Psychotherapy within old age psychiatry

Sir: Murphy (2000) looked at the provision of psychotherapy services for older adults by sending questionnaires to psychotherapy departments. She reported that respondents felt, largely on the basis of low referral numbers, that the needs of this group were not being met. The survey did not address the provision of psychotherapy within old age psychiatry departments. The NHS review of the psychotherapies (NHS Executive, 1996) highlighted the underrepresentation of older people and people with chronic illness and physical disabilities among those treated with psychotherapies. Garner (1999) has already argued that attitudes are slowly changing and she herself exemplifies the inclusion of psychoanalytic psychotherapy within old age psychiatry. Our own service includes a clinic offering systemic therapy to older adults and their families (Benbow & Marriott, 1997).

One possible criticism of psychotherapies within old age psychiatry is that older adults may be offered a second-rate service. This implies that therapists working in these areas are not properly trained, or supervised, or experienced. Might they, in fact, provide a better service? They combine psychotherapy training and expertise with understanding and practical expertise in the area of late-life mental health. This inclusive model may have other benefits, by facilitating referrals and incorporating psychotherapeutic understanding within the day-to-day work of an old age psychiatry service. We do indeed need to hold in mind the needs of older adults, as Murphy writes, but we should also recognise that needs can be met in different ways.