Therapy and the older person: relaxing the stiff upper lip

Is that stiff upper lip really helping you? Or is it masking feelings of sadness, depression or anxiety which you are bottling up inside? But bottles under too much pressure can explode, just as repressed feelings can, often in unpredictable or inappropriate ways.

Stiff upper lips have been in the news again recently: GPs have been given guidance on spotting mental illness in people used to bottling up their feelings. And that guidance is based on research for the NHS which shows that almost half of those aged over 55 have experienced depression. Nearly as many had suffered from anxiety.

The popular assumption is that it is these older generations who traditionally have been most likely to soldier on without external help. The research suggested that ill-health, bereavement and money worries were the most common triggers for depression and anxiety in older people. But a considerable proportion of them did not know where to turn for support. Hence, the encouragement to the GPs to look out for the warning signs and to ask a few questions, including wondering whether there might be an emotional element to the physical symptoms which patients might be describing. And vice-versa: might a sudden change in mental state be an indication of an underlying physical illness?

But there is another angle to this issue of therapeutic support for older people. Recent research at Plymouth University, led by Professor Richard Byng, suggests that older people are least likely to be referred for talking therapies. This is despite the fact that they are more likely to benefit than younger groups in terms of recovery rates. And the older the patient, the less likely they were to get that referral. The Plymouth study also showed that, if they are referred, older people are more likely to turn up for their first appointment. Professor Byng too suggests that doctors should do more to discuss mental health problems with older patients so that they can be aware of the therapy options available to them.

As private therapists counselling in Hastings, Eastbourne or other parts of East Sussex, we have been aware of some apparent bias by the medical profession: there sometimes seems to be an assumption that older people are no longer able to benefit from talking therapies. That has not generally been our experience. Rather, we find that the test for successful therapy is whether the client is motivated for change and able to engage. That is not necessarily a function of age.

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