Senior Citizens and Psychotherapy: Obstacles to Treatment

stk27643sptImagine that you are 86 years old and recently lost your partner of 6o years. You are grieving and find it hard to engage in daily life—it holds little meaning anymore. You go through the motions, and your family (if you’re fortunate enough to have an attentive family) expresses concern. You go to your litany of doctors, and one of them worries that you seem depressed. You scoff, thinking this is obvious, and what are you going to do about it anyway? She refers you to a doctor you can talk to about this. Because you respect your doctor, you follow up and make the appointment. You arrive expecting a sterile medical complex. Instead, you are met by a woman who ushers you into a pleasant office—more like a living room—and invites you to sit on a comfy couch. She asks you all sorts of nosy questions about your feelings and your life and you wonder: What is this?

This scenario may seem far-fetched, but it is not far from the norm in my experience. Most seniors who end up in my office did not come seeking psychotherapy. They came because someone told them to, and they have no idea what to expect. If anything, they assume someone will be prescribing them more medications. Why is this?

There are many contributing factors. Part of the problem, certainly, is a generational issue: Most people who are over 75 did not grow up valuing psychotherapy. Emotions are very personal and private;  besides, if they haven’t needed it yet, why would they now? I hope this attitude will change with the boomers as they age. Another issue is that many seniors don’t recognize that they are depressed. It is usually a family member or doctor who observes this and then pushes the person to seek help. And often it is not clearly communicated where they are sending the person. In addition, there is a dearth of quality practitioners who see seniors. I started seeing this group largely because no one else in my practice cared to.

Don’t get me wrong: Working with seniors comes with many challenges for the therapist as well. It forces you to face your own mortality and losses in life. Also, the older people are, the more set in their ways they tend to be. So it can feel like change is slow or even impossible. Another challenge is that seniors often are ill and seeing doctors, so they may attend treatment irregularly and frequently cancel last-minute.

Once engaged, I have found that being truly heard and slight adjustments can make a huge difference in a senior’s life. Often, people feel unheard by their children and doctors and they struggle with the loss of their faculties as well as of their autonomy. This can be extremely infantilizing and lonely. Overall, if I could suggest the main factor that will predict thriving in older age, it is whether the person feels engaged in his or her life. Whether helping someone to feel more connected/less isolated; whether it is accepting the constant losses that are a part of daily life; whether it is finding activities and communities to engage them; whether we help them find their voices with authorities or their own families, there is much that we as therapists can do to help seniors thrive.

© Copyright 2013 All rights reserved. Permission to publish granted by Lillian Rozin, MFA, LCSW, RYT, therapist in Media, Pennsylvania

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • E.Y


    June 10th, 2013 at 9:46 PM

    I wish I had just force-taken my mom to therapy before she passed.She was depressed at seventy and would not go to a therapist.

    No amount of talking or making her understand helped.She thought therapy is for people who are not right in their head and felt going to one would mean she was too.I commend your commitment to helping seniors.Often they are lonely and a therapist may offer help that protects them from this feeling that consumes them from inside.

  • ellie


    June 11th, 2013 at 4:23 AM

    I saw this in my own grandmother.

    When she felt like she still had some choices she was so much more pat to do the things she needed to do to keep herself up and happy, whereas when some of that had to be taken away she kind of gave up on everything.

  • Alison


    June 12th, 2013 at 4:19 AM

    Have we even talked about money being an obstacle? Think about it. Most seniors are on a very fixed income and some may have insurance plans that do not cover any sort of mental health treatment and they may not have families who are willing or able to take on some of that kind of financial responsibility.
    So this would be a huge burden for someone even if they knew that they needed help. Their financial situations may make this utterly impossible or them to consider pursuing.

  • Pru


    July 5th, 2013 at 5:05 PM

    Thanks for the infomation: Reading this article make me think of my own mother who is now 77yrs old and is somewhat experiencing some dementia she is so stubborn at times and does not listen. She appears to be stuggling with her own autonomy and medical concerns . Seeing a therapist is not something she would adhere to. Presently working in the social work/ mental health field has help me to understand her behavior and short comings.It is very difficult at times ,but she truly needs my support and love .I recommend that any one that is coping with a senor that is a parent or family member should focus on their strengths not their infantile behavior or short comings ..They will not change ……….You are the one that has to change in order to work with them or cope with their challanges. I am planning to go with my mother to one of her Yoga classes..She has not been in months..

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