Older people’s psychological change processes: a research portfolio
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Objectives. The empirical qualitative study explored Older People’s (over 65 years of age) perceptions of psychological change and the processes by which these occurred. It also aimed to add to understanding of the barriers to therapeutic change. Subsequently, a systematic review of the current literature pertaining to older people’s attachment styles, and how attachment is measured within this population, was conducted. This scrutinised the literature regarding role of attachment (as a trans-diagnostic construct) in old age, as this may influence their change processes. Design. As the empirical study was exploratory, it adopted a Grounded Theory methodology, influenced by the constructivist perspective as described in Charmaz (2014). Data was obtained via semi-structured interviews, with the later interview schedule grounded in emergent codes and memos of earlier interviews. Literature pertaining to older people, attachment, and how attachment is measured, was obtained from a systematic review. Method. Twelve participants were interviewed using a semi-structured interview, following discharge from an Older Peoples Psychological Therapy Service, for the empirical project. Participants were aged 65 years or over and had received varying models of therapy over varying durations. Those reporting improvement, or no change, as a result of receiving psychological therapy, were approached to participate. Through detailed analysis, a tentative model of older people’s psychological change processes was constructed. This model was further checked by some participants for quality control. Subsequently the systematic review explored a key theme of attachment (as suggested by the categories highlighted in the empirical project). Literature regarding attachment, older people and how attachment is measured within this population, was obtained through a systematic search through major databases, compared against a checklist, constructed for this review, with all analysis prorated by qualified clinical psychologists supervising this study. Results. Interview transcriptions were analysed in line with a constructivist perspective of grounded theory. A non-linear model of psychological change, grounded in the data, was constructed. The main concepts of the model were Age as Context, Seeking Help and Entering the Therapeutic Environment, Building a Therapeutic Relationship, Developing a New Understanding, Therapeutic Changes and Post Therapy Reflections and Commitments of Continuation. In addition, some similar processes were highlighted across different therapeutic modalities, thus supporting trans-theoretical models of psychological change. In addition, the model highlighted a theme of models of relationships having continuity through the lifespan (as evidenced in the concepts of Seeking Help and Building a Therapeutic Relationship). This echoed the trans-therapeutic concept of attachment. Therefore, a systematic review of attachment in older people was conducted. Overall the quality of the literature pertaining to attachment, older people and how attachment is measured within this population was poor. There was a paucity of evidence of minimisation of bias reported in either design or analysis. Conclusions. The empirical project demonstrated the process of psychological change in older people is non-linear in nature. Some constructs of change were similar to those found in the adult literature, but there were also some constructs relating specifically to ageing, and the theoretical developmental stage of old age. This supports suggestions that age specific constructs should be held in mind when working therapeutically with older people. The systematic review found research exploring attachment in older people is a growing field of research, but one which is still in its infancy compared to other clinical populations. In addition, several studies had serious methodological issues and therefore readers are encouraged to interpret their results with caution.