Life Review Therapy

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Life Review (life review) thinks remember and tell of meaningful life, experienced crises, conflicts and successes. It is about accepting life as a whole. By remembering, resources are activated for overcoming current problems and shaping future life.

Life review therapy is a short-term psychotherapy of about 10-20 sessions in which memories are stimulated and guided. Patients are supported in telling a coherent life story. The effects of a successful life review are a decrease in depressed mood and an increase in well-being and self-efficacy.

Similar methods are used as biography work in social work (e.g. with adopted and foster children, with young people) and in caring for people with the onset of dementia.

Forms as well as target and age groups of life review interventions are diverse. The common core of the indications can be seen as follows: A person's life course was significantly disrupted by a life event, trauma or serious age-related losses in the normal course. This also attacked the person's identity. Through a life review negatively remembered events are reevaluated, resources and hope are activated and the identity is restored or re-established.

introduction

In 1963 Robert Neil Butler made the fundamental observation that older people in general have a need to look back on life, to assess and deal with previously unresolved conflicts. "Whatever life was like, towards the end there seems to be a need for many people to think about life, but above all to appreciate it: to see the whole of life in a positive light despite adversities and strokes of fate and to understand it as meaningful " ( Kast 2010, p. 15). "The life story can be seen as the basis for shaping one's own identity ; it integrates past experiences with the concerns of the present and future goals - in the best case in the form of a coherent narrative ." From a developmental perspective, autobiographical memories of older people have the function of "maintaining the continuity of the self ".

With a spontaneous review of life in old age, it can be assumed that memories of unpleasant events, unresolved conflicts or setbacks are often avoided. As a rule, an autobiography is not a life review in the sense intended here, since it is often intended to give a certain picture of oneself or to justify actions; In addition, conflict-related reminders can be left out. Narratives usually follow a dramaturgy. "Your own story is presented in the light of personal preferences and aversions." On the other hand, a therapeutically guided life review helps a patient to gain access to all memories, e.g. Sometimes to reevaluate and improve his storytelling skills.

Forms of life review interventions

Life review interventions are measures in a professional setting , through which people are guided to a life review. You work with a limited number of appointments (between 2 and 20). A distinction is made between three forms:

Simple reminiscence : The participants are invited to tell stories from their past, often in groups (e.g. in "remembrance cafés"), but also in individual conversations. As a rule, topics are given, including festivals, holidays, children's games, recipes. The narrative flow is supported. The goals are a general increase in activity, conveying a sense of achievement in remembering as well as enjoying positive memories with certainty. Similarly, oral history projects aim to be as free as possible from remembering and telling stories about everyday life (see also the narrative café ).

Life review / biography work : For older people who are to be activated, who are manifestly depressed or who are affected by the onset of dementia, a series of individual sessions is given in each case to a phase of life from which important actions and experiences are to be told. The memory is stimulated by specific questions. The goals are: reviving the personal life story, dealing with unresolved previous conflicts and finding new starting points for activities and communication. - Biography work is also carried out with children and young people with a different objective (see below).

Life retrospective therapy : This therapy is used for generally older people with mental disorders. Often elements of other forms of therapy are also included, such as the cognitive restructuring from cognitive behavioral therapy . In particular, it is about activating memories of positive and negative events with guidance and support, as well as formulating self-reflections and assessments.

Life Review Therapy

Goals of life review therapy

Life review therapy can be used for the following illnesses or psychological disorders : Depression , anxiety disorder , post-traumatic stress disorder , adjustment disorder . The goals are:

  1. Symptom improvement in mental disorders;
  2. Increase in well-being, reconciliation with the life lived;
  3. Coping with the current situation in life, developing resources.

Mental functions in life review therapy

The life review includes a number of psychological functions that are involved in different ways depending on the problem situation.

(1) Memory labor : The accessibility of memories from episodic or autobiographical and from non-declarative memory is promoted. Positive and negative, possibly traumatizing life events should be told in detail. The emotions and sensory impressions of that time should be relived. The core is the repeated discussion of details of a stressful event. With the detailed, possibly repeated narration, the physiological arousal and emotional involvement ( habituation ) are reduced .

(2) Balancing, integrating : The activation of positive memories makes it possible to see oneself in a more differentiated, compassionate and realistic way. By linking the positive and negative memories as well as by reassessing a coherent personal life story with a "little conflicting self-view" should be achieved. Memories of critical events or losses become less stressful.

(3) Giving meaning, finding meaning : "After a critical life event , people feel the need to give it meaning." In addition to the tragedy and pain, you have the desire to experience positive changes as a result of the event and / or the coping efforts. One person discovers e.g. B. that she has learned something valuable from a difficult life event. The purpose of giving meaning is to embed an experienced trauma in the personal story.

(4) Resources Activation : Through memories of mastered challenges as well as revaluations resources enabled edit unfinished business, current problems cope or do social activities to. For the future, changed perspectives and new goals are found and motivation is developed. The expectation of self-efficacy increases.

(5) Strengthening Identity . With a progressive decrease in memory, a person suffering from dementia loses both orientation in the respective situation and the unity of self-experience . The biographical knowledge still preserved should be specifically reactivated and practiced in order to maintain the feeling of identity ("memory therapy"). - With younger people, biography work supports the formation and consolidation of identity.

(6) Working through experiences of shame and guilt : The memory of situations in which one was ashamed is often avoided. But it belongs to the review of life. Your own culpable behavior or moral failure can be a lifelong burden. Experiences of shame and guilt are dealt with in life review therapy, e.g. B. through cognitive restructuring and repentance.

(7) Taking a certificate : Often a document is created. This serves as a reminder for oneself, as a legacy for the partner or the descendants or as evidence of an injustice suffered for a selected public, e.g. B. a human rights organization. Bearing witness corresponds to the need of a person to whom an injustice has been inflicted that this is no longer denied by society and / or by reference persons, but rather recognized.

(8) Social function : Communicating life memories has important interpersonal functions. It is a form of self-disclosure to gain interest and empathic responses from listeners and strengthen social relationships.

Approaches to life review therapy

Life review therapy according to Maercker

Andreas Maercker (2013) estimates a total of 10-15 sessions in his form of therapy. In the preparatory phase , psychological diagnostics , psychoeducation about the therapeutic approach and the establishment of the therapeutic relationship take place.

In the middle phase , each selected age is discussed in a self-contained form in at least one session. The therapist actively asks questions to stimulate memories and to encourage the expression of feelings, sensory impressions and evaluations that were or are connected with the remembered experiences (5 - 8 sessions). Possible topics are: family of origin, school and upbringing, perception of the cohort (peers), sexual development, partnerships and marriages, children, professional biography, perception of ethnicity, gender and social class, body image and physical changes, religious and spiritual development or worldview , Experiences with death, view of the future, friendships.

The final phase is about a general assessment and accounting of the previous life as well as about integration and finding meaning. The patient has received suggestions as to how he can succeed in accepting his biography. It is also important to have an outlook on the future and further goals. - If the problem or symptoms have not improved sufficiently in this setting, further psychotherapy is recommended.

Life review therapy according to Kast

According to Kast (2010), life review therapy is " focal therapy on a psychodynamic basis for older people." According to its limited objectives, it comprises around 10-20 sessions. Reasons why people seek this therapy are e.g. B. the loss of a life partner or an earlier problem situation that is still stressful in old age. The therapeutic approach includes, among other things, the stimulation of living narratives in which the feelings from the situations at that time are relived. By telling successful episodes from the "Joy Biography" (p. 75), the patient's current mood and self-acceptance improve. He can also bring personal and spiritual experiences in response to literature, art, music, religion.

Memories are often filled with shame, which means that the review of life can be incomplete or broken off. A person experiences shame when identified with the "critical gaze [of another person]." After dealing with the shame experience, one's own efforts from then can be perceived and accepted; the whole of life is viewed more kindly. "This makes it possible to see our dark sides [see shadows ] - in retrospect - and to recognize them" (p. 126 ff). " Feelings of guilt indicate that we have to make amends, that we have to take responsibility for the issue that led to the dispute. [...] There is dignity in standing up for mistakes that we have made. Sure "We'll regret it, we'll make up for it if we can: But that's how it is. No excuses, no glossing over, but also no mangling." A life review is about understanding decisions that one regrets from the situation in which they were made, not from the current situation (p. 144 ff).

A significant theme of life retrospect is gratitude . The more a person mobilizes and feels gratitude, the more they can appreciate the life they have lived. "Perceiving gratitude, expressing gratitude, leads us to experience the life we ​​look back on as rich and the future we are facing as still full of possibilities for fulfillment of various kinds" (p. 155).

Structured life review according to Haight & Haight

Based on Butler's interpretation, Haight & Haight have developed a structured life review approach. They base the life review on the eight phases of personality development according to Erik H. Erikson (1950). The developmental task at the end of life then consists in achieving "integrity" and overcoming "despair". In the life review, patients should talk about their lives from early childhood to the present. The biography is divided into four sections: early childhood, family, and home; Adolescence; young adulthood; later adulthood. These are dealt with in one session each. A detailed catalog of questions was created, which the therapist should handle flexibly in accordance with the content presented by the patient. In two final sessions it is a summary and evaluation of the lived life in the sense of Erikson. "Evaluation is the key to reconciliation and acceptance, and acceptance is the key to integrity."

Effectiveness of life review interventions

In the meta-analysis by Pinquart & Forstmeier (2013) 128 intervention studies were considered. The participants were assigned to a life review treatment (all three types of intervention) or to a control group (waiting group or placebo intervention) (see psychological experiment ). In the before-after comparison, significant and meaningful effect sizes (ES ≥ 0.40) are found for the test values ​​for "depression" and "ego integrity" as well as for "positive affect", "sense of life", "self-efficacy" and "preparation for." death". In follow-up studies at least six months later, "depression", "ego integrity" and "preparation for death" have medium effect sizes (ES ≥ 0.50). The interventions are particularly effective for people with depression and chronic physical diseases (effect sizes around ES = 1.0). If one considers life review therapy alone, in which "by definition people with mental disorders participate", the effect sizes for "depressive symptoms" are ES = 1.28 in the post test and ES = 1.67 in the follow up. Life review therapy is therefore an effective therapeutic intervention for patients with depressive symptoms.

Life review interventions for individual target groups

Narrative exposure therapy

The narrative exposure therapy NET (Neuner, Schauer & Elbert 2013) is a specific psychotherapy for survivors of severe multiple or persistent trauma . As with life review therapy, the patient's entire previous life is recorded with "the formative experiences" in a positive and stressful manner; the "flowers" and "stones" are arranged in a "life line". As with trauma- focused therapies - after extensive therapeutic preparation - the exposure takes place , i. H. the patient is confronted with the traumatizing situation in memory and imagination by giving a detailed account of it under precise therapeutic guidance ( narration ). In the course of the narrative exposure, the patient's emotional reactions, arousal and fears initially increase, reach a climax and then decrease ( habituation ). The patients become calmer and there is some relief. The therapist prepares a written document of each session, which is read out in the following session and corrected if necessary. The therapy lasts approx. 15-20 sessions. The entire document is signed by the therapist and the patient and given to the latter for possible distribution. - For the "treatment of mentally ill children as a result of organized or domestic violence", the narrative exposure therapy was further developed to "KIDNET".

Life Review Therapy for Holocaust Survivors

Forstmeier, Maercker, van der Hal-van Raalte & Auerbach (2014) present a concept for a life review therapy with Holocaust survivors, which comprises six modules in a total of around 20 sessions. The target group are survivors who develop psychiatric symptoms in old age or who get worse. Christine Knaevelsrud , P. Kuwert and Maria Böttche (2013) presented a comparable life review therapy for older people with (war-related) traumatization in childhood (Integrative Testimonial Therapy ITT). This therapy takes place in written form over the Internet ( life diary ).

Biography work with adopted and foster children

A special kind of life hindsight, the biographical work with adoptive and foster children are (Wiemann, 2011). For them, the separation from their birth parents is always a very stressful life event. "Biography work is an effective way of promoting a positive self-concept in children and adolescents and thus contributing to psychological resistance ( resilience )" (p. 121). The result is a documentation, a "book of life", ie a picture book or, for older children, a folder with certificates, letters, photos, painted pictures and texts. In terms of content, it is initially about the life story up to the separation and the reasons for the separation. Then the current everyday life is described as well as the person with appearance, interests and abilities. The relationships to the "emotional and social parents" and the biological parents as well as the legal and financial circumstances are formulated. Furthermore, the child expresses ideas for his future. "The child needs an adult reference person who offers him an explanation (" translation ") of the parental behavior that respects and mourns the limitations of the biological parents" (p. 118). The biography work is mainly carried out on a case-by-case basis, about half an hour per week, total duration from six months to a year.

Life review therapy for adjustment disorders

In the event of severe stress, a critical life event or a life crisis, an adjustment disorder can occur if a person is vulnerable or if there is insufficient social support. Depressive and / or anxious symptoms are typical. Adjustment disorders can be treated with life review therapy, on the one hand about memory labor with regard to the critical event, on the other hand about acceptance, integration, resource activation and finding meaning . Treatments were carried out at e.g. B. the following events: imminent operation, stroke, care / care of a disabled or mentally ill family member (see family carers ), loss of a loved one, living with an illness that leads to death (see below).

Biography work with people with dementia

In a modified form, the structured life review from Haight & Haight can also be used for people with the onset of dementia . "It is important for people with dementia to solve problems from the past while some of their cognitive functions are still intact. Those who still have unresolved problems in life and also suffer from progressive dementia can show more problem behavior over time, if these difficulties were not identified and reconciled in life review "(p. 147). A life review intervention is no longer possible in people with advanced dementia. But there are memory fragments. Biographical information, for example from relatives, is therefore valuable in the context of care (see dementia, section biography work) and in the method of validation according to Naomi Feil .

Dignity therapy

Dignity therapy was developed as a specific form of life review therapy for people who suffer from terminal illness and are facing their death (Chochinov et al. 2011). It gives these patients an opportunity to reconsider and pass on the things, events and actions in their lives that are of the highest importance to them or that they particularly wish to be remembered by their loved ones. A "generativity document" is created from the 3 - 4 sessions and given in multiple copies to the patient, who can hand it over or leave it to someone of his choice.

See also

literature

  • V. Kast: What really counts is the life lived. The power of life review. Kreuz, Freiburg 2010, ISBN 978-3-7831-3492-6 . (Herder TB, Freiburg 2014)
  • A. Maercker, S. Forstmeier (Ed.): The review of life in therapy and counseling. Springer, Berlin 2013, ISBN 978-3-642-28198-3 .

Individual evidence

  1. ^ A b R. Butler: The life review: An interpretation of reminiscence in the aged. In: Psychiatry. 26, 1963, pp. 65-76.
  2. ↑ a b c d e V. Kast: What really counts is the life lived. The power of life review. Cross, Freiburg 2010.
  3. ↑ a b c d e A. Maercker, AB Horn: Safe thinking and life review: Psychological foundations. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Heidelberg 2013, pp. 3–23.
  4. ↑ a b P. Perrig-Chiello : Meaning and function of life review in the second half of life. In: Psychotherapy in old age. 4, 2007, pp. 35-46.
  5. ↑ B. Boothe: The Narrative. Biographical storytelling in the psychotherapeutic process. Schattauer, Stuttgart 2011.
  6. ↑ a b c A. Maercker: Forms of life review. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Berlin 2013, pp. 25–45.
  7. ↑ a b c M. Pinquart, S. Forstmeier: Effectiveness research. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Berlin 2013, pp. 47–63.
  8. ↑ a b c d e f S. Forstmeier: Life review with adjustment problems and life crises. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Berlin 2013, pp. 85-105.
  9. ↑ a b S. Forstmeier, A. Maercker, EAM van der Hal-van Raalte, M. Auerbach: The method of therapeutic life review in Holocaust survivors. In: Psychotherapy in old age. 11, 2014, pp. 433-448.
  10. ↑ Th. Fuchs: In search of lost time - memory in dementia. In: Advances in Neurology Psychiatry. 63, 1995, pp. 38-43.
  11. ↑ a b I. Wiemann: Biographical work with adopted and foster children. In: C. Hölzle, I. Jansen (Ed.): Resource-oriented biography work. Basics - target groups - creative methods. 2nd Edition. VS Verlag, Wiesbaden 2011, pp. 108-122.
  12. ^ A b F. Neuner, M. Schauer, T. Elbert: Narrative Exposition. In: A. Maercker (Ed.): Post-traumatic stress disorders. 4th edition. Springer, Berlin 2013, pp. 328–347.
  13. ↑ BK Haight, BS Haight: The handbook of structured life review. Health Professions Press, Baltimore 2007.
  14. ↑ a b B. K. Haight, BS Haight: Structured life review for people with dementia. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Berlin 2013, pp. 139–156.
  15. ^ EH Erikson: Growth and crises of the healthy personality. 1950. In: ders. Identity and life cycle. Suhrkamp, ​​Frankfurt am Main 1966, pp. 55-122.
  16. ↑ EA Hembree, BO Rothbaum, EB Foa: Exposure- focused therapy of post- traumatic stress disorder. In: A. Maercker (Ed.): Post-traumatic stress disorders. Springer, Berlin 2013, pp. 223-237.
  17. ↑ M. Ruf, M. Schauer, F. Neuner, E. Schauer, C. Catani, T. Elbert: KIDNET - Narrative exposure therapy (NET) for children. In: M. Landolt, T. Hensel (ed.): Traumatherapy in children and adolescents. 2nd Edition. Hogrefe, Göttingen 2012, pp. 120–149.
  18. ↑ Christine Knaevelsrud , P. Kuwert, Maria Böttche : Life Review Therapy for Post-Trauma Disorders. In: A. Maercker, S. Forstmeier (Hrsg.): The life review in therapy and counseling. Springer, Heidelberg 2013, pp. 122-137.
  19. ↑ Life diary
  20. ^ N. Feil: Validation. A way to understand confused old people. 10th edition. Reinhardt, Munich 2013.
  21. ↑ HM Chochinov et al .: Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomized controlled trial. In: Lancet Oncology. 12, 2011, pp. 753-762.