Lebensalter und Psychotherapie

The longer you live, the longer is your past in relation to your future. This is the same for patients and therapists. Life consists the longer the more in stories and memories - and that is exactly what psychotherapy is about. This statement seems very banal, but contains far-reaching consequences that are illustrated by the following case studies. A long time ago I met a former patient who told me that he felt he had been treated in a rather way in the clinic. In the year 1965 he was one of 120 patients who were treated by a single medical doctor. The ward round to all patients took four hours which meant that the doctor could only spend two minutes with each patient. No wonder the young patient remembered only an abstract treatment. I admit I argued that I did not have enough time. However, with the distance of dozens of years I easily admitted that his impression of a too treatment was right. As a young medical doctor I did not have much experience with ill people. Feeling insecure was the reason why my contacts with patients were short interactions. The second is a more recent case. A 95-year-old woman I had known for a long time came to see me. She claimed to suffer from a depression. However, after a while she confessed that she was extremely afraid of her own death. The fear of death was so strong that her defence mechanism could be named but not worked through. She begged for an antidepressant and I gave it to her. It saved her to think about her impending death. Making the demand to tackle with death is impossible and hypocritical. We cannot argue with death because we know nothing about it. In the third case study I will tell you about a patient who came to me when I started to run my own practice. At that time she was 70 years old, a resolute, vigorous and dominant person. For decades she had lived together with her partner -unexpectedly she had died from a heart failure. This patient also came to me because of a depression. She only wanted to die that is what she claimed at the beginning of every session. This kind of opening turned out to be a ritual. Fifteen minutes later though she changed completely. Now her reports were full of colour, suspense and not at least depressive. Some years later when my patient was 80 years old and knew that she would be dying soon, something unexpected happened. My very polite patient grew extremely angry and furious. She was fighting against her impending death - after ten years of pretending that she only wanted to die! I have learnt from that experience that in the beginning I missed not only to talk about the death of her partner but also about her own death. Maybe this topic has been too remote for me in an emotional way. In contrast to this experience it was possible to touch on the subject of death with the second patient.