Strategies of dynamic psychotherapy with the wide range of older individuals

Until recently contributions to geriatric psychotherapy tended to be limited to the consideration of the special problems of the most debilitated of the elderly, neglecting the vigorous majority of aging persons. The reluctance of psychoanalysts to treat individuals past 45 or 50 years of age by classical technique may have impeded the application of psychodynamic principles to the psychotherapy of older people. Gradually, a number of analysts and dynamic therapists reported favorable responses of the middle aged and elderly to such treatment and established some of its technical parameters. In this paper, distinguishing characteristics of the aging and of the debilitated aged are examined in order to clarify the techniques of geriatric psychotherapy. Six case vignettes illustrate the treatment aims of structural change, reinstatement of optimum functioning, and basic support in these two categories and in an intermediate group of those experiencing an emotional crisis. The application of psycho-therapeutic principles (promotion of insight, adaptive intervention, general supportive methods) is described. Psychological management is compared with psychotherapy in the debilitated aged. Treatment of emotional crises in older persons is illustrated. A sample of patients treated by means of psychotherapy--aging, in crisis, or debilitated--is examined with regard to diagnoses, precipitating stresses, the aims of therapy, and the involvement of their families in the treatment.