On the other hand, you might recall that you are paying to get your therapist's full attention, no matter how boring you fear or feel you are. You owe it to yourself to ask why, and no matter what your therapist says, one possibility you should consider is that your therapist might be both too old to practice and too addicted to the job to quit.

So proposes Lee Kassan, Associate Editor of "GROUP, The Journal of the Eastern Group Psychotherapy Society," which has devoted much of its current issue to dilemmas that face aging therapists and groups.  I asked Kassan to fill out this concept of job addiction. At what point does a healthy commitment to a profession become something dangerous, even pathological? 

As a therapist, Kassan says, he's speaking about addiction psychologically. When he sees someone pursuing something compulsively in order to avoid feelings and realities that pain them, he says, they are using that source of enjoyment as a drug; and if they can't stop seeking it, even though their attachment is destructive, it is fair to view them as addicted.

As a fan of HBO's series "In Treatment" whose mid-life protagonist, Paul, played by Gabriel Byrne, does not seem to enjoy being a therapist at all, (or anything else) one could have a hard time imagining why Paul would choose to sit in a chair analyzing other people's deluded meanderings when he could be reclining in a hot bath, wallowing in his own. But Kassan, whose  book, Shrink Rap, (1)  offered an informal survey of the therapy world, assures me that most practitioners of what is now called "the talking cure" (as distinct from the life-on-drugs cure), find their work deeply gratifying. 

Really? Kassan insists they do.  He says that  most psychotherapists, (when they are not dozing off) feel a sense of real connection with their patients; they care about them; they enjoy feeling useful. Nina D. Fieldsteel, writing in GROUP,(2) adds that patients give their therapists vicarious access to other worlds and professions, a pleasure that can verge on voyeurism.  

Additionally, beyond (or below) positive feelings about their calling, therapists, like many professionals, come to depend emotionally on their jobs. A certain respectability that comes with the shingle; there's a home away from home (complete with Kleenex box) in one's office; one becomes attached to collegial communities that won't persist through retirement.  Adding still further incentive, there's the charm of a steady and comfortable income---which therapists whose portfolios got castrated by the recession may now urgently need. And of course, there's the thrill of structured time, of having a pre-fab reason to get up in the morning, a habitual way to mark off -and fill--the day's ticking hours. Deeper down in a therapist's soul, practicing therapy bestows a mantle of expertise some may conflate-- and confuse -- with their core selves, or at least depend upon for their self-regard.  

As for the festival of murky feelings and realities that an aging therapist (or aging anybody) might not want to confront, Robert L. Weber writes in GROUP (3) that Irvin Yalom's book, Existential Psychotherapy, "boiled them down to four words: death, (loss of)freedom, isolation, and meaninglessness." These four horsepersons of dread are enough to drive even strong, self-aware people to distraction.  

Fieldsteel worries that therapists who are frequently in mourning or are ill themselves may be crushing the life out of their patients' sessions. She also lists among the aged therapist's physical and mental challenges our cultural bias against the old. Living under the forest canopy of society's distain and disgust can shade out a healer's light and sap the constructive energies that quality therapy demands. (4) 

So, because therapists are human, (for the time being, but that's another discussion http://www.zdnet.com/blog/emergingtech/mindmentor-the-first-robot-psychologist/860 ), old age scares them. And sometimes the joys of their work combined with their terror of death may cause them to delude themselves into thinking they're holding up better than they are. As one therapist Fieldsteel interviewed told her , "Ours is a wonderful profession; we can go on forever!" And some do. Sigmund Freud, in his decline, to distract himself from the wracking pain of his cancer, was still taking on new patients while the disease was devouring his jaw. Brave, bad Freud.

 And "bad" why? Because, what patients of post-functional therapists might be getting for their hard-earned recessionary dollar is cheated:  

• Age-denying therapists might be seeing more patients than they have mental energy for (hence the sudden snoring).  
• Sundowning therapists may be making appointments later in the day when their attentiveness declines.
• Even if the therapist stays awake, important clues patients drop about their problems and progress may be falling through a sieve of impaired memory.
• In single or group sessions age-impaired therapists may avoid bringing up their looming decrepitude, even when it's affecting a patient's reactions or might unlock important insights---about a lost parent, say, or a previous painful separation.
• Some therapists, as they get older, lose track of how the world works. To what's now a seventy-year old, for example, the degree and intensity of self-promotion now considered adaptive is apt to look pathological on anyone but a carnival barker. 
• Older therapists might not have stayed current on development in the field, new psychopharmaceuticals, for example, or tweaks and revisions of psychological theory. 

The question is, what to do about the age problem. Feldsteel reports that "many years ago, the New York Psychoanalytic Society suggested that after age 65, analysts should no longer accept new patients for psychoanalysis. " But people age differently, and many therapists are not only hale and sharp, but growing wiser with experience well into old age; so a generic ban on anything for senior practitioners hardly seems meet. Regular cognitive testing of the sort that "some experts," according to Laurie Tarkan in the NY Times, are recommending for older physicians and surgeons might be advisable; but therapists, like other health professionals, aren't knocking each other over for a chance to test the sharpness of their minds against their own jugulars.

The best available solution, according to Kassan, could be peer supervision groups. He is a fan of these collegial clusters and has just published a book on them. The advantage of having a peer group where professional problems can be discussed and reviewed, he explains, is that they are less hierarchal than one-on-one supervisions and can benefit from the perspectives or other subdisciplines. Nor are they as conducive to cowardice as are personal agreements with friends in the field to "Let me know when I'm losing it." Understandably, few have the heart to break that news one-on-one when the time comes.