‘Internal Reflection’ – Part of the ‘Mamma, In the Meantime’ Series
Shared with kind permission of Tony Luciani – © 2014 Tony Luciani.

Sarah Jackson’s moving account of Marjorie’s journey to herself.

When you really age, you are engaged, and from that deeper taste of being a participant, your life finds purpose and meaning, gifts of soul. Now aging is a joyful experience, because you want to be open to learning and experiences as you feel the seeds of yourself sprouting and blossoming in your evolving life.” (Moore, 2017,p.9)

Since starting my training with the Northern Guild, I was drawn to the term ‘Physis’ (Berne, 1957) – that innate powerful drive toward growth and self-actualisation that impels and surges throughout life. I have never experienced this more strongly than with my client Marjorie who, in her early 80’s, found herself deeply uncomfortable with the life she had led (and that which she hadn’t), and no longer able or willing to ignore the parts of herself submerged since childhood – now clamouring to be heard and have their needs met. No client had impacted me personally and professionally the way this lady had. I was in awe of her determination to become acquainted with her true self while there was still time, and to find what might finally bring her joy – having felt controlled and coerced by others for so long. Working with Marjorie was to be a profound lesson in the powerful force of ‘Physis’ – spurring her onward toward fulfilment and authenticity in this final phase of her life – (anonymised therapeutic material included with client consent).

When seeking to fulfil the requirement to work with older clients as part of my Northern Guild qualifications, I had no idea this would prove to be the most inspiring and enlivening work of my practice to date. So much so, I chose Marjorie as the subject of my MSc dissertation – a case-study focusing on the use of imagery and metaphor to connect with, illuminate and ease the impacts of early trauma. When reviewing the literature to sit alongside the case-study, I was shocked at the degree to which older people are viewed as a homogenised and stigmatised group – as Thompson (1993) pointed out: “While ageist stereotypes cast the elderly population as homogenous, older individuals are more different from one another than any other segment of our population” (Thompson, 1993, cited in Kropf & Tandy, 1998) – not least because of their extensive and unique life experiences.

Ageing also seemed often to be described as if a problem to be solved – with older people depicted as feeble, sick and miserable (as noted by Kerr, 1999, p.37). Marjorie was none of these things. She was creative, reflective, eloquent, determined and challenging. I was curious as to why older clients were so often overlooked in therapeutic and research terms. Was this in part because people didn’t see the benefit in working at therapeutic depth with clients who are in their later or perhaps last phase of life? I will admit that, when first working with Marjorie, I did have concerns about opening up the extensive wounds of her past. Would it be too much for her? Was it ethical? What benefit could there be to delving into such painful experiences at this time in her life, when much of what she’d experienced could not now be rectified? These were valid ethical considerations, which I not only took to supervision, but also took account of in my therapeutic contracting with Marjorie – trusting that, in inviting Marjorie to think about and express the depth to which she was happy to go, this would guide us safely through the work.

I was surprised to discover that research often misses older people as a group worthy of exploration or, where they are included, it is in terms of a specific diagnosis (e.g. PTSD) or life experiences (e.g. Veterans, Prisoners of War or Holocaust survivors) or illnesses (e.g. dementia or stroke patients in care facilities). The general ‘Community Dwelling’ (e.g. as discussed in Van Assche et al, 2020) older population are much less explored and included. And, even where they are, there are often limited methodological adaptations made to aid their full participation – which may be as simple as providing questionnaires with larger font sizes or consideration of any hearing issues in interview-based assessment (Thorp et al, 2017, p.434).

I came across other factors potentially influencing the lack of attention or inclusion of older clients. For example, cultural stigma that may have been instilled in older generations relating to mental health difficulties. Hiskey & McPherson (2013) speak of how older people may internalise distress – perhaps due to mental illness historically being aligned with social deviance or, how talking about one’s distress may be viewed as a sign of weakness or self-indulgence. Therefore, perhaps some older people do not speak up and seek help who might really benefit from it? Or perhaps, having sought help, their symptoms may be misdiagnosed as related to ageing rather than mental suffering? What I have learned from my own client is that the process of ageing – which will likely include new losses and changes in life circumstance – may be the precipitating factor that brings feelings of distress or stuckness to the fore, perhaps to such a degree that they can no longer be ignored or tolerated. This may be deeply uncomfortable, but can also be the swell of energy needed to inspire action. As Florida Scott Maxwell wrote in her 1968 memoir:

All emotions grow more intense as I age … As we age, we are more alive than seems likely, convenient, or even bearable.

(Maxwell, 1968 – cited in Kerr, 1999, p.38)

Marjorie first came to counselling for help with anxiety – now living alone since her husband of over 50 years was taken into care, and grieving the death of a dear friend. As she began to share her story, she described significant loss and trauma in her early life. Both her parents died in her infancy, she was taken in and raised by a domineering and affectionless family member, and singled out and humiliated at school for being an orphan. She described feeling extremely lonely, constrained and cruelly treated as a child, and remembered the constant fear that she’d be abandoned to an orphanage.

We began working with Marjorie’s own metaphors early on, when she identified her recent cutting back of ivy from a much-loved rose as being like the therapy she was embarking on – cutting away upsetting things that had been choking her. As her story of early loss and trauma emerged – and learning from my training and reading how imagery could provide a gentle channel for exploring such issues – I started paying attention to the imagery Marjorie brought to our sessions. We began to use this mutual language to explore her experience of self and others in the world. This led to some significant and recurring imagery entering our work – for example the image of a door – initially representing safety, both from abandonment and the perceived dangers of intimacy, and later moving to represent the possibility of freedom and real human connection. Similarly the metaphor of “Performing” became prevalent – symbolising Marjorie’s early ‘Adapted Child’ (Dusay, 1972) strategies for mollifying her strict care-giver, and later her means to portray happy relationships at the same time as keeping true intimacy at arm’s length.

Marjorie began to discuss her dreams in our sessions. One significant dream involved a fridge with shiny outward appearance but empty shelves inside. Inviting Marjorie to fill this fridge with what she would like, she initially did so with things that might be pleasing to others – noting “This looks a bit like my life doesn’t it? Have all the things that look good, but are not really good.” She then decided to fill the shelves with sweet treats “Things I really like but are condemned by others”. This felt strongly connected to her desire to have freedom to meet her own wants and needs – describing the feeling of doing so as “Very contented … feeling of achievement, to have had all these things put inside, to be nourished with the things that I love”.

Subsequently, Marjorie brought a dream of a little girl trapped behind a heavy door crying out to be acknowledged and set free. Revisiting the dream, I invited Marjorie to take whatever action felt right within the dream. She found a way to open the locked door, hold and comfort the distressed child, eventually leading her to safety and then merging with her. Marjorie stated: “I sort of analysed the dream as the little girl being me. The little girl needing attention, the little girl crying out for attention. The woman crying out for attention”.

Another significant moment in our work was when we undertook a guided imagery involving two imaginary friends from Marjorie’s childhood. In meeting and speaking with these two imaginary friends, it seemed they represented dissociated parts of herself that had not been tolerated in her childhood, and were only safe to bring out behind the safety of her bedroom door. This session helped Marjorie gain an understanding of these archaic parts which she had “Submerged”, in order to keep herself safe and not be abandoned. Following this exercise, Marjorie stated:

You are bringing up a lot of things. I couldn’t reason why they were there [imaginary friends]. I’m getting a sense of me for the first time … I do feel that I’m getting to know me – which I didn’t know before … I am beginning to see it wasn’t my fault. I want to hug that little girl and tell her she’s worth a lot. 

In exploring her early experiences through imagery, Marjorie finally understood the pernicious ripples that had been set in motion and subsequently shaped her adult life, relationships and decisions. She acknowledged and mourned precious opportunities passed up to appease others, and started untangling the binds of shame and unworthiness that had kept her life small. She considered what might finally bring her joy, and how she might allow this in. A path was being illuminated toward the greater freedom, authenticity and autonomy she desired for herself.

Working with Marjorie has undone any prejudices I might have had about working with older clients, and opened my eyes to the privilege of helping a client work through and emerge from a lifetime of self-denial. I have learned, despite my initial reservations, Marjorie does not need my protection from her own feelings; she does not complain of her age or see it as her reason for being in therapy – instead she has an unassailable drive to know and be her fully authentic self, perhaps for the first time ever – through gaining an understanding of the experiences and influences in her childhood and how these have echoed throughout her life.

My work with Marjorie has embedded for me that giving voice to and finding peace with all parts of oneself, at any stage in life, is a gift worth striving for. The work we have done has finally given permission for Marjorie’s ‘Natural Child’ (Kahler, 1978) to emerge. I saw this in the brightly coloured clothes she started wearing to sessions, her creative passion reignited as she once again started writing poetry and stories as she had in childhood, and her reconnecting with her slightly mischievous and playful side – her vibrant, occasionally risqué humour leaving us both laughing and feeling alive. Marjorie was finally able to express her sadness at the lack of affection she received as a child, as well as finding some compassion for the hardships experienced by her care-giver that made it difficult to be emotionally present and giving toward her. She was also able to vent her anger at the cruel treatment she was subjected to at school. And, as she made sense of how these early relational dynamics shaped and manifested in her adult relationships, she is considering if and how she might want to open the door to more intimacy in her current relationships.

Marjorie has taught me that older people are not to be pitied, discounted or lumped together. They deserve our time, our interest and our full commitment. She has changed me both as a practitioner and a person. I find myself more open and curious about all facets of life, as well as having my own creativity reawakened. Overall, the greatest lesson I have learned from Marjorie is – it need never be too late to change your life.

What I have discovered by working with this population is that people don’t fade with age, they open and bloom. Furthermore, when people in the latter stages of life are given an opportunity for creative self-expression, they not only rise to the challenge, but also offer those around them a greater perspective into their own experiences.

Charron (2015, p.15)


§  Berne, E. (1957). A Layman’s Guide to Psychiatry and Psychoanalysis. New York: Simon & Schuster

§  Charron, A. (2015). ‘Art therapy with older adults in long term care facilities’, Canadian Art Therapy Association Journal, 14, 15-27.

§  Clarkson, P. (1992). Transactional Analysis Psychotherapy: An Integrated Approach, Reprint, London: Routledge, 1998.

§  Dusay, J.M. (1972). ‘Egograms and the “Constancy Hypothesis”’, Transactional Analysis Journal, 2, 37–41.

§  Hiskey, S. & McPherson, S. (2013). ‘That’s just life: Older adult constructs of trauma’, Aging & Mental Health, 17(6), 689–696. 

§  Kahler, T. (1978). Transactional Analysis Revisited. Little Rock: Human Development Publications.

§  Kerr, C.C. (1999) ‘The psychosocial significance of creativity in the elderly’, Art Therapy, 16(1), 37-41.

§  Kropf, N.P. & Tandy, C. (1998) ‘Narrative therapy with older clients’, Clinical Gerontologist, 18(4), 3-16.

§  Moore, T. (2017). Ageless Soul: The Lifelong Journey Toward Meaning and Joy. New York: St Martin’s Press

§  Thorp, S.R. et al. (2017) ‘Trauma-focused therapy for older adults’, APA Handbook of Trauma Psychology: Trauma Practice, Vol.2, 431–448. [Accessed: author’s copy via personal communication].

§  Van Assche, L. et al. (2020). ‘Ghosts from the past? The association between childhood interpersonal trauma, attachment and anxiety and depression in late life’, Aging & Mental Health, 24(6), 898-905.