Reminiscence therapy is a biographical intervention that involves either group reminiscence work, where the past is discussed generally, or the use of stimuli such as music or pictures. Although closely related to reminiscence therapy, life story work tends to focus on putting together a life story album for an individual.
Reminiscence work was, in fact, introduced to dementia care over 20 years ago, and has taken a variety of forms. At its most basic, it involves the discussion of past activities, events and experiences, usually with the aid of tangible prompts (e.g. photographs, household and other familiar items from the past, music and archive sound recordings).
The essence of reminiscence therapy is described elegantly by Sarah Reed (twitter details below), who has helped to popularise reminiscence approaches through various approaches. Reminiscence can be very beneficial. What a person with dementia has to say about their life experiences is a great way of demonstrating their value as a person – both to them and you, and even when their memory storage system is inconsistent, to really engage with them while they remember happy times is therapeutic and valuable to you both. Old photographs are a great way to get going and since home and family (assuming it was relatively happy) is so central to all our lives, this may be a good place to start.
The development of reminiscence work is usually traced to Butler’s early work (Butler, 1963) on “Life Review”. Butler described “Life Review” as a naturally occurring process where the person looks back on his/her life and reflects on past experiences, including unresolved difficulties and conflicts. This concept was incorporated into psychotherapy for older people, which emphasises that life review can be helpful in promoting a sense of integrity and adjustment. Butler’s seminal work contributed to the change in professional perspectives on reminiscence. Rather than being viewed as a problem, with the older person ’living in the past’, reminiscence was now seen as a dynamic process of adjustment.
Reminiscence work also has a cognitive rationale. People with dementia often appear able to recall events from their childhood, but not from earlier the same day. Accordingly a promising strategy appeared to be to tap into the apparently preserved store of remote memories. By linking with the person’s cognitive strengths in this way, it was thought that the person’s level of communication might be enhanced, allowing the person to talk confidently of their earlier life and experiences. In fact, studies of remote memory suggest that recall for specific events is not relatively preserved; performance across the lifespan is impaired but people with dementia, like all older people, recall more memories from earlier life. Some of the memories represent well-rehearsed, much practised items or anecdotes. The almost complete absence of autobiographical memories from the person’s middle years could lead to a disconnection of past and present, which could contribute to the person’s difficulty in retaining a clear sense of personal identity. From a cognitive standpoint, autobiographical memory and level of communication appear key outcomes.
Evidence suggests that reminiscence therapy can lead to overall improvements in depression and loneliness and promote psychological wellbeing. Research also supports the view that reminiscence therapy, including life story work, can improve relationships between people with dementia and their carers and thereby ‘benefits both’. Other reported benefits include enhancing the opportunity to provide personal and individualised care and assisting the individual move between different care environments such as home to care home, or between care homes.
However, Clarke and colleagues (Clarke et al., 2003) revealed an expressed concern of care staff that psychological types of therapy involving discussion and personal interaction are often not viewed as ‘real work’. Another view explored by Kerr and colleagues (Kerr et al., 2005) suggests that depression in older people is viewed as somehow natural, even when evidence indicates that a range of interventions, many of them psychotherapeutic, can be effective. If reminiscence therapy and life story work are to be used as effective treatments for those with mild to medium cognitive impairment, it is important that the potential value of these psychotherapeutic approaches is understood by care staff and endorsed by those in managerial positions.
The research evidence on reminiscence therapy has examined its impact on older people with dementia and those without the disease. Research by Chiang and colleagues (Chiang et al., 2010) among older people without dementia in institutions in Taiwan, found that there was a positive effect amongst research subjects involved in reminiscence therapy that was not found in the control group. The study found that those participants involved in reminiscence therapy were more sociable, less depressed and showed stronger signs of wellbeing than control group members. The relatively small sample size, its composition (all male) and short-term nature of the study (three months) mean that the results, although favourable, cannot be generalised to the whole population.
The effect of reading poetry on some individuals with dementia can be remarkable.
For example, the Guardian reported that:
Working in care homes can be challenging, says Katie Clark who runs Reader groups with dementia patients. “There was one woman called Flo who was very frustrated and aggressive. She used to sit in the lounge all scrunched up and tense, leaning forward in her chair, ready to throw her juice at the next passerby. The staff said, ‘Don’t sit with her – she’ll probably try to hit you.’
“So I sat down a safe distance away and said, ‘I’m just going to try reading this poem. If you don’t like it that’s fine, but let’s see what you think of it.’
“And I read the poem through. She relaxed back in her chair, went very quiet, and at the end she said, straight away, ‘read another’.””
Where to find out more
A good place to start on ‘reminiscence therapy’ is following on Twitter @SarahReed_MHR.
Butler, R.N. (1963) The life review: an interpretation of reminiscence in the aged. Psychiatry, 26, pp. 65–76.
Chiang, K.J., Chu, H., Chang, H.J., Chung, M.H., Chen, C.H., Chiou, H.Y., Chou, K.R. (2010) The effects of reminiscence therapy on psychological wellbeing, depression, and loneliness among the institutionalised aged, International Journal of Geriatric Psychiatry, 25, 380-388
Clarke, A., Hanson, E.J. and Ross H (2003) Seeing the person behind the patient: enhancing the care of older people using a biographical approach, Journal of Clinical Nursing, 12, 697-706.
Kerr, B., MacDonald, C., Gordon, J. and Stalker, K. (2005) Effective social work with 0lder people, Edinburgh: Scottish Executive Social Research.
Kiernat, J.M. (1979) The Use of Life Review Activity with Confused Nursing home residents, American Journal of Occupational Therapy, 33, pp. 306–10.