When discussing their clinical experience of the advantages of using CAT in supporting older adult patients, Hepple and Sutton (2004) draw upon its helpfulness in examining life events to inform complex, relational causes of distress in later life. Specifically, Loates (2004, in Hepple and Sutton, 2004) discussed the systemic and organisational effects of long term psychiatric care provision, noting that very often clients who may have had support for many years prior to accessing psychological therapy, will have acquired the unhelpful label of ‘treatment resistant’ following several courses of medication change and, in some cases, ECT. The unfortunate paradox being that,’for many clients accessing older adult services for support, it is highly unlikely that they will have been offered psychological therapy until that point of last resort (Loates, 2004). Consequently, both services and the client may find themselves in a dual position of being ‘stuck’ in terms of progressing further with regards to distress reduction. Such stuck-ness in combination with the tendency of services to view older patients within a purely biological and ageing context devoid of relational, social, and life history can serve to reinforce the ‘stuck’ state for both services and the patient (Loates, 2004). Loates goes further, citing specific examples of ways in which the particular processes of CAT have helped clients to begin to notice and process powerful emotions, thus leading to a position of becoming ‘un-stuck’. For instance, Loates (2004) describes the case of Mrs A – a woman in her seventies, who experienced significant distress as a consequence of rumination. In unpacking difficult parental relationships, noting down reciprocal roles, the use of the reformulation and working towards an ending, she supported her patient towards a point of understanding and the processing of powerful and painful emotions. Mrs A had not been afforded this opportunity by services previously.

An additional advantage in using CAT with older adults is that of its potential benefits of supporting patients experiencing distant trauma. Robbins and Sutton (2004, in Hepple and Sutton, 2004) argue there is a lack of therapeutic models designed to address complex or very distant trauma, suggesting that current approaches serve to treat sudden or unexpected trauma experienced relatively recently. Robbins and Sutton (2004) argue that CAT, as an integrative approach, offers a clear model which provides scope in which to address distant trauma, thus offering very specific opportunities in supporting older adult patients. Hamill and Gaskell (2014) support such an argument, citing the use of the therapeutic relationship for the purposes of promoting well-being and the bringing about of change within CAT being particularly pertinent as factors supporting emotional regulation in later life. Hamill and Gaskell (2014) go further, arguing that the ability of CAT to explore early life experiences in the context of trauma and its subsequent effects upon the lived experience of an older adult patient offers a unique under- standing of their distress and serves to reduce feeling of self-blame and shame. Hamill and Gaskell (2014) argue that this process consequently can open the door for older adult patients to experience changes in their self-to-self and self-to-other relationships.

The literature presented here highlights the very specific and specialist needs experienced by patients aged over 65. It is argued that CAT offers a unique model which can complement and explicitly support such needs (Hepple and Sutton, 2004). Sutton (personal communication, in Ryle and Kerr, 2002) writes that while she found CBT to be a useful model in working with aspects of anxiety in older adults, she felt it fell short of fully appreciating the effects that life experiences can have upon the clients she supported. CAT, Sutton felt, was a useful model by which to draw upon early and later life experience, and to value the impact that a life lived with many relationships can have upon her client’s current situation. Sutton argues that CAT, more so than other therapeutic types, is able to value and take into consideration a rich life story, and it is for this reason that CAT ought to be especially applicable to older people.

While theoretical literature provides context and depth for the possibilities and usefulness of CAT in specifically supporting people aged over 65, the evidence base for the use CAT in supporting older people remains limited. Indeed, in Calvert and Kellett’s (2014) systematic review, of the 25 studies that did meet the inclusion criteria, none focused solely on the efficacy of CAT in supporting older adults. Hamill and Mahoney (2011) argue that within their NHS service, CAT has shown to be, anecdotally, effective in supporting the psychological needs (which include depression and anxiety) in people aged over 65 years who care for a person with dementia. Hamill and Mahoney (2011) use case examples to demonstrate that CAT lends itself well to the specific needs of older adults, which may include a complex combination of bio- psychosocial and cognitive difficulties. While arguing a case for CAT in older adults, the current evidence base may benefit from studies which include larger sample sizes by way of broadening the empirical rigour of CAT in older adults.