Counseling the Contemporary Woman. Suzanne Degges-White
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Counseling Midlife Women
Suzanne Degges-White
Case Vignette: Cara
Cara is a forty-seven-year-old woman who identifies as a multiracial, Hispanic woman. Before coming out as a bisexual at twenty-eight, Cara had married in her late teens and given birth to two children by the time she was twenty-five. Cara’s divorce was final shortly after her twenty-ninth birthday, and she was able to maintain primary custody of her children. Currently, Cara is in the middle of her second significant romantic breakup, as she and her partner of fifteen years, Sandy, have determined that their marriage is no longer viable. Sandy is a decade younger than Cara and had told Cara that she wanted to experience the world in ways that she had not been able to before, since she and Cara had moved in together when Sandy was only twenty-two. Cara recognizes that she is not the same woman she was in her early thirties and feels overwhelmed by Sandy’s departure, her adult children’s unexpected response of sadness at Sandy’s departure, and their placement of blame on Cara for the relationship breakup. Cara is bemused at her own sense of helplessness, fatigue, and sadness.
Cara decided to reach out to a counselor to help her make sense of the unexpected turn of events in her life. She arrived on time for the appointment and is eager to have someone help her figure out how to handle what feels to Cara like a total disintegration of her life as she knew it. When she entered the office of Sarah, her counselor, Cara sat down on the edge of the couch. When Sarah invited her to share what has brought her into counseling at this point in time, Cara burst into tears. Sobbing, she said to Sarah, “I thought I knew where my life was going. I have a decent part-time job, two grown children, and until a few weeks ago, I had a spouse that I thought I would spend the rest of my life with. Now, I’m looking at a second divorce. I’m worried that my kids will hate me forever. I’m worried that I won’t be able to pay my bills. I’m terrified that I’ll end up in a tiny apartment with not enough money for food. I haven’t slept through the night in months, my emotions are all over the place, and I feel like I’m either about to go off on people for no reason or just burst into tears like I did today. I don’t know who I am or where I’m going anymore.”
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The stage of life known as “midlife” describes the years between somewhere around late thirties or early forties through the midsixties. Due to our lengthening lifespans, the midlife period grew into a discrete stage of life that precedes the “older adult years.” Roughly a century ago, this period of life would have been, effectively, the late adult years as life expectancy hovered around the early fifties (Grove & Hetzel, 1968). When this period of life began to take on its own identity, forty was the age at which midlife began according to many theorists (Jung, 1971; Levinson & Levinson, 1996; Neugarten, Moore, & Lowe, 1965; Sheehy, 1993). Midlife women are a sizable population, as women aged forty to sixty-four accounted for approximately 33 percent of the total U.S. female population in 2010 (U.S. Census Bureau, 2010). Further, midlife women make up the bulk of the client population for an exceptionally large number of counselors (Shallcross, 2012). Therefore, this chapter will provide a comprehensive review of the changes and challenges that women in this age group experience.
Although midlife was traditionally, and negatively, associated with a major life crisis (Jacques, 1965; Levinson & Levinson, 1996), it has also been described as a period of psychological awakening and significant inner development (Brehoney, 1996; Jung, 1971) and a time in which individuals may begin to direct their energy into generative pursuits (Erikson, 1968). These enduring but conflicting views may contribute to the ways women respond to their arrival in this period of life. While it would be ideal if women embraced the arrival of menopause with “postmenopausal zest,” a term Margaret Mead reportedly coined, not every woman is ready to experience these age-related changes regardless of the potentially positive outcome that awaits. Following is an overview of the ways the transition into and through the midlife period may influence women’s lives physically, cognitively, and emotionally.
Physiological Changes That Occur
during the Midlife Period
It can be very useful for helping professionals to understand the vast array of changes that are taking place in women’s bodies as they move through midlife. Stereotypes of midlife women abound, and many are related to their appearance, their moods, and the aging process. While not every woman will experience the same level of upset or distress with perimenopause and menopause, it is helpful for clinicians to understand the midlife-based challenges that may motivate women to seek counseling.
Perimenopause and Menopause
Perhaps the most iconic event associated with women at midlife is the experience of menopause. Menopause is considered to have taken place after the passage of twelve months since a woman’s most recent menstrual period. Sadly, many women perceive their arrival into menopause as a marker of reaching “middle age” and a portent of a barren future. Menopause can be experienced as a natural transition or be a medically induced outcome due to removal of a woman’s ovaries. The average age for experiencing this transition naturally is approximately fifty-one, no matter where a woman resides around the globe (Rahman, Akesson, & Wolk, 2015). While the prediction of a woman’s age at menopause might inspire research, the most reliable predictor for most women is the age at which their own mothers reached menopause (Depmann et al., 2016). Some women are eager for menopause to arrive and celebrate it as a badge of honor of their arrival at a new stage of life; other women dread it as a sign of defeat.
It was only in the last two decades that any significant information was disseminated regarding the hormonal changes taking place prior to the arrival of menopause. Perimenopause describes the years that precede the final cessation of a woman’s menstrual cycles. It is during this period that a majority of the symptoms that are typically ascribed to menopause actually begin to appear, including hot flashes, sleep difficulties, and other physiological changes (Delamater & Santoro, 2018).
Hot Flashes
Hot flashes and night sweats are two of the most frequently noted symptoms of perimenopause (Ying, Zhangbin, & Minfang, 2015). Whether or not a woman is able to joke about her “own personal summer” is generally tied to the level of disruption that these experiences generate. When night sweats are keeping a woman from getting adequate sleep, any other menopausal symptoms may be exacerbated by her sleep deficit. Irritability, moodiness, and fatigue are also symptoms of insufficient sleep, and when coupled with other menopausal symptoms, a woman may believe menopause to be an exceedingly challenging transition. Hot flashes, too, can create frustration and irritability in some women. When these experiences are normalized and their transitory nature understood, they may be less likely to create significant distress. Unfortunately, this is not always the case. When these symptoms are compounded with the sleep disturbances that occur during midlife, women may be challenged in feeling stable and emotionally sound.
Sleep Disturbances
The midlife years will bring on sleep difficulties for most individuals, whether male or female (Pearson, 2017). However, the period surrounding the perimenopause and menopause transition has been shown to be particularly deleterious to women’s sleep hygiene (Jones, Zak, & Lee, 2018). While severe sleep disturbances may require referral to a physician, counselors can provide assistance to clients suffering from sleep problems. Cognitive-behavioral strategies related to relaxation can be as effective as medication (Pearson, 2017). Encourage clients to utilize free, downloadable apps (such as Calm, which includes relaxation, meditation, and sleep aids; Sleep; or a white-noise generator) that provide affordable relaxation scripts and “sleep stories.” These can be helpful in moving clients toward a state of relaxation at bedtime, which is highly beneficial. Educate clients about the importance of regular sleep–wake cycles and encourage them to limit any type of electronic stimulation (such as email, Candy Crush, Twitter, and so on) that is keeping their brain from slowing down in the hour before they want to fall asleep.