How can psychotherapy change your life at any age?
KEY POINTS
- Older people may be even more likely to respond to psychotherapy than younger ones.
- Antidepressant medications may not have the same efficacy in late-life depression as they do earlier in life.
- Psychotherapy can help adults change the way they think about themselves and others at any age.
Rita*, a 72-year-old woman, felt fatigued and unmotivated a year after the birth of her first grandchild. A retired teacher, she was very excited about being a grandparent and readily accepted her daughter’s invitation to stay with the baby on Thursday nights so that the new parents could have a “date night.” A few months into this schedule, however, she begged off babysitting for two consecutive weeks, explaining that she was “too tired.” After a nudge from her husband, she went to her primary care physician (PCP), who said that although her exam and blood work were fine, she wondered if Rita might be depressed. She offered Rita antidepressants but also suggested that she might see a therapist.
Three cheers for Rita’s PCP. By suggesting that Rita see a therapist, she has done something that, for many years, most therapists did not do—that is, refer an older adult for psychotherapy. As many authors have noted, this bias likely stems from Freud’s famous but untested 1905 statements that people “above the age of fifty” lack the “elasticity of the mental processes on which the treatment depends” and that “old people are no longer educable” (Freud, 1905). Years later, this was still the message I got when I trained to be a psychiatrist and psychoanalyst in the 1980s and 90s. Thanks to Freud, generations of people lost out on the opportunity to benefit from psychotherapy in their later life.
Advances in neuroscience, however, have taught us not only that older individuals can learn new skills and tasks but that learning supports brain and emotional health. (Pauwels, 2018). We have also learned that antidepressants do not deliver the same level of benefits to older adults as they do to younger adults (Alexopolous, 2019) and that older adults are actually more likely to benefit from psychotherapy than younger adults (Saunders, 2021).
It turns out, then, that psychotherapy may be the best treatment for later-life depression. But can psychotherapy help older adults achieve lasting change in the way they fundamentally think about themselves and others later in their lives?
Rita, who had never been in psychotherapy before, reluctantly called a therapist. Early sessions focused on strategies for improving her mood, including increased exercise and reaching out to friends. Within a few weeks, Rita’s energy level improved and she felt more motivated for projects. But when she passed on another opportunity to babysit, her therapist asked her to say more about her feelings about becoming a grandmother. As Rita talked about taking care of the baby, she began to acknowledge how much she wished she had had the same kind of help from her own self-involved mother. She was able, for the first time, to uncover how hurt and neglected she felt as a child and as a young mother and to realize that these feelings were affecting not only her relationship with her daughter and grandchild but also her feelings of self-worth. She finished the treatment with a better sense of herself as a grandmother, a mother, a daughter, and a person.
Rita’s later life experience of helping her daughter triggered feelings of deprivation and anger at not having been helped by her own mother. In the setting of psychotherapy, she was able to access these feelings for the first time—feelings that helped her to develop a stronger sense of self.
As I age, the people who come to see me age as well. I now see many people who are in their 60s, 70s, and 80s. Often, their life experiences enable them to deepen their self-understanding in ways that they couldn’t have as younger people. Many experiences of later life, such as loss, divorce, retirement, medical illness, and shifting family roles, can help to unearth unresolved feelings from early life that continue to distort our sense of self and relationships with others.
If you are an older person with depression, anxiety, or a life cycle crisis, consider that psychotherapy could be part of your treatment plan. Many types of psychotherapy, including cognitive behavioral therapy, interpersonal therapy, prolonged grief therapy, and psychodynamic psychotherapy, could be helpful. Ask the therapist you consult if they have experience with older adults, and be open to learning new things about yourself. It may help you in ways you never imagined—at any age.
References
Alexopoulos, George S. “Mechanisms and treatment of late-Life Depression.” Translational Psychiatry, vol. 9, no. 1, 5 Aug. 2019, https://doi.org/10.1038/s41398-019-0514-6.
Freud, S (1905).On Psychotherapy. The Standard Edition of the Complete Psychological Works of Sigmund Freud,7:255-268. 905
Pauwels L, Chalavi S, Swinnen SP. Aging and brain plasticity. Aging (Albany NY). 2018 Aug 1;10(8):1789-1790. doi: 10.18632/aging.101514. PMID: 30067225; PMCID: PMC6128435.
Saunders R;Buckman JEJ;Stott J;Leibowitz J;Aguirre E;John A;Lewis G;Cape J;Pilling S.Older Adults Respond Better to Psychological Therapy than Working-Age Adults: Evidence from a Large Sample of Mental Health Service Attendees. Journal of Affective Disorders, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/34274792/. Accessed 16 Apr. 2024.
*not an actual patient