Adapting Psychotherapy for Working With Older Adults
For individuals in the U.S. & U.S. territories
In Adapting Psychotherapy for Working With Older Adults, Dr. Bob G. Knight demonstrates his approach to adjusting therapy for working with this growing population. Most adaptations to therapy with older clients involve the nature of presenting problems typically brought in by older adults and the therapist–client relationship. Older adults face problems such as chronic illness, grief, and cognitive impairment at a much higher rate than younger clients. In addition, age differences between client and therapist and generational differences in acceptance of seeking help call for the need to make adaptations in approach.
In this session, Dr. Knight works with a woman in her 80s who suffered abuse throughout her life, first at the hands of her father as a child, and later, in her marriage to a verbally and emotionally abusive husband. Dr. Knight listens to the client as she recounts her life and together they gain insight into the emotional crux of her low self-esteem.
The Contextual Adult Life Span Theory for Adapting Psychotherapy (CALTAP) addresses the ways in which influences on adult development and aging affect the need to adapt psychotherapy approaches to work with older adults. Most of the changes are expected to occur in the presenting problem and in the therapist–client relationship. Developmental maturation brings about relatively small positive and negative changes in personality and emotions as well as in physical and cognitive abilities. Although not unique to later life, developmental processes and life circumstances also put older adults at greater risk for some of life's major challenges, such as chronic illness and disability, extreme frailty, grief, and caregiving responsibilities.
CALTAP posits that the need to adapt psychotherapies developed with younger adults arises more from the contextual influences on older adults including the sociohistorical and cultural experiences of an individual, which in turn interact with the immediate social ecological context. Together, they serve to shape and guide the main adaptations of therapy with older clients, particularly in regard to problem presentation and therapist–client communication. CALTAP is intended to be transtheoretical with regard to systems of psychotherapy and posits little to no change in the techniques of therapeutic change, but argues for changes in presenting problems and in the interactions between therapist and client.
In general, the model is useful when working with older adult clients. It is likely most useful when the older adult client differs from the therapist's typical younger client or when age-related or cohort-related issues arise in the therapy. As with any approach, care should be taken in working with persons with dementia to assure that the client is able to benefit from therapy
Bob G. Knight, PhD, received his doctorate from Indiana University in Bloomington in 1979, and is currently the Merle H. Bensinger professor of gerontology and professor of psychology and director of clinical training at the University of Southern California in Los Angeles. He has published extensively on the subjects of mental health and aging and is best known for Psychotherapy With Older Adults (3rd ed.), which has been translated into French, Dutch, Japanese, and Chinese. The book is used throughout the U.S. and internationally as a text.
Dr. Knight has served the American Psychological Association (APA) as president of Division 20 (Adult Development and Aging) from 2003 to 2004, chair of the APA Committee on Aging in 2001, and president of Section II, Division 12 (Society of Clinical Geropsychology) in 1997.
Dr. Knight's work has been recognized by being asked to give the the John Santos Lecture: Unique Aspects of Psychotherapy with Older Adults, at the national conference on Psychotherapy for Depression and Anxiety in Older Adults in Colorado Springs in 2005. He also received a commendation from the Los Angeles County Board of Supervisors for the community work of Los Angeles Caregiver Resource Center in 1996.
- Knight, B. G. (2004). Psychotherapy with older adults (3rd ed.). Thousand Oaks, CA: Sage Publications.
- Qualls, S. H., & Knight, B. G. (Eds.). (2006). Psychotherapy for depression in older adults. New York: Wiley.
- Laidlaw, K., & Knight, B. G. (Eds.). (in press). Handbook of emotional disorders in late life: Assessment and treatment. Oxford, England: Oxford University Press.
- Karel, M., Ogland-Hand, S., & Gatz, M. (1999). Assessing and treating late life depression: A casebook and resource guide. New York: Basic Books.
- Laidlaw, K., Thompson, L. W., Dick-Siskin, L., & Gallagher-Thompson, D. (2003). Cognitive behavior therapy with older people. Chichester, England: Wiley.
- Lichtenberg, P .A. (Ed.). (1999). Handbook of assessment in clinical gerontology. New York: Wiley.
- Scogin, F. (2000). The first session with seniors. San Francisco: Jossey Bass.
- Hinrichsen, G. A., & Clougherty, K. F. (2006). Interpersonal psychotherapy for depressed older adults. Washington, DC: American Psychological Association
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