3.8.1 Psychotherapy and Transference with Older Adults

Psychotherapy with Older Adults: Adaptations and Difference in Therapy

Psychotherapy:

Psychotherapy with older adults requires certain adaptations and differences from therapy with younger adults. Ageing brings with it unique challenges and experiences that can impact mental health and well-being. Older adults may face issues such as physical decline, loss of independence, loneliness, grief, and changes in social roles, which can contribute to the development or exacerbation of mental health issues. Therefore, therapists need to be aware of these challenges and adapt their approach to therapy accordingly. This essay will discuss adaptations and differences in therapy with older adults, transference-countertransference issues, and common themes in therapy with this population.

Adaptations and differences in therapy:

Psychotherapy with older adults requires adaptations in terms of therapeutic goals, therapeutic techniques, and therapeutic style. The therapeutic goals in therapy with older adults may differ from those with younger adults. For example, older adults may prioritize improving their quality of life, enhancing relationships with family and friends, managing physical and cognitive health, and finding meaning and purpose in life (Karel & Hinrichsen, 2000). Thus, therapists may need to focus more on improving coping skills and emotional regulation, addressing existential concerns, and providing support in dealing with physical and cognitive limitations.

Therapeutic techniques used with older adults may also require adaptations. Therapists may need to modify techniques to accommodate sensory or cognitive impairments, use more concrete examples and language, and allow for more pauses and silence in conversation to give time for processing information (Knight, 2008). Additionally, therapists may need to incorporate life review techniques, reminiscence therapy, or intergenerational interventions to help older adults process their life experiences, maintain a sense of self-worth, and bridge generational gaps with their families (Butler & Lewis, 2013).

Lastly, the therapeutic style may differ from therapy with younger adults. Therapists may need to adopt a more supportive and directive approach, provide reassurance and validation, and engage in more active problem-solving and goal-setting. Additionally, they may need to be aware of cultural and generational differences and incorporate those into the therapeutic relationship (Gallagher-Thompson et al., 2001).

Transference-Countertransference Issues

Transference and countertransference issues can occur in any therapeutic relationship, but they may be more pronounced in therapy with older adults. Transference refers to the transfer of emotions, attitudes, and behaviours from past relationships onto the therapist, while countertransference refers to the therapist’s emotional response to the patient’s transference (Karel & Hinrichsen, 2000). Older adults may have lived through different historical events, societal norms, and cultural values than the therapist, which can result in unique transference-countertransference dynamics.

For example, an older patient who has experienced discrimination in the past may transfer feelings of mistrust or suspicion onto the therapist who belongs to a different cultural or ethnic group. Alternatively, the therapist may feel guilty or responsible for the patient’s past experiences of discrimination, leading to countertransference feelings of guilt or shame. It is crucial for therapists to be aware of their own biases and reactions to transference and countertransference, and to address them in supervision or consultation.

Common Themes Psychotherapy with older adults often involves common themes, such as loss, grief, and meaning-making. Older adults may experience various forms of loss, including the loss of loved ones, health, independence, social roles, and identity. These losses can lead to feelings of grief, loneliness, and isolation. Therefore, therapists may need to provide a safe space for patients to process their grief and help them find new sources of meaning and purpose in life.

Another common theme in therapy with older adults is the search for meaning and legacy. As older adults reflect on their lives and experiences, they may seek to leave a legacy In addition, it is important for therapists to be aware of the common themes that older adults may bring into therapy. These include themes of loss, change, and transition. Many older adults have experienced significant losses, such as the death of loved ones, retirement, and declining health. These losses can lead to feelings of grief, loneliness, and depression.

Change and transition are also common themes in older adulthood, as individuals may be adapting to new living situations, changes in health, and the loss of independence. Being aware of these themes can help therapists to tailor their interventions and provide the support that is relevant and meaningful to the older adult.

In conclusion, psychotherapy with older adults requires specific adaptations and considerations in order to be effective. Therapists must be aware of the unique developmental and cultural factors that influence older adults, and adapt their interventions accordingly. Transference and countertransference issues must also be carefully considered, as older adults may have different expectations and reactions to therapy than younger clients. Finally, therapists should be attuned to the common themes of loss, change, and transition that are prevalent in older adulthood, and provide the support that is relevant and meaningful to the older adult’s life experiences.

Reference:

1. American Psychological Association. (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34-65.
2. Knight, B. G. (2018). Psychotherapy with older adults. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (6th ed., pp. 837-876). Guilford Press.
3. Leach, C. W., & Henry, R. G. (2010). Aging and psychotherapy: Transference and countertransference considerations. In Handbook of psychotherapy and behavior change (6th ed., pp. 447-479). Wiley.
4. Levy-Storms, L. (2005). Psychotherapy with older adults. In Handbook of psychotherapy and aging (pp. 27-43). Springer Publishing Company.