Comprehensive Conceptualization of Cognitive Behaviour Therapy for Late Life Depression

Cognitive behaviour therapy (CBT) has proven efficacy as a treatment for depression in older people. An important debate amongst therapists working with older people is whether CBT needs to be adapted to ensure optimal treatment outcome and, if so, what adaptations are necessary. It is accepted that psychotherapy with older people can differ from psychotherapy with younger people in a number of important respects because of the higher likelihood of chronic conditions, changes in cognitive capacity, potential loss experiences and different cohort belief systems. As psychotherapists are often much less comfortable dealing with physical problems, they may become negatively biased in terms of outcome when patients present with co-morbid health issues. The impact of loss experiences in older people can also be overemphasized in their importance by inexperienced therapists and can result in lowered expectations for therapy outcome. Consequently, there is a need to develop a model that addresses age related issues within a coherent cognitive therapy framework suitable for older people. This paper describes a CBT model that is augmented with applied gerontological knowledge, taking account of cohort beliefs, intergenerational linkages, sociocultural context, health status/beliefs and role investments/transitions. Clinical examples are used throughout to illustrate clinical implications of the model.