the losses associated with aging — such as bereavement or
the development of a chronic illness — may activate negative
age stereotypes, thereby generating unhelpful self-fulfilling
prophecies that may be harmful to the individual (Levy, 2009).
As a result, the older client may mistakenly attribute the cause
of his or her problems to aging rather than depression and
may become hopeless about the possibility for change. Unless
psychotherapists are able to recognize that these beliefs are
cognitive errors associated with the negative age stereotype,
progress in treatment may be impeded.
Depression and anxiety are major causes of mental health
problems in later life. However, while depression rates may
increase with age, rates of depression and anxiety in later life
are lower than rates reported for working-age adults (Blazer
& Hybels, 2005). Echoing this finding, Sadavoy (2009) found
that depression is surprisingly uncommon among older people
considering the challenges some face as they age. The Centers
for Disease Control and Prevention (2008) note that, contrary
to popular belief, older people do not report experiencing
frequent mental distress. In addition, their lifetime histories of
depression and anxiety are low ( 10. 5 percent and 7. 6 percent,
respectively) and lower than those reported for adults age 50 to
64 years ( 19. 3 percent and 12. 7 percent respectively).
Of course, medical conditions increase people’s chances of
being depressed later in life, with a greater burden of illness
resulting in an increased risk of depression (Alexopoulos, 2005).
The good news is that most older adults who develop physical
problems do not develop depression (Blazer & Hybels, 2005).
Nevertheless, medical illnesses complicate the recognition and
treatment of depression and anxiety (Krishnan et al., 2002). It is
estimated that 80 percent of older Americans have at least one
chronic health problem and up to 50 percent have two ( Wan et
al., 2005). As a consequence of demographic change, therapists
may be confronted with more medical issues with a complexity
and chronicity attached to them that is rarely seen currently.
Older people are also more likely to die because of non-communicable diseases, such as cancer, heart disease and stroke,
rather than injury or infection. Thus, older people may be more
likely to have lived with a number of chronic diseases for many
years before their eventual demise. This is another complicating
factor that psychologists may need to reconcile with new or
existing models of psychotherapy.
A model for optimal aging
Selective optimization with compensation (SOC) is a useful
model (or meta-theory) that promotes optimal aging in the
face of realistic challenges (Freund and Baltes, 1998). Research
suggests that using SOC as a life-management strategy may
buffer people against aging’s effects in later life (Jopp and Smith,
2006). In this model, selection (usually “loss-based selection”)
is a process in which people are encouraged to maintain their
highly valued roles and goals in the face of loss (Jopp & Smith,
on achieving goals through practicing or relearning activities. It
must be done in an intentional manner. Compensation requires
that people seek other ways of achieving the highest possible
level of functioning, thereby taking account of the reality of a
person’s capacity and physical integrity.
Baltes (1997) illustrates SOC in action when he cites the
example of the acclaimed pianist Arthur Rubinstein, who at
age 80 was interviewed about his skill. (Rubinstein retired
from performing at age 89 due to deteriorating eyesight.)
He attributed his enduring level of prowess to restricting
his repertoire (selection), which allowed him to practice
more frequently (optimization) and, “He suggested that to
counteract his loss in mechanical speed, he now used a kind
of impression management, such as introducing slower play
before fast segments, so as to make the latter appear faster”
(compensation) (Baltes, 1997, p. 371).
SOC can be incorporated into psychotherapy, especially
cognitive behavioral therapy (CBT), since its active self-
directed, problem-solving orientation fits well with an aim of
symptom reduction, enhanced resilience and positive affect.
The importance of support networks
Social capital is the amount of emotional and practical support
one can draw upon from families and friends — and viewed in
this way, social support is an outcome of social capital (Gray,
2009). Consistent with socioemotional selectivity theory, which
suggests that emotional regulation and emotional investment
in close relationships become more important as people age
(Carstensen, Isaacowitz, & Charles, 1999), people’s social
support networks may become smaller in size and diversity
as they age. This may be intentional as familial and other
emotionally nurturing relationships are preferentially selected
(Charles & Carstensen, 2009).
As a result, when psychologists work with depressed or
anxious older people, it may be important to assess whether their
accessible social capital has diminished.
In addition, as a result of people’s increased longevity,
psychologists should examine whether older couples’
relationships have become strained after retirement as they face
more years together. For many couples, retirement can require
a period of adjustment and it is more helpful to view this time
as a process rather than a state (Kim & Moen, 2002). Women
appear to find the adjustment more difficult as retirees and as
partners (van Solinge & Henken, 2005).
Further complicating relationships for older people is the
fact that families are becoming smaller and divorce rates, family
break-ups and reconstitutions are increasing, all of which affect
the potential pool of informal caregivers (Ajrouch et al., 2005).
When working with couples, the therapist is wise to remember
that quantity is not equivalent to quality when it comes to
relationships, and the longevity of a relationship does not mean
that the partnership is supportive and nurturing.