The Perspective of the Older Trauma Therapist Facing the Future

Abstract
Everyday we live we are closer to the end of our lives. Perhaps for some this is a distressing thought, and yet our mortality is a fact. Living in regret over what might have been, reliving the horrors of past traumas, wistfully recalling happier times, facing one’s end of life with fear and anxiety, or perhaps yearning for the perceived peace of death, all are common human attitudes. The psychotherapist with a career working with the survivors of trauma hears such narratives often. The most difficult place for people to inhabit, regardless of severe trauma histories, seems to be the here and now. We drift into past and future with ease. We can dissociate from bodily awareness as we dive into mental and emotional process via work life, memories, loss and grief, creativity, or social media and other escapes. As our patients age, dissociative or not, we must be open to their evolving needs, including the possibility of cognitive decline, and be willing to address them. Some have seen the interaction between dissociative symptoms and perceived or feared dementia in aging patients with urgency to be taken seriously.

Our patients are aging with us, and if we’ve taken on cases for the long term, we’ve walked the journey with some of them for years. In a recent presentation, the authors presented challenges of the older therapist and facilitated a discussion of their experiences as aging clinicians with those who attended as they shared theirs. Every participant contributed to a conversation that was both poignant and humorous. The need for this dialogue continues, especially as the ISSTD “old guard” grows older, suffers ill-health, and stops presenting at conferences. Many of us are in the old guard now, in our 70’s and 80’s and beyond, still practicing, able to travel, and enjoying our work enough to want to continue. Each may have health issues now, but medical advances such as medications, assistive aids such as mobility devices, hearing aids or pacemakers help keep us in the mix.

Older clinicians bring value to the work through wisdom, maturity, intuitive insights, resilience, years of experience, thriving despite personal traumas and loss, commitment to our professions, a sense of legacy through presentations and publications, and mentorship with younger colleagues now in the front lines in the treatment of trauma and dissociation. Older patients tend to trust older clinicians, and some younger patients do, too. Older clinicians can suffer from burnout and compassion fatigue, limitations from physical or cognitive changes, over-identification or boundary-crossing with some patients and uncertainty over how to react, resistance to newer technology such as telehealth, and not knowing when to trim one’s sails and work less, work remotely more, and limit difficult new cases. Antidotes to these include peer supervision and/or consultation, honest self-assessment, continuing education, and self-care practices such as mindfulness, creativity, and having sufficient relaxation and fun to sustain energy and be present for our patients. This workshop will facilitate a valuable dialogue with our peers, more needed than ever.