The big issue: Fighting ageism from the therapy room
Therapy Today, April 2024

Ageism is arguably one of the final frontiers in the battle against discrimination. It’s been called ‘one of the last socially acceptable prejudices’¹ as it’s easy to perpetuate and elusively hard to identify and challenge. Despite our increased longevity – life expectancy in most parts of the world is now one decade more than our parents’ generation and nearly two decades more than our grandparents’² – society is still fundamentally ageist and reluctant to accept that the wellbeing and potential of older people are directly related to our economic survival.

As psychologist and longevity researcher Laura Carstensen puts it, society has persuaded us that ‘coping’ is the main task of ageing – an inherently passive, defensive stance,³ a process we are at the mercy of rather than one we can engage with.

As a profession we’ve seen a huge increase in awareness of equality, diversity and inclusivity issues over the past four years, and an explosion of CPD on race, gender and sexuality – yet a noticeable lack of training on ageing. This begs the question – are we as a profession part of the problem? As the roots of ageism lie deep within our own prejudices – most of us fear ageing and death, and dominant social and cultural discourse and most contemporary media nurture and amplify this – is our own internalised ageism a barrier to us meeting fully the needs of the ageing population?

With the global population both shrinking and ageing at a considerable rate, age inclusivity in society has never been such a clear and present need. A cultural shift in attitudes towards ageing is not simply the ‘right thing’ to do – it’s essential to the global economy, particularly as the younger workforce is in decline. It is predicted that between 2018 and 2035 there will be 300,000 fewer workers under the age of 30, and one million more workers over the age of 50 in the UK.²

Discrimination 

Today’s workplace cultures may be more accepting of diversity and tolerant of individuals’ expectations of flexibility in their working lives⁴ – but they are still riddled with outdated and endemic attitudes towards ageing. The number of people still working into their 70s has already doubled in the past 10 years and is anticipated to continue to grow,⁵ yet between 2019 and 2021 the number of age discrimination tribunals also rose by 74%.⁶

But ageism isn’t restricted to the workplace – it’s so entrenched in everyday life that few of us even react to blatantly ageist advertising and media narratives about ‘winding back the clock’ and ‘recapturing your youth’, promoting the trope that ageing is a deficit game. There are no social media pile-ons or attempts at cancelling comedians who get laughs from deriding older generations’ attitudes to technology, emerging music, language and ideas, whether it’s Lee Evans on YouTube asking, ‘Why have old people got such big ears, and yet they hear… less? And they all wilt after they get to a certain age, what’s going on with that?’ or Lachlan Patterson offering, ‘You ever want to learn patience – sit with your father and watch him try to enter his email address with a TV remote’, or clickbait articles promising ‘22 photos of confused old people on the internet that’ll warm your heart and make you laugh’.

Even small talk reveals how entrenched ageist ideas are in our society – we ask young people what they want to be when they grow up, younger adults what plans they have for their next career step, and newlyweds if they plan to start a family, but once we hit middle age, suddenly the future-focused enquiries stop or are limited to when we’re planning to ‘slow down’ or ‘retire’.

Workforce

Last year, the UK Government’s Chancellor, Jeremy Hunt, infamously encouraged the over-50s to ‘get off the golf course’ and go back to work, responding to the data that showed that the pandemic created a trend of people in this age bracket dropping out of the workforce, adding to the shortage in skilled workers. Yet even this apparently pro-age comment was loaded with the typical microaggressions that older adults experience daily – not only perpetuating the stereotyping of the over-50s as financially privileged and somewhat self-indulgent but also showing no recognition that during and since the global pandemic older workers were more likely to be at risk of losing their job,² and to struggle to get a new one.

Another barrier is that despite the rise of hybrid working post-COVID, most jobs follow the traditional structure of set hours and limited flexibility. This makes many jobs impossible for the 20% of the population aged 50-69 years in England and Wales who may be providing informal care for spouses, parents or other older family members. Around 60% of unpaid carers are 50 years old or older.⁷ A long-term client of mine was made redundant from her role at a bank where she had worked since leaving school. As a single, middle-aged mother of five and grandmother to three, she had a financial imperative to recover quickly from this loss that she was experiencing on many levels and find an alternative career in her mid-50s. It wasn’t only her confidence and sense of identity that held her back – shortly after her redundancy she became the sole carer for her elderly, dying father with whom she had a complex relationship. Quite apart from the mental and emotional load of the confluence of these two major life changes, she had the practical barrier of finding a job, at her age, that allowed her the flexibility to accommodate her carer responsibilities. She did eventually find a very rewarding job, with some flexibility, but the challenges she experienced in getting there are shared by a large number of people in their 50s, 60s and 70s.

Health

Combating ageism and creating a truly all-age inclusive society also means being open to making reasonable adjustments for physical disabilities and chronic conditions. Fifty per cent of those in the workplace who have long-term health conditions are likely to be over the age of 55,⁸ and in that age group the amount and impact of long-term health conditions have increased by more than 40% in the four years since the start of the COVID-19 pandemic. But such people also face prejudice and assumptions that they don’t want to work or have little to offer. One client I worked with had chronic, debilitating pain due to an early career that was physically demanding. He was approaching midlife and wanted to find a way to accept the pain and limitations on his body and find a more meaningful career and life path in working in the third sector. His journey there took many months of work with me and within himself to find acceptance for his new embodied identity, and of grieving his past career and connecting with his purpose again. It also involved navigating job adverts seemingly aimed at younger people – with an emphasis on being ‘dynamic’, ‘ambitious’ or ‘energetic’ rather than ‘experienced’ or ‘skilled’. He was determined to find the right job and had much to offer, and after failing to even get an interview for several positions, a forward-thinking employer gave him a chance and he instantly thrived in his new role. 

Ageism has an even more invidious impact on minority groups. A prominent US longitudinal study into women’s health concluded that for black and minority ethnic women, the chronic stress caused by institutionalised racism impacts cardiovascular health, disrupts digestion and triggers inflammation, leading to greater risk of diseases and reduced resilience to illness and the ageing process.⁹ Awareness has also increased of racism within healthcare settings, including mental health services, creating another potential barrier to optimal health and wellbeing in later life for people of colour. 

Life events

Of course, as a profession that is dominated by older adults (52.25% of BACP members are over the age of 55)¹⁰ counsellors are no strangers to ageism. Many of us are attracted to the profession in midlife simply because it’s one of the few careers where being older can be an advantage and where the wisdom that comes with life experience is valued. But we’re also not immune to ageism and may doubt that we still have something to offer in later life, perhaps prompting a decision to stop working before we would like. In addition, our own internalised ageism may mean that older clients will find themselves objectified not only in society but marginalised within the very psychotherapy services from which they could richly benefit.

Older clients have much to bring to therapy – developmental theory suggests the period of life between 50 and 80 involves reflection on our lives so far, seeking purpose, awakening to bodily changes and mortality, and redefining our identity in a youth-focused world. We do not stop wanting to live successfully, to grow, change or heal as we enter the second half of our lives. Our personal growth journey continues and, I would argue, even intensifies, right up to the point we take our last breath. We often navigate this rich inner landscape over years or decades, the sands shifting within us while we try to maintain our working life and careers. The life events stack up as the years pass, and losses begin to multiply – children leaving home, elderly parents requiring care or dying, confronting our own failing health, and possibly facing divorce (data that show living longer after retirement is driving up grey divorce rates, with the over-65s the age group seeing the fastest rise).¹¹ Irvin Yalom, the existential therapist and theorist, calls these ‘awakening experiences’ – life events that can move us from the everyday into the ontological – the awareness of our being, our aliveness and ultimately our death. As we move through them, they will inevitably impact our lives, both practically and emotionally. And yet older people are still not consistently accessing counselling support. Although one in four people aged 65 years and over are living with depression and anxiety, they are much less likely to get the support they need, according to Age UK – this age group constitutes only five per cent of referrals to NHS Talking Therapies.¹² We accept that specialist youth counselling services, although underfunded, are a unique psychotherapeutic offering, but there are few calls for more funding for counselling for an arguably equally vulnerable cohort – older people. The source of depression and discontent in later life still tends to be attributed to the individual – the ‘grumpy old person’ trope – with little acceptance that the pro-youth environment we live in plays a major part. 

Freud famously stated that older people were not able to make effective use of therapy.¹¹ While few people would admit to holding this view today, some of the barriers to older people accessing therapy may come from their own perceptions or situations – they may worry about being a nuisance if they have grown up being told ‘not to make a fuss’ in the post-war era, or have reservations about working with younger counsellors or in some cases issues physically accessing therapy services. It is our job to help people navigate these if they wish to.

Progress

There are some signs of a cultural change in our profession. BACP guidelines on working with older people were published in 2019,¹³ and we are beginning to see training emerging in this space – although not at the pace we need, given the phenomenon of our ageing, shrinking population. When I began a placement in my final year of training within a service working with the elderly and searched for literature on this topic it was sparse, and that which was most useful only focused on dementia. It was partially because of my frustration that I wrote my own book on the subject at the time – I simply couldn’t understand why more people consider it as a specialism. If we are to provide a fully adaptive, flexible, informed counselling provision for older age groups we have much more to do.

The good news is that this is not as hard to achieve as we might think. As counsellors, when we meet with older adults in the therapeutic space, what is asked of us is that we are not only free of prejudice but that we account for our own views and experience of ageing so that we have freedom to be with the unique individual before us, with all their lived experiences. We must also strive to actively provide an environment that does not create obstacles for older adults to seek support. Finally, and crucially, we must focus on empowering those we are with, and allow for the same growth-orientated curiosity and enquiry and powerful moments of interrelating that we would hope to co-create with anyone of any age who chooses to come to counselling. There are few better places to explore these possibilities than within the safety of a trusting counselling relationship. It’s time we woke up and accepted that age inclusivity isn’t about older people – there is no ‘them’ in ageism, it is about all of us. Our combined bright futures depend on it.