Working with older people and complex posttraumatic stress disorder: a review of the field and case study using schema therapy

Abstract

ABSTRACT Objective To demonstrate the utility of the diagnosis complex posttraumatic stress disorder to inform psychological practice with older people (>65); to examine the applicability of schema therapy in this context. Method Complex posttraumatic stress disorder is described and the literature on psychological interventions is reviewed. In the absence of literature specific to older people, evidence that psychological interventions are effective with older people presenting with posttraumatic stress disorder is presented. The literature on schema therapy as an intervention for posttraumatic stress disorder, and as an intervention with older people, is reviewed. A case study grounds the objectives in day-to-day practice. Results Older people present to services with complex posttraumatic stress disorder. The literature on psychological interventions for complex posttraumatic stress disorder consists of guidelines arrived at using consensus methods. There is no literature specific to older people. Schema therapy is consistent with the guidelines and there is evidence of its effectiveness with posttraumatic stress disorder. The literature suggests schema therapy is useful when working with older people, although there is no evidence that includes control conditions. Conclusion The objectives were met to the degree this was possible given the current literature and the limitations of the case study. KEY POINTS (1) Events occurring many decades ago can take a central role when making sense of problems presenting in later life. (2) Schema therapy fits with current guidelines on working with complex posttraumatic stress disorder. Research with control conditions is warranted to demonstrate effectiveness when working with older people presenting with this disorder. (3) There are significant gaps in the literature on complex posttraumatic stress disorder and older people.