Psychoanalysis and psychoanalytic psychotherapy of the older patient. A developmental crisis in an aging patient: comments on development and adaptation.

The psychoanalysis of a depressed 69-year-old woman is described briefly. She was seen four times weekly for two years and treated on the couch. The goal of analysis was modified in keeping with the concept of her problem as a developmental disturbance of aging. Here the aim of analysis was not extensive character change, as is usual in treatment of a person with neurotic disturbance, but help in making the necessary adaptive changes in the phase of aging. There was relatively less emphasis on the "archaeological" treatment model of uncovering the predisposing childhood neurosis, and more emphasis on analysis of the patient's current character structure and its underlying dynamics. The patient coped with threats of object loss and narcissistic injury by living through others, both helping and controlling them. The case exemplifies the way in which the analyst dealt with the patient's narcissistic injury of having to come for therapeutic help, the analyst's use of empathy and effort to understand transference and countertransference, and the course and results of the analysis.