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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Our Geriatric Population and Their Need for Psychotherapy

Allan N. Schwartz, LCSW, Ph.D. Updated: Feb 17th 2008

 elderly man on a benchFor 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?

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Absolutely Mistaken? - Allan N. Schwartz, PhD - Jul 24th 2010

    Before you rush to judgment, I suggest you re-read the this particular article. Its purpose is not to assess CBT for any population but to state the obvious: Many depressed elderly want others to speak to!!!

    Dr. Schwartz

    absolutely mistaken - - Jul 23rd 2010

    You are absolutely mistaken about the evidence base for interventions such as CBT and problem solving therapies for older adults, and to site to poorly designed studies from Britain as evidnce that CBT does not work is misleading. For decades the American Association for Geriatric Psychiatry, the National Institutes of Mental Health and the Depression and Bipolar Alliance have indicated that psychotherapy is a first line treatment for late life depression. In a recent article published in the American Journal of Psychiatry (Arean et al, 2010) problem solving treatment and supportive therapies resulted in a number needed to treat of 4; antidepressants average around 7 -- this means that more older adults respond to problem solving therapy and supportive therapy than they do to antidepressants.  Further, this recent study investigated the effects of these interventions in older adults with comorbid depression and mild cogntive impairment. You really need to review the data batter before blogging about what scientists and policy makers think about psychotherapy for late life depression.

    Psychotherapy With Mid & Late Adulthood Patients - Suzanne Rodgers, LMSW - Jan 4th 2009

    My experience in working with older patients is that they very much respond to psychotherapy, I usually utilize psychodynamic therapy because it allows them to tell their story the way they want to tell it.  Patients need a safe person and place to talk about their history, whether it be painful, sad, or humorous.  I believe they want to understand themselves better, feel feelings, and review things before they pass away.  

    With the patients I have worked with most of them have developed better relationships with family and made new friends, and feel better about themselves overall even when some of the work we have done together has been quite difficult.  Their depression has usually decreased and they feel more of a sense of satisfaction.  I work with older patients in their homes or in assisted living facilities or at my office.  I will be teaching continuing education classes on psychotherapy with older adults.  I enjoy the work very much and think we need more professionals involved in psychotherapy with older adults.   

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