Late-Life Psychotherapy: Challenges and Opportunities to Enhance Well-Being in the Oldest Old

Abstract

This chapter discusses problems with psychosocial treatments for the oldest old. We attempt to straddle the tenets of the Developmental Adaptation and Changes of Adaptation models as well as the offerings in other chapters. We highlight how the distal and proximate variables noted in the previous chapters are necessary but not sufficient for the eventual understanding of treatment outcomes in the oldest old. To date, the psychosocial adjustment and treatment of the oldest old have been largely ignored, having been given short shrift as a result of the medical model. The present chapter considers the biopsychosocial model as it applies to this developmental stage – issues, problems, strengths, and future directions. Given inherent biological limits, we specify the role of a life lived, one's life history, and how this might influence current stress and well-being. Finally, we discuss treatment models for other age groups and their applicability to empirically supported principles for oldest-old adults. INTRODUCTION In our chapter on posttraumatic stress disorder (PTSD), we argued that the trauma response is fundamentally a diathesis-stress response. The role of aging as a largely moderating influence in the expression of psychological trauma was construed as somewhat distinct, especially for the oldest old. Trauma itself is multidimensional and mixes with age, a variable that owns both positive and negative features as it relates to health and well-being. In that chapter, treatment required a focus on the “person” of the victim of trauma.

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