Seniors and psychotherapy
The world’s population is aging. In 2023, there were 1.1 billion people age 60 and over, with that projection expected to double by 2050. Senior adults play vital roles in our communities, but just like other age groups, they face mental health struggles. While 14.74% of adults 70 and over lived with a mental disorder, these numbers may be underreporting mental health issues like depression that may appear at subclinical levels; that is, the symptoms may not be “bad enough” for a diagnosis. In addition, stigma around mental disorders can make it hard for people to ask for help. Psychotherapy can be a great resource to learn more about these topics and to receive help in order to make life more meaningful and engaging for seniors.
What is Psychotherapy?
While psychotherapy can be a number of things, it is often understood as a professional relationship between clinician and client where they learn personal insights, strategies, and skills to help address life’s problems, all in a safe, empathetic relationship. One of the unique things about therapy is that it can be conducted in almost countless ways, with various different modalities, theories, skills, and therapists for people to choose from. At its core is a trusting, deep, and meaningful relationship between the clinician and their client.
Psychotherapy is not, however, a one-size-fits-all process or a quick fix. When therapy is done ethically, it also does not try to change a person from who they are in terms of their deeply held values or beliefs. Instead, it aims to help the client learn more about themselves and to explore important – and sometimes difficult – experiences and ideas. It aims to address problems that the person is experiencing so that they can live more meaningfully with themselves and others.
Senior Adults’ Mental Health Concerns
There are a number of important issues senior adults may face, but it is important to clarify that these are not the fault of the senior nor are they simply a matter of age alone. The context of the senior in terms of their social and environmental world, such as retirement communities and nursing homes, is important to factor in. Likewise, the historical backdrop of a senior’s life and their totality of lived experience provide limitless avenues of unique differences that need to be explored. Developmental changes also occur, all the way from age-related physical changes to changes with one’s emotions. Seniors also face unique challenges, such as chronic medical problems or the loss of lifelong relationships, which hold their own meaning and importance to seniors.
Seniors, like other age groups, can face a range of problems that could be addressed with mental healthcare. Some of these include:
Changes in appetite such as eating less or more than before
Feeling more down or sad than usual
Noticing things irritate you more
Having a hard time sleeping or finding yourself feeling more tired than usual
Feeling restless or having difficulty concentrating
Worrying about things more than you used to
Not engaging with important roles or relationships in your life
Feeling more or worse headaches, digestive issues, or other physical symptoms
These symptoms may arise from a number of issues unique to seniors, including:
Chronic conditions
Decreased functional ability
Mobility issues
Financial strains
Elder abuse
Caregiver stress
Bereavement
It is important to rule out other, non-mental causes, however, including medications or other underlying medical conditions. That being said, it is possible for people to misinterpret symptoms, such as thinking the sleepiness or slowness are simply a matter of age.
While anxiety and depression were issues before the COVID-19 pandemic, these numbers increased. In fact, one in four seniors reported anxiety or depression in August of 2020, and numbers were higher for those with financial constraints, those who lived alone, those who were Hispanic, and those who were women.
Like other mental distress, symptoms may appear differently in older adults than in younger adults. For example, sadness may not be the main symptom a senior adult is experiencing. Instead, it may be a loss of interest in pleasurable things, loss or increase of appetite, or feeling more sluggish and slow than before.
Loneliness and social isolation are a particular concern with seniors and they affect roughly a quarter of seniors. Loneliness is a personal, subjective experience where one’s desired social interactions do not match their actual, lived social interactions. Social isolation is a measured indicator of having few social relationships, roles, and interactions.
Loneliness and isolation also impact Medicare, with social isolation accounting for $6.7 billion in spending each year due to greater hospital and nursing facility spending. In terms of health, social isolation had a greater effect on hypertension risk than even diabetes. It also affects seniors’ cognitive health, with chronic loneliness resulting in a 50% increase in developing dementia. Over a 12-year study, “cognitive abilities declined 20% faster among those who reported loneliness.” Loneliness and social isolation can also lead to a greater risk of feeling more anxious or depressed.
In older adulthood, it is also common for seniors to come face-to-face with questions about end-of-life care. While this topic is most relevant with regard to terminal illnesses, it is still an important issue for all senior adults. Discussions around end-of-life care can be difficult for people to comfortably engage in, including for medical professionals, caretakers, and seniors’ family members. Yet, having these discussions sooner can help ensure the seniors’ wishes for care are met, that relationships are finished on a satisfactory note, and that the senior feels hopeful for their family members still alive. It can also provide an important first step in the grieving process once the individual has died.
How Therapy Can Help
Therapy can help address a number of these presenting concerns seniors may have. Research has found various forms of therapy to be helpful, including Cognitive Behavioral Therapy, Psychodynamic therapy, as well as behavioral activation and life review therapy (Gum & Crawford, 2026). This benefit of therapy has also been found to be consistent across different age groups, meaning that older adults can get as much benefit out of therapy as younger adults.
A key factor in this is a holistic view of the senior, with wellness focused on multiple areas including developmental, cognitive, physical, emotional, spiritual, relational, vocational, and contextual factors.
Reminiscence Therapy has also been found to be effective, drawing on the memories of the senior adult with a focus on the positive experiences most salient to them. Music and art can also be incorporated to facilitate memory processing, and it can be done both individually and in groups.
Acceptance and Commitment Therapy (ACT) allows seniors to engage with and challenge assumed beliefs and attitudes about what is “normal” aging and to focus on their values most important to them. ACT also provides time for reflection on how one’s behaviors and thoughts may be inconsistent with these values and setting goals to act in a more value-based manner. In this way, they can engage with life more fully and find meaning in their daily experiences.
Meaning-making is an important part of human life, but it is highlighted in older adulthood. These therapies allow for some meaning-making exploration, but Existential therapy can bring these questions to the forefront. In Existential therapy, the senior explores their identity and sense of self in relation to their natural, social, personal, and spiritual worlds, aiming for clarity about what truly matters most to them and how to act out these most desired goals (Deurzen, 2012). Existentially focused therapy also explores important questions around death, one’s own responsibilities and choices, and making sense of the self in relation to others (Yalom, 1980).
Even though these are all different therapies, they are similar in the fact that they process lived experiences, promote learning new ideas and behaviors, as well as how to encourage healthy, engaging relationships between seniors and the people they care about.
Conclusion
There are a number of relevant mental health concerns for older adults to juggle and make sense of. There are normative changes and unique challenges in the physical health as well as mental health of older adults which need to be considered. Fortunately, there are lots of different therapies out there which can help in various ways. While they may have different goals and work better for some clients and not others, all of the therapies are united in trying to help the older adult make better sense of their lived experiences and to learn new ways of living life more meaningfully.
References
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Deurzen, van E. (2012). Existential counseling & psychotherapy in practice (3rd ed.). Sage Publications.
Gum, A. M. & Crawford, N. O. (2026). Psychotherapy for older adults with depression: A narrative review. American College of Neuropsychopharmacology. https://doi.org/10.1038/s41386-026-02327-z
Knight, B. G. (2009 October). Psychotherapy and older adults resource guide. American Psychological Association. https://www.apa.org/pi/aging/resources/guides/psychotherapy?item=1
Koma, W., True, S., Biniek, J. F., Cubanski, J., Orgera, K., and Garfield, R. (2020, October 9). One in four older adults report anxiety or depression amid the COVID-19 pandemic. KFF. https://www.kff.org/mental-health/one-in-four-older-adults-report-anxiety-or-depression-amid-the-covid-19-pandemic/
McDarby, M. (2019). Older adults and palliative and end-of-life care. American Psychological Association. https://www.apa.org/pi/aging/programs/eol/end-of-life-factsheet.pdf
Mills, K. I. (Host). Dotson, V. (Guest). (2025 April). Keeping your brain healthy as you age, with Vonetta Dotson, PhD (326). [Audio podcast episode]. In Speaking of psychology. Americal Psychological Association. https://www.apa.org/news/podcasts/speaking-of-psychology/brain-health
National Institute of Mental Health. (2025, June 5). Infographic: 4 things to know about depression and older adults. https://www.nia.nih.gov/health/mental-and-emotional-health/4-things-know-about-depression-and-older-adults
National Institute of Mental Health. (April 2024). Older adults and mental health. https://www.nimh.nih.gov/health/topics/older-adults-and-mental-health
Office of the U.S. Surgeon General. (2023). Our epidemic of loneliness and isolation. U.S. Department of Human and Health Services, National Institutes of Health. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
Shand-Lubbers, R., & Diaz, A. M. (2025). Closing the gap: Addressing older adults’ mental health needs through access, advocacy, and adaptive aging. Eyes on Psi Chi 29(3), 31-34. https://doi.org/10.24839/2164-9812.Eye29.3.31
World Health Organization. (2026, July 20). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
