You Can't Treat Older People Without "Getting Old" Yourself: A Grounded Theory Analysis of Countertransference in Psychotherapy With Older Adults

• Published in: Professional psychology, research and practice research and practice, 2023-10, Vol.54 (5), p.352-360
• Main Authors: Lederman, Shai, Shefler, Gaby
• Format: Article
• Language: English
• Subjects: Aging; Countertransference; Death & dying; Death and Dying; Female; Geriatric Psychotherapy; Grounded theory; Human; Male; Older Adulthood; Older people; Parents; Psychotherapy; Therapists; Transference (Psychology)
• ISSN: 0735-7028; 1939-1323
• DOI: 10.1037/pro0000523

Therapists are expected to work therapeutically with increasing numbers of older adults due to the unprecedented global growth in older population. This work is considered emotionally challenging because it can evoke intense countertransference reactions in therapists. However, the field lacks empirically based practice recommendations on how to better identify and manage therapists' countertransference with older patients. This study explores therapists' experience of their countertransference in psychotherapy with older adults, using Hayes's (2004) structural model of countertransference as a guide. Semistructured interviews were conducted with 14 therapists and analyzed using grounded theory methodology. The findings are clustered around three themes: (a) unresolved conflicts related to therapists' own aging and death as well to their own parents are the sources of therapists' countertransference toward the older patient, (b) therapists' countertransference reactions are triggered inside therapy in response to the patients' health issues and the issue of death, and (c) countertransference is manifested as various affective and behavioral reactions to the older patient. Our findings indicate that therapists' unresolved issues related to the inevitable developmental phase of aging as well as to their own parents might be regarded as countertransference sources unique to psychotherapy with older adults. Our findings also demonstrate the wide range of emotional and behavioral countertransference manifestations in psychotherapy with older adults. Since effective management of countertransference is related to psychotherapy process and outcome, therapists should consider expanding their awareness of how countertransference origins are triggered and manifested in therapy with older adults, in order to engage in effective management strategies. Public Significance Statement The present study suggests that therapists' unresolved issues related to their own aging and death as well as to their own parents are the sources of therapists' countertransference toward the older patient. These issues are then manifested inside therapy in response to certain triggers in the form of various emotional and behavioral reactions. These findings highlight the importance of being aware of unique countertransference issues when working with older adults.