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Recommendations About the Knowledge and Skills Required of Psychologists Working with Older Adults

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Recommendations About the Knowledge and Skills Required of Psychologists Working with Older Adults Professional Psychology: Research and Practice In the public domain 2003, Vol. 34, No. 4, 435–443 DOI: 10.1037/0735-7028.34.4.435 Recommendations About the Knowledge and Skills Required of Psychologists Working With Older Adults Victor Molinari Michele Karel Houston Veterans Affairs Medical Center, Houston, Texas Veterans Affairs Boston Healthcare System Scott Jones Antonette Zeiss Perry Point Veterans Affairs Medical Center, Veterans Affairs Palo Alto Health Care System, Perry Point, Maryland Palo Alto, California Susan G. Cooley Laura Wray Department of Veterans Affairs Veterans Affairs Western New York Healthcare System, Buffalo, New York broadly. publishers. Elizabeth Brown Dolores Gallagher-Thompson Veterans Affairs Boston Healthcare System Stanford University School of Medicine and Veterans Affairs allied Palo Alto Health Care System, Palo Alto, California disseminated its be of to This article is an initial attempt to furnish recommendations for the skills and knowledge psychologists one not need to work competently with older adults. We use two levels of competence across seven broad areas or is that are most relevant for professional practice. The first competence level is that required of general and psychologists who provide some professional services to older adults; the second level is that needed by more specialized experts in the field for practice and training. This article is not fashioned as a “how to” user document and is not intended to disenfranchise anyone. Recommendations are proposed that delineate the Association types of competence needed for specific geropsychology activities that are relevant to a variety of settings providing mental health services to older adults. individual the Psychological of use Adults 65 years of age or older make up approximately 13% of by the year 2020 (U.S. Bureau of the Census, 1996). With this our total population, and this percentage is expected to rise to 20% demographic surge there will be an increase in the number of older American personal the the by VICTOR MOLINARI received his PhD in clinical psychology from the University University of New York (SUNY) at Stony Brook. She is a clinical gero- for of Memphis. He is a professor in the Department of Aging and Mental Health psychologist for the VA Western New York Healthcare System and an of the Florida Mental Health Institute at the University of South Florida. His assistant professor of clinical medicine at the School of Medicine and solely areas of research interests are mental health interventions in long-term care Biomedical Sciences, Department of Medicine, Division of Geriatrics/ copyrighted settings, life review reminiscence, and personality disorders in older adults. is Gerontology at SUNY Buffalo. Her areas of research include behavioral MICHELE KAREL received her PhD in clinical psychology from the Univer- management of dementia, caregiver quality of life, burden of care, and intended sity of Southern California. She is a staff psychologist at the Veterans is health care utilization. Affairs (VA) Boston Healthcare System and assistant professor of psy- ELIZABETH BROWN received her PhD in clinical psychology from Florida document chology in the Department of Psychiatry at Harvard Medical School. Her article State University. She is the acting chief of the domiciliary at the VA research interests include late-life depression, advance care planning for This Boston Healthcare System and an assistant clinical professor of psychology This end-of-life care, and issues in geropsychology training. in the Department of Psychiatry at Harvard Medical School. Her research SCOTT JONES received his PhD in clinical psychology from Miami Univer- interests focus on issues of the seriously and persistently mentally ill, sity. He is the staff geropsychologist and neuropsychologist at the Perry program evaluation, and quality assurance. Point VA Medical Center, Perry Point, MD. His research interests include DOLORES GALLAGHER-THOMPSON received her PhD in clinical psychology interpersonal psychotherapy, neuropsychology of the dementias, and phi- from the University of Southern California. She is a professor of research losophy of science issues. in the Department of Psychiatry and Behavioral Sciences at Stanford ANTONETTE ZEISS received her PhD in clinical psychology from the Uni- versity of Oregon. She is clinical coordinator and director of training in the University School of Medicine and is also affiliated with the VA Palo Alto Psychology Service at the VA Palo Alto Health Care System. Her research Health Care System. Her area of research is caregiver interventions with and scholarly interests include depression, sexual dysfunction, psychother- diverse populations. apy with older adults, and interprofessional teamwork. WE THANK George Niederehe and Mary Jansen for their astute comments SUSAN G. COOLEY received her PhD in clinical psychology from the on earlier versions of this article. University of Florida. She is affiliated with the Geriatrics and Extended CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Victor Care Strategic Healthcare Group at the Department of Veterans Affairs in Molinari, Department of Aging and Mental Health/MHC 1440, Louis de la Washington, DC, where she is chief of Geriatric Research and Evaluation Parte Florida Mental Health Institute, University of South Florida, 13301 and chief of Dementia Initiatives. Bruce B. Downs Boulevard, Tampa, Florida 33612-3899. E-mail: vmolinari@ LAURA WRAY received her PhD in clinical psychology from the State fmhi.usf.edu 435 436 MOLINARI ET AL. adults requiring psychological services (Jeste et al., 1999), as well psychologists for a number of reasons: (a) It will help to serve the as a corresponding need for training in geriatric mental health profession of geropsychology; (b) it will act as a guide for training (American Psychological Association [APA], Interdivisional Task psychology students in geropsychology at the graduate, internship, Force, 2000). The need for specialized training in geropsychology and postdoctoral levels; (c) it will help psychologists to identify to address the common mental health problems of later life is their continuing education needs for serving older clients; and (d) based on the very extensive extant literature about how aging it will posit specific descriptive criteria for job positions that entail differs from other periods of the life cycle. Just as specialized varied amounts of expertise in addressing the mental health needs knowledge is required to treat children and adolescents effectively, of older adults. so too is such knowledge needed to treat the unique problems that The TAGG aims to provide recommendations for the skills and individuals confront in the latter half of life. Persons in their 60s, knowledge needed to work competently with older adults. A recent 70s, 80s, and beyond are likely to experience more negative life series of articles discussed geropsychology training within clinical events than younger or middle-aged adults. For the most part they psychology graduate (DeVries, 2001; Qualls & Ogland-Hand, also experience a variety of cognitive and physiological changes 2001), internship (Fruit, Gantz, & Hefner, 2001), and postdoctoral (e.g., decreased memory efficiency, decreased physical strength, (Hinrichsen, 2001) programs. That discussion was framed mainly etc.). Responding to these challenges, they draw upon their history with regard to the recommendations of the APA Interdivisional broadly. of effective (or ineffective) coping, as well as on their personality Task Force on Qualifications for Practice in Clinical and Applied style, social support systems, and values and belief systems that Geropsychology (2000) in their draft document concerning prac- publishers. interact (with other factors—e.g., genetics) to determine whether tice in clinical geropsychology. We have extended these efforts mental health or mental illness occurs. Understanding the adjust- and outlined in detail the skills we believe are necessary for allied disseminated ments of aging and the typical/atypical responses of older adults competent practice in postgraduate employment settings by mod- its be of requires a genuine interest in this stage of life, plus a broad ifying the framework of the 1992 National Conference on Clinical to spectrum of knowledge and skills (Bengston & Schaie, 1999). Training in Psychology (Teri, Storandt, Gatz, Smyer, & Stricker, one not or There is now an APA Committee on Aging (CONA), and 1992; reproduced in Knight, Teri, Wohlford, & Santos, 1995). By is clinical geropsychology has recently been awarded proficiency broad consensus, the 1992 report conceptualized three levels of and status by APA’s Commission for the Recognition of Specialties training in aging-related knowledge and skills: (a) general expo- user and Proficiencies in Professional Psychology. Although the profi- sure to aging; (b) training in clinical geropsychology compatible Association ciency status acknowledges that a certain set of skills and knowl- with proficiency status; and (c) training in clinical geropsychology edge is necessary to work competently with older adults, there has compatible with specialty expertise. Although that framework was individual been much debate about how to adequately credential those li- helpful conceptually in developing an understanding and definition the censed psychologists whose clinical responsibilities involve some of clinical geropsychology, we propose a simpler model for the Psychological
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