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From Dr Jane Garner:
Dear Editor
The work which Joan Hunter described in the latest APP journal1, the treatment of an 82-year-old woman for panic attacks, raises two important issues for those working with older adults: the re-emergence of early conflicts and trauma with increasing dependency in old age and the need for a flexible approach to treatment.
With regard to the second point, external reality intrudes into the therapy with older people in the form of physical handicap, immobility and sensory impairment in ways that need to be accommodated. Not to give a hand to a patient struggling to stand could be considered abusive. Ardern (1997) reminds us to recognise the social aspects of a therapy group for patients leading isolated lives constrained by physical and financial problems as much as by psychological factors.
Jung (1931), who thought that psychotherapy could be extended to the second half of life, suggested there should be some modifications in technique. Working with patients who have a diagnosis of dementia requires further modification (Hausman 1992): the therapist may even need to serve some memory function for the patient whose ego is under siege.
Hunter describes the treatment of her patient as unavoidably ‘unorthodox’, as it involved individual and group therapy as well as telephone sessions. For particular groups of patients, therapy is only an option if it is unorthodox. However, that is not to say that the underlying principles are different. The theoretical base is perhaps doubly important so that one is always mindful of when and why one might be departing from it. Hunter is to be congratulated for her work.