This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60 + years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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心理治疗师为有长期护理需求和抑郁症的居家老年人提供家庭心理治疗的经验。

本研究采用定性方法探讨心理治疗师对有长期护理需求和抑郁症的老年人（60 岁以上）进行家庭心理治疗的经验。我们对 16 名女性心理治疗师（26-70 岁）进行了半结构化访谈，她们为有长期护理需求和抑郁症的居家老年人提供家庭认知行为治疗。我们还进行了 10 个患者案例研究。通过采用扎根理论的方法，我们迭代地开发了一个层次模型。结果显示，心理治疗师经历了三个困境：（a）推动改变与承认局限性；（b）提供帮助与维持界限；（c）作为患者家中的客人与心理治疗的主人。由于缺乏对治疗的共同理解以及面对患者的生存痛苦，加剧了这种困境的体验。这些困境产生了职业自我怀疑和负面情绪，进而引发了反思过程，最终引发了参与者的职业发展。参与者找到了一种方法来整合最初被认为是相互排斥的驱动力，并进一步发展他们的专业自我形象和治疗技术。我们将这些困境解释为反映了协调“治疗”和“关怀”治疗范式的困难。实践和支持管理三个困境，以及对治疗范式的反思、对老年的看法、对存在痛苦的恐惧应该成为与需要护理的老年人一起工作的心理治疗师资格的一部分。与其他护理提供者合作可以减轻心理治疗师提供各种支持的压力，这种压力可能导致负担过重并阻碍治疗进展。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。