Are You Getting the Psychotherapy You Need?
Many older Americans don’t receive the right treatments to foster mental health
When my 90-year-old mother died of pneumonia in a distant city before I could get there, I was overwhelmed by a toxic mix of guilt as well as grief. Why hadn’t I, her only child, taken time off sooner from my oh-so-important career in New York to speed to her side in Honolulu? Ashamed of my selfishness, I had difficulty sleeping, eating properly or concentrating for weeks until a close friend suggested I might want to consult her therapist.
Although I was initially reluctant, fearing a costly lifetime habit straight out of a Woody Allen movie, I quickly warmed to this wise and funny clinical social worker. In two years of weekly sessions, she helped me pull myself out of depression, mend my tattered relationship with my father and develop coping strategies that I still use to deal with stress, many years later.
Mental Disorders Common
Like me, millions of Americans sometimes feel undone by their fears and emotions; the National Institute of Mental Health estimates that nearly one in five of us will experience significant anxiety, depression or other emotional disorders in a given year.
And while diagnosed anxiety and panic disorders tend to decline with age, depression is especially likely to strike younger boomers, ages 50 to 64, according to a recent analysis of federal data covering 46,000 adults. Published in the journal JAMA Internal Medicine, the study showed that the odds of someone in this age group screening positively for depression are almost twice as high as those of someone aged 18 to 34.
“Adults in their 50s and 60s often have to care for children as well as aging parents and their own declining physical health,” says lead researcher Dr. Mark Olfson, a professor of psychiatry at Columbia University’s College of Physicians and Surgeons. That can contribute to depression, he notes.
Most Don’t Seek Help
Many boomers confront a cannonade of depressing losses, as parents or spouses die, children grow up and jobs disappear due to layoffs or retirement. Yet only a surprising minority — 36 percent — of those who report depressive symptoms at this age seek any treatment, Olfson notes; just 25 percent of those over 65. The vast majority of those who do get help take antidepressants (often prescribed by their regular physicians), rather than undergo psychotherapy, also known as talk therapy.
But antidepressants can cause side effects, particularly for older patients who may take other medications. And they’re not always the best option.
Several studies show that psychotherapy alone can be highly effective for less severe depression when administered by licensed mental health specialists. These include psychiatrists (who are M.D.s and can prescribe psychoactive medications), psychologists (who have doctorates in psychology and often work with prescribing physicians), clinical social workers (who have at least a master’s degree in social work, psychology or a related field) and grief or family counselors or psychoanalysts with specialized educations.
For deep, clinical depression, research suggests that a combination of drugs and talk therapy is the gold standard.
“Medication alone doesn’t teach you anything,” says psychologist Ryan Howes, who practices in Pasadena, Calif. “You need to learn why you became anxious or depressed so you can work through it the next time.”
You Don’t Have to Be 'Crazy'
Why don’t more troubled people in this generation ask for professional help? Some resistance may be due to the same Woody Allen misconceptions that originally haunted me, plus the stigma that “therapy is only for crazy people,” says Howes.
And in a growing number of cases, the right psychotherapy can be costly and difficult to find. While Medicare will cover mental health treatments, a declining number of therapists will accept it. (And, of course, the patient must be 65 or older.) The same goes for private coverage. According to recent surveys, more than half of psychiatrists don’t accept private insurance, nor do a quarter of psychologists.
And when it comes to depression, there’s still widespread belief that you should snap out of it as soon as possible after a loss. But that is not reasonable.
“Americans are inexperienced at grief,” says Dianne Henry-Leggette, a grief counselor at Capital Caring, a nonprofit hospice in Falls Church, Va., that offers more than a year of bereavement counseling to families of the deceased. “We are taught to keep our emotional expressions of grief behind closed doors, to quickly get over our grief so we can get back to our productive lives.“
Heed the Warning Signs
When you do need professional assistance, there are usually plenty of warning signs. Experts at the American Psychological Association, the Mayo Clinic and the American Psychiatric Association cite these signals of depression and other disorders:
- Prolonged sense of helplessness, worthlessness and overwhelming sadness that don’t seem to improve as weeks go by
- Suicidal thoughts of any duration
- Unusual insomnia
- Difficulty carrying out everyday assignments and activities
- Significant weight gain or loss without dieting
- Changes in behavior: outbursts of temper, paralyzing anxiety, drinking and eating to excess
- Extreme fatigue and loss of energy
- Diminished interest in activities you once enjoyed
Apathy is a particular hallmark of clinical depression. “Someone who is grieving can still laugh at a joke or find other pockets of joy,” says psychologist Howes. “Someone who is depressed is down all the time.”
Finding the Right Fit
If you decide to turn to therapy, how can you find a good fit? As our mental health knowledge increases, treatment techniques have proliferated. But most tend to fall within two broad categories, which you’ll encounter as you search:
- Cognitive Behavioral Therapy (CBT), which aims to change unhealthy or troubling behavior by changing self-defeating patterns of thought. CBT tends to be shorter term and goal-oriented, may involve homework, and seems to be most helpful for breaking bad habits, dealing with anxiety and mild to moderate depression.
- Psychodynamic therapies try to identify the underlying causes of current symptoms. These may be somewhat longer term, with as many as three sessions per week for classic psychoanalysis. It is particularly helpful for understanding deep-seated relationship problems and phobias.
Start your search by asking for referrals from those who know you best: friends, family members, your physician or clergy.
Use an online treatment locator to identify local practitioners, such as the ones linked to ZIP codes at Psychology Today and GoodTherapy.org (which allows you to filter by insurance accepted). Check with your insurance provider for covered practitioners,and try listings at local medical schools, hospitals and medical associations.
Ask for an exploratory session to discuss how the therapist might handle your particular problem. And if you aren’t comfortable with that approach or attitude, try again. For the best results, the experts emphasize, therapy must be a collaborative process.