Theory and Practice of Contemporary Psychotherapies

Mental Health Treatment for Elderly: Challenges and Adaptations Video Transcript

There are challenges to psychotherapy in older people that have to be overcome. One would be the person in their family's own perceptions of aging. Time is limited, and who has time to see somebody once a week for several weeks? Give me a med that will make me get better quickly because I don't have time. Or, just seeing themselves kind of overly influenced by Freud, seeing themselves as they're too old to teach new tricks to. Their problems are fixed and unchangeable, and that's an attitude that has to be overcome. And that's an attitude that not only a lot of older people have about themselves, but sometimes their family members and children may have about them as well, and that's one of the reasons working with families is so important. But there are also a number of physical limitations that can affect one's ability to respond to psychotherapy.

Psychotherapy is talking and listening, and if you have significant hearing or visual problems, that can affect your ability to be in a talking and listening environment. If you're not ambulatory, it may be very difficult to get in a car, go to an office, climb the stairs, and then sit there for an hour talking about yourself. So those are issues that may need to be overcome. Similarly, if you've got urinary urgency or incontinence, not an uncommon problem in older people, you may not be able to sit for an hour at a time talking without taking breaks, and you don't want to be humiliated. You need to see somebody who is aware of that as a possibility and provides breaks as necessary, which you wouldn't do for somebody who's 30 or 40. It wouldn't be necessary.

Physical discomfort. If you have lots of pain, you may not be able to sit still. You may need to pace, you may need to walk around, you may need shorter sessions. Transportation difficulties. A lot of older people don't drive, and need other ways of getting to an office. Cognitive limitations. There are memory problems that are part of being older, and in psychotherapy, which is a talk therapy, not remembering things can get in the way of certain types of therapy. And reimbursement, you know, many of us have limited coverage, both for medications and for psychotherapy, or some coverage is only for medications, and psychotherapy is expensive. So, some of the ways of dealing with these, somebody who works a lot with older people may provide written information for forms with large print and large writing spaces to accommodate fine motor skills and difficulty with vision. That can help.

Audio-taping sessions, so the person who is visually impaired may be able to go home and listen to what went on in the therapy. Sitting closer to the patient, speaking slowly and speaking in tones that may be appropriate for somebody with various levels of hearing loss might be an adjustment that a therapist has to make in working with older people in psychotherapy. And certainly considering briefer, less frequent sessions, take-home support materials, teleconferencing, online supplements. There are lots of really good ones that we can recommend that people can use between sessions so that the sessions can be less frequent and less prolonged or useful. And last but certainly not least is therapy can be so gratifying with older people as we take advantage of the vast wealth and knowledge and experiences that they can bring to the therapy. I think any therapist who's going to be a worth their salt working with older people, I think needs to be very aware and respectful of the unique attributes that older people have that can make therapy so incredibly exciting to do, actually.

Collaborative care. What is collaborative care? Well, that's kind of working within the medical environment so that if you're seeing a primary care physician, rather than also having appointments to see a psychiatrist or a psychologist and kind of doubling the difficulty, it's working within the primary care setting. And in many collaborative care models, there may be a depression specialist, a nurse specialist, a social worker specialist who is knowledgeable about depression and evidence-based treatments that can provide collaboration and suggestions to the primary care physicians, can also meet with the patients and provide information to them. Sometimes can also themselves provide short term psychotherapy within the context of the primary care setting. Many collaborative care environments will have a visiting psychiatrist who may come in for an hour a week, not to see the patients, but to work with the staff and to educate the staff and to hear about cases and provide insight and encouragement and collaboration.