Mike Fox is Senior Practitioner and manager of the Older Persons’ Service in an alcohol agency in North London, and also works as Lead Clinician for Dementia at another counselling service in the same area.

Lesley Wilson is currently a lecturer in occupational therapy. Prior to this she was a practising occupational therapist and has many years’ experience of working with older people, both in the NHS and in the community.

Here, Mike and Lesley answer some questions about their new book, Counselling Older People with Alcohol Problems.

How did you come to do this work?

Mike: Before training to be a counsellor I had worked with older people in a variety of capacities and enjoyed it, so initially I was attracted by the idea of working as therapist with people with a lot of life experience – I imagined that the work might be very rich, and so it proved. Previously I’d had little experience of working with people with alcohol problems, other than a few who came through the detox when I worked in a psychiatric hospital. As time went on I became increasingly fascinated with the client’s stories, and particularly with the way that alcohol had become entwined in their lives, and what it came to represent to them in a very personal way. I also began to recognise common themes, which for instance helped me to understand why people with a certain type of temperament might use alcohol in a particular way.

As well, the people I meet are extraordinarily diverse – many of them certainly wouldn’t fit the stereotypical image that the thought of an older problem drinker might conjure up, and I find the sheer variety very stimulating. I also feel that it’s a privilege to witness how older people come to view their lives in retrospect – there’s an enormous amount to be learned about how to live one’s own life, I feel.

How did the book come about and why did you write it?

Lesley: We had the original idea some time ago, and it came really from the desire to capture the processes that seemed to be helping people at a time in their lives when typically it is thought that no further development or change would be possible. Mike wanted to make a practical guide available and accessible to others who might be inspired by the clients’ stories in the case studies. We also wanted to pay tribute to the courage and resourcefulness of people who, despite the seriousness of their alcohol problems, showed that they were willing and able to change.

I also recognised that Mike’s perspective as a practitioner echoed some work I had done in the community years before, where I discovered while doing my Masters dissertation that a high percentage of older people living with a disability also had significant difficulties with alcohol. So as well as counsellors, we hope this book will enable healthcare professionals working in the community and perhaps carers and family members to find a way of offering help in an area that is often ignored until it becomes a “medical” problem. As part of our proposal I carried out a literature search and there didn’t seem to be any other book like it.

As a married couple with similar interests but different backgrounds we’ve talked for a long time about doing something together, and as Mike is a current practitioner in the field and I’m an academic with experience of working with older people as an occupational therapist, we felt we could complement one another. We also took clear roles, he doing the initial writing with me editing each chapter and then the book as a whole. I also did the referencing, gave some advice on medical aspects, and got him started again when he was stuck!

How is counseling older people with alcohol problems different from counseling younger adults?

Mike: This is a fundamental question and we look at it in considerable detail in the book. We felt that if we could answer it successfully we would justify both the need for the book and for specialist services for this particular client group. In a way I’ve been led to make the comparison all the time, having run a small private practice where I see clients of all ages, although only a few of my private clients have presented with alcohol problems.

Simply because they have lived longer, older people tend to have more extensive and more complex histories of alcohol misuse. It’s not unusual to meet people who have been drinking problematically for 20, 30 or even 50 years. Also their relationship with alcohol might have gone through several phases, for instance a particular individual might have had times when he or she drank heavily every day, and at other times perhaps developed a pattern of binging, or yet again had spells of drinking normally or not at all. There are also certain life events that are more typically associated with older people and which can trigger or worsen a drink problem. As a counsellor you’re more likely to encounter bereavement, also serious heath problems. Retirement and redundancy can also have a big impact because of they tend to be accompanied by a change of status and loss of daily structure and purpose. For women the menopause can be a trigger – both the process and the aftermath; some women say that they feel they’ve lost an important aspect of their femininity. Some also believe that they metabolise alcohol differently after the menopause, and certainly physiological changes relating to aging in both genders mean that they will process alcohol less efficiently, and so it will tend to have a more harmful effect.

On a political level, it would seem that most funding for services for people with alcohol problems assumes the likelihood of both criminality and co-dependent drug use, and I rarely encounter either of these in the people I meet, who are 55 and over. Perhaps because of this, or at least in part, it is hard to attract funding for older drinkers, because the overall need is seen as less urgent – a mistake in my opinion.

What is the hardest part of your job? What is the most rewarding part?

Mike: In terms of working with older people with alcohol problems, I guess the transformational aspect makes it most rewarding. Anyone who overcomes a significant drink problem will have discovered or rediscovered considerable personal resources. Alcohol can act as a brake on the realisation of one’s potential. Once that is released people often go on to flourish in a way that they or others might not have imagined possible. We both believe that personal development is a life-long possibility and that any development is good at any time, and I find it particularly inspiring to see older people continue to grow and blossom.

As for the hardest part, in a therapeutic sense it’s working with the inertia that accompanies a serious drink problem – people get very stuck and it takes a lot of energy and hope on the part of the counsellor to encourage and support change, and to maintain momentum in the client’s progress. In a more general sense I find that older people are often patronised, and their ability to recover and make changes in their lives is often not acknowledged. Dr Martin Blanchard speaks in the Foreword of a ‘therapeutic nihilism’ that exists in attitudes towards the client group described in the book. One effect of this is that older people are often expected to fit into generic treatment systems, when they clearly have needs that will not be met by those systems. Thus the need for a specialist approach such as the book describes.

Who is the book for? What do you hope people will gain from it? How can it help to improve support and services for older people with alcohol problems?

Lesley: Our philosophical stance is essentially client centred with a practical foundation. This approach has worked with clients and can be adopted by others working in this area, be they counsellors, occupational therapists, social workers, community nurses or medical practitioners. Even family members or friends of an older person for whom alcohol had become a problem will be able to gain insight from the book, as will the person themselves. It may be that one of the stories resonates and leads that person to seek help or to draw solace from reading the evidence that change is possible.

Copyright © Jessica Kingsley Publishers 2011.

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