Life Review and Life-Story Work

Transcription

1 Life Review and Life-Story Work Gerben J. Westerhof University of Twente, Netherlands Life review refers to a process of evaluating one s personal memories, whereas life-story work describes interventions that use personal recollections of one s life to enhance mental health and well-being. Although the recollectionofpersonalmemoriesispartofthe process of life review, life review also includes the appraisal and evaluation as well as the attribution of meaning to memories. Similarly, life-story work includes reminiscence interventions that aim to support people in recollecting and sharing personal memories as well as life-review interventions that focus on a more systematic evaluation and integration of bothpositiveandnegativememoriesfromall life periods. The concept of life review goes back to the work of psychiatrist-gerontologist Robert Butler (1963) and lifespan psychologist Erik Erikson (1950). Both theorists see a return to the past as a naturally occurring process in later life that allows older persons to come to terms with their own death. Some older adults repeatedly keep thinking back about mistakes, failures, and missed opportunities in their lives. Their lives are filled with guilt, regret, and remorse. Whereas Butler describes this as a psychopathological form of life review, Erikson describes it as despair. Other older adults succeed better in evaluating and integrating their memories into a larger whole. Here, Butler distinguishes reminiscence or the recollection of personal memories from life review that is, the process of evaluation, integration, and acceptance of both positive and negative memories. Erikson (1950, p. 268) uses the concept of ego integrity to refer to the latter: the acceptance of one s one and only life cycle as something that had to be. A successful life review thus results in an integrated view of one s past life, including positive memories and achievements alongside the reconciliation and acceptance of failures and disappointments. There is only limited evidence that life review is a naturally occurring developmental task that serves to come to terms with life s finitude. Older cross-sectional studies have shown that ego integrity is unrelated to age (Ryff & Heincke, 1983). More recent longitudinal studies have also found that ego integrity does not follow a clear unidirectional trajectory across the lifespan (Whitbourne, Sneed, & Sayer, 2009). Similarly, it has been estimated that only about half of older persons are involved in a more or less systematic review of their past (Coleman, 1986). Some older adults may see no point in looking back on their lives, as they prefer to focus more on the present or the future than on the past. A smaller group even tends to avoid looking back on their past entirely, probably as an avoidant coping strategy in dealing with past problems. A meta-analysis of 20 studies on the relationship between ego integrity and death anxiety found a moderate relationship between ego integrity and death acceptance (Fortner & Niemeyer, 1999). Although ego integrity is related to death acceptance, the moderate relationship shows that there are older adults who accept death without a process of life review and vice versa. Wecanconcludethatlifereviewisnotthenatural developmental task that Butler and Erikson thought it was. Rather, it is nowadays seen as a process that can take place throughout the adult lifespan, in particular during times of change. This lifespan perspective is further supported by research that has shown that the integration of positive and negative personal memories may serve functions other than death acceptance (Webster, 1993). Life review also has identity functions that are related to the The Encyclopedia of Adulthood and Aging, First Edition. Edited by Susan Krauss Whitbourne John Wiley & Sons, Inc. Published 2016 by John Wiley & Sons, Inc. DOI: / wbeaa209

2 2 LIFE REVIEW AND LIFE-STORY WORK construction of meaning in personal memories. Especially in times of change, reflecting on the past may help people to maintain or to flexibly adjust their identity. Similarly, problem-solving functions go beyond the mere recollection of memories, as the recollection of earlier coping strategies may help people to deal with current problems. These functions show that life review is not only about plunging intothepastforthesakeofreminiscingabout the good times. Rather, memories are used to help older persons navigate through their present and even their future. Death acceptance, identity construction, and problem solving all refer to constructive uses of memories in life review. They can be distinguishedfromsocialfunctionsthatbuildmore on reminiscence, such as conversation or teaching and informing others. They can also be distinguished from more counterproductive uses of memories, such as bitter revival of negative memories, escape to the past in order to reduce boredom in the present, or long-term longing for people who have passed away. Studies using the self-reported Reminiscence Functions Scale (Webster, 1993) found that constructive uses of personal memories have a positive relationship to mental health and well-being, whereas counterproductive uses of memories have a negative relationship and social functions are only indirectly related to mental health and well-being through both constructive and counterproductive functions (Webster, Bohlmeijer, & Westerhof, 2010). These relationships have also been confirmed in longitudinal studies (Cappeliez & Robitaille, 2010). Further evidence of the relation of life review to mental health and well-being comes from other fields in psychology. In cognitive psychology, autobiographical memories refer to the unique memories of one s own life. Studies on autobiographical memories have focused on the use of memories to maintain a positive and consistent view on oneself. In his influential model of the self-memory system, Conway (2005) describes autobiographical memories as building blocks of one s identity. Episodic memories of specific events that are often laden with sensory details are dynamically related to semantic knowledge about the person. The model holds that episodic autobiographical memories are not simply retrieved from an archive of memories but are reconstructed in relation to current concerns and goals. The concept of autobiographical reasoning describes how people link episodic memories to more general meanings at the conceptual level, a process similar to life review. Experimental studies have shown that such autobiographical reasoning is important for mental health and well-being (Singer, Blagov, Berry, & Oost, 2013). However, the benefits of meaning making may depend on personal characteristics, the type of event, the context, and the type of meaning attributed to the memory (Greenhoot & McLean, 2013). Autobiographical memories have also been seen as the building blocks of more encompassing stories about a person s life (Conway, 2005). Narrative psychologists make clear that narrating a story of one s life is always a socially and culturally embedded process that serves to provide life with a sense of purpose and unity. Through stories about their lives, people construe a narrative identity that plays an important role in psychological adaptation and development (McAdams & McLean, 2013). The meaning of life events is construed by ordering events in a narrative plot. Qualitative research has shown that at least two types of narrative plot about life episodes exist: redemption and contamination (McAdams & McLean, 2013). In a redemption sequence, an initially negative experience is salvaged by the good that follows it. For example, people see what they learned from a difficult experience, how they grew from it, or how it strengthened their social relations. A contamination sequence refers to a plot where an emotionally positive experience becomes negative, as it is ruined or spoiled. These negative consequences often come to dominate the life story. Thus, redemption stories provide a means to attribute meaning to negative events in one s life, similar to the process of life review. Redemption sequences are positively related to well-being and mental

3 LIFE REVIEW AND LIFE-STORY WORK 3 health. Studies from narrative psychology thus provide further evidence for the role of life review in mental health and well-being. This role of life review has also inspired practical applications in life-story work (Webster et al., 2010). The basic idea is that stimulating people to review their lives will promote their mental health and well-being. Nowadays, a wide variety of applications exists for many different target groups, varying from community residents, family members, and voluntary aids to specific groups such as rural-dwelling older adults, persons with chronic illness, lesbian and gay older persons, war veterans, migrants, and ethnic minorities. Activities are also very diverse: autobiographical writing, storytelling, instructing younger generations, oral history interviews, life-story books, artistic expressions, family genealogy, blogging, and other Internet applications. Interventions are used in various contexts, including neighborhoods, higher education, primary schools, museums, theaters, churches, voluntary organizations, assisted living communities, nursing homes, dementia care, and mental health institutions. Reminiscence interventions (e.g., Subramaniam & Woods, 2012) mainly target social functions. They stimulate the recollection and sharing of positive memories in order to improve mood and foster bonding. Cultural artifacts (objects, photographs, music) dating back to the times that the older adults were young are often used to stimulate the recollection of memories. Life-review interventions ask people to recollect positive and productive memories and to attribute new meanings to negative memories (e.g., Birren & Deutchman, 1991; Haight & Webster, 1995). A life-review intervention typically encompasses all phases of life, from childhood to old age. A recent development is that life-review interventions are strengthened by including psychotherapeutic techniques such as those from creative therapy, cognitive behavioral therapy, psychodynamic therapy, or narrative therapy (e.g., Korte, Bohlmeijer, Cappeliez, Smit, & Westerhof, 2012). These interventions, also called life-review therapies, oftentargetpeoplewith depression or who are at risk of developing depression. These interventions aim to bring about a change in how one generally thinks and feels about oneself and one s past life. The evidence for the effectiveness of life-story work has accumulated since the early 2000s. Meta-analyses have shown that such work improves well-being and alleviates depressive symptoms. The most comprehensive meta-analysis, of 128 studies (Pinquart & Forstmeier, 2012), observed moderate improvements in depression and ego integrity and smaller effects on purpose in life, death preparation, mastery, mental health symptoms, well-being, social integration, and cognitive performance. Most effects were maintained at follow-up. The effects are strongest when life review is combined with psychotherapeutic techniques. The effects of life-review therapy are similar to those of cognitive behavioral therapy for older adults. It is nowadays recognized as an evidence-based intervention for depression in older adults (Scogin, Welsh, Hanson, Stump, & Coates, 2005). Effects are apparent across a broad range of participants, although larger improvements in depressive symptoms were found among persons with clinical depression or with chronic physical diseases (Pinquart & Forstmeier, 2012). In a large trial of life-review therapy, almost no differences in effectiveness were found according to demographic characteristics, personality traits, or reminiscence functions (Korte, Bohlmeijer et al., 2012). More extroverted persons profited somewhat more from group therapy than more introverted persons. Persons who reminisced more to reduce boredom were somewhat less likely to benefit. There is also evidence that increases in mastery and meaning of life explain the mechanism of benefit for these interventions (Korte, Westerhof, & Bohlmeijer, 2012; Westerhof, Bohlmeijer, Van Beljouw, & Pot, 2010). Conclusions Life review involves a process of recollecting, evaluating, and attributing meaning to positive

4 4 LIFE REVIEW AND LIFE-STORY WORK and negative memories. Although life review is about memories from the past, it serves to guide people through their present and their future. Life review takes place across the entire adult lifespan, in particular during times of change. When adequately encouraged in interventions, life review can be used to promote mental health and well-being in older persons. SEE ALSO: Autobiographical Memory; Death Anxiety; Ego Integrity; Identity; Life Regret and Sehnsucht; LifeStory;MeaningofLife;Narrative Gerontology; Psychotherapy and Behavioral Health Interventions for Older Adults; Reminiscence References Birren, J. E., & Deutchman, D. E. (1991). Guided autobiography groups for older adults.baltimore, MD: Johns Hopkins University Press. Butler, R. N. (1963). The life-review: An interpretation of reminiscence in the aged Psychiatry, 26, Cappeliez, P., & Robitaille, A. (2010). Coping mediates the relationships between reminiscence and psychological well-being among older adults. Aging & Mental Health, 14, doi: / Coleman, P. G. (1986). Ageing and reminiscence processes: Social and clinical implications. Hoboken, NJ: John Wiley & Sons. Conway, M. A. (2005). Memory and the self. Journal of Memory and Language, 53, doi: /j.jml Erikson, E. H. (1950). Childhood and society.new York, NY: W. W. Norton. Fortner, B. V., & Neimeyer, R. A. (1999). Death anxiety in older adults: A quantitative review. Death Studies, 23(5), doi: / Greenhoot, A. F., & McLean, K. (2013). Introduction to this special issue: Meaning in personal memories: Is more always better? Memory, 21, 2 9. doi: / Haight, B. K., & Webster, J. D. (Eds.). (1995). The art and science of reminiscing: Theory, research methods, and applications.bristol,pa:taylor& Francis. Korte, J., Bohlmeijer, E. T., Cappeliez, P., Smit, F., & Westerhof, G. J. (2012). Life review therapy for older adults with moderate depressive symptomatology: A pragmatic randomized controlled trial. Psychological Medicine, 42, doi: /S Korte,J.,Westerhof,G.J.,&Bohlmeijer,E.T. (2012). Mediating processes in an effective life review intervention. Psychology and Aging, 27, doi: /a McAdams, D., & McLean, K. C. (2013). Narrative identity. Current Directions in Psychological Science, 22, doi: / Pinquart, M., & Forstmeier, S. (2012). Effects of reminiscence interventions on psychosocial outcomes: A meta-analysis. Aging & Mental Health, 16, doi: / Ryff, C. D., & Heincke, S. G. (1983). Subjective organization of personality in adulthood and aging. Journal of Personality and Social Psychology, 44(4), doi: / Scogin, F., Welsh, D., Hanson, A., Stump, J., & Coates, A. (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice, 12(3), doi: /clipsy.bpi033 Singer,J.A.,Blagov,P.,Berry,M.,&Oost,K.M. (2013). Self-defining memories, scripts, and the life story: Narrative identity in personality and psychotherapy. Journal of Personality, 81, doi: /jopy Subramaniam, P., & Woods, B. (2012). The impact of individual reminiscence therapy for people with dementia: Systematic review. Expert Review of Neurotherapeutics, 12(5), doi: /ern Webster, J. D. (1993). Construction and validation of the Reminiscence Functions Scale. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 48(5), P256 P262. doi: /geronj/48.5P256 Webster, J. D., Bohlmeijer, E. T., & Westerhof, G. J. (2010). Reminiscence and mental health: A review of recent progress in theory, research, and intervention. Ageing and Society, 30, doi: /S X Westerhof, G. J., Bohlmeijer, E. T., Van Beljouw, I. J., & Pot, A. (2010). Improvement in personal meaning mediates the effects of a life review intervention on depressive symptoms in a

5 LIFE REVIEW AND LIFE-STORY WORK 5 randomized controlled trial. The Gerontologist, 50(4), doi: /geront/ gnp168 Whitbourne, S., Sneed, J. R., & Sayer, A. (2009). Psychosocial development from college through midlife: A 34-year sequential study. Developmental Psychology, 45(5), doi: /a Further Reading Westerhof, G. J., & Bohlmeijer, E. T. (2014). Celebrating fifty years of research and applications in reminiscence and life review: State of the art and new directions. Journal of Aging Studies, 29, doi: / j.aging