Language Recall Letting Go of the Jargon

Many CT manuals are laden with jargon and new terminology that eventually make sense to younger patients but can leave older patients behind. Longitudinal studies indicate that as people age, they begin to show a decrease in the ability to recall new terminology; thus, when working with older patients, therapists should limit their use of jargon (Small, Dixon, & Hultsch, 1999). Difficulties in recall also influence older patients' ability to engage in self-expression and to conduct exercises that require defining an emotional experience in different ways (Knight, 2004). Verbal recall particularly affects the ability to conduct thought records, because patients must first be able to separate mood from thinking, label the depressive thinking to uncover depressive patterns, and then restructure or redefine the thoughts to reflect a different perspective about the triggering event—all activities that rely heavily on language and verbal recall. At the Over-60 Clinic program, we have simplified the thought record to involve only a few categories for the older person to define. Instead of the typical four-column approach— Activating Event, Belief, Cognition, and Dispute—we use simpler terms, such as "What made me feel badly," "What I said in my head," "What I felt," and "Another way of looking at my problem," and the record is in the form of a diary, a recording method with which older patients tend to be more familiar.1 Although many CT experts have attempted to simplify terms such as "cognitive distortions" into terms that are more meaningful, such as "mental filter," these terms also may be hard for some older people to grasp. Instead, terms such as "helpful thoughts" or "balanced thoughts" have more semantic meaning for older patients and do not require them to learn new terminology.

A topic related to jargon is the use of terms that, because of their emotional meaning to the older patient, can make adherence to the process of CT difficult. We have found that a common distraction for many older patients is the use of the term "homework" or "assignment." For many older adults in the current cohort, or for those with poor educational backgrounds, referring to between-session activities as "homework" can increase the risk of early termination. Instead, we use the term "action plan" to described between-session assignments. Many older adults with chronic illnesses are familiar with this term, which was developed by chronic illness programs and is used extensively in the health fields to describe health

'Adapted CT materials can be acquired by e-mailing Brandon Brown at [email protected]; materials are also available at the COPED website http://psych.ucsf.edu/copedweb/members/ucsf.asp, and may be downloaded for free.

maintenance behaviors upon which patient and physician agree in managing an illness.

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