AgeSong’s Central Vision

by Nader Shabahangi, AgeSong Founder and CEO

AgeSong and Pacific Institute are vision-driven organizations. This means that people who belong to these organizations understand their work as contributing to a larger vision of a more loving and aware world that makes room for the many diverse expressions of all there exists. At its core, AgeSong is grounded on the belief that we live in an interdependent world where all is related with and to each other. As such, AgeSong emphasizes a relational model of working together as opposed to a model that believes in absolutes, that is in one right way of being and doing.

At AgeSong’s elder communities, we strive to create, both in theory and practice, a place where we can allow people to be who they are, a place where the intention of those with whom they interact, such as carepartners (commonly termed caregivers) staff, interns, family, and volunteers) is to understand more deeply about the Other facing them. As such, AgeSong desires to create learning organizations where we ask such basic questions as the following: Who are we? What helps? How do we help? What does it mean to live, to age? How do we age? At AgeSong, our intentions are to take a stance of curiosity rather than knowing, to understand how we best care for the other and to appreciate difference as much as homogeneity.

At AgeSong’s elder communities, AgeSong and Pacific Institute implement the foundational belief that all phenomena we humans experience are meaningful and important for a deepening of human awareness and for the enjoyment of life. This belief understands phenomena normative society designates as undesirable, even deviant – through labels such as disturbance, disorder, illness or disease – as essential for understanding and living human life. Among the phenomena mainstream regards as unwelcome belong also aging and old age and often any behavior different from what we consider normal, ‘appropriate’, or ‘well adjusted’. AgeSong elder communities share in the belief of the meaningfulness of all phenomena through by creating therapeutic environments at its elder communities. In this spirit, AgeSong works together with Pacific Institute to combine resources, apply internship training, and implement AgeSong’s varied and diverse specialized programs. These specialized programs are modeled on an existential, processwork philosophy and psychology that are non-comparative and do not pathologize. Such a philosophy and way of life do not separate the world into good or bad, right or wrong, better or worse. As such, this philosophy and practice stands in contrast to present-day mainstream perspectives with their emphasis on dividing the world into things that are more desirable and less desirable.

At this time, the following programs are being implemented at AgeSong senior communities:

• Community Living (Assisted Living Care)
• Forgetfulness (‘Dementia’) Care
• Engagement and Outings
• Expressive Arts Therapies
• Gero-Psychological Care
• Spiritual Care (Interfaith)
• Palliative (Hospice) Care

The intent of these seven programs is to address the many different facets and dimensions of aging, old age and of being human in as comprehensive a way as possible. The central concern of all of these programs is to educate and train carepartners, staff and interns in a basic attitudinal shift. At the heart of this shift is learning to perceive life as meaningful. Though seeing something better than something else, such differentiation and judgment are necessary in some parts of life, applying this attitude without discrimination to the care of the human being marginalizes and perpetuates suffering.

Towards an Attitude of Curiosity and Acceptance

An existential, processwork-oriented attitude that lies at the foundation of an AgeSong therapeutic environment approaches human beings and the world we inhabit with an attitude of curiosity and acceptance. It is this attitude of curiosity and acceptance in which both AgeSong and Pacific Institute would like to train carepartners, staff, volunteers, and interns. Such an attitude welcomes and enjoys difference. It understands perceived difference as an opportunity for growth, and thus wants to learn from it.

Stated personally:

“From each difference I perceive in the other allows me to see a part within myself that may as yet be unfamiliar to me. That which I perceive as different is different because I do not identify with it or know yet. What I know already I do not regard as different or ‘other’. It is my attitude towards difference that is essential here.”

I have a choice to reject or accept difference. In rejecting difference I state that the ‘other’ is not part of me, is not worthy of being understood further. But would I not want to understand what I don’t know if it could help me understand myself better? In accepting difference I state that there is something I can learn from the other, something that deepens my awareness of myself, hence the world within which I live.

This attitude of acceptance and curiosity translates into the way each of the specialized programs is carried out. For example, in assisted living care the special needs of the elderly residents are met with an attitude that understands each need as a way the elderly communicate their unique difference to us. All kinds of possibilities can lay behind a community member’s tentative or slow walk, need to be fed, or desire to be quiet for a long time. Rather than ‘seeing’ these ways of being as aberrant, we might understand them as ways of expression in their own right. This holds true as well for those elderly who seem to forget what they once knew, appear confused to us in the way they go about their daily lives. If we do not judge forgetfulness or confusion as abnormal, but rather as the way this particular individual now lives his or her life, then we could see the wisdom behind this change and difference. As importantly, we can enrich our own lives with another way of being we did not imagine or ‘see’ before.

Educating and Training a New Generation of Carepartners and Interns

The central task in teaching and educating a new generation of managers, administrators, supervisors, coordinators, interns, carepartners and volunteers is to start with showing how each of us holds certain beliefs, values, ways of seeing people and the world. The purpose here is to have us become clearer about how our beliefs shape our perception and thus determine how we see our world. It is important to show how, for example, what we judge to be undesirable or aberrant can also be seen as something valuable, even enjoyable. Working primarily experientially, we are invited to probe in ourselves for character and behavior traits with which we would normally not identify. In this way we may begin to first notice and then counter the tendency to judge whatever may be in front of us.

Another training consists of learning to make contact with one’s own ‘inner elder’. This training conveys a connectedness to the wise part in oneself. This part allows us to learn to look at life and living from the ‘long view’. In such a perspective all phases of life are seen as important for the creation of a full life.

Central to the attitude of acceptance and curiosity is learning to be cognizant about our expectations. Noticing our expectations, becoming explicit of them, helps us be in and with the moment. We develop a ‘beginner’s mind’ attitude where we feel more and more comfortable with not knowing what will be, what should happen. This attitude allows us to enjoy what is. Enjoying the beauty of the moment means enjoying life, enjoying all that happens. This enjoyment is based on us being present with the unexpected events that often go unnoticed: the graceful movement of an elder, the faint smile, the warm hand I touch, the green plant I see, the food I taste, the raindrops I hear.

Important in this shift to an attitude of acceptance and curiosity is learning the art of listening. This involves as much noticing our desire to speak as our tendency to assume what the other is saying. Language, however, both verbal and non-verbal, is very complex and difficult to understand fully. Every word, movement and expression contains multiple meanings, often unknown even to the person communicating. Here trainees will learn ways to listen and understand, to take time paraphrasing and helping the other search for understanding.

Warriorship of the Heart

What we want to communicate to the world ought to be congruent with our message itself. At AgeSong we desire to communicate to others that we would like to re-define aging as an important phase of life. This phase of life is given special importance through re-establishing the role of eldership in our culture and society. To be truthful with others we need to model the ways of elders ourselves: being attentive listeners who continually practice being aware of what occurs in the moment, within and without.

The Seven Specialized Programs

All seven programs are based on the same attitudinal shift towards a loving curiosity and acceptance of the other. The only difference is the form this loving attitude takes. In assisted living care, carepartners practice their loving attitude of acceptance and curiosity when they bathe, groom, feed, walk, and otherwise help, support and sit with our residents. In forgetfulness care, carepartners and interns practice an attitude of curiosity and acceptance when they work with elders’ attempt to remember, find their room, walk the hallway, search for contact, do activities or engage in the many different forms of communication and relating. In expressive arts therapies, interns, staff lovingly follow community members’ many diverse attempts in being creative and expressive. In our spiritual care program residents encounter a safe place where they can express their struggle for meaning and their search for the transpersonal aspects of life. In our memory improvement, interns in training work patiently and lovingly with elders’ desire to remember and to stay cognitively active. In hospice care, elders find acceptance in the way they are and need to be as they move through their process of dying.

Once the attitudinal shift to a loving curiosity and acceptance of the other – whether the other be community members, family members, or carepartners, staff, and interns – has been made, the above programs meld into one. This means that whether we do expressive arts, memory training or assisted living care, the basic attitude with which we undertake each program always follows the process of the elder moment to moment.

A Different Model of Doing Business

At AgeSong we try to walk the talk. The way we care for our organization, for people and things ought to reflect the way we would like to care for community members. This is what we mean by staying aware of the Circle of Care – as I do to do, you will do to others, to yourself. This circle of care extends not only to the people who work with AgeSong, but includes the community and environment, the larger world in which our organization lives. As such, our organization desires to stay aware of this interrelationship by paying attention to how it cares for and relates to this world. Concretely, we try to remember that there are different bottom lines, that return on investment does not only refer to a monetary return but also to what we return to our workers and our community, near and far.
For additional reading and study, please view:

Process Work on the Arni and Amy Mindell website.

From Mindell:
What is Processwork?
“Processwork is the art, science, and the psychology of following the nature of individuals, communities, and eco-systems.
What is this nature exactly? It appears in the descriptions or self- descriptions of nature and people, as well as the subtler often missed signals and deep experiences of everyone and everything involved. Following this nature is often a great help for everyone involved. Following nature often gives meaning and necessary change.
Processwork, also called process-oriented psychology, is a multicultural, multi-leveled awareness practice including people and their natural environment. It is an evolving, trans-disciplinary approach supporting individuals, relationships and organizations to discover themselves.
Processwork uses awareness to track psychological and physical processes that illuminate and possibly resolve inner, relationship, organizational, and world issues. Processwork theories and methods, skills and metaskills are available for anyone to experience and can be tested.
Processwork Applications:
Processwork can be used to help people in all states of consciousness, that is in so called normal awareness states, or in altered states such as psychotic or extreme states, comatose and near-death states. It can be applied to psychological problems, body symptoms, groups, organizations, governments, and has been used for very young and very old people.”

More Info on Processwork

Read more about What is Process Work?

Books by Arnold Mindell:

City Shadows: Psychological Interventions in Psychiatry 

The Quantum Mind and Healing: How to Listen and Respond to Your Body’s Symptoms

The Shaman’s Body: A New Shamanism for Transforming Health, Relationships, and the Community

Dance of the Ancient One

The Deep Democracy of Open Forums: Practical Steps to Conflict Prevention and Resolution for the Family, Workplace, and World

 

 

The Concept of Meaning and Unmet Needs

It is common to talk in eldercare communities about difficult residents. Those are residents who do not fit in with the expectations of peace and quiet in an eldercare community. They seem to have more energy than others, seem disruptive and even appear aggressive and loud. The problem is seen as one that belongs to those disruptive residents. The approach is thus to engage in behavior management or, as is more common, to look for medication to extinguish the behavior. This attitude of simply blaming the disruption on the person who seems to cause the problem is convenient for the staff as it is the residents who are being asked to change. This approach, however, ignores that there might be reasons for residents’ behavior, that we have something to learn from them.

A major shift in the conceptual understanding of looking at so-called difficult residents is to believe that their behavior is expressing an unmet need thus far overlooked. This attitude does not make residents wrong for being who they are but rather understands their behaviors as important signals to be explored and understood.

The concept of “unmet needs” is not at all a new way of thinking about behavior. As a matter of fact, our own bodies are designed to express pain if something is wrong and most parents would not ignore a child’s cry or otherwise unusual behaviors. Rather, they feel naturally drawn to want to understand such expressions further. Similarly, elders living in an elder community are not any different, especially if their language capabilities have changed over time. They often express their needs through subtle and not so subtle changes in their behaviors. We need to learn to understand such behaviors, and primarily, we need to believe that any and all behaviors have meaning.

The concept of ‘unmet needs’ moves us away from a pathologizing attitude to one of wonder, curiosity and further exploration. Not the elder or client is “wrong” or needs “fixing;” but we care-partners need to deepen our awareness and understanding about human beings and life.

From Caregiving to Care-partnering, from Custodial to Relational Care

In assisted living and eldercare in general, it is common to refer to assistants as caregivers. This implies a one-way direction of care: I give care to you. Understood as such, care-giving can easily lead to a one-way, custodial type of care where the caregiver is in control of the care he or she administers. This can also lead to a diminishing of the elder for whom we care: rather than being sensitive to what elders are still able to do for themselves, we override those abilities and do for them rather with them. This points out the difference between a custodial type of care directed by task completion and a relational type of care directed by the deepening and nurturing of the relationship with the elder for whom I care.

By being present to the person whom we encounter, we value relationship. Valuing the relationship means we feel ourselves as partners with the person with whom we relate – not superior or inferior, not better or less good. We meet in our shared humanity. As in an existentially based psychotherapy where therapists understand themselves as partners in the journey towards a deeper understanding of their clients’ lives, so those helping elders in eldercare communities understand themselves as care-partners in the care and services they provide. Only through such an attitude of equality can a genuine relationship be formed and continually nurtured. And only through such an attitude do we human beings ever feel valued, ever feel loved.

 

The Language of Eldercare

The poet Ingeborg Bachmann stated aptly that a new world requires a new language. In order to move away from the idea that human beings are biological objects in decline that can be manipulated, objectified and thus “commodified”, we need to make a change in the language used to describe aging, old age and elder care. Foremost, we need to become aware of the gain-loss paradigm that permeates our culture. Given we equate aging mostly with human biology, it is easy to look at the changing body and observe losses: inability to run as fast as in earlier years, less vision and hearing, forgetfulness, and so forth. The story of gain and loss can be replaced by a more complete viewpoint, one that does not interpret what it thinks it sees but rather stays with the phenomena. For the phenomena themselves speak a language of their own. They simply express: we are changing. Without a measurement stick and standard, all we truly can observe is that we are a body and mind in process of change. It is our interpretation that wants to either make it good or bad, desirable or undesirable, define it as gain or loss. Who is to say that we do not need exactly the changing body to help provide the ground for our deepening?  That we need to go more slowly so we can live more wisely? That bone-density needs to be less dense in order for us to be more accepting? That muscles need to be softer so the mind can think more compassionately? After thousands of years of pondering, we have yet to understand the relationship between body and mind. What we have learned is that it is increasingly more difficult to know where one ends and the other starts. Moreover, it is important to remember that words such as body, mind, and soul are only roughly pointing to something we have yet to understand, let alone define.

Changing the Face of Aging

Using the youthful body as a measurement stick against which we judge our well-being at different ages is based on an overly simplistic understanding of the human being. This standard is predicated on the belief that biological strength, speed, and performance in terms of actual biologically measurable numbers – muscle mass, blood values, bone density, calcium levels, and the like – are superior over other aspects of being human, actually determines our humanity. This myopic, bio-centered viewpoint ignores, as stated before, the deeper dimensions of being human. Our ability to make choices, to fight for causes, to stand-up for beliefs, to be altruistic, generous, kind, and loving such a simplistic view does not consider. For example, is not our ability to discern the value about what presents itself before us at least as important as our ability to take in the particulars with our senses? This issue parallels the debate about our information age where we begin to question the value of information. If it remains data, we simply cannot process, cannot understand, and cannot act upon it.

A biological view of the older adult that measures itself against a youthful body also dominates our attitude towards eldercare. As such we enter a “declinist” view of the human lifespan: the older we get, the more we decline. We emphasize losses and have no vocabulary and concepts to speak of the gains we experience as we age. This is why we are in need of an existential-humanistic, process-oriented approach to eldercare. Such an approach will introduce concepts such as meaning, purpose, mystery, maturity, wisdom, creativity and beauty. Being guided by these concepts, we will begin seeing more completely, will notice when these so very important aspects of human life are present or absent.

The Centrality of Meaning

The existential-humanistic view emphasizes that a fulfilled life is inextricably linked to a life grounded in meaning. In other words, human beings need to create meaning in their lives if they are to live a life that is worth living. The importance of meaning-creation becomes even more pronounced in the so-called second half of life. Whereas the social and economic obligations of the first half of life are often quite circumscribed with education, family, and career, the second half of life can offer more freedom in terms of thinking and feeling into questions of what is important to be and to live now. These questions are also pushed to consciousness by an increased awareness of the finitude of life, an awareness that makes us wonder about our primary considerations, our priorities – whether those are based on individual and/or global concerns.

In the Indian tradition, the second half of life begins at sixty. The question of how to create meaning in our second half of life is moving to the forefront of our consciousness today. The demographics are shifting speedily away from the outdated pyramid structure of age distribution. As will be remembered, in such a structure the old comprise only a small percentage on top and the younger a much bigger percentage on the bottom. This old pyramid shape is now giving way to a cylindrical shape, where in the next thirty years – world-wide – the older over sixty will be as numerous as the young under fifteen. Such a shift, combined with the continued increase in life-expectancy and longevity, will place much more focus on meaning and purpose of the second half of human life. William Thomas, geriatrician and Eden Alternative founder, faces this issue head-on with the title of his book: What is Old Age for? As a physician, he opposes the idea of the youthful body as the standard against which we measure the continued aging process. He writes that society views the youthful body as optimal and that “scientific theories about how we age nearly all accept without question the doctrine of youth’s perfection. They focus on decline and pay little heed to the steady emergence of new gifts and capacities.

What if we could not wait to be an elder, like a child can’t wait to be an adult?

An Existential-Humanistic, Process-Oriented Approach to Eldercare

As someone who has developed and operated eldercare places for close to twenty years ranging from independent to assisted living to so-called “dementia” care communities, I witness an attitude to elders and eldercare in the continental United States very much imbedded in a quantitative perception of life. Though there are always many exceptions, most operators of elder communities, especially large-scale companies, look at aged adults as customers whose biological health and longevity – measurable statistics – are of primary concern to them. As good a beginning as this might be, such a mindset must be augmented with a deeper understanding of aging and old age if we are to do justice to our elders and our true humanity.

In contrast to a “numbers and figures” approach to eldercare, stands a humanistic attitude that understands the importance of the subjective, the psycho-spiritual dimensions of the human being. An existential-humanistic approach to eldercare emphasizes that human beings at any age or stage of life, including those who are forgetful, need to ‘feel’ themselves as valued and important, as meaningful contributors to people and causes. This approach understands that relationships and relationship building are at the core of what makes human beings feel alive and content. It also recognizes that human beings are highly individual; they have different viewpoints and must be allowed to make choices that fit their own perception. As such, techniques and otherwise fixed or mechanical procedures are counterproductive to capturing the diversity of the human spirit and will invariably lead to the creation of an oppositional force – the many revolutions and uprisings in human history are examples of this dynamic.

An existential-humanistic perspective of elders and eldercare starts foremost with the belief that elders are immensely valuable members of our societies. In their last phase of life they continue to deepen and give back to those ready to listen. They have much to offer those younger in years in terms of guidance and experience as well as in terms of a different perspective on life that allows other, deeper human values and attitudes to surface. For from the perspective of the elder, the existential-humanistic mindset truly encompasses the depth and richness of life in that it acknowledges all of its many dimensions. In addition, the last phase of life constitutes the necessary conclusion of each person’s life and contains all too important messages for our societies in terms of creating a more sustainable and loving world.

Humanistic Eldercare: Toward a New Conceptual Framework for Aging and Care

As family members, friends, professionals and care-partners, we will need to face our own aging, as well as the aging of those elders for whom we might need to care. These elders can be our own parents, siblings, or other relatives, can be friends or acquaintances. Elders might also be part of our professional clientele, as therapy clients, as people for whom we are responsible as guardians or conservators, as care-partners, staff, managers and directors of eldercare communities throughout the country.  How we face aging and eldercare is largely based on the mindset with which we approach these challenges. This mindset frames how we apply our knowledge, skills, and passion, how we assist and partner with elders in all aspects of their care. The mindset we use also informs our attitude towards how we understand our meaning of life, what we understand to be important and of value.

To honor elders as wisdom keepers and social contributors sets the stage to look at elders from their needs in terms of connecting, feeling valued, that they can give and receive – like all of us.   The question becomes: what can we do to remind ourselves of the fundamental needs they and all of us have? How can we live in a deep relationship with our elders – including our own inner elder – and receive their wisdom so important in terms of us living a meaningful and sustainable life?

Re-visioning Aging and Elder Care

The present conceptual framework used in the way we look at aging and the way we care for our elders is demeaning and harmful to our elders and to the well-being of our societies at large.  Yet, this outdated framework and understanding continues to disgrace and devalue our elders. In contrast to this outdated and harmful attitude stands an existential-humanistic, process-oriented approach. Such an attitude regards aging and old age as purposeful. It understands caring – whether it is receiving or giving care – as essential to our humanity; and it regards the many symptoms of aging and old age as meaningful guideposts to be understood rather than made into problems and/or pathologies.

This attitude opposes the present mainstream idea of aging, old age and care for elders where aging is understood as a disease, old age as a phase to be avoided and basically useless, and the many symptoms associated with aging and old age as meaningless problems in need of treatments and cures. Even recently added concepts, such as successful and healthy aging, use longevity and physical health as basic measures of what are deemed successful and healthy. These concepts of aging and care are most often based on biologically quantitative and normative measures of human life. This means that measurements and standards to which those measurements are compared form the basis of evaluating a human being’s life; that is, whether a person, for example, is performing, declining, successful, smart, healthy, or diseased.

In many ways, we have turned our understanding of human beings and their needs upside down: rather than measurement and quantification being in the service of human beings’ well- being, the quantifying mindset increasingly demands that human beings fit into measurable categories and labels. We have become the servants of the very tool we have created to help and serve us.

Sept 30, 2013 – AgeSong to Host Upcoming Existential-Humanistic Institute Conference

A process-oriented, existential-humanistic philosophy and therapeutic approach to being with fellow human beings lies at the heart of AgeSong eldercare. This is the reason that AgeSong is proud to sponsor the annual Existential-Humanistic conference within its Hayes Valley eldercare communities.

This year, 2013, marks the 7th annual EHI conference with a rich potpourri of presentations and experiential discoveries.

Through a quick perusal of the topics and abstracts, any initiate and non-initiate will quickly glean the core precepts of the existential-humanistic approach: an emphasis on experiential learning, being present, therapists’ personal understanding of themselves, the importance of meaning and meaning-making, the body, community, the centrality of the relationship between therapist and client, and the focus on helping clients’ unfolding of their personal processes.

Besides these core precepts, a hallmark of the existential-humanistic approach is its openness to other approaches, such as the many expressive arts, the research in mindfulness and neuroscience, and the discoveries from other theoretical orientations including those of psychoanalysis, somatics and cognitive-behaviorism.

Research shows again and again the central significance of therapists’ personal understanding of themselves and, connected to that understanding, their ability to relate to their clients’ world. Yet, it continues to amaze those of us of the existential persuasion that the academic and practical training of student and seasoned therapists have yet to catch-up to embracing an existential-humanistic attitude in their therapeutic work. Granted, we existential-humanists are not an easy group of people to classify and categorize. Nor are our manifold theories easily grasped, let alone comprehended.

The question of what makes an existential therapist does not have a ready answer. Rather, referencing Rilke, it is the continued questioning of who we really are as people and practitioners that make us existential therapists “existentialistic” in nature and attitude. We might even go as far as stating that the therapist who claims to be an existential therapist is not an existential therapist. For the point is this: human beings are simply too mysterious and complex, too unfathomable and peculiar, as that word, any word or plurality of words, can begin to apprehend who we are. The moment we try to describe ourselves, we understand the limits of our description.

Comfortable with paradox, mystery, the uncanny, existentialists try to stay aware of the illusion of knowledge.

For eons humans have struggled to become conscious of themselves, and have endeavored to reach an awareness of the meaning of their existence. Even those who claim that life is meaningless express their meaning through the idea that life has no meaning. We cannot escape our drive for meaning, acknowledged or not as may be the case.

This conference seeks nothing but the continuation of meaning-making and the sharing of our personal journeys along this path, to have us connect with and relate to one another, enjoy each other’s company, and to share our joys and pains, struggles and achievements together.

The 7th annual conference of the Existential-Humanistic Institute promises no universal techniques, only experiences of what worked for us under specific circumstances. It offers no anxiety reduction around what to do and how to be, only an honest sharing of our vulnerability as we continue to live with our struggles every day.

Finally, our conference offers no simple answers, but promises to leave each of us with even more questions – this, alas, we can be sure of!

Nader R. Shabahangi

President