Counseling the Contemporary Woman. Suzanne Degges-White
Читать онлайн книгу.
avoiding caffeine or large amounts of liquids close to bedtime. Some clients have irrational fears about missing sleep or being unable to fall asleep; help clients let go of these thoughts and encourage them to practice exercises such as “drop that thought.” When their brains get stuck in a loop of negative thoughts about missing sleep, which are on continuous playback at night, tell them to consciously and figuratively “drop that thought” and imagine themselves picking up their negative thought and “dropping it” off the edge of a cliff or the earth. The more clients are able to relax at bedtime, the more likely it is that they are able to drift off to sleep.
Not only does inadequate sleep decrease subjective well-being and mood, it is also linked to a greater risk for obesity (Jean-Louis et al., 2014). With the cultural messages regarding youth, size, and beauty, women’s aging bodies may be a significant cause of emotional distress.
Aging Bodies
Throughout the midlife period, many physical changes occur. For instance, menopause signals the end of fertility for women, and it also is a harbinger of other physical changes that women are often unprepared to acknowledge and accept. As the body’s production of estrogen winds down, health risks may increase and physical processes are altered. When fertility’s end is appreciated as freedom from the risk of pregnancy, some women perceive this as a gift. Other women perceive the loss of fertility as a symbol of the loss of their feminine power and sexual attractiveness. Concerns about sexual well-being can be exacerbated by the vaginal dryness that can accompany menopause, as it can negatively affect women’s desire for or pleasure in sexual intercourse (Waetjen et al., 2018). Unfortunately, the female body’s transition into midlife can be accompanied by changes that can be of both psychological and medical concern. Following is an overview of some of the most concerning outcomes of hormonal changes, such as bone density changes, cardiovascular changes, and changes to the skin and hair. While the majority of these are related to physiological changes that counselors are not able to address, it can benefit clients to have their concerns validated by a counselor and to normalize the changes that they are undergoing. In addition, if they are comparing themselves negatively to media images of beauty and feel that they are lacking, encourage them to focus on what their experience in life has taught them about their strengths and skills, and remind them that external appraisals of worth or value do more to damage all women than they do to help a single one.
Bone Density
Bone density changes over time, peaking in the midthirties but decreasing much more rapidly once menopause has been reached (Condon, 2004). Lower bone density can lead to osteoporosis as well as result in more fragile and breakable bones. Other risk factors identified for decreased bone density include cigarette use, inadequate physical activity, and insufficient vitamin D intake or lack of sufficient exposure to natural sunlight (van Dijk, Kavousi, Troup, & Franco, 2015). In addition to the skeletal system, the cardiovascular system and integumentary system (skin and hair) also change during this time.
Cardiovascular System
The heart and circulatory system are also negatively affected by the cessation of estrogen production in women. Thus, older women are at an increased risk of heart disease than younger women. In addition, as the body transitions into menopause, many women experience heart palpitations that can be alarming when they arise. Headaches are related common complaints of women during this stage (Inayat, Danish, & Hassan, 2017). Choices that women make regarding diet, exercise, smoking, and alcohol consumption can positively or negatively affect their cardiovascular health. Educating clients on the intensified risk of heart disease during menopause is especially important when they are engaging in behaviors that present increased health risks in themselves. The skeletal system and the cardiovascular system are internal targets of the aging process, but for some women, the more outwardly visible signals of their advancing age, such as skin, hair, and weight changes, may be their primary concern.
Skin and Hair
Outward signs of advancing age include changes in skin, which includes both a thinning of the skin and a loss of elasticity, which contribute to the development of wrinkles. The desire of women to stave off the physical signs of aging can be measured in dollars; a recent research report projected annual spending for antiaging products and services would reach over $330 billion by 2021 (Orbis Research, 2017). This is a phenomenal amount of money, and it reflects the current cultural perceptions regarding the worth of women once they reach midlife. Encourage your clients to challenge media stereotypes about beauty as you encourage them to value the life experience and depth that maturity bring. Women’s skin, at menopause, also tends to weaken in its ability to ward off infections and is more subject to irritation (Condon, 2004). Age spots and discoloration also begin to appear in midlife, and these can generate strong emotional reactions in some women who are afraid of the natural aging process. For women who are still premenopausal, it might benefit them to know that sun exposure and smoking are two identified risk factors for substantial wrinkling that can both be avoided for multiple health-related reasons.
In addition to changes in the skin’s texture and appearance, hair also undergoes similar changes. A woman’s head of hair, just like a man’s, can begin to thin in midlife, and as pigmentation cells die, it loses its usual color and changes to gray or white (Baran & Maibach, 2017). While gray hair may be seen as “trendy” today by some women, it is often seen as a marker of advancing age that many women believe promotes ageism toward them or leaves them virtually “invisible” to others (Cecil et al., 2018). There’s a joke about a midlife woman who complains, “I’m losing hair from where it should be, and it’s showing up in places that it shouldn’t!” As estrogen production slows down, facial hair growth often increases. Most women today are already familiar with and practiced at removal of unwanted hair from other parts of the body. The same methods, such as tweezing, bleaching, or electrolysis, are generally the most effective for unwanted facial hair as well. Sudden hair growth, however, could suggest something more significant that the typical hirsutism of midlife, and a visit to a physician might be recommended to a client (Blume-Peytavi, 2011). Hormonal changes can affect appetite as well.
Weight Gain
Weight gain is also typically associated with the midlife period, and the average woman will gain approximately five pounds during the menopause transition. Weight gain is often seen as an inevitable part of the aging process, but it is important to encourage clients to avoid using menopause as an excuse to overeat to the point of an unhealthy weight. Obesity has been linked to the development of adult-onset diabetes and multiple types of cancer, and the risks for these diseases increase during midlife (van Dijk et al., 2015). Women also tend to devalue their worth when they are unhappy with their weight, which can lead to emotional distress and lowered self-esteem. While healthy support networks are the key to a sense of satisfaction in life and happiness, healthy relationships can also promote positive behaviors and healthy choices. In fact, Chen and colleagues (2018) found that a supportive marital relationship was directly linked to healthy body weight and less weight gain for midlife women. Assessing for relationship quality and exploring any related concerns can be useful for clients in multiple ways. Being actively engaged in social support networks can encourage clients to stay healthy and stay engaged. However, if clients report that their support networks encourage unhealthy behaviors and choices, encourage them to seek out new social connections where healthy choices will be reinforced.
Please also note that contrary to some beliefs, midlife women may continue to suffer from long-term eating disorders or experience the initial onset of an eating disorder (Baker & Runfola, 2016; Mangweth-Matzek et al., 2014). Counselors should be alert to clients’ expression of weight-related concerns or if they note any significant changes in client weight. For additional information on eating disorders or body image concerns, please refer to chapter 14. Perhaps one of the most beneficial interventions that counselors can offer is helping the client understand the changes that are occurring.
Suggestions for Client Education
Although there are certainly many books