Psychotherapy with Older Adults

Working with a senior population has been satisfying and rewarding for me as a psychologist.  One might think that the therapeutic issues revolve around loss, adverse physical issues, death, and dying; however, it has been quite the opposite experience.  The focus is staying vibrant, healthy, and engaged with life and relationships.  My oldest patients are 95 and 100.  The 95-year-old drives, takes long walks with her dog, goes to the gym daily, and has no cognitive impairment.  My 100-year-old patient walks daily, attends symphony concerts, is politically active, and has an astute mind.

I currently have about 15-20 Medicare patients in my practice.  I find them reliable, likable, and often quite wise about life. They are typically on time and appreciate the opportunity to have someone to talk to.    Working with this population has genuinely been fulfilling.

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Aging and Adaptation

If there is one word that captures the key to successful development across all species, it is probably “adaptation.”

Life has constantly been changing from day one. Weather changes, environments change, people change, and circumstances change. Adaptability is crucial if a person is to move forward successfully.

It makes sense that a good prognosis for successful adaptation in later life is a prior history of flexibility and effective adjustment. Most people will face challenges as they age, so the ability to change direction when necessary is crucial for successful living.

So, what are some problems many will face in their senior years? Certainly, health issues must rank high on the list. Health problems are not only intrinsically difficult, but they have ramifications in many other areas. Hearing loss affects social life and can push a person toward social isolation. Joint replacements and arthritis can end an active lifestyle. What does one do, then?

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Who Says Home Visits Are a Thing of the Past?

My interest in specializing and working with the older adult and elderly population began as an undergraduate student at San Diego State University. There, I chose elective courses that focused on the sociology and psychology of the aging population. I was also fortunate enough to connect with two professors/mentors who were older adults.

To gain clinical experience working with the older adult population, I contracted with a home-based organization in 1993, treating clients in their homes who would otherwise not be able to access mental health services due to being bedbound, homebound, or unable to access transportation, among other reasons. In-home therapy was not only intrinsically rewarding for me in helping clients bring back purpose to their lives, but I also envisioned its value in helping improve the quality of mental healthcare in San Diego. The increasing need for “home visits,” changes in Medicare reimbursement, technology, and an interdisciplinary team approach influenced the decision to generate a business model around these services, known today as Help Therapy.

Annette Conway, Psy.D., is a clinical psychologist who owns Help Therapy. She has a long-standing interest in providing home-based mental health services for older adults.

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Retiring and Moving

One million people move every year following retirement.  Most change within their state, but 38 percent relocate to another state.  Why do retirees move?

Many retirees came here on my Reno street of about forty-five families living in newly constructed homes because they wanted to be closer to family, particularly grandchildren.  Many appreciated the absence of state income tax to maintain their standard of living.  A few moved for health reasons and a love of outdoor activities like skiing and hiking.  All of these new retirees who came predominantly from Northern and Southern California ( four of us are from San Diego County ) comment they like the less crowded conditions and the fewer cars in Reno compared to large areas such as the Bay Area and San Diego County which has a population of 3.3 million.  Washoe County in 2021 was 493,014, while Reno qualifies as a smallish town with only 268,509 inhabitants.

Michele LaRue is a former San Diego psychologist now living in Reno, Nevada.

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People, as they age, begin to worry about their legacy. How will they be remembered? Will they be seen as having lived a life of value and consequence? Will they be appreciated for having lived a life of purpose and accomplishment? Were they a good worker? A good spouse? A creative person?

Of course, their curiosity is doomed to failure since they won’t be around to see how their legacy plays out. In addition, our legacies are experienced differently by different people. Here is an example.

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The Last Frontier

When planning a journey, I think it’s always a good idea to know where you’re starting from, where you’re going, who your traveling companions will be, and most importantly, who you are. Retirement is a journey. 

I recently retired from my clinical practice, so I’m a newbie at being retired. Still, I prepared for retirement as a personal project and worked hard to get my practice and patients ready. One critical takeaway I’m learning from people I’ve talked to about retirement is: that despite common factors, everyone’s retirement is unique and personal. As psychologists, we focus on self-awareness, regardless of our professional activities or theoretical orientation. The question, ‘who am I’ is an existential must for psychologists to answer, first about ourselves and the patient, client, group, organization, etc., we are serving.  

Peter LiBero is a retired clinical psychologist. He continues to work as an executive coach and psychological consultant to management.

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Older Adults with ADHD (Part 2)

Katherine Quinn, Ph.D. interviewed Dr. Kathleen Nadeau on May 3, 2022 as a tease prior to the release of her book in September, “Still Distracted After All These Years,” where she reported the results of interviews of older adult individuals with ADHD and their functioning in later life.  Dr. Quinn’s interview questions presented below were based on Dr. Nadeau’s presentations and writings as well as highlights of her findings from her interviews for her book. 

The first of two parts of Dr. Quinn’s interview of Dr. Nadeau was presented in the July issue of Age in Action. The second is presented below.

Katherine Quinn, Ph.D. is a clinical psychologist in private practice. She is a Past President and Fellow of SDPA. She was also previously Editor of the San Diego Psychologist.

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Tragedy: An Opportunity for Growth

We live in a culture that values youth, spending millions of dollars promoting anti-aging products. Most of us live with a fantasy that we should and will live a long, happy, healthy life. When illness or aging comes to our door, it can feel like an unwanted enemy barreling down upon us. Aging and disease can enter our awareness and lives often sooner than expected.

Staring into the heart of emotional and physical pain unflinchingly is a problematic part of our work that can arouse fear and worry in the mind and hearts of us therapists. We want and often consciously or unconsciously need to see progress in our patients’ eyes (I use patient because it is derived from the word sufferer).

Michelle Lalouche-Kadden, Ph.D. is a psychologist and psychoanalyst in private practice in Solana Beach. She works with adults of all ages.

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Designing a Retirement Plan that Works

Retirement presents many challenges. It is an ending but also a beginning. Many are relieved that working life is over: others are anxious about what they will do. There are some universal issues around retirement, but the process varies from person to person.

Everyone has to design their own retirement plan. For some of us, this is easy, but for others, not so much. Here are some issues to think about as retirement approaches.

1. Think hard about what you like to do. Retirement doesn’t work well if you do what you think you should do. Sometimes, it is not easy to figure out and may take trial and error.

2. Work at retirement. Create structure. Don’t waste time.

3. Try to get good at things. Whether cooking, golfing, traveling, or gardening, study and improve. Being competent makes any endeavor more fun.

4. If you value relationships, get social. Take the initiative. Time is limited, and you have an opportunity. Don’t wait for your phone to ring. Reach out!

5. Retirement brings freedom. Don’t worry about what others think. The canvas is empty. Paint away.

6. If you want to try new things, do it now. Learn and grow.

7. Take some time to assess your past life and put it in perspective. Acceptance that you did the best you could brings peace and makes it easier to move on. Think of your working life as an athletic contest. The game was played. It is over, and you are free to move on to other endeavors.

8. Try to stay as healthy as possible. Illness compromises retirement.

9. As aging makes one activity difficult or impossible, move on to another activity. Find things that are fun and do them. If you can’t play tennis, play pickleball.

10. Remember that we can all keep growing and learning. You really can teach old dogs new tricks.