Reminiscence

1. Reminiscence Professor Richard Cheston University of the West of England

2. Reminiscence – an overview • Background • Purpose • Evidence base • How to do it

3. Background • Sometimes seen as negative – ramblings, or as incidental and irrelevant. • Now seen as potentially very important • Life review • Identity • Working through emotions, making links with the past • Pleasurable

4. Life Review • Butler – reminiscence as a specific process related to age – a response to approaching one’s death – looking back and placing things in order – address unresolved conflicts • Erikson – each stage in life brings different challenges • Look back on your life with either a sense of integration and fulfilment or with regret, bitterness, and despair • Putting the parts of one’s life into order - the one and only life you could have lead • But not just about age or mortality – we all do it!

5. Identity • Other people learn about you • Staff attitudes change • You get to tell people – to be centre stage! • Memories of the past are stronger – can be an expert • Leaving a legacy • Raising self-esteem • Inter-dependency

6. Working with feelings • Stories about the past • Have structure • Have themes – e.g. heroism, overcoming adversity, things going wrong, renewal and friendship • Told within the context of the present day • May contain powerful feelings

7. Martin: surviving a tidal wave I was in the bar, we’d just got up, and I looked out of the window and saw this line on the horizon, and there’s me a country bumpkin boy seeing this and so I turn to my wife and say – “look at this darling, you’ll never see another one of these in your life”. So she looks up and says “what’s this?” And I says “well that’s a tidal wave and it’s coming straight for us”. “Well” she said, “nah, don’t be silly”. But then in a little while, she looks up and it’s still coming our way, so she says “you’re right, you are, that’s what it is”. So I says to the barman that he better get on the phone to the captain and tell him to put up the sides of the funnel, so that the funnel isn’t flooded. And he says “well no, you’re wrong, you don’t get tidal waves where we are”. And the place that we were in was mid way between Africa and the Azores.

8. But a bit later on, he said that we were right, that there was a tidal wave coming towards us. And I turned to my wife and my oldest daughter and told them that we needed to get ourselves into the bar so that we would be out of the way. But as we start to go up the wave I turns to them and say, “how about we go outside now and see what it’s like?” And that ship, she went up the wave so that you’d not even notice that anything had happened, and when we went outside, we saw that we had go to the top, and it was like being on the top of a mountain. And then down we went the other side, and that ship, boy were she wonderful, you’d not even notice that we had moved, that anything had happened to us. 43,000 tons she was and you’d hardly notice she had moved.

9. And when we went to bed that night, I turned on the radio and we listened to the BBC news, and it said that the Canberra had been in a tidal wave, but that it had come out of it with nobody on board injured. So I said to my wife that that’s it, there’s no doubt about that then. And then it went on to say that the Cunard board had let it be known that on either side of the Canberra, in case anything had happened were the Star of India and the Empress, and that that had just docked at Falmouth with 200 people on board.

10. Working with feelings • In pairs, think about: • Is there a hidden meaning behind the story? • How could you respond to Martin? • Does it matter if the story is true or not?

11. Pleasurable • Evidence is that reminiscing lifts mood regardless of age • But a bittersweet quality – not everyone wants to do it • Some people manage their feelings by NOT thinking about the past, but being busy and active • Should you try to avoid some areas? • The potential for both pleasure and distress

12. How to do it • No single way – but make sure the person with dementia chooses – tells their story • Group or individual • Structured or spontaneous and informal • To be shared with others or kept to oneself • Create something • a book, poster, collage … • collect together memories

13. Different types • Focussing on themes and transitions • Holidays, childhood, working life, being a parent • Activity based • Cooking, gardening, art, physical re-enactment of memories, singing, using objects • Think about i-pads, video as well as writing • Decide how to involve the family • e.g. as active participants, sources of information, or as the recipient of the life story?

14. Does it work? • Although reminiscence therapy evolved in the 1970s, evidence is surprisingly thin • Generally evidence is that there are benefits. However, NICE did not find enough evidence to support its use, although recognised its potential • Recent, large study looked at husband and wife pairs - found no evidence of improvements to the person with dementia, and that their spouse became more stressed

15. Nostalgia • Not all memories make you feel nostalgic • Being nostalgic may be psychologically protective • Higher self-esteem, greater social connectedness, creates personal meaning, raises affect • People are less defensive – more able to accept difficult things • The active ingredient in reminiscence??