We are witnessing the emergence of a new demographic, “the young old.” Compared with preceding generations, many people well past the ages of 60-65 are living longer, more active, healthier, and happier lives. The numbers are increasing as the baby boomers, born during 1946 to 1964, approach and enter their senior years.
Both the lifespan and healthspan of these active seniors have grown longer. But, to some extent, all must face the unique and potentially stressful challenges of later life. For many in this age group who will turn to psychotherapy for assistance, some bad news awaits them. For various reasons, including systemic ageism, too few therapists are eager to work with active older individuals or know how best to work with them.
Having had a good deal of experience as a therapist working with active seniors, and being one myself, I have given considerable thought and study to the best ways to help this group. I will share some of my thoughts to benefit members of this age group, and, hopefully, provide some food for thought for their therapists.
One’s senior years are like a two-sided coin, bringing both advantages and disadvantages. Often, the latter of these, the disadvantages, are emphasized. But I have found that more than with other age groups, therapy with active seniors must balance both sides of the coin, having the dual purposes of reducing the psychological and behavioral effects of negative changes, while also fostering the new and positive possibilities of later life. In this way, the therapy leans more toward a holistic approach than with many other individuals that focus more narrowly on distress and other symptoms.
On the negative side, older people must face physical decline and other issues associated with loss, conflicts with partners and adult children, medical concerns, ageism, shame and guilt over past misdeeds, loneliness, sometimes finding a new partner, and the ultimate coming to terms with their own mortality. It is understandable that many older patients arrive at therapists’ offices clinically depressed. Octogenarian actress Bette Davis put it this way, “Getting old ain’t for sissies.”
In contrast, feminist Betty Friedan, also an octogenarian, emphasized the flip side of the coin. She observed, “Ageing is not ‘lost youth’ but a new stage of opportunity and strength.” Ageing has benefits, such as less career pressure, freedom from childcare, perspective gained from life experience, greater calm and ability to manage feelings, more leisure time and opportunity for political and volunteer participation. In fact, research shows that seniors are among the happiest groups, especially compared to their middle-aged counterparts. Therapy with this age group also can cultivate and extend these advantages of ageing.
Growing up in an ageist society adds an additional burden to the biological stressors of growing older. We cannot avoid internalizing many of the disparaging biases that our culture promotes about later life, and they result in demoralizing expectations of and for our older selves. Many seniors have been addressed in “elderspeak,” for example, a specialized speech style used by younger adults that presumes elders’ impairment. It is characterized by a patronizing, simplified vocabulary and sentence structure, speaking more slowly, overly endearing terms, closed-ended questions, using the collective “we”, and repetition. Perhaps in their youth, seniors have been guilty of this behavior. Real harm is done when ageist self conceptions are internalized. Some have never been formulated, and in therapy can be identified by seniors, then challenged.
Active seniors benefit when they have positive expectations, such as endorsing self-actualization as a lifelong process of personal growth. Young people typically fail to appreciate the gift of youth, but older people must not repeat that error by failing to recognize the gift of later life. Accepting that life is finite is part of what makes the later, active stages of life so precious and helps us understand why these final years—our legacy—must be lived well.
Many seniors, regarding getting older as the enemy and themselves as its victims, must learn not to struggle against the inevitable ageing process. Research shows that ageing well involves accepting, even affirming the ageing process, and going with the flow. That is not to say one ought to be passive and not participate fully in life. On the contrary, to thrive in later life one must accept certain limitations while deliberately and purposefully seeking out vitalizing new challenges.
Not all seniors realize that advancing age can be approached from a forward looking, progressive perspective. With its energizing wind in our sails, we can counter the biased view of our “Act III” as being only about decline. In later years, active seniors can do what they never had time to do, what they always have dreamed of doing. Or they can finally begin to dream, imagining new and exciting possibilities for themselves. One must not stand by and witness life passing by. Rather, the mandate of advancing age is to be the architect of a meaningful, satisfying, participatory life and to use one’s remaining time well. That may be the effective core of psychological success in later life because no matter what life brings, forward-looking curiosity, acceptance, purpose, and gratitude sustain our flexibility, resiliency, and optimism. This is the orientation to later life that therapists must support.
Reminiscing, looking back, has its place. If motivated by a self-accepting attitude and desire to come to terms with the past, it can be a wonderful, even transformative experience, and is productive in psychotherapy. But seniors frequently look back self-critically, feeling regret over failures, unrealized dreams, or what they can no longer change. That is unhelpful. A life review is beneficial when it looks back with acceptance of what could not be, appreciation of the opportunities and achievements one has had, and celebrates a life’s journey blessed with longevity. These form a true basis for gratitude.
Therapists can also help reduce the risk of seniors developing problems later in life. They can support the health- and life-extending processes of ongoing physical and intellectual activity, social engagement (versus isolation), creating meaning and purpose, and optimism. Longitudinal studies of ageing have shown that these activities promote relatively healthy, satisfying, longer lives.
There are many useful therapeutic approaches to apply. Each carries forward an important part of the therapeutic agenda. These therapies include:
- Psychodynamic therapy, the approach that best helps us understand ourselves and what is and is not working in our relationships.
- Cognitive-behavioral therapy, which supports initiating new activities and behavior change.
- Acceptance and commitment therapy (ACT), which promotes flexibility, perspective, and resiliency.
- Positive psychology and Humanistic therapy, which build on personal strengths to help people lead meaningful lives with fulfilling experiences of love, work, and play.
All are supported by neuroscience research demonstrating that the brain’s neuroplasticity (its capacity for new learning and change) is lifelong. Old dogs can learn new tricks!
In summary, ideally, therapy with active seniors implements dual goals. Foremost is the elimination or reduction of current psychological distress and behavioral problems. Importantly, too, therapy can promote ongoing physical and intellectual activity, social engagement (versus isolation), meaning and purpose creation, and optimism. These activities mobilize strengths and personal agency, providing experiences that mitigate current, and prevent future problems. When seniors are helped to adopt an active, forward looking, progressive attitude that counters a view of the later years as decline only, they are helped to actively create a purposeful, rewarding life. Using their resources, therapists can inspire patients to make beneficial changes that both help them handle negative developments and foster continuing self-actualization. Hence, therapy helps the individual address both sides of the ageing coin.
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