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Our Geriatric Population and Their Need for Psychotherapy

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

For a long time now I have been reading articles stating that those who are over 65 years of age and older and are depressed are not helped by psychotherapy. The University of Liverpool in England released the results of a recent research study that showed that geriatric patients with depression were not helped by Cognitive Behavioral Therapy. Past studies came to the same conclusion as the Liverpool study. The purpose of this post is to state my opinion, based on my experience, that many patients who are elderly and are receiving anti depressant medications do benefit from psychodynamic or "talking therapy."

During my 40’s I worked in an outpatient psychiatry clinic based in a major New York City Hospital. The particular clinic I worked in provided psychotherapy and medication for patients aged 60 and over. Many of our patients were in their 70’s and late 80’s. All came to the clinic with public transportation. Most of these people were experiencing depression, taking anti depressant medications and were in long term individual and group psychotherapy as frequently as once per week and as few as once per month.

Were these patients helped by the psychotherapy? In my opinion, they certainly were. Of course, a lot depends upon the interpretation of the word "helped." Anti depressant medications succeeded in alleviating depressant symptoms such as agitation, hopelessness, tearfulness and suicidal ideation. Just as important as the alleviation of these symptoms was their willingness to travel to the clinic to see their therapists and attend their group meetings. They had a sense of being cared for by the clinic. For one thing, therapists arranged for meetings with family members, such as adult children and grandchildren responsible for patients. In some cases, if spouses were still alive, there were marital counseling sessions. For the most part these people were widowed and were living alone in their urban neighborhoods. In the clinic there was a sense of camaraderie and belongingness.

Cognitive Behavioral Therapy was not used in this clinic primarily because this population wanted to come and chat rather than get homework assignments. In fact, I believe that CBT would be less successful than group therapy, couples therapy and individual therapy in which they could talk about anything they wished because it would not suit their needs. At least in my experience, the needs of this population was to have a place where they would feel less isolated, be accepted by their therapist and by their group and where they could feel cared for.

It is my opinion that while CBT and Dialectical Behavior Therapy work for many younger people. However, when it comes to the elderly, something different is being requested and needed. What is being requested is a therapist and a place where they can feel listened to and where they can feel relief from their depression as a result of medication and talk.

In other words, maybe there are some things that cannot be measured scientifically and that will not show up in these research studies. I do not believe there is a way to measure the sense of relief I witnessed with the people at that geriatric clinic in the psychiatry department of the hospital.

What are your opinions about this issue?

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