Deconstructing Demons: The Case of Geoffrey
Keywords:aging, comorbidity, transdiagnostic approach, cognitive behavior therapy (CBT), executive skills training, baby boomers, African American
Research in late life mental health has not kept pace with the rapidly aging population of the U.S. Older adults (over age 65), more specifically the “baby boomer” cohort, are likely to pose unique challenges to mental health care providers. This report describes the case of Geoffrey, a 66-year-old African American male who presented with a complex range of psychiatric conditions (e.g., major depressive disorder, social anxiety disorder, and a history of polysubstance dependence), and challenging life circumstances (e.g., limited financial and social resources, and poorly controlled medical illness). Because Geoffrey also evidenced impairment in several cognitive domains (attention, memory, executive functions), a combined intervention of executive skills training (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) and cognitive behavior therapy (CBT) was selected. Furthermore, because time for conducting therapy was limited (fourteen, 90-minute sessions over a ten-week period), a “transdiagnostic” approach was taken to maximize efficiency. Results suggest the utility of augmented, transdiagnostic therapies to achieve optimal response with older clients. Although Geoffrey’s intervention progressed well, an event occurring late in treatment changed the course of therapy and led to an unexpected outcome. Several noteworthy aspects of the intervention, including the relevance of Geoffrey’s case to the current aging trend in the U.S., the use of a combined transdiagnostic intervention, and aspects of the therapy process are discussed throughout.
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