En español | The man who coined the term “ageism” back in the 1960s wasn't a sociologist or a politician. He was a psychiatrist named Robert Butler. Yet more than half a century later, age discrimination is still a serious problem in our field: Nearly 20 percent of our older-adult population suffers from one or more mental health and/or substance use conditions, but mental health services account for less than 4 percent of Medicare expenditures. As a geriatric psychiatrist, I see how the field of mental health is failing our older population. It's an issue we should all be aware of.
Why therapy is in short supply
Unfortunately, there are relatively few therapists (such as psychiatrists, psychologists or social workers) with the interest, training and experience to work with older adults. The supply of mental health professionals trained in geriatrics is so woefully inadequate that the National Academy of Medicine predicts we'll never catch up.
Yet the need for such services is pressing. One study found that as many as 1 in 10 people older than 60 may suffer a bout of major depression, but as many as 90 percent do not get proper treatment. Those who receive any treatment at all are usually prescribed antidepressant medication by their primary care provider, not by a psychiatrist. Talk therapy is rarely in the conversation.
There are a number of reasons why we're in this position — all one form or another of ageism — but an insidious factor is a long-standing, misguided belief that people become too old to change. (Even Sigmund Freud, the father of psychoanalysis, believed that people stop developing after age 50.)
If health care professionals don't think therapy will help, then it's no surprise that much of the general population holds the same prejudice. One study of people ages 60 to 79 found that the greatest barrier to seeking help was the belief that a decline in mental health was a normal part of aging. (It's not.)
The truth about age and psychotherapy
I have always treated adults of all ages. Now that I'm older myself (I am 70), I realize that the older people I treat benefit perhaps even more than younger patients. Some examples:
Marci, 59, was diagnosed with Parkinson's disease. Her neurologist referred her to me for “mood swings.” What emerged quickly was that her mood swings were actually panic attacks, which resulted from her efforts to deny the reality of her illness. In therapy she learned to accept her condition, which translated into significant improvement in her tremors and far fewer panic attacks.
I met Bob, 65, when he and his wife started couples therapy. Bob was initially skeptical, but as he moved into individual therapy, his chronic anxiety diminished, leaving him with an enhanced feeling of personal agency, liberation and comfort in his own skin.
Gladys, 85, lost her husband to COVID-19 and was unable to attend his funeral. She felt like a “stranger” to herself, full of grief and anxiety. Therapy helped her realize that she could make it, even on her own.
In each of these cases, the patients had successful therapeutic experiences in part because of the advantages conferred by their age: Studies show that aging is associated with more openness and an improved capacity to manage difficult feelings.
Getting better with time
Finding a suitable therapist can be challenging, but don't be discouraged. Since there are relatively few therapists with actual formal training in geriatrics, it is usually more realistic to search out a general therapist who is open to working with older adults.
Start by asking your primary care doctor for a referral. (Neurologists are also a good source for referrals.) If you're taking any medication for emotional management, it's important to include talk therapy as part of your overall health plan.
The American Association for Geriatric Psychiatry lists more than 500 geriatric psychiatrists in the U.S. and some in Canada. Many psychiatrists provide medication rather than psychotherapy, but they can be a good resource for referrals.
Many medical schools have departments of geriatrics that can refer you to resources.
Psychology Today's Find a Therapist online tool, the APA's Psychologist Locator and the ZenCare therapist database are terrific resources. Type in your zip code and you'll find a list of professionals near you. Refine your search by clicking on treatment methods, specialties (such as life transitions or marital problems), age-group specialization (seniors, for example) or cost per session.
Private insurers, Medicare and Medicaid all have lists of in-network providers. Check that list against referrals you've gotten.
When you've identified a potential therapist, call and request a free consultation. (Many will continue to offer sessions over the phone or via teletherapy.) Ask, too, if he or she has experience treating people in your age group or with your particular concerns.
To be sure, there are cognitive changes that may limit therapy in some older patients. But therapy isn't a classroom — it's a journey of self-discovery, and those with mild impairment often do just fine.
Daniel Plotkin, M.D., is a clinical professor of psychiatry at the University of California, Los Angeles.