Psychodynamic psychotherapy with the older adult: challenges facing the patient and the therapist

The subject of advanced age is often neglected in discussions of diversity and intersubjectivity in psychodynamic psychotherapy. In addition, psychologists historically have underestimated the ability of older individuals to utilize and benefit from psychodynamic treatment. This article provides support for the belief that many older individuals are capable of engaging in insight-oriented treatment and addresses some of the unique challenges faced by the older patient and the psychotherapist. The importance of determining the impact of age on intrapsychic conflicts is examined. Concepts from developmental psychodynamic theory are reviewed and applied to the clinical case of A., an 81-year-old widow. This case illustrates several themes that often emerge in work with older patients. The significance of changes in family structure and roles, object loss, and narcissistic injury in the life of this patient and older individuals in general is discussed.