[The geriatric psychiatry patient--a new indications field for psychotherapy?]

Despite the fact that 9% of the elderly would need psychotherapeutic treatment, only 1% of the applications for such treatment were initiated by the elderly. Older people often lack the ability to verbalize their emotional problems, which is an obvious prerogative for expressing the wish for psychotherapy. However elderly people tend to indulge in childhood memories, and therefore would be excellent candidates for psychoanalytic-orientated treatment. Because objective time is not a factor in subconscious life, older people can suffer from unsolved intrapsychic-, intra- and intergenerational conflicts and trauma reactivations. Without considering these psychological conflicts, the most important fields for psychotherapeutic intervention in the elderly are depression, mild cognitive impairment, incipient demential syndromes, and the impairment of psychosocial competence resulting from these conditions; caregiver-related therapy also plays an important role. For those between 65 and 75 years of age, the indications for psychotherapy are similar to those of younger adults: first of all depression, anxiety-syndromes, insomnia and suicidal attempts. For those over 75 years old, isolation, polymorbidity, preservation of autonomy and self-determination, and the fear of loosing autonomy and becoming care-dependent are the most important indications for psychotherapy. A feature common to all psychotherapeutic schools is that they try to overcome disturbances, to reduce emotional pain, to preserve, establish and improve psychosocial competency and the activities of daily living. Psychotherapy in a narrow sense is indicated when the psychic structure, the mental flexibility and the motivational state are quite good and if differentiated verbal interactions are possible. In a broader sense, psychotherapy stands for actional and training aspects, and integral environmental and socio-therapeutic treatment so that autonomy and quality of life can be properly improved. This definition of psychotherapy makes it obvious that demented and care-dependent patients are potential candidates for psychotherapy.