Working Psychotherapeutically With Older People

The following discussion outlines some basics in working with older adults. For a fuller discussion of the psychological approach to treating depression in older adults, the reader should consult Laidlaw et al. (2003). As Knight (1999) comments, there are two key questions for psychotherapists when working with older adults; can psychological interventions developed in adult settings be expected to work for older adults, and does one need to adapt these psychological interventions for use with older adults? From the foregoing, the first key question may be answered with a resounding yes. In this section, the second key question is explored and answered. It is important to understand that older adults are the least homogeneous of all age groups. Older adults often have many more dissimilarities than similarities (Steuer & Hammen, 1983). As Zeiss and Steffen (1996) point out, there are at least two generations contained within this age grouping. With the increase in longevity, there can be four decades separating the youngest old from the oldest old. In working psychologically with older people, it can often be useful to bear in mind the importance of cohort beliefs (Knight, 1999), which refer to the set of cultural norms, historical events, and personal events that obtained or occurred during a specific generation. Cohort beliefs may influence how easily older adults, particularly older men, will find discussing their feelings, and they may also influence stigmatising beliefs about mental illness. Cohort beliefs can act as a barrier to older adults receiving treatment for depression. Understanding older people in terms of their generational cohort allows therapists to gain insight into the societal norms and rules that may influence an individual's behaviour. Understanding cohort experiences and taking these into account when working psychotherapeutically with older people is no more difficult, and no less important, than when working with cohorts such as ethnic minority groups.

Koder et al. (1996: 105) state: 'The debate is not whether CT is applicable to elderly depressed patients, but how to modify existing CT programmes so that they incorporate differences in thinking styles in elderly people and age related psychological adjustment.' However, chronological age is the worst marker for determining whether therapeutic adaptations are necessary in cognitive therapy (Zeiss & Steffen, 1996).

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