I was 31 years old and newly trained in psychodrama and group therapy when a friendly psychiatrist, seated beside me at a local conference, confided in me that he hated doing therapy with older clients. “All they do is complain. They’re boring as hell,” he said. “Do you think you could do something with them in group?” Nervous at the prospect, but eager to gain clinical experience, I suggested we talk further. A few weeks later, in a cramped, drab office in his psychiatric suite, I arranged eight chairs in a circle and readied myself to be a group therapist to clients twice my age or older.
“I can’t open my bedroom window,” Sadie announced right off the bat. Wearing an oversized flowered dress, she was a widow in her late 60s. “What should I do? Should I ask my super to help? If I ask him, should I tip him? How much is enough?” She bit her lip. “I guess I could wait until my son-in-law visits and ask him. But what if he starts thinking I’m a burdensome old lady? Maybe I should just get used to sleeping in an airless room.”
A stuck window seemed a less-than-promising opening for a discussion of any depth. My psychiatrist colleague is right, I thought. This will be an incredibly boring group. I was therefore surprised by the vibrant conversation that ensued. Group members talked with deep feeling about what it was like to need help—the humiliation that came with loss of self-sufficiency, the worry about the trustworthiness of the people you had to rely on, and the shift in your self-concept when you felt incapable of doing things you used to do easily. I wasn’t bored. I was riveted. Forty-nine years later, I remain riveted by my work with older people—even as I’ve now joined their ranks.
Despite my passion for my work, I’d started out with a grim view of old age. When I was a child, Grandma Schaffer, “Bubby,” was in her 80s. Frail and silent, she emanated wretchedness. She’d emigrated from tsarist Russia decades earlier, yet she spoke no English. Occasionally, she tottered around the kitchen, trying, ineffectually, to help my mother. Most often, she sat quietly, staring into space. I don’t remember ever seeing her smile.
Now I recognize that what I was witnessing wasn’t old age, but trauma. Bubby had married young and borne 11 children, eight of whom survived. When pogroms drove her and her family to flee to New York, she held her family together as they all sought new lives. She must have had compelling stories to tell, but I spoke no Yiddish and never heard them. All I saw was that old age was a time of decrepitude and misery.
A large and compelling body of research, much of it conducted by Becca Levy of Yale University, demonstrates that our expectations about aging have a dramatic effect on both physical and mental functioning in later life. Memory loss, cardiovascular functioning, and life expectancy are all influenced by one’s personal vision of aging.
Fortunately, my own vision of older age changed after the days of living with Bubby. That my parents did well in their later years helped, but pivotal to my expectations have been my experiences with my older clients, which taught me that many of our society’s messages about aging—particularly, that it’s inevitably accompanied by mental decline, the loss of creativity, and the death of sexuality—are simply false.
Initially, I’d assumed that our profession, at least, was reasonably free of our society’s ageism. Then, a few years ago, I decided to write a paper about clients I’d treated decades earlier who’d returned to therapy in older age. In preparation, I consulted the literature about therapy with older adults and was startled by its paucity. I thought then about conferences I’d attended, and how seldom work with older clients was even mentioned. The ageism in our field made me angry. After all, the therapy I’ve done with older adults has been deep, life-changing, and fruitful. And it’s work that has changed me—and will continue to change me—as a therapist.
Debunking Myths About Aging
Freud wrote that after the age of 50, people are too inelastic to change and can’t benefit from therapy. He was turning 50, and I wonder if his pessimism had arisen from his own fears of aging. In my experience, older adults have strengths that make them a delight to work with in therapy. They have a lifetime of experience to draw on, and they’re often strongly motivated, knowing they don’t have time to fool around. While they may experience areas of cognitive decline, for example in retrieving names, their capacities for recognizing patterns and understanding complex situations often increase—the very abilities that help people examine their lives and make changes.
In addition, the adage that you can’t teach an old dog new tricks is absolutely false. Older age brings with it an enormous demand to learn new tricks. Ashley, who lived with her parents until she married and is now widowed after a 45-year marriage, must learn how to pay her bills online, travel by herself, and go to dinner parties alone. Sid, who used to run marathons, must find ways to enjoy life now that walking requires a cane. And Sheila must find a way to make her marriage work when her husband, who worked long hours, retires and is suddenly home all day, every day.
Using all they’ve learned in a lifetime, older adults may meet these challenges with courage and humor. Research repeatedly shows that, contrary to stereotypes, older adults are generally happier than younger ones. They describe themselves as enjoying greater life satisfaction than their middle-aged counterparts. Perhaps the perspective gained by their many years allows them to savor more of what life has to offer and to disregard trivial disappointments. I know that’s true for many of my clients—and for me.
Some older people, of course, do sink into states of depression, apathy, or agitated irritability, but emotional distress in this population is too often seen as part of an inevitable downward spiral, not a temporary and treatable state. Over the years, I’ve been consulted by therapists who, noticing diminished functioning in an older client, simply ascribed the problem to age-related cognitive decline. When I suggested to one young therapist that he consider whether his client could be suffering depression, he all but slapped his forehead, exclaiming, “I never even thought of that!” Once he realized that he’d have readily considered the possibility of depression in a younger client, we explored the inaccurate beliefs about aging that had led to his lapse. Sure enough, when treated with both psychotherapy and medication, his client’s functioning improved considerably.
I suspect that the harm done by these kinds of lapses is immeasurable, causing many people to spend their last years in misery because their age misleads others into believing they can’t be helped.
Revisiting Our Ghosts
While the rigors of older age can cause considerable distress, these hardships are often exacerbated by what I call ghosts. I’ve learned from my clients that long-buried problematic experiences and troubled relationships from early life can gain greater disruptive power in older age. Falling and skinning your knee, warm urine running down your leg, being bathed by another person, being told you can’t do something that you want to—all these experiences may bring emotional memories roaring back to life.
When someone can no longer climb onto a bus without a helping hand, the ghost of a long-dead father may taunt him for his weakness. A maladaptive solution would be to stop taking buses, but therapy could help him adapt to the realities of his changing body by confronting this ghost so that he can accept assistance with dignity.
Or the death of a spouse may reawaken the terror that accompanied the early death of a parent. Regrieving that early loss allowed a new widow to say, “A part of me feels like a child who’ll die without my spouse. Another part of me knows that, although I’ll miss my partner with every cell of my body, I’m strong and will survive.”
A ghost was the culprit when 75-year-old Eliot, undergoing treatment for prostate cancer, plunged into a suicidal depression. He was a lifelong clarinetist who’d recently retired from his job as a manager in a bookstore. He told me that the cancer made him feel disgusting, damaged, and abhorrent to others. When we began to explore these feelings, he realized they weren’t new.
Eliot told me he had a troubling secret, a trauma he’d never divulged to anyone, including two previous psychotherapists. When I asked what made it hard to talk about, he began to talk, haltingly, about his fear that I’d stop caring about him once I knew the details. “I know you like me,” he’d said. “But the look of disgust on your face will kill me.” Then, finally, holding back tears, he was able to tell me that a neighbor had raped him when he was a preteen. Eliot was then able to process that what he was currently suffering—shame, helplessness, the feeling of being dirty and contaminated, and the sense of imminent death—were all sensations he’d endured during the assault.
As Eliot and I explored this material over time, two things changed. First, his depression began to lift. Second, he began to relate to others in a new way. Previously, burdened by shame and a belief in his own repulsiveness, he’d gotten along well with others by assuming a stance of affability while remaining emotionally hidden. Now, he could stop hiding. He took steps to deepen his existing relationships, and his musical career began to blossom as he overcame his inhibitions about promoting his work. “I can’t believe I’m playing for a crowd and having fun,” he told me. He still had his bad days—cancer treatment was tough—but now he wanted to live.
Was this work with Eliot different from what it would have been with someone younger? No and yes. No, because the work of unearthing the impact of early trauma is at the heart of our work with clients of all ages. But also yes, because I believe that Eliot’s age contributed to the intensity of his suffering and to his ability to make excellent use of therapy. The normal changes of aging had made him particularly vulnerable to the ghost of his trauma. His retirement, for example, had already diminished his sense of being a worthwhile person, and his knee problems had eroded his physical confidence. But the revelation of his secret, and the speed with which he made changes in his life, stemmed from an awareness of his age—from the feeling of “it’s now or never.”
Talking About Death
Early on, one area of this work terrified me: talking about mortality. Our culture—death denying and youth obsessed—presents few opportunities to acknowledge that we all die. Plus, talking about death is a downer, a social no-no. Many people keep it out of mind for most of their lives, until they turn 70, or 80, or 90, and it smacks them in the face.
How could I help my clients come to grips with their mortality? Initially, I’d felt out of my depth. Wasn’t that a job for a priest, imam, or rabbi? But eventually, I realized that my clients didn’t need answers to existential questions: they needed a safe place to explore their concerns and feelings about death. It was often on their minds; they were just afraid of bringing me down or appearing morbid if they talked about it. When I inquired, they brought up their concerns readily. How can I enjoy life when the clock is ticking so relentlessly? What will happen to me when I die? How can I face death when I’m so disappointed with what I’ve accomplished in my life?
For many clients, just being heard was enormously comforting; others, however, were enraged that I couldn’t help. “Why am I here if you can’t make it better?” they’d shout. I’d respond by honoring their courage in expressing their feelings to me and encourage them to explore the painful reality that there’s no sheltering parent to help us fend off death. I might say something like, “I know I can’t keep you from dying; I can’t keep myself from dying either.” Together, then, we’d mourn our lack of omnipotence. Often, I experienced a deep intimacy as we met as two human beings pondering our mortality.
In exploring fears of death, we sometimes encounter surprising ghosts, as with John, a 66-year-old gay man. He was in good health, but he told me he was terrified of dying and confessed that his dread was fueling a depression that was destroying his ability to enjoy his current life and driving his husband crazy.
When I asked him what he feared about death, he had trouble answering. But in his next session, he said, “I thought about what you asked me and realized I had an image in my head.” He then sprang from his chair and pointed aggressively at me. “That’s what I see,” he told me, sitting back down. “An angry, vengeful god telling me I’ll go to hell for loving another man—which is crazy because I’m a staunch atheist. How can that be my picture of death?”
“Isn’t the human psyche amazing!” I answered, and we both burst into laughter. Then we began to explore more about John’s fear, which stemmed from his teenage years of hiding his sexual orientation from his family, friends, and teachers while attending a religious private school. In those years, he’d felt tormented and deeply unhappy, and he’d sometimes wondered if he would, in fact, end up in hell. Now, identifying the ghost—his childhood god—weakened its impact. Our work didn’t erase his fears of death, but these anxieties stopped preoccupying him, and he could be more present in the moment.
It’s Not All Sunshine and Roses
Of course, not all endings are happy. Novelist Philip Roth wrote that old age isn’t a battle, but a massacre. To work as a psychotherapist with older adults is to recognize the cruelties that can accompany aging.
An octogenarian may lose a spouse, endure chronic pain, be embarrassed by a sudden failure of bladder control, and suffer a bad health scare—all within the space of a few months. As a therapist, you can do only so much to help. You can’t eliminate arthritic pain or the agony of losing a spouse. You can’t cure cancer or fend off death. You can’t undo the wrong turns your client has taken earlier in life and now deeply regrets. You may have to watch someone with a brilliant mind start to exhibit signs of dementia. Sometimes, all you can do is bear witness.
Like many therapists, I entered the field driven by my own experience of emotional pain to relieve the anguish of others. With clients of all ages, I’ve had to make my peace with the limits of what a therapist can do. But this peace has sometimes been harder to attain while working with my older clients. How so?
When younger clients are in emotional pain, I help myself by envisioning a better future for them. I trust that their work in therapy, whether it’s with me or someone else, will lead to brighter years to come. With older clients, I’m often deprived of this comfort: their lives may get harder to bear before the end. But over time, I’ve come to appreciate that while their external lives may not be bettered by therapy, their internal lives may improve dramatically.
Then, too, sometimes a client dies. Since I’m an outsider in the client’s life and not included in the circle of mourners, I’m often left to bear the heartache and find a way to mourn alone. I’ve learned that my own self-care is crucial in doing this work and that joining in conversation with other therapists is essential.
Working with older adults brings up my own anxieties. Being exposed to their hardships brings up an existential fear: Is this what will happen to me? When a client loses a spouse, receives a terminal diagnosis, or can no longer walk, I’ll think, Is this in my future? How will I cope when that happens?
Sometimes I’ve felt overwhelmed by my work with older people and wondered why I do it. But I’ve repeatedly had the experience of watching these clients bloom and hearing them say things like, “My life is hard in many ways, but my relationships are so much better. For the first time in my life, I actually like myself. You know, I’m the best I’ve ever been.” Or, “I wish I had my young body back. But if had a choice, I’d stay my current age. I’m finally who I always wanted to be.” Moments like these—recognizing that while there’s so much that I couldn’t do, there was also so much that I could—foster my longstanding excitement about the work.
What, Me Get Old?
I woke up on my 75th birthday terrified by the thought: I’m on an express train hurtling toward death. My heart was racing, and I had to do breathing exercises to calm down. The feeling passed quickly, and soon I moved into celebrating my achievement: three quarters of a century. I wish I could say that working with elders robs death of its sting, but that would be a lie. I’ve learned, however—both for myself and for my clients—that while death anxiety doesn’t disappear, it can become much less troubling.
As I struggle to face my own mortality, I’m nourished by numerous conversations with my clients over the years. I know we’re all in this together, and this knowledge provides enormous comfort. The powerful experience of talking about death with others loosens its grip. The saying “Shared feeling is bearable feeling” applies.
My client Anna recently died at 91, and I’ve been mourning her passing. I first met her as a middle-aged woman who started therapy for marital problems and left a few years later with a greater understanding of her contribution to these problems and a better marriage. I knew her as a smart, competent, and confident person, who’d made a name for herself in market research. She returned decades later, a tiny, frail, and deeply unhappy woman.
What had happened? Her body had been ravaged by several maladies; her husband was demented and perpetually angry; she hated herself for screaming back at him; her closest friends had died. We worked hard. As she recognized the ghost of her rageful, alcoholic father, she began to handle her husband’s anger more calmly. She was feeling somewhat better. Then, in rapid succession, her husband died, she became sicker, and finally, largely bedridden.
Was working with Anna now depressing? Not at all. She knew that death was approaching and was determined to make the best of her remaining time. Since her early days as a parentified child, she’d been fiercely self-sufficient. Now she required help but refused to accept it. After we challenged the ghost of the overburdened mother who’d needed Anna not to need help, she hired a live-in caregiver.
To Anna’s delight, she discovered that she loved having someone take care of her. After a session in which she told me she could barely remember her former self, she created a shelf she could see from her bed on which she placed a picture of her deceased husband, a medal she’d been awarded at work, and a painting she’d made years before in an art class. She also found ways to meaningfully engage in life by supporting her caregiver through the process of finding a therapist for a mentally ill relative. Life was far from blissful: she missed her husband, her body hurt, and she didn’t want to die. But she lived creatively, and even to the end, our sessions were punctuated by laughter.
I miss Anna, and I’m grateful to her and to all the others who mustered the courage to change and, in the process, transformed my vision of what it is to be old. Because I’ve gotten to know and admire so many older clients, I’m not ashamed of my age. I remember the multitude of older women I’ve known over the years who lied about their ages, and I can think of several peers who even now refuse to get hearing aids, complaining, “They’ll make me look old.” I’m happy I don’t feel that shame. I’m glad to make use of these wonderful inventions and don’t care if they betray my age. When my hairdresser wants to style my hair to make sure they can’t be seen, I tell her it’s okay with me if people see them.
I don’t sky-dive, bungee-jump, or engage in other activities that defy ageist stereotypes, and aching knees have relocated my hikes from the mountains to the valleys. But I did undertake the writing of a book—my first—published the day after my 79th birthday! And I’ve challenged myself to use a phone app to polish up my French. Following my clients’ examples, I continue to grow.
I’m now 80, an octogenarian, and feel fortunate to work in a field that doesn’t force retirement. Clinical wisdom, acquired from decades of experience, is typically highly valued by our profession. I’m proud to be a member of this particular elder’s club. For as long as possible, I want to continue assisting others on the challenging, complex, and often joyful path of aging. And along the way, I’ll keep on getting some tips for myself.
PHOTO © ISTOCK/PEOPLEIMAGES
Amy Schaffer, PhD, is the author of Blooming in December: Psychodynamic Psychotherapy with Older Adults. She’s a faculty member and supervisor at the Institute for Contemporary Psychotherapy and president-elect of the New York State Psychological Association’s Division of Adult Development and Aging. She has a private practice and has worked with older adults for 49 years.