In the last edition of Mental Health Matters, I interviewed therapist Robin Dromey, LCSW. I thought her explanations about counseling and individual and group psychotherapy were informative and raised more questions so Robin has agreed to a follow-up interview.

DR FLEMING: Robin, one question that came to my mind after our last interview was this: it seems that as we progress through life, we face different challenges. The well known psychologist Erik Erikson wrote about the different developmental tasks we encounter at different ages. I assume this means that the therapist will be approaching a 13 year old who is referred by his/her parents or school official much differently than say a college age student seeking help on his or her own vs someone in their late 40s or early 50s experiencing a “midlife crisis”. Can you comment on how, as a therapist you approach these different situations, perhaps using Erikson?s terminology as a guide? And by the way, it may be helpful if you could comment on your experience treating patients of different ages.

ROBIN DROMEY: Yes, Dr. Fleming you are correct. Erik Erickson believed that we go through 8 stages of psychosocial development. Psychosocial development means that we experience changes in our interactions and understanding of one another as well as in our knowledge and understanding of ourselves as members of society. According to Erickson, moving through each stage means that we resolve a conflict or crisis. If we do not resolve the conflict in one stage, then we have difficulty resolving crisis or conflict in the next stage. No crisis is completely resolved, because life becomes very complicated as we grow older, but it needs to be resolved enough so one can deal with the next stage. I am only going to talk about the last 4 stages.

To answer your question, from the ages of 13 to early adulthood; people are trying to figure out who they are, what they want for their lives, and what their purpose is in life. During this stage, one is focused on one’s peers more than they are on parents or adults. This is a difficult stage, because one is trying to figure out what one wants for his/her life and has many pressures. Such pressures come at a time when physical and societal changes are expected of him/her. Erikson calls this the identity vs. role confusion stage.

The early adulthood stage is called intimacy vs. isolation (18 to 30). People in this stage focus on loving, sexual, and close relationships with others. Difficulties in this stage result in feelings of loneliness and a fear of relationships with others. When resolving this stage successfully, one can have relationships that are intimate on a physical, intellectual, and emotional level.

The next stage is the generatively vs. stagnation stage. This is middle adulthood, where people focus on his/her family, community, work, and society as a whole. Success in this stage results in positive feelings about the continuity of life.

Difficulties in this stage result in feelings of trivialization of one’s activities. This means one may feel he/she has not done anything for upcoming generations. In others words they left nothing for others to look up too.

In older adults, which means late adulthood the stage is referred to as “ego-integrity vs. despair”. This stage involves one having a sense of unity in one’s life’s accomplishments. The time period is from late adulthood until death. During this stages one focuses on what he/she has accomplished or not accomplished during his/her life. People know who they are, but focusing on whether they met the goals they set for themselves when they were adolescents. Difficulties in this stage result in regret of what they did not achieve.

Yes, I have to approach therapy in a different manner when working with older adults. We have to focus on the here and now and identify what they have accomplished, rather than what they wanted to accomplish. Many times, one does not accomplish what he/she expected; but have accomplished and survived more than he/she can see. I approach this with helping one see the challenges they have overcame, even if it was not what they set their goals to be. Many times one sells him/herself short, because he/she does not see what he/she has truly accomplished; because he/she is so focused on the goals he/she set for him/herself when an adolescent or middle adult. Older adults are amazing and all of us can learn from them, because they have overcame so much.

I worked with adolescents for many years and they are great. I found that in many cases, they need a family or adults to care for them and give them direction and motivation to succeed in life. They need positive role models. Unfortunately, this is not always the case and many have to fend for themselves. With middle adulthood, I focus on marriage, family, career, and societal needs that may result in daily and future stressors that keep them from being happy with life in general.

DR FLEMING Interesting. It sounds like you have had experience treating people of varying ages and I know you now provide both individual and group therapy for the Senior Life Solutions program. Since the patients in this program are at or beyond retirement age, what are the unique challenges that this age group faces and how does one help?

ROBIN DROMEY: When working with older adults, I find it difficult to motivate and get patients to try new things to improve their life. Some feel that their life is over and they cannot change it to make it better. We work very hard to get them to understand that they can change their negative thinking and self-defeating behaviors that reinforce their depression. Due to having health problems, some feel they cannot improve their life. This is not true, when they take our suggestions; they feel better mentally and physically. Another challenge is trying to get them to see that they do have control over their lives and can change it. Some feel they are disabled and cannot improve, but this is not true; small changes are very important for them to see. We point out the baby steps they make. Have you heard the saying “old dogs can’t learn new tricks?” That is not true, we see it every day. If we can help just one, then it is worth it!

Hope is both the earliest and the most indispensable virtue inherent in the state of being alive. If life is to be sustained hope must remain, even where confidence is wounded, trust impaired. --Erik Erikson