Balancing Between Empirically-Supported Methods and Individualized Treatment Design in the Case of Geoffrey

Abstract

This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on "The Case of Geoffrey" (Mohlman et al., 2008). The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey.Keywords: African American; aging; comorbidity; transdiagnostic approach; augmenting cognitive behavior therapy (CBT); baby boomers _____________________________________________________________________________________ RESPONSE TO KNIGHT AND HYER COMMENTARIESThe commentaries on Deconstructing Demons: The Case of Geoffrey (Mohlman et al., 2008) by Dr. Knight (2008) and Dr. Hyer (2008) were thoughtful and comprehensive. We appreciate Dr. Knight's observation that there are few didactic resources for psychologists whose clients have multiple diagnoses (e.g, psychiatric, cognitive, medical), which is the rule rather than the exception with aging adults. Dr. Hyer points out the usefulness and appropriateness of the transdiagnostic approach, especially with clients who have a range of symptoms and poor prognostic indicators. The empirical case study is one way to begin to amass the necessary documentation for mental health practitioners to make informed choices about treatment planning when working with older adults with multiple problems. This response will address three major themes raised in the commentaries: the notion of cultural competence in the psychotherapeutic setting, possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults, and the growing use of cognitive remediation in the treatment of psychiatric disorders.

Embedding the silver thread in all-age psychological services: training and supervising younger therapists to deliver CBT for anxiety or depression to older people with multi-morbidity

“…tailoring to the individual whilst working with a coherent framework. [For a case-based discussion of the balance between individualising treatment and using empirically supported approaches, see Mohlman et al, 2008b. ] (3) Consider differences in client-therapist age as a form of cultural diversity Age is a protected characteristic (alongside disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) for which public organisations have a duty to promote equality and reduce inequality (Equality Act, www.gov.uk/guidance/equality-act-2010-guidance).…”