Have you ever heard of reminiscence therapy? L'Appui met with Dr Philippe Cappeliez, an Emeritus Professor of the University of Ottawa’s School of Psychology who developed an interest in the cognitive approach combined with autobiographical memories.
Dr Philippe Cappeliez: It is an intervention during which the therapist plays an active role by asking questions to help a person who is feeling remorse or regret, for example, that wants to come to terms with the past.
Patients have the opportunity to feel relief in relation to some of the negative feelings associated to some aspects of their past. We also help the person reconnect with some parts of their identity, since personal and autobiographical memories are the constituents of our identity. In that sense, when losing our own memories, we are losing a big part of our identity.
For example, the person may revisit their past and find adaptation strategies. By accessing memories, the person might say: “Back then, I was able to cope with this kind of challenge because of what I had done and what I had put in place.” Therefore, this can help the person reactivate capabilities that are part of their existing resource base.
I have also noticed that this method inspires a sense of accomplishment, value and competence, even with people who suffer from advanced cognitive impairments.
PC: Absolutely. Very often, when we speak of dementia or Parkinson's disease, we talk about the person’s disability. Because we are seeing the disease from the outside, this creates a mental block that prevents us from seeing our loved one otherwise than a person with impaired autonomy. This can mask everything that is behind, such as their past life and personality as a whole.
An example that comes to mind is a very disabled man who built 4 houses by himself, who did competitive dog sledding races and repaired countless cars. His past life is completely masked by his present condition. It is very unfortunate, because behind this dementia is a person with an exceptional past and everyone would win from knowing more about his past. This is where reminiscence therapy can help.
PC: It is definitely beneficial when done at the beginning of the dementia, because there will come a time where it will no longer be possible to evoke memories once cognitive capacities are diminished. This defining moment allows passing the person’s legacy, which will leave traces not only for the caregiver but also for the entire family. This shouldn’t disappear, because whenever someone passes away, a wealth of information dies along with them. It’s a library of knowledge, manners and life experiences that are interesting to collect before it is no longer possible.
PC: No, not exclusively. Furthermore, I have written a book entitled À la lumière de mon passé : Mes souvenirs autobiographiques pour me connaître et me comprendre, which is directed to the general public outside of depression, who wish to explore autobiographical memories to better understand themselves, in a personal development objective. Therefore, this kind of intervention caters to depressed elderlies, but also to people in general. It's a guide and a working tool with a suggested method and questions to help you explore and examine your memories. It is something that can be used by everyone, in particular at home, because the emphasis is on positive and identity memories by means of a method which promotes constructive retrospective. Classic symptoms of depression are listed at the beginning of the book. It is advised to consult a mental health professional if you answer yes to a number of these.
PC: It’s interesting to talk about, because we feel that everyone likes reminiscence, just as everyone likes ice cream or apple pie. However, for some people, the past is past, and they would rather leave it behind. In that case, fine – we don’t want to force them, because we must respect the fact that they are not interested.
With others, we might touch sensitive points that can trigger a lot of bitterness, regrets and remorse. The risk is that the person sinks into despair in regard to this. In cases like these, a therapist will attempt to turn the intervention into something positive.
PC: Absolutely. Because this happens in a clinic before an intervention, we must inform ourselves on the person’s past to avoid sensitive subjects during a reminiscence session. If this happens despite this, it will be necessary to distract our loved one or to transform the bad memories into positive ones to continue the conversation.
PC: Compared to other existing therapy methods aimed at depression, reminiscence therapy not only helps the individual cope with the depression, but it also opens the possibility to personal development, because it goes further than simply counteracting depression. We explore the positive aspect of therapy. Essentially, it allows the person to reconnect certain links in their web of life so to approach death in a more peaceful and integrated manner. Other types of interventions lack this developmental aspect. The reminiscence approach provides the means to address these existential and fundamental questions: "What was my purpose in life? What is the meaning of my life? "
When used properly, this approach differs itself by its possibility to consider the life of the person as a coherent and significant whole, with a more measured frame of mind.
PC: Yes, absolutely! This is extremely important because, remembering memories also means maintaining and developing social links. It’s an unmatched inter-generational communication tool. After all, grandchildren love to hear life stories from their grandmother or grandfather. This creates a feeling of self-worth for the person speaking and it creates a positive climate between the members of a family or interaction partners.
I remember in my early days, one of my students proposed to give some kind of certificate at the end of a series of interventions. An elderly hung this certificate on his fireplace; when his son came to visit, he asked him what it was, and he explained it to him. That ignited the conversation and they spoke of stories they had never discussed previously. So, this kind of context can actually encourage conversation between individuals, especially within a family.
PC: We typically host weekly sessions with small groups of three or four people in a CHSLD. The meetings are theme-based. So, before the meeting, participants are informed of the theme of the week, for example, "My Achievements." Then, before meeting with the group, we ask people to think about a personal memory related to an outcome, a realization, something they are proud of. It can be something small or something great, as long as it’s an accomplishment. When the group session begins, we ask "Who wants to start?” The volunteer then talks about their memory as the group listens. Participants are informed beforehand that the therapist or the facilitator will ask questions to explore.
For example, we asked a gentleman who used to be a public servant in a government ministry in Ottawa to talk about the new professional standards in his sector. He mentioned that he was very afraid to talk about it since he had never spoken in public in this way. Despite everything, he stood up and made his presentation. Then, I asked him: "What helped you to stand up and walk to the podium? The fact that you were able to face your anxiety to speak in public – what does that say about you?” We could then say that he is someone brave, someone who can take responsibility, etc. We replay the events in his head by finding his strengths.
Then, we ask the other participants what they thought, if they have any questions. It allows people to create relationships.
PC: No. This is not a treatment that targets cognitive functioning. That said, cognitive stimulation produced by this activity can be positive in the present moment. In other words, the person will be more alert, more in contact at that specific moment. It will not reverse the course of the disease, such as Alzheimer's. Because the therapy uses the words “memory” and “remembrance”, this might lead to confusion; it is not a memory rehabilitation treatment.
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