Mental Health Treatment for the Elderly: Challenges and Adaptations

now there are challenges to psychotherapy in in older people that have to be overcome one would be the person and their families own perceptions of Aging time is limited and and who has time to see somebody once a week for several weeks give me a med that'll make me get better quickly because I don't have time or or just seeing themselves can I'm overly influenced by Freud seeing themselves as they're too old to teach new tricks too their problems are fixed and unchangeable and and that's an attitude that has to be overcome and that's an attitude that not only a lot of older people have about themselves but sometimes their family members and children may have about them as well and and and that's one of the reasons working with families is so important but there are also a number of physical limitations that can affect one's ability to respond to psychotherapy psychotherapy is talking and listening and if you have significant hearing or visual problems that can affect your ability to be in a talking and listening environment if you're not ambulatory it may be very difficult to you know get in a car go to an office climb the stairs and then sit there for an hour talking about yourself so those are issues that may need to be overcome similarly if you've got urinary urgency or incontinence not an uncommon problem in older people you may not be able to sit for an hour at a time talking without taking breaks and you don't want to be humiliated you need to see somebody who is aware of that as a possibility and provides breaks as necessary which you wouldn't do for somebody who's 30 or 40 it wouldn't be necessary physical discomfort if you have lots of pain you may not be able to sit still you may need to pace you may need to walk around you may need shorter sessions transportation difficulties a lot of older people don't drive and need other ways of getting to an office cognitive limitations there are memory problems that are part of being older and in psychotherapy which is a talk therapy not remembering things can get in the way of certain types of therapy and reimbursement you know many of us limited coverage both for medications and for psychotherapy or some coverage is only for medications in psychotherapy is expensive so some of the ways of dealing with these a somebody who works a lot with older people may provide written information for forms with large print and large writing spaces to accommodate fine motor skills in difficulty with vision that can help audio taping sessions so the person who is visually impaired may be able to go home and listen to what went on in the therapy sitting closer to the patient's speaking slowly and speaking in tones that may be appropriate for somebody with various levels of hearing loss might be an adjustment that a therapist has to make in working with older people in psychotherapy and certainly considering briefer less frequent sessions take-home support materials teleconferencing online supplements with there are lots of really good ones that we can recommend that people can use between sessions so that the sessions can be less frequent and less prolonged or useful and in last bit but first certainly not least is therapy can be so gratifying with older people as we take advantage of the vast wealth and knowledge and experiences that they can bring to the therapy and and I think any therapist who's going to be worth their salt working with older people I think needs to be very aware and respectful of the unique attributes that older people have that can make therapy so incredibly exciting to do actually collaborative care what is collaborative care well that's kind of working in a within the medical environment so that if you're seeing a primary care physician rather than also having appointments to see a psychiatrist or a psychologist and you know kind of doubling the difficulty its working within the primary care setting and in many collaborative care models there may be a depression specialist a nurse specialist a social worker specialist who is knowledgeable about depression in evidence-based treatments that can provide collaboration and suggestions to the primary care physicians can also meet with the patients and provide information to them sometimes can also themselves provide short-term psychotherapy within the context of the primary care setting many collaborative care environments will have a visiting psychiatrist who may come in for an hour a week not to see the patients but to work with the staff and to educate the staff and to hear about cases and provide insight and encouragement in collaboration

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