The Royal College of Psychiatrists and the British Geriatrics Society (2018) have highlighted depression in care homes as a priority area. There are an estimated 400,000 older people living in care homes. Although many people live well within care homes, it is estimated that 60 per cent of those living in residential care have poor mental health (Age Concern and the Mental Health Foundation, 2006). Depression in care homes is underdiagnosed and impacts on the wellbeing of care home residents, being associated with loneliness, failure to thrive and suicidality. Therefore, consideration of the mental health needs of care home residents, and the role of counsellors in supporting those needs, is paramount.

This book, whilst based within an Australian context, provides a very clear guide to practitioners on some of the very practical considerations when working in a care home setting and with this client group. The book is separated into three parts, firstly setting out the context, then looking at the intervention and then the final part explores ‘the bigger picture’. This is a helpful format for practitioners to dip in and out of depending on what stage of the process they are at in beginning work in this context. Throughout the book the author provides case study examples that help the reader envisage themselves in that situation and consider what may constitute the most effective techniques.

In Part 1 the author discusses some key elements of working in the context of a care home, the importance of building trust with the care teams and working collaboratively, whilst of course maintaining boundaries and confidentiality. Some very practical matters are highlighted, such as the challenges of negotiating the space when in a busy care home where staff are used to coming and going as required into different areas of the home. As well as these practical issues, the author discusses other barriers to engagement such as the older persons unfamiliarity and wariness which needs to be handled carefully by the counsellor. This first part of the book also provides a useful reminder of the types of distress an older person in care may be experiencing, from physical, neurological, social, psychological or environmental.

Part 2 then follows on to discuss the intervention itself, beginning with assessment, and exploring engagement and types of intervention. Chapman suggests methods for both informal and formal assessment, including standardised measures of depression that may be appropriate for use with clients who may be experiencing cognitive impairment. The author also touches on the difficult decisions a counsellor needs to make as to whether to continue seeing a client or to refer on to another service if appropriate, with consideration of the pros and cons of doing so (e.g. no guarantee of positive outcomes, long waiting lists). The issue of engagement is discussed specifically around the fact that often older people do not self-refer for therapy, therefore there may be a wariness at the first meeting. Chapman plays out different scenarios, helpfully demonstrating how a slight change in tone or approach to exploring therapy with a client could influence their willingness to engage.

A key aspect of the book is the range of interventions the author discusses as potentially useful with this client group; clearly approaching with a pluralistic, client-centred approach to therapy to use the tools available to the practitioner to best engage with the client, depending on their individual circumstances. Importantly, the final part of the book considers the bigger issues, how to care for yourself as a practitioner when working in a challenging environment, where you may face challenges from other key professionals working in that environment and very practical difficulties in being able to undertake the work.

Chapman successfully manages to provide an insight into working as a counsellor in a care home environment, providing useful guidance to practitioners on some of the challenges they may face but maintaining a positive outlook on the client group and the setting as a very rewarding and worthwhile area for counsellors to work. I would recommend this book to any counsellor who may be embarking on therapeutic work in a care home for the first time.