(p. v) Foreword
(p. v) Foreword
Clinical geropsychology has been growing as a field for several decades and a book like this Oxford Handbook of Clinical Geropsychology summarizes where the field is at now but also calls attention to its growth from being the preoccupation of a few dedicated psychologists in the 1960s and 1970s to a worldwide and globalized science and profession in the twenty-first century. In fact, one of my first responses to looking at the book was that there are many more authors in this volume than there were geropsychologists early in my career.
There are two broad perspectives in mental health and ageing. One is to see older adults as a special population that needs certain types of specialty services. While true in some ways, this view tends to lead to a focus on older adults with dementia and with physical frailty and reinforces the perception of older adults as ‘others’. The other perspective is to emphasize the roots of clinical geropsychology in lifespan developmental psychology. The lifespan perspective puts older adults into developmental perspective, reminds us that we are all ageing, and focuses attention on normative and successful ageing as well as highlighting the needs of those growing old less successfully as being due to causes other than ageing itself. The chapters of this volume pay attention to the lifespan perspective, the importance of longitudinal studies and longitudinal thinking about ageing, and the need to consider trajectories of cognitive change in addition to simple one-time snapshots of cognitive functioning.
The understanding of the developmental psychopathology of late-life has advanced a great deal within clinical geropsychology. This book calls attention to and explains a wide variety of psychopathology in later life including the neurocognitive disorders (formerly known as the dementias), depression, anxiety, substance abuse, psychosis, personality disorder, and insomnia. There is also considerable attention paid to the interconnection of these psychopathologies with physical illnesses and the interconnection of psychological factors and pain. This coverage will please, but likely not surprise, specialists in geropsychology. This level of nuanced understanding is, however, in my experience considerably beyond the general thinking of the nonspecialist physical health, mental health, and social service professionals who often serve older adults. They have moved from thinking of all older adults who act strangely as having dementia, as was the case in the 1980s, to recognizing that depression is also an issue. But for far too many, the understanding of mental health problems in later life stops there. Hopefully, this book and those who read it can continue the work of educating nonspecialist colleagues and the general public about the full range of potential psychological disorders affecting older adults seeking help, and the interactions of those psychological disorders with physical health maladies.
The range of interventions covered here is similarly broad with attention to cognitive-behavioural therapy, interpersonal therapy, acceptance and commitment therapy, cognitive analytic therapy, reminiscence-based approaches, and family therapy. Several of these chapters focus on the use of therapy in helping older adults address some of the (p. vi) specific challenges of later life: (1) physical illness and functional disability including end-of-life issues, (2) grief, and (3) care-giving. The attention to the effects of physical exercise and to healthy life styles as factors in improving mental health and possibly reducing risk of cognitive decline is an important reminder that not all helpful interventions are psychological or psychopharmacological.
The coordination of psychotherapy and medication is covered as are the issues in taking psychological assessment and treatment into particular social contexts such as primary medical care, long-term care, and into the courts with capacity assessments. All work with older adults involves the need to work with other professionals, and so having the knowledge base, attitudes, and skills to work well in interprofessional teams is of critical importance. Geropsychologists also need to be prepared to work with a variety of older adults with a full range of individual diversity, including older gays and lesbians.
The range of nations represented among the contributors is inspiring proof of the extent to which clinical geropsychology has grown and spread around the world. It is especially gratifying to see signs of the spread going beyond the western world of Europe, North America, Australia, and New Zealand and into other nations such as China.
The attention to normative and positive ageing is heartening. This focus is of critical importance for clinical geropsychologists who can lose track of the fact that our patients, clients, and residents are a selected group from the wider population of older people in the world. Focusing on those who are not doing well and are in need of help is the main reason for there being a field of clinical geropsychology, but we cannot allow this focus to lead us to view ageing itself as always having negative consequences and so to reinforce societal ageism in ourselves and others.
Finally, technology perhaps gives us a glimpse into the future of the post-retirement life style and also into the future of psychological intervention. It provides an important reminder to those of us earlier born geropsychologists who are gradually moving into the digital age that the world and the way we communicate and heal are changing. It is likely to come more naturally to later born geropsychologists, and they can be prepared to work effectively with the future cohorts of older adults in need of psychological assessment and treatment.
Bob G. Knight, PhD
Director, Tingstad Older Adult Counseling Center
The Merle H. Bensinger Professor of Gerontology
Professor of Psychology and Medicine
University of Southern California
Los Angeles, CA 90089-0191