What can therapists learn from older adult clients?

Most mornings, I drink from a coffee cup featuring an owl, given to me by a client nearly 15 years ago. She was in her 80s and in failing health. Her death occurred after I stopped working with her. Unfailingly, my owl cup triggers positive memories of a woman who lived a full life and influenced my perspective on how to align my lifestyle with my values and priorities.

At the time I received the gift, I did not anticipate the enduring impact of this humble gift. As a clinical health psychologist, I see a substantial number of older adults in the context of coping with physical health problems. Often, the reason for seeking psychotherapy is the health problem itself but typically therapy becomes broader in scope.

The concept of “older adult” is subjective and goes beyond numerical age. However, it is less about chronological age than it is about the period where the person recognizes themselves to be at a later stage in life. Erik Erikson referred to it as the psychosocial stage of integrity vs. despair.

Many people are not particularly self-reflective and go to their death seemingly without having made effort to understand their life in any meaningful way. Seniors seeking psychotherapy may be the sort who are more apt to feel a need to think about and reflect on their life course.

Though it often feels that there is little that can surprise me any longer, I have been more astonished by some of the life experiences of patients from the “Silent Generation” compared to any other age cohort.

This generation was born between 1928 and 1945 with a childhood influenced by World War II. Clients born of this generation and now in or entering their 80s are endlessly fascinating to me. Their life experiences are marked by the dramatic cultural shifts that occurred between the 1950s and today.

Clients of this generation who have reflected on marriages marked by loss of a child, infidelity, domestic violence, self-sacrifice, alcohol abuse, or mental illness have often brought tears to my eyes.

Many years ago, I worked with a gentleman who was imminently dying of lung cancer. He spoke in an offhand way about his history of cigarette smoking. Almost to himself, he mused that his smoking was a “young man’s carelessness.” That such carelessness could have led to his death seemed to him to be absurd, yet it was important to him to find a way to accept it.

Patients often speak of things that they regret, such as the importance of maintaining physical health or taking greater advantage of times in life when health is not compromised. In so doing, they gently offer up free advice, gleaned over decades, motivated only by altruism.

Is it ever too late for psychotherapy? In my experience, the expectations of older people for therapy are realistic with goals such as gaining perspective or finding peace about aspects of their life on which they felt conflicted.

This generation appreciates the opportunity to meet face-to-face, having lived without the internet for most of their lives. I appreciate that my older clients are usually reliable in keeping appointments and conscientious about paying their bills. Do people from the Silent Generation have better manners than younger people or has there simply been a generational shift in what is considered proper etiquette? Or perhaps I simply have a positive bias?

Establishing rapport usually seems effortless with my older clients. Sometimes the patient remarks that all their health care providers are younger or compares me to their children in age. Rather than seeming to be judgmental, such observations come across with respect for the differences in perspective that we bring to the relationship.

Findings from the US Census, published in 2023, indicate that older adults from the Baby Boom generation had the fastest growth rate, 38% from 40.3 million to 55.8 million between 2010 and 2020. This growth rate is five times more rapid than the total population.

There is a clear need for mental health professionals to treat this growing demographic. Many of the Silent Generation are in their 80s, a cohort that is diminishing in size. As therapists, we should take advantage of the opportunity to learn from and be impacted by people older than ourselves.