Countertransference Issues with the Later Life Patient

KARL ABRAHAM (1919) WAS THE FIRST analyst to strike a note of optimism about treating the later life patient. He noted, however, as have many analysts who work largely with regressed elderly patients, that they wish to be "guided" by the doctor, who signifies "the superior father" to their unconscious. This characterizes the transference of the elderly patient. Magical expectations that the therapist be an omnipotent figure who is a safeguard against external danger dominates the relationship. The therapy does not aim at uncovering, insight or reconstruction, but seems to merely be a holding operation. The therapist thinks in terms of limited goals such as improved daily functioning and applies a limited form of treatment which falls into the category of brief or supportive psychotherapy.

Two types of countertransference difficulties arise in therapeutic work with the regressed later life patient. The first are those resistances which have to do with professional ageism, i.e. fear and prejudice against advanced age which is prevalent in our society. This type of prejudice leads to referrals and recommendations other than therapy, such as adjunct services or nursing home placements. It is commonly assumed that the regressed patient is senile and the regression is irreversible. Actually there is an emotional breakdown due to loss and other precipitating stress factors which overload the adaptive capacities of the individual during a period of life marked by declines of all kinds. This type of prejudgment masks the therapist's anxiety aroused by the loneliness, helplessness and death imagery that these patients evoke. A second type of countertransference difficulty, however, has to do with the nature of the modifications in technique which accompany the application of brief, supportive, transference indulgent psychotherapies. In this paper I will focus on these countertransference