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I am 91 years old and have been in practice for more than 66 years. During this span of time, I have been part of a changing culture and have been exposed to many new clinical developments. Today there is much more emphasis on the use of the therapist's emotional resources as a therapeutic response to patient's communications. Involved in this development are important contributions from brain research, attachment theory, and mindfulness-based interventions. Professionally and personally, this explosion of information and stimulation places a heavy burden on the elderly. There is a demand to keep up with the quick pace of life. At the same time, the vulnerability of aging, the reality of loss, and the possible shame that arises out of these life changes requires attention and communication. The intent of this essay is to open up a dialogue that connects all of us to the challenges that face the elderly therapist and patient.
The title of this essay requires clarification. The concept of developmental challenges implies that getting older produces unique emotional struggles that are connected with the experience of aging. Our bodies show signs of wear and tear. There are losses of friends and colleagues, and we are aware of the specter of life ending.
The notion of old age has changed remarkably during my lifetime. Now, middle age extends into the 60s, and old age begins between 80 and 90. This extension of our life span bears little resemblance to the one that was part of our parents' time. Being in your 60s then was already considered old. Both my parents passed away at the age of 62.
The notion of old age requires reformulation. Subjectively, it becomes a period of loss and pain, as well as the potential to develop a capacity for reflection. The confrontation with our death puts everything in perspective. A reflection on what is truly important in life may take center stage. As we age, many of us are involved with a long-term life review.
The term expansion refers to