I N T E R N A T I O N A L J O U R N A L O F INTERNATIONAL JOURNAL OF PSYCHOLOGICAL RESEARCH R E V I E W A R T I C L E P S Y C H O L O G I C A L R E S E A R C H Late-Life Depression and the Counseling Agenda: Exploring Geriatric Logotherapy as a Treatment Modality Depresión en edades avanzadas y la agenda de asesoramiento psicológico: Explorando la logoterapia geriátrica como modalidad de tratamiento John Henry Morgan , a a Ph.D., D.Sc., Psy.D. Graduate Theological Foundation, United States The counseling agenda established for dealing with late-life depression is often followed in consort with pharmacotherapy which has proven clinically to be quite effective in reducing and, in many cases, relieving symptoms of low self-esteem and anxiety. : Whereas conventional medical intervention concentrates on the reduction of depression symptoms, psychotherapeutic modalities such as cognitive-behavioral therapy have Logotherapy; proven somewhat effective in creating a more stabilizing experience of existential Geriatric; contentment, offering a deeper sense of well-being rather than simply symptom reduction. Depression; Geriatric logotherapy has come forth with an emphasis upon existential contentment Counseling; drawn from accessing what is called the “life story window” wherein the therapist assists Treatment. the patient in exploring the past in search of the “happy memory.” Since palliative rather than curative care is the therapeutic agenda in late-life counseling, this logotherapeutic approach has produced a treatment modality worthy of further exploration with particular attention to reminiscence and life review studies. La agenda de asesoramiento psicológico establecida para tratar con la depresión en edades avanzadas es a menudo realizada con farmacoterapia, la cual ha probado clínicamente ser bastante efectiva reduciendo y, en muchos casos también, aliviando los síntomas. Mientras que la intervención médica convencional se enfoca en la reducción : de los síntomas de la depresión, las modalidades psicoterapéuticas como la terapia cognitiva-conductual han probado ser de alguna manera efectivas creando una Logoterapia, experiencia más estable de satisfacción existencial, ofreciendo un sentido más profundo geriátrico, de bienestar que simplemente reduciendo los síntomas. La logoterapia geriátrica se depresión: presenta con un énfasis en satisfacción existencial extraída de la entrada a lo que se asesoramiento denomina “la ventana a la historia de vida”, en donde el terapeuta asiste al paciente psicológico, explorando el pasado en búsqueda de “la memoria feliz”. Puesto que la agenda de Tratamiento asesoramiento en edades avanzadas es más paliativa que de asistencia curativa, este enfoque logoterapéutico ha producido una valiosa modalidad de tratamiento de exploración adicional con atención particular en la reminiscencia y en el estudio de la historia de vida Recibido/Received Revisado/Revised: Aceptado/Accepted Octubre 8 de 2012 Enero 5 de 2013 Febrero 13 de 2013 Morgan, J.H; Graduate Theological Foundation, 415 Lincoln Way East (Dodge House), Mishawaka, IN 46544, 1-800-423-5983 (U.S. & Canada), 574-255-3642 (International), 574.255.7520 (fax), www.gtfeducation.org Email: [email protected] | ISSN printed 2011-2084 | ISSN electronic 2011-2079 | 94 R E V I E W A R T I C L E INTERNATIONAL JOURNAL OF PSYCHOLOGICAL RESEARCH Geriatric Depression and the Counseling Agenda psychotherapists are eager to make a disclaimer of In just over 50 years, the American Medical that domain of study and research. Though close-of- Association has collected over twelve hundred life issues intersect with end-of-life issues, they are articles in medical journals dealing with issues distinct and separate, particularly as relates to related to aging and depression. In the 1950s, the medical and psychotherapeutic intervention. With field was wide open for both psychiatric research in regarding to geriatric depression particularly, it is psychopharmacology as well as in psychological unfortunate that both the patient and the family are counseling (Alexopoulos & Kelly, 2009). During this commonly disinclined to report a debilitating level of period of half a century, the research has become depression common among the elderly, attributing increasingly sophisticated and disproportionately rather their depressed moods as either resulting from pharmacological (Steffens & Potter, 2008). Without the side effects of medication (whether reasonably in any way suggesting that psychotropic medication probable or not) or to the normal stresses and strains is inappropriate or over-used, the following of the aging disengagement from power and exploration will be of the use and value of therapeutic responsibility (Alexopoulos, 2005). counseling rather than medication as a first-choice treatment for late-life depression (Mitchell & Nevertheless, depression, whether major or Subramaniam, 2005). Of course, predicated on the minor in intensity, is a mental disorder encompassing clinically determined assurance that no biogenic such feelings, usually not articulated, as low self- disorders are operative within the patient, the use of esteem, loss of interest or pleasure in normal psychotherapy as a mode of treatment for activities and, according to the American Psychiatric psychogenic depression among the elderly should be Association (APA, 2000:354), nearly 5 million of the continually explored even in the face of 31 million Americans over 65 years of age suffer overwhelmingly advancing psychopharmacological from clinical depression with 20% of those having research in geriatric biogenic dysfunction. major depression symptoms. Understandably, major debilitating depression is higher among the medically The history and relevance of the relationship ill over 70 year olds with suicide more than double between the terms “geriatric depression” and “late life the average population. Chronic diseases, it should depression,” while providing an interesting historical be noted, associated with deep depression among and historiographical sideline, is not our focus here, the elderly include, not surprisingly, stroke, coronary so we will not to be distracted by these linguistic heart disease, cancer, Parkinson’s, Alzheimer’s, and niceties (Yohannes & Baldwin, 2008). While the dementia. According to Rapaport and colleagues AMA’s online library, PUBMED, provides an (Rapaport et al., 2002), minor depressive moods historically interesting roster of articles dating from eventually develop into full blown major depression the 50s dealing with geriatric depression and from up to fifty percent of the time according to a major the 70s with late life depression, the 1,200 articles of study (Birrer & Vemuri, 2004). the former and the 2,200 of the latter category simply demonstrate the research explosion which has Psychiatrically-diagnosed late-life depression occurred in this field of medicine and counseling within the close-of-life population is characterized by (Krishnan, 2007). For our purposes, we will use the a variety of symptoms identified by Birrer and terms interchangeably as no case has been made to Vemuri. To meet the criteria for a major depression medically differentiate them. episode, they explain, a patient must have a presentable demonstration of 5 of the following 9 It should be made clear from the beginning symptoms every day for at least two weeks. They of this exploration that late-life depression is not include a depressed or sad mood, loss of interest in considered by the medical community as normal in pleasurable activities, increased or decreased sleep, the aging process, though it is, indeed, quite increased or decreased appetite, increased or common (Atiq, 2006). Because our interest is decreased energy/activity level, poor memory and/or particularly in the “close of life” period where concentration, feelings of guilt or worthlessness, a palliative rather than curative treatment is sought, change in mental and physical speed perceived by since the nurturing of the elderly is not aimed other people, and thoughts of wishing to be dead. primarily as a cure for which there is none, we will Exacerbating the diagnosis and treatment of late-life employ both sets of terms, i.e., late-life depression depression is the fact that changes in brain chemistry and geriatric depression, as suggestive of “close of and function which may be causing these feelings life” issues rather than using a broad-based are simply not yet known, though medical studies application to individuals in a post-retirement period have verified that these brain functions are triggered of life. Since “end of life” issues are covered more by such things as stress and life style (Wong & thoroughly by thanatologists, geriatric Licinio, 2001). Morgan (2013) int.j.psychol.res. 6(1) PP. 94 - 101 | | | | 95 R E V I E W A R T I C L E INTERNATIONAL JOURNAL OF PSYCHOLOGICAL RESEARCH Geriatric Depression and the Counseling Agenda psychotherapy drawing from Freud, Adler, and Jung Treatment usually consists of a mixed is not new information (Morgan, 2012e). Yet, and in combination of psychotherapy and pharmacotherapy, spite of the oversight by practicing psychotherapists, with proportions of each determined by both medical logotherapy as a growing school of thought and and psychiatric consultation and counseling professional practice cannot continue to be ignored resources and preferences dictated by either the owing to its aggressive and reportedly successful patient or the patient’s family (Frazer, Christensen & address