Every Monday at 5pm for the last three months, I have been lying on the metaphorical couch and talking for 50 minutes all about me. Never mind that the couch has been replaced by an office chair, and rather than my therapist sitting silently out of sight behind me I am face-to-face with her on Zoom and she actually speaks when I pause for breath. My wonder at what I’m doing has less to do with 21st century technology than the fact I’m 71-years-old and a novice when it comes to this kind of thing.
I can imagine readers’ lips stiffening and their criticism rattling in my ears even as I write these words. Isn’t it a bit late for all this malarkey? If you’re not sorted by now, why do you think you ever will be? Aren’t we talking about pure self-indulgence here? All questions I’ve already asked myself.
But while I’ve lived a good life in many ways – with a successful career as an editor and writer, close family and friends, an adored son and loving relationships, I’ve also, in the past, experienced clinical depression, off-the-Richter scale anxiety and panic attacks. I continue to lead a good life but sometimes my head is too full of questions about meaning and purpose, and I need an outlet for this whirring activity. An outlet that doesn’t burden my partner or friends with what occupies the deep recesses of my mind. I am privileged to have the money to pay for private therapy and I’m prepared, right now, to see whether unpacking parts of my life, reflecting on the decisions I made, good and bad, and how I process my emotions, might benefit me now and in the years I have left. And perhaps help me face the future – to put it bluntly my old age– with the equanimity I aspire to.
According to Age UK, the charity dedicated to helping people make the most of later life, there is a woeful lack of focus on the mental health needs of older adults, and encouraging provision and access to talking therapies for the over-65s is one of their core objectives. There is evidence to show that psychological therapies are effective in treating late life depression and anxiety disorders. For young people, therapy today is widely accepted and openly discussed. But for my generation it has often been regarded as a last resort or outright dismissed.
While one of the issues is that older people do not often ask for support with mental health issues, another is that – when they do – they are more likely to be prescribed medication than the talking cure. A further barrier is that GPs often regard low mood and depression, which regularly exist alongside diseases of age such as Parkinson’s, as a natural part of ageing.
According to a recent report, based on age profile, the actual referral rate for NHS therapy in England for older people should be 12 per cent, yet it currently stands at 5.6 per cent. The NHS Talking Therapies report says that “older people, especially those with depression, are as likely to benefit from talking therapies as much as everyone else.” In addition, older people have been disproportionately impacted by the pandemic and are reporting much higher than normal levels of mental distress.
Going to therapy need not, of course, be related to the kind of mental health issues that require an official referral. Another later-life convert to talking therapy is Mandy Farthing*, 69, a recently retired solicitor, whose main aim in going to a psychotherapist is to get help in coming to terms with the difficult relationship she has with her mother, who is still alive and turned 100 earlier this year. “It’s not that I was ever opposed to therapy,” she says, “in fact I wanted to go, but was always so busy with work, kids, life, that I never prioritised myself. Now I’m retired and I can focus on myself a bit more.”
Mandy describes her childhood as challenging, with two brothers, one of whom was autistic, and parents who didn’t cope. She has spent her life listening to her mother, but has never felt any empathy coming from her and has never felt listened to. “From the earliest age, I had to mother my mother, and my brother, too, and now, although she still lives in her own flat, I am busy cooking for her, visiting, arranging carers and speaking to her twice a day, and she’s still very demanding.
“I know I can’t resolve the issues, or have the conversations with her I would have liked, but when she does die, I don’t want to be full of anger and resentment. And of course, despite everything, there’ll be a big hole when she goes.”
Mandy is finding therapy hugely helpful. “I have talked to good friends about some of this over the years. But this is different. A therapist is there for you and you alone and they’re doing it because they want to and it’s their job and they get paid for it, and you hope that they have the skills to facilitate the client to better understand themselves.”
According to the integrative psychotherapist Joanna Holroyd, one of the barriers for older people entering therapy, never having talked about themselves in a therapeutic capacity, is the fact of a lot of life having been lived. They feel daunted by questions such as: “Where do I start? What will happen when I start? Will it be overwhelming? What will it feel like after the session and between sessions? What will the therapist think of me? Will it be helpful? And while all these are understandable hurdles, which the client may want to discuss with the therapist, ultimately the most important aspect of any therapy will be the therapeutic relationship and whether you feel really comfortable talking to that person. You may need to try one or two therapists before you decide,” she advises.
Certainly I’ve faced all these issues. Sometimes I start a session saying I don’t know what to say, but soon I’m off at a gallop. It might be something about childhood, or it could be something that happened the previous day or a dispute with my partner which triggered a surprising emotion and which I want to explore. The therapist may reflect back what I say to her, and sometimes she highlights contradictions. I’m learning to acknowledge that we are contradictory by nature and it’s perfectly possible to love and hate at the same time, to be resentful and empathetic, confident and full of uncertainty. Accepting those contradictions is something I find particularly challenging. I’ve cried in therapy and I’ve laughed, too. Sometimes I exit the 50 minutes feeling stirred or shaken, sometimes soothed.
‘I was so angry about my wife’s affair’
For Steve Stanway*, 80, his entry into therapy came via a bereavement group. Six months after the death of his wife of 45 years, he was still struggling to cope. “I was leaving the house less and less, I was telling my kids not to visit because I wasn’t feeling up to it, I’d stopped painting in my little studio at the back of the house and I was existing on deliveries of rubbish frozen dinners. It was my daughter who insisted I attend a bereavement group and I was pretty reluctant. I’m ex-army and buttoned-up is, according to her, my middle name.”
The group was the beginning of a transformation for Stanway. “For the first session I barely said a word. Later on, though, I was able to share that I wasn’t just depressed, but angry. Angry at the wife of 45 years who confessed to me long ago that she’d had a lover for 25 years during our marriage and that when the love of her life emigrated to Australia, where his family originally came from, her life felt barely worth living. And yet for the last 10 years of our life, I was her carer.
“After she died, I kept thinking I’d wasted my life, I should have left her, but I didn’t share this with my kids because they loved their mum and I didn’t want to disillusion them. Sharing it with the group who had so many of their own stories to tell felt really humbling somehow. When my wife died, I didn’t cry. I did in the group. And when the group ended, I decided to do some private therapy. These days I paint, swim and socialise. Life is not as I would have liked, but it is still worth living.”
For Dr John Prentice, a consultant clinical psychologist whose PhD looked at older people (aged 66 to 91) with no previous mental health problems and how they presented their lives when first referred to mental health services, says the theme of “loss of significance” came out very strongly inhis interviews. “They all felt,” he says, “that theyounger generations avoided them because they were seen as old and irrelevant.”
The jury is still out for me on how much benefit I will get from therapy, but it’s proving an interesting journey. At times, I feel I’m just telling stories. At others, encouraged by my therapist, I feel full of emotions that I’ve bottled up for decades. I’ve spent most of my 71 years so busy ignoring those emotions that reflecting on my life has always taken the back seat. It was Socrates who said, “the unexamined life is not worth living,” and I’m finally up for examining mine.
