Review of Tammi Vacha-Haase, Stephen R. Wester, and Heidi Fowell Christianson, Psychotherapy with Older Men

Psychotherapy with Older Men
Tammi Vacha-Haase, Stephen R. Wester, and Heidi Fowell Christianson
(New York: Routledge, 2010) xxv + 187 pp.

Philip Culbertson

This is the eighth volume in a continuing series from Routledge devoted to issues of interest to scholars in Men's Studies, as well as to psychologists, counselors, psychotherapists, psychiatrists, social workers, and clergy. I wrote a review of volumes 3 and 5 in this series, published in previous issues of JMMS. At least seven more volumes are projected in the series.

In my previous reviews of two books in this series, I gave quite a strong recommendation to the readers of JMMS concerning their usefulness. With this book, I have some reservations. Don't get me wrong: this book should be indispensable for psychotherapists and psychiatrists who work with white older male clients. However, the intersection between masculinities and spirituality, which is the raison d'etre of JMMS, is granted only one brief insubstantial paragraph in this book, even though the authors concede that "religion and spiritual beliefs will play a role in the lives of many older men" (p. 47). If that is true (which I believe it is), then the book's failure to address the topic is even more glaring.

The previous volumes I reviewed were edited collections of chapters by a wide variety of authors with strong credentials. Rather than being an edited collection, this volume is team-written by three authors, all with academic credentials in psychology and psychiatry, who apparently have chosen to focus on the "hard clinical edge" of mental health treatment and counseling. Perhaps an exploration of the spirituality of older men was considered by them too ephemeral, or perhaps too "soft" (as it were—an overdetermined word to use with older men) to merit inclusion in the book. The role of sexual orientation in shaping the masculinity of older men is also given only one brief paragraph (pp. 46–47) and the role of ethnographic culture is given only four pages (pp. 43–46). I was disappointed by these slights, and believe that they significantly reduce the usefulness of this volume to many professionals who work in mental health or ministry.

I appreciated their clarity about their "Expectations of the Reader" (p. xxi). I can't recall ever seeing that so clearly stated in a book before. The authors write: "This book is intended for the experienced therapist … Expectations include familiarity with the American Psychological Association's ‘Guidelines for Psychological Practice with Older Adults' (APA, 2004) … and the Pike's Peak model of professional geropsychology." Yet, while I appreciated the clarity, I also was troubled, given how few people have been trained in practicing psychotherapy with older men, by the number of potential readers of this book who would immediately feel uninvited into the conversation. The study of the psychology (and spirituality) of older men is thus positioned as elitist, it seems to me, when in fact this specialist area needs to be opened up to more practitioners and those committed to the promotion of physical, emotional, psychological, relational, sexual, and spiritual [page 25] health among the target population. As a 66-year-old white male, who conducted a practice in psychodynamic psychotherapy for ten years and taught psychodynamic psychotherapy in a tertiary training program for mental health professionals for eight years, I wasn't even sure that I was invited into the conversation.

Fortunately, there is a small selection of materials other than this book on the market that address the target audience for JMMS, such as an essay by Edward H. Thompson entitled "Men's Faith: The Effects of Pre- and Post-Retirement Masculinities" (in The Spirituality of Men, ed. by P. Culbertson, Fortress Press, 2002); the chapter on "Religion, Spirituality, and Older People" by Alfons Marcoen in The Cambridge Handbook on Age and Aging (2005); and sections in the two-volume Aging, Spirituality and Religion by Melvin Kimble and Susan McFadden (Fortress Press, 2003). The subject of the religion and spirituality of older men is in need of much more extensive research, written in a manner that is intended to invite mental health professionals, caregivers, and pastors into the conversation.

When I was reading this book for review, I kept thinking about a sad experience I had last year. A friend and I went to a local nursing home to play an afternoon of piano duets for the residents. I noticed one frail older man in the room who was clearly depressed, by his demeanor, and who was accompanied by a solicitous younger man to whom the older man barely responded. What I saw bothered me, and I asked a nurse's aide about the older man. She explained that he was the only elderly gay man among the residents, that his family was all dead and he was painfully lonely and frightened, and that the younger man was his former neighbor who came to offer companionship from time to time, but the older man remained inconsolable. Psychotherapy with Older Men would probably offer little to that older man, either, since the Series Foreword (p. xiii) by Mark Kiselica falls immediately into the trap of presumed Caucasian heteronormativity, a presumption never really challenged by the rest of the book either.

There is much more yet to be written in the field of the psychospiritual needs of aging males. As a case in point, 84 percent of the suicides among America's elderly population are committed by males. Older men can easily become lost men—lost in their inherited gender expectations and their inability to live up to those often-rigid constructions as they age. This book says some very important things, but, to my mind, defeats its own usefulness by the restrictions and presumptions from which it starts.