Depression, Physical Decline and Existential Psychotherapy in Late Life

Late life brings with its wisdom, long experiences, contentment, and respect, love and care of many generations in the family. As an individual grows older, however, decline and changes are inevitable, too. So that, very common among the older persons are feelings of depression. How can this rapidly increasing population with growing demands for better quality of life, be helped? I conducted a research based on the Frankl’s Existential Theory and Logotherapy [1] and designed and implemented an intervention program for late life depression. The research had three phases. In Phase One, old participants (n=37) were administered tests and especially selected using the variables on age, cognitive functioning, depressive symptoms, gender, and perceived disability functioning. From those who qualified (n=28), 10 were randomly selected to participate in the Focused Group Discussion. From them, common themes and topics in old age were identified. These became the basis of the topics, tasks and activities of the intervention program. The program called the Existential Psychotherapy for Old Persons was designed and developed.

In Phase Two, the program was implemented in 18 sessions for eight weeks. 10 participants completed the 18 sessions. To measure effectiveness of the program, levels of depressive symptoms were monitored at the end of the sixth session, the 12th and the 18th session.

In Phase Three, four of the 10 participants to the Existential Psychotherapy for Old Persons were selected as subjects for the case study method. They narrated their stories to establish symptoms of depression. They were also asked factors which they considered to have contributed to the effectiveness of the program.

Phase One of the research, found a very high prevalence rate (94%) of depression among old people. Phase Two established three important points. First, old age depression can be described to be about emptiness, problems in memory, boredom, preference to stay at home, feeling that others are better, and helplessness. These were common symptoms of depression reported by the participants before the intervention was implemented. Secondly, after the implementation of the intervention, some symptoms reported before the start of the program were no longer present. Hence, the program can be described to effectively regulate feelings of energy, good spirits, and satisfaction in life, worth, happiness, hope, and going out and trying new things. Thirdly, statistically, therefore, a significant difference between levels of depressive symptoms reported before and after the intervention (Asymp. Sig. 2-tailed = 0.043) was found.

In Phase Three, factors were identified which were perceived to have contributed to the effectiveness of the Existential Psychotherapy for Old Persons. These made up the meaning triad [2] of the program or the creative, experiential and attitudinal meaning or values of the program. Meaning was experienced by the participants in the existential activities and tasks, in the relationships they recalled from the past, in the relationships they developed with the facilitators and other participants in the program, and the lessons they learned in spite their pain, suffering and negative experiences.

The Existential Psychotherapy for Old Persons was implemented in 18 sessions, in eight weeks or two months. The program generally aimed to recall and enumerate experiences which are sources of despair, sadness and joy and inspiration. The program facilitated the exploration of emotions and beliefs in attempts to assign options or new options for creating meaningful experiences.

Twelve sessions were conducted in group and six sessions were on one-on-one sessions with the participants. In group sessions, the participants were brought together in a specified venue for activities for about 90 minutes each session. Individual sessions were conducted in the homes of the participants for 45 minutes each session. Sessions were prepared according to themes about age in old age, developmental stages, physical body, family, salary and pension, services to others, calamity or disaster, farewell and goodbye, God, gatherings, personal values or wishes, and thanksgiving.

The program included strategies such as meditation, physical exercises, reminiscence, life review, individual work, group work, story-telling, song singing, coloring-task, drawing, individual disclosure, small- and big-group discourse or sharing, insight, integration, prayer, care of pechay plant, home visitations and interviews.

Each group session was composed of five parts. It had opening activities like meditation for the older participants, body exercise, singing or dancing, and prayer. The next was the working part with instructions and group or individual tasks to the old participants. The third part was sharing and processing. The fourth part was the transformation and integration part with insights or action plans. And the fifth part included closing prayer and songs.

The fifth session of the intervention program was titled Ang Akong Lawas (My Body) and especially designed to explore and delve into issues of the physical body of the participants or to acknowledge physical capacities or decline. Printed drawings of body were distributed. The participants were asked to acknowledge hurting and painful parts of their bodies. Then, with the printed drawings, they color-shade those parts. They recalled experiences associated to the painful parts of the bodies. And more importantly, they were asked to recall experiences of gratefulness and joy and lessons learned despite pain.

Meaning was found in the courage to bear the suffering and pain, and in the support provided by family and relatives in helping them handle physical concerns, and also in actively providing care for the self and one’s own body. There was recall of times and gratitude in relationships when, for example, in spite hospitalization and physical pain, children came to take care of the participant:

They came back home. I thanked God for my children. I was so happy they came home, and they took good care of me.

Suffering was remembered with care and concern:

I thank God for the concern and worry of my husband.

The attitudinal meaning includes becoming more aware of the need to provide care for one’s body:

Sometimes, the reason of man’s body pain is about the food we eat. We must be conscious of healthy foods so that we help ourselves take good care of ourselves.

Session Five, as like the other sessions of tasks and activities of the designed and implemented intervention program, effectively facilitated the search for meaning in late life and finally, regulated depressive symptoms of the participants. Physical decline is an existential reality in old age and can contribute to feelings of depression. Existential Psychotherapy, the participation to the Existential Psychotherapy for Old Persons, and the search of meaning in the experiences of physical decline, however, can help regulate feelings of depression. The tasks of Session Five led to an exploration of suffering and pain, and the meaning of physical decline.

I acknowledge help of my teachers and assistants to the research. I am thankful to Xavier University and the CHED-R10. I am deeply grateful to my Senior participants. And I am blessed with the loving support of my family and of my husband, Cristian Evan Contreras.

No conflict of interest.

1. Devoe D (2012) Viktor Frankl’s Logotherapy: The Search for Purpose and Meaning. Student Pulse.
2. Lewis MH (2011) Defiant Power: An Overview of Viktor Frankl’s Logotherapy and Existential Analysis.