ABSTRACT
As a psychologist working with older people, I often carry out psychotherapy assessments and make decisions over the most appropriate interventions. For some clients, a straightforward approach using cognitive behavioural methods to cope with current issues may be the therapeutic choice, but for others there is a necessity to understand the meaning of symptoms and to acknowledge the roots of the problem that may emerge decades later, sometimes in response to other changes in a person’s life. For example two referrals for treatment of anxiety may reveal completely different reasons behind the overt symptoms. In the first instance a woman became anxious in response to physical symptoms arising from stress that led her to believe she was having a heart attack. In that situation education and stress management was the most helpful intervention. A man in his sixties presented with extreme anxiety, such that his wife would not leave him on his own for more than ten minutes for fear that ‘something would happen to him’. Anxiety management had been attempted but had made no impact on his symptoms. Assessment revealed that this man’s mother had been unable to cope with her fear of separation from her youngest son and in consequence he had stayed home from school on the slightest pretext. While he had coped during his adult life, ageing and health problems had resulted in the re-emergence of the anxiety of abandonment and it was with the psychodynamic understanding of CAT that we were together able to make sense of the meaning of his symptoms, and this allowed other changes to come about.
