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.

Last month, we discussed working with elderly patients who've been traumatized, abused or spent lifetimes in dysfunctional relationships, and now at ages 65, 70, or even over 90, begin the work of introspection, understanding and making peace with their own processes. Our therapists support seniors by meeting them wherever they are. Most patients are seen in-home, in long-term assisted living units, SROs, or board and care facilities.

Home visits allow frail persons who can't make regular clinic visits to engage in ongoing therapy, and it expands the concept of the clinical frame. Aspects of a patient's life are often presented immediately to a therapist. This can be helpful, providing insights from examples of problematic behaviors — such as the degree of hoarding and cluttering. It can also be overwhelming and the concrete nature of this information can hinder the unconscious.

Many elderly clients are lonely or even wish their therapist was a friend. Meeting in-home can blur this distinction. Maintaining respect for the frame, yet occupying a professional role in the space traditionally 'owned' by the client can be tricky. Some of the containment or neutrality of the consulting room must be present in the body of the therapist. When first starting this work, my sense of abandoning clients in their homes after delving into their most painful wounds worried me considerably. After meeting with a client following a particularly difficult session, I learned that having the memory of the therapist on her sofa helped her integrate the trauma at the base of our work.

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.