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This is one of the most practical books ever written on the psychoanalytic psychotherapy of the elderly. Because increasing numbers of elderly are seeking treatment, many readers are likely to need the wisdom contained within it in the near future. It provides help, for example, in deciding whether or not individual, family, or group therapy is indicated. We need to broaden our perspective from the individual to the family system without losing our intrapsychic focus.
This is not a simple book. It demands frequent stops for self-confrontation and reflection on such matters as our own aging, the age-biased selection of patients, and the therapeutic accessibility of various categories of aging patients.
In his foreword, Irvin Yalom observes that among the age-specific, dynamic themes discussed, the one most emphasized by the contributors is loss. One of my first papers, twenty-five years ago, "Loss and Restitution," was controversial in that some felt I had not fully appreciated the adaptive, constructive side of growing old. Yalom quotes Heidegger on death as "the possibility for impossibility." He notes that recent generations of elders are the first in history from whom younger people may have little to learn. It seems probable that the relationship between the realities of aging and feelings of optimism or pessimism are important countertransference issues for many young, enthusiastic therapists confronted by elderly patients who are facing limited possibilities in life. At no other time does functional impairment play such a prominent part.
George Pollock's more optimistic focus on the mourning-liberation process in the first chapter stands in fitting counterpoint. He acknowledges how catastrophic living long can be, but reminds us that vast numbers of the "old old" today are less frail, less often institutionalized, and more independent than previously believed. He inquires into the factors that allow them to thrive. He addresses the appropriateness of