Picture a female client facing a bleak employment market, stressing out about finding a new living space and struggling to find a boyfriend who wants the same things she does. She also suffers from low self-esteem and has been dabbling in some disordered eating.

Based on that description, perhaps you are envisioning a millennial in her mid-20s. In fact, this client could just as easily be 60 years old and confronting the same complicated issues that we typically assign to younger people. Women in “midlife,” defined for our purposes as age 45 and beyond, may face career issues, changes in their primary coupling, challenges parenting adult children and becoming caregivers to their own parents — all at a time of life when Hollywood tells us they should either be enjoying complete success or be thoroughly ignored as popular culture trains its spotlight on ever younger role models.

Counselors serving this population can help put today’s struggles in the context of the woman’s entire life, assisting her with making sense of the past and deciding whether a new lens could be used to process her current circumstances. These counselors must be capable of navigating a variety of topics, from sexuality to career development, often while bumping into lifelong stereotypes about women’s self-worth and poor boundary-setting skills. The rewards are manifold for counselors who can work in this space, and the experience can enrich their own understanding of development across the life span.

Carolyn Greer, a longtime American Counseling Association member and an adjunct professor at Texas A&M University-Central Texas, was inspired by the major transitions women in midlife often face, including moves, divorce, the death of loved ones and new family arrangements. She and a counseling colleague developed a workshop to help women facing these circumstances explore some of the new pathways before them, while also considering the mental, physical and social changes associated with these changes. Greer highlights her own personal interest in an evolving approach to adult development.

“As I have aged and dealt with many personal situations, I have gained better insight into what Erik Erikson proposed with his stages of adult development, a theoretical approach I learned in my counselor training and have continued to teach in my counseling courses,” says Greer, who adds that her membership in other organizations studying adult development deepened her interest in questioning old thinking about aging.

“As life expectancy extends, the expected ideas about what individuals will look like, feel like and be doing by middle age continue to be questioned,” she says. “Erikson called ages 35 to 60 middle age, with an expectation that the adult would be at a point midway of having many accomplishments that lead to the personal life dream. However, what once was midlife, with all the preconceived thoughts, no longer fits the picture.”

“The life expectancy in 1900 was 47 years, but in 2000, it was 77 years. So, what is middle age?” Greer asks. “Adding to changes in this picture, what one looks like as an aging adult is [changing] as more and more effects from improved medicine, exercise and environment tend to lead to a more youthful life and outlook. There is an accepted premise that the current 50-year-old is the previous 40-year-old, and the changing age concept continues upward. Adding to these phenomena, the fastest-growing population group in our country is 85-plus, with an ever-increasing number of adults living to 100 and above.”

Changing relationships

With such a wide definition of midlife, counselors must be able to walk with these women through an array of topics that can have an impact on mental health. Jean Dixon, a licensed professional counselor with private practices in Houston and The Woodlands, Texas, leads several groups that help empower women facing life transitions. Noting that at age 42, she also is experiencing transitions unlike those earlier in her life, Dixon says she understands the immense change and growth occurring in midlife.

“It’s like adolescence all over again but with the added advantage of wisdom,” she says. “[Women at midlife] are often experiencing emotions that are deeper than they have experienced in the past. Due to increased awareness of themselves, others [and having more] experience, this new stage of life can be trying but also very exciting. It’s a lot for them to take in and process.”

For some women, midlife becomes a time to consider past unresolved issues that they did not have the time or energy to address previously. Dixon says these clients often feel that they need direction and a dedicated space to process their feelings. In her experience, empowerment is a very popular topic for this population.

“These women are often successful in life but continue to feel a sense of low self-worth,” she says. “Many … are wanting to work after being at home with children [but] are facing self-esteem and self-worth issues related to being out of the workforce, feeling inferior to younger women and sometimes even to their own [adult] female children who are not always supportive. … These younger women can be critical, as they have their own self-centered desire to keep mom as mom.” 

Dixon mentions a client who attended one of her women’s empowerment groups. “She talked about how her grown girls would comment to her, ‘Why do you need that group, Mom? You don’t struggle with empowerment.’ Their concept of her as ‘Mom’ was that she was in charge, and she was of them, but they did not see what she felt about herself.”

Carol Boyer, an ACA member in private practice in Montclair, New Jersey, mainly works with women ages 25 to 60. She advises counselors to be on the lookout for relationships as a key component of many of the struggles women face in midlife. For example, she recalls one of her clients who ended a romantic relationship.

“It was her choice to end it, but now she feels like she lopped off her arm and is having trouble moving forward,” Boyer says. “One of the things she brought up was, ‘I’m 60, and I don’t want to start with someone new.’ As we get older, if we’re not in a stable, continuing relationship, I think it can hit us harder when we break up. We are not as resilient as we were in our 20s. The stakes are higher. We aren’t as comfortable in looking for the next one. Meanwhile, we are bringing more baggage to the situation.”

Dixon has found that her clients in midlife possess great interest in discussing their sexuality, often for the first time in their lives. Some are struggling with the way their bodies are changing, while others have accepted those changes but are noticing that sex has a different meaning for them at this stage.

“They often come to therapy asking for help being more open-minded with sex or wanting to help their partners develop a healthier and mature relationship with sex,” Dixon says. She notes that often these women are with partners whose sex drive has decreased, while their own libido is stronger than it was at earlier stages of their life. Dixon works with these women to adjust to the changes and helps them develop the communication skills to address the shifts with their partners.

The women’s husbands or partners often have difficulty adjusting to the changes, at least initially, Dixon says. “I have heard my clients comment that at first, their partners did not really like hearing them speak [up] or share their opinion, and that this would create power struggles,” she says. “But in time, most of them come to appreciate it and can see that the power equality feels more intimate and increases their enjoyment of each other. The intimacy actually encourages other types of intimacy as well and can rekindle old flames.”

Continued career development

With longer life expectancy comes the desire or need to continue investing in a career. As such, career development issues often work their way into therapeutic discussions of life satisfaction and meaning-making. But the career development needs of women in midlife may be quite different from what career counselors typically see.

Jill Dustin, an ACA member and assistant professor in the Department of Counseling and Human Services at Old Dominion University in Norfolk, Virginia, specializes in career development. She has found that women in midlife often exhibit a strong desire to embark on new career-related adventures, such as tackling long-held goals or changing careers entirely. But at the same time, they also have financial concerns and struggle with work-life balance, just like younger workers often do. She notes that women in midlife also struggle with barriers to career success that may be structural or even related to their physical and mental health changes at this stage. Finally, women in midlife may be recognizing career dissatisfaction and a loss of self-identity.

Boyer has witnessed this struggle in her own office. “Some people at this midlife point say to themselves, ‘This is the best I’m ever going to feel, ever going to do. This is the most money I’m going to make.’ People get stuck when thinking that forward motion is not an option anymore,” she explains. “There’s a loss when we believe we’ve reached the end of our promotional ability. People find themselves a little depressed that life is kind of over and that things are just going to start getting worse. It can become a self-fulfilling prophecy.”

Boyer could cite herself as an example of why that line of thinking is too limiting. “For me, I went to grad school at 45, and I’m about to turn 57,” she says. “My career is still on the ascendancy. While chronologically I’ve reached midlife, professionally, I consider myself quite young in the profession. It’s all relative.”

When teaching counseling students how to help women with midlife career development issues, Dustin emphasizes that each woman is unique and comes to the process with diverse experiences and challenges. “It is very important that counselors working with women in midlife do not stereotype their clients,” she advises. “For example, counselors should not assume that since their client is in midlife, she is experiencing a ‘crisis.’ This certainly is not the case. Many women experience midlife as an exciting time of transition in which they can redesign their lives and explore careers that hold greater meaning for them.”

Career development is often viewed as a separate entity from personal counseling, but in reality, Dustin says, it is very personal and can be transformative. For that reason, she encourages counselors to include career development as part of their work with female clients in midlife.

“I would urge [counselors] to actively engage their clients in their career development,” she says. “This can be achieved by supporting, encouraging and empowering women throughout their journeys and assisting them in discovering and uncovering their strengths, barriers, types of support, goals, fears, abilities, values and desires.”

Methods in midlife

While the counseling methods applied to working with midlife women may not be too different from those used with other populations, the enthusiasm these clients show for trying new things can be inspiring. From empowerment workshops to psychoeducational book groups, psychodynamic analysis to mindfulness, women in midlife are often accepting of diverse approaches.

Greer has witnessed this herself. She explains that her workshop for midlife women in transition was not designed to be a clinical experience. But the end result is that many of the participants evaluate their own lives and set out in new directions that were mostly unknown to them at the beginning of the class.

Boyer also agrees, noting that she has used mindfulness techniques to help women connect with their bodies and become more aware of how they experience stress — something many women go through life never truly understanding. She recalls a 51-year-old client whose menopausal symptoms brought her into counseling. But the client’s mother was also in a nursing home, and on top of that, she was managing the stress of a change in her workplace review process and a complicated issue in her marriage.

“She is managing the aging aspect while she’s in a situation caring for her mother because she is an only child. Meanwhile, she’s trying to do an impossible job professionally and trying to save a marriage at the same time,” Boyer reflects. “She’s feeling misunderstood and it’s overwhelming to have to deal with these things all at the same time. Her energy level is different than it has been in the past, her moods are more labile [and] she doesn’t have the same kind of resources to bring to the other issues in her life.” Working with clients to simply name the stressors can be a major turning point for those who have spent decades ignoring their own needs, Boyer says.

Assertiveness training and building decision-making skills are other common techniques used with these clients. Dixon adds that basic decision-making can be a challenge for women in midlife who have rarely felt heard by their families or communities. She explains that they struggle with saying “no” without feeling guilty, often viewing themselves as one-dimensional beings: mothers, wives, workers or children of aging parents.

“Long-standing roles as ‘doers’ and caretakers take a toll,” Dixon says. “These women often report feeling depressed and lonely and very often just not knowing who they are or what they want. For example, often these women even struggle with deciding where they want to go to dinner. They are afraid to make the wrong decision. Having someone angry or disappointed with them is a big deal and creates such anxiety that they would rather just leave decisions to others.”

Dixon also finds that many of these women are afraid of being alone or being left by a partner. “Their sense of self and self-confidence is so low that we work on basic skills and communication, as well as self-talk and self-acceptance, for quite awhile,” she says.

She advises counselors to be sensitive to the client’s past experiences when working with current struggles, noting that understanding how the client managed transitions in her past can offer good direction today. She also suggests asking the client about current resources and supports, as well as what supports she may have possessed in the past. Then ask how her life is similar or different as she transitions through this current stage or challenge. For example, Dixon notes that women in midlife may suffer from anxiety or depression as their bodies age and they face new medical challenges. Being able to connect current frustrations to old struggles that they may have overcome — an eating disorder, for instance — can be transformative, Dixon says.

Dixon’s love of working with women in midlife comes from the joy she finds in helping them finally release their inner voices. “To help someone value and learn to listen and respond to themselves is the greatest gift I receive from my work, and these women have it in them so strongly it can’t be stopped,” she says.

However, Dixon acknowledges, fear of change is the main obstacle to making progress. “Change is hard, and the work it asks of us can often seem insurmountable,” she says. “That is why I spend so very long sometimes just working on the value of the person, improving and uplifting [the women’s] belief in themselves as they ready for the work it will take to change. But many times, luckily, the beauty of working with these women … [is that] they are ready for the work. They actually love the work because it is so very self-satisfying and serves their confidence, and they see their worth increase steadily. It is very satisfying work.”

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Contributing writer Stacy Notaras Murphy is a licensed professional counselor and certified Imago relationship therapist practicing in Washington, D.C. To contact her, visit stacymurphyLPC.com.

Letters to the editor: ct@counseling.org