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Discussing concerns helps create intimacy and growth between patients and therapists

By Patti Carmalt-Vener 01/23/2014

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Dear Patti,
My mother, Ruth, is 90 years old and in very good health, considering her age. She’s lost some muscle strength, causing her to move more slowly, her jaw has shrunk, which sometimes affects her speech, and she has some hearing loss but is sharp intellectually and, at times, quite wise. When I have problems, she’s often the best source for support and clarity. She still lives alone and wants it to stay that way for as long as possible.  

She has been feeling sad lately and requested psychotherapy. She was in therapy 30 years ago and loved it, but has been to two different therapists recently and didn’t like either one. Mom can occasionally be feisty and obstinate, but she can also be very sweet, funny and right-on in terms of evaluating people, so I’m not sure if I should encourage her to return to one of those counselors or keep searching. 

She felt the first therapist had a negative stereotype concerning seniors, treated her like she was sick, had limited intellect and talked to her like she was a child. She felt insulted by this and refused to go back after two sessions. 

The second therapist, mother said, didn’t challenge her emotionally or deal with her grief directly. She also complained about the stairs she had to climb — there was no elevator in the building — and that the therapist’s room was too dark to allow her to see the therapist’s face as clearly as she would’ve liked. 

Is my mom being too picky? Is she missing her old therapist and refusing to give someone a chance? Should I keep trying to find other therapists or insist she try a few more sessions before she gives up?
— Marion

Dear Marion,
Your mother could be missing her old therapist as well as her own “younger self” and, therefore, finding fault with any new experiences. Until we see a pattern of her rejecting more therapists, however, I’m not so sure at this point that’s the case. She has a high standard set from her past positive therapeutic experience and is probably right.  

I don’t think asking for a physical environment that’s comfortable and accommodating to her sensory limitations/physical losses or wanting a therapist that’s willing to support her facing her grief fully and directly is unreasonable. 

I also think wanting a therapist with the ability to evaluate her as an individual first and only secondarily as elderly is reasonable as well. Empathy training and the ability for a therapist to make environmental adaptations to promote comfort for a senior is often necessary and appropriate. Many seniors are mourning the loss of their loved ones and it’s necessary to have a therapist able and willing to facilitate the expression of their sad feelings. 

One possibility for your mother is bereavement therapy, which will help her cope with grieving and address her thoughts about her own death and dying. Other therapies particularly helpful with seniors include psychodynamic therapy, cognitive-behavioral therapy, life review therapy and group therapy. 

Psychodynamic therapy will explore past relationships and behaviors and link them to present problems and emotions. 

Cognitive-behavioral therapy is more goal-oriented, working on specific issues. This may be beneficial for her as well. 

Life review therapy discusses one’s personal history, recounting life stories which may help to better understand the past, realize past successes and abilities and give new meaning to one’s present life. 

Group therapy can be beneficial due to an environment where people come together, support and listen to each other.

Therapeutic goals should include experiencing her feelings about her physical disabilities, her loneliness and any other feelings and subjects she chooses in addition to supporting her sense of strength and autonomy as much as possible under the circumstances. It’s not uncommon for seniors to have transference where they view the therapist as the “good child,” an authority, or a substitute spouse; recognizing these transferences is part of the therapeutic process. Common countertransference may include a therapist’s own personal unresolved feelings about death, dying or aging.

I think your mother’s ability to evaluate her experience with new therapists is probably a strength, not a problem. Rather than remain silent, though, I’d encourage her to discuss concerns and problems with the therapist as they come up.

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her Web site,


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