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Psychotherapy for Older Adults: Specifics and Challenges

In my experience as a clinical psychologist, I have come across reports from professional colleagues concerning the increased demand for psychology clinics aimed at older adults. While psychological training in Brazil mainly focuses on children, adolescents, and adults, when clinicians enter professional practice, they encounter another demographic; older adults. This group can pose a different set of demands that were not well addressed in their clinical training.

As long ago as 2004, Neri's research described this lack of training, which was confirmed in Ribero’s 2015 study   , and more contemporaneously by Gomes and Vasconcellos in 2021. Unsurprisingly, increases in demand for clinical training focusing on older adults intensified during the pandemic. Cases of older adults experiencing anxiety and depression have increased worldwide. However, in Brazil older adults represent the largest cohort of people suffering from these conditions (Brazilian Institute of Geography and Statistics 2020). According to the ageing portal (Portal do envelhecimento), depression ‘has such a common occurrence over the age of 60 that it is often portrayed as a phenomenon related to the ageing process’. (Interestingly, depression was the primary consideration in the aforementioned study by Gomes and Vasconcellos (2021)). During the pandemic, in Brazil several psychotherapeutic services for older adults started. Universities throughout the country promoted these free services to ensure that they were welcomed and accessible. Although the pandemic has abated, the need for therapeutic services appears to be on the increase.

But what do the particular psychotherapeutic requirements of older adults consist of? First and foremost, it is important to emphasise that there is no such thing as a typical older adult. We need to remember that chronological age does not define personality or any other personal characteristic of a human being as this allows us to avoide generalisations and the proliferation of ageist stereotypes. Nevertheless, the ageing process, and how it is experienced, does have certain commonalities. Therefore, understanding what is particular about this stage of human development may help professionals to provide quality psychological services. In her blog for the ageing portal, clinical psychologist Lidiane Klein suggests that while ageing consists of many similar changes, the ways these are experienced by each individual are unique. She provides the example of changes to physical appearance, which for some may be difficult to process on account of how body perception is often closely related to a person’s sense of identity.

Significantly older adults who engage in therapy may benefit from deconstructing the ageist ideas they hold regarding their own ageing process. Stereotypes related to old age, such as inflexibility, which can generate beliefs that older adults are unable to learn anew, or to change, can be problematised and transformed. In other cases, ageist views held by family members, may result in limitations on autonomy and/or influence decision-making affecting an older relative’s life. Therefore, psychotherapy can work as an empowerment tool since these ideas and practices can be challenged and reconfigured; reducing the fears and insecurities older adults may have regarding ageing.

Several therapeutic approaches have specialised their services for older adults by incorporating Paul Baltes' lifespan paradigm as a theoretical reference point. This perspective brings the concepts of selection, optimisation, and compensation from the field of human development plasticity to bear on the ageing process. Several cognitive behavioural therapies, mainly those considered to be of the ‘third wave’, such as Acceptance and Commitment Therapy are particularly efficacious. In Brazil, psychoanalysis has also revisited some of its key concepts in order to incorporate ageing into its clinical practice. In the main, psychotherapeutic services are located in university psychology schools, at private clinics and in hospitals. However, the clinical psychologists interviewed by Gomes and Vasconcellos (2021) highlighted that they still lacked the resources to meet the sheer number of older adults requiring their services.

The challenges are, therefore, clear. It cannot be denied that psychotherapy for older adults can promote healthy ageing both physically and mentally. Nevertheless, therapy for older adults has yet to be widely discussed, although its demand continues to increase. Is this because of a stigma associated with the profession of clinical psychology? Does psychology remain marginal to public health debates? Or, is it that studies of ageing are not being incorporated into clinical psychological practice? Answers to these questions are debateable and I continue to grapple with responses. However, it is salient to point out that there is an increased demand for psychological services for older adults, in Brazil.  Although I do not wish to underplay sociocultural factors, psychotherapy for older adults can help with various issues regarding ageing. The challenges are clear: our training as clinical psychologists needs more focus on the multifarious aspects of ageing, considered more comprehensively and globally. Finally, psychologists, need to move beyond their clinics’ walls and engage with colleagues in public health in order to make provision for a world that caters for all age groups.

About the Author

Emily Schuler was a Visiting Student at the Oxford Institute of Population Ageing. Emily obtained her PhD in Clinical Psychology at the Catholic University of Pernambuco with a Capes Scholarship (Coordination of Improvement in Higher Education of the Brazilian Education Ministry).

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