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~ Is It
Normal to Feel Bad? ~
Those Over Sixty-Five Dealing with
Barbara Riley-Baker, BA, MA, CMC, C.P.G.
D. is a seventy-two-year old woman who
lives alone. She has been a widow for
eight months. Her husband of fifty years
died suddenly as the result of a car
accident, (Mr. D was crossing the street
and was hit by a drunk driver). Mrs. D.
has a daughter who lives in Chicago, her
name is Mary. Mary stayed with her
mother as long as she could after her
father’s funeral, but Mary eventually
had to get back to work. Mary urged her
mother to move to Chicago, but she
refused. Mrs. D. assured her daughter
that friends and neighbors would be
checking on her and she would be fine.
She just needed time to adjust to life
without her husband.
sees her primary care physician on her
scheduled appointments about every six
months, unless a problem arises between
visits. Mrs. D. has several chronic
conditions arthritis, high blood
pressure, and osteoporosis. She takes
medications for her conditions along
with a daily multi-vitamin. Lately, Mrs.
D. has been showing signs of confusion,
anhedonia (marked disinterest in most
activities), difficulty sleeping, and
fatigue. Neighbors assure her these
changes are all just part of growing
old. She fears she may be
experiencing signs of Alzheimer’s
disease; she says nothing more to anyone
about these troubling changes for fear
of nursing home placement.
pays her mother a surprise visit on her
mother’s birthday and is shocked to see
the decline in her mother and her home.
Mary calls the primary care physician
and schedules an appointment for the
next afternoon. Mary too fears the
Smith is also surprised by Mrs. D.’s
flat affect and gives her a complete
physical and labs. Scans may also be
needed. While in the doctor’s private
office, Dr. asks Mrs. D. to tell him how
she is feeling, to describe a typical
day, and list her concerns. Dr. Smith asks
her numerous questions to test her
memory and also screens for depression.
The doctor concludes depression appears
to be the culprit.
Smith informs Mrs. D. that it is not
normal to feel bad; her symptoms appear
related to depression, not dementia.
Mrs. D. is greatly relieved. Dr. Smith
starts her on an antidepressant,
discusses how and when to take the
medication, lists possible side effects,
and schedules a follow-up appointment in
six weeks. Dr. Smith would like Mrs. D.
to see a counselor and gives her a
list of therapists in the area. She
agrees to give counseling a try.
begins to research the therapists on the
list and the type or model of therapy
they practice. Mary discovers there are
dozens of approaches to solving her
mother’s depression. Mary has to pick
the right practitioner for her mother.
learns that Client-Centered Therapy, put
forward by Carl Rogers in 1940, would
not be appropriate for her mother at
this time. This model focuses on client
self-discovery through empathy,
congruence, and unconditional positive
regard. The outcome of this approach
increases self-awareness and
self-esteem. Mary concludes this form of
therapy would be appropriate for
individuals who have specific issues
such as relationships. Mary believes her
mother’s depression is based on loss,
the loss of her husband and soul mate.
Mary investigates other possible
Individual therapy from a Family Systems
Perspective also proves not to be the
correct approach for Mrs. D.’s
depression. This model focuses on how
each person in the system influences
every other member of the system. Mary
concludes this model would work well for
wants to find the therapy model that
meets her mother’s needs based on where
her mother is now, what she is feeling
now, not issues Mrs. D. had as a child
or in young adulthood. Mary continues
researches the Ecological Systems Model,
by Gibson. This approach is not what
Mrs. D. needs either. This model focuses
on perception and prevention. Mrs. D.
needs counseling centered on her
Rational Emotive Therapy, founder Albert
Ellis, may be what Mary is looking for.
This model borrows from the cognitive
and the behavior theories. Its premise
states psychological problems are the
result of irrational thinking and
behavior that support irrational
thought. Counseling’s goal is to
increase the patient’s ability to think
and behave more rationally. Could Mrs.
D.’s depression be self-generated based
on irrational ideas? Perhaps, but Mrs.
D.’s depressed mood is due to real
issues, most likely grief and anxiety
due to the sudden death of her husband.
So many theories, there has to be one
for Mrs. D. Mary continues her search.
quest uncovers the Cognitive Therapy.
Martin Seligman refers to this approach
as “learned optimism.” Cognitive
training can turn negative thoughts and
behaviors into positive ones benefiting
one’s mental as well as physical health.
According to Hans Eysenck’s review of
personality and health studies, there is
a strong correlation between
personalities and disease. Feelings of
hopelessness and depression have been
associated with cancer and heart
disease. Eysenck and Ronald
Grossarth-Maticek conducted an
experiment in preventive medicine. The
results were amazing. The study
consisted of 100 heart disease and
cancer prone people. The participants
were divided into two groups of 50
people; 50 who received therapy and 50
who did not. The two psychologists used
cognitive therapy to teach 50 volunteers
coping skills to reduce stress, positive
ways to express their emotions, and
become more self-reliant. After 13 years
45 out of the 50 who received therapy
were still alive. Only 19 out of the 50
in the non-therapy group were still
Beck’s Cognitive Therapy of Depression
proposes sad mood and lack of motivation
to be the result of cognitive
distortions the patient holds about
himself, the world, and their future.
Three basic beliefs interfere with
reasonable information processing in the
1. I am
inadequate, deserted and abandoned, and
world is an unfair and harsh place.
There’s nothing in it for me.
There is no hope for the future. My
current troubles will never go away.
therapist’s goal is to assist the
patient in altering these beliefs in
order to improve the patient’s emotions
and motivations. Mary was definitely
getting closer. Cognitive therapy deals
with thoughts. Abnormal thoughts lead to
Behavior therapy focuses on behavior,
emphasizing current conditions that
maintain a behavior. All healthy or
abnormal behavior is learned. This
approach is based on Ivan Pavlov’s classical conditioning, learning
refers to associations formed between
events and actions, B.F.
Skinner’s operant conditioning, the likelihood of repeating a behavior
depends on the consequences of the
behavior, and Albert Bandura’s social
learning theory, learning occurs by
watching other people. Behavior
therapy is problem centered not person
centered. “The origins of a problem are
not as important as the conditions that
keep it going.”
knew her mother needed a psychologist
who practiced cognitive and behavioral
therapies. Mary also thought a woman
therapist would have a better repartee
with her mother. Mary began calling the
therapists on Dr. Smith’s list. Mary
inquired which therapy model or models
the clinician practice, whether or not
the therapist was a female, what
literature each office had pertaining to
the therapist’s training and experience,
the therapy process, goals, usual number
of visits, costs, etc.
third call seemed to be a perfect match
for her mother’s needs. The office sent
the requested information as well as the
intake forms for Mrs. D. to complete
prior to the initial visit. The packet
arrived three days prior to the
appointment. Mary reviewed the
literature with her mother and helped
complete the paper work. Mrs. D. seemed
more comfortable with concept of
therapy. She was already starting
to feel a bit better due to the
prescribed antidepressant. In
counseling, the therapist helped Mrs. D.
deal with her tragic loss and grieve for husband. She also
stated attending group bereavement
counseling. The counselor gave Mrs. D.
tools to use for the anxiety created by
uncertainty about her future alone.
Through homework assignments and therapy
sessions Mrs. D. learned that she could
carry on without her husband and that
time would help ease her pain. She
regained her self-confidence and
returned to the activities she
previously enjoyed. The combination of
medication and counseling was able to
give Mrs. D. her life back. She knew if
the negative thoughts ever returned she
could call her therapist to schedule a
Many seniors suffer from untreated
depression. Depression as previously
stated makes one prone to heart disease
and cancer. Depression needs to be
addressed; it is not a normal part of
aging. It is not normal to feel bad.
Seniors benefit as well as younger
patients from medication and counseling.
Primary care physicians need to look for
depressive symptoms in their elderly
patients and treat with drugs and
counseling. Cognitive and behavioral
therapy seems to be appropriate for all
seniors dealing with depression and its
Adam. Psychology for Dummies.
Hoboken, NJ: Wiley Publishing, 2002.
Morton. The Story of Psychology.
New York, NY: Anchor Books, 1994.
Florence W. “Individual Therapy Form A
Family Systems Perspective.” American Psychological Association
10, 2005 www.apa.org/
Lipstein, Owen, Marnao, Hara Estroff.
“Loss loss loss.” Psychology Today July1992: pages1-12, Oct.10,2005. http://cms.psychologytoday.com/articles/index.
“Cognitive-Behavior Therapy.” American Psychological
Association Pages 1-4, Oct. 10,
Nathaniel J. “Client-Centered Therapy”
pages 1-4, Oct. 10, 2005 www.apa.org
Seligman, Martin. “Avoiding Catastrophic
Thinking.” May/June 1994, Oct. 10,