524: Working With Elders-Aging, Control, and Legacy

Working With Elders: Aging, Control, and Legacy

Hosts:
Dr. David Burns
Kevin Cornelius, LMFT

Guests:
Dr. Jill Levitt
Thai-An Truong, LPC. LADC

Episode Overview

What happens when aging begins to change the things that once gave us independence, identity, and a sense of purpose?

In this episode of The Feeling Good Podcast, Kevin Cornelius, Dr. David Burns, Jill Levitt, and Thai-An Truong explore the emotional challenges that can accompany aging—and the ways therapists, caregivers, family members, and loved ones can respond with greater empathy, dignity, and respect.

Thai-An draws on her experience working with older adults in an inpatient setting and introduces two fundamental needs that can become especially important in later life: control and legacy. As people age, they may experience layers of loss involving physical strength, health, friends, spouses, independence, financial security, familiar surroundings, and even their sense of identity. At the same time, family members and caregivers may become increasingly focused on getting things done, making decisions, and addressing practical or medical concerns.

That difference in agendas can create painful power struggles.

The episode explores a different approach: slowing down, reducing urgency, and giving older adults as much agency as possible. Rather than interpreting resistance or insistence on doing things a certain way as simply being “stubborn” or “difficult,” the conversation considers whether these behaviors may reflect a deeply human need for control, safety, familiarity, and dignity.

The conversation then turns toward legacy and life review. Thai-An describes a process of listening for the stories, people, experiences, and themes that repeatedly emerge in an older person's conversations. Those stories can provide clues about the values that have mattered most throughout their life—and about how they would like to be remembered.

The episode concludes with a moving demonstration of this process, with Jill Levitt role-playing her mother, Wendy. Through stories about the Peace Corps, Brazil, travel, family, grandchildren, and her career, the conversation reveals deeper themes of adventure, learning, connection, love, acceptance, honesty, generosity, and respect.

Ultimately, this episode asks us to consider whether helping an older person is always about doing more for them. Sometimes, it may be about slowing down enough to listen, allowing them to remain the author of their own story, and helping them recognize that their life continues to matter.

Key Takeaways

1. Aging can involve many layers of loss

Thai-An emphasizes that loss can accumulate as people grow older. These losses may include:

• Physical strength and health
• Independence
• Friends and peer relationships
• A spouse or life partner
• Financial independence
• Familiar surroundings and one's home
• A previous role in the family
• A sense of productivity or contribution
• Identity and social status

When several of these losses occur at once, older adults may be asked to make major decisions at precisely the time when they are feeling least able to cope with change.

2. Independence is about more than physical functioning

The discussion highlights how deeply identity can become connected to independence.

Kevin describes how his mother had previously derived meaning from helping other members of the family. When the roles reversed and she began needing help herself, she experienced shame and worried that she was becoming a burden.

Thai-An suggests that losing the ability to contribute can challenge an older person's sense of worth. Someone who spent a lifetime caring for others may struggle when suddenly placed in the position of needing care themselves.

3. The need for control doesn't disappear with age

One of the central ideas of the episode is that control is a fundamental human need.

When older adults lose the ability to perform tasks independently, they may increasingly depend on other people to do things for them. As a result, they may become particularly concerned about how those things are done.

What can look like being demanding, controlling, or “set in one's ways” may sometimes be an attempt to preserve agency in a life where many other choices have already been taken away.

Jill points out that someone who previously handled things independently may understandably want things done according to their preferences once other people become responsible for those tasks.

4. Caregivers can unintentionally create control battles

Family members and professionals often have legitimate reasons for wanting an older person to make a decision quickly: medication management, medical care, safety concerns, housing, transportation, or other practical issues.

But urgency can collide with the older person's need for control.

Thai-An describes the importance of “sitting with open hands”—reducing the pressure to make something happen immediately and instead creating room for the older person to participate in decisions about their own life.

Instead of:

“You need to do this.”

the caregiver might ask:

• “How can I help?”
• “What would you like to decide?”
• “What feels most important to you?”
• “What would make you feel more comfortable?”
• “What do you want to happen?”

The goal is not to ignore genuine medical or safety concerns. It is to preserve as much agency as possible while addressing those concerns.

5. Slowing down does not necessarily mean diminished capacity

Thai-An challenges the assumption that slowing down in old age automatically means that someone is less intelligent or less capable.

She discusses the idea that certain cognitive changes can actually create opportunities for reflection. Rather than rushing to process new information or make decisions, older adults may draw upon decades of experience and take more time to reflect, consider, and make meaning of what they have experienced.

This creates an important reframe:

Slowing down isn't necessarily something that needs to be fixed. Sometimes it may be part of what makes reflection possible.

6. Legacy is a fundamental need

Once the need for control is respected, Thai-An turns to what she describes as another major need: legacy.

Legacy isn't simply about leaving behind possessions or accomplishments. It can involve questions such as:

• What has mattered most to me?
• What have I learned?
• What values have guided my life?
• What do I want my family to remember?
• What do I want to pass on to the next generation?
• How do I want to be remembered?
• What parts of my life still need to be understood or made meaningful?

Life review can provide an opportunity to explore these questions without treating the older person as someone who is merely reminiscing about the past. Their stories can become a way of understanding the values that have shaped their life.

7. Listen for the stories that keep coming back

Thai-An describes a particularly useful way of listening: pay attention to repeated stories and themes.

An older person may tell the same story over and over. Instead of thinking, “I've heard this story before,” a caregiver or therapist can become curious about why this particular story continues to matter.

What people repeatedly talk about can reveal:

• Relationships that were important
• Experiences that shaped them
• Values they continue to hold
• Unresolved losses
• Important accomplishments
• Regrets
• Traditions they want to preserve
• Lessons they want future generations to understand

Thai-An compares this process to “well watching”—slowing down and observing what emerges rather than rushing toward an agenda.

8. Start with open-ended questions

Life review doesn't require an elaborate intervention.

It can begin with simple questions such as:

• “Tell me about growing up.”
• “What was your life like when you were young?”
• “How did you meet your spouse?”
• “Tell me more about your parents.”
• “What do you remember about that time?”
• “What was that experience like for you?”
• “What did you learn from it?”
• “What mattered most to you about that?”
• “How did that experience change you?”

The important part is not asking a long list of questions. It is creating enough space for the older person to lead the conversation.

Thai-An emphasizes putting distractions aside, reducing urgency, and genuinely giving one's attention to the person.

9. The life-review process can be organized into several themes

Thai-An describes a framework for listening to an older person's stories. Among the elements she discusses are:

Repeated stories and themes
What stories, people, experiences, or events keep appearing?

Values
What does the story reveal about what matters to this person?

Recontextualization
Is there an old experience that could be understood differently now? Are there events that need healing, closure, forgiveness, or a new meaning?

Legacy
How does the person want to be remembered? What would they like future generations to know or carry forward?

This process can transform an ordinary conversation into an opportunity for deeper reflection and meaning-making.

 

Life Review

Repeated Stories or Themes

• Listen for themes.
• Notice repetitions.
• Listen for topics described in exhaustive detail.
• Notice people mentioned over and over again.
• Pay attention to significant events.

Values

• What does this show about your values?
• What is the biggest takeaway for you?
• How did this experience affect or change you?
• Summarize the person's values and what they seem to deeply care about.

Recontextualization

• Use tools like EOV to help make new meaning and work through distortions.
• Ask whether there is any unfinished business.
• Explore the need behind repeated stories or themes.
  • Mend a relationship.
  • Leave a lost loved one some advice.
  • Express unsaid words.
  • Reconnect with an estranged loved one.
  • See familiar places once more.
  • Share memories.
  • Find a resolution.

Legacy

• How do you want to be remembered, and by whom? For example, your children and grandchildren.
• What do you want to be remembered for? Consider the things you value most.
• How has your life reflected these values?
• In what ways have these values become part of your life?
• How has your life been different from your parents' lives?
• What values do you want to pass to the next generation? Consider the vehicles for your legacy.

 

Life Review

Repeated Stories or Themes

• Listen for themes.
• Notice repetitions.
• Listen for topics described in exhaustive detail.
• Notice people mentioned over and over again.
• Pay attention to significant events.

Values

• What does this show about your values?
• What is the biggest takeaway for you?
• How did this experience affect or change you?
• Summarize the person's values and what they seem to deeply care about.

Recontextualization

• Use tools like EOV to help make new meaning and work through distortions.
• Ask whether there is any unfinished business.
• Explore the need behind repeated stories or themes.
  • Mend a relationship.
  • Leave a lost loved one some advice.
  • Express unsaid words.
  • Reconnect with an estranged loved one.
  • See familiar places once more.
  • Share memories.
  • Find a resolution.

Legacy

• How do you want to be remembered, and by whom? For example, your children and grandchildren.
• What do you want to be remembered for? Consider the things you value most.
• How has your life reflected these values?
• In what ways have these values become part of your life?
• How has your life been different from your parents' lives?
• What values do you want to pass to the next generation? Consider the vehicles for your legacy.

Life Review

Repeated Stories or Themes Listen for themes. Notice repetitions. Listen for topics described in exhaustive detail. Notice people mentioned over and over again. Pay attention to significant events.

Values What does this show about your values? What is the biggest takeaway for you? How did this experience affect or change you? Summarize the person's values and what they deeply care about.

Recontextualization Use tools like EOV to make new meaning and work through distortions. Ask whether there is any unfinished business. Explore the need behind repeated stories or themes. Mend a relationship. Leave a lost loved one some advice. Express unsaid words. Reconnect with an estranged loved one. See familiar places once more. Share memories. Find a resolution.

Legacy How do you want to be remembered, and by whom? For example, your children and grandchildren. What do you want to be remembered for? Consider the things you value most. How has your life reflected these values? How have these values become part of your life? How has your life been different from your parents' lives? What values do you want to pass to the next generation? Consider the vehicles for your legacy.

feeling good

 

10. Recontextualization can help unfinished stories find new meaning

An especially interesting part of the life-review framework involves recontextualization.

A person may revisit an event that has carried pain or resentment for many years and begin to see it from a different perspective. This doesn't mean denying what happened. Rather, it can involve asking whether additional context, understanding, or meaning is now possible.

The conversation also raises questions about unfinished business:

• Is there something that needs to be said?
• Is there someone with whom the person wants to reconnect?
• Is there an apology or amends that would bring peace?
• Is there something they wish they had done differently?
• Is there an action that could provide closure?

In this way, life review can become more than remembering. It can become an opportunity for healing.

11. Don't force someone into vulnerability

Thai-An makes an important distinction: the life-review process should never become another agenda imposed on an older person.

The person gets to decide how much they want to share.

Some days they may want to tell stories for an hour. Other times they may not want to talk about the past at all.

The same principle applies to therapy and caregiving more broadly: invite rather than force.

The goal is to give the person control even while inviting them into meaningful reflection.

12. You don't need an entire hour to create meaningful connection

Thai-An notes that this kind of work does not necessarily require a formal, hour-long life-review session.

A therapist, nurse, physician, or caregiver might have only ten minutes.

Even in that short period, simply slowing down and reflecting a person's values can make a meaningful difference:

“It sounds like loyalty has really mattered to you.”

or

“I'm hearing how important your relationship with your brother has been.”

These reflections communicate that the person's life—and the meaning they have made from it—is worth noticing.

The Life-Review Demonstration

One of the most moving sections of the episode is a demonstration between Thai-An and Jill Levitt, who role-plays her mother, Wendy.

Thai-An begins by asking about stories that repeatedly come up and remain close to Wendy's heart.

Jill describes her parents' experience in the Peace Corps in Brazil shortly after they married. What initially sounds like a story about travel gradually reveals a much richer set of values:

• Adventure
• Curiosity
• Travel
• Learning about other cultures
• Family
• Sharing experiences
• Passing traditions to future generations

Jill also recalls her father's tradition of singing to his grandchildren in Portuguese—a small family ritual that became part of what the grandchildren remembered about him.

Thai-An then moves beneath the stories and asks what these experiences meant.

The conversation ultimately arrives at a deeply personal question:

“What would you want them to remember you for?”

Jill describes wanting to be remembered as loving, accepting, open, honest, supportive, and “no strings attached.” She also reflects on the importance of balancing her career as an occupational therapist with her role as a mother and grandmother.

The demonstration illustrates the central idea of the episode: the repeated stories are the doorway; the values underneath them are the legacy.

Sample of Wendy’s Life Review

Repeated Stories or Themes During the Vietnam draft, your dad and I left for Brazil instead for a couple of years. Shared a lot of Brazil stories with grandkids.

Values Adventure, culture, travel. Learning a new language (Portuguese). Contributing to building up the world instead of war and destruction. The best part of life was being a grandparent. Love, family, connection.

Recontextualization It wasn’t another boring Brazil story. It was about sharing the best parts of life with the most important people.

Legacy I want to be remembered for being loving, accepting of others, open and honest, and truly showing interest in others. I respect others and their agency. No one is forced to be one way or another. No strings attached. I was an OT, and my career of helping others was really meaningful to me, as was raising my family. The best part of life was being a grandparent. I still live for the updates, messages, and connection with Jill and my grandchildren.

feeling good

 

 

A Different Way of Thinking About Therapy With Older Adults

At one point, David observes that the discussion isn't sounding exactly like a technical lesson in how to apply TEAM-CBT to an elderly population.

Instead, he suggests that it sounds more like learning how to be a decent human being with older adults—how to relate to them respectfully, preserve the relationship, and avoid creating unnecessary frustration and power struggles.

Thai-An connects this directly to TEAM-CBT: empathy, respect, understanding resistance, and using methods that honor the person's needs.

The result is an approach that isn't primarily about getting the older person to comply with someone else's agenda. It is about understanding what matters to them and helping them meet those needs with dignity.

Questions for Reflection

Whether you're a therapist, caregiver, adult child, or simply someone with an aging loved one, consider:

• What losses might this person be experiencing that I don't immediately see?
• How much control does this person still have over their daily life?
• Am I unintentionally creating a power struggle?
• Could what looks like stubbornness actually be a need for agency or safety?
• Am I moving too quickly?
• What stories does this person tell repeatedly?
• What values are hidden inside those stories?
• What do they want future generations to know?
• What do they want to be remembered for?
• Is there unfinished business that could benefit from attention?
• What would happen if I simply slowed down and listened?

Final Thought

The episode offers a simple but profound shift in perspective.

An older person is not merely someone who needs to be managed, protected, or helped.

They are a person with a history, values, relationships, wisdom, preferences, unfinished stories, and a continuing need for agency and meaning.

Sometimes the most helpful thing we can offer is not another solution.

It may be our attention.

It may be our patience.

It may be a willingness to ask one more question.

And sometimes, it may be the opportunity to tell a story one more time—and finally have someone listen closely enough to discover why that story mattered.

Key Takeaway in One Sentence

When we slow down, respect an older person's need for control, and listen deeply to the stories they tell, we may help them discover—and pass on—the legacy that gives their life meaning.

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Contact Information

Thai-An Truong is a Licensed Professional Counselor (LPC) and Alcohol and Drug Counselor (LADC). She is the first Certified TEAM-CBT Therapist and Trainer in Oklahoma. She has found TEAM-CBT to be life-changing professionally and personally and is passionate about training other therapists in this “awesome approach.” In her private practice, Thai-An specializes in the treatment of trauma and OCD. To learn more about her TEAM-CBT Trainings, visit www.teamcbttraining.com.

Dr. Jill Levitt is the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. If you would like to contact her for treatment, training, or supervision, you can reach her at [email protected].

Kevin Cornelius, LMFT is a Level 5 Certified Master TEAM-CBT Therapist and Trainer and the Clinical Director of Feeling Good Institute--Silicon Valley. He specializes in the treatment of trauma, anxiety, depression, relationship problems and insomnia. You can reach Kevin at [email protected] and visit his website at www.tools4change.me.

You can reach Dr. Burns at [email protected].

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