The following outlines some basic issues to be considered when working with older adults. For a fuller consideration of the basic issues in psychotherapy with older adults, there are a number of alternative resources to consult - see Knight, 2004; Laidlaw et al., 2003, 2004; Miller, et al., 1998; Nordhus & Neilson, 1999; Steuer & Hammen, 1983; Zeiss & Steffen, 1996). It is important to make sure that these are thought out in advance - for instance, is there a specific room set aside for the purposes of psychotherapy? Is it well ventilated and light? Is it soundproofed and free from external noise sources or other distractions. As many older adults have sensory deficits in hearing and or vision these basic aspects to a consultation cannot be ignored. As older patients may have concerns about the functioning of their memory, they can be encouraged to use notebooks in therapy to remember important details (Thompson, 1996). Using an audiocassette recorder to provide a patient with a tape of the session to listen to for homework can also be helpful. It is recommended that the therapist repeat important points throughout therapy and encourage patients to provide feedback to the therapist about their understanding of what has been said (Dick et al., 1996). In working with older people, the pace and length of treatment may be slower than with younger adults, although the coverage of topics may be the same. Sessions may be shorter and therefore more treatment sessions may have to be planned (Zeiss & Steffen, 1996). The age of the therapist may be an issue, as may be the therapist's credibility. The age difference can be discussed early in session if this is considered a barrier to developing a collaborative working relationship (Knight, 2004).
Older people are often unused to psychotherapy and so may need encouragement to talk about personal issues outside of family and friends. Encouragement to talk may take the form of simply saying to the patient their problems are not trivial and that depression is an illness, not a defect of character. It is common for older people to 'wander' off topics. In many cases therapists, mindful of being respectful to elders, will allow their patients to talk without interruption, often losing the focus entirely. This can result in a frustrating and confusing experience for both therapist and patient, leaving both feeling uncertain about the value of future sessions. In working with older people the therapist should be active and directive and it can be helpful to have a discussion with the patient in order to seek their permission to interrupt stories, if necessary, in order to keep the focus on the clinical problem. This should be done with some humour to avoid interruptions seeming to be too rude. At the end of therapy it is important to consider some summarizing sessions to develop a relapse-prevention set of strategies. In some circumstance the issue of ending therapy may need to be discussed well in advance (if possible) with patients, especially if they live alone. The fears of the patient and the therapist may need to be explored prior to completion of therapy. Therapists need to bear in mind that older people are remarkably resilient. The nature of the therapeutic relationship between client and therapist is very important in this setting.
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