Jeremy J. Berry, Ph.D., LPC-S, NCC

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1 Jeremy J. Berry, Ph.D., LPC-S, NCC

2 A growing population Today, there are 37 million people age 65 or older in the United States. That number is expected to increase as baby boomers age. New programs are targeting baby boomers that promote health and prevent premature disease and disability.

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4 As the number of older Americans increases, their financial and medical needs become issues. More people will be drawing from Social Security while less people contribute to the system. Health care costs to the individual will rise as Medicare coverage becomes less adequate. Housing and living arrangements will be a problem for low-income elderly. A shortage of donor organs will present difficult ethical questions.

5 Typical physical changes Skin Bones and joints Head Urinary tract Heart and lungs Eyesight Glaucoma Macular degeneration Hearing Sexual changes Body comfort

6 Typical mental changes Intelligence Memory Adaptability Depression Senility

7 Develop and maintain healthy relationships Enrich the spiritual side of life Improve fitness Eat for health What other strategies come to mind when you think of healthy aging?

8 Many of the elderly feel marginalized and misunderstood. By gaining a better understanding of the many aspects of their existence and the many issues that they consider to be important in their lives, counselors may learn to be more empathic and accepting of this historically neglected population A wellness counseling approach was used since this strategy has been demonstrated in the literature to be a burgeoning model which may facilitate the aging population s improved care by pursing a total person approach for improving the quality of life in proactive and positive ways.

9 A way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community. Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000)

10 Improvements in healthcare, nutrition, and general living conditions, are all contributing to the increase in life expectancy. In addition to the increased life expectancy, we must take into consideration the population boom that we are currently facing in regards to the aging population. One of the primary mechanisms for the delivery of counseling services, specifically to the aging population, is group counseling. The interpersonal nature of the group process itself may be therapeutic for aging adults, especially those who are dealing with isolation or loneliness (Gladding, 2008).

11 The American Counseling Association has placed emphasis on promoting wellness as the foundation to the counseling profession (Tanigoshi, Kontos & Remley, 2008, p. 72). While, assessment tools for wellness have been extensively explored in the literature, Myers and Sweeney (2005) point to the scant literature available examining holistic wellness among older adults, specifically pointing to a need for "qualitative studies examining the meaning of wellness to older person," (p. 103). In a review of the literature, only one study was revealed to have worked specifically with the aging population. This was a study specifically on older adults and companion animals.

12 Wheel of Wellness Sweeney & Witmer Move away from physical health Interdisciplinary: health, quality of life, longevity Adlerian Psychology as organizing principle

13 Spirituality most important characteristic of well-being 12 spokes direct self as person responds to Adlerian life tasks of work and leisure, friendship, and love Components of wellness are interactive

14 Enhancement of dignity and worth. Counselors need to sell the positive benefits of counseling. Counselors need to attend to the physical environment. The counselor is often an advocate of the client. Goals should be short-term and clear-cut. Counselors need to attend to dependence/independence issues. Counselors need to attend to the age differential. Counselors need to attend to the client's place in history. Counselors need to diagnosis carefully with this population.

15 To decrease anxiety and depression. To reduce confusion and loss of contact with reality. To increase socialization and improve interpersonal relationships. To improve behavior within institutions. To cope with crisis and transitional stress. To become more accepting of self and the aging process.

16 Session 1: The initial session will begin with an introduction of the Wheel of Wellness. Each of the components of the wheel will be briefly introduced. In addition, an explanation of how the components on the wheel interact and are multi-dimensional, influencing one another. The session will include an opportunity for each of the group participants to review and reflect on the wellness model, and identify their personal feelings about wellness as a whole. Finally, we will discuss and reflect on the participants personal meanings of the specific components of the wheel. Session 2: In the second session, an informal assessment of wellness will take place. This will involve a global self-report of the participant s functioning in each of the components of the wheel. This will simply involve a rating scale of 1 to 10, with one being very low and 10 being very high levels of wellness. Once the informal assessment has taken place, participants will be asked to reflect on their scores, and attempt to identify if any patterns are present. Session 3-8: The sessions following the informal assessment will involve the participants using their assessments and reflections of the assessments to identify one or more specific areas of wellness that they wish to improve or change. Once these areas have been determined for each participant, the group will collaborate and work towards identifying treatment plan interventions to utilize in creating change in these areas. Worksheets will be created to informally track the participant s self-assessed feeling of wellness in these specific areas. Each session in this block will consist of evaluating the interventions, perceived change, thoughts and feelings related to the intervention and it s affect on their self-assessed rating, and any questions or concerns that the intervention may have created. The sessions will also focus on identifying objective measures for which to identify change, methods to effect change, and any resources that may be utilized to create said change.

17 Session 9-11: These sessions will consist of evaluation of selected interventions, and necessary alterations to the treatment plans that may be warranted. The participants will discuss as a group their perceived progress, and will be able to discuss aspects of their personal journeys. In these sessions, participants will follow up with the group leader on their progress, and will work to identify additional methods, tools, or interventions that may be added to their treatment plan. In the later sessions of this block, participants will begin to process their overall experience with a wellness plan, based on the wheel of wellness. Participants will explore the journey towards wellness, and their experiences in group counseling. Session 12: The final session will include additional follow up, in order for group members to gain closure at the conclusion of the 12 session program. Participants will be asked to reflect on what they have learned and what impact they feel it has had or will have on their lives. In addition, participants will also have an opportunity to share with each member what they have gained or learned from sharing this group experience. Note: The first few sessions will use dyads to build trust and rapport. The latter few sessions will include reflecting on emerging themes and exploring their experiences with group therapy and wellness counseling specifically.

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19 Release of anxiety or nervousness Maintain a sense of control over life Breaks down interpersonal barriers Increases pleasure, reduces pain Physiological homeostasis Promotes general well-being Release of anger 19

20 Humor as a healing power Humor within the subtask of self-worth Humor within the subtask of emotional awareness and coping Humor within the subtask of self-care. Humor within the life task of leisure Humor within the life task of love.

21 Many group members indicated that a wellplaced joke could alleviate a lot of physical and emotional pain even if only temporarily. Robert s War Story Members indicated that it was family and laughter and positive memories that helped through difficult point in their lives. "I've taken anti-depressants before, and I imagine they do whatever they are supposed to do, but a laugh, a really good laugh, is as good as any drug."

22 Group members often discussed their appearance and the changes that accompany aging. Members frequently used humor as a way of connecting with each other in their personal struggles and concerns related to changes in the body and sensory processes.

23 Humor was universally discussed as a coping mechanism. Many would use humor in anxious and even in angry emotional states as a way of dealing with these complex emotions. Others stated humor was a way of making a really bad situation seem less so, especially after a loss: "There was mourning, but there was a lot of laughter, and telling stories and that just seemed to help make things a little better."

24 Many members feared the loss of specific aspects of their self-care, but those who were at different points on the aging continuum where quick to utilize humor in explaining their adaptations. One member in response to concerns about thinning hair stated: "I'm running out of way's to hide my thinning hair, and the only wigs I can find are for Halloween. So, I suppose if you see a witch roaming in your neighborhood it might just be me."

25 Many of the group members were able to discuss various leisure activities they enjoy or have enjoyed over the years and in particular how aging has changed their access. For example one group member stated that one of her hobbies used to be cutting coupons but indicated, "if I did that now, my hobby would be cutting my fingers."

26 Humor plays a vital role for many members in their romantic relationship (past and present) and in the interactions with their families. Alice s Private Joke Many indicated that laughter was a sign that things were going well when pursing a mate. They indicated in various ways how humor had attracted them to their romantic partners in the past.

27 Counselors would be remiss not to utilize something that is evidenced as salient in the aging adult s life, and is evidenced in various fields to be a beneficial aspect of the human condition. Many counseling researchers have pointed to the advantages of using humor in counseling, and specifically the value of humor in counseling groups (Gladding, 2008; 2012). Counselor's should always be mindful and attentive of client's reactions, emotional states, and comfort levels when applying humor into group settings, (Gladding, 2012).

28 Gladding. (2008). Groups: A counseling specialty, 5th ed. Upper Saddle River, NJ: Prentice-Hall. Gladding. (2012). Group Work: A Counseling Specialty. Boston: Pearson. Myers, J. E., & Sweeney, T. J. (2004a). The indivisible self: An evidence-based model of wellness. Journal of Individual Psychology, 60(3), Myers, J. E., & Sweeney, T. J. (2008). Wellness counseling: The evidence base for practice. Journal of Counseling & Development, 86, Myers, J., & Sweeney, T. (2005). The indivisible self: an evidence based model for wellness. Journal of Individual Psychology, 61,

29 Myers, J. E., Sweeney, T. J., & Witmer, J. M. (2000). The wheel of wellness counseling for wellness: A holistic model for treatment planning. Journal of Counseling & Development, 78, Tanigoshi, H., Kontos, A., & rempley, T. (2008). The effectiveness of individual wellness counseling on the wellness of law enforcement officers. Journal of Counseling and Development, 86, Witmer, J. M., & Sweeney, T. J. (1992). A holistic model of wellness and prevention over the life span. Journal of Counseling & Development, 71,

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