Kim Scott, LMFT



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September-October 2023

Member Columnist — Kim Scott, LMFT

Embracing the Third Act:
Mental Health and Therapy for Older Adults

As we all know, the population is aging. At times it is negatively referred to as a “Gray Tsunami,” which the younger generation will be left to “deal with.” At other times, in a more neutral vein it is called the “Graying of America.” But however, you label this trend, the 65+ population is growing, and they are not the grannies and gramps of yesteryear who had much shorter life expectancies. They are not silently fading into the background and dying soon after they retire. In fact, in the 1950s the average life expectancy was 68 and now it is hovering close to 80. And the Baby Boomers who were born between 1946 and 1964 are 73 million strong, second only to their children, the Millennials.

So, what does this mean to us as therapists? It means that since the demographics of our client base is changing, to provide effective therapy and to establish rapport we need to do more and dig deeper than just treating them the same as we would a 35-year-old client. Just as we need to take cultural issues into account when working with clients, we also need to consider age. I know that we routinely consider age with children and teens but seniors are often lumped in with all other adults ignoring the important and new developmental phase they are embarking upon. Additionally, this stage of life can span upward of 40 years! It is literally the longest span of human development! Accordingly, a 65-year-old and an 85-year-old are both seniors but are experiencing different aspects of aging, as a 5- and 10-year-old would be experiencing different aspect of childhood. To be effective therapists we need to understand the differences and diversity in this life stage.

Not only is this phase of life ignored by so many therapists, but our society has also treated seniors as if they are invisible, irrelevant and have nothing left to offer, other than, of course, deciding when to retire so that their job can be reallocated to a young adult.

In a 2014 article published in the Atlantic by Dr. Ezekiel Emanuel titled “Why I Hope to Die at 75,” Dr. Emanuel suggests that Americans live too long and said that at age 75 he would basically stop all medical care aimed at prolonging his life. He questions “whether our consumption is worth our contribution.” This viewpoint epitomizes the belief that past a certain age, seniors do not offer much to society. They are just a drain. The 65+ Generation is so much more than this and to effectively meet their needs we must identify and confront our own ageist beliefs and attitudes. For instance, when your 75-year-old client tells you about his sex life, do you say things like, “that’s so cute?” or something else equally diminishing? Or when your 80-year-old clients says that she is treated like she is invisible when she is out in the world, do you discount her reality, or do you acknowledge that ageism does exist and help her navigate and confront this socially condoned prejudice. We need to learn about how ageism impacts our clients in the workplace, with their families and health care providers, and in their own thinking.

It took an insightful, bright young woman in my life to call me out on the ageism I was displaying and to help me begin my education and consciousness raising. Just as the Feminist Movement in the 60’s was spurred on by consciousness raising, I believe it is now time for each of us to begin this same process for our older clients. If we do not, I believe that this savvy senior will vote with their feet and look elsewhere for counseling. Today’s seniors were raised with a therapy consciousness and have quite likely been in therapy before. They will not be passive observers.

Historically, women and people of color have been treated as “less than” and have been excluded from leadership and decision-making positions. Today those over 65 are being ‘othered’ and treated as if they are irrelevant and again, a drain on the system. In fact, did you know that ageism is one of the only “isms” that is still socially acceptable? As therapists, we must become aware of ageism and how it impacts our treatment of our clients and their views of themselves. We as therapists need to let our senior clients know that we see them for who they are (more than just an age), that they are relevant and that they can create a better, fuller 3rd Act for themselves and the generations that follow.

We also need to understand some of the specific issues that impact our 65+ clients. Such as:

  • Empty nest and changes in parent/child relationships as their children become adults
  • Physiological changes and medical conditions that impact depression and anxiety
  • Feelings of isolation
  • Death of a spouse or loved one
  • Losses of many kinds including loss of friendships and body mobility
  • Cognitive changes
  • Lack of purpose
  • Loneliness
  • Existential issues related to life and death
  • Decisions regarding retirement or ‘unretirement’
  • Life Transitions
  • Chronic Pain

In this bi-monthly column we will discuss the above topics and other issues that are significant to our treatment of the 65+ generation so that as a community we can raise our consciousness and keep ourselves relevant to our older clients. If you have ideas or issues that you would like to see addressed, please feel free to email me at

Kim Scott, LMFT (MFT21184) is a licensed marriage, family and child therapist who practices in Granada Hills. She has a blog, Therapeutic Musings, at Ms. Scott can be reached at 818.309.7780 or Her office is located at 17402 Chatsworth Street, Suite 104, Granada Hills, CA 91344.

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San Fernando Valley Chapter – California Marriage and Family Therapists