forgetting important events and information. For instance, the therapist can advise Martin to write down all vital details and regularly consult his notebook in order to always perform the necessary actions.
Interpersonal therapy is another type of intervention which can be utilized to assist Martin with his anxiety and depressive symptoms related to the cognitive decline and the family conflict. Interpersonal therapy is based on the assumption that the social context is the primary factor in understanding and treating depression in people. There are four major causes of depression, according to the Interpersonal theory, and one of them is conflicts with relatives (Broderick & Blewitt, 2020). As a result, Interpersonal therapy can be considered ideal for the present case because Martin’s anxiety stems from the conflict with his daughter. Studies indicate the interpersonal therapy has been successfully implemented in treating depression in older adults even without any additional pharmacological interventions (Blackburn et al., 2017). Thus, interpersonal therapy can also be used for resolving the anxiety of Martin and helping him overcome the conflict.
There can be several scenarios for therapy depending on Martin’s expectations and desire related to his relationship with the daughter. Helping Martin accept the existing disagreement with Maria as an impasse is one of the options. In this case, the therapist must focus on assisting Martin in recognizing that no further relationship with Maria will be possible and that communication with the grandchildren may no longer be achievable.
If Martin comes to a conclusion that he is no longer interested in continuing his relationship with Maria, then the therapist must assist the client in undergoing the process of selective optimization with compensation. As described earlier, the selective optimization with compensation process developed by Baltes and colleagues constitutes a cycle which is necessary to perform to achieve life satisfaction. Previously, Martin underwent the process by successfully switching from golf and gardening to caring for grandchildren. Yet, once Martin decides to avoid any contact with Maria, he will be unlikely to be around his grandchildren physically often. Thus, he will have to find another goal in life which would promote his well-being and would ultimately help him achieve integrity instead of despair.
Thus, the selective optimization with compensation process should be introduced, and the therapist has to help Martin find the new activities to engage in and set goals related to them. According to studies, the selective optimization with compensation process in older adults can be promoted with the help of information and communication technology which can significantly contribute to their well-being (Nimrod, 2020). As a result, for instance, Martin can make video calls to his grandchildren using his smartphone, which will help him pursue the goal of communicating with his family. Additionally, martin can focus on gardening and golf again by optimizing activities related to them and compensating for his cognitive decline. For example, instead of playing golf, he can simply watch tournaments on television, and instead of working in the garden, he can care simply for his flowers at home.
Additionally, when speaking of earlier issues manifested during adulthood which can be relevant to the case, it would be important to determine whether Martin had depressive symptoms before. Moreover, Martin’s unwillingness to reconcile with Maria may suggest that they had certain problems in their relationship in the past. The attachment theory would be helpful in determining the development of Maria’s attitude towards her parents. In case Martin’s challenges remain unaddressed, he may experience considerable negative consequences. For example, research shows that depression can contribute to a faster onset of severe dementia (Dafsari & Jessen, 2020). Martin’s mother died from Alzheimer’s disease, and he himself has been diagnosed with mild dementia, which puts him in the high-risk group. Thus, the possible projection for Martin is the rapid cognitive decline if he does not undergo therapy and continues to suffer from anxiety and stress.
Conclusion
The current paper demonstrates the effectiveness of Psychodynamic, Cognitive Behavioral, and Interpersonal therapies in the context of a case of an older adult named Martin with cognitive challenges and depressive symptoms. Martin fails to achieve integrity which is the essential developmental goal of his age, and interventions can help him do it. Psychodynamic therapy has been proven to have a positive effect on the reduction of depressive symptoms among older people. In the case of Martin, the therapist can utilize the life review therapy in order to help him to explore the causes and implications of his conflict with the family. The cognitive-behavioral approach can be used to assist Martin in coming to terms with his condition and adjusting to a new life. Essentially, Martin must learn how to counter his cognitive deficit by employing various techniques, including writing down notes. Interpersonal therapy will be used to resolve Martin’s conflict with the daughter, which causes his depressive symptoms. Thus, after applying the aforementioned interventions, Martin will be able to improve his well-being and ultimately will achieve integrity.
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