New Futures for Older Clients: Psychotherapy as Art By Cecilia Dintino, PsyD on 4/9/20 - 12:47 PM

Joan comes for therapy at 60 because she feels lost and unsure of herself. Mary Jane sits in my office because she is sad and wishes her marriage of 30 years hadn’t ended. Corine feels bad about her body and finds her menopausal hot flashes unbearable. Lulu is depressed because she’s made mistakes in her life and doesn’t see anything changing.

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Psychotherapy dictates that I take their histories, assign diagnoses based on their symptoms, mine the past for the cause of their distress and, if appropriate, use cognitive behavioral skills to examine and manage their thoughts and emotions.

But what about creating new lives that Joan, Mary Jane, Corine and Lulu can grow into?
What might that look like? And who or what does one grow into at 50, 60 or 70 years old?

There are very few psychological theories addressing the developmental stages of life from 50 until death. The ones that do are vague and need updating. There seems to be a lack of imagination about what we can expect from life between “grown-up” and death.
There’s even more confusion about the role of psychotherapy when it comes to aging. Years ago, when my husband was in his mid 40s, he was told by a psychoanalyst that he was too old for therapy. Supposedly his development was over, and his psyche was too fixed for change.

How do we help clients understand and navigate the experience of aging if we don’t understand it ourselves? Recently, at 61, I considered doing another round of therapy myself. My wish was to evolve, perhaps transcend. But all that was offered to me was more digging into my past to “figure things out.” I don’t want to figure out that which has already happened. I want to figure out what to do and who to be next. Beyond symptom amelioration, what is therapy for? Is it just to fix? And why does it seem to always turn to the past?

Imagine a therapy for older adults that is future-focused and creative. What if therapy were more like art? A culture without art would be stuck and unchanging, doomed to repeat and remain fixed in the already known. A culture without art limits our unique potential. To infuse psychotherapy with the spirit of art is to make it about creating instead of repairing — keeping it future-focused and more than a review. Here are four bold challenges for psychotherapy with aging clients.

We need new visions and roadmaps for the stage of life between grown-up and dying.

What it can mean to be an older adult needs a radical reformulation and new, diversified visions. Our life spans have increased by about 40 years since 1900. This longevity supplies us with the opportunity for one or more life stages to make meaningful and of value. This requires psychotherapists to use their imaginations. If we are going to hold the space for others to think outside the box and reinvent what it means to age, it’s just as important to flex our own thinking, confront our own ageism and encourage beliefs and actions that shine light on paths not yet worn. In The Big Shift, Mark Freedman calls life stages “social construction projects.” He goes further to say, “What’s abundantly clear is that life stages don’t just emerge… They are… big projects requiring vision, language, leadership, institutions, and often social movements with multiple thinkers dissecting the same key questions”¹. Psychotherapists can have a critical role in constructing new life-stage possibilities for clients to live into.

Psychotherapy that focuses on the past is not enough to help us evolve.

Our stories, our memories, our experiences can serve our futures. We use the present to pull through the threads of our past lives and weave a fabric that will make something new. If we want to make change, if we want to evolve, we must look forward and stop trying to revisit and reset an elusive past. We are prospectors by nature. Martin Seligman in Homo Prospectus explains we are not doomed to repeat our pasts over and over. We are not stuck in stasis until the past is changed or until the traumas are resolved. Instead, we are creators of what lies ahead. We are activators, activists and authors of what is next. A psychotherapy that engages clients as makers rather than reactors will open doors to what else is possible for us all.

Individuals 50, 60 70, 80 and beyond would be best served with a psychotherapy that is future-focused.

Does this really sound so outrageous? Do you automatically think it makes more sense to serve older clients with a therapy that sums up the past and wraps up the narrative? Putting the affairs in order, so to speak. While reviewing the past as an exercise is indeed satisfying and can be beneficial in so many ways, wouldn’t it be much more potent if it included a future-focused purpose? The story is not over, after all.

A recent public health study by the Journal of American Medical Association (JAMA) demonstrated that subjects over 50 with a strong purpose lived longer and experienced better overall well-being. Purpose is future driven and motivates action and growth. To be alive is to grow, until we take our last breath. Psychotherapy could serve to enrich lives and extend longevity via a future-focused therapy.

All the above could be achieved by reconceiving psychotherapy as art (and not just a science).

In Art Thinking, Amy Whitaker says, “If you are making a work of art in any area of life, you are not going from a known point A to a known point B. You are inventing point B. You are creating something new — an object, a company, an idea, your life — that must make space for itself”². To socially construct new possibilities for individuals 50 and beyond, we use our imaginations, write new scripts, practice alternate identities and encourage bold action. Reimagining psychotherapy as art becomes a process and not just a product. It becomes and serves the process of becoming.

Joan’s therapy could be a design project. She can imagine her future self, strategize and act to become her. Mary Jane’s 30-year marriage is over, but Mary Jane is not. Her grieving can include dreaming and crafting a new identity and direction. She can rehearse new ways to be in and see her world. Corine’s menopausal symptoms are painful and disruptive. We can identify them as a portal for transformation and a new stage of life. Corine’s therapy can focus on locating her physical struggles in a narrative that gives them meaning and momentum. And Lulu’s regrets, even the devastating mistakes, can be composted and re-composed into a rich story that provides self-compassion and universal acceptance of our human experience.

Together, as a culture, with our clients and with each other, we can move from stuck and confused to innovators who create a new vision in the space that our longevity provides.


(1) Freedman, M. (2011). The Big Shift. Philadelphia, PA: PublicAffairs.

(2) Whitaker, A. (2016). Art Thinking. New York, NY: Harper Collins.  

File under: The Art of Psychotherapy