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Book Forum: Aging and Geriatric Psychiatry   |    
Handbook of Counseling and Psychotherapy With Older Adults
NORMUND WONG, M.D.
Am J Psychiatry 2000;157:1716-a-1717. doi:10.1176/appi.ajp.157.10.1716-a
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Landstuhl, Germany

Edited by Michael Duffy, Ph.D. New York, John Wiley & Sons, 1999, 721 pp., $87.50.

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This ambitious work consists of 39 chapters explicitly devoted to the practice of counseling and psychotherapy with older adults. The editor emphasizes that this is a book for practitioners written by practitioners of vastly different theoretical persuasions who employ a wide range of modalities. The book consists of two parts. Part 1, Approaches to Psychotherapy With Older Adults, is devoted to treatment modalities such as individual psychotherapy, group and expressive approaches, family and intergenerational interventions, and social and community interactions. Part 2, Treatment Approaches for Selected Problems, discusses conceptual and best-practice interventions for specific problems such as personality, anxiety, and mood disorders. It also presents adjunctive psychological approaches for organic disorders and behavior disorders.

No fewer than 56 authors contributed to this book to provide some authoritative chapters. Among my favorites in part 1 are "Adjusting to Role Loss and Leisure in Later Life," by Jane Myers; "Addressing Late Life Developmental Issues for Women: Body Image, Sexuality, and Intimacy," by Royda Crose; "Developmental Issues in Psychotherapy With Older Men," by Margaret Huyck and David Gutmann; and "The Impact of Cultural Differences in Psychotherapy With Older Clients: Sensitive Issues and Strategies," by Pamilla Morales.

Myers writes especially well, furnishes a scholarly bibliography on her subject, and illustrates her intervention strategies with plausible case studies. Crose examines three of the most meaningful subjects for older women—body image, sexuality, and intimacy. In a lucid and deft manner, she covers their developmental pathways to focus attention on these subjects in late life. She expertly weaves together theory and relevant sociological data with her therapeutic interventions in the treatment of older women who are conflicted in these areas. Huyck and Gutmann examine developmental issues in psychotherapy with older men and dwell mainly on the evolution of male eros or eroticism. They delineate four major divisions in the male life cycle: "the child of the mother," "the father’s son," "the father of sons and daughters," and, finally, full circle as "mother’s son." The chapter is interesting and unique in that the focus is on the perspectives of wives in helping their husbands in middle and later life. The authors maintain that during this period "older men shift their erotic gears toward sexual appetites which rely less on hormonal surges, and more on the receptive pleasures of the mouth, the skin, the eyes, and secure, nurturing relationships." Toward the end, they say, the man "relapses back to the psychological status that predominated at the beginning of life."

Morales’ chapter on cultural differences in psychotherapy with older adults is an ambitious attempt to describe in 21 pages the characteristics of familial and community relationships and important considerations in counseling Native Americans, African Americans, Asian Americans, and Hispanics. Given the drastic space limitation, she can provide only pertinent sound bites and is not to be faulted for offering no more than an overview of these subjects.

Part 2 of the book is titled Treatment Approaches for Selected Problems. The division between parts 1 and 2 appears to be arbitrary, in that one may ask why the chapter "Integrated Group Approaches With the Early Stage Alzheimer’s Patient and Family" is in part 1 while the chapter "Reaching the Person Behind the Dementia: Treating Comorbid Affective Disorders Through Subvocal and Nonverbal Strategies" is placed in part 2. Outstanding selections in the second part include "Interpersonal Psychotherapy for Late-Life Depression," by Hinrichsen; "Strategies for Treating Generalized Anxiety in the Elderly," by Stanley and Averill; "The Effects of Trauma: Dynamics and Treatment of PTSD in the Elderly," by Hyer; "Reaching the Person Behind the Dementia: Treating Comorbid Affective Disorders Through Subvocal and Nonverbal Strategies," by Duffy; and "Management of Alcohol Abuse in Older Adults," by Dupree and Schonfeld.

Hinrichsen presents succinct overviews on the social well-being of the elderly, the impact of depression on social relationships, and recent research on interpersonal issues in late-life depression. He devotes the remainder of his work to the practical issues and problems of conducting interpersonal psychotherapy with the elderly. Stanley and Averill discuss the subject of generalized anxiety, beginning with a description of generalized anxiety disorder in the elderly and presenting a brief literature overview of cognitive behavior therapy with older adults. The focus of the chapter is on cognitive behavior therapy techniques, and less than a page is devoted to alternative psychosocial approaches such as supportive therapy, reminiscence therapy, insight-oriented psychotherapy, and interpersonal psychotherapy.

Hyer’s excellent article is worthy of special mention. He looks at stress as it applies to older people, offers research data on the general curative factors in the treatment of trauma, examines issues in the care of older victims, presents a treatment model, and provides case material outlining the features of the model. He concludes by raising numerous critical and yet unanswered questions such as, "What really is PTSD at later life…do trauma symptoms occur as a result of age-related coping decline, recent stressful events, or is it just the nature of the disorder?" and "What is the best developmental framework to understand the core issues of the older person?"

Duffy raises concerns that extend beyond the subject of treating patients who have lost their ability to communicate verbally. Many of his observations, gleaned from working with patients who are cognitively impaired, can be applied to the psychotherapy of all patients. His section on the impact of touch in both physical and psychological functioning is persuasively presented and rings true from clinical experience. Dupree and Schonfeld look at the literature on the management of alcohol abuse in older adults, a subject of considerable importance, and offer practical methods for assessment and treatment planning. The case material is excellent, and these authors afford the reader a detailed description of their self-management, cognitive behavior therapy approach.

In conclusion, the editor claims that this book is directed to an audience ranging from experienced geropsychiatrists and geropsychologists to all practitioners working with older adults, including students in advanced undergraduate courses. How well does this claim stand up? I agree that, within a broad audience, each group will find something of interest; however, it behooves readers to supplement their interest by reading further literature and books on any of the topics in this book.

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