The Use of the Life Story Work for older people with and without cognitive impairment Differentiating between Reminiscence, Life Review, and other Psychosocial Approaches Claudia K Y Lai, RN, PhD Associate Professor, School of Nursing The Hong Kong Polytechnic University President, Pi Iota Chapter Honor Society of Nursing Sigma Theta Tau International

Background of the Development of the LS Approach (Butler, 2000)  In the 1950s, psychology, psychiatry and gerontology textbooks devalued reminiscence and memories  Reminiscing was condescendingly called “living in the past,” and phrases like “wandering of mind,” “boring” and “garrulous” were used to describe elders who looked back.  Reminiscence was thought to be an early diagnostic sign of senile psychosis – what is known today as Alzheimer’s disease.  Butler wrote his seminal article in 1963.

Types of Reminiscence  6 Types (Watt & Wong, 1991) Integrative Instrumental Narrative Transmissive Escapist Obsessive  Another Classification (Gibson, 1994) General Specific

Life Review  “A naturally occurring, universal mental process characterized by the progressive return to consciousness of past experiences, and, particularly, the resurgence of unresolved conflicts; simultaneously, and normally, these revived experiences and conflicts can be surveyed and reintegrated. Presumably this process is prompted by the realization of approaching dissolution and death, and the inability to maintain one’s sense of personal invulnerability.” Butler, 1963, p.66

Reminiscence and Life Review (Rybarczyk & Bellg, 1997) ReminiscenceLife Review NatureRemembering with emotions aroused An integrity-seeking process ApplicationAllied health professionals Psychotherapists Role of FacilitatorPrimarily supportiveMore active role trying to intervene ProcessesPositive feelings evoked Often targets painful memories and issues Desired OutcomeSatisfying in itself without necessarily leading to insight Integrity Place order on chaotic events Develop and maintain a sense of identity

Reminiscence and Life Review (Butler, 2000) ReminiscenceLife Review The PersonAlthough young people facing death may engage in life review Essentially it involves the older age group who are at the end of one’s life OccurrenceStructured or spontaneous Same NatureNot evaluativeEvaluative OutcomesMay have therapeutic effect Not always favorable, may result in depression

Cont. Reminiscence and Life Review Groups (Coleman, 1999) GroupReminiscenceLife Review Clients  May be verbal, or motivated  Cognitive integrity not a must  Not in acute crisis  Likely needing professional help  Needs to be cognitive intact Format  “Closed” Group  Generally not for appropriate for a group setting, but… Processes  Topics for each session  Topics to go through but they may be more individually focused

Activity vs. Therapy  Activity  Therapy  Presumably can bring about positive outcomes  Contractual  Informed consent (explicit or implied)  Mutually agreed processes and goals  Client must be motivated

References  Butler, R. (1963). The life review: An interpretation of reminiscence. Psychiatry, 4,  Butler, R. N. (2000). Butler reviews life review. Aging Today, 21 (4), 9, 12.  Coleman, P. G. (1999). Creating a life story: The task of reconciliation. The Gerontologist, 39 (2),  Gibson, F. (1994). What can reminiscence contribute to people with dementia. In J. Bornat (Ed.). Reminiscence Reviewed: Evaluations, achievements, perspectives (pp ). Buckingham, England: Open University.  Rybarczyk, B., & Bellg, A. (1997). Listening to life stories: A new approach to stress intervention in health care. New York: Springer.  Watt, L. M., & Wong, P. T. P. (1991). A taxonomy of reminiscence and therapeutic implications. Journal of Gerontological Social Work, 16 (1/2),