Many practitioners are applying psychodynamic principles to the work they do, even when treatment doesn't conform to the traditional frame. This month, Melissa Anderson, M.A., Elder Abuse Specialist at the Institute on Aging, continues exploring this topic.

Over the past months, we've written about elderly clients with abuse and the added complexity of working in non-traditional settings. Now we present a brief look at the situations accompanying our community-based clients* and consider how a psychoanalytic approach is helpful.

Mrs. A, a 73-year-old African American woman, presented anxiously. She'd gone to the police and reported being assaulted by her 29-year-old grandson, refused an order of protection, but agreed to meet with a social worker from Adult Protective Services and weekly psychotherapy. Concern for her grandson, his children, and his mental health and drug use (he has a dual diagnosis of substance abuse and psychotic disorder) were central. Mrs. A. cared for him on and off throughout his life; he was born to Mrs. A's daughter at age 16, a year after her release from Napa State Hospital, where she was treated for schizophrenia. Mrs. A. received calls from her daughter's neighbors expressing concern for her grandson, starting at age two, due to neglect.

Mrs. A lived alone in senior housing. Her asthma worsened and she developed pulmonary disease, resulting in constant use of oxygen. Her mobility became more limited, and her son moved in. In his mid-fifties, he has a diagnosis of psychotic disorder, history of substance abuse, although was not using, and was HIV+ at the start of Mrs. A's therapy. During the course of her treatment, he converted to AIDS, went on a crack binge and emptied Mrs. A's checking account. By using psychoanalytic and supportive methods, the therapy became a container for Mrs. A, and she expressed her feelings. She looked forward to it, and sharing events and responses. She eventually took out an order of protection against her grandson, but more importantly began to make time for herself, her own life, and discovering meaning.

Melissa C. Anderson, MA, Marriage and Family Therapist Intern,
Ph.D., Neurobiology
Elder Abuse Specialist
Institute on Aging

* a composite of several clients

Know of an unconventional application of psychoanalytic work? You're invited to write a PSYCHOANALYSIS ON THE STREET or just contribute an idea. Contact us.