Sometimes things just seem to happen. Yesterday, Mary Ellen and I spent a long lunch discussing various changes to our practice. Of course I’d also asked for comments, thoughts, questions and recommendations in last week’s Newsletter. When I got home I found the following in my email:
Responses to Last Week’s “A Favor, Please?”
As we are in the midst on changing our model – at least the delivery parts – for 2020, it would be helpful if you would give us your suggestions.
How would you be most comfortable receiving services (in person, via distance delivery, on the phone?);
I’m told that Skype or a similar remote face-to-face interaction without the huge logistical and financial problems of travelling to meet you would be an ideal method. Body language and expression are important, and no one really wanted to speak to a disembodied voice. There are plenty of existing online tools for that.
To which I will add in reply: We have been experimenting with that for 6 months now and have found that the use of ZOOM, a secure service preferred by medical professionals, works very well and clients have liked it. It is now available for all consultations, sessions and followup.
What services do you think you would find most helpful (CBT? Assertiveness Training? Habit change? Motivational Enhancement? Other?);
A couple of people said they are tired of CBT being touted as the all-purpose cure for everything behavioral. They raised the interesting point that older people are usually well able to outwit the re-framing strategies of CBT with re-framing of their own. They further thought that CBT can work well for younger people with scant life experience who don’t yet understand the connection between thoughts and emotions, but older people can be crafty enough to hang on to a lifelong bond between a certain set of thoughts and patterns of emotional responses. From the few responses I got to this question, it seems simple habit change and assertiveness training would be most helpful because by now most of us already have strategies for enhancing motivation.
And I reply: We agree, though we will probably provide a CBT guide to those who are interested. Many of us, myself included, were interested in learning that a skill we had learned independently actually had a name and to compare our self-taught to the formal.
What is preventing you from changing your drinking habits?
The consensus here was simple habit. You get a reward over a long enough period of time and you become set in your ways.
Reply: Again we agree and note that habit also becomes ritual and we are as fond of our rituals as we are of all of our cherished patterns and behaviors.
What might motivate you to begin changing?
Same principle as above: if it’s no longer rewarding or if life changes don’t allow that same coping mechanism/reward system to continue as in the past.
Reply: Or if there is a big enough trade off. For example, as a single man in my 50s, quitting smoking allowed me to date a better selection of women. For many, vanity is also a reward and the price of drinking escalates rapidly after 50.
What else would you like to learn that I can address through these Newsletters?
Is it just loneliness or major life transitions that persuade older people that alcohol is a quick fix for not being able to cope with sudden or major disruptions and a loss of control, or is there much more?
Reply: I have always loved the comment by a client in his late 60’s made: “I realized that I was just using drinking to put in time waiting to die.”
But as noted, drinking fills voids created by retirement, children leaving, and a lack of structure in our lives.
It also mitigates physical and emotional pain and becomes a mainstay of social activities when more physical activities decline.
It’s difficult to make the transition from being scheduled by work and family to other activities – especially if you haven’t cultivated any interests before finding yourself bereft at 55+.
On behalf of Mary Ellen and me, I will add that over lunch we also talked a lot about our preferred client demographics. When we started out 15 years ago, I was 59 and she was 50. Our ages, we decided, made it most appropriate to work with clients aged 40+.
That was not a random numbers game. We had both spent a long time in gyms trying to find trainers who had any notion about working with aging bodies, joints, injuries and other age related considerations. The answer was pretty much, “no.”
Now that we have moved along to 74 and 65 respectively, we’d move the preferred age range up to 50 and older. This doesn’t mean we rule out working with younger clients, just that we, and they, all need to be assured be assured during the consultation phase that the fit will be an appropriate and productive one.
We also like working with smart, educated, informed and involved women and men, many of whom may just need to spend some time reflecting on what they might enjoy doing now that the constraints of professions and families have been fulfilled.
Your thoughts on this, and other matters will be appreciated and, please, don’t say, “Oh, well, someone else will ask/mention that thought of mine.”
Maybe they will, or not. That reminds me of my first college class when the professor said, “Ask! Whatever the question, ten others are wondering the same thing and don’t have the nerve to ask. So ASK!”