- Now there are challenges to psychotherapy in in older people that have to be overcome. One would
be the person and their families 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'll make me get better quickly because
I don't have time. Or just seeing themselves can overly influenced by Freud, seeing themselves
as they're too old to teach new tricks too. Their problems are fixed and unchangeable, and 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 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, you know, 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 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 patients, 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 in
last, but first - 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.
And and I think any therapist who's going to be 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 you know kind of doubling the difficulty. Its
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.