In the past, aging excluded the elderly from the benefits of psychotherapy. Today, this form of discrimination is no longer present in the literature nor in practice. According to the literature of the last twenty years, cognitive psychotherapy has been very useful for treating geriatric depression. Recently, clinicians have worked out manuals in order to encourage therapists to offer psychotherapy to this population. Moreover, recent research has explored the possibility of applying CT to demented people in the early stages suffering from depression. This presentation will underline the necessity to integrate different aspects (i.e. developmental and psychopathological) of the work with the elderly, in order to maximize the efficacy of the psychological intervention. We will give some clinical examples of this adaptation.
The first one shows how we have developed a group cognitive psychotherapy for the treatment of depressed young old patients, which we called Cognitive Therapy enriched with Decentering Strategies (CTDS). Decentration, commonly augmented in late life, could be defined as a mechanism in which one distances oneself from one's own automatic thoughts, searches for new alternative ways of thinking and departs from the egocentric position. We will discuss the process by which we build decentering strategies with the patients and we will show some data.
The second example discusses the opportunity of offering cognitive psychotherapy to older depressive people suffering from early dementia. Depression is present in 20-30% of patients affected by Senile Dementia. If one wants to suggest a cognitive therapy to depressed early demented geriatric patients, it is essential to assess a) the ability of setting up a connection between cognition and emotion, b) the way the patient can access and verbalize his own emotional experience and c) what strategies are indicated to compensate cognitive and emotional impairments. We will illustrate this topic by clinical material.
The third example addresses another important topic for the psychotherapist working with the depressed elderly, which implies the distinction between young old (aged from 60 to 80 years) and the oldest old (aged more than 85 year). Cohort-based, developmental and contextual reasons are here suggested to modify the standard cognitive therapy with this special population. Integrative life review and narrative approach combined with cognitive schema approach seems a well adapted psychological intervention for depressed old old patients. We will illustrate this last example by a clinical case.
Finally, our experience in treating late-life depression allows us to observe, if we introduce some specific accommodation, similar effectiveness to a treatment of depression in other periods of life. These observations lead us to suggest, in the field where we are actually working (prevention of depressive relapse), to that we pay a particular attention to the characteristics of the lifelong depressive course.
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