Consultation, Please
February/March 2002 

Dear Consultant:
I have received a call from a 60-year-old woman, who got my name from the agency where I consult. Her sister is 54, and her mother is in her mid-80s. She feels that her mother is becoming more dependent and somatically focused, as well as lonely. The sisters feel resentful and pressured by their mother and are seeking a support group that helps children deal with aging parents. I need help in structuring such a group. Should it be time-limited or open-ended? Is it too problematic to have siblings in a group together? If I put these siblings in the group, should the entire group be composed of other pairs of siblings or couples who are also dealing with their aging parents? Even though I have run a number of groups over the years, I am not in this same situation with my parents who are still young and vital. Would it be better to find a therapist for the group who has had elderly parents? Your suggestions would be very helpful.

Sincerely,
Anxious and Uncertain

Dear Anxious and Uncertain:
I agree that a support group for children of aging parents is an excellent idea. I want to answer all of your questions with "it depends," however, I will do my best to share my thoughts with you. I would start this group as a 12-week, time-limited group with an option to contract for another 12 weeks. I like the 12-week model because it gives the leader and the participants the opportunity to work toward a point of re-evaluation. At that time, some of the members may choose to leave. I would then fill the group with new people. This would change the model somewhat because now you have another dynamic operating. I find that this keeps the participants from feeling as if they can never leave and provides an example for the reality that people come and go in our lives. They may all decide to stay for another 12 weeks and then they have recommitted to the task.

There are some good reasons for assigning two siblings to separate groups, the most important having to do with the subsystem. Because of their shared history, daily experiences with one another and their family dynamics, they would be an obvious subgroup within the group. If you feel confident of your ability to deal with this subsystem, you may still choose this option. If not, I would recommend against it. Including couples would bring a similar kind of challenge.

The co-therapist is also an important consideration. Of course, anyone who leads a support group should be well trained in group leadership. A co-therapist who has experience in issues dealing with aging parents might bring a nice complement. However, a solid co-therapy team takes time to develop. If you have someone who fits that description and you have successfully co-led other groups together, then co-therapy might work in this situation. Otherwise I would not recommend it.

A major task for you will be to determine how you will structure the support group in spite of the sisters' "cry for help." You may feel pressure from them to meet their needs just as they feel pressure from their mother to meet her needs.

Etta Martin, MSW, CGP, FAGPA
Lake Oswego, Oregan

Dear Anxious and Uncertain:

It sounds like you are in touch with your community. The problems of caring for geriatric parents are increasingly widespread as people are living longer and the baby boomers continue to age. The applications of group work can be very useful and effective in this area, but there are a few things to consider when planning such interventions.

The first consideration in the development of group interventions is the purpose of the group. In this case, you want to design a therapeutic intervention that will be useful for assisting individuals with the emotional consequences of dealing with aging parents. There are a variety of ways to go about this work.

Generally speaking, group work can be divided into three categories of the intensity of intervention. The psycho-educational group is best used for conveying an educational curriculum and makes use of group process to increase the intensity and depth of experiential learning. The counseling group uses interpersonal learning with an emphasis on shared experience and the exploration of historical data. The psychotherapy group focuses on interpersonal relationships through the concepts of projection and transference in order to help members understand unconscious distortion and inter-subjective experience. Psycho-educational groups are frequently curriculum-based and time-limited. Counseling and psychotherapy groups can function well in either time-limited or open-ended formats.

If you choose to treat both sisters together and wish to design an intervention that will be helpful in this regard, I would advise you to choose the psycho-educational model. This model can help them understand the underlying dynamics and tensions that people with aging parents experience. The sister relationship would be less confounding and, perhaps, even useful in a psycho-educational group, while it would likely be a source of difficulty in a counseling or psychotherapy group. Since your previous group experience has been limited in this area, I would advise you to seek consultation from an experienced colleague before you initiate this work. The decision whether or not to run this group alone or with an experienced co-leader is something that you would probably discuss with your consultant in the context of your clinical expertise and the type of group you intend to lead.

Joshua Gross, PhD, ABPP, CGP
Tallahassee, Florida

This Consultation, Please column was published in the February/March 2002 issue of The Group Circle.