chapter  Chapter 11
11 Pages

Maintaining boundaries

Counselling in a care home
WithSusan Maciver, Chris McGregor, Tom C. Russ

The maintenance of boundaries and a suitable therapeutic space is one of the cornerstones of psychoanalytic practice (Maciver and Russ, 2014). However, when working with older adults - particularly those who are frail or who have mobility difficulties or cognitive impairment - an element of flexibility is helpful. Some people may not be able to attend an outpatient clinic or a therapists’ consulting room and, in order that these people are not discriminated against, we should change our practice to enable them to be seen. However, this brings its own challenges and maintaining a safe space for the consultation to take place may be difficult. In this chapter we will discuss the unusual case of a woman seen for counselling in a care home and the issues which it raises for those of us who offer a service to older adults. Although this client did not have dementia, she was affected by it in a significant but largely unacknowledged way through living in a unit which was largely a dementia-specific facility and where the staff and management were understandably focussing on the primary resident group. The “plight” of the elderly person with intact cognitive abilities living in such a setting does not appear to get therapeutic attention. The person we will consider here - who we will refer to as Emma - generously consented to have her case written up for publication. The description of the case is followed by two commentaries from psychodynamic and psychiatric perspectives.