Psychoanalytic contributions to psychotherapy in later life

This article summarizes key psychoanalytic contributions to psychotherapy in later life. According to the psychoanalytic developmental model for the second half of adult life, physical aging processes organize psychological development. The body as a conflict partner expresses unconscious conflicts and repressed affects. The article discusses how unconscious conflicts are reactivated by age-related changes. The theory of secondary structural deficits, which assumes an increased structural vulnerability in later life, underscores the particular suitability of structure-oriented and mentalization-based psychotherapy. The challenges of dealing with reverse transference are addressed, where the role of the (grand)child is transferred to the psychotherapist. As older patients are more often affected by loneliness, therapists need to engage more deeply with the attachment needs and actively support the building of relationships and activities. Finally, the dynamics involved in terminating therapy are discussed.