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Pessimism about psychotherapy with aged persons is common and not without grounds. The results that may be achieved when a patient has limited resources and brings to treatment a myriad of immobilizing social and economic entanglements, of which many have been more or less arranged by himself, are not usually so marked or dramatic as to greatly gratify the physician or to balance his expenditure of time and effort. Because this is true with young patients, it is even more disappointing in aged persons in whom the expected life span is short. At first glance, psychotherapeutic effort with the elderly seems largely wasted as compared to the product of quantity and length of improved function they can achieve.
Attitudes, however, can and do change with the times. In 1919, Abraham affirmed that even psychoanalytic treatment had application to patients at an advanced age. However, the patients he spoke of were “over forty and even fifty years of age.” His view of “advanced age” was not without foundation for his time, although it is so recent, for this brilliant man himself died in his forty-eighth year. Our present view of “advanced age” is different; the patients upon whom this paper is based, for example, include only a few in their early sixties; the majority are in their seventies and a fair proportion are over eighty years of age. These elderly persons are residents in a home for the aged and represent a few of those who are benefiting because the expectation of many, so well expressed by Freud, has been realized, “… that at some time or other the conscience of the community will awake and admonish it that the poor man has just as much right to help for his mind as he now has to the surgeon's means of saving life….” He might well have specified the aged when he continued: “… clinics and consultation departments will be built, to which analytically trained physicians will be appointed, so that the men who would otherwise give way to drink, the women who h