Mental Wellness in Aging: Strengths-Based Approaches

Contents

About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Foreword: Blurring the Lines, Expanding the Vision Scott D. Miller. . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

Section I Engaging Peoples Strengths for Successful Aging

Chapter 1 Aging in the Next Millennium: What the Future Holds for UsAudrey Weiner and Sheldon L. Goldberg. . . . . . . . . . . . . . . . . . . . . . . . . 3

Chapter 2 Autonomy and Consumer Empowerment: Making Quality of Life the Organizing Principle for Long-Term Care PolicyLawrence Polivka and Jennifer R. Salmon. . . . . . . . . . . . . . . . . . . . . . . 15

Chapter 3 Strengths-Based Health Care: Self-Advocacy and Wellness in AgingRaymond Vickers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Chapter 4 Care Management: A Strengths-Based Approach to Mental Wellness with Older AdultsRona S. Bartelstone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Chapter 5 The Social Portfolio: The Role of Activity in Mental Wellness as People AgeGene Cohen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113

Chapter 6 Why Most People Cope Well with Retirement Robert C. Atchley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123

Chapter 7 Conscious Aging: A Strategy for Positive Change in Later LifeHarry R. Moody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Chapter 8 Changing Institutional Culture: Can We Re-value the Nursing Home? Judah L. Ronch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

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Section II From Symptoms to Strengths in Therapy and Counseling

Chapter 9 Fundamental Concepts of Milton H. Erickson and Their Relevance to Older ClientsJoseph A. Goldfield . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

Chapter 10 Solution-Focused Therapy: Elders Enhancing Exceptions Marilyn J. Bonjean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201

Chapter 11 Narrative Therapy with Older AdultsRaymond Grimm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237

Chapter 12 The Narrative Solutions Approach: Bringing Out the Best in People as They AgeJoseph B. Eron and Thomas W. Lund . . . . . . . . . . . . . . . . . . . . . . . . . 273

Chapter 13 Strengths-Based Approaches to Trauma in the Aging: An Albanian Kosovar ExperienceJack Saul, with Shquipe Ukshini, Afrim Blyta, and Shukrie Statovci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299

Chapter 14 Caring for People with Alzheimers Diseaseand Related Dementias:Strengths-Based Approaches Judah L. Ronch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315

Chapter 15 Lessons from the Lifelines Writing Group for People in the Early Stages of Alzheimers Disease:Forgetting that We Dont RememberAlan Dienstag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343

Chapter 16 Exploring the Creative Potential of People with Alzheimers Disease and Related Dementia: Dare to Imagine Anne Davis Basting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

Afterword Gary J. Kennedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373

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Introduction

The New York Times headline read, Decades After Midlife Mark a Frontier for MentalHealth (March 16, 1998). The accompanying article described how a growing cadreof professionals is challenging the idea that mental health care is wasted on the old. Thischallenge is timely, given the surge in life expectancy and the demand by the burgeon-ing cohorts of aging and young old baby boomers that they have access to the highestpossible quality of life. For these couch-broken generations, as well as those influentialand educated, wellness-oriented elders-to-be who have learned to take command of theirown destinies, psychotherapy is an accepted part of the concept of taking care of oneself.

The Times article went on to warn of a coming crisis in which there will be too fewproperly prepared therapists for older people. Those who do provide therapy for older in-dividuals can count on being inundated as projected increases in life expectancy create awave of demand. The generation at risk is composed of the very same savvy consumeristboomers who can be expected to demand expert, specialized services before enough areavailable. The size of population needing these services is sobering and clearly documentsthe need. For example, life expectancy has grown three decades since 1900, from the mid-40s to 76.1 years. The number of people older than age 65 was estimated to be in excessof 34 million in 2000 and was projected to rise to 70 million (or 20% of the population)by 2030, with the largest increase occurring among those older than 85 (Administrationon Aging, 2000).

Demographics are not the only trend driving this heightened opportunity/need.The availability of more effective treatments in medical and health care, psychotherapy,and pharmacology have created heightened optimism among the older population andpioneering geriatric specialists who have been treating them through the years.

Mental health providers will need to expand their horizons and continue their ownprofessional development in ways that are intellectually well-grounded and reflect con-temporary realities of how services are provided to the public. This includes the need toprovide mental health services in the form of psychotherapy or counseling to people whoseek help not because they are sick but because they wish to be stronger and enjoy abetter quality of life into very old age. Future cohorts of older adults will assert their abil-ity to be partners in the process of care, not passive patients, and will bring considerabletalents, strengths, and life skills to the process. They will also be sensitive to the elementof time as a factor, perhaps because their health benefits will be rationed or managed, orbecause they, like most busy boomers, prefer to solve problems as expeditiously as pos-sible and get on with living.

The approaches represented in this volume reflect the idea that strengths-based,time-sensitive (not necessarily the brief therapies per se) mental health and wellnesscare are powerful resources and are perhaps the most appropriate modalities to meet the

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challenges of the 21st centurys so-called Age Wave (Dychtwald, 1989). We see a trendtoward increasing numbers of aging people who will assert their wish to be in control asmuch as possible of their successful aging (Rowe & Kahn, 1998).

This is a book of practical approaches based on contemporary thinking and tech-niques to help people engage and strengthen their own abilities to promote successfullives as they grow older. Our scope reflects both wellness-related behaviors for the layreader to use to promote mental wellness as aging progresses and counseling and psycho-therapy modalities that use personal strengths as the cornerstone for improvement.

The chapters are written by recognized experts in this field. Their unique collabo-ration has yielded a series of discussions about successful aging, not a controversy sur-rounding the best path to take (see Hubble, Duncan, & Miller, 1999). We recognize thatpeople are different and that better ways to achieve mental wellness in aging are still tobe discovered, both in and outside of the consultation room. This volume is a gatheringof ideas that reflect, and hopefully accelerate, the historical transition in the field of geri-atric mental health away from nihilism toward positivism. These strengths-based ap-proaches veer from an exclusive focus on coping with deterioration toward the view thatolder people are not only educable but also (to turn Freuds old view around) have thepotential to utilize their unique lifelong assets to benefit their aging.

THE FUTURE OF AGING AND MENTAL HEALTH ISSUES

The Surgeon Generals Report on Mental Health (U.S. Department of Health and HumanServices, 1999) attested to the societal challenge of meeting the demands of the enormousnumber of aging people who constitute the Age Wave. The size of this group is not theonly challenge; it also will be larger and more diverse than any previous generation in ourhistory. Some of the details are compelling and set a frame for future service design.

The population of older adults is expected to double in number and reach 70 mil-lion by 2030 and will represent the most heterogeneous group in history in terms of gen-erational cohorts, gender balance, ethnic mix, income levels, living arrangements, andquality of physical and mental health. The growth in demand for mental health serviceswill result not only from the sheer numbers of aging people but also from the impact ofdiverse experiences that created the enormous heterogeneity of this group. These cohortswill challenge any lingering assumptions mental health and other service providers mayhave that aging is a singular experience rooted only in chronological events. To put itsimply, models of intervention that are based solely on chronological age of the recipientswill become obsolete. A number of dimensions mentioned in the Surgeon GeneralsReport are worth considering in order to fully understand what the aging population andmental health providers will be facing.

Stressors and Adaptations

Aging exposes people to a combination of stressors that is unique in both its nature andvariety. Normal aging brings unplanned changes, declines, and losses that are potentiallyproblematic for even the most well-adjusted individuals. What were once minor changesthat people easily compensated for are more likely to become major, either because newbarriers and challenges arise to the marshalling of resources people have used all theirlives to function independently or because challenges increase exponentially and at an ac-celerating pace. Two of the most stressful unplanned events are declines in health and loss

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of loved ones. In addition, stresses may result from loss of community, relationships, orenvironmental resources. Most older people are able to adapt to these changes by usingtheir traditional coping mechanisms or, if necessary, by adapting them. But there arethose for whom these and similar stressors create major threats to well-being, especiallywhen the belief that the experience of aging per se is the reason they cannot access theirlifelong resources for achieving mental wellness. How will the next generations of agingpeople cope with stresses they didnt create (e.g., working too much) and those overwhich they have no control?

Service Delivery Issues

Older adults typically underutilize mental health services. Reasons for this include de-nial of problems because of feared social stigma or the generational psyche (Ronch &Maizler, 1977) that casts a shaming and critical eye on the mentally ill as weak, crazy,or morally inferior; failure of professionals to identify the signs and symptoms of emo-tional and psychological problems; and barriers to access such as cost, location, andgerontophobic, ageist attitudes among providers. Systems currently in place functionsuboptimally due to a lack of collaboration between agencies and systems, funding andreimbursement problems, health care models oriented to acute medical illnesses ofyounger people, the role of managed care, and a shortage of trained providers in the med-ical and mental health arenas. How will the future generations deal with any barriers thatblock their access to services they have come to depend on for optimum wellness?

Aging and Mental Health

Contrary to myth, aging is not inevitably accompanied by deteriorating cognitive andemotional status. Nevertheless, conservative estimates indicate that nearly 20% of people55 years and older experience mental disorders that are not part of normal aging. Themost prevalent are anxiety disorders, severe cognitive impairment (e.g., Alzheimers dis-ease), and mood disorders (chiefly depression). Suicide is at an especially high rate amongthe aging, especially among Caucasian males. Although schizophrenia and personalitydisorders are less common, prevalence data should be considered in light of the under-reporting and diagnostic inaccuracies common with this population. In terms of emo-tional or cognitive problems, most individuals experience them for the first time after age55; however, not all of these disorders occur for the first time in later life. Onset is pos-sible at all ages, from adolescence throughout the adult years, and severity and chronic-ity are highly variable as well.

The major issue with which future cohorts of aging people will have to contend isthe lack of enough adequately trained professionals who possess the expertise and expe-rience needed to understand the biopsychosocial origins and unique treatment require-ments of mental health problems in these cohorts. How will the future aging populationtolerate the lack of a well-trained and gerontologically enlightened health care providernetwork?

Barriers and Stigma

The underutilization of mental health services is probably a result of interacting biases.Mental health providers may avoid the aging client partially because of ageist myths,gerontophobia, and lack of expertise, while many of the aging avoid acknowledging their

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mental health problems because of the negative stigma associated with these difficultiesthat pervade the culture. The stigma of mental difficulties reflects and is reflected in so-cial attitudes and the way society relegates these problems to subordinate status in healthcoverage, a powerful synergy for mutual disincentive on the part of providers andprospective consumers. Additional contributions to the erection and maintenance of barriers to appropriate service include fragmented and less-than-adequate funding andreimbursement for needed services; inadequate coordination and competing priorities be-tween primary care, mental health, and aging service providers; gaps in service that re-flect a view of people as disparate diagnoses or unrelated needs; an alarming shortage ofproperly trained professional and paraprofessional staff; and the lack of an adequatelypowerful consumer voice. How will these barriers be addressed and removed in the fu-ture when a consumerist, activist cohort comes of age and resists ageist stigmatization?

Reliance on Managed Care

At present, managed care is the most prevalent payer model in the health care arena.Called managed cost by some of its critics, it has of late been particularly troubled bymanaged Medicare debacles and a failure to deliver on preventive services that address theunique, interrelated health care (physical and mental) needs of the aging. Limits on men-tal health benefits combine with an inadequate network of expert providers to limit ac-cess for those aging people in need of state-of-the-art care. As these models confront theireconomic and conceptual limits, the number of aging people continues to grow with in-creasing rapidity. The result is increasing pressure on our current system of care that ap-pears to be unprepared to answer the call for the health and wellness oriented system thatwould likely be the most beneficial and least costly in the long run. How will the busi-ness of health care in the United States respond to the converging gerontological chal-lenges of a provider shortage and the conceptual and economic obsolescence of its mod-els that it appears to be facing as the Age Wave hits?

Primary and Long-Term Care

In the acute care arena, older people turn first to their primary care providers when theyhave a mental health problem. More than 50% of those who receive mental health carereceive it from primary care physicians, probably because it carries fewer stigmas thangoing to a mental health provider, insurance plans encourage use of the primary careprovider, and they are usually more accessible. But many primary care providers are notadequately trained in mental health problems of the aging and tend to use psychotropicdrugs as the first or only line of treatment. Pressures from managed care economics alsoresult in briefer physician visits, often averaging 8 minutes in duration. Finally, many pri-mary care physicians have negative attitudes toward aging people that undermine physi-cians effectiveness. More desirable collaborative service models that coordinate mentaland physical health services in primary care are in the initial stages of investigation.

Long-term care settings such as nursing homes are characterized by high incidenceof cognitive impairments and dementias (notably Alzheimers and related disorders) andemotional disorders (especially depression) among their residents. Elderly nursing homeresidents are also prone to health conditions and medication side effects that cause cogni-tive and emotional symptoms. These older residents of care facilities confront significantbarriers to adequate care as well, such as a shortage of qualified mental health profession-als, lack of adequate knowledge and ongoing training for nursing home staff about men-

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tal health issues, lack of adequate Medicare and Medicaid coverage for the needed ser-vices, and problems in attracting the services of qualified mental health professionals dueto inadequate reimbursement policies. How will these problems be addressed as agingcohorts arrive at their physicians offices armed with scads of information gathered on theInternet about mental health issues of concern to them, and how will long-term care fa-cilities respond to the boomer children of their residents who are similarly informed andunwilling to settle for a shortage of expert providers to meet the entire range of theirloved ones needs?

WE ARE ALL AGING PEOPLE

The issues identified in the Surgeon Generals Report will play out in a society increas-ingly made up of professional and volunteer helpers, policy makers, and researchers whoare growing older at the same time. The us versus them issues will become we arethem such that aging will become a matter of personal interest for client and helperalike. We envision an increasing movement toward an entente of sorts between aginghealth care providers and their aging clients that we hope will create in providers a newsensitivity about the experience of aging, especially about the impact it has on ones senseof self. If this entente, or increased mutual appreciation of the aging experience in the con-text of being a helper, does emerge, it will be because each constituency will becomeaware of their common preference for an active later life. This awareness of how crucial itis to preserve access to all personal and societal resources that are needed to support pos-itive aging will, we believe, join the client and helper around a common belief aboutwhat aging could optimally be like for them.

This book is, in one sense, a beginning step to bring about the entente. We envi-sioned that our readers might either come to this volume with experience in helping oth-ers but with relatively little background in aging, or as experienced providers of servicesto aging people who are unhappy with traditional deficit-based approaches and have nothad much exposure to the clinical literature of strengths-based therapies. We hope toreach students or practitioners new to the field of aging services. We also hope that wehave provided a basis for lay readers to engage their own strengths in guiding their searchfor resources that enhance the quality of the aging experience. It is important to us topresent some valuable information people might use to enhance their own strengths asthey age, especially as self-advocates, as they seek out or utilize the services of helpers. Inaddition, this material was included so that people might increase their knowledge aboutaging and thus realize benefits through their own intervention. They might thus becometheir own helpers and not need to utilize formal professional services or intervene forthemselves in tandem with utilizing the services of others. The information presented inthis book from experts is intended to make readers better informed consumers who holdfast their strengths while seeking services and who resist surrendering their traditionalcoping abilities as the price of receiving help.

Obtaining quality medical care, counseling, and psychotherapy; utilizing availablecommunity services; and coping with illness are all challenges to ones sense of masteryand quality of life. We hope that the contributions in this volume help inform individu-als choices, stimulate their creativity and enable them to mobilize their own individualstrengths and those of their families, friends, and neighbors. These chapters are not a sub-stitute for expertise in any field of health care, but rather a way to identify the nature ofan approach to caring for aging people that might suit various preferences.

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MENTAL WELLNESS

We use the term mental wellness to reflect our belief that health and illness are not di-chotomously arranged in nature or in life and because people can, at times, in collabora-tion with knowledgeable helpers, move along the continuum toward optimal wellness ateach stage of life by dint of their own efforts. People have more options than to be sick orhealthy; they do not have to be sick in order to take advantage of the means to improvewellness. This is an especially important outlook for aging as a processpeople can havean array of illnesses as they age and yet enjoy wellness and a good quality of life.

We also think that the old Cartesian mindbody separation is fading from view andthat a growing body of evidence in the scientific and lay literatures is correct when it in-dicates that somato-psychic and psycho-somatic phenomena are mutually influencingand influenceable. Damasios (1999) writing on the neurological basis of the unity ofmind and body, and the postmodern view of illness and the central role of individual expe-riences of disease on prognoses (Morris, 1998), suggested that mental and physical domainsare inseparable and profit from approaches informed by these synergistic views. Fein-bergs (2001) work added another level of richness to the analysis of how the self as aunifying, perpetually created, process of the brain, is a lifelong process. He shed impor-tant light on the intricate, fluid, lifelong nature in which the holistic nature of mindbody unity are played out in ways seen throughout the human lifespan.

Although we have framed the issue as mental wellness, we are not ignorant of themany infirmities and illnesses that befall people as they age. Our use of the term wellnessis not intended to deny the existence of the maladies, frailties, and dependencies thatoccur in later life. We intend only to bring attention to the entire continuum of experi-ence that is aging and the need to recognize the assets older people bring to the experi-ence of their illness or dependency.

Though the terms wellness or strengths may not appear per se in every chapter, theyare included as organizing constructs and philosophical approaches to the subject matter.The absence of illness paradigms or terminology is one aspect of this approach; anotheris that the authors view aging as a process and an era of development and as the purviewboth aging people and their helpers, paid and unpaid. The wellness orientation and itstheoretical complement, strengths-based appraisal, assessment, and intervention (Butler,Lewis, & Sunderland, 1998; Cohen, 1993; Cohen, Kennedy, & Eisdorfer, 1984; George &Clipp, 1991; Kivnick, 1993; Kivnick & Murray, 2001; Lustbader, 1991; Rowe & Kahn,1997; Sacks, 1985; Sherman, 1993) are reflected in the use of terms, including skill, re-siliency, autonomy, collaboration and historical preferences. It is noteworthy, and perhaps a re-flection of how far we have come in the development of approaches that are applicableacross the entire lifespan, that the terms wellness and strength can be used in discussionsabout aging without fanfare as they would be for any other age group.

As pundits ponder the future of aging and of those who will age, the impact of sci-entific progress on aging as a future achievementand indeed, the very nature of whatit will mean to ageis open to revision. That alone will require us to re-think the essenceof the relationship between the helping professions and the aging people they serve.Featherstone (1995) predicted that technology (especially nanotechnology) will preventthe physical decline that has for so long characterized the narratives of old age andthereby expand the opportunities to constantly redefine the self. This, he proposed, willbring about the ability to give meaning in old age through freely chosen self-narratives,rather than through the experience of disability and dependency. If Featherstone is cor-rect, how might that change each of our future plans about our own aging and our future

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careers as practitioners? The concept of helping aging people may have to undergo radi-cal transformation, even a questioning of whether achieving mental wellness in later lifewill require therapy and therapists at all?

Strengths-Based Approaches

The strengths-based approaches we have chosen have a number of aspects in common,and we hope the reader will appreciate both the historical evolution and richly diverseapplications of theory and practice that have evolved. Though there are real differencesevident in the chapters, they share a core of assumptions that are particularly beneficial inwork with aging people. These include the following:

1. Client resources: All of these approaches assume that clients enter therapy withmany skills, capacities, and resources (personal and environmental). The primarytherapeutic endeavor is to elicit and channel appropriate and relevant clientskills toward the achievement of the clients goals. This is in contrast to manypathology-based approaches, which emphasize the necessity of clients having tolearn new skills and a new vocabulary in order to resolve their problems.

2. Collaborative clienthelper relationships: In pathology or deficit-based approaches,the relationship between client and helper tends to be hierarchical, with thetherapist or other clinician acting as a benevolent expert who has the responsi-bility of teaching the client new skills and that the helper alone knows what isbest for him or her. In contrast, strengths-based approaches emphasize collabo-rative clienthelper relationships in which the client and helper together seek todiscover which client capacities will prove useful for developing solutions in linewith the goals and outcomes that are important to the client.

3. Causality and time effectiveness: Whereas deficit or pathology models tend to spenda great deal of time in attempting to understand how unhealthy tendencies de-velop or maintain themselves, the strengths-based models discussed in this vol-ume give more attention to building on healthy tendencies that already existwithin a clients life. This process allows therapy to be efficient in terms of timeas well as of other resources.

4. Anti-ageist perspective: The aspects just outlined are of special benefit to therapistsworking with older clients because these processes prevent therapists from lim-iting the scope of their thinking and actions (in assessing or intervening) interms of generalizations based on age or diagnostic categories. Therapists are in-stead able to notice subtle possibilities and abilities in their clients that other-wise might have been missed. The principles of these strengths-based ap-proaches also benefit older clients because these individuals are not forced to takeon new roles based on societal myths about the deficits presumed to be intrinsicto aging in order to resolve their problems.

A FINAL NOTE

This book came about in response to a question one of us asked the other over a cup ofcoffee. We couldnt recall having seen a book that looked at strengths-based approachesin helping aging adults and their therapists who were coping with issues of living well

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as they aged in spite of the myriad problems that attend growing older in this society.Thus we decided to try to put one together that would elicit some creative conversations.We hope it will not be the last word on the subject.

We look forward to continuing the dialogue with you. If you have any thoughts orexperiences using these or similar approaches in clinical practice, or would be interestedin an interchange with the editors or chapter authors, please contact us at [email protected] [email protected].

REFERENCES

Administration on Aging. (2000). Profile of older Americans. Retrieved fromhttp:// www.aoa.gov/aoa/stats/ profile

Butler, R., Lewis, M., & Sunderland, T. (1998). Aging and mental health: Positivepsychosocial and biomedical approaches. Needham, MA: Allyn & Bacon.

Cohen, D., Kennedy, G., & Eisdorfer, C. (1984). Phases of change in the patientwith Alzheimers dementia: A conceptual dimension for defining health-caremanagement. Journal of the American Geriatrics Society, 32(1), 1115.

Cohen, G. (1993). Comprehensive assessment: Capturing strengths, not just weak-nesses. In M. Smyer, (Ed.), Mental health and aging (pp. 93102). New York:Springer Publishing Co.

Damasio, A. (1999). The feeling of what happens: Body and emotion in the making ofconsciousness. New York: Harcourt Brace and Company.

Dychtwald, K. (1989). Age wave. Los Angeles: Tarcher.Featherstone, M. (1995). Post bodies, aging and virtual reality. In M. Feather-

stone & A. Wernick (Eds.), Images of aging (pp. 227244). London: Routledge.Feinberg, T. (2001). Altered egos: How the brain creates the self. New York: Oxford

University Press.George, L., & Klipp, E. (Eds.). (1991). Aging well [Entire issue]. Generations,

XV(1).Hubble, M., Duncan, B., & Miller, S. (1999). The heart and soul of change: What

works in therapy. Washington, DC: American Psychological Association.Kivnick, H., (1993). Everyday mental health: A guide to assessing strengths. In

M. Smyer (Ed.), Mental health and aging (pp. 1936). New York: SpringerPublishing Co.

Kivnick, H., & Murray, S. (2001). Life strengths interview guide: Assessing elderclients strengths. Journal of Gerontological Social Work, (34)4.

Lustbader, W. (1991). Counting on kindness. New York: The Free Press.Morris, D. (1998). Illness and culture in the postmodern age. Berkeley: University of

California Press.Ronch, J., & Maizler, J. (1977). Individual psychotherapy with the institution-

alized aged. American Journal of Orthopsychiatry, 47(2).Rowe, J.W., & Kahn, R. (1998). Successful aging. New York: Pantheon Books.Sacks, O. (1985). The man who mistook his wife for a hat. New York: Summit Books.

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Sherman, E. (1993). Mental health and successful adaptation in late life. In M.Smyer. (Ed.), Mental health and aging (pp. 8592). New York: SpringerPublishing Co.

United States Department of Health and Human Services. (1999). Mental Health:A report of the Surgeon General. Rockville, MD: US Department of Health andHuman Services, Substance Abuse and Mental Health Administration, Centerfor Mental Health Services, National Institutes of Health, National Instituteof Mental Health.

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Sherman, E. (1993). Mental health and successful adaptation in late life. In M.Smyer. (Ed.), Mental health and aging (pp. 8592). New York: SpringerPublishing Co.

United States Department of Health and Human Services. (1999). Mental Health:A report of the Surgeon General. Rockville, MD: US Department of Health andHuman Services, Substance Abuse and Mental Health Administration, Centerfor Mental Health Services, National Institutes of Health, National Instituteof Mental Health.

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Front CoverContentsIntroduction

Mental Wellness in Aging: Strengths-Based Approaches

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Transcript of Mental Wellness in Aging: Strengths-Based Approaches