Just as it is impossible to draw a sharp chronological line between the young and the experienced, it is impossible to draw a sharp chronological line between the experienced couple and the older couple. It is true that the sexual functioning of the elderly (especially the elderly man) differs from that of the non-elderly in certain age-related physiological changes (time required for erection, length of refractory period, and so on) (Masters and Johnson). Sex therapy for the elderly must take these changes into account.
But in their extrasexual functioning elderly couples exhibit all the variations in type, intimacy, and style as do younger couples. Once age-related changes are recognized, sex therapy for the elderly is the same as sex therapy for the younger, with perhaps a stronger attitude on the part of the therapist that “forbidden” normal practices are in fact not merely permissible but even desirable.
The elderly are popularly supposed to be resistant to change, but I have not encountered this phenomenon in my own practice. I have concluded that this resistance of the elderly is not so much inherent as evoked. It is a reaction to two complementary sets of changes experienced by the elderly: those they perceive in their own physical functioning and those they perceive in the way they are treated by others.
The perception of internal change, especially the perception of weakening powers, can provoke anxiety. However, this anxiety can be managed satisfactorily by most of the elderly when they understand that weakening powers do not mean reduced gratification. But when this anxiety is coupled with the attitude of most other people that the elderly person is less competent and less useful than other people are, the elderly feel diminished indeed. This external attitude is harder to fight against because it seems to be confirmed by their own aging bodies. Undermined by the loss of their sense of themselves as accomplished, whole people, they regain a sense of mastery by assuming a rigid posture, by insisting on no-change. When the elderly then are directed to change, this insistence can be defended successfully and a sense of strength is gained.
But only let the therapist encourage the elderly with the same attitude of optimism with which he or she encounters younger patients, and the results are striking. When the external world confirms not the diminution but the sustenance of the elderly, the elderly most often will respond with a mental and emotional (and often physical) vigor that can serve as a lesson to the younger.
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