PHILADELPHIA – Marriage undergoes stress as a couple becomes elderly, partly because “the goals of middle age are gone,” Erlene Rosowsky, Psy.D., said at a conference sponsored by the American Society on Aging.
“In middle age, the goal is getting there, but in older age, you're there.” The “getting there” has often been the glue of the marriage, and now it's gone, said Dr. Rosowsky, who is a geropsychologist in Needham, Mass. This means that the goals for each person and for the marriage need redefinition.
“What worked at an earlier stage in the marriage is no longer appropriate,” she said. For example, at an earlier stage in a marriage, the couple might have been involved in child rearing and a career. However, at the midlife to late-life shift, spouses might reassess their union and wonder what's next.
As a result of these shifts, most couples therapy is essentially communication therapy, said Dr. Rosowsky, also affiliated with the department of psychiatry at Harvard Medical School, Boston.
For the therapist, a goal is to identify communication stoppers, help couples deal with them, and accentuate communication enhancers, she said. The ability to adjust to change is also important. For example, a successful elderly couple needs to be able to change their mode of communication when necessary, she said. Overall, marital interactions tend to be more positive late in life.
In old age, marriage has its own purposes: collaboration, companionship, continuity, affirmation, support, protection, and physical intimacy. Marriages can become more positive in old age if the pair succeeds in bringing a truce to old conflicts, adopting an attitude of letting go, and feeling linked as they pass through old age.
Assessing the marriage of an elderly couple involves observing them, noting what is present and what's missing, clarifying problems for the couple, and exploring the history of the marriage. For example, it helps to know what their own parents were like, how the couple met, and what their expectations were when they were first married.
Issues that need to be explored in therapy are different for older adults. For example, there is the importance of physical concerns and countertransference issues–the powerful emotional responses that are provoked in a relationship. Common themes of a countertransference relationship include futility, hopelessness, pain, and fear–which might include fear of being alone, fear of pain, or fear of humiliation.
Other issues that need to be addressed in therapy are those such as retirement, differential aging between the spouses, bereavement, caregiving, and a sense of running out of time. Illness or disability can cause togetherness and separation. Typical interventions for an elderly couple include psychoeducational, communication training, joint reminiscence, and presentation of models.
One model of couples therapy attempts to move the couple from mutual tolerance to acceptance. The ideal is for both partners to come to believe that their life together was a good personal choice, and something that they each would do again given the chance, Dr. Rosowsky said.