Psychoanalytic psychotherapy with depressed older adults. A qualitative research study

McKenzie-Smith, Savi (2012) Psychoanalytic psychotherapy with depressed older adults. A qualitative research study. PhD thesis, Tavistock and Portman NHS Foundation Trust. Full text available

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This thesis is a qualitative investigation of once-weekly psychoanalytic psychotherapy practised by the researcher over a period of one year with a sample of six patients, all of whom were over 65 at the beginning of their treatment and had been previously diagnosed by clinical referrers as depressed. The purpose of the study was to explore whether psychotherapy could alleviate their distress and enhance the quality of their later life. It was also to investigate if there were other reasons for depression in later life than the failure to mourn early losses. In an earlier study I had applied the method of psychoanalytic infant observationto the study of aged adults suffering from dementia, both to learn about their states of mind and to study their responses to this kind of close observational attention. This new study brings my training and experience as a child and adult psychotherapist to bear on the experience of older adults. I adopted a qualitative method of research, applying a form of Grounded Theory to the analysis of clinical data which I wrote up in detail after each clinical session. I sought to identify themes which explained the origins of depression in later life in otherwise well-functioning adults both from thematic analysis of the separate case studies and by comparing them, In a follow-up review meeting three months after the completion of treatment research patients completed a questionnaire which enabled me to assess the changes which had taken place as a consequence of clinical treatment. These results and the outcomes of the CORE measures, an independent assessment, indicated significant improvements in the states of mind of all the patients since the beginning of their psychotherapy. The context for this qualitative clinical study is provided by a chapter which reviews the literature on the psychology and especially the psychoanalytic study of old age, identifying earlier theoretical contributions beginning with the work of Freud which were formative to my work. A central finding of my study was that losses, sometimes from childhood, remained the significant unrecognized sources of depression, and that enabling patients to reflect on aspirations which were no longer attainable could bring them relief from depression and a renewed interest in life. Most previous psychoanalytic writing in this field is based on single clinical cases. My study is original both in its systematic comparison of six cases of depression in old age and in its adoption of an explicitly qualitative research method adapted to clinical data. A further context for my investigation is provided by a chapter in which my research methodology is described. A chapter on the social context of old age is included, which takes note of the growing proportion of aged people in the population and the demands placed on social provision to meet their physical needs as well as their mental well being. The final chapter draws some further conclusions and recommendations from the study.

Item Type: Thesis (PhD)
Additional Information: A research thesis submitted to the University of East London in association with the Tavistock Centre for the degree of Doctor of Philosophy
Subjects: Disabilities & Disorders (mental & physical) > Depression
Psychological Therapies, Psychiatry, Counselling > Psychoanalytic Psychotherapy
Children, Young People and Developmental Pyschology > Old age
Social Welfare > Social Work
Department/People: Adult and Forensic Services

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