Donation
Sigmund Freud once remarked that old age is accompanied by rigidity and a diminished capacity for change. For this reason, he argued, older adults are not suitable patients for psychoanalysis—a treatment born in the early 20th century that transformed theoretical models of the mind as we know them today.
Though Freud was a groundbreaking and controversial figure, his legacy endures. And though it is somewhat overlooked, psychoanalysis is still practiced today. In its most traditional form, psychoanalytic treatment takes place four times per week, with the patient lying on a couch and the analyst seated behind, listening closely and offering occasional interpretations. While this is not the only way psychoanalysis is practiced, it demands significant commitment of time, energy, and emotional effort from patient and therapist both.
The structure of the U.S. healthcare system and associated economic pressures make intensive treatment like psychoanalysis largely inaccessible, especially for older adults. Mental health care for older adults is often relegated to brief behavioral interventions or pharmacological management. Treatments like cognitive behavioral therapy or psychiatric medication prioritize short-term symptom resolution, often at the expense of deeper, lasting change in the patient's inner world, self-concept, and relational patterns.
Many geriatric and psychiatric nurses find that their tools are limited, their behavioral strategies exhausted, and patients’ mental wellness not fully realized. The dual challenges of dementia and mental illness push clinicians toward surface-level interventions, unintentionally neglecting the patient’s subjective experience, inner life, and personhood. Yet nursing was built on psychoanalytic foundations. Hildegard Peplau, regarded as the mother of psychiatric nursing, drew directly from psychoanalytic theory to shape the nurse-patient relationship, a valuable tool for healing. Despite this lineage, geropsychiatric practice today often overlooks the patient’s inner world, offering an impoverished model of care at a valuable stage of human development.
It is time to reconsider Freud’s view. He underestimated the psychological resilience and developmental potential of older adults. In fact, older adults are uniquely positioned to benefit from psychoanalytically informed therapy. Research has shown that aging individuals are motivated to make meaning of their lives and integrate their life narratives. Their rich life experience becomes a powerful resource in therapy, where free association and storytelling are central to psychological change. Moreover, many older adults in retirement have the time and reflective space to engage deeply in this work.
If more geriatric and psychiatric nurses were trained in psychoanalytic techniques, perhaps more older adults would feel seen and supported in their mental health. Psychoanalytic psychotherapy champions person-centered care, with the therapist listening closely and respectfully to the patient’s inner world. Psychoanalytic practice conveys, implicitly and explicitly: "I am here, and I am ready to help you process everything that has come before now." If we embraced this approach, we might begin to offer older adults the kind of care that honors their minds as alive, complex, and capable of transformation.
----------