Psychotherapy with older adults in primary care medical settings

Abstract

˜Whereas many older adults are hesitant to seek psychotherapy in traditional mental health settings, primary care medical settings offer many advantages in reaching underserved elderly clients with a variety of mental disorders. The present article reviews the growing importance of primary care in our health care system and as a setting to reach clients in need of psychotherapy; important issues for psychotherapists interested in practicing in primary care medical settings; and special issues in treating older adults in primary care. Case studies illustrate varied approaches to psychotherapy with older adults and their families in primary care, with such problems as depression, alcohol abuse, and dementia. Adaptations to conventional psychotherapy necessitated by the primary care setting are highlighted. © 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 991‐1004, 1999. A growing literature has documented the effectiveness of psychotherapy with older adults. In general, older clients respond as well to psychotherapy as younger individuals. However, a recurring concern in the literature has been that older adults rarely present to traditional mental health settings. Rather, older adults present their psychological problems predominantly in medical settings (Haley, 1996). This is of great concern because most physicians have not been adequately trained to assess or treat mental disorders, and with the increasing time pressures to treat clients quickly, psychological problems are rarely treated effectively in medical settings (Callahan, Hendrie, Dittus, Brater, Hui, & Tierney, 1994; Higgins,1994; Kroenke & Mangelsdorff, 1989). The present article will review reasons that the primary care medical setting is an underutilized setting but one with many advantages in accessing and treating older adults with mental disorders. In addition, unique characteristics of primary care, and special