Thursday, April 10, 2014

Remembering As a Form of Therapy

Why reminiscing can be therapeutic.
By Michael Craig Miller, M.D., Harvard Health Publications
Memory looms large in our understanding of mental health and mental illness. For some people, remembering painful events, like abuse or the death of a loved one, causes suffering. But as we age, remembering too little becomes the problem for many of us. A simple form of therapy can be helpful when memory begins to fail. And, as an additional benefit, it can help with mood problems.
What is Reminiscence Therapy?
Reminiscence therapy uses prompts, such as photos, music or familiar items from the past, to encourage the patient to talk about earlier memories. It's generally offered to people in their later years who have mood or memory problems, or need help dealing with the difficulties that come along with aging.
Since the late 1990s, partially controlled studies have shown that this treatment has a small but significant positive effect on mood, self-care, the ability to communicate and well-being. In some cases, this therapy improves intellectual functioning.
The History of Reminiscence as Therapy
The idea that reminiscing could be therapeutic was first proposed in the 1960s. Robert Butler, a prominent psychiatrist who specialized in geriatric medicine, coined the term "life review." He proposed what many now take as a given: When approaching death, people find it helpful to put their lives in perspective. In an earlier decade, talking about distant memories was thought of as "living in the past" and therefore a problem.
The idea behind reminiscence therapy is consistent with the theories of adult psychological development that were being proposed around the same period by another famed professional, the psychologist Erik Erikson. Erikson thought that for the greater part of adulthood, we are challenged to find creative, meaningful work in order to avoid feeling stuck. Then, in the final phase of life, we may try to review where we have been and what we have accomplished in the hope that we can feel good about our lives. Reminiscence therapy, which incorporates both Dr. Butler's insights into life review and Dr. Erikson's theory of psychological development, may help a person achieve that goal.
How Does Reminiscence Therapy Work?
Reminiscence therapy can be conducted formally or informally with individuals, families, or groups. Typical topics are:
  • Family and friendships
  • Loves and losses
  • Achievements and disappointments
  • Adjustments to life's changes
Sessions can last from 30 to 60 minutes and occur weekly or even several times per week. Depending on the training of the clinician, the patient's needs and the setting, the goal may be to:
  • Improve communication
  • Foster a person's sense of self
  • Improve mood
  • Provide an enjoyable social activity
Perhaps it is easiest to think of reminiscence therapy or life review as a variation on supportive psychotherapy. Reminiscence is a way for a therapist and patient to develop a therapeutic relationship. By creating a sympathetic situation, therapists may make it easier for patients to verbalize their problems and concerns.
In the best case, this therapy can help patients establish realistic goals and come to terms with life's disappointments and limits, while taking pleasure and pride in recalling accomplishments.
What Does The Research Say?
Research has shown that older people with symptoms of depression who participate in reminiscence therapy report better self-esteem and are more positive about their social relations than similar people who do not receive the therapy. They also tend to have a more favorable view of the past and are more optimistic about the future.
The results for patients with dementia are not quite as encouraging or clear — although mental abilities and behavior do seem to improve. But the more interesting effect may be on the people caring for people with dementia. Caregivers report a reduction in stress and improved knowledge of the patients.
As treatments go, there are few side effects to reminiscence therapy. But you still need to be cautious. Not all memories are pleasant, and some individuals use the time to nurse their bitterness over disappointments. People with advanced dementia cannot participate. There are still relatively few controlled studies in this area of research, so clinicians must keep their expectations realistic.
A Valuable Benefit to Any Relationship
It might be worthwhile to think about reminiscence more broadly. It may be a valuable element of any relationship, not just a therapeutic one. The sports commentator, Bill Simmons (on ESPN in his podcast), regularly calls old college friends to discuss not just today's sporting news, but to remember experiences shared several years earlier. He and his friends laugh a lot and I smile listening to them.
Think of this the next time you visit old friends, or have an opportunity to see an older relative. The pleasure of reminiscing may help the person you're talking to, and you may feel better too.

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