Who can help

Mental health professionals who offer marital counseling for elderly couples include psychologists, social workers and pastoral counselors. In many states, anyone can claim to be a counselor or psychotherapist. Choosing a state-licensed practitioner indicates that, at minimum, the person has had supervised instruction and regular in-service training; such caregivers are more likely than others to have their fees covered by Medicare or private insurers. Ask about their experience in dealing with aging issues; a therapist in general practice may have little familiarity with older couples.

Where to look

Ask a geriatric medical practice or hospital social worker, or search the Web or the yellow pages under "geriatric care management" or "senior citizen services." You may also want to seek recommendations from friends or family members.

Some care managers may focus primarily on physical problems and practical arrangements. Ask if they have a licensed counselor on staff or can provide a referral.

Paying for treatment

Counseling in the Washington area generally ranges from $100 to $150 an hour. While Medicare and most private insurance will cover treatment for an individual with a family member present, they may not cover a session billed as "couples therapy." Ask if the therapist is able to bill under a code covered by your insurance. Nonprofit clinics and pastoral counselors often bill on a sliding scale and have a policy of turning away no one due to inability to pay.

Resources for older couples and their families:

* "Growing Older Together: A Couple's Guide to Understanding and Coping With the Challenges of Later Life," by Barbara Silverstone and Helen Kandel Hyman (Pantheon Books 1993)

* "For Better or for Worse . . . But Not for Lunch: Making Marriage Work in Retirement," by Sara Yogev (McGraw-Hill/Contemporary Books, 2001)

* "Coping With Your Difficult Older Parent: A Guide for Stressed-Out Children," by Grace Lebow, Irwin Lebow, Barbara Kane (Avon Books, 1999)

-- Mary Kay Schoen