A geriatric counseling case study exploring identity loss in older Indian women as family structures shift; with insights on recovery and emotional resilience.
Rachmanas Counseling
Presenting (Geriatric Counseling) Problem
Mrs. K is a 66-year-old woman from South Delhi, referred for geriatric counseling at Rachmanas by her family physician after her son expressed concern about her increasing emotional withdrawal.
She had spent nearly two decades as a general manager at a prominent automobile showroom before choosing to step back from her career to manage the household full-time. By her own account, she was good at it. Exceptional, even.
Her son’s marriage three years ago quietly rearranged everything.
The decisions she once made without a second thought; what to cook, when to buy groceries, how the living room should look; gradually shifted away from her. Nobody formally removed her. Nobody said anything unkind.
That, in some ways, made it harder. She began making small cutting remarks at the dinner table. She stopped attending family gatherings without explanation. At night, she lay awake replaying conversations that had not gone the way she hoped.
She told us in our first session, “I built this home. Now I feel like a guest in it.”
Her sleep had deteriorated significantly. Her appetite was inconsistent. Most mornings, she said, she could not find a reason to get dressed before noon. The emotional distance between her and her daughter-in-law had grown quietly but steadily, and she felt her son caught in the middle.
The assessment began with a Personal Information Questionnaire to gather background details, followed by individual intake interviews across the first two sessions. Reflective exercises on life roles helped Mrs. K articulate what she valued about herself, and selected questions drawn from the Geriatric Depression Scale helped explore mood patterns over time.
She did not meet the criteria for a major depressive episode. What emerged instead was a picture of situational distress rooted in something deeper: a loss of identity.
In sessions, it became clear that Mrs. K had always defined herself through competence. First at work, then at home. Both roles gave her authority, visibility, and a sense of being necessary. When the household center of gravity shifted toward the younger couple, she experienced it not as a normal family transition but as a personal erasure.
Psychologically, this was understood through a combination of role loss theory and attachment insecurity in later life. Her thought patterns reflected overgeneralization and personalization; two well-documented cognitive distortions.
The formulation drew on Cognitive Behavioral Therapy, Person-Centered Therapy, and Narrative Therapy, with careful attention to Indian family dynamics and the cultural expectation that older women remain central to the home.
Research consistently shows that strong therapeutic alliance and shared problem understanding significantly predict outcomes in counseling (Lambert, 2013; Wampold & Imel, 2015).
The counseling spanned 15 sessions across eight months. The pace stayed slow and deliberate, always following her lead.
Step 1: Person-Centered Work
The first three sessions were not about changing anything. They were about listening without an agenda. Mrs. K arrived guarded. She framed everything in terms of what others had done wrong. We did not challenge that early. Instead, we reflected on her thought that she felt invisible, and that invisibility hurt.
A shift came in the fourth session when she paused mid-sentence and said, “Maybe I’m also angry because I don’t know who I am now if I’m not running this house.”
That sentence opened the real work.
Step 2: Cognitive Behavioral Work
Once she felt safe enough to examine her own thinking, we began looking at recurring thoughts such as “They have pushed me out,” and “I have become useless to everyone.” I did not argue with these thoughts. Instead, we asked her to examine them.
“What would you say to a friend who said she had become useless?”
“I would tell her that’s not true,” she replied.
“What stops you from saying that to yourself?”
Thought records helped her track these patterns between sessions. Over time, she began catching distortions before they spiraled. CBT has strong meta-analytic support for this kind of cognitive work (Butler et al., 2006; Cuijpers et al., 2019).
Step 3: Narrative Therapy
Mrs. K had written herself into a single story: a woman who managed the home, now replaced. Narrative work helped her see that this was one chapter, not the whole book.
We revisited her years as a general manager; the negotiations she had led, the teams she had steadied, the problems she had solved under pressure. She had forgotten she was that person. Gradually, her self-description shifted from “I was someone once” to “I carry all of that with me still.”
Step 4: Behavioral Activation
Around the sixth month, she began tutoring a neighbor’s granddaughter in mathematics twice a week. Small, quiet, and entirely hers. She came to the next session looking lighter. “She actually listens to me,” she said, half-laughing.
Later, she joined a group of older women in her colony who met weekly to discuss books and current events. These were not large gestures. But they gave her a life that existed outside the four walls of a family dynamic she could not fully control.
Step 5: Communication Work
What appeared as passive aggression was actually an unexpressed need. Mrs. K had grown up in a generation where asking directly for something felt presumptuous, even rude. We practiced simple reframes together.
Instead of, “Nobody tells me anything in this house,” she practiced saying, “I would feel more included if you kept me in the loop about household decisions.”
The difference was not just in words. It was in the relationship that followed.
By the twelfth session, Mrs. K’s irritability had reduced noticeably. Her daughter-in-law mentioned to her son that his mother seemed “calmer, easier to talk to.” Mrs. K herself used the word “lighter” repeatedly, which is a word we have come to trust. It usually means something real has shifted.
Her sleep improved. She resumed a morning walk she had abandoned two years earlier. She stopped measuring her worth by how many household decisions she was consulted on.
She still had difficult days, particularly during festivals when old expectations and new realities collided. But she moved through those moments with more steadiness. “I don’t fall apart the way I used to,” she told us near the end of our work together.
Therapy outcome research supports that gradual, sustainable change of this kind reflects deep and durable progress rather than surface-level symptom suppression (Lambert, 2013).
All identifying details, including name, location specifics, and background information, have been modified to protect confidentiality. Informed consent was obtained before the use of anonymized material for educational purposes. The counseling process followed ethical guidelines set out by the American Psychological Association (2017), ensuring respect, autonomy, and professional responsibility throughout each stage of the work.
India is full of Mrs. Ks. Women who built families from the inside out, who organized, managed, sacrificed, and held things together for decades, and who now find themselves standing at the edge of a household that has quietly reorganized without them.
Geriatric counseling does not give these women their old roles back. It does something harder and more lasting: it helps them find themselves again beneath the roles they carried.
What strikes most about this case is not how much has changed in eight months, but how little Mrs. K had needed in the first place. She needed to be heard. She needed someone to say, without flinching, that her discomfort made sense.
When that happened, she did the rest herself.
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate (2nd ed.). New York, NY: Routledge.
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Washington, DC: Author.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31.
Cuijpers, P., Karyotaki, E., Reijnders, M., & Purgato, M. (2019). Meta-analyses and mega-analyses of the effectiveness of psychological interventions. American Psychologist, 74(3), 245–258.
Lambert, M. J. (2013). Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed.). Hoboken, NJ: Wiley.
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