The Silent Therapist: Teddy Bear Therapy with Adults

Alex is a tall, thin, 86-year-old former psychotherapist now living in a nursing home, and walking with a walker. He experiences mild anxiety and depression associated with adjustment to his advanced stage of life development, and he experiences mild cognitive issues. I meet with him for life review therapy.

The Importance of Everyday Objects

Alex loves music and theater, and he wrote and performed in plays, in addition to practicing and teaching psychotherapy. He had studied in a Catholic Seminary yet decided against becoming a priest. He has a teddy bear named TJ in his room with a scarf around its neck knitted by his daughter. Alex was given TJ many years earlier, and for 30 years TJ served as his co-therapist. “I gave presentations at maybe 75 conferences with at least 75 participants each time, and I always brought TJ with me,” Alex said. “I would approach the podium and introduce myself. The audience members were probably wondering what was going on with this guy holding a teddy bear. ‘This is my partner TJ. He doesn’t have a lot to say, but he would be glad to meet some of you while I am speaking.’ Always, someone would raise their hand and ask to hold TJ. “While I was speaking, I would notice one person tap the shoulder of the one holding TJ, and pretty soon he would be handed along, person to person. When I was wrapping up and asking if there were any questions, one or more hands would shoot up, and someone would say, ‘We haven’t had a chance yet to hold TJ.’ The experience of TJ being at the meeting would create a warm sense of camaraderie, and people always spoke to me afterwards to remark on the special experience it had been for them,” Alex said. In his private practice, Alex had TJ placed in a chair next to his in the office. “Clients would walk in and say, ‘What’s up with the bear?’ ‘Oh, this is TJ. He just likes to listen; he doesn’t say too much; you can hold him if you’d like to get to know him better.’ Some who scoffed at TJ the first time, might return the next time and just pick him up and hold him without saying anything. “TJ was like a doorway to feelings and thoughts that clients might not get to for a long while if I had only used language. It was always remarkable to me the things that people remembered and talked about because they were holding TJ,” said Alex. He added; “With my students or clients, they look at me, and they see their projection on me. But when they look at TJ, they see into themselves; a part of their self they have not been in touch with, or for a long time, and they sometimes don’t know what to do with it.” “TJ helped me have a tangible connection to the child in me, and helped me evoke that in others,” Alex said. He added, “TJ represents innocence, and there are not so many ways in therapy, or in society, for an adult to access their innocence — and I don’t only mean childhood innocence, but a sort of opening to wonder and mystery and spirit — because if those things aren’t present in therapy, what are we doing,” Alex asked?

***

Teddy bear therapy has been around for many decades, yet mostly used in work with children. Alex found clever and effective ways to incorporate TJ into his teaching and therapy practice. At a time when he feels saddened by the need to adapt to a slower and less productive period, life review therapy validates Alex’s notable accomplishments and restores his positive sense of self-worth and makes room for his mischievous and warm-hearted sense of fun, which is where TJ comes into play. Questions for Reflection and Discussion What are your personal and professional impressions of the author’s work with this patient? How might you have addressed the patient’s relationship with TJ’s similarly? Differently? How have you made use of inanimate objects in your clinical work?

Spilling Over Modernity’s Borders and Boundaries: A Decolonial Story About Alzheimer’s, Family, and Migration

“¿De dónde eres?” My friend’s 9-year-old niece asked me shortly after we were introduced to each other during Christmas. This was in Bogotá last year at my high school friend’s place. She sat next to me, leaning slightly toward me. Her question seemed fueled by a kind of curiosity that two strangers at times share when wanting to rush through the unfamiliar and quickly find a common place from where to discuss matters of much greater importance, like her Christmas presents. It must have been around 15 years since my high school friend and I last knew about each other’s lives. Various life circumstances might have contributed to vanishing from each other’s lives—including living in two different countries—until whenever the day was going to come for us to meet again and pick up our friendship right from where we left off to catch up on whatever many years in between.

My eyes shot open and met her curiosity, sensing all over my body the shock of her question. Did she unwittingly render me foreign to and within my homeland? I wondered.

“Pues de aquí. De Bogotá. Rola 100%!” I said to her, stating what for me was the obvious.

“Es que hablas diferente.” She further explained.

“¿Y tu?” Le pregunté,” pretending to ignore the state of my body, and attempting to reciprocate an interest in our origins.

“De acá.” Me respondió, while organizing her Christmas presents for their exhibit.

My friend overheard our conversation. On the way to the kitchen, she provided some context to resolve her niece’s confusion and to create mine.

“Ella es de aca pero hace mucho que no vive aquí por eso habla así.” my friend explained with the tone of certainty of an irrefutable conclusion.

“Así cómo ???” I yelled in horror; but she had now gotten lost far back in the kitchen as the Christmas host.

Like many, I became well acquainted with the origin question as an immigrant, hence actual foreigner to the sociopolitical and material history of my host country, the United States (U.S.); as well as with the experiences of those who although were born in the United States are inadvertently or intentionally rendered foreign in their homeland by others. This is, when informed by discriminatory singular and monolingual principles about nationals and foreigners from a land. Having left Colombia as an adult, in the U.S. the socio, geo, and body-political history of Latin America/Abya Yala I carry, materializes not only in my accent but in my interactional manners, phenotype, epidermis, and knowledges, which intertwined with local racializing practices, continuously mark the well or ill intended curiosities of the inquirers, nationals or immigrants alike, about their assumptions about my foreign origins. Regardless of their intent, in foreign soil, I share my origins with my chest filled with air, trying out a new sense of pride in the diaspora evoked by its nostalgia, not quite reaching patriotism but maybe darn close to it, if I were to speculate on what incarnated patriotism would be like:

“From Colombia.” I usually respond to that question and sometimes I point at my wrist when I wear its colors.

Re-entering: From Here and From There Migration Experience

During the last couple of years, I have been spending more and more time in Bogotá than I ever have since the early 2000’s when I left. My mother’s health and increasing loss of memory called for it. Although no doctor would diagnose her with Alzheimer’s in her late 80s, that was the family’s narrative about that part of my mom’s life and our relationship with her still to this day. Her four daughters were no longer living in Colombia. My three sisters and I migrated to the U.S. at different times during our adult lives, for different reasons that required no explanation. Mom and dad raised us during the Colombian armed conflict, intensified by the international drug war and the U.S. intervention.

In a country living and enduring the ongoing wounds of war, poverty, and state neglect, as it is the case for many countries living through long-standing conflicts around the world, as I recalled, for many Colombians across various socio-political circumstances, since birth, the idea of leaving Colombia becomes part of what it means to live in Colombia, aspiring for refuge elsewhere. Violence humiliates the homeland and elevates the non-realizable promises of foreign land. Those of us who realized the idea of leaving Colombia represent the 6% of the population who currently live outside of the country—primarily in the U.S., Spain, and Venezuela. According to the Migration Policy Institute, Colombians are the largest group of South American immigrants in the U.S., representing 2% of U.S. immigrants. Colombian migration to the U.S. has increased three times as fast, from 144,000 Colombians in 1980 to 855,000 in 2022.

During our lives in the U.S., mom would come to visit for various periods of time, visiting with each one of us across states. My dad traveled once, which was more than enough contact with U.S. soil for him, given his politics. We would stay in contact through daily emails or texts, otherwise. Also, from time to time, I would travel to Bogotá for a long weekend or so for a visit. Before migrating, and all throughout the Covid pandemic, my oldest sister lived with and cared for mom in Bogotá until the impending heart-wrenching decision finally came knocking at the door to meet the four of us face to face.

The emotional intensity, and dedicated care my sister and her children had been providing mom with for the last few years had proven to be no longer sustainable for either of them. Con cabeza fría, we had to make the overdue decision, even against mom’s wishes that she no longer remembered. Mom needed to be relocated to a specialized nursing home for her proper care. She had outlived friends and close relatives. My father died back in 2008, and we heard that mom’s last living sibling, the oldest, Alberto, was still alive but bedridden in deteriorating health conditions. He died not too long after mom moved to the nursing facility.

My relatively advantageous immigrant conditions afforded me alternatives that only so many immigrants in the U.S. have in similar circumstances, with aging parents still living back in our home-countries. I began traveling to Bogotá regularly during the last year before mom died, spending months at a time with her while working remotely. My sisters would visit when able. Daily, morning and afternoon, raining or not, I would walk back and forth to visit mom at the nursing place in the north area of Bogotá from the small place nearby I rented during my stays. I would pick up on my way some kind of dessert for my mom’s sweet tooth that memory loss had forgotten to forget. I became very well acquainted with mom’s co-living folks and their visiting families; and also the nurses, aids, physical therapists, and cooking and cleaning staff, majority women, to the extent that exceptions for their visiting hours became the new visiting hours. It was through their lives—the only people I had close contact with at that point in Bogotá—that I re-entered a sense of living a life in Bogotá, although still having more than one foot in my immigrant life in the U.S., to which I remained virtually connected through a laptop.

Through life at the nursing home, I reintegrated myself to the familiar tensions of the Colombia Nation-State’ s sociopolitical heartbeat, revealing along the signs of the 24 years that have passed and have transformed both the country and my politics in the diaspora. The tensions were palpable. On the one hand, the advantageous circumstances of the families who could afford their relatives to live there were visible. And, on the other, so were the injurious sociopolitical conditions and longstanding neglect by the Nation-State toward the lives of the people working there. Although responsible for the care of the facility’s residents, they had to do so while undergoing living conditions that seemed to cry out in state neglect. This was one of the other jobs they needed for their survival and the survival of their family.

Some of their children were being educated under precarious conditions in public schools. Evictions from their home were more tangible month after month. The impeccable makeup of some of the women working in the kitchen kept hidden the marks of patriarchy’s hands from the night before, some of which was documented in futile police reports as well as in her self-defense fingernails imprinted on his skin. Their clothes served as curtains behind which their bruised bodies were concealed, while their bones would heal from their forceful impact against the wall, or the push down the stairs. Their children were their witnesses. According to the Colombian newspaper, El Pais, between May of 2023 and 2024, 149.017 family violence incidents and 630 femicides were reported in the country. Limping, the women would arrive on time at the nursing home after a 3-hours-long commute from the south of Bogotá to care for my mom with the best of dispositions possible. Story after story, the nostalgic Nation-State Colombia of the diaspora that I was so proudly holding tight to, wearing it on my wrist, and expanding my chest, started to melt throughout my body, transpiring through my skin, forming a polluted stream of outrage that took off running through la Avenida 19, running all the red lights, turning toward la Autopista Norte, eventually merging with Bogotá River, considered one of the most contaminated rivers in the world, according to WSP.

My relationship with mom that year was not exempt from a sort of re-entering experience. It was similar to how my re-entering to a life in Bogotá was. On occasion, mom would seem as if she could see in my face sort of a familial resemblance but not quite family. I was beginning to feel that way about everyday life in Bogotá although not linked to a matter of memory but migration. I recognized aspects of what I remembered was my homeland out of the unrecognizable features of the obvious changes since I left. I was able to discern some things but not others with my renewed borderland eyes as a Colombiana inmigrante en the U.S.

My life from when I lived in Colombia during the late 1900s met with my life as an immigrant living in the U.S. since the beginning of the 2000s only to discover they had already met over two decades ago and have become inseparable since. My memories from Colombia were never left behind. On the contrary, they carried me through the making of a new life in a new land. After all, we can’t separate ourselves from the history that makes us. I have been living both lives simultaneously, through a multiplicity unfolding either in Colombia or the U.S.

A sense of foreignness within the familiar, and a sense of familiarity within the foreign helped me discern the experience of dwelling in the borderlands, which my friend and her niece also brought out in the open during Christmas, when I reconnected with them months after mom died on March 29, 2023. The borderlands became a point for reflection on what it was bringing forth—difference—to ultimately transcend modernity’s definition of difference as fracturing borders or boundaries since the conquest of the Americas—the colonial difference. Walter Mignolo has written extensively on this topic.

The colonial difference refers to a hierarchy of separation (for control purposes) through the development of borders or boundaries that create races, cultures, Nation-States, identities, languages, genders, etc. Modernity’s colonial difference fractures the bones of the communal into hierarchical separate pieces whereby those lower in the hierarchy can be thrown down the stairs or against the walls of separation that it created. Thus, my friend nieces’ question about my origins, became a recognition of difference stemming from my 24 years in the diaspora crawling up my Colombian accent to renew it within a sense of plurality. My renewed accent marks a difference that does not have to be of borders, exclusion, fracture, or separation, but of relationality and connection out of what it means to live relationally, or in more than one world simultaneously.

I have heard many stories, mostly from Mexican, Chicanxs, Mexican-American, or Texanes, about their experiences when returning to their homelands in the Nation-State of México. They shared being made to feel that they do not belong on either side of the border: “not from here, not from there,” “ni de aquí, ni de allá [neither from here nor there].” I understand this to be a symptom of modernity’s logic of criminalization by difference and punishment when crossing the border. Anything that does not represent nationalism on either side of the border, thus promotes monolinguality, monoculturality, or singularity, is destitute and criminalized. On the contrary, from the borderlands of my experience, I am thinking about immigration interrogating the borders while being interrogated; thus, opening at the same time possibilities to rethink the fracturing premise of separation modernity promotes into being “from here AND from there, simultaneously, thus relationally.” This revised premise eases my body when facing the origin question by Colombians in Colombia.

Rendering the Familiar Unfamiliar: Radical Listening

More often than not, mom did not know exactly who I was, or when and where we may have met at some point in our lives. Only a couple of times, she recognized me as her youngest daughter, “marce,” as she used to call me. Although she never forgot her name, Gloria, she did not know where she was nor recognized her own image in the mirror. Sometimes I was her youngest sister, and other times, she would address me as her nurse or aid. When I would rub her hands, the touch would call her to reposition her hands and to start giving me instructions on how she wanted her nails done that day. When I would pass my fingers through her hair, sometimes she would address me as her hairdresser, or quite firmly in a tone I did not recognize, she would push my hand away demanding that I do not touch and mess her hair.

As much as mom did not remember that I was her daughter, I did not always fully recognize mom in the body and interactions of the 89-year-old woman living in the nursing home—except during her brief inconfundibles momentos [unmistakable moments] of humor here and there. This was not surprising to me, having learned about similar yet different stories from folks from various backgrounds with parents living with Alzheimer’s or dementia, not only in my therapy work. My family was now living through those stories but creating our own. Our story is also likely to be my story about possibly inheriting from mom a life with Alzheimer’s yet to manifest, at least as far as my memory can tell thus far.

Although not surprising, witnessing mom’s increasing experiences of discomfort, suffering, and loss of conversational abilities was at times hard. Yet, unexpectedly, under such unfortunate circumstances, not being remembered by mom at times opened alternative relational possibilities. But it required radical listening to recognize these as possibilities and through the rather overwhelming presence of Alzheimer’s. I have learned radical listening from various perspectives that I carried with me every day to the nursing home during my visits. These include perspectives on borders, memory, history, and aesthetics shaped by my lived experiences as a bilingual immigrant, my understanding of Narrative Therapy in English as a family therapist, and mostly by my engagement with the decolonial project from Abya Yala y el Caribe in Spanish and Spanglish as a member of the civil political society. These are perspectives that have shaped not only my family therapy work but my life as I write here.

Cognitively speaking, Alzheimer’s configured mom and I as strangers, no longer family. We became foreigners to one another. Most interestingly, however, it rendered us foreigners to modernity’s concept of the family. As an immigrant, working and living in community with immigrants in the U.S., questioning, revising, expanding, or delinking from the westernized idea of family has not been uncommon. Migration is a context for the necessary renegotiation of our ties and kinships within the context of voluntary or involuntary separation, and deportation. For example, during the current administration in the Nation-State of the U.S., during the last four years, nearly 4.4 million people have been deported to more than 170 countries according to the Migration Policy Institute.

Mom and I became foreigners to the western idea of the family settled and promoted in Colombia, and many other parts of the world, through Catholicism, heteronormativity, patriarchy, capitalism, and their institutionalization of relationships. As one of mom’s four non-adopted or non-in vitro children, our half a century-long enfleshed relationship was governed in great part by humanized fracturing assumptions of reproduction, motherhood, productivity, and gendered relationships founded on who gave birth and who was birthed to constitute a family. Thus, oddly, Alzheimer’s liberated us, not from accountability for all the headaches I caused mom over the years, rather, from thinking ourselves, and listening to each other, through the institutionalization of boundary-based relationships, its imposed social expectations, and Nation-State’s laws whereby the western family has been instituted as some sort of a social mandate. If I were to take a guess, these sort of institutionalized human laws and western concept of the family might be the sort of conundrums that would make la Pachamama, Madre Tierra, shake the earth. Mom’s forgotten aspirations for my life and my sisters’, which included growing up to become Colombian mothers, with good husbands, and decent, healthy, economically independent (from men), and hard-working women, were no longer shaping our relationship.

Deinstitutionalized by the unfortunate circumstances of Alzheimer’s, thus no longer being a Colombian mother and a Colombian daughter in the modern sense, we learned each other and cared for each other otherwise, sometimes minute by minute. The fracturing logic of the family boundaries planted by modernity was removed. Thus, I understood care to be instead about honoring the relationship with the person I owed my existence to in so many ways in addition to giving birth to me. As a family therapist, I am attentive to what the global and western concept of family imposes on relationships in an exploration of what sort of relationships are possible otherwise or in addition to.

My relationship with mom was unpredictable and in constant movement. It was to be discovered by dwelling in the moment of its expression. We had to discover who we were, a cada momento (every moment), according to the memories invoked and received as they came, no matter what. Was I the hairdresser, the woman who does her nails, her sister, one of my sisters, her nurse, or any other character out of my mom’s history? I could not arrive at the nursing home with certainty of who I was, but with clarity of where my existence—and my sisters’— came from. I became someone only through the act of being with mom and our memories, some of which we invoked together.

We connected through the ever-changing moment of the circumstances that brought to life some of the memories of what we were made of. The circumstances I am referring to were for the most part sensorial. The senses evoked sparkles of memories, interconnected with other memories, both hers and mine. The taste of the daily desserts, my touch, the temperature of my hand over hers, the boleros we listened to, the noise from the novelas on the TV we stared at, pictures of her younger life, the colors and textures of my clothes, my gray hairs, the co-living folks’ speech or appearance, the birds’ colors and their singing having Bogotá’s traffic as their symphony far in the background, as well as the colors of the flowers around us when we sat outside in the garden evoked memories intertwined. Those memories that have shaped, among other things, our half a century relationship, not only formed our lives but who we were to become moment by moment. I realized I was mom’s sister, por ejemplo, only in the brief moment that she saw me as her sister. Undoubtedly, we were radical historical and relational beings.

I can’t help to think about how social relationships, including relationships within the context of westernized therapy look like when we are to arrive at the encounter with someone else not with certainty (or doubt of) of who we are as therapists but with clarity about where we come from—as historical beings. This shifts away from the mainstream conceptualization of the therapist as an empty (no history) interventionist, solely performing according to the regulations of the institution and professional Eurocentric theories to be good or effective therapists. As historical therapists, instead, we become available to engage and receive the encounter with another, attending carefully to our histories, intentionalities and how we are shaped by the experience of the encounter. Thus, similar to who I became when visiting mom, who is the therapist is not independent from the encounter with who consults. The therapist becomes a therapist in the encounter with the person who is consulting. This shift requires an initiative to des-institutionalize the therapist, and to foreignize westernized therapy perspectives that situate an ahistorical therapist.

The Sensorial Grammar and Temporality of Memories

As mom’s cognitive abilities continued to deteriorate, it seemed as if for those of us around her, her presence in this world began to disintegrate into oblivion. She was talked about, no longer engaged with, her body moved from one place to the other, and words were put in her mouth, at times necessarily. Her existence was for the most part reduced only to her possibilities, or lack thereof in her present, in the here and now. Although her body was present, the growing absence of thought, reason, and the ability to access frameworks of intelligibility to express ideas in the present moment seemed to cast doubt on her very existence. Hence, if we were to recognize mom’s existence and vivid presence in this world, it required us—decolonially speaking —to overcome modernity’s spatial (here), temporal (now), universal assumptions. It also meant to cast doubt on the overemphasis on cognitive function, (capitalist) productivity, modern storytelling (or framework of intelligibility), and conversational skills as the only ways of being or existing. Then, it became more possible for me to continue to relate to mom, to learn from her, and to be transformed with her.

I came to understand that the sensorial had become the grammar of our communication, through memories. Mom’s life was unfolding through her bits of memories that situated us in their respective temporalities. Although evoked in the present, mom’s slivers of memories were transgressing modernity’s contemporary framework, its universalized linearity—past, present, and its spatial metaphysics that places the present as the monopoly for the principles of what is real and represented as real. She brought me into her life to take part in events that were happening before I was even born. When some of the aides or co-living folks would overhear our conversations at the nursing home, however, it was not uncommon that they would mistakenly “correct” mom’s temporality when instructing her about their (modern) sense of time—the time most of us operate under. They would persist in telling mom what year, place, and person she was, alluding to the calendar present even though it did not match the temporality of her memories. I could see in mom’s face deep concern and confusion by their efforts. She was in complete disbelief and shocked by how wrong and confused they were.

“What are they saying?” She would ask me.

Thus, even as an unborn person, unquestionably I was mom’s companion through the pieces of her history from a time that for folks in the nursing home and in the majority of the Eurocentrically educated world, was not chronologically feasible. Both of us experienced those brief moments often to resolve whatever concerns she may have had, at times involving her parents and siblings—my grandparents, aunts and uncles, all biologically dead—and her childhood home in La Candelaria, in Bogotá’s historic downtown. She worried if we had locked the house after we left, or if we had brought the keys with us, if we had enough time to eat dessert and get home in time before her younger sister, Estella, would get there, or Alberto, her oldest sibling, would pick us up. It seemed as though the sensorial grammar of our communication implicated mom’s entanglement with what decolonial theorist Rolando Vázquez calls a relational idea of time and space that doesn’t have either a geometrical, chronological, linear, or circular understanding of time like modernity marks reality.

I got a sense of the temporality of mom’s memories not by asking mom her age, since she no longer had reference to that kind of time-thinking. Modernity’s temporality—defined by calendar date, clock time, age, or generations—were not determinants for tracking her stories or a reference to time. Instead, it was the people who featured in that memory and its setting that gave me a reference to the time of the events, making them feasible. Her experience in the present was happening through her history—that is, through her memories from a time when her parents were alive, she was living in la casa de La Candelaria with her siblings, and I had not been born. Hence, there were no westernized life span or human developmental theories that would serve as frameworks to interpret her experiences.

Instead, the vegan cheesecake de maracuyá of La Despensa, the bakery around the corner of my rental, would bring to the surface memories that contained mom’s lived experiences with their own temporalities in no specific order. Events would unfold through particular relationships and their settings. Her memories jumped from one moment to the other according to what the cheesecake called for, and I jumped along. Following her memories was more helpful than listening to them from assumed theories of time, stories, and development. I would say, decolonially speaking, that relational time re-dignified mom’s existence that modernity’s capabilities of erasure through its overinflation of cognition, the contemporary idea of time, and the metaphysics of presence had rendered it suspicious. For modernity, Alzheimer’s had placed mom in an evacuated present time—with no history. She was seen as living in an empty time like Walter Benjamin’s because all that counted as a measurable reality was no longer mom’s reality. Thus, on the contrary, from de-modernity, I would say that by radical listening to the plurality of mom’s lived experiences in their own terms that modernity destitutes through erasure, the senses restituted.

Sensorial Invocation

One of the settings or temporal references that would come up quite a bit in mom’s memories was the colonial casa de La Candelaria of my grandparents. It was the house where mom and her siblings were born and raised until she married dad. This was also the house that kept many explanations of the scars still visible in my body—head, knees, and face by roller skating throughout the house from one patio to the other, running up and down, and playing with my sisters on the swing set by the large fig tree in the back patio still standing. Every weekend mom would take us to visit our grandparents. The house was finally sold to an Italian man much later after my grandparents died. He renovated it into a hotel, maintaining its colonial architecture.

Late afternoon on Sundays when Bogotá’s traffic would be more bearable, I would drive mom from the nursing home to la casa de La Candelaria. The first time we got there I was dying of anticipation for the memories and experiences we were about to live together and for what I was going to learn about mom’s history once she would see the house and the colonial neighborhood. I was hoping that seeing the material presence of the house we have visited several times, through her memories, imaginatively, from the nursing home, would call upon a flood of pieces of memories here and there, unleashed from Alzheimer’s and running loose through La Candelaria’s narrow streets, passing through la Catedral Primada were she married dad, right across from the presidential residence, el Palacio de Nariño.

Overjoyed, I would yell out calling and pointing out various landmarks of our shared history through the neighborhood. I had not been there in years! It was extraordinary to be back. To my surprise and quite a bit of disappointment, my persistence in calling upon mom’s memories was futile. The house we had been at through the memories evoked and configured from the sensorial grammar of our relationship was not the material house of la casa de la Calle 11 con 2nda in the year 2023, nor its representation. It existed in a different temporality.

Over a year after mom died, cousins on my dad’s side, my sisters, and I were finally able to arrange a time to meet in Bogotá and drive to my dad’s family farm in Sasaima, one hour away with no traffic, to bury mom’s ashes. She is buried next to my dad’s, my paternal aunt’s, and paternal cousin’s ashes. They are overlooking the mesmerizing landscape of the Andes mountains, surrounded by the farm’s variety of lush vegetation that my dad had a deep connection to. The scars on my body that la Casa de la Candelaria could not explain, the farm in Sasaima could from rolling down the hills, swimming, and barbecuing with my sisters and cousins during the various trips with dad’s family growing up. Unlike the scars of the women working at the nursing home, these were privileged scars of a life from the minority in Colombia also living in the midst of Colombia’s armed conflict. Privileged and all, even so, neither la casa de La Candelaria nor the farm in Sasaima were exempt from becoming sites for violence where kidnappings took place of an aunt and cousins on both sides of the family while I was still living in Colombia.

During our day or weekend trips to the farm growing up, at lunchtime the family would get together and sit around the large dining table to eat what the land offered–herbs, vegetables, and fruits among other foods. We were always served delicious vegetable soup with cilantro. In the diaspora, I have experienced being at that table and sipping soup with cilantro millions of times. Cilantro calls on that memory. In a split of a second, cilantro opens the door for me to enter into that moment although I am on U.S. soil. It brings me to the sensing of the taste of food, the light coming from the wood windows, the touch on my skin of Sasaima’s humidity in the mid 70’s, and the crackling sound of the straw woven mats. I can’t recreate that experience otherwise. I’ve tried. I can see static images but can’t experience the sensation of being there that cilantro brings to life.

Returning to the farm in 2024, I was amazed by being at the same table, eating the food of the land, and soup with cilantro. I couldn’t believe it. It did not take me too long to realize though that it was a different “coming back,” it did not feel the same as the experience of the memory from the diaspora. It was as if the memory linked to cilantro existed in a life with a different temporality, in a parallel reality, yet intimately connected to the material farm. Just like mom’s experience of driving by la casa de La Candelaria in 2023, the vividly sensed farm within my connection to cilantro also belongs to a reality that was embedded in a different temporality, and therefore a different relationality. It is a place I can no longer drive to on my own—no matter the traffic or the day —but I can taste my way to it.

In connection to a decolonial premise, I would say that la casa and the farm exist in memories that do not subscribe to an understanding of modernity’s contemporary, its linear temporality, and notion of reality as presence. Although I would say that our memories surfaced in the present as expressions from a relational time, relationally, not always on our own volition, but under certain circumstances, such as sensorial. According to Vázquez, these memories, like all our memories, live in a plurality that is always moving. Hence, memories are not chained to a particular date or someone’s age in a dead or static past, for example. In that sense, these memories are not representations of the material in the present—mom lived certain moments of her day at La Casa de la Candelaria while being at the nursing home, but could not recognize the material house on Sundays when we drove by.

Our lived experiences live in our memories and grow their own heartbeats, giving us life. We are made of memories, collective memories, with their own lives, sensings, and times. Our existence comes from those memories. Thus, it might be more suitable to say that memories are beside us. They are not deep in history but wide in history, next to us or in front of us, accompanying us, guiding us, and constituting our lives, even though they do not always show up in the present, unless relationally and sensorially called upon.

Like my memories, mom’s seemed to be interacting with other memories, perhaps being that the reason why it was possible for me to join her in a moment in her life when although I had not been born, memories of my aunt, uncles, grandparents and the house better helped me to be there for her and with her. Therefore, although mom’s ability to recall events that took place in the nursing home that morning, an hour ago, or last week kept dwindling, her memories interconnected to mine and our senses kept alive aspects of what she had lived, shaping how she lived, and continue to live through us, her four daughters’ memories and the memories of all she had contact with, perhaps even before she was born.

Her existence spilled over modernity’s placed boundaries of her skin to re-exist via her relational memories in a relational time that has kept her alive after her biological death. Mom got to re-exist, inadvertently putting doubt to and rendering suspicious for me modernity’s persuasive cognitive driven and over inflated perspectives that previously rendered mom’s life doubtful and suspicious, when her life was reduced to be only cognitively spoken about.

Re-existence: Restitution by De-institutionalization

After getting over my disappointment from my mom’s unexpected response to La Candelaria, I chuckled a bit and rolled my eyes while driving back to the nursing home before it got dark. “Really?” I thought. Although I had been experiencing and learning from the ongoing and uncertain movement of my relationship with mom, and attentive to what the unpredictability that each bit of memory would offer to us, my over-a-decade of experiences as a therapist, academic, and researcher—Eurocentrically trained—couldn’t help it but to show up.

I realized that I had begun to identify a pattern of response from mom to “study it” and identify its conditions or context. I tried to generalize it by manufacturing similar conditions for the sustainability of the pattern of response. I wanted to replicate it. In doing so, I was attempting to manipulate mom’s response at my will by driving her to la casa. Ugh! I was guided by my own assumption and best intentions to create a “happy” moment for mom. I am fairly confident in saying that this is somewhat similar to modernity’s logic of knowledge production in therapy.

Based on the therapeutic model’s theory of change—or what the therapist believes (based on research) makes people “happy” (well, stable, healthy, or problem free etc.), interventions are identified with expected outcomes (via research or clinical case examples) to be replicated (mostly to a homogenous population). Such interventions are technified or manualized for easier distribution, consumption, and implementation for others to use with the persuasive generalized promise of delivering an outcome of change to help a-historical people. I am afraid that by doing so, I was imposing a boundary between the subject (investigator) and object (mom) to arrogantly identify sensorial tools for change, to technify and manualize our relationship based on modernity’s arrogance to self-define what is good for others.

Very gladly so, unintentionally perhaps, mom sort of delivered a candid middle finger—not the first nor the second in her life—at my attempts at technifying our relationship. I received her delivery happily. I had re-institutionalized our relationship, losing sight of the possibilities that come from the borderlands, memories and their sensorial grammar, relational time, and defamiliarization from modernity’s logic of erasure.

Mom’s implicit middle finger reconnected me to our lived experiences to sense more clearly what institutional practices do and fracture, like the institutionalization of the land, bodies, relationships, healing, and histories. Thus better discerning deep connections—being from here AND from there—to my home-land, in various relational times, my languages, and relationships with the people I owe my existence to, the food the land offers, the Andes where my parents ashes are spread, la casa and the farm along with their explaining histories, the Bogotá altitude, the strangers in the street, the acquaintances of the bakery around the corner, and the long-time friends and the people they owe their existence to. These are the sort of experiences that contribute to de-institutionalizing my work as a therapist and training therapists, to begin conceptualizing our work first and foremost from the histories that make us.

Author’s Note: I want to thank Jill Freedman & Gene Combs at the Evanston Family Therapy Center and their 2024 training cohort for listening to my reading of an earlier version of this story, which helped me revise it. 

Impactful Encounters: The Truth About Therapy in Nursing Homes

What do you imagine it might be like to spend a day doing psychotherapy in a nursing home?

Well, no, it would not be like that.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

In some nursing homes, there are many patients from age 40 to 70, with disabling or sometimes terminal diseases and medical conditions, who might likewise suffer from major mental illnesses, a history of trauma, and/or substance use disorders. And all of this can play out in the social dynamics between clients and sometimes understaffed, overburdened, and maybe inadequately trained caregivers.

Staff persons often turn to behavioral health clinicians with complaints about the “behaviors” of clients. A key part of my work is to help staff persons see how “behaviors” might be trauma reactions, or manifestations of pain, or psychiatric disorders, or medical conditions, or simply responses to the style of approach used by that staff person.

Challenges to Nursing Home Psychotherapist

While I am protecting my clients’ basic confidentiality, as a consultant psychotherapist, I understand that I am not practicing in a vacuum. I am seeking to relieve the symptoms of my clients while helping the staff to better understand and respond to the needs and symptoms conveyed through sometimes troubled and troubling behaviors.

The 10 clients I met with on this particular day each had major medical and psychiatric needs, were facing the end of their life, were actively grieving. Many had histories of difficult personal relationships. The clients were all in their 60s and 70s. Many were socially avoidant and isolated, some tended toward paranoia, and were argumentative, while some experienced auditory hallucinations. Nevertheless, and almost to the one, all were lonely, fearful, and frustrated by a loss of control.

I encountered each of these individuals in the vividness and complexity of their situation, tried to help them gain new perspectives on their experiences, better recognize their available choices, and to consider alternate ways of thinking and acting. Therapy can support persons facing the end of life and can help them better appreciate the psychiatric nature of peculiar subjective experiences. It can also widen the focus of attention from their medical condition to their whole self.

Nursing homes provide settings for meaningful, challenging, and beneficial psychotherapy, and I strongly encourage therapists to consider practicing where the need is so greatly concentrated. Look, you are not going to find such dynamic cases in any other setting.

At the end of this day, I got in my car, and I felt tired and drained. But why, I wondered, should I interpret my tiredness as being heavy stress? None of the clients I saw that day would say the encounter had been stressful; they would each say it had been relieving and encouraging. The encounters ended with expressions of thanks, handshakes, and comments about looking forward to the next session.

As I drove home, I could look back in my mind’s eye at each client and see ways I had helped them or eased their burden on that day. Was the work stressful? Sure. But I chose to maintain perspective and balance, and take care of myself, while enjoying a rewarding sense of fatigue from a day’s good work.

Questions for Reflection and Discussion  
What is your first reaction to the author’s message about working clinically in a nursing home?

What personal and professional challenges would you anticipate in this setting?

What countertransference reactions might you have in this kind of work?  

The Elder in Exile: Psychotherapy with Older Adults

A frustrated and depressed nursing home resident recently described the facility as “a place where unwanted elders can be exiled.” Through our therapy conversation in that session, he came to acknowledge that he did have problems with his memory and his health, and that his facility residence was reasonable — even though unwanted — and was not a rejection by his son. “I know he’s only doing what he thinks is right for me.”

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

The Emotional Plight of the Nursing Home Resident

Many residents of nursing homes view their predicament as a rejection, or an exile, or an imprisonment. Many blame family members for the situation and try to pull the heart strings of loved ones in efforts to get them “to take me home.”

Many adult children weep as they speak with me about the conflicts they feel over the placement of their mother or father in the facility. Daily care at home with family is desired by all, yet available to only a few.

The older person living in the nursing home may feel a loss of home, family, their former roles, and too often, their sense of the value of their life. Some older people feel not only cast out by others, but inadequate due to the infirmities of their advanced age and their medical problems.

As I speak with seniors in psychotherapy at nursing homes, I discuss the specific aspects of their situation and seek to place some of their experience in a broader cultural and societal context. For example, I talk of ways that “the Elder” has traditionally been venerated in human societies.

Whether sitting around a fire in the cave, or in a small tribe, or a simple village, it has been the Elder who others looked to for history, stories, and advice. The younger members of the tribe or clan or family came to the Elder to learn the lore and lessons of their people. Others listened to and memorized the stories told by the Elder, and those stories they passed along when they, in turn, became an Elder.

The older nursing home resident might feel adrift from their family and their former life, but the value and the lessons of their life endures, and the sharing of their personal stories — whether in life-review therapy, with family, or with others at the facility, is a key part of reclaiming and affirming the value of their experience.

I encourage residents to share their stories with me and others in their life. I point out and affirm the dignity and value of the person’s journey through a long life. I speak to seniors of ways the society has changed, and how elders might not socially be held in the respect that their lives deserve and have earned.

Some people have suggested that nursing homes ought to have daycare programs attached to them, for the mutual benefit of old and young. But I think that it might be more productive, and developmentally appropriate, to have programs for troubled teens associated with nursing homes. Then, a teenager might share her problems about a relationship, her parents, school, or a career choice, and the senior might be able to understand and share suggestions, relate anecdotes, and offer guidance that might be helpful and in line with the long history of ways younger persons have been helped and guided by the wisdom of the Elder.

“Okay, but I don’t know if I really am wise, and I have all kinds of problems,” an elderly lady said as we discussed these ideas one day. I point out that throughout the long history of human life, the Elder who others looked to and venerated, likely also experienced problems with balance, and with short-term memory, and with urinary incontinence; but that did not erase the value of what they could contribute to younger generations.

It is important to share the stories of one’s life. As we age, we might become less active, and we might forget some of the recent events, but we might retain long-term recall of long past events and situations and relationships — and the sharing of those stories can enrich the understanding and the development of the younger person.

A nursing home sponsored a program a few years ago in which all the staff wore a round metal pin labeled “I’m a Future Senior Citizen.” That program enhanced the awareness of younger workers about the aging process. We each may now be, or may later be, senior citizens. Aging does not invalidate the adventures and lessons of a full life. A key task for the elderly person is to share their tales, and that is as it ever has been, and should be. And one of the most valuable tasks a therapist can undertake with the elderly is to give them the opportunity to share their story. 

The Costs and Benefits of Virtual Reality in Psychotherapy

Learning to Weather a Patient’s Emotional Storms

Edith typically experienced a fire-hose intensity in the flow of her emotions. She would dye her hair in bright colors, and these colors changed almost as often as her moods. She could be washed over by waves of anger or sadness. She frequently stormed in rage at her caregivers in the nursing home, or on the phone with her son. During psychotherapy conversations, her anger often dissolved into tears. The symptomatic features of her Bipolar I disorder were like a flashing neon sign on her forehead.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Part of the therapeutic work with Edith’s case was to educate the staff that her dramatic and unpredictable swings of mood from manic to depressed and her sometimes rapid speaking were elements of her illness. Edith would also verbalize sharply critical comments to her caregivers: “You don’t even care, you don’t listen, what do you get paid for, anyway!” I thought it was important to help the staff to appreciate how reacting with strong personal emotions to her symptomatic behaviors might provoke even greater instability. They were taught to maintain a sense of role boundaries, avoid personalizing her actions or comments, establish clear expectations for daily care, set limits on unreasonable or unacceptable behaviors, and see how those steps would add to the effectiveness of their care and to their professional satisfaction.

The Pain of Virtual Rejection

One morning upon greeting Edith, I was assailed with, “My fiancé dumped me!” As I sat down, I thought, “what fiancé?” She’d not been in a relationship. Edith had a tablet computer and spent many hours playing a virtual reality game. Her avatar was a slim and pretty lady who owned a florist shop and was a personal fitness trainer. As she was interacting that morning with the male fiancé avatar, another female avatar approached and claimed that he was her boyfriend, and the male character “virtually” walked away with the other female character.

In response to our conversation, Edith was able to acknowledge that she had designed her avatar as an entertainment, and a partial fulfillment of things desired yet not available in her present life. But she was unable, at that moment, to realistically distinguish between herself and her fantasy avatar, or to distinguish her emotions from those she projected onto the avatar. The stress of the situation triggered a psychotic episode for Edith. She experienced a loss of ego-boundaries.

I consulted with team members at the facility about ways to manage Edith’s care and treatment. Psychiatric hospital care was not indicated because she made no threats to herself or to others, and an involuntary admission might add to her sense of rejection from persons and supports available to her at the home. Safety checks every 15 minutes were unobtrusively put in place, and staff would make frequent, brief contacts to help her regain her sense of self and her composure. Privately, I wondered if one day I might need to develop a therapy avatar and enter virtual reality settings to conduct therapy interventions.

Four years later, I worked again with Edith at a different nursing home. She had been living in an apartment and was helped by home-based care providers. She’d become ill with an infection, went to the hospital, then to the nursing home for further care prior to discharge home. Since I last worked with her, Edith had experienced significant diminishments in her eyesight, her memory, her mobility, and her overall functioning. She did not remember having worked with me in the past. As we sat for therapy one morning, Edith said that she’d been trying to compose and memorize a poem, because she could not write due to visual loss.

She dictated the poem, and I wrote it down so she could bring it home with her. In her poem, Edith was confronting the many losses she’d experienced, and additional ones she anticipated. Her poetic reflections were sorrowful yet realistic and reasonable given her situation. She showed no indications of psychotic symptoms and was no longer using a virtual reality game. “I know it’s getting darker for me,” she said, “But I just have to face it.” Her medical condition had worsened over time, yet she showed an improved psychological ability to deal with her circumstances. Edith was also more comfortably willing to rely on people in her life who provided helpful services.

***

Postscript: Virtual reality systems are playing an increasingly prominent role in entertainment, education, business, and in the treatment of mental illnesses. Will the use of virtual reality be a positive influence in all cases, or might it be risky or possibly harmful for some? Might virtual reality headsets be a sort of psychosis-induction device for some vulnerable people? How will we as psychotherapists better understand how risks and benefits of virtual reality might vary for different people? Time, experience, and research findings will help guide our future steps. But we can at least proceed with a sense of caution, as well as curiosity about potential new and helpful approaches.

Questions for Thought and Discussion

How might you have clinically addressed the situation with Edith and her virtual fiancé?

What are your thoughts about the use of AI in psychotherapy?

Would you like to gain familiarity with AI in therapy? If so, what kind and for what purpose(s)?

How to Help Clients Change the Narrative of Aging

'I want to tell people approaching and perhaps fearing age that it is a time of discovery. If they say – ‘Of what?’ I can only answer, ‘We must each find out for ourselves, otherwise it won’t be discovery.’

(Florida Scott-Maxwell, The Measure of My Days)

Psychotherapy and Ministry: Trafficking in Metaphor

Who doesn’t relish the odd adventure to spice life up, be it bungee jumping, looking for love online, or watching a thriller on TV? Major or minor, firsthand or vicarious, adventures are essential, it’s been said, to a robust sense of self.

But might aging itself be an adventure?! The very idea seems a contradiction in terms. Before I propose that it isn’t, let me make a confession.

Prior to becoming a gerontologist, I was a protestant minister. In that capacity, I did my fair share of counseling, seat-of-the-pants though my listening skills were, but I’m no psychotherapist. What follows, then, are thoughts from the sidelines alone and should be taken, if not with a grain of salt, then with this admission in mind.

My sense, though, is that the two fields, therapy and ministry, share a key thing in common. They both traffic in metaphor; by which I mean, for instance, that there is always the possibility for a chance turn of phrase leading to an image that can be enlisted to help someone gain insight into their situation and move forward with their lives.

Given the profile of the average congregation, those I dealt with were mostly older adults. This might well have turned me off, as it can some psychotherapists — the feeling being that they are simply too old, and their problems too entrenched to benefit from counselling of any sort. However, I had no choice. They were “my people” and it was my job to get to know them. What I realized, though, was that they were often the most fascinating to work with.

Compared to my younger parishioners, these older adults had richer stories to listen to and learn from. And in attending to them as closely as I could, less as a professional, really, than as a friend, I felt that I was providing them with something that was implicitly healing. I call it “narrative care,” a concept that takes in everything from full-on psychoanalysis to soulful conversation. And because they had that many more memories under their belts, they had that much more inner material on which an aptly deployed metaphor that emerged amid our exchanges might work its magic, enticing them to re-story a little their way of looking at life. The metaphor of aging as adventure, I suggest, can do just that.

Growing Old: A New Narrative About Aging

Since switching from ministry to gerontology, my appreciation for the role of metaphor in both language and life has only intensified. The best example is my 30-year interest in the metaphor of “life-as-story," or what Ted Sarbin calls the “root metaphor” of narrative. This led me into a sub-field known as narrative gerontology.

Drawing on insights from narrative psychology, Narrative Therapy, and (in my own case) narrative theology, narrative gerontology focuses on the biographical dimensions of aging as opposed, say, to its biological ones, dimensions to which gerontologists, certainly geriatricians, devote a disproportionate attention. It focuses on how human beings are hermeneutical beings — makers of meaning — and how our main means of doing so is by making up stories, big or small, about events, the world, and ourselves. And it focuses on how our self-stories, these meandering works of imaginative non-fiction, these myths by which we understand ourselves, change over time, and the effects of that change, for better or worse, on our overall well-being. It looks, too, at the storyline we subscribe to about aging per se.

Whereas gerontology remains dominated by a biomedical paradigm, which, with the best of intentions, pathologizes aging as a problem to be treated with all the anti-aging strategies we can muster, narrative gerontology represents a different starting point for exploring the complexities of later life.

Rather than defaulting to a storyline of aging as a downward drift to decrepitude and death, as an intrinsically tragic trajectory or “narrative of decline” (which older adults can unwittingly internalize, as can therapists too), narrative gerontology looks at aging through the lens of a more optimistic narrative, a better story. It views aging as a matter of growing old, potentially, and not simply getting old. It views aging as a way to the light and not the darkness alone, as a narrative not merely of decline but of discovery, of adventure.

Depression, Decline and Narrative Foreclosure

Before proceeding, let’s consider the narrative challenges that older people often confront. These can underlie and, if unaddressed, exacerbate the many other challenges that later life brings. Since I’ve written elsewhere on these challenges — which go by labels like narrative loneliness, narrative loss, narrative dispossession, and narrative imprisonment — I won’t go into them here except for one that deserves singling out. It is narrative foreclosure.

Narrative foreclosure is the premature conviction that our story has effectively ended, that no new chapters are apt to open up, no new characters or themes will thicken the plot and take it in fresh directions. While our life itself — talking, eating, going here, going there — continues apace, our “story” of it is over. Granted, narrative foreclosure can befall us at any age.

When you’re 20 and your lover bids goodbye, you can suffer an acute case of it, and hurling yourself into the river seems a reasonable course of action. Why go on? The story of you riding off into the sunset together and living happily ever after will not come true! But later life, I fear, renders us unduly vulnerable to this condition, and thus the depression we may be diagnosed with and the pills we’re prescribed, when a dose of narrative care might work equally well to re-open our story. Here’s how it happens…

We retire from the career that defined our identity and our self-story loses a vital source of support. Our children get work in other parts of the country, taking our grandchildren with them, and our story-world shrinks still more. Our life partner departs this life and with them goes our raison d’etre. Our vision and hearing, mobility and autonomy grow more limited until we’re relocated to a nursing home where our world is reduced to whatever we can squeeze into one little room.

Though our life itself keeps plodding along, “the story” is all but over. Intensifying our sense of loss is, of course, the narrative of decline that permeates our culture and quietly penetrates our hearts. But, real as the decline surely is, it’s not the only narrative in town. Our stories aren’t stuck in stone, in other words. We get to choose the ones by which we live and age.

Alternative Narratives of Later Life

In The Wounded Storyteller, sociologist Arthur Frank reflects on his time as a cancer patient and identifies three broad storylines by which people facing such conditions can make sense of their experience. First is the restitution narrative, where you reason “this too shall pass; I’ll be back to normal in no time.” Second is the chaos narrative, when the doctor says the tumor is inoperable and you have mere months to live, and the story of your life is thrown into a state of foreclosure from which you might never recover. Third is the quest narrative, where you interpret your illness, however serious, as — at the bottom — an opportunity to learn and an invitation to live life on a deeper level.

I’d like to build on Frank’s typology and propose that aging itself (often implicitly perceived as “a sickness unto death”) can be experienced in these three same ways. The restitution narrative goes like this: “If only I exercise more, do more puzzles, and drink less liquor, I will extend my life … indefinitely.” Such a storyline feeds emphasis on “successful aging” or “healthy aging” that are regularly promoted and obviously have their place.

Then there is the chaos narrative: “I’m old; I can no longer do X, Y, and Z, so my life is basically over.” This narrative can fuel the depression, if not despair, to which many older adults — especially men perhaps — may succumb. It's a recipe for narrative foreclosure.

Third is the quest narrative. “True, I can no longer do X, Y, and Z, but, as frustrating as it is, this is just one more chapter in my story. And there’s something to be learned in it, things to see that I couldn’t see before. This is new territory with new horizons to approach.” I see this narrative as underlying the positivity which, however “wounded” they might be otherwise, many older adults exude, despite (often because of) the troubles they’ve seen. It’s as if — as Wise Elders, perhaps? — they’ve taken those troubles and fashioned them into a good strong story: a narrative of adventure even…

Near Death Experiences and New Adventures in Aging

Aging as adventure — while not the whole story, I believe, warrants consideration. In fact, I’ve spent the past two years doing precisely that, reading and scribbling to where I have over 250 pages of single-spaced, typewritten notes that I hope someday to work into a book.

At present, these are grouped around four broad directions that I see the adventure leading: outward, inward, backward, and forward.

I’ve been toying with aging as adventure downward and upward too, but I’ll sketch just these four here. I see them, though, as tightly entwined. Movement in one direction is eventually movement in another. Also, movement in certain directions may come more naturally for some, with certain personality traits (like “openness to experience”) than for others. But I’ll leave such permutations and combinations for future reflection.

Outward and Inward

Depending clearly on our income and our health, aging can usher us into a phase of life where we’re open to fresh endeavours. This can mean, upon retirement for instance, if not bungee jumping, then learning a new language, or taking up the piano, or trying our hand at painting, or going on that long-dreamed-of cruise, and generally cruising outside our comfort zone. In the process, we may become acquainted with sides of ourselves that we barely knew existed, thus thickening the plot of our lives in ways not feasible when raising our families and keeping the wolf from the door — whatever form or forms that wolf takes.

Every person has their own unique kind of wolf and/or wolves. With each such venture, we open new subplots, welcome new characters, weave new themes into the stories we are. Our horizons keep widening, including our horizon of self-awareness.

Concerning the adventure inward, we have more time (if not inclination) to tackle what’s been dubbed the “philosophic homework” of later life, something that may be neither easy to do nor appreciated by those around us. Sooner or later, though, it is our duty, Jung insisted, to turn inward. The longest journey, the saying goes, is the journey inward. Longest, often loneliest, but perhaps also most pressing, and sooner or later, it has us looking back.

Backward and Forward

The adventure inward leads to the adventure backward. It leads to an examination of our past, or at least the stories in which we’ve enshrined it. It leads to life review, which for Erikson is a core developmental task of later life, and a very narrative one at that. I call it “the autobiographical adventure.”

This adventure — fraught, like any undertaking worthy of the word, with both revelation and risk, promise and peril — can come to us naturally, of course, insofar as time-past becomes more compelling for us to contemplate than time-future. But it may be prompted, too, by changes in our brains themselves, improved cooperation, for instance, between left and right hemispheres, plus increased openness to paradox and contradiction, to uncertainty, ambiguity, and metaphor — all of which, it’s argued, heightens the autobiographical drive.

Going with that drive and accompanied by a skilled listener, gazing back across the years, there are discoveries to make, patterns to discern, secret corners (not always cozy) to investigate, issues around trauma or abuse, legacy or grief to be acknowledged, and overall, pieces of the puzzle, positive or negative, to try and fit together. As we ponder “the mystery in my story,” to quote a former student, we may well find that we’d gotten the story wrong, that the past wasn’t as horrible as we’d assumed.

The adventure forward, however, could seem the most controversial, and cruelest, to consider. In what universe does aging as an adventure forward even make sense!? We’re born, we suffer, we die. End of story. What is there to look forward to?!

To speak of the adventure forward requires looking at the links between aging and spirituality. A few years ago, I did so in a public lecture in which, intrigued by literary scholars’ insights into the problematic nature of “endings” in narrative generally, and by research into Near-Death Experiences (NDEs), I mused on the process of aging as a near-ing death experience. As such, it possesses several of the transformative elements that NDE’rs routinely report.

Besides the panoramic life review that the experience commonly entails, these include a decreased attachment to material possessions, a deepened appreciation for the preciousness of life, a sense that this world is not finally our home, and a major reduction in our fear of death. Death is viewed as transition, not termination, as a horizon beyond which we can’t yet see, a doorway to an even greater adventure maybe; the very sort of view which, in one form or other, the world’s great spiritual traditions have long espoused.

More recently, I’ve been reflecting on aging as a process of going slower, deeper, and wider into the landscape of later life. By “wider,” I mean a broader horizon of understanding — a bigger story — that moves aging out of a biomedical worldview and situates it amid the multi-dimensional mysteries of the cosmos itself.

Narrative psychologist Mark Freeman, writes openly, for instance, about “the transcendent horizon of the life story,” a theme which, despite gerontology’s reluctance to broach it, theorists of “gerotranscendence” and “transpersonal gerontology” are more than open to entertaining. It is one, certainly, that author Florida Scott-Maxwell alludes to when, writing in her 80s, she asks rhetorically, “Is life a pregnancy?” To which she answers, “That would make death a birth.” And it is one which scientist-mystic, Teilhard de Chardin, hints at with his cryptic phrase, “the hidden mystery in the womb of death.”

If such language has any merit beyond that of fanciful phrasing or wishful thinking, then it points, I think, to the need for a significant reconfiguration — a major re-genre-ation, if you will — of what aging is ultimately about. A shift, in short, from tragedy to adventure.

Helping Older Clients Shift Their Narratives

These are early days in what, itself, is proving to be a vast adventure: an adventure of ideas. Who knows where it will lead me? I’m certainly uncovering many questions in my quest.

For instance, how to enlist the adventure metaphor in a group setting versus one-on-one, or with the deeply depressed, or those at death’s door? And where on earth is the “adventure” in dementia?! So, my efforts might well turn out to be a wild goose chase. We’ll see.

Is this not, though, the mark of a bona fide adventure? We set out with no exact knowledge of where we’ll end up. Amidst the twists and turns, setbacks and surprises that are invariably involved, we don’t know — can’t know — how things will turn out. Yet we press on all the same, with curiosity and courage, humility and hope … and hopefully a bit of wonder too.

Naturally, the metaphor of aging as adventure will not be everyone’s cup of tea, nor every clinician’s either. But as agents of restorying in your older clients’ lives, as story companions walking beside them for a while, whether you buy into it yourself, you might find them open to giving it a try. And why not? If it nudges them toward a more inviting myth by which to live and age, then what’s there to lose?

Questions for Reflection and Discussion

How does the author’s notion of the narrative of aging impact you?

How might his ideas help you in your work with elderly clients?

How does your own relationship with aging impact your clinical work with the elderly? The dying?

What countertransference experiences have you had with clients who are dealing with aging, mortality, and dying?

* Editor’s Note: While he is not a therapist, I asked Dr. Randall to write this essay with you (the therapist, the clinical supervisor, the trainee) in mind.

Psychotherapy with a WW II Survivor: Bearing Grief with Grace

An Incalculable Loss

Sakura was born in 1931, in the Japanese city of Nagasaki, a major port city and center for shipbuilding. She enjoyed a pleasant childhood with many friends and family. The early years of her adolescence were overshadowed, though, by the increasingly grim circumstances of her country being at war.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

On August 9, 1945, the day seemed ordinary for the 14-year-old Sakura, until in a flash, nothing ordinary remained, after an atomic bomb was dropped on her city by the U.S. Upwards of 80,000 people were killed directly, and many more later. Nagasaki was attacked, in part, for its role in shipbuilding.

I felt a cold chill of fear the first time Sakura told me about having survived that unspeakably horrific event and its devastating, life-altering aftermath. I felt ashamed that she had suffered indescribable losses, and that my country had made that assault on her home city.

The Shadow of Grief

Sakura was in her late 80s and lived in a nursing facility where I was working. She always smiled, was impeccably dressed, and stayed active socially, having many friends among the other residents and the staff with whom she joined in on the many group activities. She was referred to me for psychotherapy, and although she had not been formally diagnosed with depression, she suffered depressive reactions during anniversaries associated with her losses.

Working with Sakura, I had assumed that she might feel great anger towards America and Americans. My assumptions were upended when Sakura shared that she had married an American soldier several years after the end of the war, that she had lived in America, raised her children and grandchildren here, and had enjoyed a mostly happy life. Sakura deeply grieved over the death of her beloved husband a few years earlier.

Sakura’s remarks about Nagasaki were always brief, factual, and matter-of-fact. I never heard her verbalize blame or vent feelings of anger, and I never saw her publicly display her most deep and personal (painful) emotions. Sakura would discreetly weep as she spoke of the sad events in her life during our private therapeutic conversations. On the occasions of major anniversaries, she would spend the day fully dressed while lying still and sad and silent on her bed. Thus, on August 6th, the anniversary of the atomic bomb attack on Hiroshima, on August 9th, the anniversary of the attack on Nagasaki, and on the anniversary of the death of her husband, she did not speak and would barely eat or move. Yet, she would be up and smiling and greeting others the following day. Those were the days she set aside for her most public showings of grief and perhaps even protest, although neither were likely her intent.

There were so many things I wanted to know about her wartime and life experiences, but I curbed my curiosity and attended to her choices of what to reveal or not. The importance of her dignity outweighed my inquisitiveness. I work with many persons who have been deeply traumatized, and for some, a probing therapeutic approach might undermine the fragile balance of their defense mechanisms. Some people have lost so much control it can be important to respect the choices they make about what or when to disclose or discuss traumatic topics.

I thought of Viktor Frankl and his comments about the many ways persons responded to the horrible circumstances they shared with him as prisoners in Nazi concentration camps during World War II — the same war that had forever changed Sakura’s life on the other side of the world. Frankl recalled how some prisoners turned against their own fellow sufferers, seeking advantages by aligning with their captors. Some collapsed inwardly and died soon after. Some chose an entirely different course by becoming the best person they could be.

Sakura was one of those remarkable individuals who could see good, remain good, and live fully, despite inexpressible suffering.

  

5 Simple Questions to Improve Your Work with Elderly Clients

In the long-term care setting where I work, residents have a far greater amount of life experience than they do control and influence. This might contribute to many of them losing their sense of worth and appearing frail, or even foolish, to the younger workers entrusted with their care. Wisdom is the distillation of lessons learned from life experiences and evidenced in fleeting comments or responses rather than in detailed and articulate expressions. This wisdom, however, may be lost or obscured by cognitive impairment or language problems.  The idea for our Wisdom Project arose in the course of uncounted hours of psychotherapy, during which I was privileged to hear the lessons and insights derived from the long and often quite challenging life experiences of the residents with whom I have worked. I’ve found that all too often, these residents have feared that their invaluable life experience has gone to waste because they are no longer in what most would consider to be an active stage of life. Or that a young staff person might overlook the depth of background and knowledge still present in an otherwise faltering and frail man or woman under their care.  I developed a simple questionnaire for select residents—those who seemed most able to verbalize responses. I believed that gathering their thoughts would provide them with a sense of validation and empathy, which would, in turn, provide workers with a glimpse of the wisdom that is all too often obscured by their physical and cognitive frailty. The following are some of the questions I developed, and several select responses.  What have you learned from your life experience? I’ve learned to be more patient. I’ve learned to be quiet and listen to other people. It helps me to not be selfish. At the time you don’t think things matter, but they do. The choices you make are more important than you think. So, make good choices. I’ve learned to communicate with people. I was too shy and reserved and passive. I should have more strongly pursued my dream to sing. I learned to love. I think it is very important to have a good marriage. My ability to love has grown as I’ve gotten older. Hold close, but not too close, the ones you love. I learned that the important things in life are marriage, children, friends, and an active life. Those are the things that teach you appreciation of life. I learned how valuable it is to have a loving, caring family. Everything else comes second. I have learned that life is brutal; it is hard on your soul and body and mind. It is hard to comprehend why life must include illness and death, but life still has its bowls of cherries. You can’t answer the questions of life with simple answers; you need heart.  What does illness teach you?   Illness teaches you that you have to be strong. I try to understand the meaning of illness, medically and spiritually. It has made me stronger. I had to learn to rely on others. Before, I thought leaning on others was cowardly. When there is illness, you want to help, to remove suffering. But you cannot always do that. I should just talk to myself, and just turn my feelings around the other way. Learn to take better care of yourself. But you cannot rely only on yourself. You sometimes need others. Even when you are ill you can still help yourself, to a certain degree. Don’t expect people to do everything for you just because you are ill. Illness has taught me a lot about caring, about understanding, and soul searching. You learn how a person can endure the trials of illness. You learn that you don’t give up. Illness teaches you that you shouldn’t try to take on too much at one time.  Who taught you important lessons in life, and what did you learn from them? I lost my mother when I was 4 years old. I had to rely on my father and we became close. He taught me what to expect from life. He taught me not to believe everything you hear; you have to experience it for yourself to know if something is true or right. I had a doctor who pulled me through a bad part of my life. He taught me to take one day at a time. To deal only with today’s problems today. That helped me to not be overwhelmed by the problems I had then. My mother taught me that it is important to be honest and kind. To be kind and try to help; that is what matters. To be honest no matter how much it hurts: but it pays. My sister taught me to stand up for myself. My father loved us. He put his arms around us and provided and protected us. He taught me honesty and responsibility, and to be kind to others. I worked for someone once who taught me to keep going despite pain and problems. My mother taught me to work hard on my education and to prepare to take care of myself, and to take care of my appearance. My brother and I helped each other through hard times. That taught me a lot. My father taught me to always reach higher.  What would you like to teach others? Patience is one thing. You’ve got to have patience. You will be able to do many things if you believe in what you really like, and really put your mind to it. Have more faith in yourself. Don’t be afraid to ask for help; there’s always more available than you know. Learn all about finances and how to manage money. Be honest and don’t lie. It’s very important not to lie. To be kinder. Staff people should be kinder because your attitude toward a resident is noticeable, and it really influences how I feel. You should mix in with others. Get involved and stay active. If you take a job, follow through with it. Don’t drop short or give up on it. I would like to teach people how to listen to others. How to care and be kind and gentle.  What lessons or advice would you like to offer to the workers at the nursing home? Be more patient. Get in bed and try being a patient for a while. I want to tell the young women to not give away yourself too easily to men. It will lower your self-esteem. There are too many pregnancies and too few marriages for young women now. That means there are too many irresponsible and immature men. Don’t go sleeping around when you are young. Hold out for a better man. It is important to have a good marriage. Life is about more than their boyfriends, and cigarettes, and time off and on at work. I’m here as a patient. Do what you can for me. Just pay attention to me and do what you can for me. Make sure this work is what you want to do, being around sick people. If you just want it because there’s no other job, forget it. Have patience with the residents. Don’t always say I’m too busy. Listen more closely. Make time for individuals. If you’ve had a divorce don’t jump quick into many relationships. Stay within limits with your money. Buy a house or a car and save your money. Be more content with what you already have. 

**** 

In the course of developing and implementing the Wisdom Project, I have learned how important it is to see the individual resident not just in their symptoms of today, but also in the story of their full life, and to help her or him find and affirm the lessons in that story. It is important to look respectfully at all a person may have been prior to the needfulness of now, and to be open to learning from the painfully acquired wisdom of each person. 

Working Therapeutically with Generational Conflict

Conflict between generations in a family is normal and even within bounds, healthy. But strife between loved ones can be painful and distressing, damaging not only some of our most important relationships, but also the self-esteem and sense of well-being of everyone involved. When it occurs between adult clients and their older parents, therapists and clients are sometimes in danger of simply repeating old stories about how the parents failed, disappointed, or abused their children. But it can sometimes be far more therapeutic to use this time to re-evaluate this thinking from a new perspective.

My own non-scientific data gathering from clients, supervisees, students, and colleagues meshes with the results reported in a 2020 article entitled “The Psychology of Family Dynamics Amid the COVID-19 Pandemic” in the Chicago School of Professional Psychology’s Insight magazine. There, the author notes that COVID’s global outbreak, with its accompanying lockdowns, significantly, and often adversely, impacted family relations. Political differences and social anxiety are also impacting families, such that intrafamily responses to COVID and to politics are widening gaps between generations in families all over the world. So much so that there has been a call to expand public health services to address the intergenerational issues with which families increasingly struggle. This was highlighted in a 2020 article entitled “We’re in This Together: Intergenerational Health Policies as an Emerging Public Health Necessity” in Frontiers in Human Dynamics.

A Family in Crisis

Julie* is a married teacher in her late fifties. Her parents are in their eighties. I had worked with Julie when she was much younger to help her deal with a mix of depression and anxiety that she had been struggling with since graduating from college. During our work, her symptoms had improved, she had met the man whom she later married, and she made several important career moves. She came back into therapy for help with some issues related to her teenage son, but before too long, it became clear that she also needed help dealing with her aging parents.

“My dad was a great athlete,” Julie told me. “I learned to respect and care for my own body from him. Mom wasn’t much for exercise, but she was always working in the garden and taking walks. And she cooked healthy meals for us throughout my childhood. But now, Dad just sits in a chair and watches TV all day and orders my mom around. And although she still cooks, it’s mainly mac and cheese, brownies and ice cream—stuff she knows he’ll eat. They’re both overweight now, they both have heart disease, and I can’t see this going anywhere but downhill.”

Julie had tried bringing her concerns to her parents, but each time she did, they both got mad at her. Her dad told her that he was an old man, that he knew he was going to die one of these days, and he was “goddammned going to do what he wanted to do for the first time in his life.” Her mother said Julie should leave him alone—she didn’t want him to get upset and have a heart attack. As was true for many families, Julie’s struggles with her parents escalated during COVID.

“They had a hard time self-isolating during the pandemic,” Julie told me. “Now they’re vaccinated, but I’m afraid they’re not being safe. I’m frightened for them. I kept telling them that if they got sick, what were we going to do? I couldn’t take care of them, because I’d worry about infecting my kids, because we didn’t have a vaccine for teens yet. I was frustrated and angry with them. As usual, they weren’t thinking about anyone but themselves. I kept wanting to shout, ‘What about me? Don’t I count? Don’t I matter to you?’”

A fair amount of our earlier work together had centered around Julie’s childhood relationship with her parents. Initially, she spoke of her parents’ marriage as ideal. “I had a wonderful childhood,” she told me. “So whatever difficulties I’m having now don’t stem from problems growing up.”

She described her father as “bigger than life, a big man, physically, but he was also beloved at work and in the community. When he retired from his job, people giving tributes cried as they talked about how important he was to them personally, how he had helped them move forward in their careers, how he had always been there when they messed up and helped them figure out how to correct a mistake and use it for their own growth, and sometimes for the company’s, too.” After his retirement, he volunteered to coach local football and soccer teams. When she came back to therapy, she still saw him as a special person, telling me that “the kids he coached and their parents all adored him. He played pick-up basketball in the gym with much younger guys up until the minute they shut the gym down because of COVID. He had a weekly coffee klatch with some buddies. He was a busy, active man.”

But Julie’s image of her father changed over the course of our earlier work together. One of the areas that we opened up in that work was her anger at both of her parents. As she told me during that time, “My mom was too docile for him. He was so big, so loud, so stubborn, he needed someone to push back at him. I felt protective of her, and mad at him, so I would stand up to him. We had some pretty big fights. My mom was always trying to get me to back off, leave him alone.”

We could say that much of the work of therapy is, in some ways, about helping clients tell us their life stories, and then helping them understand how their life stories impact who they are, how they live their current lives, and what they struggle with. Most of us have what Esther Perel has called our “go-to-stories,” that is, a story that explains something about us that we go back to over and over again. These stories, which can be as simple as “I was always a go-getter,” or as complex as “I was neglected by my parents my entire life,” can motivate us, give us hope, or leave us feeling helpless and hopeless. In therapy, as Roy Schafer wrote many years ago, we help clients learn how they construct their personal version of their own history, and then we help them start to reconstruct it.

Julie’s go-to-story of a perfect family and a bigger than life dad shifted over the course of her therapy to a more realistic version that she had kept out of her conscious awareness. But unfortunately, as happens perhaps more often than we like to acknowledge, therapy gave her a new go-to-story in which her parents had failed her. Julie’s story about herself changed significantly, so that she was able to move forward as a young adult with a greater sense of agency and self-confidence. She was also able to tap into her anger with less guilt and anxiety. But now that she and her parents were all older, that story was ready to go through another reconstruction.

Rewriting “Go-To” Stories

In the early days of therapy in particular, clients want sympathy for their feelings and their point of view much more than they want to think about what anyone else might be thinking or feeling. But years ago, as I gathered information for my book Daydreaming, I discovered that the stories people were telling me through their daydreams were ways of reflecting on themselves and on other people. Today I see those stories as a form of what Fonagy and other attachment theorists call “mentalizing.” Mentalizing is a process in which a client works to put into words what they imagine another person might be feeling. Children, even adult children, often have difficulty separating their own needs and feelings from what we imagine our parents are thinking and feeling, which can make it difficult to mentalize.

When clients bring in conflicts, I ask them to tell me as much as they can about their ideas about themselves and about other people, including their parents. Following Harry Stack Sullivan’s idea that important truths reside in tiny details, I ask for all of the smallest details they can tell me. At one point, Julie was talking about her teenage daughter’s fights with her dad. I asked her to tell me about one of their arguments. After going into it in great detail, she said, “It’s kind of funny. I’m watching my daughter and my husband struggle to come to grips with the fact that she no longer sees him as having all the answers. I can’t tell who’s suffering more—my husband, who has fallen off of a very high pedestal, or my daughter, who doesn’t know how to think about him as just a person.”

She was silent for a little while, and then she said, “She’s lucky, although she doesn’t know it. My husband is sad, and he’s hurt, but he’s also just proud of her for standing up for herself. I never thought about it this way before, but I wonder if some of that is what went on with my dad. He didn’t have the psychological understanding to talk about any of this, but I did get the feeling that he was proud of me for standing up to him. He’s always made comments about my being more like him than like my mother, but until just now I never thought of that as pride.”

The realization that some of their old conflicts could be seen from a different perspective led Julie to rethink some of her current struggles with her parents. “My dad has always been so strong, so vital. It must be horrible for both of them to see him feeling helpless…and hopeless. No wonder they’re doing stuff they shouldn’t be doing. No wonder they’re eating stuff they shouldn’t be eating. It’s their attempt to get themselves out of this difficult place—and maybe not just the one we’ve all been in during the pandemic. Maybe it’s also about getting older. They would never be able to talk about it, at least not to me. But maybe they’re a little scared about the future. Do they worry about being dependent? Do they hate thinking that my siblings and I will need to take care of them?”

In his classic paper “The Waning of the Oedipus Complex,” Hans Loewald wrote about the difficulty of this change for both parent and child, both of whom lose something as their mutual adoration dissipates in the face of separation and individuation. But, he says, something important is gained by both participants, who can become connected in a different way because of the changes they also mourn. This balance is a fragile one, Loewald tells us, and needs to constantly be negotiated and renegotiated. Therapists can help by encouraging clients to revisit old “go-to-stories” to see if they still hold true, or if they might be revised in any ways based on a client’s changing perspectives on his or her own life.

One day after Julie had begun to consider the struggles with her parents from this new point of view, she said, “I started to think about the fact that they’re in their eighties, they had been expecting life to unfold in a certain way, and suddenly it took a different turn. What were they supposed to do with that, I asked myself? What would I have done in their shoes? And suddenly I realized that they had handled these difficult times really well! Better than some of my friends, even. They’re still together, still talking to each other—more than that, they seem to really love and enjoy one another. That’s pretty amazing all by itself.”

***

Both relationships and identity are, according to the psychoanalyst Stephen Mitchell, an ongoing and ever-changing process. Therapists can help with this process by opening up space for clients to tell their story, and then for them to retell it and revise it as time goes on and they develop into new versions or new variations of themselves. During these shifts, parents, children, friends, and other important people in a client’s life also change; and part of the healing work involves learning and forgetting and learning again that all of us are, as Sullivan once put it, “far more human than otherwise.”

Through the Looking Glass: Helping Clients with Retirement

When I began my practice over thirty years ago, more than half of my clients were older than I was. Now, in my sixties, only a handful of my clients are older than I am. When I look back on my early work, I cringe at my rudimentary understanding of how aging changes one’s outlook and opportunities. What was once an academic understanding of this stage of life has morphed into a personal one. Recently, I have taken more of an interest in learning about what makes for a good retirement and how to help my clients manage this transition. My interest is fueled by the age of my clients and the impact of COVID-19 on people’s work lives. In addition, my husband, along with a number of our friends, recently retired, which brings the topic close to home. Through my research, I’ve learned that there are two major paths for retirement. They are typically labeled the “cliff” versus the “transition.” There are positives and negatives about each one, but the path taken is not always a function of choice by the retiree. External circumstances, including the type of job one holds, play a major role in how one will cross the threshold into retirement. The cliff version of retirement was more common when the mandatory age for retirement was 65. The advantage of this type of ending is that it is clear and expected. You can make plans for the days and weeks after. I have seen people prepare for the cliff by relocating, joining volunteer organizations, and/or planning long-awaited travel. One patient of mine, a physician, left the day after his retirement on a six-week cross-country road trip with his wife. What he wanted most was not having to plan or live by a schedule after years of being bound to a pager. After their adventure, he returned with a new perspective about how he wanted to spend the next chapter of his life, one he could never have conceptualized while he was fulfilling the demands of his job. You can prepare if you know you are going cliff-jumping, but when the cliff appears unexpectedly due to illness or a layoff, it can easily lead to depression or anxiety. Another patient of mine was forced out of her job three years earlier than she expected due to a change in leadership at her company. As a single woman with no children, her work life doubled as a major component of her social life. To make matters worse, most of her friends were still working, so she suddenly found herself with empty days and no social contact. COVID-19 protocols exacerbated how isolated she became, and doing more things on Zoom was not an antidote to being home alone every day. Together we mourned an unceremonious end to her career and brainstormed how she could continue to feel relevant and engaged in the world. The transition path, one most therapists in private practice seem to choose for themselves, allows for cutting back on one’s hours while still working in the same position. Not all careers are flexible in this way, and sometimes a decision to go part-time means losing more than just income, but stature in the workforce as well. The positive side of transitioning into retirement is that it allows one to try out new endeavors slowly and to ease into a different schedule. The risk is that a gradual leaving can feel more like fading out rather than having a capstone moment to acknowledge one’s work life. Retirement is a phase of life and not a solitary moment in time. The retired clients I see who have fared the best have found a cohort group. Similar to Maslow’s hierarchy of needs, if health and finances are in order, then the next step is building community. Whether it’s meeting a walking partner or offering to read to young children, being counted, and counted upon, can help counteract depression and isolation. Like most therapists in private practice, for me, deciding when to retire has always felt like a decision that would be in my control. But, now older and wiser, I have seen colleagues forced to retire unexpectedly either for personal health reasons or to become caretakers for loved ones. Unfortunately, I am also privy to a few rare cases where therapists did not retire soon enough and their performance at the end of their careers was substandard. Sometimes clients ask me directly when I am planning to retire. They ask the question with a mix of curiosity and trepidation. I have promised them that unless there is a dramatic change in my health, I will give them a year’s notice. The depth of our work as therapists warrants allotting time for a thoughtful ending. The pandemic has certainly impacted my thinking about when I will retire. On the positive side, the ability to work remotely has changed the calculus around some of the aspects I like least about my work (commuting, for example) and made the thought of working longer a real possibility. On the negative side, the current mental health crisis makes finding appropriate referrals for clients right now seem impossible, which by default extends my sense of responsibility to my clients. Thinking about my own retirement, I am aware that unlike other life experiences that have shaped my work as a clinician, ironically, I will not be able to draw on my personal experience after the fact to the benefit of my clients. Whenever my last day of work is, I hope it will be my choice. Turning out the lights and saying goodbye will not be easy. Despite that reality, I hope that the way I prepare both my clients and myself for the end of our work together will be an opportunity for growth for each of us.