Piedmont-based psychiatrist and psychoanalyst Dr. Audrey Kavka, 67, has been helping patients work through significant issues and make positive changes in their lives for almost 40 years. The daughter of two psychiatrists, one of whom also was a psychoanalyst, as well as the granddaughter of one of Chicago’s early forensic psychiatrists, Kavka has developed a subspecialty in her Oakland practice: working with older patients.

J.: More than half of your patients are 55-plus. Many are in their 80s and 90s. How did you develop a following of older clients?

Dr. Audrey Kavka: When I did my psychiatric residency at Mount Zion Hospital in San Francisco — before it became part of UCSF — in the late 1970s, the average age of my assigned inpatient caseload was 72. I was really surprised and disappointed at first. I came to understand that I was influenced by an age bias in psychiatry then. It was generally believed that older patients were not really capable of significant psychological changes. We were told to provide them straight service, which meant simply maintaining them on various tranquilizers or antidepressant medications.

But by the end of my first week of that inpatient year at Mount Zion, I fell in love with my patients. I soon learned that they were not only open to forming a professional relationship with me, but that they were, indeed, capable of experiencing psychological growth — growth that could occur up to their dying days. Listening to them share their life histories was like reading rich narratives. This was a gift to me. And the interest I took in their lives had an amazing therapeutic impact on them.

Every patient is different, of course, and everyone has a different story. But are there any shared themes among older patients with depression?

There’s actually a greater diversity of depression in older adults than in younger ones, but older patients often feel diminished in relation to their former selves, or feel completely cut off from their former selves. There is the sense, “I want to be that attractive 40-year-old again.”

Many patients in their 50s and 60s and still in the workplace frequently are very sensitive to any actual or pending changes to their level of competence And when they begin to anticipate retirement, they think about the losses involved. “What am I giving up? Finances? Stimulation of colleagues?” Working offers a sense of who they are.

This happens to people later in life, too, of course. My own father liked to refer to himself as “Dr. Kavka of Chicago,” even at 86! One of the things that bothered him after he moved into an assisted-living facility in his mid-80s was that people wanted to call him “Jerry” and he wanted to be called “Dr. Kavka.” He complained to me that the only things his fellow residents wanted to talk to him about were grandchildren and travel — and he wanted to talk about psychoanalysis.

We’ve all heard about the 80- or 90-year-old resident of an elder-care facility who doesn’t want to leave her room for meals and activities. Any insights?

Many patients feel that they are giving away their autonomy. They are grieving, and they are overwhelmed. They are the new person on the block. Everyone seems to know their name, but they don’t know anyone else’s name. Going to dinner with 100 people in a large room is daunting. The depressed resident’s children, who often urged mom or dad to move into assisted living, very often freak out about their parent’s depression. Some of my work involves working with the whole family to help them learn how to support their parent and grandparent.

Recently, we are hearing about sex in nursing homes among residents. Younger people, in particular, are shocked to learn that people in their 70s, 80s and 90s are still sexually active. What do you make of this?

While there are changes in sexual capacity as we age, particularly among men, the fantasy life endures — and the desire to be desired or to desire someone persists, as does the otherworldliness of a positive sexual experience. Because they have worked through inhibitions and other issues, some people have more positive sexual experiences in their 80s than they did during their younger years.

Psychoanalysis has often been called a “Jewish science.” Is that because most of its most famous practitioners, Freud, Adler and Deutsch, along with many of its not-famous practitioners, have been Jewish? Or are there other reasons?

It is true that many psychoanalysts have been Jewish. I think that, at its roots, psychoanalysis comes from our Jewish tradition of wanting to relieve emotional suffering. The Yiddish term mensch, a good person, suggests more than someone who does a good thing. It’s a good person who does a good thing with a good attitude.

You now are at the age, or approaching the age, of many of your patients. What life lessons have they taught you?

I’ve learned that later in life, there is a shift from external things — what I did today— to a more internal perspective: a good sense of self on the inside. Many of us go into therapy or analysis looking for clinicians to give us a road map of how to avoid landmines during our lives. What we come to accept is that the landmines will always be there, but because we have developed resilience, we can deal with them.

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