Group Therapy With Older Adults: Psychotherapy, According To

Group Therapy with Older Adults Psychotherapy, according to Wheeler (2014), can be used to treat varying psychological disorders throughout the lifespan of an individual.

Psychotherapy tailored to older adults plays a crucial role in addressing diverse psychological challenges, including depression, anxiety, sleep disorders, personality disorders, substance use, and neurocognitive disorders. As Wheeler (2014) emphasizes, such therapy must be adapted to cater to the unique needs of this age group, taking into account common neurological deficits and comorbidities that may impede participation and benefit from therapy.

Group therapy offers older adults a platform for socialization with peers who share similar symptoms, fostering a sense of community, reducing feelings of isolation, and providing opportunities to develop altruism and empathy while feeling useful (Tavares & Barbosa, 2018). Many elderly individuals experience loss of relationships, diminished occupational roles, and declining capacities, which can perpetuate social withdrawal. Group therapy mitigates these issues by encouraging connection, mutual support, and shared understanding, which are vital for mental health and overall well-being in later life (Wheeler, 2010).

This paper describes a hypothetical group therapy session with older adults, analyzing its stage, potential issues, therapeutic modalities employed, and challenges encountered. The group comprises ten members aged between 64 and 80, with diverse diagnoses including depression, sleep and anxiety disorders, neurocognitive impairments, substance use disorders, and personality disorders. The participants range from hyperactive to withdrawn, representing various stages of group development: forming, storming, norming, performing, and adjourning. Notably, the group’s progression is irregular, with ongoing orientation and some members approaching termination, and others newly admitted.

The session duration was 60 minutes, scheduled from 10:30 to 11:30 am, and was intentionally modified to maximize effectiveness for older adults. Strategies incorporated included note-taking, memory aids, mnemonics, and organizing the session to encourage comfortable sharing and active participation (Tavares & Barbosa, 2018). The initial phase involved introductions, background sharing, and establishing rapport, crucial in geriatric group dynamics.

Issues and Challenges in the Session

Resistance was evident early in the session. One member, a 70-year-old male, expressed skepticism, citing historical attitudes towards emotional expression among men and skepticism about the relevance of therapy ("back in the day; people did not meet with each other to talk about everyday life hurdles; we dealt with it, that is what is expected of us as men"). Similarly, a 65-year-old female responded with denial and discomfort, asserting she was not "crazy" and should not be in the group. Her body language, including smiling and distancing herself, indicated discomfort and resistance to engagement. These reactions are common in older adults due to stigma, fear, or unfamiliarity with psychotherapy.

The heterogeneity of the group, including hyperactive and depressed members, presented management challenges. Hyperactive members tended to dominate conversations, monopolize interactions, and attempt to control the session, which heightened anxiety among quieter participants. Conversely, depressed individuals often withdrew further, feeling intimidated or irritated by the boisterousness, creating a tension-filled environment. Navigating these dynamics required careful moderation and empathic facilitation to ensure balanced participation.

Therapeutic Modalities and Techniques

Device utilization of Cognitive-Behavioral Therapy (CBT) is particularly effective with older adults in a group setting. CBT assists participants in recognizing and restructuring negative thought patterns, enhancing interpersonal skills, and managing symptoms of depression and anxiety (Secker et al., 2020). As a structured approach, CBT emphasizes collaborative goal setting, with therapy markers agreed upon by both clinician and patient, facilitating measurable progress (Domhardt & Baumeister, 2018).

In practice, CBT techniques included cognitive restructuring exercises, behavioral activation, and stress management strategies. The group engaged in activities designed to promote internal resources, foster adaptive coping, and encourage social interaction. For example, psychoeducation on cognitive distortions was delivered through large print materials, which accommodated sensory impairments common in the elderly (Wheeler, 2014). The therapist facilitated shared experiences, guided reflection, and reinforced progress, which bolstered confidence and resilience among participants.

Challenges and Adaptations

Working with older adults imposed several logistical and clinical challenges. The COVID-19 pandemic mandated social distancing, requiring larger spacing between seats, which reduced intimacy and hindered spontaneous interaction. Some members exhibited intrusive behaviors and poor boundaries, complicating session management. Physical impairments, such as hearing loss, poor eyesight, and cognitive decline, necessitated adaptations. For hearing impairments, louder speech, clearer articulation, and visual aids were employed; for visual impairments, large print worksheets facilitated participation. Cognitive deficits prolonged some stages of group development, particularly the forming and storming phases, affecting group cohesion and progress.

Another challenge was accommodating the emotional and cognitive variability among participants, which impacted their ability to engage fully in therapeutic exercises. The dynamic nature of the group, with ongoing admissions and discharges, created instability that complicated the therapeutic process. Despite these challenges, the importance of flexibility, patience, and tailored interventions proved essential in optimizing outcomes for geriatric populations.

Conclusion

Group therapy, particularly when utilizing evidence-based techniques such as CBT, offers significant benefits to older adults facing psychological disorders. It promotes social connectedness, reduces isolation, and enhances coping skills. However, therapists must remain cognizant of the unique challenges posed by age-related physical, cognitive, and social issues, and adapt their approaches accordingly. Early diagnosis and intervention are critical for maximizing therapeutic efficacy and improving the mental health trajectory of elderly individuals. As Wheeler (2014) asserts, mental health practitioners must develop specialized competencies and implement flexible, patient-centered strategies to serve this growing demographic effectively.

References

• Domhardt, M., & Baumeister, H. (2018). Psychotherapy of adjustment disorders: Current state and future directions. The World Journal of Biological Psychiatry, 19(sup1), S21-S35.
• Secker, D. L., Kazantzis, N., & Pachana, N. A. (2020). Cognitive behavior therapy for older adults: Practical guidelines for adapting therapy structure. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 22(2), 93-109.
• Tavares, L. R., & Barbosa, M. R. (2018). Efficacy of group psychotherapy for geriatric depression: A systematic review. Archives of Gerontology and Geriatrics, 78, 71-80.
• Wheeler, K. (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company.
• Hummel, J., Weisbrod, C., Boesch, L., Himpler, K., Hauer, K., Hautzinger, M., & Dutzi, I. (2017). AIDE–acute illness and depression in elderly patients. Cognitive-behavioral group psychotherapy in geriatric patients with comorbid depression: A randomized, controlled trial. Journal of the American Medical Directors Association, 18(4), 312-322.