Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-18T21:02:43.935Z Has data issue: false hasContentIssue false

Chapter 3 - Choice of Psychotherapy Approach

from Part 1 - Introduction to Psychotherapy in Later Life

Published online by Cambridge University Press:  09 January 2020

By
Feyza Marouf
Edited by
Rajesh R. Tampi ,
Brandon Yarns ,
Kristina F. Zdanys  and
Deena J. Tampi
Rajesh R. Tampi
Affiliation:
Case Western Reserve University, Ohio
Brandon Yarns
Affiliation:
VA Greater Los Angeles Healthcare System
Kristina F. Zdanys
Affiliation:
University of Connecticut
Deena J. Tampi
Affiliation:
Diamond Healthcare Corporation
Get access

Summary

Older adults have low rates of psychotherapy use despite the effectiveness of multiple psychotherapeutic modalities in late life. Frequent themes in late-life psychotherapy include coping with losses in the setting of physical and cognitive decline, dependence and debility. Choice of treatment modality is based on the abilities and needs of the individual patient rather than age alone. Therapists decide between more structured therapies like cognitive behavioral therapy (CBT) and problem-solving therapy (PST), and more exploratory, affect-focused modalities like interpersonal therapy (IPT) and brief dynamic psychotherapy (BDP). Cognitive therapies have the strongest evidence base for the treatment of depression and anxiety, especially in the setting of medical illness. Problem-solving therapies offer a behavioral approach to patients with depression and executive dysfunction. Interpersonal therapies are readily applicable for older adults struggling with complicated grief, retirement, or family conflict. Brief psychodynamic treatment can be particularly useful for patients with mild to moderate depression struggling with self-esteem or acceptance of mortality. Clinically relevant differences between treatment modalities are difficult to detect due to limited and underpowered trials. Factors common to all psychotherapies, including empathy, alliance, positive regard, and expectations may account for much of the variability in psychotherapy outcomes. Research focused on understanding the mechanism of change associated with psychotherapy is needed to clarify the role of common versus specific factors.

Keywords

psychotherapycognitive behavioral therapy (CBT)problem-solving therapy (PST)interpersonal therapy (IPT)brief dynamic psychotherapy (BDP)
Type
Chapter
Information
Psychotherapy in Later Life , pp. 23 - 34
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

CDC healthy aging data: the state of mental health and aging in America. Retrieved from: www.cdc.gov/aging/agingdata/data-portal/mental-health.html (May 10, 2019).Google Scholar
Byers, AL, Arean, PA, Yaffe, K. Low use of mental health services among older Americans with mood and anxiety disorders. Psychiatr Serv. 2012;63(1):66–72.Google Scholar
Garrido, MM, Kane, RL, Kaas, M, et al. Use of mental health care by community-dwelling older adults. J Am Geriatr Soc. 2011;59:50–56.Google Scholar
Karlin, BE, Duffy, M, Gleaves, DH. Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States. Psychological Services. 2008;5:275–294.Google Scholar
Mackenzie, CS, Pagura, J, Sareen, J. Correlates of perceived need for and use of mental health services by older adults in the collaborative psychiatric epidemiology surveys. Am J Geriatr Psychiatry. 2010;18:1103–1115.CrossRefGoogle ScholarPubMed
Wang, PS, Lane, M, Olfson, M, et al. Twelve-month use of mental health services in the United States: results from the national comorbidity survey replication. Arch Gen Psych. 2005;62:629–640.CrossRefGoogle ScholarPubMed
Verdoux, H, Cortaredons, S, Dumesnil, H, Sebbah, R, Verger, P. Psychotherapy for depression in primary care: a panel survey of general practitioners’ opinion and prescribing practice. Social Psychiatry Psychiatr Epidemiol. 2014;49:59–68.Google Scholar
Frost, R, Beattie, A, Bhanu, C, Walters, K, Ben-Shlomo, Y. Management of epression and referral of over people to psychological therapies: a systematic review of qualitative studies. Br J Gen Pract. 2019;69(680): 171–181.CrossRefGoogle Scholar
Bosworth, HB, Voils, CI, Potter, GG, Steffens, DC. The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults. Int J Geriatr Psychiatry. 2008;23(2):129–134.Google Scholar
Gum, A. M., Iser, L., Petkus, A. Behavioral health service utilization and preferences of older adults receiving home-based aging services. Am J Geriatr Psychiatry. 2010;18(6):491–501.Google Scholar
Olfson, M, Marcus, SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848–856.Google Scholar
Ayers, CR, Sorrell, JT, Thorp, SR, Wetherell, JL. Evidence-based psychological treatments for late life anxiety. Psychol Aging. 2007;22:8–17.CrossRefGoogle ScholarPubMed
Samad, Z, Brealey, S, Gilbody, S. The effectiveness of behavioral therapy for the treatment of depression in older adults. A meta-analysis. Int J Geriatr Psychiatry. 2011.Google Scholar
Laidlaw, K, Davidson, K, Toner, H, et al. A randomized controlled trial of cognitive behavior therapy vs treatment as usual in the treatment of mild to moderate late life depression. Int J Geriatr Psychiatry. 2008;23(8):843–850.Google Scholar
Bower, ES, Wetherell, JL, Mon, T, et al. Treating anxiety disorders in older adults: current treatments and future directions. Harv Rev Psychiatry. 2015;23:329–342.Google Scholar
Kiosses, DN, Alexopoulos, GS. Problem-solving therapy in the elderly. Curr Treat Options Psychiatry. 2014;1:15–26.CrossRefGoogle ScholarPubMed
Lipsitz, JD, Markowitz, JC. Mechanisms of change in interpersonal therapy (IPT). Clin Psychol Rev. 2013;33(8):1134–1147.CrossRefGoogle ScholarPubMed
Garner, J. Psychotherapies and older adults. Aust N Z J Psychiatry. 2003;37:537–548.CrossRefGoogle ScholarPubMed
Magai, C, Cohen, C, Milburn, N, et al. Attachment styles in older European American and African American adults. J Gerontol B Psychol Sci Soc Sci. 2001;56(10);S28–35.Google Scholar
O’Connor, D, Kelson, E. Boomer matters: responding to emotional health needs in an aging society. J Gerontol Soc Work. 2018;61(1):61–77.Google Scholar
Gallagher-Thompson, D, Steffen, AM. Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. J Consult Clin Psychol. 1994;62:543–549.Google Scholar
Arean, P, Hegel, M, Vannoy, S, et al. Effectiveness of problem-solving therapy for older, primary care patients with depression: results from the IMPACT project. Gerontologist. 2008;48:311–323.CrossRefGoogle ScholarPubMed
Schulberg, HC, Post, EP, Raue, PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry. 2007;22:106–114.CrossRefGoogle ScholarPubMed
Gellis, ZD, Bruce, ML. Problem solving therapy for subthreshold depression in home healthcare patients with cardiovascular disease. Am J Geriatr Psychiatry. 2010;18:464–474.Google Scholar
Wilkins, VM, Kiosses, D, Ravdin, LD. Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clin Interv Aging. 2010;5:323–331.Google ScholarPubMed
Willis, J, Todorov, A. First impressions: making up your mind after a 100‐ms exposure to a face. Psychol Sci. 2006;17:592–598.Google Scholar
Connell, J, Grant, S, Mullin, T. Client initiated termination of therapy at NHS primary care counselling services. Couns Psychother Res. 2006;6:60–7.Google Scholar
Markin, R. Toward a common identity for relationally oriented clinicians: a place to hand one’s hat. Psychotherapy. 2014;51:327–333.Google Scholar
Huppert, JD, Fabbro, A, Barlow, DH. Evidence-based practice and psychological treatments. Evidence-based psychotherapy: where practice and research meet. 2006;131–152.Google Scholar
Crits-Christoph, P, Gibbons, MB, Hamilton, J, Ring-Kurtz, S, Gallop, R. The dependability of alliance assessments: the alliance-outcome correlation is larger than you might think. J Consult Clin Psychol. 2011;79:267–278.CrossRefGoogle ScholarPubMed
Wampold, BE, Flückiger, C, Del Re, AC, et al. In pursuit of truth: a critical examination of meta-analyses of cognitive behavior therapy. Psychother Res. 2017;27:14–32.Google Scholar
Arnow, BA, Steidtmann, D, Blasey, C, et al. The relationship between the therapeutic alliance and treatment outcomes in two distinct therapies for chronic depression. J Consult Clin Psychol. 2013;81:627–638.Google Scholar
Mace, RA, Gansler, DA, Suvak, MK, et al. Therapeutic relationship in the treatment of geriatric depression with executive dysfunction. J Affect Disord. 2017;214:130–137.Google Scholar
Ackerman, SJ, Hilsenroth, MJ. A review of therapist characteristics and techniques positively impacting the TA. Clin Psychol Rev. 2003;23:1–33.Google Scholar
Baldwin, SA, Wampold, BE, Imel, ZE. Untangling the alliance-outcome correlation: exploring the relative importance of therapist and patient variability in the alliance. J Consult Clin Psych. 2007;75:842–852.Google Scholar
Crits‐Christoph, P, Connolly Gibbons, MB, Crits‐Christoph, K et al. Can therapists be trained to improve their alliances? A preliminary study of alliance‐fostering psychotherapy. Psychother Res. 2006;16:268–281.CrossRefGoogle Scholar
Horvath, AO. The alliance in context: accomplishments, challenges, and future directions. Psychotherapy: Theory, Research, Practice, Training. 2006;43:258–263.Google Scholar
Benish, SG, Quintana, S, Wampold, BE. Culturally adapted psychotherapy and the legitimacy of myth: a direct‐comparison meta‐analysis. J Couns Psychol. 2011;58:279–289.Google Scholar
Constantino, MJ, Arnkoff, DB, Glass, CR, et al. Expectations. J Clin Psychol. 2011;67:184–192.Google Scholar
Price, DP, Finniss, DG, Benedetti, F. A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol. 2008;59:565–590.Google Scholar
Benedetti, F. Placebo effects: understanding the mechanisms in health and disease. 2nd ed. New York: Oxford University Press; 2014.Google Scholar
Laidlaw, K, Thompson, LW, Dick-Siskin, L, Gallagher-Thompson, D. Cognitive behaviour therapy with older people. Chichester: John Wiley & Sons; 2003.Google Scholar
Pinquart, M, Duberstein, PR, Lyness, JM. Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and CBT. Am J Psychiatry. 2006;163:1493–1501.Google Scholar
Wilson, KC, Mottraam, PG, Vassilas, CA. Psychotherapeutic treatments for older depressed people. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004853.Google Scholar
Gould, RL, Coulson, MC, Howard, RJ. Cognitive behavioral therapy for depression in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc. 2012;60(10):1817–1830.Google Scholar
Cuijpers, P, Karyotaki, E, Pot, AM, et al. Managing depression in older age; psychological interventions. Maturitas. 2014; 79(2):160–169.CrossRefGoogle ScholarPubMed
Joosten-Weyn Banningh, LW, Kessels, RP, lade Rikkert, MG, et al. A cognitive behavioral group therapy for patients diagnosed with mild cognitive impairment and their significant others: feasibility and preliminary results. Clin Rehabil. 2008;22:731–740.Google Scholar
Freedland, KE, Carney, RM, Rich, MW, et al. Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA Intern Med. 2015;175:1773–1782.CrossRefGoogle ScholarPubMed
Hummel, J, Weisbrod, C, Boesch, L, et al. Acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: a randomized controlled trial. JAMA. 2017;18:341–349.Google ScholarPubMed
Calleo, JS, Amspoker, AB, Sarwar, AI, et al. A pilot study of a cognitive-behavioral treatment for anxiety and depression in patients with Parkinson Disease. J Geriatr Psychiatry Neurol. 2015;28:210–217.Google Scholar
Hendriks, G, Kampman, M, Keijsers, G, et al. Cognitive-behavioral therapy for panic disorder with agoraphobia in older adults: a comparison with younger patients. Depress Anxiety. 2014;31(8):669–677.Google Scholar
Stanley, MA, Wilson, N, Novy, D, et al. Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care. J Am Med Assoc. 2009;301(14):1460–1467.CrossRefGoogle ScholarPubMed
Thorp, SR, Ayers, C, Nuevo, R, et al. Meta-analysis comparing different behavioral treatments for late-life anxiety. Am J Geriatr Psychiatry. 2009;17(2):105–115.CrossRefGoogle ScholarPubMed
Huang, AX, Delucchi, K, Dunn, LB et al. A systematic review and meta-analysis of psychotherapy for late-life depression. Am J Geriatr Psychiatry. 2015;233:261–273.CrossRefGoogle Scholar
Brenes, GA, Miller, M, Williamson, J, et al. A randomized controlled trial of telephone-delivered cognitive-behavioral therapy for late-life anxiety disorders. Am J Geriatr Psychiatry. 2012;20(8):707–716.Google Scholar
Brenes, GA, Danhauer, SC, Lyles, MF, et al. Long term effects of telephone-delivered psychotherapy for late-life GAD. Am J Geriatr Psychiatry. 2017.CrossRefGoogle Scholar
Staples, LG, Fogliati, VJ, Dear, BF, Nielssen, O, Titov, N. Internet-delivered treatment for older adults with anxiety and depression: implementation of the Wellbeing Plus Course in routine clinical care and comparison with research trial outcomes. BJPsych Open. 2016;2(5):307–313.Google Scholar
Stanley, MA, Wilson, NL, Amspoker, AB, et al. Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder. Depress Anxiety. 2014;31(5):391–401.CrossRefGoogle ScholarPubMed
Arean, P, Hegel, M, Vannoy, S, et al. Effectiveness of problem-solving therapy for older, primary care patients with depression: results from the IMPACT project. Gerontologist. 2008;48:311–323.Google Scholar
Choi, NG, Marti, CN, Conwell, Y. Effect of problem-solving therapy on depressed low-income homebound older adults’ death/suicidal ideation and hopelessness. Suicide Life Threat Behav. 2016;46:323–336.Google Scholar
Bell, AC, Zurilla, TJ. Problem solving therapy for depression: a meta-analysis. Clin Psychol Rev. 2009;29(4):348–353.Google Scholar
Malouff, JM, Thorsteinsson, EB, Schütte, NS. The efficacy of problem solving therapy in reducing mental and physical health problems: a meta-analysis. Clin Psychol Rev. 2007;27(1):46–57.Google Scholar
Alexopoulos, GS, Raue, PJ, Kiosks, DN, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability. Arch Gen Psychiatry. 2011;68(1):33–41.Google Scholar
Visser, MM, Heijenbrok-Kal, MH, Van’t Spijker, A, et al. Problem-solving therapy during outpatient stroke rehabilitation improves coping and health-related quality of life: randomized controlled trials. Stroke. 2016;47(1):135–142.Google Scholar
Gustavson, KA, Alexopoulos, GS, Niu, GC, et al. Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction. Am J Geriatr Psychiatry. 2016;24(1):11–1766.Google Scholar
Arean, PA, Raue, P, Macken, RS, et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry. 2010;167:1391–1398.Google Scholar
Kiosses, DN, Ravdin, LD, Gross, JJ, et al. Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry. 2015;72(1):22–30.Google Scholar
Van Schaik, A, van Marwijk, H, Ader, H, et al. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry. 2006;14:777–786.Google Scholar
Markowitz, JC, Milrod, BL. The importance of responding to negative affect in psychotherapies. Am J Psychiatry. 2011;168(2):124–128.Google Scholar
Miller, MD, Silberman, RL. Using interpersonal psychotherapy with depressed elders. In: Zarit SH, Knight BG, editors. A guide to psychotherapy and aging: effective clinical interventions in a life-stage context. Washington, DC: American Psychological Association; 1996. p. 83–99.Google Scholar
Lipsitz, JD, Markowitz, JC. Mechanisms of change in interpersonal therapy (IPT). Clin Psychol Rev. 2013;33(8):1134–1147.Google Scholar
Miller, MD, Reynolds, CF 3rd. Expanding the usefulness of Interpersonal Psychotherapy (IPT) for depressed elders with co-morbid cognitive impairment. Int J Geriatr Psychiatry. 2007;22(2):101–105.Google Scholar
Morgan, AC. Psychodynamic psychotherapy with older adults. Psychiatric Services. 2003;54(12):1592–1594.Google Scholar
Roseborough, DJ, Luptak, M, McLeod, J, Bradshaw, W. Effectiveness of psychodynamic psychotherapy with older adults: a longitudinal study. Clinical Gerontologist. 2012;36:1–16.Google Scholar
Nordhus, I. Current psychodynamic approaches with older people. In: Laidlaw, L, Knight, B, editors. Handbook of emotional disorders in later life. New York: Oxford University Press; 2008. p. 165–182.Google Scholar
Kennedy, GJ, Tanenbaum, S. Psychotherapy with older adults. Am J Psychotherapy. 2000;54:386–407.Google Scholar
Critchley-Robbins, S. Brief psychodynamic therapy with older people. In: Evans, S, Garner, J, editors. Talking over the years: a handbook of dynamic psychotherapy with older adults. New York: Brunner-Routledge; 2004.Google Scholar
Cuijpers, P. Are all psychotherapies equally effective in the treatment of adult depression? The lack of statistical power of comparative outcome studies. Evid Based Ment Health. 2016;19:39–42.Google Scholar
Bell, EC, Marcus, DK, Goodlad, JK. Are the parts as good as the whole? A meta‐analysis of component treatment studies. J Consult Clin Psychol. 2013;81:722–736.Google Scholar
Ahn, H, Wampold, BE. Where oh where are the specific ingredients? A meta‐analysis of component studies in counseling and psychotherapy. J Couns Psychol. 2001;48:251–257.Google Scholar
Kaplan, BJ, Giesbrecht, G, Shannon, S, McLeod, K. Evaluating treatments in health care: the instability of a one-legged stool. BMC Med Res Methodol. 2011;11:65.Google Scholar
Rosenbaum, P. The randomized controlled trial: an excellent design, but can it address the big questions in neurodisability? Dev Med Child Neurol. 2010; 52 :111.Google Scholar
Bradley, H, Rucklidge, JJ, Mulder, RT. A systematic review of trial registration and selective outcome reporting psychotherapy randomized controlled trials. Acta Psychiatr Scand. 2017;135:65–77.CrossRefGoogle ScholarPubMed
Webb, CA, DeRubeis, RJ, Barber, JP. Therapist adherence/competence and treatment outcome: a meta‐analytic review. J Consult Clin Psychol. 2010;78:200–211.Google Scholar
Owen, J, Hilsenroth, MJ. Treatment adherence: the importance of therapist flexibility in relation to therapy outcomes. J Couns Psychol. 2014;61:280–288.CrossRefGoogle ScholarPubMed
Fournier, JC, Price, RB. Psychotherapy and neuroimaging. Focus 2014;12 : 290–298.Google Scholar
Mulder, R, Murray, G, Rucklidge, J. Common versus specific factors in psychotherapy: opening the black box. The Lancet Psychiatry. 2017;4(12):953–962.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×