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As we ourselves age — and particularly in my own cohort of clinicians in their 60s and 70s — a fearful symmetry occurs between our development and that of our patients. Of course, throughout our professional lives we often encounter patients who are facing similar problems to our own, but this happens more frequently in older age. Within the past few years, nearly all of my closest colleagues have dealt with caring for aging and dying parents and siblings, our own and our spouse's illnesses, anxiety over retirement, and multiple losses. While our training and experience help us contain our primitive anxieties, none of us are exempt from the ravages of age. The countertransferential context changes and new difficulties arise as the line between our aging patients and ourselves blurs. While this blurring is problematic, it also reminds us that we are all in this together.
If we think of our professional selves as having a developmental trajectory, then we, too, are faced with regression in this context, and this in turn potentiates further growth or debilitation. The kinds of anxieties that beset us early in our careers return and, once again, we struggle with basic questions: Can I really help this person or this couple? Do I have the right training or experience to handle these frightening issues? Would another therapist be better able to work in this arena? And so on. Like our patients, we don't want to know what lies ahead and yet we know that turning a blind eye will impoverish our inner worlds and darken our remaining days.
Balfour poses several questions throughout the paper, but one, in particular, seems vital and, I think, serves as the organizing principle for the argument he advances here. He writes, “The question, then, is what scope is there for development in late life…” This paper addresses the question in a highly nuanced way. He tells us that the forces against development are formidable, yet there are possibilities for growth as we age. This orientatio