Psychotherapy

Psychotherapy is extremely effective for older adults. Scientific studies have dispelled the idea that long-term therapy is required for certain types of cognitive problems.

There are many different forms of psychotherapy and they are offered both one-on-one or in group format. Depression, in particular, can be helped by short-term therapies like cognitive and interpersonal therapy.

Below are brief descriptions of the most helpful psychotherapies used to treat late-life depression.

• Cognitive Behaviour Therapy

  Research shows that people who have depression or anxiety show thinking patterns that are less adaptive than those who have good emotional health.

  Cognitive Behaviour Therapy (CBT) is a structured, well-researched and effective form of talk therapy in which an individual works closely with a therapist to change maladaptive patterns of thinking into more functional, problem-solving thinking and skills.

  The goal of this therapy is to help people learn to think more clearly and problem-solve in ways that are useful and efficient in order to improve their mood, everyday functioning, relationships

• Problem-Solving Therapy

  Problems are a normal part of life for most people. However, the stress associated with the accumulation or complications of ‘everyday problems’ can become overwhelming and trigger a depressive episode or perpetuate the illness in seniors. The negative nature of depression is such that it causes a vicious cycle:

  • When depressed, you don’t feel up to doing things you usually enjoy
  • Doing less and enjoying less may make you feel worse
  • Problems grow
  • Depression deepens

  As the name implies, Problem-Solving Therapy (PST) is a systematic, common sense approach to coping with everyday problems. Applying the skills learned in PST can help people regain control of their problems and increase their ability to cope with and manage challenges more effectively. This approach may impact their mood in a positive way.

  Working with a therapist you will:

  • Acquire skills to help you solve problems
  • Learn to cope more effectively with everyday life challenges
  • Discover alternate ways to look at the problem
  • Find creative ways solve problems
  • Develop skills that can be applied to future stressors

  PST can be very helpful for older adults with depression, cognitive impairment associated with late-life depression and those who are frail. Everyday problems that come with age may include role transition, loss, retirement or moving. By applying the techniques of PST, every problem that is solved – no matter how small – is a victory, encouraging and empowering, which can improve mood.

  An important aspect of this therapy is the relationship between the therapist and the client. The therapists works together with the client in a collaborative and supportive way to teach them the skills necessary to successfully solve their problems.

  The seven stages of problem-solving therapy include:

  • Defining the problem
  • Identifying a (realistic and attainable) goal
  • Brainstorming solutions
  • Identifying pros and cons of each solution
  • Choosing the solution that works best with the least emotional or financial impact
  • Writing an action plan – most important step – defining specific steps and timelines
  • Reviewing the process and measuring the impact on the client

  This is a learning and behavioural therapy that is effective for older adults with mild to moderate mood disorders. Those who are able to focus and are willing to engage in the process will benefit most from PST. Once learned and honed, the client can apply these problem-solving skills to future issues at any time.

  This therapy may be used alone or with medication as part of a treatment plan.

  Time commitment: This is a short-term, time-limited therapy. The length is determined by the therapist. An important component to this therapy is practicing the skills acquired, not just in session, but during the week in between sessions.

• Mindfulness-Based Stress Reduction

  Mindfulness-Based Stress Reduction (MBSR) is a training program for helping people learn to explore and manage their responses to stress. Delivered through weekly group learning sessions and supported through daily reflection, meditation and yoga homework exercises, MBSR is a self-management intervention. This educational approach is different from group psychotherapy as it promotes conscious living.

  In this approach you:

  • Learn specific skills
  • Become educated about concepts and themes

  This approach is effective for those with mild to moderate mood disorders such as depression or anxiety because it offers skills to help manage day-to-day stress.

  People tend to spend a lot of time being distracted with thoughts of:

  • The past
  • The future
  • Being disconnected from the present – what’s happening right now

  Mindfulness is an innate skill that everyone has – it is about paying attention to ‘this moment’ – the one you are in with an attitude of curiosity, openness and acceptance. The practice of mindful attention can help uncover your habitual patterns of thinking and behaviour. Awareness of these patterns allows a person to adapt lifelong habits that will support goals and values.

  This intervention is typically done in a group setting. Each week involves receiving detailed instruction on different forms of meditation:

  Body scan meditation:

  • • Paying attention to different parts of the body
    • Learning to be stable – holding your attention to a particular body sensation, even if it is unpleasant
  • Learning to be flexible – moving your attention from one place to another – letting go of preoccupation with particular sensations

  Sitting meditation:

  • • Breath
    • Physical sensations
    • Sound
    • Feelings
    • Thought
  • Flexible, open attention; awareness of momentary, transitory experience

  Moving meditation:

  • • Building awareness through ‘mindful movements’
    • Walking – paying attention to each footstep – noticing each sensation

  The purpose of these meditation techniques is for systematically cultivating and training attention in order to apply it in everyday life. It’s about:

  • Being in the moment
  • Paying attention to what you’re doing
  • Maintaining qualities of kindness, openness and curiosity in daily life

  Paying attention cultivates ‘self-awareness’. Self-awareness creates ‘choice’.

  In addition to the meditation each week also includes specific educational instruction:

  • Noticing positive and negative daily experience
  • Effects of stress on the body
  • Flight/fight response
  • How applying mindfulness can reduce stress

  Anyone dealing with stress can benefit from this therapy. It’s about re-connecting mind and body:

  • How body sensations inform us about our emotional triggers and reactive habits
  • Re-connecting to ‘this moment’ through the immediacy of body sensations

  The self-management skills learned in Mindfulness-based Stress Reduction help you to:

  • Stop ‘reacting’ to situations
  • Start ‘responding’ to situations – choose how you want to respond
  • Be ‘with’ your experiences – whether pleasant or difficult
  • Understand:
    • How a physical reaction contributes to your thinking and feelings
    • How your thoughts impact physical reactions in your body
    • What ‘triggers’ certain responses

  This intervention requires focus and commitment. People who do the meditation practices and integrate them into their everyday lives program will benefit most.

  Time commitment: Intensive, eight-week structured program. Participants must attend two and a half hour group sessions each week and complete one hour of homework daily.

• Interpersonal Psychotherapy

  Interpersonal Psychotherapy (IP) is a short-term therapy that focuses on common ‘onsets’ of late-life depression. Depression is often triggered by a combination of issues – it’s complicated. This is a ‘focused’ therapy, so determining what to focus on and discuss first is important. The goal is to help people cope, problem-solve, understand and feel better with the loss, conflict or difficulties they’re having in their interpersonal relationships.

  Change becomes a part of our life as we age. Generally, there are three main issues of focus:

  • Adjustments
  • Bereavement
  • Conflict

  Some older adults may become depressed or face psychological difficulties because they are experiencing problems in relationships or transitions:

  • Loss: spouse, children, friends, family, health, driver’s license, support network, moving
  • Divorce
  • Alienation from children
  • Change of role: from partner to caregiver; move to long-term care, retirement
  • Disputes that cause interpersonal issues
  • Character issues that affect social function

  This therapy helps a person understand the nature of the difficulties they’re having, how they communicate, teaches them how to adjust expectations and helps them find new ways to deal with conflict.

  The many ‘adjustments’ that accompany age can cause stress in older adults. For example retirement may mean a loss of status, a change of routine, loss of and change in relationships.

  Having to ‘reinvent’ yourself later in life can be a challenge. Some may see it as liberating, but if health issues influence the decision, or a person is forced to retire (their position becomes redundant) that complicates things. Some people deal well with such life changes, but others do not.

  Interpersonal therapy helps people cope with the emotional aspects of age-related adjustments and offers strategies and solutions for remaining socially active.

  For some mild forms of depression, interpersonal therapy can be as effective as medication, although it may be used in combination with medication as part of a treatment plan.

  This therapy is most often practiced one-on-one. It can be done in a group setting, however it is not the same as ‘group’ psychotherapy. Interpersonal applies to the client and the difficulties they’re having in their relationships and situations, not the relationship between the therapist and the client.

  Time commitment: Eight to 12 one-hour sessions. Can be up to 20 sessions. Homework may be involved.

• Group Psychotherapy

  Psychotherapy is a term referring to the therapeutic interaction and treatment contracted between a trained professional and a client, family, couple or group. It is a type of ‘talk’ therapy and often is misunderstood.

  Research shows group psychotherapy to be equally as effective as individual psychotherapy in the treatment of depression. In fact it is often used in combination with individual psychotherapy and the two combined are more effective than either one alone.

  Many clients get anxious over the idea of talking about themselves in front of others. It is important that they understand that everything that is said is kept strictly confidential. Building trust is the key.

  The emphasis of this therapy is on ‘understanding’ other people, not judging, comparing, or blaming. Over time, the group becomes a safe environment where people feel comfortable and begin to share their feelings. Sharing feelings is very important for the process of getting better.

  Depression is isolating and people often feel hopeless, alone and may have no sense of purpose. Also, many older adults have suffered personal loss:

  • Death of a family member, friends, spouse
  • Loss of physical health i.e. mobility, chronic pain, vision, frailty etc
  • Financial loss

  People may also have trouble getting along with others which leads to feeling misunderstood, frustrated and can complicate their relationships which can add to their isolation.

  It’s about courage. It takes courage to come to group therapy, and courage to talk in a group, but the benefits far outweigh the fear. Group psychotherapy is very helpful because:

  • You are with others who share the same problem.
  • The feeling of ‘being alone’ begins to diminish.
  • A sense of hope is instilled by meeting and talking with others who have improved.
  • The group becomes a small community.
  • Participants learn from each other.
  • Social skills improve.
  • Self-worth increases through the opportunity to listen, or share advice or even mentor others in the group.
  • Through helping others you help yourself.
  • Learning to understand your own behaviour and taking responsibility for it helps improve relationships.
  • The better your relationships, the better your mood will be.

  Even after they have recovered, many people continue to attend group psychotherapy in order to continue growing as a person and improve relationship skills.

  Time commitment: Four months. Three and a half days per week. 60-75 minutes per session. Weekly after-care groups are available for those who want it.