Save the Youngthe Elderly Have Lived Their

Lives: Ageism in Marriage and Family Therapy*

DAVID C. IVEY, Ph.D.
ELIZABETH WIELING, Ph.D.
STEVEN M. HARRIS, Ph.D.

The paucity of literature addressing

mental health issues concerning geriatric
populations represents the perpetuation of
ageist practices and beliefs in the field of
marriage and family therapy. The purpose
of this study was to assess whether client
age and clinical training relate to the
evaluation of couples who present for
conjoint therapy. Written vignettes describing two couples, one older and one younger,
who report issues involving the absence of
sexual intimacy, increased frequency of
arguments, and increased use of alcohol
were evaluated by practicing marriage
and family therapists, therapists-in-training, and individuals with no clinical
background. It was hypothesized that
respondents views would vary in connection with the age of the couple and with the
three levels of participant training. Results indicate that client age and participant training are associated with perceptions of individual and couple functioning.
* This project was supported by Faculty Development Grant #0150440804 from the College of
Human Sciences, Texas Tech University, awarded to
David C. Ivey, Ph.D.
All authors are affiliated with the Marriage and
Family Therapy Program, Department of Human
Development and Family Studies, Texas Tech University. Elizabeth Wieling and Steven M. Harris are
Assistant Professors; David C. Ivey is an Associate
Professor. Send correspondence to Dr. Ivey at Box
41162, Texas Tech University, Lubbock TX 794091162; e-mail: divey@ttu.edu.

Our findings suggest that the relational

and mental health concerns experienced
by elder couples are not perceived as
seriously as are identical concerns experienced by younger couples. Contrary to our
expectations the observed differences between views of the two age conditions did
not significantly differ between levels of
participant training. Training and experience in marriage and family therapy may
not significantly mitigate vulnerability to
age-discrepant views.
Fam Proc 39:163175, 2000

ISTORICALLY,

little attention has been

given to the potential intrusion of
age biases in theory-building, research,
and clinical interventions within the mental health field in general (James & Haley,
1995; Reekie & Hanson, 1992), and even
less with respect to the discipline of
marriage and family therapy (Hughston,
Christopherson, & Bonjean, 1989; Van
Amburg, Barber, & Zimmerman, 1996).
While considerable interest in otherperson variables and associated biases is
evident, the role of age is essentially
overlooked by the marriage and family
therapy literature. Butler (1969) coined
the term age-ism to describe a chronologically age-based process of systematic
stereotyping and discrimination. Ageism,

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like other forms of bias that devalue and

stereotype particular groups of people,
permeates societal attitudes and values
and is suspected to influence perceptions
and attitudes in both overt and covert
ways (Bytheway, 1995; Schaie, 1993).
Ageism, in such fashion, may be demonstrated on multiple levels within the
helping professions.
Although empirical examinations of ageism in psychotherapy are few, the available literature suggests that elder individuals are systematically disadvantaged
when interacting with mental health professionals. The belief that older persons
are rigid, possess limited capacity for
change, are mentally deteriorated, ill,
tired, incompetent, unhappy, and lack interest in social interaction often leads
primary care physicians as well as therapists to believe that, as an age group, the
elderly are poor candidates for psychotherapy (Lewis & Johansen, 1982; Reekie
& Hansen, 1992). Similar disadvantaging
views probably exist with respect to couple
and family functioning.
Traditional systemic conceptualizations
of couple and family life reflect the Western predisposition toward objective, rational, and mechanistic values. In like fashion, traditional models of couple and family
therapy typically view relational dysfunction as an internal and linearly derived
systemic problem, independent from extrafamilial context and broader social factors. Traditional models assume an equitable distribution of authority and
influence among relational constituents
and fail to attend to the discriminating
role of societal norms and influences on
interpersonal power associated with person variables, including social class, race,
ethnicity, gender, and age (Hare-Mustin,
1989).
We contend that an understanding of
how clinicians views of individuals and
relationships vary with respect to age is

needed in order to determine whether

ageism and related biases exist within
contemporary couple and family therapy
practice. We endorse Hare-Mustins (1989,
p. 66) conceptualization of bias as a systemic inclination to emphasize certain
aspects of experience and overlook other
aspects rather than as a simple probability of error or distortion in views, and we
borrow from her notion of the alpha-beta
schema. Alpha bias exaggerates differences between groups of people while beta
bias ignores or minimizes differences
(Hare-Mustin, 1989). Both sources may
function to promote perceptions of individuals and relationships that inadequately suit the true situation and result
in potentially discriminatory or disadvantaging treatment.
Gerontological research has produced
evidence of substantial inter- and intraindividual variability in aging processes
(Baltes & Smith, 1997; Birren & Schaie,
1996). As a consequence, despite the utility of examining global population trends,
general assumptions pertaining to an age
group may poorly reflect actual individual
experiences. Such vulnerability is particularly probable when considering the complex constructs involved in relational functioning, as is the case with marital quality
and marital satisfaction (Lee, 1988a,b).
With this caveat in mind, the available
literature suggests that, for a large proportion of older adults, marriage functions as
a major source of life satisfaction. Herman
(1994) found that levels of marital satisfaction are generally stable across the
lifespan. Gilford (1984) found that marital
satisfaction tends to increase with age,
followed by an eventual decline during the
final stages of life.
In terms of sexual functioning, Brecher
(1984) found that 75% of men and 61% of
women at age 70 and over are sexually
active and satisfied. Although evidence
suggests a decrease in the frequency of

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IVEY, WIELING, & HARRIS

sexual activity associated with age, sexual

interest in old age is highly related to
early life interest (Call, Strecher, &
Schwartz, 1995). Turner and Adams (1988)
report that changes in interest that occur
with age appear primarily to comprise
preferred sexual activities. Despite consistent findings suggesting that healthy active aging includes sexual interest and
competence (Rowe & Kahn, 1998; Zank,
1998), prevalent stereotypes persist linking aging with disease and demise.
With respect to mental health, the proportion of the overall population suffering
from mental disorders appears to remain
stable across the lifespan (Baltes & Horgas, 1998; Gatz, Kasl-Godley, & Karel,
1996). Variability in association with age
does appear to occur, however, with respect to the particular form of mental
health difficulty, whereas suicidality, dementia, and specific forms of major mental illness appear to occur with greater
frequency among older persons. In contrast to stereotypes, the occurrence of
alcoholism appears to be roughly consistent across the lifespan. Stoddard and
Thompson (1997) report that an estimated 56% of the elder population experiences alcoholism.
Although the highest prevalence of major mental illness and suicide in the United
States exists among older persons (Cohen,
1982), this segment of the population has
historically been underserved by the mental health system (Lebowitz & Niederehe,
1992; Reekie & Hansen, 1992). Knight
(1986) reports that the psychological services provided to older persons tend to be
qualitatively different from those offered
to younger adults, and they are characterized by more inpatient and crisis treatment as well as less long-term outpatient
psychotherapy (Gatz, Karel, & Pearson,
1988; Gatz & Smyer, 1992; Reekie & Hansen, 1992). The lack of psychotherapists
with specialized training in gerontology,

165

inadequate insurance coverage and poverty in the elderly population, as well as

the scarcity of research addressing age
bias in the treatment of older adults further exacerbate the difficulties encountered by the mental health professions in
responding to the needs of the elderly. Van
Amburg et al. (1996) content-analyzed
873 articles published in four major journals during an 8-year period, evaluating
the extent to which gerontological issues
were addressed in the family therapy literature. The finding that less than 4% (28)
of all journal articles were related to aging, reinforces the assumption that gerontological issues are inadequately addressed
in the family therapy literature.
In light of the rapidly evolving population demographics in the United States
specific to life span and other age-related
variables, the need for examination of
susceptibility to ageist practices within
the mental health professions is becoming
ever more critical. We contend that the
discipline of marriage and family therapy
shares responsibility for the study of ageism and its relationship to access and
efficacy in mental health practice. Our
hope is that a greater understanding of
the effects of ageism and the processes by
which ageist attitudes are maintained will
contribute to the eventual redress of agerelated barriers within the mental health
fields.
This study seeks to advance the literature on aging by evaluating the relationship between client age and therapist
clinical training and how this relationship
affects perceptions of couples who present
for therapy. We examined the effect of
therapist training by comparing the clinical perceptions of practicing marriage and
family therapists (MFTs) with those of
therapists-in-training and individuals
with no clinical background. We hypothesized that clinical views would vary in
connection with the age of a couple and in

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relation to different levels of participant

training. Specifically, we tested three assumptions. First, we hypothesized that,
independent of the level of participant
training, views about an older couple
would be more favorable than those about
a younger couple presenting with identical concerns. Our second hypothesis was
that the level of discrepancy between views
of an elder and younger couple would be
less for trained MFTs than for therapistsin-training. Last, we hypothesized that
the level of discrepancy between views of
an elder and younger couple by nontherapists would be greater than by therapists-in-training.
METHODS
Participants

Adult participants (N 359) were selected from university courses as well as

from a national directory of marriage and
family therapists.
Non-Therapists
Non-therapists (n 128) were recruited
from undergraduate and graduate courses
in a family studies department at a large
Southwestern university. Each participant received course credit for participation. Sixty-six percent were women. The
majority of the non-therapists identified
themselves as white (n 110, 86%), while
Hispanics comprised 6% of the sample
and blacks 4%. The remaining 4% were
persons of Asian and multi-racial decent.
Twelve percent of the group was married
or living with a partner and 5% had
children. The mean age for the nontherapists was 22.5 (SD 3.3) years, and
each averaged 2 completed years of undergraduate education.
Therapists-in-Training
Therapists-in-training (n 113) were
sampled from a list of Associate members of The American Association for

Marriage and Family Therapy (AAMFT).

Associate members are individuals in
training who are working on advanced
degrees in marriage and family therapy.
Members of the group were selected by
means of random sampling from an
AAMFT-published national listing of members. Of a total of 200 selected Associate
members, 113 (56.5%) returned completed
surveys in a useable form. Thirty-four
percent of the returned surveys were
obtained following the initial mailing,
17% subsequent to a reminder letter, 23%
following a second reminder, 14% after a
third, and the remaining 12% responded
to a fourth reminder. Seventy-eight percent of the group were women. The
majority of the sample identified themselves as white (n 105 or 93%). Seventy
percent were married or living with a
partner and 52% had children. The mean
age for the therapists-in-training was
37.75 (SD 8.47) years. The mean educational level was three semesters of graduate study.
Therapists
The final group (N 118), therapists,
was sampled from the population of
Clinical members of AAMFT. To be classified as a Clinical member, one must
complete a minimum of a masters degree
and have over 1000 hours of direct client
contact. Participant therapists were identified via random sampling from an
AAMFT-published national listing of members. Of the 200 selected individuals, 118
(59%) returned completed surveys in useable form. Twenty-eight percent of the
returned surveys were obtained following
the initial mailing, 21% subsequent to a
reminder letter, 26% following a second,
12% after a third, and the remaining 13%
following a fourth reminder. Fifty-two
percent of the therapists were women.
The majority identified themselves as
white (n 109 or 92%). Eighty percent
were married or living with a partner and

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IVEY, WIELING, & HARRIS

80% had children. The mean age for the

group was 48.17 (SD 12.24) years. The
mean educational level was 3 years of
graduate studies.
Procedure

Participants were randomly assigned to

one of two case-history conditions. Half
read an older couple condition and half a
younger. The groupings of participants on
the case-history conditions were essentially equivalent in the distribution of age,
education, gender, race, and level of
clinical training. Participants were informed that the purpose of the investigation was to explore how couple functioning
is evaluated. After reading the case histories, participants completed forms assessing both the couple relationship and the
individual partners.
Case-History Conditions
Each participant was exposed to one of
two written case histories. One described
an older (male age 74, female age 69)
married couple presenting for marital
therapy because of their concerns about
the absence of sexual intimacy in their
relationship, an increased frequency of
arguments, and the male partners recent
increased use of alcohol. The second case
history contained the same information
except that the ages of the stimulus couple
were changed (female age 29, male age
34). In both conditions, the female partner
stated that she was concerned that the
sexual difficulties in the relationship were
occurring because she was no longer
attractive to her spouse. She was described as appearing depressed. The male
partner was described as anxious and
defensive, and as requiring significant
prodding to participate in the interview.
The couple had been married for 8 years
and had children from prior marital
relationships.

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Measures

Global Couple Rating Form (GCRF)

The GCRF is a ten-item measure designed to assess judgments of overall
couple functioning. Respondents evaluate
couples by indicating their perceptions on
the ten, 10-point, Likert items of the
GCRF. The ten items assess perceptions of
communication, conflict negotiation, support and nurturance, roles, promotion of
individual development, closeness, stability, ability to change, mood, and global
couple adjustment. Scores from the ten
items, each ranging from 1 to 10, are
summed to obtain a composite. Composite
scores range from 10 to 100, with lower
scores indicating perceptions of problematic couple functioning and higher scores
indicating perceptions of healthy couple
adjustment.
A study was conducted to determine the
criterion-related validity of the GCRF.
Sixty-one undergraduate students in human development and family studies at a
large southwestern university evaluated
five written descriptions of couples using
the GCRF. The validity of the measure
was determined by analyzing the association between scores from the GCRF and
rank-orders (on a healthyunhealthy continuum) of the couple descriptions. Rankorders of the couple descriptions were
provided by a panel of four faculty members from a doctoral marriage and family
therapy training program. A Spearmans
rho coefficient of .85 was obtained. Coefficient alpha for the GCRF in the validation
study was .92. Coefficient alpha for the
GCRF in the current study was .90.
Individual Rating Form (IRF)
The IRF (Ivey, 1993) is a single-item
measure designed to assess judgments of
an individuals current global adjustment
or mental health. Participants evaluate
an individuals adjustment on a 10-point
scale. Scores on the IRF range from 1 to

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10, with lower scores reflecting perceptions of dysfunctional global adjustment

and higher scores reflecting perceptions of
healthy global adjustment. Support for
the criterion-related validity of the IRF
was obtained in an examination of the
association between expert rankings of
case descriptions and scores on the IRF
provided by undergraduate and graduate
university students. The IRF validation
study revealed a Spearmans rank-order
coefficient of .89 (Ivey, 1993). The stability
of IRF scores was assessed using ratings
of three case histories obtained from 56
undergraduate students enrolled in family studies courses at a large southwestern university. A test-retest (6-week interval) reliability coefficient of .86 was
produced.
Data Analysis

Perceptions of the Couple

The data for participant perceptions of
couple functioning was analyzed using a
2 3 (case history participant training)
analysis of covariance (ANCOVA) for the
dependent measure (GCRF). Participant
age was the covariate. Participant age
was selected as the covariate in order to
control for the substantial differences on
this variable between the non-therapist,
therapist-in-training, and practicing
therapist groups. Case history was a
between-subjects factor involving two levels, older and younger. The second independent variable, participant training,
was a classification variable composed of
three levels or groups (non-therapists,
therapists-in-training, therapists).
Perceptions of Individual Partners
The data for participant perceptions of
individual partner functioning was analyzed using a 2 2 3 (case
history partner gender participant
training), mixed model, analysis of covariance (ANCOVA) for the dependent mea-

sure (IRF). Participant age was the covariate. The first (case history) and third
(participant training) independent variables were the same as those examined for
perceptions of couple functioning. The
second factor, the individual gender of the
partners, was a within-subjects variable
involving two levels (male partner and
female partner). Ratings of the two roles
were counterbalanced as a means to
control for the effects of order.
RESULTS
Couple Functioning

The ANCOVA procedure yielded no

significant interaction between the two
variables. However, significant main effects were indicated for participant level
of training F(2, 357) 14.22, p .001,
and case history F(1, 357) 7.80, p .01.
The participants perceived the quality of
the couples relationship described in the
younger case history to be less healthy
than that of the older couple. Post hoc
comparisons between the three levels of
training were performed to determine the
source of the second main effect. A Bonferroni adjustment was employed to maintain a .05 familywise alpha (per comparison alpha .016). These comparisons
revealed that the members of the nontherapist group held significantly more
favorable views of the couples relationship in comparison to the views of the
therapists-in-training F(1, 239) 50.72,
p .001 and practicing therapists F
(1, 245) 102.54, p .001, and that the
therapists-in-training held more favorable views than the practicing group F(1,
229) 8.70, p .01. A planned comparison of the old-young difference scores
between each of the three levels of participant training revealed no significant difference. Table 1 reports the means and
standard deviations for ratings of global
couple functioning by case history, and the
participant training classifications.

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TABLE 1
Means and Standard Deviations for Ratings of
Couple Functioning by Case History and Participant
Level of Training and Experience
Case History
Training Level
Undergraduates
M
SD
AAMFT Affiliates
M
SD
AAMFT Clinical Members
M
SD

Younger
Couple

Older
Couple

56.95
13.85

61.48
9.92

46.22
11.04

50.17
11.43

42.75
12.21

44.93
10.67

Individual Partner Functioning

The mixed model ANCOVA, with age as

the covariate, on ratings of individual
partner functioning, revealed no significant interaction between the variables.
Significant main effects were indicated for
participant level of training F(2, 707)
17.71, p .001, case history F(1, 707)
6.93, p .01, and partner gender F
(1, 707) 33.37, p .001. Participants
perceptions of the healthiness of the
individual partners described in the case
histories were more favorable for the older
than for the younger couple. We also found
that in the participants views of the
female partner were significantly more
favorable than their perceptions of the
male partner. Post hoc comparisons, using
the Bonferroni adjustment (per comparison alpha .016), were performed between the three levels of training. The
views of the non-therapists were found to
be significantly more favorable than the
perceptions of the in-training F(1, 475)
57.68, p .001 and practicing F(1, 487)
132.91, p .001 groups. The views of the
therapists-in-training were more favorable than the views of the practicing
therapists F(1, 451) 12.73, p .001.
Planned comparisons of the old-young
difference scores between the three partici-

169

pant groups revealed no significant differences in ratings of both the male and
female partners. Table 2 reports the
means and standard deviations for the
individual partner measure by case history, partner gender, and participant training.
DISCUSSION

This study examined perceptions of

couple and individual partner functioning
in case material that identified sexual
difficulties, marital conflict, and substance abuse as primary concerns motivating the initiation of couple therapy. The
aim of the research was to determine
whether client age and participant training are associated with differential views
of client mental and relational health.
Couple Functioning

The results indicate that client age and

participant training are both associated
with variability in perceptions of couple
functioning.
Client Age
Consistent with our expectations, we
discovered that across the three groups of
TABLE 2
Means and Standard Deviations for Ratings of
Individual Partner Functioning by Case History,
Partner Gender, and Participant Level of Training
and Experience

Training Level
Undergraduates
M
SD
AAMFT Affiliates
M
SD
AAMFT Clinical Members
M
SD

Younger
Couple

Older
Couple

Y1

Y1

Y2

Y2

5.48 6.00 5.87 6.30

1.79 1.64 1.42 1.40
4.26 5.17 4.70 5.21
1.46 1.41 1.40 1.46
3.95 4.48 4.09 4.95
1.31 1.23 1.25 1.42

Note: Y1 Male Partner; Y2 Female Partner.

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participants, the overall quality of the

older couples relationship was viewed to
be healthier in comparison to participants
perceptions of the younger couple. The
effects of client age did not vary as
predicted however in a relationship to
participant training. Therapists and lay
persons alike seem to use age as a partial
basis from which to evaluate the mental
health of others. The results also suggest
that sexual concerns, substance use, and
elevated conflict indicate more serious
impairment to a younger couples relationship than they do to the relationship of an
older couple. Although the specific origins
of this effect cannot be delineated from
these findings, it is evident that the views
of non-therapists, therapists-in-training,
and practicing therapists are affected by
age. The observed differences in views are
consistent with the results of other investigations that suggest ageist attitudes are
prevalent in contemporary society (Gatz &
Smyer, 1992; Gekoski & Knox, 1990; James
& Haley, 1995; Reekie & Hansen, 1992).
Several potential explanations exist for
this overall finding. It is possible that the
more critical views attributed to the younger condition come from an assumption
that sexual concerns, increased alcohol
use, and relational conflict are not as
important when they occur within the
context of older relationships. Hence,
these concerns may only be construed
problematic for the young, who have full
lives ahead of them. For older persons,
these complaints may not so much engender concern based on the view that they
are to be expected developmentally. A related ageist assumption may entail the
view that sexual difficulty, relationship
conflict, and substance abuse are normative for elder segments of the population.
Participant Training
We also found that non-therapists overall views of the couple relationship were
significantly more favorable in compari-

son to the views of therapists-in-training

and practicing therapists, and that the
views of the in-training group were more
favorable than those of the practicing
group. These findings indicate that training and experience in marital and family
therapy are important factors in the
evaluation of couple relationships. Although the precise nature and significance of the effects of training and experience are not established by these results,
it is evident that the views of experienced
MFTs substantially depart from those of
therapists-in-training as well as from
those of individuals with no clinical background. Several explanations are possible
for the observed distinctions.
As individuals accrue training and experience in marriage and family therapy
they may develop an ability to recognize
more effectively and to report the detrimental relational consequences exerted
by substance abuse, sexual impairment,
and conflict escalationthat is, in comparison to the views of non-therapists and
individuals in-training. Alternatively, the
results may suggest that with training
and experience, MFTs become vulnerable
to overestimating the pathological significance of such concerns in the assessment
of couple relationships.
Contrary to our expectations, the observed differences between the non-therapists, therapists-in-training, and experienced clinicians were found to not vary in
relationship to the two age conditions.
Although training and experience in marriage and family therapy appears to relate
to how couple relationships are perceived,
the effects of training and experience do
not appear to mitigate vulnerability to
ageist views. MFTs, therapists-in-training, and non-therapists exhibit similar
susceptibility to differential views on the
basis of client age. These findings point to the
potential influence of ageist attitudes in the
practice of marriage and family therapy.

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Individual Partner Functioning

The results of this study indicate that

the age and gender of clients, as well as
participant training, significantly affect
perceptions of individuals within couple
relationships.
Client Age
As hypothesized, we found that the
older male and female partners were
viewed to be significantly more healthy in
comparison to perceptions of the partners
described in the younger case history. The
effects of client age did not vary in
relationship to participant training.
This finding suggests that age is a critical factor in the perception of mental
health for individual members of relationships. Concerns regarding sexual behavior, substance abuse, and marital conflict
are perceived as being more of a reflection
of a personal adjustment difficulty in younger as compared to older people. A primary implication from these results is
that differential expectations and standards for the evaluation of mental health
appear to be associated with the age of the
individual being examined. As a consequence of ageist attitudes and expectations, the emotional and relational concerns of older individuals may be
minimized or discounted by both the general adult population and the mental
health professionals. Older persons may
struggle to gain adequate recognition of
viable concerns and to secure access to
social or therapeutic assistance because of
age-inequitable standards and stereotypes. Alternatively, this finding may suggest that the concerns of younger individuals in couple relationships tend to be
excessively viewed as indicative of personal pathology. When marital conflict,
sexual problems, and alcohol use are identified among presenting issues, younger
individuals may be the subject of overly

171

critical assumptions pertaining to individual adjustment.

Client Gender
We found that the participants views of
the female partner, in both case histories,
were significantly more favorable in comparison to perceptions of the male. This
finding likely reflects the distinctions in
individual behavior between the two partners provided in the case histories. In the
case history, the male partner was emotionally withdrawn and defensive. Additionally, he acknowledged problems regarding alcohol use and sexual desire. The
female partner was self-doubting and
depressed. The noted differences in views
between the male and female partners
may have occurred because of the varied
significance of such behaviors in perceptions of individual emotional adjustment.
The male partner may have been seen as
less healthy because of the more pernicious implications associated with substance abuse, emotional withdrawal, and
inhibited sexual desire, in comparison to
the implications from self-doubt and depressed mood. Another explanation considers that the observed differences in views
may have derived from differential, gender-related assumptions regarding individual adjustment in relationships. The
significance of the identified concerns to
the personal adjustment of individuals
may vary in association with gender. This
possibility supports the calls of others to
attend to the concomitant roles of both age
and gender in the study of individual and
relational health (Guttman, 1987; HareMustin, 1989; Snell, 1993; Zube, 1982).
Participant Training
Again consistent with our expectations,
we found in ratings of both partners that
the therapists-in-training and non-therapists held more favorable views than the
practicing therapists, and that the views

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of the in-training group were more favorable than those of the non-therapists. This
finding suggests that as a result of
training and experience, marriage and
family therapists may possess a refined
ability to recognize problems in the individual adjustment of male and female
partners in couple relationships. Although beneficial effects from training
alone appear to be indicated, as therapists
accrue experience beyond the initial training period, their ability to assess individual partner adjustment in relationships may become increasingly proficient.
Non-therapists and therapists-in-training
may be less equipped to evaluate the
functioning of individuals in couple relationships. Alternatively, these findings
may suggest that experienced marriage
and family therapists are vulnerable to
errantly critical views. This possibility is
consistent with the results of other investigations that indicate that experienced
clinicians exhibit an increased rate of
false positive diagnoses (Berman & Berman, 1984; Ziskin, 1981).
As was the case with perceptions of
relationship functioning, and again contrary to our expectations, differences in
views related to level of training were
found not to vary in association with
differences between the two case histories. This finding suggests that although
training and experience appear to influence perceptions of the individual adjustment of partners in couple relationships,
the effects of training do not appear to
correspond with susceptibility to age discrimination. MFTs, therapists-in-training, and non-therapists all appear vulnerable to variability in views related to
client age.
General Conclusions

Three general conclusions are derived

from this study. First, perceptions of couple
and individual partner functioning are complicated and appear to relate to several

factors. Although influences of overriding

importance may exist, views appear to be
associated with a complicated set of variables.
Age is a critical factor in the evaluation
of both individuals and couples. Agerelated stereotypes appear to promote differential and potentially inequitable views.
Substance abuse, sexual problems, and
conflict escalation tend to be construed as
indicative of more serious relationship
difficulty and greater personal dysfunction when client age is younger. Vulnerability to age-related stereotypes and perceptions does not appear to be substantially
reduced by clinical training and experience. It is evident that non-therapists,
therapists-in-training, and experienced clinicians are alike prone to differential age
standards. Given the finding that views
vary in relationship to client age, a corollary vulnerability may exist for agerelated discriminatory treatment. We
consequently contend that the conceptualization of individual and relationship difficulty and associated intervention should
include specific attention to the role of
age.
Last, training and experience may be
influential in how individuals evaluate
couple and individual partner functioning. Although the specific mechanisms of
the observed training differences are not
clearly evident, training and experience
appear to result in more critical views. It
is not certain whether this tendency reflects a pathologizing bias or a refined
ability to recognize and report adjustment
difficulties. It is also evident that training
and experience do not eliminate susceptibility to age-related bias in assessments of
couple and individual partner functioning.
Clinical Implications

The results of this study demonstrate

that the views of both lay people and
trained mental health professionals are

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influenced by client age. Although age

bias in clinical situations is a topic that
many therapists have yet to consider,
most recognize the importance of resolving age-based discrimination: it may occur
in a variety of forms, and affect all age
groups and segments of the population.
Consider the young-looking therapist
who is repeatedly challenged by clients
based on the assumption of limited real
life experience. Or conversely, the challenges faced by older-looking therapists.
When considering the special vulnerabilities and needs for reassurance and understanding so often typical of the therapeutic relationship, it is not surprising that
clients are inclined to exhibit such prejudice. If clients believe that a particular
therapist characteristic, such as age, could
prevent them from receiving the best service possible, they may naturally assume
that the efficacy and helpfulness of therapy
would be compromised. But what of the
therapist who holds beliefs about particular client characteristics? Do such beliefs
contaminate therapy? Do they prevent the
therapist from being as effective as possible?
Culture, ethnicity, race, sexual orientation, religious orientation, gender, and
other person variables have been recognized as central in significance to the
quality and conduct of the therapeutic
relationship (Falicov, 1988; Hardy &
Laszloffy, 1995; McGoldrick, Pearce, &
Giordano, 1996). Such person variables
are considered noteworthy largely because of the potential stereotypes and
prejudices with which they are so often
associated. By their very nature, phenotypic differences, which may be involved
in ageism, readily elicit prejudice because
they are easily and visually assessed. Varied thoughts and feelings associated with
the young, the old, and proximity to ones
own age group are commonplace and perhaps unavoidable. During an initial en-

173

counter, individuals readily and somewhat automatically determine a persons

gender, ethnicity, and age group. Subsequent related assumptions then guide the
manner in which a person is understood
and treated.
Our findings suggest that client age
influences therapist views. Although this
possibility alone does not pose concern,
vulnerability to discriminating conduct
may well derive from the resulting tendency to employ stereotypes in an effort to
comprehend the individual and his or her
needs. Problems arise when a rigid dichotomization (old/young) or even trichotomization (old/young/my age) is used to
construe age groups with the associated
assumption that the categorically developed views are sufficient and infallible.
Such categorizations, though simplifying
complex mental tasks, typically restrict
understanding and interaction. Use of
them engenders the risk of discounting
the unique experience of those we perceive to be younger than us, on the one
hand, and attributing too much importance or wisdom to the older persons
experiences, on the other hand. Conversely, we may attribute too much importance to the experience of the young and
devalue the experience of the old. Regardless of the scenario, we run the risk of
failing to appreciate the unique realities
and special needs of our clients because of
the meanings we construct and attribute
to particular age groups.
The results of this research indicate
that therapists are not immune to subtle,
age-based prejudices. We are left to question how as MFTs we might be vulnerable
to ageism in clinical practice. It is possible, despite our best efforts to be equal in
the way we treat clients, that we respond
to older persons discrepantly and in a
potentially oppressive fashion? Such questions are but a starting point from which
to determine whether age-based prejudice

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FAMILY PROCESS

exists in the training and practice of marriage and family therapists. We challenge
and encourage marriage and family
therapy training programs not to ignore
the significant influences of age. Sensitivity to the pervasive presence of ageist
views and attitudes should be incorporated into the curriculum of training institutions and, to the extent that it is possible, trainees should have direct
experience working with an age-diverse
population.
Limitations

There are several limitations to these

findings. First, the analogue nature of a
study that uses a written case history may
not provide an adequate characterization
of how couples present in real therapy
situations. A second limitation concerns
the participants. They were an ethnically
homogeneous group that is less than
representative of the general population.
Another limitation is the fact that the
non-therapists were from the same geographic location while the MFTs and
therapists-in-training were sampled nationally. As a result, the evident differences between groups could be attributed
to attitudes informed as much by regional
affiliation than by exposure to family
therapy training or experience.
Suggestions for Future Research

The results of this research suggest that

further attention to age is necessary in the
training and supervision of MFTs and
family therapists. We encourage additional investigations aimed at identifying
the manner by which clinicians may be at
risk for ageist views and to determine how
training may be influential in reducing
vulnerability to inequitable practice. Future studies should examine varying
couple and family constellations and presenting problems. It is our hope that
future studies will be sensitive to the

multifaceted nature of ages influence and

avoid reliance on single-factored conceptual models.
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