What it's like to start therapy later in life

A walk in the rain with a 65-year-old relative. Climbing stiles, wading through mud—England. “But what if I go into therapy and find out that my son’s illness is all my fault?” she asked. I probably replied by saying something like: well, you said it, so you clearly feel it might be your fault. Therapy then might be more of a way of working through that guilt, accepting your own responsibility as well as understanding that there are things you couldn’t have done anything about.

People often wonder if really knowing about themselves will make them feel worse, but it’s not so much about better and worse, more about murky and clear. “Anyway,” she went on, squelching a welly out of the mud. “It’s too late.”

A psychiatrist I once shadowed described the age of 65 as “crazy time,” a bit like late teens, when a lot of people crash. If you can face the reality of death and get through the crisis, you can go on to have a fulfilling old age, she told me. I was 35 then and having enough trouble with the reality of life, never mind death. “It’s never too late,” she said.

Obviously, it’s too late for some things. It’s too late to realise your dreams, fulfil your potential, believe that anything’s possible and the other kinds of ludicrous crap that people wearing earpieces march around stages shouting about. Psychotherapy is more about understanding your dreams, accepting your limitations and acknowledging what is not possible than the TED talk fantasy version of life which leaves everyone feeling a failure.

I have an older patient, actually my only patient who is older than I am. With younger patients there is a feeling that they want to sort themselves out so they can get on with things, feel happier at work, start a family, begin a decent relationship, leave an abusive one, stride into the future with a clear head. And with an older patient… it’s exactly the same (apart from the start a family part). There’s a lot more material, many more years of whatever behaviour or thinking it may be that is causing damage and misery. Sturdier defences. Whatever propaganda you’ve been peddling about yourself, whoever you’ve been pretending to be, you’ve been doing it a lot longer.

In a session the other day I found myself saying: “So, you’ve been pretending to be the life and soul of the party when you feel absolutely desperate for more than 50 years?” Fifty years! That’s a long time to have a mask on. “Well,” he said, “Nobody wants to hear about that, do they.” No question mark, just a statement of fact. “You wonder if even I want to hear about what’s really going on?” I said. I very much did. Seriously, I can’t imagine a person who would rather their interlocutor was putting on a fake happy act than being sincere. And then this patient wonders why all his relationships feel rather hollow.

After all, why shouldn’t older people be allowed to form meaningful relationships, leave damaging ones, find fulfilling uses for their time and understand what exactly they’re up to via good therapy? Oh, wait—they are! I was breathless now, after my little one-to-one, TED-style lecture of precisely the kind I loathe. Oops.

“Hmm,” my walking partner said, dubiously, head bowed, the rain really coming down. And I knew she was planning to bottle it all up for another decade or so instead.