When the Body Intrudes: Psychotherapy with Older and Medically Ill Adults

  • Tamara McClintock Greenberg


In this extraordinary age of advances in medical technology, people live longer than any other time in history. As mental health clinicians, we are now treating a greater number of older and medically ill patients than ever before. These populations: aging adults, medically ill adults, and those who are both older and medically ill, are the subjects of this book. Aging and illness are not always mutually exclusive. Although aging does not necessarily imply the presence of illness, it is an independent risk factor in the development of disease. Additionally, bodily changes that accompany aging are inevitable, and as we age, we are all confronted with the limits of physical abilities. However, naturally occurring physiological effects of aging, emotional reactions to the aging process, and the impact of medical illness vary widely from person to person. Therefore, some sections of this book will address aspects of aging that are distinct from medical illness.

As psychodynamic clinicians, we are not only in the position to reduce the psychological distress that accompanies aging or illness, but we have the unique ability to make sense of the complicated and sometimes confusing emotional states that can result in response to bodily changes and limitations. Consider the following example:

Betty is a 79-year-old female who has no cognitive difficulties beyond what would be expected of someone her age. She is in good health, though her vision has declined slightly due to mild macular degeneration. She has no history of mental health problems. However, around the same time that her vision changed, she began having anxiety and depressive symptoms, and her primary care physician observed increasingly guarded behavior. Eventually, Betty began to suspect, and then complain that others were entering her apartment while she was gone, and stealing her furniture. She spent increasing amounts of time “checking” her furniture to make sure it was not missing. As it was evident that no one was really breaking into her apartment, she developed stories to explain how her furniture had been moved or stolen and then moved back to its original position.


Medical Patient Mental Health Treatment Medical Illness Mental Health Clinician Psychoanalytic Theory 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abraham, K. (1924). The applicability of psychoanalytic treatment to patients at an advancing age. In Selected papers on psychoanalysis (pp. 312–317). London: Hogarth Press.Google Scholar
  2. Aldwin, C. M., & Gilmer, D. F. (2004). Health, illness, and optimal aging: Biological and psychosocial perspectives. Thousand Oaks, CA: Sage.Google Scholar
  3. Alexander, F. (1950). Psychosomatic medicine. New York: Norton.Google Scholar
  4. Alexander, F., & French, T. M. (1946). Psychoanalytic therapy: Principals and Applications. New York: The Ronald Press Company.Google Scholar
  5. Boulanger, G. (2002). The cost of survival: Psychoanalysis and adult onset trauma. Contemporary Psychoanalysis, 38, 17–44.Google Scholar
  6. Bromberg, P. (1994). “Speak! That I may see you”: Some reflections of dissociation, reality, and psychoanalytic listening. Psychoanalytic Dialogues, 4, 517–547.CrossRefGoogle Scholar
  7. Cohler, B. J. (1998). Psychoanalysis and the life course: Development and intervention. In I. H. Nordhus, G. R. VandenBos, S. Berg, & P. Fromholt (Eds.) Clinical geropsychology (pp. 61–78). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  8. Culpepper, L. (2003). Use of algorithms to treat anxiety in primary care. Journal of Clinical Psychiatry, 64(Suppl. 2), 30–33.PubMedGoogle Scholar
  9. Davenhill, R. (2007). Looking into later life: A psychoanalytic approach to depression and dementia in old age. London: Karnac.Google Scholar
  10. Deutsch, F. (1939). The choice of organ in organ neurosis. International Journal of Psychoanalysis, 20, 252–262.Google Scholar
  11. DiMatteo, M. R., Lepper, H. S., & Crogan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment. Archives of Internal Medicine, 160(14) 2101–2107.PubMedCrossRefGoogle Scholar
  12. Duberstein, P. R., & Masling, J. M. (Eds.). (2000). Psychodynamic perspectives on sickness and health. Washington, DC: American Psychological Association.Google Scholar
  13. Dunbar, F. (1938). Psychoanalytic notes relating to syndromes of asthma and hay fever. Psychoanalytic Quarterly, 7, 25–68.Google Scholar
  14. Dunbar, F. (1943). Psychosomatic diagnosis. New York: Hoeber.Google Scholar
  15. Erikson, E. H. (1950). Childhood and society. New York: Norton.Google Scholar
  16. Fenichel, O. (1945). The psychoanalytic theory of neurosis. New York: Norton.Google Scholar
  17. Freud, S. (1905). On psychotherapy. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 7, pp. 265–268). London: Hogarth Press.Google Scholar
  18. Freud, S. (1961). The future of an illusion. In J. Strachey (Ed. & Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 21, pp. 3- 56). London: Hogarth Press. (Original work published 1927)Google Scholar
  19. Goldschmidt, O. (1986). A contribution of the subject of “psychic trauma” based on a course of a psychoanalytic short therapy. International Review of Psychoanalysis, 13, 181–199.Google Scholar
  20. Greenberg, T. M. (2007). The psychological impact of acute and chronic illness: A practical guide for primary care physicians. New York: Springer.CrossRefGoogle Scholar
  21. Haber, D. (2006). Life review: Implementation, theory, research and therapy. International Journal of Aging and Human Development, 63(2), 153–171.PubMedCrossRefGoogle Scholar
  22. Levant, R. F. (2004). The empirically validated treatments movement: A practitioner/educator perspective. Clinical Psychology: Science and Practice, 11(2), 219–224.CrossRefGoogle Scholar
  23. Muslin, H. L. (1992). The psychotherapy of the elderly self. New York: Brunner/Mazel.Google Scholar
  24. Nemiah, J. C. (1973). Psychology and psychosomatic illness: Reflections on theory and research methodology. Psychotherapy and Psychosomatics, 22, 106–111.PubMedCrossRefGoogle Scholar
  25. Paulley, J. W. (1991). Specificity revisited and updated. Psychotherapy and Psychosomatics, 55, 42–46.PubMedCrossRefGoogle Scholar
  26. Renik, O. (1998). Getting real in analysis. Psychoanalytic Quarterly, 67, 566–593.PubMedGoogle Scholar
  27. Settlage, C. F. (1996) Transcending old age: Creativity, development, and psychoanalysis in the life of a centarian. International Journal of Psychoanalysis, 77, 549–564.PubMedGoogle Scholar
  28. Sifneos, P. E. (1973). The prevalence of “alexithymic” characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2), 255–262.PubMedCrossRefGoogle Scholar
  29. Sobel, E. F. (1980). Countertransference issues with the later life patient. Contemporary Psychoanalysis, 16, 211–222.Google Scholar
  30. U.S. Department of Health and Human Services. (2006). Summary Health Statistics for U.S. Adults, National Health Interview Survey, 2005 (Series 10, No. 232). Hyattsville, MD: Author.Google Scholar
  31. Zackheim, L. (2007). Journal of Psychosomatic Research, 63, 345–347.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of PsychiatryUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations