Eldership rites

1. Introduction

Version followed: Sage-ing (Spiritual Eldering) as the Schachter-Shalomi movement and Sage-ing International describe it; croning, saging and eldering rites as the pagan communities that hold them publish them; Indigenous Elder roles only as an Indigenous institutional office publishes them; and, for the clinical side, the leave-taking ritual structure of van der Hart and Goossens (1987), the ritual-planning elements of Imber-Black and Roberts (1993), and the DSM-5 Cultural Formulation Interview (CFI) supplementary modules 5 (Spirituality, Religion, and Moral Traditions) and 10 (Older Adults).

Eldership rites are not a psychotherapy. They are a family of later-life rites of passage that mark a move into recognised elderhood: women's croning and men's saging ceremonies, community eldering rites, congregational elder ceremonies, and the workshop-and-circle practice of Sage-ing. The term "Spiritual Eldering" was coined by Rabbi Zalman Schachter-Shalomi after a 40-day retreat at the Lama Foundation in New Mexico in preparation for his 60th birthday; the Spiritual Eldering Institute (Philadelphia, later Boulder) closed in 2005 and the movement continued through the Sage-ing Guild; "Spiritual Eldering" and "Sage-ing" were trademarked and are used synonymously [source: University of Colorado Boulder, Post-Holocaust American Judaism Collections]. Sage-ing International (Davis, California) states that it "redefines aging as a vibrant time of life" through learning, service and community, and runs a Sage-ing Leader Certification Program [source: Idealist listing for Sage-ing International]. In pagan communities, croning marks a woman's move from the childbearing ("Mother") stage to the Crone, with saging as the men's counterpart, and the core act is the community formally declaring the person a wise elder [source: Pagan Song, Croning & Saging Rites; Religion News Service c. 2004]. The Temple of Witchcraft distinguishes its Eldering Rite, which concerns wisdom and service to community, from croning and saging, which concern biology and chronology [source: Temple of Witchcraft, The Eldering Rite].

Core idea of change, as these sources hold it (attributed, not stated as fact): later life becomes a time of growth rather than decline when a person reviews and repairs their life, "harvests" accumulated wisdom, faces mortality, and takes up an elder's role of mentoring and service, and when a community witnesses and confers that role [source: Hollyhock Sage-ing workshop page; Gear 2023 slide deck; Jewish Sacred Aging]. Clinically, a ritual gives a transition a bounded, symbolic, witnessed form; the client authors its content and the therapist guides its structure [source: van der Hart and Goossens 1987]. Anthropological framing of rites of passage as separation, transition and incorporation is usually attributed to van Gennep (1909) [uncertain: not verified].

What the psychotherapist does: assesses what elderhood means to the client and their community; prepares and debriefs a client taking part in a rite held by others; co-designs a client-authored ritual where no rite exists; works with grief, shame and family conflict around a missed, refused or unavailable rite; and collaborates with clergy, Sage-ing leaders or community Elders when the client wishes [synthesis]. Related guides: 063 (elderhood and spiritual eldering, Schachter-Shalomi), which covers Sage-ing as a formation approach; 110 retirement rites; XIII 172 (eldership in the Orthodox sense of the starets, a different meaning); V 182 (land-based programmes with Elders); 112 mourning rites; 113 ancestor rites; 115 hospice spiritual care.

Evidence status: no controlled outcome evaluation of eldership rites is cited in this guide [uncertain: not verified].

2. Framework

There is no manualised protocol and no published session count for eldership work in therapy [uncertain: not verified]. The figures that sources give are: a Sage-ing residential workshop of five days, which also serves as the prerequisite for Certified Sage-ing Leader training [source: Hollyhock]; a community elder group that studied together over several years before a congregational consecration [source: Jewish Sacred Aging]; and, for a therapist-guided leave-taking ritual in mourning therapy, one reported case of 21 sessions over about 18 months with weekly-or-more contact during active phases [source: van der Hart and Goossens 1987]. The working frame below combines the Sage-ing themes with van der Hart and Goossens' three ritual phases; the combination is [synthesis].

Phase A. Assessment and meaning. Goal: understand what elderhood means to the client, their tradition and their family, what rite (if any) is available, and what is hoped for or feared. Tools: CFI core plus modules 5 and 10; a preliminary contract (van der Hart and Goossens end assessment with one). Move on when the client can name the transition being marked and wants to work on it [synthesis].

Phase B. Preparation (review, repair, harvest, mortality). Goal: the inner work Sage-ing names: life review and life repair, forgiveness, harvesting wisdom, examining myths of aging, facing mortality and preparing legally, medically, emotionally and spiritually, and envisioning an elder role [source: Hollyhock]. If a ritual is to be designed, agree its design and the shared work in a definitive contract [source: van der Hart and Goossens 1987]. Move on when the client shows less preoccupation with the past and growing interest in the present, the readiness signs van der Hart and Goossens describe for finalising a leave-taking ritual (adapted here) [synthesis].

Phase C. The rite. Either a rite held by the client's community (congregation, coven or temple, Sage-ing circle, Indigenous community through its own Elders) or a client-authored ceremony. Van der Hart and Goossens' finalisation sequence (a leave-taking ceremony, a cleansing act, a reunion with important people) is one model; Imber-Black and Roberts' planning elements (preparation, people, place, participation, presents) are another [source: van der Hart and Goossens 1987; Imber-Black and Roberts 1993, contents].

Phase D. Reincorporation and elder role. Goal: debrief, consolidate the new identity, take up mentoring, service or intergenerational roles that Sage-ing names [source: Hollyhock; Idealist], and plan for anniversaries and later setbacks, which van der Hart and Goossens treat as expected [source: van der Hart and Goossens 1987]. End when the client describes their life in present and future terms and the elder role is lived rather than only planned [synthesis].

Format: individual, couple or family sessions; the client may in parallel attend a group (Sage-ing workshops and wisdom circles are group formats [source: Idealist; Gear 2023]). Most ritual work is done by the client between sessions as homework, with session time used to review and adjust it [source: van der Hart and Goossens 1987].

3. Guiding principles

The client is the author. The therapist guides and suggests; the client decides the ritual's content and symbols [source: van der Hart and Goossens 1987]. Practical meaning: offer structure and options, never a script.
Elderhood is recognised, not merely reached. The Lakehead Indigenous Initiatives guide says Elder roles "are not defined by age" but by knowledge and cultural wisdom; the Temple of Witchcraft says its rite is not automatic and not a reward for growing old [source: Lakehead; Temple of Witchcraft]. Practical meaning: explore what the client's community recognises, and do not confer "elder" status yourself.
Describe each tradition only as it publishes itself. Practical meaning: speak of a community's rite in outline and in its own terms; ask the client, their clergy or Elders for anything more; never ask for or record initiatory content (the Temple describes its rite as an initiation into "the mysteries of elderhood" and does not publish them) [source: Temple of Witchcraft].
No appropriation of closed or Indigenous ceremonies. Indigenous ceremony is held by the community's own Elders and Knowledge Keepers; the Lakehead guide stresses relationship and in-person teaching [source: Lakehead]. Practical meaning: a non-Indigenous client is not offered an "Indigenous elder ceremony"; an Indigenous client is supported to approach their own community.
Cultural humility and structured inquiry. Practical meaning: use the CFI and its modules rather than assumptions about what age, religion or gender mean to this client [source: APA CFI supplementary modules].
Counter ageism, including your own. Module 10 asks about age-related attitudes and discrimination, including within the clinical relationship; Sage-ing examines myths of aging [source: APA CFI supplementary modules; Hollyhock]. Practical meaning: check your own assumptions about decline, sexuality, capacity and usefulness in later life.
Hold growth and loss together. Sage-ing frames later life as growth; the same transition involves retirement, bodily change, bereavement and mortality [source: Gear 2023; Hollyhock]. Practical meaning: neither push celebration nor pathologise grief.
Forgiveness is offered, not demanded. The Sage-ing workshop presents forgiveness as a gift you give yourself [source: Hollyhock]. Practical meaning: explore forgiveness as an option, never as a condition of becoming an elder.
Life review can bring despair; plan for it. Van der Hart and Goossens report a common low point, sometimes with suicidal feelings, during ritual work, and build in between-session contact and crisis cover [source: van der Hart and Goossens 1987]. Practical meaning: risk-assess before and during, with a written crisis plan.
Group practice is not therapy. A Certified Sage-ing Leader's group ground rules include confidentiality, the right to pass and the statement that the session is not therapy [source: Gear 2023]. Practical meaning: refer to groups as a complement; keep clinical work in therapy.
Gender and family-stage framings are not universal. Croning as published ties elderhood to the end of childbearing within a Maiden, Mother, Crone cycle, while noting the Mother stage applies "whether or not she has children" [source: Pagan Song]. Practical meaning: check fit for childless, trans, non-binary and intersex clients and anyone for whom reproductive framing is painful.
Roles and competence. If you are also a Sage-ing leader, celebrant or member of the client's congregation, consider multiple relationships under APA Ethics Code Standard 3.05 [source: APA Ethics Code]. Practical meaning: decide in advance whether you will attend or officiate, and usually do neither.
Name a spiritual problem when that is the focus. Where the difficulty centres on a rite, a tradition or loss of faith, "religious or spiritual problem" sits under ICD-10-CM Z65.8 [source: ICD-10-CM Z65.8 (Unbound Medicine)]; DSM-5-TR wording [uncertain: not verified].
Consent and family. Practical meaning: adult children, spouses or congregations may push or resist a rite; the client decides whether to take part and who attends [synthesis]. Where cognitive impairment is present, assess capacity for each decision and involve the client's legal representatives as required [synthesis].

4. Intervention inventory

The sources describe themes (Sage-ing), ritual phases and acts (van der Hart and Goossens), planning elements (Imber-Black and Roberts) and assessment domains (CFI) rather than a full set of session procedures, so the step-by-step instructions below are largely therapist procedures built on those sources and marked [synthesis] where the steps are not sourced.

4.1 Cultural and spiritual assessment of elderhood (CFI core and module 5)

Purpose / when: First sessions with any client raising later-life transition, a rite, or a feeling of being "old but not an elder". Module 5 covers religious, spiritual or moral affiliation and family background, participation in community and home practices, the role of these traditions in daily life and decisions, how they help with coping, and stresses, conflicts or discrimination linked to them, including whether they contribute to the problem [source: APA CFI supplementary modules].
Steps: (1) Run the core CFI in your own words. (2) Add module 5 (16 questions in the published version; do not read items aloud from memory, use the APA form) [source: APA CFI supplementary modules]. (3) Ask specifically whether the client's tradition has an elder rite, who confers it, and whether they are eligible, wanted or excluded [synthesis]. (4) Note any secret or initiatory parts and agree not to explore their content [synthesis]. (5) Summarise back the client's own explanatory model of elderhood [synthesis].
Example language (illustrative): "In your community, who decides that someone has become an elder, and how would you know it had happened to you?"
Watch for: the client deferring to what you might expect; conflict between personal belief and family or congregation; signs that a rite is a source of pressure rather than meaning. Working: the client can describe the transition in their own vocabulary.

4.2 Ageing and transition assessment (CFI module 10)

Purpose / when: With older clients, or when aging itself is part of the presenting concern. Module 10 covers how the person views aging and compares themselves with peers, how age-related transitions affect the problem and coping, how medical conditions and treatment interact with it, adequacy of support and caregiving, and experiences of age-related attitudes or discrimination, including in the clinical relationship [source: APA CFI supplementary modules].
Steps: (1) Use the module (17 questions in the published version) alongside 4.1 [source: APA CFI supplementary modules]. (2) List current transitions: retirement, end of active parenting, grandparenthood, bereavement, illness, relocation [synthesis]. (3) Ask directly about ageism in your own sessions [source: module 10 domain; wording synthesis]. (4) Screen mood, cognition and suicide risk using your service's standard tools [synthesis].
Example language (illustrative): "Have you felt treated differently because of your age, including by health professionals, including me?"
Watch for: depression presenting as "just getting old"; untreated medical problems; cognitive change needing referral. Working: the client distinguishes what aging means to them from what others assume.

4.3 Mapping available rites and fit

Purpose / when: When a client wants their elderhood marked but does not know what exists, or is unsure whether a known rite fits [synthesis].
Steps: (1) With the client, list rites their own communities hold: congregational elder ceremonies (one Reform congregation consecrated an elder havurah after years of shared study [source: Jewish Sacred Aging]); croning or saging in pagan communities (held around Samhain in some communities, and adapted by a Methodist educator using scripture and hymns [source: RNS c. 2004]); eldering rites that require preparation and community service (the Temple of Witchcraft sets a minimum age of 60 and prior preparation [source: Temple of Witchcraft]); Sage-ing workshops and circles [source: Hollyhock; Idealist]; or the client's Indigenous community through its own Elders [source: Lakehead]. (2) For each, note who holds authority, eligibility, cost, accessibility and whether it is open or closed [synthesis]. (3) If none fits, consider a client-authored ritual (4.14) [synthesis].
Example language (illustrative): "Let's look at what your own communities already offer before we think about designing anything new."
Watch for: borrowing closed rites; a client being steered by one family member; costs or travel the client cannot meet. Working: a short list the client owns.

4.4 Guided life review

Purpose / when: The Sage-ing preparation begins with looking back on one's life with present understanding [source: Hollyhock]. Use when the client is ready to reflect and not in acute crisis.
Steps (synthesis): (1) Agree a structure: decades, places, relationships or turning points. (2) Ask the client to bring photographs, objects or notes between sessions. (3) In session, explore one period at a time, noting achievements, regrets, people and recurring themes. (4) Keep a running list of "unfinished business" for 4.5 and "lessons" for 4.6. (5) Pace by distress; pause for grounding if trauma memories surface.
Example language (illustrative): "Looking at that decade with the eyes you have now, what do you understand that you couldn't then?"
Watch for: rumination rather than review; trauma surfacing that needs trauma-focused treatment; a low point of despair, which van der Hart and Goossens report as common in ritual work, sometimes with suicidal feelings [source: van der Hart and Goossens 1987]. Working: stories become more coherent and less loaded with self-blame.

4.5 Life repair and forgiveness

Purpose / when: Sage-ing pairs review with "life repair" and the courage to forgive, presented as a gift to oneself [source: Hollyhock]. Use when review uncovers resentment, guilt or estrangement.
Steps (synthesis): (1) Pick one item from the unfinished-business list. (2) Clarify what repair would mean: an apology, an amends, an unsent letter, acceptance, or nothing. (3) Assess safety and wisdom of contact before any real-world approach. (4) Rehearse in session. (5) Review outcome and meaning, whether or not the other person responds.
Example language (illustrative): "Forgiveness is one option here, not an obligation. What would leave you freer, whatever the other person does?"
Watch for: pressure to forgive abuse; contact with an abuser; the client seeking repair to win approval. Working: reduced preoccupation and a decision the client stands by.

4.6 Harvesting wisdom

Purpose / when: Sage-ing speaks of "harvesting" the wisdom of a lifetime and offering it as a legacy [source: Hollyhock; Gear 2023]; Schachter-Shalomi held that people become elders through harvesting in community [source: Jewish Sacred Aging].
Steps (synthesis): (1) From the life review, ask the client to draw out what they have learned, in their own words. (2) Group lessons into themes (relationships, work, loss, faith, mistakes). (3) Ask for whom each lesson might matter. (4) Choose a form of passing it on (conversation, writing, recordings, mentoring).
Example language (illustrative): "If one younger person could take away one thing you've learned the hard way, what would it be?"
Watch for: a client who believes they have nothing to offer (see section 5); lecturing tone that could strain family relationships. Working: the client speaks of their experience as a resource.

4.7 Elder exemplars

Purpose / when: In a Sage-ing group, participants reflect on elders they admire and want to emulate, then share in pairs with intentional listening while a partner notes traits [source: Gear 2023]. Adapt for individual therapy when the client lacks a picture of the elder they want to be.
Steps: (1) Ask the client to recall admired elders, living or dead, known or public [source: Gear 2023]. (2) Have them describe one at length while you listen and note the traits you hear [source: Gear 2023, adapted for a dyad]. (3) Read the traits back and ask which the client already has and which they want to grow [synthesis].
Example language (illustrative): "Tell me about an older person you admired. I'll jot down the qualities I hear, then we'll look at them together."
Watch for: idealisation that sets an impossible standard; grief for the exemplar. Working: a concrete, personal description of the elder the client aims to be.

4.8 Examining myths of aging

Purpose / when: Sage-ing examines common myths of aging and affirms a new vision for the second half of life [source: Hollyhock]. Use when internalised ageism drives low mood or withdrawal.
Steps (synthesis): (1) Elicit beliefs about aging ("old people are a burden"). (2) Trace where each came from. (3) Weigh each against the client's experience and observations. (4) Draft an alternative belief in the client's words. (5) Test it in a small behavioural step.
Example language (illustrative): "Where did you first learn that being older means being in the way?"
Watch for: dismissing real losses as "just a myth"; your own ageist assumptions. Working: more flexible, less self-dismissing talk about age.

4.9 Mortality preparation

Purpose / when: Sage-ing includes facing one's mortality and preparing legally, medically, emotionally and spiritually for peace of mind [source: Hollyhock].
Steps (synthesis): (1) Ask permission to talk about death. (2) Explore fears, beliefs and hopes about dying, in the client's religious or moral frame (link 4.1). (3) Help the client list practical tasks and route each: will and powers of attorney to a lawyer; advance care planning to their physician; spiritual questions to their chosen clergy or a hospice chaplain (see 115). (4) Track emotional responses as tasks are done.
Example language (illustrative): "Some people find that once the practical arrangements are made, it's easier to think about how they want to live the rest of their time. Would it help to look at both?"
Watch for: death talk masking suicidal ideation (assess directly); giving legal or medical advice yourself (do not). Working: less avoidance and a clear list of next steps with named professionals.

4.10 Elder role and service planning

Purpose / when: Sage-ing asks participants to identify how they can serve as a mentor and healer and to develop their own vision of themselves as an elder; Sage-ing International lists service, wisdom circles, intergenerational relationships and volunteering [source: Hollyhock; Idealist]. Use in Phase D, or earlier for a client without purpose after retirement.
Steps (synthesis): (1) From 4.6 and 4.7, name roles that fit (grandparenting, mentoring, congregational or community service, advocacy). (2) Match roles to health, energy and access. (3) Plan a first small step. (4) Review with behavioural-activation logic: what was done and how it felt (see II 040).
Example language (illustrative): "Which of these feels like you, rather than like what people expect of a retired person?"
Watch for: overcommitment and burnout in helpers; roles the client takes on to escape grief. Working: regular, satisfying contribution the client describes as meaningful.

4.11 Leave-taking ritual for the role being left

Purpose / when: Van der Hart and Goossens developed leave-taking rituals as short-term, directive mourning therapy for conflicted or unexpected grief [source: van der Hart and Goossens 1987]. Using the same structure to take leave of a role (career, active parenting, a home) before claiming elderhood is an adaptation [synthesis]. Retirement can itself be the occasion: a croning reported by RNS included smashing an alarm clock [source: RNS c. 2004].
Steps: (1) Preparation: explain how a ritual may help; confirm motivation, since the work is demanding; inform supportive family members and identify "standbys"; agree a contract on the ritual's design [source: van der Hart and Goossens 1987]. (2) Reorganisation: the client collects or makes symbols of the role (4.12) and writes regularly (4.13) [source: van der Hart and Goossens 1987]. (3) Finalisation: a leave-taking act with the symbols; a cleansing act marking exit from the in-between phase; a reunion with important people symbolising new relationships [source: van der Hart and Goossens 1987]. (4) Follow-up: anticipate anniversaries [source: van der Hart and Goossens 1987]. The authors stress that the aim is not to erase memory; some symbols can be kept and related to differently [source: van der Hart and Goossens 1987].
Example language (illustrative): "Before you step into what comes next, it may help to say goodbye properly to what you're leaving. What would stand for those working years?"
Watch for: ending too early to avoid painful feelings (the authors advise deciding the end together); sadness rather than relief afterwards, including grief for lost years [source: van der Hart and Goossens 1987]. Working: the client speaks of the old role in the past tense without bitterness.

4.12 Working with key symbols

Purpose / when: Van der Hart and Goossens identify key symbols (linking objects) early, sometimes have the client give one to the therapist for safekeeping, and have the client collect, rearrange or make symbols such as framed photographs, drawings or poems [source: van der Hart and Goossens 1987]. Use in any ritual work.
Steps: (1) Ask what objects carry the transition [source]. (2) Invite the client to bring or make symbols [source]. (3) Decide with the client what happens to each at the ritual: kept, given away, transformed, or let go [source: van der Hart and Goossens 1987; choices offered as synthesis]. (4) If you hold an object for safekeeping, agree how and when it is returned [synthesis].
Example language (illustrative): "Is there an object that holds this part of your life for you? You could bring it next time."
Watch for: objects with religious or ceremonial status the client may not have authority to alter; irreversible acts the client may regret. Working: the client handles symbols with feeling and clear intention.

4.13 Continuous letter

Purpose / when: The core homework of the reorganisation phase: the client writes regularly at a fixed time and place, rereads earlier writing, expresses the complete message including negative feelings, and stays seated even when stuck; the authors describe writing daily or at least three times a week for up to an hour, or less if tension is too high, and separate notebooks for different people or themes [source: van der Hart and Goossens 1987].
Steps: (1) Agree the addressee: originally the deceased; in eldership work it may be the role being left, a younger self, or descendants [adaptation: synthesis]. (2) Agree time, place and rhythm with the client [source]. (3) Review content in session and adjust [source]. (4) Decide together when to stop, using readiness signs: less preoccupation with the past, dreams of taking leave, growing interest in the present [source: van der Hart and Goossens 1987].
Example language (illustrative): "Write to the person you were at forty. Say everything, including the parts you're angry about."
Watch for: stopping abruptly; rising despair (contact and crisis plan); writing that becomes rumination. Working: content shifts from past to present and future.

4.14 Co-designing a client-authored eldering ceremony

Purpose / when: When no community rite fits, or alongside one. Imber-Black and Roberts organise ritual planning around preparation, people, place, participation and presents, and treat symbols and symbolic actions as how rituals make meaning; they also discuss family ritual styles [source: Imber-Black and Roberts 1993, contents]. Their named "five purposes of rituals" are not reproduced here [uncertain: not verified].
Steps (synthesis, organised by the published planning elements): (1) Preparation: what the ceremony marks, what the client wants to be different afterwards. (2) People: who witnesses, who speaks, who confers recognition, who is not invited. (3) Place: somewhere meaningful and accessible. (4) Participation: what each person does; the client's own act of claiming. (5) Presents: gifts or tokens, including what the client gives to the next generation (link 4.6). (6) Symbols: chosen from 4.12. (7) Rehearse the emotional arc, not a script. (8) Plan after-care.
Example language (illustrative): "This is your ceremony. I can help you think about who, where and what; you decide what it says."
Watch for: borrowing elements from closed traditions (name the source and check whether it is open); the therapist's taste shaping content; cost. Working: the client describes the plan with ownership and some excitement.

4.15 Preparing for a community-held rite

Purpose / when: The client will be croned, saged, eldered or consecrated by their community. Some communities set their own preparation (the Temple of Witchcraft requires preparation and commitments to self, community, the Earth and the Gods; its guidelines are not published) [source: Temple of Witchcraft].
Steps (synthesis): (1) Clarify what the client knows of the rite, in outline only. (2) Explore hopes, fears and the commitments it implies. (3) Address practical access: mobility, hearing, sight, outdoor or night-time settings, cost. (4) Plan for family members who object or will be absent. (5) Agree how to debrief (4.16).
Example language (illustrative): "You don't need to tell me anything that's meant to stay within your community. What do you want to carry into it?"
Watch for: pressure to take part; commitments beyond the client's health or means; disclosure of protected content. Working: the client attends by choice and with realistic expectations.

4.16 Debriefing and reincorporation

Purpose / when: After any rite. Van der Hart and Goossens treat follow-up, later memorials and anniversaries as part of the work [source: van der Hart and Goossens 1987].
Steps (synthesis): (1) Invite an account of the experience in the client's own terms. (2) Explore what changed and what did not. (3) Note disappointment, anticlimax or sadness as expected. (4) Link to 4.10: the first elder actions. (5) Mark the next anniversary.
Example language (illustrative): "What was it like to be named an elder in front of people who matter to you? And what has felt different since, if anything?"
Watch for: feeling unchanged; a rite that went badly or was disrupted; conflict that surfaced. Working: the client refers to themselves in the new role.

4.17 Collaborating with clergy, Sage-ing leaders or community Elders

Purpose / when: When the client wants their religious leader, Sage-ing facilitator or community Elder involved.
Steps: (1) Obtain written consent specifying what is shared [synthesis]. (2) Let the client lead contact where possible [synthesis]. (3) For Indigenous Elders, follow the community's or your institution's protocol; one published guide advises asking first whether tobacco is offered (not everyone follows this), introducing yourself with your name, heritage, place of origin, treaty land and role, stating the request clearly, and recognising reciprocity through honoraria and gifts [source: Lakehead]. (4) Respect that cultural authority sits with the Elder or clergy, not the therapist [synthesis].
Example language (illustrative): "Would it help if I spoke with your minister, with your permission, about how the ceremony might fit what we're working on?"
Watch for: confidentiality leaks within small communities; the therapist becoming a go-between in community disputes. Working: a clear, consented division of roles.

4.18 Working with a missed, refused or unavailable rite

Purpose / when: When the client feels unrecognised, was excluded (for example by sexuality, gender identity, divorce, childlessness, disability or leaving a faith), or refused a rite and now grieves or feels ashamed [synthesis]. The UU Cleveland service observes that US culture does not honour elderhood well and aging people often feel overlooked [source: UU Congregation of Cleveland].
Steps (synthesis): (1) Name the loss and its history. (2) Separate the client's worth from the community's recognition. (3) Explore whether repair is possible in the community, in an inclusive alternative, or through a client-authored rite (4.14). (4) Consider whether Z65.8 applies.
Example language (illustrative): "It sounds as if the people who should have recognised you didn't. That's a real loss, and it says nothing about what you carry."
Watch for: shame, anger at a faith, spiritual distress needing a spiritually informed colleague. Working: less shame and a chosen route to recognition.

4.19 Family and intergenerational sessions

Purpose / when: When adult children, spouses or grandchildren are part of the rite, oppose it, or are the intended recipients of the elder's legacy; van der Hart and Goossens assess whether the whole family is affected and note family therapy may fit better [source: van der Hart and Goossens 1987].
Steps (synthesis): (1) Map each member's view of the rite and the elder role. (2) Address interfaith or mixed-heritage differences openly. (3) Agree roles in the ceremony (4.14). (4) Rehearse how wisdom will be offered without control.
Example language (illustrative): "Your mother wants to mark this; you're uneasy. Can each of you say what the ceremony would mean to you?"
Watch for: elder abuse or financial exploitation (safeguarding duties apply); coercion in either direction. Working: family members can disagree and still attend or opt out respectfully.

4.20 Referral to and evaluation of Sage-ing groups and circles

Purpose / when: For clients who want peer community. Sage-ing groups use ground rules of confidentiality, respectful listening, speaking from the heart, the option to pass and a statement that the group is not therapy [source: Gear 2023]; Sage-ing International trains Certified Sage-ing Leaders [source: Idealist; Hollyhock].
Steps (synthesis): (1) Ask the facilitator about training, ground rules and how distress is handled. (2) Check cost, accessibility and whether faith content fits the client. (3) Agree how group material will be brought into therapy. (4) Review fit after the client starts.
Example language (illustrative): "A group won't replace our work, but it might give you peers who are asking the same questions."
Watch for: a group drifting into unstructured therapy; charismatic leadership; pressure to buy further training. Working: the client reports belonging and brings useful material back.

5. Handling problems

Sourced points are tagged; everything else is [synthesis].

Despair, low points and suicidal feelings during review or ritual work. Van der Hart and Goossens report a common low point, sometimes with suicidal feelings, and responded with extra contact, between-session phone access, emergency cover and sometimes a medication review by the prescriber [source: van der Hart and Goossens 1987]. Response: assess risk directly at each session in this phase, keep a written safety plan, involve the client's physician for any medication question (never advise changing medicine yourself), pause ritual homework if risk rises, and give crisis lines: 988 (US); Samaritans 116 123 (UK and Ireland) [synthesis].
"I have nothing to offer." Response: slow down 4.6; start with small, concrete lessons; use 4.7 to locate qualities; test with one low-stakes act of sharing; treat persistent worthlessness as possible depression and assess [synthesis].
Stuck in regret or rumination. Response: shift from review to repair (4.5) or to the continuous letter (4.13) with a defined rhythm; if regret centres on trauma, refer for or provide trauma-focused treatment before ritual work [synthesis].
Ending too early or avoiding the finale. The authors warn that clients may stop or end a ritual prematurely to avoid feeling, and that an incomplete ritual may not achieve leave-taking; they reframe setbacks as signs of remaining work [source: van der Hart and Goossens 1987]. Response: name the avoidance kindly, agree the end jointly, allow postponement rather than abandonment.
Non-adherence to homework. Response: shrink the task, fix a time and place together, review obstacles without judgement, and check whether the ritual is truly the client's or one you suggested [synthesis].
Anticlimax or sadness after the rite. Expected; clients may grieve "lost years" [source: van der Hart and Goossens 1987]. Response: normalise, debrief (4.16), mark anniversaries.
Family or congregation pressure. A Methodist adaptation of croning drew mixed reactions [source: RNS c. 2004]. Response: the client decides whether to take part and who attends; offer family sessions (4.19); explore compromise forms; never mediate religious doctrine.
Exclusion by gender, sexuality, family status or disability. Published croning ties elderhood to the end of childbearing and a Maiden, Mother, Crone cycle [source: Pagan Song]. Response: ask how the client relates to that framing; seek inclusive communities or a client-authored rite (4.14); check venue access; treat exclusion as a real loss (4.18).
Request to borrow a closed or Indigenous ceremony. Response: explain that such ceremonies are held by their communities' Elders and Knowledge Keepers [source: Lakehead]; explore what the client is seeking (recognition, belonging, connection to land) and find routes in the client's own heritage or open practices; cross-refer V 182 for land-based programmes run with Elders.
Client wants the therapist to officiate, attend or join their group. Response: consider multiple relationships under APA Ethics Code Standard 3.05; usually decline officiating, discuss attending only if clinically justified and documented; if you are trained as a Sage-ing leader or celebrant, keep the roles separate and refer the ceremonial role to a colleague.
Questions about secret or initiatory content. Some rites describe elderhood as an initiation into mysteries they do not publish [source: Temple of Witchcraft]. Response: do not ask for it or record it; work only with the client's experience and meaning.
Cognitive impairment. Response: assess capacity for each decision; involve the client's chosen family and legal representatives as the law requires; simplify the ritual, use familiar symbols, and keep the client's voice central.
Grief overlapping elderhood. Bereavement often accompanies later-life transitions. Response: assess grief, including prolonged grief disorder as DSM-5-TR and ICD-11 define it [uncertain: not verified], and cross-refer 112 mourning rites and 113 ancestor rites; van der Hart and Goossens place dependent grief within a secure therapy relationship before rituals [source: van der Hart and Goossens 1987].
Elder abuse, neglect or financial exploitation surfacing. Response: follow local adult safeguarding procedures; document; do not let ceremony planning delay protection.
Ruptures from therapist ageism or cultural misreading. Module 10 explicitly asks about age-related attitudes in the clinical relationship [source: APA CFI supplementary modules]. Response: invite feedback, acknowledge the misstep, repair, and use module 8 (Patient-Clinician Relationship) if useful [source: APA CFI supplementary modules list].
Spiritual crisis or loss of faith around elderhood. Response: consider Z65.8 (religious or spiritual problem) [source: ICD-10-CM Z65.8 (Unbound Medicine)]; consult a colleague with spiritual and religious competence (Vieten et al. 2013 [uncertain: not verified]); offer referral to clergy or a spiritual director the client chooses.
Group harms. Response: if a group pushes members into unstructured emotional exposure, drifts into therapy, or pressures purchase of training, help the client reassess fit (4.20).
Cost and access. Response: look for congregational, community or online options; scale a client-authored rite to the client's means.

Sources

Web sources:

Further references:

APA Ethical Principles of Psychologists and Code of Conduct (Standard 3.05, Multiple Relationships)
ICD-10-CM Z65.8 , Other specified problems related to psychosocial circumstances (includes 'Religious or spiritual problem')
van Gennep, A. (1909). The Rites of Passage [uncertain: edition not verified].
Vieten, C. et al. (2013), spiritual and religious competencies for psychologists [uncertain: not verified].

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