Clinical support

Key considerations for counseling older adult clients

Find effective therapy counseling approaches for older adults that support mental health, improve connection, and foster resilience in later life.

December 19, 2025

By Savanah Harvey, AMFT

10 min read

By Savanah Harvey, AMFT

Supporting older clients often forces us to slow down, expand our perspective, and approach a lifetime of spoken and unspoken experiences with curiosity. For many therapists, working with older adults is challenging, as it often comes along with layers of grief, a new lack of independence, illness, and generational norms that often view therapeutic work as foreign. Keeping those hurdles in mind, we’ve created a compassionate framework to help guide you in designing treatment plans that respect the pace, experience, and realities of later life while uncovering the strengths to push through.

Understanding the unique mental health landscape of older adults

As adults enter the later phases of life, mental health challenges may persist. Symptoms such as irritability, somatic complaints, and cognitive changes may seem common in older adults, but they are clear indications of the 6.2% of older adults suffering from depression. As these symptoms compound, social isolation, cognitive decline, and chronic medical conditions begin to intensify, making assessment and treating adults over the age of 65 more complex.

Many clients and their families label these symptoms as anxiety or “just another part of getting older.” This discreditation and misconception is a key contribution to a significant treatment gap as nearly 70% of older adults never receive the care they need and deserve. As clinicians, it is our responsibility to reframe aging not as a slow, inevitable decline but as a chapter and opportunity where growth, healing, and meaning are possible and accepted.

Breaking through generational barriers to therapeutic engagement

For many adults, therapy is either an entirely new experience or one that has been deeply stigmatized. The generation of older adults today may have grown up being told that emotional struggles weren’t a priority and were to be handled privately.

As you begin to learn about a patient's pre-conceived relationship (or lack thereof) with therapy, remember to be patient and intentional as you build rapport. Using inclusive language like, “Let’s look at how you experienced this situation together,” normalizes therapy as an open, collaborative conversation rather than a diagnosis or clinical intervention. It’s a means to shift the energy in the room from walled resistance to trust-building.

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Adapting communication strategies for effective therapy

Practicing clear transitions between topics can help older clients feel more engaged. Asking re-affirming questions like, “What I’m hearing you say is _____, am I getting that right?” or “Does this track for you?” grounds the client into their work and the relationship you are building together.

Work with your client to set a pace that feels comfortable to them. Intentionally leave room in the conversation for questions, and use clear, concrete language when processing complex emotions and memories.

Therapeutic approaches that resonate with older adults

Understanding how certain treatment approaches align with the developmental tasks of later life helps keep therapy feeling natural.

Reminiscence therapy is exactly what it sounds like. It helps older adults reflect on their many life chapters, highlighting the resilience needed and identity formed along the way. This might look like supporting clients in reflecting on their earlier life roles, whether they spent years as a caregiver, experienced life in the military, or giving them an opportunity to revisit old relationships or creative experiences that shaped who they became.
Life review therapy equips clients with the tools to explore their life through a “meaning-making” lens. As they explore their legacy, work through unresolved emotions, and identify the moments that shaped their lives, they begin to take control of the storyline of their life. This may look like practicing forgiveness with conflicted relationships, recognizing the impact they have had on their families, communities, and loved ones, or identifying the common themes that are present in their life story.
Narrative therapy offers older adults the opportunity to re-author their life story. This gives clients a sense of autonomy while helping them separate their identity from loss, illness, or aging-related changes while focusing on strengths, values, and who they are today. This may look like reframing physical decline, loss, or grief through a perspective centered around wisdom, gratitude, and adaptability while honoring who they’ve been and how it’s influenced who they are today.

For older adults battling anxiety or depression, adapted CBT can be extremely effective. In addition to mindfulness and strength-based interventions, slowing down the pace, providing homework assignments, and practicing more repetition reminds older adults that therapy is less about symptom removal and more about restoring and building connection to oneself and one’s unique journey.

When using adapted CBT, rather than asking a client to complete a detailed record of thoughts and feelings each day, you might encourage them to focus on a single recurring thought, worry, or behavior. After encouraging this focus, provide a brief homework prompt, such as “When this [thought, worry, behavior] showed up, what helped you feel 5% more safe, steady, and grounded?”. Using the same weekly prompt can help the client see the gradual change without feelings of overwhelm.

Addressing physical limitations in the therapeutic setting

As your clients enter older adulthood, designing sessions with accessibility in mind communicates a safe, inviting, and respectful relationship. If you have clients with physical and/or sensory limitations, consider their abilities when planning your room layout as well as the lighting, sound, and overall comfort of the room. Keeping the lighting soft in in-person environments and ensuring audio clarity during telehealth appointments will help the client feel safe and comfortable. If a client is uncomfortable or in pain, the willingness and ability to grow will be limited.

Small details can make or break a therapeutic relationship. Use a simple checklist like this one when creating your therapeutic environment:

Comfortable, stable seating with back support and sufficient height so it’s not difficult to get out of
Amplified audio or visual aids if/when needed
ADA-compliant pathways and accessible seating arrangements
Option for telehealth
Printed summaries of session

Navigating grief, loss, and end-of-life concerns

For older adults, grief is not a single event but often becomes a common theme. As loss of loved ones, abilities, roles, and identities become more frequent, grief can become a main character in the emotional story of later life. Discussing layers of grief in therapy can help clients explore grief’s presence in their lives with curiosity, rather than collapsing into hopelessness.

Gently inviting patients to explore their grief may look like:

“What loss has been the hardest to carry?”
“How has grief/this loss changed the way you view yourself?”
“Despite the change, what still brings you meaning, even in the smallest way?”
“What does your grief tell you about this relationship/experience? What do you miss about this person/experience that you want from other people/experiences in your life?”

Using open-ended questions around grief creates a space to explore fears around death, decline, or a change in identity. When we explore the topic with empathy, curiosity, and a balance of honesty and containment, clients feel supported to process the feelings of overwhelm while reconnecting with purpose.

Integrating family systems in geriatric therapy

As adults enter the later stages of life, it’s essential to consider family involvement and the potential effects aging has on family members. Adult children may begin to hover, overstep, or dismiss concerns, often in response to seeing their parents enter a new, slower chapter of life. Additionally, partners of our older adult clients may also be navigating their own aging challenges, meaning a change in the rhythm and role of their relationship. Exploring these relational shifts, goals, and dynamics allows us to support clients in strengthening autonomy within the family, rather than minimizing it.

Self-care strategies for therapists working with aging populations

Working with and supporting older adults means participating in conversations and thought processes about death, regrets, and the realities of decline. While deeply meaningful, this phase of life can be emotionally taxing, especially on younger therapists. Being mindful of how the appearance of countertransference in the form of protectiveness, urgency, or personal grief, accumulates and shows up in life outside of the therapy room. In order to continue to support older adults, prioritizing self-care practices that regulate your nervous system helps to sustain your presence, compassion, and understanding over time.

Headway can strengthen your practice

Counseling older adults invites us to treat the areas where grief, identity, and resilience intersect. When we use intentional pacing, clear communication, and evidence-based frameworks, therapy can become a place where older adults feel seen, sometimes for the first time in their lives.

Headway’s tools, from streamlined scheduling to accessible, population-specific resources, support you in meeting the needs of your clients with clarity and compassion. With Headway, we work with you to ensure that every client, at every stage of life, receives the care they need to honor their story.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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