This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on "The Case of Geoffrey" (Mohlman et al., 2008) . The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised

more »

... by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey. We wish to respond to Dr. Knight's astute comments on changing the therapy to fit the client, and the cultural aspects of the case of Geoffrey. Dr. Knight rightly points out that the discussion of ethnic issues is too often left at an abstract level in the literature of geropsychology. This may stem from a more pervasive problem -the serious lack of data on modifying existing therapy protocols for use with diverse clients of all ages (e.g., on the issues of ethnic matching in the clinic setting and on the benefits of ethnic-specific services). Moreover, practice guidelines in this area are relatively vague (e.g., APA, 1990) and do not specify any particular changes that should be made to evidence-based therapy when working with minority clients (e.g., Hall, 2001; Lam & Sue, 2001) .