Are Older Adults Unique? Examining Presenting Issues and Changes in Therapy Across the Life Span

Abstract

With the urgent need to increase and improve mental health care of the growing population of older adults in the United States, clinical research is warranted to further the knowledge and improve the relevant training for mental health professionals working with older adults. This study drew from two diverse clinical samples of adults ages 18 years to 80 years to examine whether and how initial clinical presentations and changes over time in individual, family-of-origin, and relational measures differed across the life span. Results indicated a variety of linear and curvilinear associations between individual, family-of-origin, and relational measures at intake and age, with some moderation by gender. There were no significant results between the amount of change on those measures and age, indicating that older adults may change in similar fashion to middle-aged and younger adults in psychotherapy. Relevant clinical implications are provided.

Keywords

mental health intervention ageism

Over the last several decades, the proportion of older adults in the U.S. population has grown substantially and is expected to continue to do so (U.S. Census Bureau, 2014). Major implications for society arise from this reshaping of the population, especially as approximately 20% of older adults have been diagnosed with a mental health disorder (Bartels, 2003; U.S. Surgeon General, 1999). One implication is that there will be greater responsibility for mental health care providers to work with older adults (Karel, Gatz, & Smyer, 2012; Laidlaw & Pachana, 2009). Although caring for physical health is usually the emphasis for aging generations, mental health care may be just as relevant for their well-being (Jeste et al., 2013). Unfortunately, many mental health providers lack training about aging issues relevant to psychotherapy and those who are trained still often feel unprepared (Bryant & Koder, 2015; Yorgason, Miller, & White, 2009). As many experts have argued the need for specific knowledge about the clinical treatment of older adults (Karel et al., 2012; Karlin, 2011), psychotherapists would benefit from additional clinical knowledge regarding the uniqueness of older adults in therapy.

Older Adults in Therapy

Given older adults’ distinct developmental challenges (Blazer, 2003; Carstensen, Isaacowitz, & Charles, 1999; De Ridder, Geenen, Kuijer, & van Middendorp, 2008; Fiske, Wetherell, & Gatz, 2009), they are considered a special population in terms of mental health and psychotherapy treatment (American Psychological Association [APA], 2014; Molilnari et al., 2003). Fortunately, there has been a recent swell in research about older adults’ mental health. This comes at an opportune time as the need for mental health services for older adults is growing and expected to continue (Karel et al., 2012). Accordingly, the APA (2014) has published “Guidelines for Psychological Practice With Older Adults” to describe best practices for psychotherapy with older adults.

Experts have specifically discussed that established therapeutic approaches ought to be amended to fit older adults’ developmental stage and relevant needs (Kennedy & Tannenbaum, 2000; Knight & Poon, 2008; Molilnari et al., 2003). The majority of these age-related adjustments to psychotherapeutic approaches have been based on theories of aging and relevant research on older adulthood in general rather than clinical data (Knight & McCallum, 2011). Thus, questions remain about age-related adjustments for psychotherapeutic treatment (Laidlaw & Pachana, 2009). In particular, it is unknown whether older adults initially present in symptomatically unique ways (e.g., varying levels of depression, relationship satisfaction) or if they change in distinct ways over the course of therapy compared with younger adults. This knowledge may aid mental health professionals in understanding how older adults uniquely present in therapy or in reassuring them that working with this population may not be significantly different from working with other age groups.

The lack of clinical data on older adults is somewhat understandable given that there are relatively fewer older adults in psychotherapy and even fewer psychotherapists specializing in older adulthood issues (Klap, Unroe, & Unützer, 2003). The low proportion of older adults in therapy may be a consequence of therapy being more heavily stigmatized for this group (Berger & Spira, 2016; Conner et al., 2010). Older adults may be less likely to seek out mental health services because many clinicians do not feel comfortable treating them (F. B. Friedman & Goldbaum, 2016; Klap et al., 2003). Explanations for this trend among therapists have been offered and include a lack of training, lack of interest, discomfort with aging issues, and ageism.

Although ageism includes a variety of negative beliefs, one of the most damaging for psychotherapy is that older adults are too old to change (Laidlaw & Baikie, 2007). Mental health professionals and older adults themselves may believe that older adults do not have the desire to change (e.g., they are stubborn and grumpy), the ability to change (e.g., their cognitive functioning is too diminished), or they are not worth the effort (e.g., they are close to death; Lee, Volans, & Gregory, 2003). Although literature supports the effectiveness of psychotherapy with older adults, myths and misconceptions persist, perhaps due to a lack of education and experience (Yorgason et al., 2009). Whatever form ageism may take among psychotherapists, it has the potential to bias the treatment that older adults receive, adding to the need for further research, education, and training.

Current Study

Although mental health care for older adults has improved, many psychotherapists feel less comfortable treating this population, leaving a need for continued advancement of quality of care (Bartels, 2003). Clinical research examining how older adults may commonly present for therapy and how their individual and relational symptoms change over time would be valuable to potentially increase confidence in working with older adults. Although individual clinical presentations are important (Laidlaw & Pachana, 2009), clinicians might feel more prepared at the outset of treatment if they understood the links between old age and individual and relational functioning. At the same time, some researchers propose that age may be less predictive of the uniqueness of older adults than cohort experiences and other contextual factors (Knight, 1999; Laidlaw & Pachana, 2009). Clinical training may be more empirically informed by considering whether initial assessments and/or the amount of change over time in treatment differ across the adult life span.

Thus, we sought to answer the following research questions:

Research Question 1: How do initial clinical presentations on individual, family-of-origin, and relational self-report measures differ across the adult life span?

Research Question 2: How does change over the course of treatment on those measures differ across the adult life span?

Consequently, we conducted a set of regression analyses using two samples from a large not-for-profit mental health organization and examined initial clinical presentation and amount of change over time as predicted by age. The first sample included only initial assessments, whereas the second sample included both pre- and postassessments to examine change scores. Recognizing that gender also plays a role in aging experiences (Laidlaw & Pachana, 2009), we also tested for moderation by gender across all measures.

Method

Sample Participants

The first sample included 1,834 adults who received psychotherapy at a large not-for-profit outpatient mental health organization in the Midwest. The second sample (independent of the first) consisted of 744 adults who received psychotherapy at the same organization and who participated in a randomized clinical trial (RCT) for the systemic therapy inventory of change (STIC). Participants characteristics of both samples are described in Table 1.

Table 1.

Sample Demographics.

	Sample 1	Sample 2
n	1,834	744
Age (years)
M	33.96	37.69
SD	9.72	13.03
Range	18-72	18-80
Gender
Female	60%	64%
Male	40%	36%
Transmale/-female	<1%	<1%
Sexual identity
Heterosexual/straight	86.6%	89.1%
Gay/lesbian	5.6%	5%
Bisexual	7%	5.9%
Race/ethnicity
White	64.8%	75.5%
Hispanic	44.7%	15.6%
Black/African American	20%	15.5%
Asian (e.g., Chinese, Japanese, Korean)	7.6%	1.5%
American Indian/Alaskan Native	3%	2%
Other	11.1%	10.6%
Education
Bachelor’s or advanced degree (e.g., MS, PhD)	64%	65.9%
Some college	20.1%	15.6%
Associate’s degree	6.1%	3.8%
Technical school degree	2.3%	2.2%
High school diploma/GED	6.2%	9.8%
Less than high school/GED	1.3%	2.8%
Income
Below $10,000	11.7%	11.2%
$10,000-$20,000	16.4%	10.8%
$21,000-$40,000	25%	15%
$41,000-$60,000	13.7%	13%
$61,000-$100,000	11.6%	16.4%
$101,000-$150,000	7.5%	13.3%
$151,000-$200,000	4.4%	5.4%
Above $200,000	8%	13.3%
Relationship status
Married	36.4%	38.7%
Serious relationship (e.g., dating, committed, engaged)	43%	31.5%
Not in a committed relationship	15.3%	21.9%
Widowed, separated, or divorced	4.8%	7.8%
Therapy modality
Individual	50.2%	70.7%
Couple	49.8%	24.5%
Family	NA	4.8%

Sample 1 Procedure

Therapists trained to use the STIC (Pinsof et al., 2009) invited clients to complete the STIC assessment tool as a part of treatment. Clients were requested to complete the STIC initial, an assessment capturing individual, family-of-origin, and relational variables at initial clinical presentation, prior to beginning treatment.

Sample 2 Procedure

The purpose of the STIC RCT was to determine if use of the STIC feedback system (Pinsof, Goldsmith, & Latta, 2012) over the course of therapy improved outcomes. Adults who were already seeking therapy were recruited by participating therapist invitations or through an online advertisement. Clients who agreed to participate completed the STIC initial online prior to their first therapy session and were randomly assigned to either the STIC condition or treatment-as-usual condition. Clients in the STIC condition completed weekly STIC measures online prior to therapy sessions and received regular feedback from the therapist on their self-reported progress from the STIC measures. All clients were asked to complete a termination package online identical to the STIC initial upon completion/termination of therapy. Clients were compensated for completing the questionnaires ($20 for individuals, $50 for couples for the initial questionnaires; $90 each for the termination questionnaires).

Measures

STIC

It is a multisystemic and multidimentional client-report questionnaire separated into six distinct scales, designed as a diagnostic tool to assess initial reports and changes in clinical problems within the client system over the course of psychotherapy (Pinsof et al., 2012; Pinsof et al., 2009). The STIC is divided into six clinical scales that contain items rated on a 5-point Likert-type-scale ranging from (1) never to (5) all of the time.

The six clinical scales address six dimensions of the client’s life: individual problems and strengths, family of origin (FOO), relationship with partner (RWP), family/household, child problems and strengths, and relationship with child. The three that were included for this study were (a) The individual problems and strengths (IPS) scale, to assess individual mental well-being and functioning. The IPS consists of 22 items that comprise eight subscales including negative affect, disinhibition, life functioning, open expression, flexibility/resilience, self-misunderstanding, substance abuse, and self-acceptance. Sample items include “How easy is it for you generally to overcome difficulties,” and “I can speak up for myself when the situation calls for it.” (b) The FOO scale is used to examine clients’ familial life/structure in the family in which they were raised. The FOO consists of 22 items that comprise six subscales including mutuality of expectations, positivity, abuse, intrusiveness, negativity, and substance abuse. Sample questions include “I knew the right thing to do in my family” and “My family was too much in my business.” (c) The RWP scale measures the client’s relationship with a partner in a committed relationship and consists of 24 items that comprise 7 subscales including commitment, partner positivity, sexual satisfaction, trust, anger/inequity, physical abuse, and substance abuse. Sample items include “We enjoy doing things together” and “I am filled with anger toward my partner.” The other three scales (i.e., family/household, child problems and strengths, and relationship with child) were not included in this study given the relatively low frequency of family therapy in the samples. The STIC has been found to be reliable and valid, with each scale being concurrently valid with comparable measures such as the Beck Depression Inventory and the Revised Dyadic Adjustment Scale (Pinsof et al., 2009; Pinsof et al., 2015; Zinbarg et al., 2018). In this sample, the total scales and the majority of subscales indicated good reliability, with the exception of IPS substance abuse (.43) and RWP substance abuse (.31), which is consistent with previous studies (Pinsof et al., 2015).

Results

Preliminary Analyses

We first examined bivariate associations between age and each of our variables of interest in both samples. In both samples, age was significantly correlated with the majority of the STIC scales, with correlation coefficients ranging from .05 to .21. Age was not correlated with FOO positivity, FOO abuse, FOO substance abuse, RWP trust, and RWP substance abuse. Age was uncorrelated with change over time across all STIC scales in Sample 2.

Sample 1—Regressions With STIC Initial

Using Sample 1, we first tested for linear relationships between age and each STIC initial scale. We report those linear relationships here only if there was not a significant curvilinear relationship between age and the STIC initial scale that was tested subsequently. Linear regression results are presented in Table 2 and curvilinear regression results are in Table 3. The STIC scales with significant positive linear relationships with age included FOO total, IPS flexibility/resilience, IPS life functioning, and FOO mutual expectations. For these scales, older adults would generally have better family-of-origin total scores, individual flexibility/resilience, individual life functioning, and mutual expectations in the FOO at initial clinical presentation than those younger than them, although the amount of predicted variance was small. Scales with significant negative linear relationships with age included IPS disinhibition, IPS substance abuse, and RWP physical abuse. For these three scales, older adults would generally have lower individual disinhibition, individual substance abuse, and partner physical abuse at initial clinical presentation than younger aged adults. The amount of variance predicted was again small. Moreover, none of these relationships were moderated by gender. In sum, for all linear relationships, both male and female older adults were clinically “better” than those younger than them.

Table 2.

Significant Stepwise Regressions With Age Predicting STIC Scales.

STIC scale	β age	R ²
Positive linear
IPS total	.009 (.166)	.027
FOO total	.004 (.05)	.002
IPS flexibility/resilience	.009 (.116)	.014
IPS life functioning	.009 (.095)	.009
IPS open expression	.007 (.072)	.005
IPS self-acceptance	.01 (.107)	.012
FOO mutual expectations	.007 (.074)	.005
RWP anger/inequity	.01 (.117)	.014
Negative linear
RWP total	−.011 (–.17)	.029
IPS disinhibition	−.007 (–.117)	.014
IPS negative affect	−.01 (–.122)	.015
IPS self-misunderstanding	−.016 (–.182)	.033
IPS substance abuse	−.009 (–.126)	.016
FOO intrusion	−.016 (–.145)	.021
FOO negativity	−.008 (–.078)	.006
RWP commitment	−.007 (–.078)	.006
RWP partner positivity	−.017 (–.21)	.044
RWP sexual satisfaction	−.026 (–.205)	.042
RWP physical abuse	−.004 (–.085)	.007

Note. Standardized coefficients in parentheses. STIC = systemic therapy inventory of change; IPS = individual problems and strengths; FOO = family of origin; RWP = relationship with partner.

Table 3.

Significant Stepwise Regressions With Age and Age² Predicting STIC Scales.

STIC scale	β age	Delta R²	β age²	Delta R²	Point of inflection
Predominantly positive, concave downward curvilinear
IPS total	.027 (.477)	.028	−.0002 (–.314)	.003	59.70
IPS open expression	.040 (.433)	.006	−.0004 (–.363)	.004	46.84
IPS self-acceptance	.040 (.421)	.011	−.0004 (–.319)	.003	51.88
RWP anger/inequity	.059 (.679)	.014	−.0006 (–.570)	.008	47.30
RWP substance abuse	.041 (.523)	.000	−.0005 (–.535)	.007	38.83
Predominantly negative, concave upward curvilinear
RWP total	−.066 (–1.00)	.029	.0007 (.840)	.018	47.22
IPS negative affect	−.035 (–.427)	.015	.0003 (.309)	.003	54.19
IPS self-misunderstanding	−.060 (–.669)	.034	.0006 (.490)	.007	53.53
FOO intrusion	−.062 (–.556)	.021	.0006 (.416)	.005	52.69
FOO negativity	−.041 (–.400)	.006	.0004 (.326)	.003	48.30
RWP commitment	−.043 (–.446)	.006	.0004 (.373)	.004	47.47
RWP partner positivity	−.086 (–1.04)	.044	.0009 (.837)	.018	49.45
RWP sexual satisfaction	−.116 (–.924)	.042	.0011 (.729)	.014	50.30
RWP trust	−.057 (–.509)	.003	.0007 (.463)	.006	43.61

Note. Standardized coefficients in parentheses. STIC = systemic therapy inventory of change; IPS = individual problems and strengths; RWP = relationship with partner; FOO = family of origin.

p < .05. **p < .01.

Next, all STIC scales were tested for curvilinear relationships with age. Those scales that had predominantly positive, concave downward curves were IPS total, IPS open expression, IPS self-acceptance (Figure 1), RWP anger/inequity, and RWP substance abuse. These curves indicate that the relationship between age and the relevant scale goes from positive to negative over increasing age. Points of inflection for each of these scales (i.e., the age at which the statistical association changes from positive to negative) were 59.7 for IPS total, 46.84 for IPS open expression, 51.88 for IPS self-acceptance, 47.3 for RWP anger/inequity, and 38.83 for RWP substance abuse. For all these scales, older adults fall beyond the point of inflection indicating that the relationship between the STIC scales and age is negative for older adults whereas the relationship between the STIC scales and age is positive for most others. For example, from age 18 years to 52 years, adults coming into therapy will generally have greater self-acceptance the older they are, whereas adults aged 52 years and above will generally have less self-acceptance the older they are; self-acceptance peaks at the age of 52 years.

Figure 1.

Estimated curvilinear regression model of IPS self-acceptance by age.

Total scales and subscales that had predominantly negative, concave upward curves included RWP total (Figure 2), IPS negative affect, IPS self-misunderstanding, FOO intrusion, FOO negativity, RWP commitment, RWP partner positivity, RWP sexual satisfaction, and RWP trust. These curves indicate that the relationship between age and the relevant scale goes from negative to positive over increasing age. Points of inflection (i.e., the age at which the statistical association changes from negative to positive) were 47.22 for RWP total (Figure 2), 54.19 for IPS negative affect, 53.53 for IPS self-misunderstanding, 52.69 for FOO intrusion, 48.30 for FOO negativity, 47.47 for RWP commitment, 49.15 for RWP partner positivity, 50.30 for RWP sexual satisfaction, and 43.61 for RWP trust. Older adults again fall beyond the points of inflection for each scale, indicating that the relationship between each scale and age is positive, compared with most younger others with the relationship being negative. For example, for adults aged 18 years to 47 years, being older equates to a generally poorer RWP, whereas adults older than 47 years will generally have more positive partner relationships with age; RWP is at the lowest at age of 47 years.

Figure 2.

Estimated curvilinear regression model of RWP total by age.

One of the significant curvilinear associations suggested moderation by gender, namely, RWP partner positivity (Figure 3). The slopes in the curvilinear relationship for females are slightly steeper than for males, indicating that females’ ratings of their partner’s positivity are more variable by age than males’ ratings. Finally, the three scales that were not significantly associated with age included FOO positivity, FOO abuse, and FOO substance abuse.

Figure 3.

Estimated curvilinear regression model of RWP partner positivity by age, moderated by gender.

Sample 2—Regressions With STIC Change Over Time

Equivalent analyses, testing linear and then curvilinear relationships, were conducted using the amount of change on each STIC scale between initial assessment and termination using Sample 2. Regression analyses indicated no significant linear or curvilinear relationships between age and the amount of change over time across all STIC individual and relational scales and subscales. Effect sizes of the regression analyses were quite small—all R² were less than .013. In sum, age was not significantly related to how much change an adult reported on all measures from before treatment to termination. In addition, testing gender as a moderator of potential associations between age and the amount of change on the STIC individual and relational measures did not reveal any significant results.

Discussion

Given the growing need for clinicians to provide effective mental health services for aging individuals, these results highlight the importance of taking a developmental approach in the assessment and treatment of older adults in therapy. In this study, we found that age was related to a variety of self-reported individual, family-of-origin, and relationship characteristics for adults presenting for therapy, indicating that older adults differ from those of younger ages on many key therapeutic issues. Second, we found age was not significantly related to the amount of change over time across all individual and relational measures, thus failing to support the notion that older adults differ from younger adults in their rates of clinical change.

How Older Adults Uniquely Present to Therapy

Older adults appear to differ from others in initial clinical presentation in many ways. Our findings suggest that prior to starting therapy, older adults almost uniformly enjoyed advantages not seen at younger ages. At initial consultation, the older the client, the less likely that client reports abuse and the more likely they report greater flexibility and resilience, and have positive perceptions of their FOO. Carstensen et al.’s (1999) socioemotional selectivity theory explains that as we age, we strategically act to increase social and emotional gains. As people feel their lives drawing to a close, they gradually shift their attention away from dramatic and problematic relationships and give more attention to the positive aspects of their emotional and social lives. Consistent with the tenets of socioemotional selectivity theory, being older may result in additional perspective regarding a family-of-origin issue, and an individual turning attention away from negative aspects of those early relationships to prioritize and benefit from more positive ones.

The nonlinear results exemplified the intricacies of age as it relates to many personal and relational outcomes. For example, from the age of 18 years to 52 years, adults coming into therapy generally reported greater self-acceptance the older they were, whereas adults aged 52 years and above reported less self-acceptance with increasing age. For adult clients, self-acceptance peaked at the age of 52 years, which is noteworthy given the existing links between self-compassion (i.e., self-acceptance) and more adaptive psychological functioning (Neff, Kirkpatrick, & Rude, 2007). Similarly, RWP anger/inequity tended to increase from 18 years to 47 years and decrease thereafter. This is relevant for providers working with middle-age clients as intense emotional expression may be normalized during this life stage when “sandwich generation” (i.e., caring for aging parents and caring for one’s own children) couples often find themselves dealing with numerous external stressors (E. Friedman, Park, & Wiemers, 2017). Moreover, clinicians may observe lower presenting levels of anger among older adults due to maximizing positivity and overlooking minute annoyances that previously occupied their attention (Jensen & Rauer, 2015).

Alternatively, certain variables of interest decreased over time before hitting a point of inflection and then increased with age. Overall relationship quality with partner decreased until the age of 47 years, at which time the association changed from negative to positive, suggesting that after the age of 47 years, relationship quality with partner increases with age. Clinicians working with older couples may initially notice that levels of relationship quality are higher among older couples. Other variables that change similarly after a point of inflection were IPS negative affect, IPS self-misunderstanding, FOO intrusion, FOO negativity, RWP commitment, RWP partner positivity, RWP sexual satisfaction, and RWP trust. The increase in sexual satisfaction with age after 50 years is consistent with the work of Heiman and colleagues (2011), who examined sexual satisfaction among older couples from Brazil, Germany, Japan, Spain, and the United States. Although men’s satisfaction appeared to increase linearly with age, women’s sexual satisfaction initially decreased over time early in the relationship, then began increasing again after approximately 25 years with their partners. Heiman and colleagues asserted that women may experience an increase in sexual satisfaction after the age of 50 years due to fewer distractions with parenting and freedom from reproductive worries accompanying menopause.

Older Adults Do Not Change Differently Than Their Younger Counterparts

Whereas older adults may present to therapy differently than younger adults, our analyses suggested there were no significant relationships between age and the amount of change in treatment across all STIC individual, family-of-origin, and relational scales. The false belief that older adults tend to be more psychologically or emotionally stubborn in therapy has no empirical or theoretical backing insofar as we can tell. On the contrary, clinical researchers have suggested that psychotherapy has been effective with older adults, resulting in reliable and positive improvement over time and decreasing symptomatology (Intrieri, 2016; Roseborough, Luptak, McLeod, & Bradshaw, 2013). Hence, older adults may be unique in some ways, but their ability to change and positively adapt in therapy does not appear to be one of them.

Clinical Implications

These results have important implications for clinicians. Mental health providers should increase their knowledge regarding the unique presentation and treatment of older adults, while avoiding inaccurate biases (e.g., older adults are less able to change). Although there can often be generational differences between clinician and client, age alone may be less helpful than an understanding of differing social, cultural, and technological advances across generations (Laidlaw & Pachana, 2009). For example, expectations and options for women (i.e., assuming the breadwinner role, deciding to not have children) have evolved over the past 50 years, potentially altering the assumptions a 25-year old female therapist may have compared with a 75-year old woman in therapy. Not only should therapists be aware of national longevity patterns and demographic changes, but also be equipped to work through incorrect age-related assumptions held by both clients and society (e.g., “aging is miserable and always painful”; Laidlaw, Thompson, & Gallagher-Thompson, 2004). If clients are stuck in such automatic negative cognitions, one example for promoting cognitive flexibility is challenging these appraisals using standard cognitive behavioral therapy techniques such as cognitive restructuring (Hall, Kellett, Berrios, Bains, & Scott, 2016). Moreover, some emotional and behavioral differences may be tied to increases in normative age-related physical limitations older adults face. Clinicians will increasingly need to be aware of these issues that accompany personal and relational challenges in therapy, particularly, as the movement toward more integrated care accelerates (Hodgson, Lamson, Mendenhall, & Crane, 2014).

Coupling with the large cohort of baby boomers settling into older adulthood, the growing acceptance of psychotherapy services by older adults (Zarit & Knight, 1996) led Jensen and Rauer (2015) to call for therapists to become more adept at working with aging couples. Yet, despite results linking age and initial clinical presentation (Chen & Feeley, 2014), therapists should remain culturally humble when making assumptions about clients based solely on age. Indeed, clinicians have been warned to avoid unintentional overemphasis on shared-group characteristics as this may result in privileging therapist expertise about a client’s culture, further exacerbating power imbalance in the therapist–client system (Ortega & Faller, 2011). In other words, an awareness of potential differences based on age is warranted and helpful, yet, unwavering assumptions based on a particular aspect of a person’s social location (i.e., age) should be avoided.

Limitations

Despite the meaningful contributions this study makes to the literature on the clinical treatment of aging adults, there are various limitations that merit attention. First, the education level of both samples may be higher than the general population. Given the association between education levels and mental health challenges, there may be some limits to generalizing these results. Second, participants engaged in various clinical modalities (i.e., individual, couple, family), which may differentially influence reports of individual and relational variables. Next, we did not explicitly account for physical health–related variables across adulthood. Given that older adults are more likely to experience physical ailments (De Ridder et al., 2008), assessing for such constructs may have further informed us about emotional and relational processes. Finally, given the low reliability of the IPS and RWP substance abuse subscales, the results of these subscales should be interpreted cautiously.

Conclusion

As psychological well-being buffers the health impact of age-related stressors (Bookwala, 2012), society has a vested interest in enhancing the emotional health of aging adults. However, perhaps due to older adults’ reticence to seek psychotherapy, there is a lack of clinical research within the field on aging issues (Lambert-Shute & Fruhauf, 2011), leaving clinicians feeling less confident when working with older clients (Yorgason et al., 2009). Future research should continue evaluating whether traditional approaches to therapy will be as effective for older populations, as previous research has found that some relationship processes (e.g., conflict, support) may operate differently for older adults (Rauer, Sabey, & Jensen, 2014). Helping adults process relational, emotional, and social changes that accompany aging will assist in promoting a successful and fulfilling transition from middle age to older adulthood (Rauer & Jensen, 2016). As the quantity of older adults seeking clinical services for mental health and relationship issues inevitably increases, practitioners must provide more nuanced treatment based on clinical data. Finally, clinicians should bear in mind that although older adult clients may present somewhat uniquely from others in therapy, older adults may be able to change as much as the newlyweds who sat in their office earlier.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research presented in this article was funded by the Chicago Community Trust, the Harris Family Foundation, and the Epstein Family Foundation. The authors, whose names are listed above, certify that they have no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this article. IRB: 009052, 076656.

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