This research addresses an issue of considerable clinical and theoretical interest which has received relatively little research attention, that of treatment of depression in non-institutionalized elderly. Two distinctly different brief therapy modalities will be systematically studied in an experimental design to determine their relative effectiveness as well as to compare both with a control condition. The control condition is designed to represent the type of naturally occurring interaction typical in social settings of elders. Both short- and long-term effectiveness will be investigated, as will client characteristics differentially predictive of outcome and maintenance. The two treatment modalities are Life Enhancement Counseling (LEC) and Time Limited Dynamic Psychotherapy (TLDP). LEC views depression in the elderly as frequently associated with a loss of meaning or purpose that results from environmental and/or late life developmental changes. LEC uses two types of interventions, verbal and ecological. The verbal interventions are non-psychodynamic, and are designed to help the elder rediscover past strengths and explore the potential for current reenactment. The ecological interventions structure current environmental resources to support these reenactments which provide a source of new meaning and purpose in life. TLDP views depression and other presenting problems as originating in disturbances in human relationships with significant others, both past and present, that result in maladaptative interpersonal patterns. The major focus of TLDP rests on the dynamics of the patient-therapist relationship, with the transactions between patient and therapist receiving primary attention throughout therapy. The goal of TLDP is to work toward changes that are experienced by the patient as significant improvements in her/his feeling state, day-to-day social functioning, and greater satisfaction in interpersonal relationships. The subject population will consist of 120 Cuban elders, 60-75, diagnosed under the Research Diagnostic Criteria classification as suffering from a Major Depressive Disorder Subjects will be randomly assigned to either LEC, TLDP or a Naturalistic Control Condition (NCC). Forty subjects per condition will be assessed using a standardized battery at intake, termination, and 3, 6, and 9 month follow-ups. The assessment battery covers three major areas of client functioning: (1) depressive symptomatology; (2) psychosocial/ecological functioning; and (3) level of life satisfaction. The assessment battery will be administered blind by a clinical evaluator to maintain independence from treatment modality. The treatment modalities will be closely monitored to insure their adherence to research protocols. The research plan includes a comprehensive strategy to disseminate project findings.
