Q: Therapy is a profession without any clear retirement age. How do we know when it’s finally time to stop seeing clients?
A: We like to think that with age comes wisdom, but often what accompanies it are unwelcome changes in outlook and acuity that may go undetected in a therapist’s work. Experienced clinicians take pride in their ability, honed over decades, to stay alert and attuned to the nuances of their clients’ histories. But as we grow older, details in these histories may slip from memory, and our stamina may be diminished throughout day.
Nevertheless, it can be hard to decide when it’s time to slow down, or even close a practice. How many therapists recognize their own cognitive decline? If they do see signs, do they simply go on autopilot? Many competent therapists who’ve been in practice for a long time probably know how to cover up and compensate for minor losses of attention and memory. Some may rest on their laurels or assume that having “seen and heard it all,” they can practice at full tilt without being fully present. How many of these clinicians have honest friends, colleagues, or relatives who will tell them when it’s time to reconsider how they work?
The solo practice of psychotherapy is a largely unregulated career path. No one watches your sessions, measures the outcomes, evaluates your efficacy, or dictates when you should retire. The CME requirements for license renewal are mainly academic, and there are no mandated peer-supervision groups. Working in this kind of vacuum, we have to rely on our own discretion to ask for help and honest feedback. So how do we figure out our “best if used by” date?
In some situations, advanced age is definitely an advantage. Older clinicians often bring greater skill to the therapeutic partnership and a calm and measured evaluation of problems that may appear daunting to younger, less experienced clinicians. With decades of life experience, they can be sage and comforting, calm and unflappable. Plus, clients can surely benefit from a vision of aging that’s wrinkled but vital, curious, and even humorous.
It’s not necessarily the case that an 80-year-old therapist should have one foot in the office and the other in a pasture: you don’t have to be youthful and full of life to be effective. But you do have to have the right balance of empathy and objectivity to adapt to a broad range of suffering and work accordingly. As such, older clinicians must watch for issues of countertransference, identification, and empathy as closely as ever, as these sly devils can alter, damage, and neutralize the gift of wisdom.
If therapists become too immersed in the challenges associated with aging, or preoccupied with family or personal woes like disease, frailty, and death, the sufferings more typically associated with youth and maturation to full adulthood may feel increasingly trivial or casual, less worthy of deep consideration. For example, what of the anxious college freshman who isn’t adjusting well and wants to return home, or the new MBA whose boss is a tyrant, or the kid whose parents won’t support an acting career, or the teenager whose girlfriend has cheated on him? Are these miseries less serious than the macular degeneration or ALS that the aging therapist might be grappling with? The rapport established during the painstaking process of building trust and mutual respect depends on the therapist’s ability to take all complaints and conundrums seriously.
The 80-year-old therapist needs to contemplate whether self-pitying malingerers are going to get his or her full concern, sympathy, and insight. It’s easy to reply, “Yes, of course, we’re trained professionals! That’s an absurd question!” Perhaps, but therapists have their own body language, vocal inflections, vocabularies, and attention spans that may belie this knee-jerk response. To do the work we do, with as much ethical integrity as we can sustain, aging clinicians need to be attentive to the subtle changes in attitude and perspective that inform the practice of psychotherapy. It’s hard to imagine that as most people grow old, they’re immune from feeling a bit dismissive of the complaints of young people who may not appear to know “real” suffering yet.
If age brings with it a sense of contentment and the satisfaction of having helped so many people for so long, then the aging therapist is a very lucky person. But self-confidence has to be tempered by self-awareness, which isn’t easy at any age.
Many therapists who keep notes by hand are only too aware of the differences between themselves and those whose daily existence, occupational and social, is electronically structured. And while most oldsters have come to embrace various forms of technology, if only to maintain intimacy with friends and family, many view those connections as either second-rate or a mere bridge to the real deal. What of today’s clients who are just as enthralled by cellphones, game consoles, and iPads as earlier clients once were by color TV, telephone extensions, and air travel? Should the Tinder and sexting of today be viewed as less intimate and deep than the necking and petting preliminaries of previous generations? Has aging and the accompanying feeling of being left behind caused conscious or unconscious condescension? Do some clients consider their therapist’s “wisdom” outdated?
How exactly do we determine our “best if used by” date? And what do we do when we feel we may be getting close to it? Many therapists decide to work less and use their time in new ways as they ease into the twilight of their careers. That’s a great idea, but we need to keep in mind that a therapist’s frequent or extended absence may not be in the best interest of many clients, some of whom require more scaffolding and containment than can be provided by someone with a newfound love of travel or who wants to work just one day a week in hopes of spending more time with the grandkids.
We have the right to change our work routines and the rules of our practice at any point, but we also have an obligation to face facts. Therapists must be available, physically and emotionally, and when it’s time to bow out, we should do so with gratitude and make way gracefully for a new generation of clinicians. After all, in a world filled with anxiety and seductive distractions, the best gift we can give our clients, at any age, is our undivided attention.
Photo by iStock/Cecile Arcurs
Barbara Rickler, MD, is an adult, child, and adolescent psychiatrist who has been practicing for 33 years in Connecticut, with a special interest in consultations with schools.
Susan Braiman, LCSW, is close to being fully retired after 53 years as a social worker. She maintains a part-time private practice in Manhattan.