Can Psychoanalytic Psychotherapy Help Older Adults?

“My dad has turned into a complete grump,” my client Robert* told me. “He’s always had a kind of gruff style and a sense of humor that could be biting sometimes. But he’s a good guy. We had our difficulties, normal ones for a father and son, but overall, I loved having him for a father, and all of his grandkids adore him. I’m worried that something’s wrong, but he won’t talk to me about it.”

Art, like many other grandparents, had stepped in during the COVID crisis and had helped Robert and his wife manage the pandemic world with three children, a dog, and two high-pressure jobs. As Robert put it, “He took over as family cook, supervised some of the online schoolwork with my kids, and ran a full-service ‘after-school’ program for our children and my nieces and nephews. I don’t know what we would have done without him.”

But as the COVID scare has diminished and life has gone back to some semblance of normal, Robert’s father has become irritable, critical, and withdrawn. Although I couldn’t make a diagnosis without meeting him and doing a full workup in conjunction with a full physical to look for medical issues, I wondered if he might be depressed, a common but often ignored problem in individuals over 65.

Some Older Adults Suffer From Depression

Research has found that in the United States, among the 34 million people 65 and older, nearly 2 million suffer from some form of depression. Depression has multiple causes, including physical illnesses ranging from heart disease and diabetes to cancer. It can be a biological disorder itself. And it can be caused by the loss of a loved one, a career, a home, pet, or a sense of purpose.

Again, I could not know without meeting with Art in person, and without making sure that he had a full medical evaluation as well, but it seemed plausible to me that Art, who seemed to have enjoyed his role during the COVID crisis, was feeling a sense of loss now that it was over. His retirement plans, which had been put on hold for three years, might not appeal to him as much as spending meaningful time and deepening his relationships with his children and grandchildren.

Aging Can Be Hard

Aging can be difficult, but there is a growing body of research suggesting that psychotherapy can be helpful as we pass 65. There is some controversy about what types of therapy is most useful, although CBT, counseling, medication, and “talk therapy” have all been shown to have good outcomes. It has generally been assumed that an older population doesn’t do well with psychoanalysis, in part because psychoanalysis is often a long process and older clients don’t have the luxury of indefinite time.

Psychodynamic Psychotherapy Can Be Particularly Helpful for Older Adults

However, in my own work, I have had a number of wonderful experiences with older clients who engaged in a modified form of psychoanalysis, or what is more commonly called psychoanalytic or psychodynamic psychotherapy. And I'm apparently not alone in having this experience. Research has shown that psychodynamic psychotherapy is particularly effective with adults in the over-65 age range.

The Chicago Institute of Psychoanalysis describes psychoanalysis as a therapeutic process that “seeks to understand emotions and patterns of behavior that can interfere with the achievement of relationships, rewarding work and human connection.” In an analysis, you make connections between your behavior, your emotions, and your unconscious, which can lead to change in how you act and how you feel.

Brenda* was in her mid-60s when she came to see me. Her husband had just ended a year of treatment for cancer, and the doctors were pleased with the outcome. “But instead of feeling like celebrating, I want to get in bed, pull the covers over my head, and cry,” Brenda told me. During the treatment she had gone with her husband to all of his appointments, prepared special foods for him, and helped him bathe and do all of his activities of daily living. Her husband was a good sport, but the treatment and the feeling of helplessness had been extremely difficult for them both. Brenda felt like she hadn’t had a minute to breathe or think about herself during that time.

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“Everyone tells you to take care of yourself, that you can’t get sick, that you’re too important. But I didn’t have time to take care of myself. I mean, I made myself do the things I needed to do, I got my annual physical and my mammogram and all of that stuff, and I managed to get some exercise every day. But everything was focused on getting my husband better. And now I feel like I’m falling apart. I don’t have the energy to do anything. I can’t even get myself to take my online yoga classes, which were my life-savers during the past year.”

Brenda had never been in therapy before, and she felt like she was just “being a baby coming in here and whining to you.” An independent woman, she was embarrassed not to be able to take care of her own needs. But over the course of the next year and a half, as we talked about the pain of almost losing her beloved husband, we also talked about her relationships with her children, her friends, and her parents, both in the past and in the here and now. We looked at some of the ways that her unconscious—or what the psychoanalyst Christopher Bollas calls “unthought known,” that is, those things we might know, but never think about or put into words for ourselves—influenced how she was feeling.

For example, Brenda was deeply ashamed that she sometimes thought about what she would do if her husband didn’t pull through the cancer treatment. “I feel like I’m being disloyal by thinking about how I would manage without him,” she told me. “And I know this isn’t logical, but I worry that I’m jinxing the treatment by having these thoughts.” Putting those “secret” thoughts into words to another person who did not judge or criticize her was helpful. But even more helpful was that once she had named the feelings, we were able to understand how those thoughts made sense under the circumstances and how they might even have helped her cope with the pain and fear that accompanied her husband’s illness.

Once she and I together had found ways to talk about some of the things that she wasn’t aware of, that were impacting her feelings, she found herself feeling and acting differently in her life. A traditional psychoanalyst might not call this work psychoanalysis. Other names for what we were doing is “psychodynamic psychotherapy” or just “talk therapy.” Whatever we want to call it, it has been my experience that working this way can be extremely helpful for many older people and should not be ruled out because of its name or the age of the client.

*Names and identifying info changed to protect privacy.

Copyright@fdbarth2023.

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