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Chapter 3 - Choice of Psychotherapy Approach

from Part 1 - Introduction to Psychotherapy in Later Life

Published online by Cambridge University Press:  09 January 2020

By
Feyza Marouf
Edited by
Rajesh R. Tampi ,
Brandon Yarns ,
Kristina F. Zdanys  and
Deena J. Tampi
Rajesh R. Tampi
Affiliation:
Case Western Reserve University, Ohio
Brandon Yarns
Affiliation:
VA Greater Los Angeles Healthcare System
Kristina F. Zdanys
Affiliation:
University of Connecticut
Deena J. Tampi
Affiliation:
Diamond Healthcare Corporation
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Summary

Older adults have low rates of psychotherapy use despite the effectiveness of multiple psychotherapeutic modalities in late life. Frequent themes in late-life psychotherapy include coping with losses in the setting of physical and cognitive decline, dependence and debility. Choice of treatment modality is based on the abilities and needs of the individual patient rather than age alone. Therapists decide between more structured therapies like cognitive behavioral therapy (CBT) and problem-solving therapy (PST), and more exploratory, affect-focused modalities like interpersonal therapy (IPT) and brief dynamic psychotherapy (BDP). Cognitive therapies have the strongest evidence base for the treatment of depression and anxiety, especially in the setting of medical illness. Problem-solving therapies offer a behavioral approach to patients with depression and executive dysfunction. Interpersonal therapies are readily applicable for older adults struggling with complicated grief, retirement, or family conflict. Brief psychodynamic treatment can be particularly useful for patients with mild to moderate depression struggling with self-esteem or acceptance of mortality. Clinically relevant differences between treatment modalities are difficult to detect due to limited and underpowered trials. Factors common to all psychotherapies, including empathy, alliance, positive regard, and expectations may account for much of the variability in psychotherapy outcomes. Research focused on understanding the mechanism of change associated with psychotherapy is needed to clarify the role of common versus specific factors.

Keywords

psychotherapycognitive behavioral therapy (CBT)problem-solving therapy (PST)interpersonal therapy (IPT)brief dynamic psychotherapy (BDP)
Type
Chapter
Information
Psychotherapy in Later Life , pp. 23 - 34
Publisher: Cambridge University Press
Print publication year: 2020

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