She’d started young. At age 3, she was named “Miss Beautiful Baby.” Shortly thereafter, she became a regular –“Bubbles Silverman” — on the Uncle Bob’s Randbow House radio show.
Voted “most likely to succeed” by her high school classmates, she sang everywhere and anywhere before landing a position as “house soprano” at the City Opera of New York in 1955. Her later performance of the aria, “Se Pieta” in Handel’s Julius Ceaser led a New Yorker magazine theatre critic to comment, “If I were recommending the wonders of New York to a tourist, I would place Beverly Sills at the top of the list.” High praise given the vast pool of talent in the “city that never sleeps.”
Not suprisingly, when Sills died in 2007, she was hailed as, “one of this country’s great operatic voices” — a remarkable compliment given that no one had heard her sing at that point in nearly three decades! Rather, in 1980, at the height of her fame, she chose to retire.
“There is a kind of desperation,” she later said, “staying at something too long … and I am not a desperate woman. I wanted people to say, ‘It’s too early,’ rather than, ‘When is that woman ever gonna quit? It was the perfect time to go out — on top.”
In today’s media and influencer saturated world, some might deem Sills’ decision foolish. “Why quit? Why not hang around, make as much ‘bank’ as you can, ride the waves of fame and adulation as long as far as they will carry you?” Heaven knows many in the public eye stick around far longer than their expiration date. For her, however, her commitment to performance excellence trumped any resulting celebrity.
Personally, I admire the choice Sill made. As I age, I’ve found myself wondering more often about when to “hang it up.” It can’t be based on demand, real or perceived. Indeed, there is a kind of conceit in leaving the decision up to others.
Seems to me that exiting at the top of one’s game is even more challenging in the field of therapy where age and experience are believed to confer special advantage. The same may be said of commercial airline pilots — at least, I know I feel more confident when the flight crew trends older than the cast of High School Musical. And yet, given the declines in memory, reasoning, verbal fluency and comprehension skills associated with advancing years, pilots have a mandatory retirement age, a standard applicable across 193 member-nations! Surely, some could continue for longer, but doesn’t that beg the question?
As reviewed here, research on therapists makes clear age and experience confer no advantage and are likely associated with poorer performance (1, 2).
So, what are your criteria?
Until next time,
Scott
Director, International Center for Clinical Excellence
As an educator teaching clinical practice, FIT is a vital part of what I call the Complete Treatment Model that I offer my students, so I would love to participate. Scott, you may remember me.
At age 77 I suffered quadricep tendon tears in both legs and wound up in orthopedic rehab, totally bed ridden, for 5 months. I had to close my office, discard my furniture, put my records in storage, and retire. I thought I was done after 54 years. But some of my former clients wanted service from me so I returned in a telehealth practice and then they wanted to see me in person so I got a new office, new furniture, and reopened my practice on May 1, 2024.
After my orthopedic rehab I switched my primary care to a new gerontologist and I asked him, “How long do you think I will be able to practice?”
He asked, “Do you enjoy it?”
I said, “Yes.”
He said, “Well you will probably practice as long as you enjoy it.”
I am enjoying it. I get more out of it than my clients I am sure. Is this a sign of counter transference where I am exploiting my clients? Colleagues who I have consulted me assure me this isn’t the case. But I still wonder about it.
Today, I find this post from Scott in my inbox and I think to myself “Am I at the top of my game and should quit?” This question doesn’t make much sense to me. How the heck could I know if I ‘m at the top my game or not? Using FIT? And if I am at the top of my game so I quit where does that leave my clients and other people in my community who want and could benefit from mental health services?
So, I think to myself, “Well if people want to meet with me who am I to deny them my service?” Like the Blues Brothers, “I am on a mission from God.” I will leave it up to God’s will when I am no longer to do this work. God’s will at this point seems to be that I keep on providing service to people in my community. So I keep going. However I take the dictum “primum non nocere” very seriously.
1. It may not be about age. It’s about keeping good at the game. I know therapists in their twenties who, because of their mish-mash training (trauma! trauma! trauma!) and inherent unwillingness to expand and question their knowledge, practice from such a narrow bandwidth that they are essentially ineffective. At the same time, I know therapists well into their older years who have never lost their mojo.
2. Maybe it’s not so much about age itself but rather about “burning out” or losing passion.
3. Maybe it’s not what *we* think about age. Maybe–and more importantly– it’s about whether our clients consider age an issue. “Age” may come locked and loaded with its own preconceptions, ready to spring into play and influence our clients’ assessments of the therapist, much like all of those certificates that hang on the therapist’s wall (the “wall of doom,” as I call it). First impressions make a difference. And those impressions are mentally calculated based on personal experiences, beliefs, attributions, and biases. These qualities probably and unwittingly formulate a client’s initial and ongoing evaluation as to whether or not therapy will work. I believe this was a running problem for Doogie Houser, M.D….
3. …because success is ultimately in the eye of the beholder– or the client, in this case. Managed-care company metrics aside, if a client finds their therapy successful, whether it is provided by a young therapist or an older therapist, it is a deeply personalized experience. And relationship matters. True, the therapist can shape this (as Freud did with his complex models and machines). But if feeling better and legitimate results happen from a conversation with a 30-year-old therapist, a 75-year-old therapist, or the bartender down the street, who are we to argue?
Well said Eric. I have worked over thirty years and in a variety of places that have not been easy, but taught me a great deal; child welfare, youth corrections, substance abuse treatment and others. I believe my willingness to learn has kept me fresh in my work with clients and also informed the quality of my work with clients. Maybe the secret sauce is not age, but attitude. And I do wish those of us who are “old” could get a little credit for being dedicated to our work. God knows I have made much less money across my career than recent graduates who from the get go make more than I make now. Good for them, but it has taken years for clinicians to get paid what I think we deserve.
Such an interesting topic. I’m at that age that I’ve been contemplating when and how to end my career for some time now. I’m proud of my career and have no regrets. I’ve set the arbitrary age of 70 for my anticipated bon voyage. I started my mental health career in the late 70’s and have always been very passionate about providing high quality services. That passion has been stronger in my efforts to train future generations of licensed MFT’s & CPC’s in my state. But I cannot ignore my waning something. I don’t think it’s passion because I get seriously irritated by interns who have a passe attitude about providing quality therapy and think they have nothing to learn or have a list of issues or ages, etc. of what they aren’t willing to work with. Forget the eyerolls I get when I say, “family therapy.” I think it is a dying modality. I still get a charge when a client makes progress or achieves their goals. I think it’s that the field of mental health feels different to me from when I started almost 40 years ago. I’m not sure if managed care and insurance have played a role in that change, but it makes me sad.
So, I’m doing my exit from the field in stages. I’ve stopped taking on new interns. That was a hard decision. Next step was to close my private office. Closing the office was not a hard decision, but an actual relief. I’m currently contracting with an online company to provide therapy part time while I continue to finish up with my remaining interns. Not sure if I’ll make it, but I’ll re-evaluate when I hit 70, which isn’t too far in the future.
Wishing you all well and continued passion for the amazing service we provide to others.
Again, a very thought provoking piece.
My one question would be around the interpretation of the age/experience literature as it applies to the field of talking therapies. Yes, these variables are unrelated ACROSS the field; however, if looking at INDIVIDUALS (as in, individual therapists), does expertise not require time to develop? So in other words, age and experience bear no relevance to expertise and effectiveness when considering all therapists however, for those few individuals who do advance their capabilities during their careers, surely time is be needed?
I guess findings about the effectiveness of trainees vs. professionals or veterans would need to be taken into account, where PARTICULAR trainees on any number of occasions, have been found superior in the outcomes they achieve but again, depending on the individual I would think? And further, trainees who outperform would not be as effective as those therapists who have continued to learn those things relevant to outcomes over the course of their careers I would think? I’m not sure as I don’t know the exact numbers on this.
Thoughts?
Well, you are right. There are exceptions, even in the study we did — the first to really tightly follow clinicians over time and measure their outcomes. I can’t recall the exact figure, but a certain percentage did defy the general trend to stagnation and decline. Your comments about trainees is the most difficult to explain. Typically, in the studies we have, they have been found to be as or more effective than their trainers or supervisors. My take? This has to do with learning and automaticity. We tend to work until we achieve a basic level of ability (competence and expertise are difficult concepts to define in our field and I think the research shows have a questionable if any relationship with outcome). Once people achieve a reliable performance, they tend to shift their attention elsewhere. Their behaviors become automatic, executed with little conscious effort (unlike students). The second issue is considering how psychotherapy works. For 50 years, our field has claimed that technical knowledge (of particular models) and adherence in the therapy room are responsible for effectiveness. I believe this view to be unsupported by the evidence. So, train as you might in say CBT or Trauma treatment, you won’t get better.
When is it time to leave …?
– The love of our work has faded into mere routines and repetitions.
– The names of the other providers and programs have changed so many times, that I can’t remember what, where or whom to refer patients to nowadays.
– The battle to get paid is more work than the reward of helping a patient.
“- New” therapy techniques are forcing me more and more often to remember the decade when I the techniques had learned in school was considered new.
– People frequently care more about feeling well, than doing the work to get well.
– On line searches are showing other providers promising better care (for more money) and in beautiful vacation locations.
– Remembering the names of the medications, patients or passwords is harder.
– Patients find it normal to repeatedly use their mobile phones in session to take/send texts.
– Third party billing companies get hacked, yet don’t seem to share too much with the providers about the HIPPA data losses or protocols of protection used and needed.
– Some insurance companies make up their own unique ‘required’ needs in order for the provider to be paid, pay only the amounts they decide when they choose, and seem to enjoy having the provider wait long periods of time to resolve most complaint issues.
– Retirement and doing fun things seems more exciting than does going to work.
… Still … I like what I’m doing and am not quite ready to stop.
In two weeks I’ll only be seventy.