Knowing ourselves fully and making sense of the past: Reflections on the use of reminiscence approac
CHAPTER SUMMARY AND KEY POINTS
Reminiscence and life review are practiced across many inter-related fields, including social work, and research has highlighted many benefits for service-users, professionals and agencies (Webster, 1997; Gallagher & Carey, 2012). These approaches have grown in popularity since Butler’s work in the 1960s, which identified adaptive outcomes in later life with these activities (Bender et al, 1999) and their evidence-base has steadily increased since then (Gibson, 2011; Webster & Haight, 2002).
These terms now incorporate a range of interventions, which seek to empower service users to better understand how their past has shaped present circumstances. Although this was originally associated with older age groups, with the majority of research reflecting this, studies increasingly indicate that different age groups are using reminiscence for different purposes (Coleman, 2005; Gibson, 2004 & 2011).
Reminiscence work embodies many of the characteristics of effective social work practice. This includes a commitment to holistic, strengths-based approaches to understanding the lives of service users and responding appropriately to their needs (Social Work Strategy, 2017; Clark, 2000). It corresponds well with the ‘personalisation’ strategy in adult social care (SCIE, 2012). The importance of a humanistic, practitioner-client relationship in reminiscence work (Chan et al, 2014; Gibson, 2004) is compatible with the Social Work Strategy (2017) guidance around the need for social workers to develop meaningful, empathetic relationships with service users.
Within criminal justice practice, the “Good Lives Model” (GLM) of offender rehabilitation, embodies a similar person-centred, holistic and strengths-based ethos. It was recognised that the theoretical basis of this rehabilitative model aligned with the principles of reminiscence and life review, which was central to developing this work. The GLM promotes the creation of a more positive self-identity, which requires:
“…respect for individuals’ history and past selves, which is in keeping with cultural and social perspectives that place great value on the past and its meaning” (Ward et al, 2007, p.95).
This chapter relates to the recent implementation of therapeutic reminiscence programmes within Extern’s Floating Support Service for ex-offenders. This is a voluntary sector, field-work team, providing community based support to adults who have experienced the criminal justice system, representing one of the most marginalised and stigmatised groups in society. The team provide holistic support to facilitate community reintegration and resettlement, assisting service users to sustain their tenancies and build positive lifestyles. This involves partnership with other key agencies, including statutory criminal justice bodies, particularly the Probation Board of Northern Ireland (PBNI) and the Police Service of Northern Ireland (PSNI).
In 2014 the author successfully completed a post-graduate module in ‘Reminiscence, life story work and life review: narrative methods, theory and application across the life cycle’ delivered by the Reminiscence Network Northern Ireland, in partnership with Ulster University. This required the planning and implementation of a programme of reminiscence work, which initiated an awareness of the potential benefits of these approaches within a criminal justice setting. This inspired the project to apply for and secure funding for a pilot scheme through the Social Work Strategy Innovation Scheme in 2015-2016 and, more recently, funding through the Belfast Health and Social Care Trust for reminiscence work with service users with learning disabilities.
This chapter will predominantly relate to the 2015/2016 pilot scheme, the design and delivery of which afforded immense learning. Funding was secured with the following objectives agreed:
To improve the self-esteem of participants, enabling them to develop more pro-social identities and to make positive changes.
To assist service users to adopt positive coping mechanisms in the face of the difficult transitions associated with community resettlement and reintegration.
To offer service users the opportunity to tell their stories within a supportive environment, employing methods which are best suited to their individual communication needs.
To gain a more holistic perspective of service user’s lives which may contribute to future support plans/assessments (including risk assessment) and possible need for referrals for additional support from other agencies in identified areas.
To contribute to positive lifestyles and reduce recidivism.
The innovative nature of reminiscence work within a criminal justice setting presented notable challenges in the design and implementation of the pilot scheme. It is documented that practice with this service user group can be challenging for professionals (Briggs & Kennington, 2006). There exists conflicting evidence regarding the measurement of reminiscence functions within the literature and an obvious gap in research regarding reminiscence work with offender groups. However, the suggestion that reminiscence functions may be relevant across different service user groups (Bender et al, 1999) assisted in the identification of four methods of reminiscence and life review for the pilot scheme. These were simple reminiscence, life story work, structured life review and guided autobiography. Participants chose their preferred method before starting the work, and each of the four approaches was used at least once during the scheme, which encouraged a wider analysis and understanding, despite the small target group.
This chapter will provide an overview of how the work was completed, describing methods with reference to relevant literature which influenced the design of the project. Attention will then be paid to key knowledge gains emanating from the design and delivery of the work, also highlighting the influence of relevant theoretical and evidence-based knowledge. There will then be an exploration of reflection points for practitioners within the criminal justice field who may wish to utilise these methods. Consideration will be given to ethical challenges and tensions between personal and professional values arising from this work, before finally examining how the work was evaluated.
INTRODUCTION TO THE WORK
Participation in the pilot scheme was open to all Floating Support service users regardless of their offending backgrounds, following a referral from their key-worker and an assessment to determine suitability for the project. It was also expected that many of the participants would have a sexual offending background, due to the high representation of individuals with this offending history among the service’s case load. This proved accurate, with most of the seven participants having a history of sexual offending.
Although the expected number of sessions per programme was initially anticipated to be around ten, flexibility was required. This was in response to the needs of service users, which were diverse and complex. Up to three planning sessions also took place before the work commenced. These involved the participant and facilitator, with the number generally depending on the needs of the participant and the demands of the work. This ties in with the advice of Gibson (2011), who recommends taking time over detailed preparation, which should account for “…the desired objectives, the characteristics of participants, the context in which the work is to take place and the resources available” (p.57).
During the planning stage decisions were made regarding the most suitable method and strategies were agreed to mitigate against any anticipated risks or barriers. These included concerns surrounding any negative or re-traumatising impact of the work, particularly for service users already experiencing mental health difficulties. Additionally, it was imperative that legal restrictions or licence conditions were fundamental to planning and shaping the nature of the intervention.
This stage culminated in a written contract and joint plan for the work, agreed in the first session, with negotiation around such issues as the location of sessions. This was decided individually with participants according to their specific needs, considering factors such as travel and lone worker risk. An ending activity was carried out with each participant and the referring key-worker, which was well-received as a means to provide closure and express gratitude for the service-user’s participation and emotional investment in the work.
The “simple reminiscence” approach involved the facilitator employing open-ended prompt questions and multi-sensory triggers, e.g. pictures, music, visits to significant locations and memorabilia, etc. to stimulate memory recall (Gibson, 2011). The literature generally favours this method with a group work approach, which is viewed as beneficial in assisting individuals to value their own memories through sharing them with others (Coleman, 1986; Cappeliez et al, 2005; Heathcote, 2007; Gibson, 2011).
The risks associated with group work within a criminal justice setting, including the potential for disclosures (Kunz, 2007; Reeves, 2013), influenced a decision during the planning stage of the scheme, to offer one-to-one interventions. The fact that the pilot was at an embryonic stage had a significant bearing on this decision.
The “simple reminiscence” method was therefore adapted and sessions were planned to focus on the needs and experiences of each individual participant. Guidance within the literature, suggesting that this method could promote positive feelings (Heathcote, 2007; Westerhof et al, 2010), appeared to correspond with the experience of those who engaged with this approach.
Life story work involved the rediscovery and recording of information about life experiences, which evidence suggests could promote a strong sense of identity and boost self-esteem (Bender et al, 1999; Gibson, 2004; Wills & Day, 2008). Between eight to ten sessions were planned in partnership with participants. During sessions the facilitator used multi-sensory triggers to encourage exploration of past memories and the identification of key themes or topics. These were then captured within a tangible framework, e.g. a piece of artwork, memory box or life story book, which were produced during sessions.
The experience of participants seemed to reflect guidance that, although the end product can bring pleasure, the process of recollection is most valuable (Heathcote et al, 2005; Kunz, 2007; Gibson, 2011). Indeed, the final outcome was often regarded by participants as a cherished reminder of the process. Life story work was usually employed alongside “simple reminiscence”, and this combination assisted the process of recall and provided a focus.
The literature identified life story work as a particularly person-centred intervention with the potential for empowering service users (Wills & Day, 2008; Ellem and Wilson, 2010; Chan et al, 2014). However, during the pilot scheme it was observed that the less directive nature of this method could present challenges, particularly for one participant whose ability to focus fluctuated due to a mental health condition. Adhering to the values of reminiscence work meant respecting this service user’s decision to complete life story work, even though the more directive and structured methods might have provided more of a focus (Gibson, 2011). Reviewing objectives, as well as renegotiating roles and responsibilities for the work provided satisfactory responses.
Life review is an evaluative and integrative form of reminiscence, which is usually associated with older age. It is also understood to have the potential to benefit any individual faced with events that question their identity. The employment of Haight and Haight’s (2007) structured life review method involved therapeutic one-to-one sessions and the analytical appraisal of memories therein.
To achieve this the facilitator led a process of reflection, using the structure and suggested interview questions in Haight and Haight’s (2007) handbook. Within this, sessions are planned around Erikson’s life stages, from early childhood to the present, to promote understanding and acceptance of the past (Gibson, 2004 & 2011). Following guidance within the book some of this content was tape-recorded, depending on whether written consent was obtained from participants. Recordings assisted the facilitator in reviewing the work between sessions and drawing out key themes for exploration and analysis.
Therapeutic benefits have been linked to this method, including self-acceptance and increased life satisfaction (Haight & Haight, 2007). Life review is regarded as particularly effective for integrating traumatic memories into an individual’s life story (Westwood & McLean, 2007) and Gibson (2004) mentions positive outcomes if painful memories are expressed to warm, empathetic listeners. Potential risks were identified when considering suggestions within the literature that the process of life review could re-traumatise individuals who have had adverse experiences in the past (Cohen, 2000; Gibson, 2011).
Alternatively, the capacity for learning that life review affords in encouraging the individual to challenge and reframe negative evaluations of the past and ‘victimic’ life stories (Bohlmeijer et al, 2008), was regarded as potentially advantageous with this service user group. Offender-based studies have highlighted the success of narrative methods in encouraging participants to build understandings by constructing and reconstructing their life stories (Maruna, 2001; Gadd & Farrall, 2004; Dewhurst & Nielsen, 2007; West, 2007; Sandberg, 2010; Ellem & Wilson, 2010). These studies have shown such methods being employed for therapeutic and treatment purposes, based on evidence that self-narratives can influence future behaviour.
Guided autobiography provided a semi-structured method of life review, which involved the participant writing short essays using a thematic approach, assisted by sensitising questions (Birren & Cochran, 2001). Nine themes were covered including “The major branching points in my life” and “Your family” (Birren & Cochran, 2001, p.6). Research highlighted that this intervention can produce positive outcomes, including an increase in psychological wellness and a decrease in depression (Watt & Cappeliez, 2000; Bohlmeijer et al, 2005; Coleman, 2005; Bohlmeijer et al, 2008; Gibson, 2011).
This was pioneered by Birren and colleagues (2001) usually combining quiet reflection with mutual group support, which was adapted to working on an individual basis with service users. For the participants who chose this method, ten one-to-one sessions took place, during which their written work was read aloud, reviewed and explored, within a therapeutic environment. Instead of this taking place within a group context, this process involved one-to-one interactions between the facilitator and participant. Planned discussion and activities were employed to trigger reflections and prepare for each theme, with a view to assisting the writing process. Written pieces were prepared by participants independently between sessions.
There existed some hesitations regarding the utilisation of this approach when planning the pilot scheme. The literature indicated that guided autobiography requires a degree of social confidence and a reasonable standard of education (Gibson, 2011). Much offender-based research suggested that this method might exclude many within a criminal justice setting, with indications of high levels of literacy difficulties and low educational attainment among offender populations (Maruna, 2001; Tardif & Gijseghem, 2001; Ellem et al, 2008).
The more explicit subject areas covered by guided autobiography and structured life review meant that these appeared to be more intrusive than other methods. Furthermore, the facilitator faced the additional complication of compensating for the benefits a group might have offered. This was significant given that Birren and Cochran (2001) propose that the group offers a structure for the recall of memories that individual writing might overlook.
Despite these potential pitfalls, results indicate that guided autobiography was utilised successfully during the pilot. Data was collected that indicated higher self-esteem scores, and the stabilisation or increase in mood/functioning results for participants who employed the approach, which qualitative feedback supported. This is evidenced in this feedback from one participant (J):
“My mood overall has definitely lifted over the piece and I feel greatly encouraged in pursuing the modest goals that I have now set for myself.
I walk away too with a body of work that I feel proud of. I do not know as yet what the end result will be, but I rather think that it is the start of something, that I am willing to follow through and see where it takes me.”
Starting out on this journey, the limited evidence-base supporting reminiscence work within criminal justice presented an unavoidable challenge. However, despite the scarcity of research specific to offenders within the reminiscence literature, recurrent themes of imposed social marginalisation and negative stereotyping, and their impact, which reminiscence seeks to address with older people (Coleman, 1986 & 1994; Buchanan & Middleton, 1994; Bender et al, 1999), are also common in research concerning sexual offenders (Hudson, 2005; Harris, 2014). This appeared significant given the high representation of participants with sexual offences.
Erikson’s psychosocial theory of life-span development is the foundation for reminiscence and life review (Coleman, 1986; Bender et al, 1999; Cohen, 2000), and therefore provided a theoretical basis for the project. Reminiscence theory acknowledges Erikson’s contention that earlier unfinished tasks carry on affecting individuals throughout their lives, but continued growth can provide opportunities for healing in later life if formative stages were problematic (Bender et al, 1999; Cohen, 2000; Gibson, 2011).
However, shortcomings in this theory were recognised, particularly the criticism that it assumes that healthy development depends upon the individual conforming to societal norms (Sugarman, 2001). For example, Erikson’s concept of ‘generativity’ during the maturity stage is linked to family roles that were absent for some participants, raising questions as to how reminiscence work could benefit them. Nonetheless, the notion of identity development as a lifelong task (Coleman, 1986 & 2005; Cohen, 2000) and McAdams’ progression of Erikson’s ideas, discussing identity as a person’s life story and the life course as a narrative concept (Sugarman, 2001), undoubtedly presented possibilities. Moreover, the link between identity development and reframing narratives seemed appealing in a work setting wherein change is essential.
In the case of sexual offenders, research has alluded to deficits in self-identity, with studies linking insecure childhood attachments, weaker ego identities and reduced psychosocial functioning with sexual offending behaviour (Hudson, 2005; Ward et al, 2007; Tardif & Gijseghem, 2001). Studies comprising life history narratives from offenders have underlined the connection between internal self-identity and offending behaviour (Maruna, 2001; Terry & Abrams, 2015). Some have argued that the societal stigma facing offenders, when internalised, can risk continued offending behaviour (Moore et al, 2016).
Building knowledge regarding the GLM and its theoretical basis for identity development as a goal in offender rehabilitation, enabled a wider appreciation of how reminiscence and life review could be successfully linked with offender rehabilitation. The GLM utilises an ecological approach to explain offending behaviour, arguing that there are multiple causes, since human beings exist within a network of social, cultural and physical relationships (Ward & Maruna, 2007). It contends that, in order to construct viable identities, individuals must draw on resources within these environments, hence impoverished resources will lead to unsatisfactory self-concepts, thus contributing to offending behaviour (Ward & Maruna, 2007). Reconstructing one’s personal identity to build a more meaningful, pro-social life, is viewed as essential for successful rehabilitation (Ward, 2002).
However, studies have questioned the evidence-base of the GLM (Andrews et al, 2011; Netto et al, 2014). Alternative risk-based models of offender rehabilitation, including the “Risk-Need-Responsivity” model (RNR), are concerned with identifying and reducing ‘criminogenic,’ risk factors (Ward and Maruna, 2007). These dominate modern statutory criminal justice practices and have empirical support (Dewhurst & Nielsen, 1999; Ward & Maruna, 2007; Ward et al, 2007; Ward & Marshall, 2007; PPANI, 2012). The GLM seeks to facilitate a more positive self-identity among offenders and criticises the tendency of risk-based models to neglect this, whilst over-focusing on behaviour change (Ward, 2002; Ward & Maruna, 2007; Ward & Marshall, 2007; Ward et al, 2007; West, 2007).
Netto et al (2014) suggest that practitioners should utilise validated evidence-based approaches (e.g., cognitive behavioural therapy) in conjunction with GLM-type interventions, whilst its evidence-base is still being evaluated. The developers of the RNR model have conceded that proponents of their method might learn from the positive, strengths-based approach of the GLM, and, moreover, addressing non-criminogenic needs can promote treatment engagement, enhance motivation and lower participant attrition (Andrews et al, 2011; Netto et al, 2014). Indeed, participants in the pilot scheme who completed the assessment process, and were therefore fully informed of this, showed high levels of motivation to engage in the programme.
For us this raised the potential of increased multi-agency collaboration with statutory agencies regarding treatment provision however, in practice, this often presented difficulties, e.g. reluctance to share information due to confidentiality concerns. Seeking regular communication and feedback from other professionals was often problematic, which may be symptomatic of the pressures facing staff in statutory criminal justice agencies (Ford, 2017). Discussing the treatment of people with mental disorders in the criminal justice system, The Criminal Justice Inspection Northern Ireland (CJINI, 2010) called for greater collaboration between justice agencies and so strategies to overcome these issues are now highly desirable.
Much of the reminiscence literature deals with the possibility of painful memories; knowledge that was particularly important in the development of the pilot scheme; considering research pinpointing the high prevalence of traumatic life experiences among offenders (Graham, 1996; Tardif & Gijseghem, 2001; Hudson, 2005; West, 2007; Harris, 2014). The reminiscence literature encouraged the understanding of memories with regard to their wider context (Bluck & Levine, 1998; McAdams, 2003; Hunt & McHale, 2007), which ties with Erikson’s attention to the social, cultural and historical determinants of personality development (Sugarman, 2001). Sugarman (2001) argues that most knowledge regarding this is limited to Western societies; an important consideration that was admittedly overlooked in the design and delivery of the scheme.
The cultural and historical significance of the Northern Ireland ‘troubles’ within individual life histories emerged as an important theme, with the project demonstrating the therapeutic potential of reminiscence work to address its impact. The requirement for social workers to respond to the needs of those affected by the conflict is set out by the Department of Health, Social Services and Personal Safety (DHSSPS, 2012) and a wider understanding of this was crucial.
Conway (2003) and Gibson (1997) discuss how the political and social environment during the ‘troubles’ perpetuated individual and group identities in opposition to the other. In their study, Hautamaki and Coleman (2001) identified socially supportive community networks as protective factors in coping with traumatic experiences. Yet Gibson (1997) implies that communities in Northern Ireland have sometimes imposed life scripts on members, reinforcing negative feelings. This may explain the ambivalence often accompanying these memories, with stories of pain and loss alongside nostalgic recollections of community cohesion and camaraderie.
REFLECTION POINTS FOR PRACTITIONERS
The importance of effective working relationships within reminiscence work (Gibson, 2004; Chan et al, 2014) parallels the GLM notion of a strong ‘therapeutic alliance’ (Ward & Maruna, 2007; Ward et al, 2007). In our experience, striving for this level of collaboration with participants helped shape the success of interventions. The outcomes of scheme supported guidance within the literature regarding the importance of humanistic practitioner-client relationships in reminiscence work. For example, one participant (J) discussed the therapeutic benefits of feeling respected and experiencing genuineness from the facilitator, which led to increased confidence and the ability to be more open with others.
We would therefore strongly advise that time and attention should be given to relationship-building during assessment and planning. Reminiscence work is essentially humanistic and person-centred in nature (Gibson, 2004). A Rogerian approach was therefore adopted in the planning and implementation of this work. This demanded the integration of the core conditions of “empathy,” “congruence” and “unconditional positive regard” into the worker’s practice, which formed the basis of the therapeutic relationship and working alliance (Kirschenbaum & Jourdan, 2005, p.37).
One benefit of this approach was visible early on. The worker was able to identify and address initial apprehension among participants that this intervention may mirror their previous experiences of offence-focused work, which differed significantly as it usually took place in controlled environments, using highly structured methods and focused on criminogenic needs.
Understandably some participants needed more time to understand reminiscence and what this would involve. Therefore the planning stage sometimes needed to be extended, which offered key learning. This had to be balanced with the need to complete the programme to meet funding requirements, but we would highly recommend that attention is given to pacing work appropriately.
Overall the significant investment of time and energy that the work required was a key reflection point. In part this was due to the meticulous planning and preparation entailed, both for the overall project and for individual programmes and sessions. This often presented difficulty as, due to funding, the facilitator was completing the work on a part-time basis and effectively fulfilling two separate roles. Gibson (2011), Birren and Cochrane (2001) and Haight and Haight (2007) provided key texts influencing practical planning for the work.
The Social Work Strategy (2017) commits to building the capacity of the workforce, including the skills and knowledge of practitioners. Completion of this pilot scheme evidenced the unique potential of reminiscence and life review to develop the facilitator’s social work skills through a variety of diverse experiences, particularly since all methods were employed. This included the ability to practice interviewing and counselling skills, as a crucial aspect of structured life review (Haight and Haight, 2007), and the use of empathy during guided autobiography sessions, which was of particular significance given the absence of the group approach.
Close collaboration with relevant colleagues and professionals was essential to the success of the scheme and, in our experience, this began with in-house training to build knowledge regarding the work amongst the team. This ensured that key-workers could make informed decisions regarding referrals and subsequently, the vast majority of referrals were appropriate.
Strategies to manage any risks to participants associated with the work included Ellem and Wilson’s (2010) suggested use of a ‘support person’ who has regular contact with the service user to provide support between sessions and make appropriate referrals if needed. This was usually the floating support key-worker and sometimes also another professional was identified by the participant. The ready availability of this support provided an important safeguard.
The innovative nature of this work meant that all systems of collecting and recording information had to be newly designed, requiring time and deliberation at the beginning. Recommendations of social work academics such as Trevithick (2012) regarding the potential of jargon-laden language to exclude service users became relevant when an information sheet composed at the early stage, required redrafting in response to service user feedback.
In retrospect, this was hastily compiled and not user-friendly. Following this experience we would recommend that practitioners take time to reflect upon how they might convey important messages to service users to ensure that the process is collaborative. This is of critical importance when explaining agency policies regarding confidentiality, given risks around disclosure present in work with offenders (Ellem et al, 2008).
ETHICAL CHALLENGES AND VALUE-BASED CONFLICT
Northern Ireland Social Care Council (NISCC, 2015) standards of practice reflect the care versus control dichotomy within social work, with practitioners encouraged to promote the rights and autonomy of service users, whilst also safeguarding them and others from harm. Judging from participant feedback, the potential for reminiscence work to rebalance power was realised and this appears to have had a wider impact for service users, including greater confidence in decision-making in other areas of their lives (Buchanan and Middleton, 1994).
Principles of Kantian philosophy were present within much of the decision-making, with the rights and choices of participants regarding how the work would take place given high priority (Banks, 2012). However, the complexity inherent in encouraging independence and self-determination when service users are assessed as posing a risk to others (Kemshall & Pritchard, 1997) was felt during situations wherein public protection concerns overrode the wishes of service users, including pausing the intervention.
There is a recognition within the literature that those working with perpetrators of sexual abuse can be negatively affected by this work and an identification of the challenges in developing a “therapeutic alliance” in rehabilitative work with offenders (Briggs & Kennington, 2006; Ward et al, 2007). This became significant during the pilot scheme when themes of “bitterness revival”, including victim-blame, entered self-narratives (Gibson, 2011, p.47). This required a degree of emotional intelligence and self-awareness from the facilitator to manage the feelings of anger that this could evoke (Howe, 2008).
Effective use of supervision was vital in supporting the worker to manage these feelings by engaging in critical self-reflection and following the learning cycle. This was crucial, given the potential for oppressive practice should such feelings have influenced the facilitator’s responses, considering the expectation that social workers should show equal respect for the rights of service users regardless of their beliefs or attitudes (Clark, 2000; Banks, 2012).
Vicarious trauma can be experienced while listening to others telling their life stories where there is exposure to traumatic material, although it is a contested concept (Devilly et al, 2009). Information shared in work with sexual offenders can be potentially overwhelming for workers and burnout can occur (Briggs & Kennington, 2006). The social worker’s level of experience has been shown to mitigate against this, as well as regular access to supervision, which can address such issues (Briggs & Kennington, 2006; Devilly et al, 2009; Wagaman et al, 2015). On this occasion, these factors may have helped to avoid the negative consequences of secondary trauma and burn-out. However, during the planning stage, more attention might have been paid to identifying strategies for managing risks to the social worker.
Another dilemma concerned the extent to which participants should be encouraged to explore potentially difficult themes, including past trauma and offending behaviour, with the literature offering conflicting advice. Coleman (1986) suggests that blocking these memories may deny opportunities for self-growth and forgiveness. Research has found better mental health outcomes for those with painful pasts, resulting from recalling instances of effective coping (O’Rourke et al, 2011). However, we were aware that themes of bitterness revival and rumination during reminiscence have been shown to result in lower life satisfaction and greater psychiatric distress (Cappeliez et al, 2005). Apprehension regarding this prevailed throughout the scheme, however looking out for despairing reminiscence styles among potential participants during the assessment stage provided an effective safeguard (Gibson, 2011).
Nonetheless, we suspected that promoting a positive identity might demand a greater emphasis on other aspects of the participant’s life, considering Bluck and Levine’s (1998) suggestion that individuals who are dissatisfied with life, might employ reminiscence techniques to broaden the range of memories by which they define themselves. On reflection, the decision to empower service users to make decisions regarding subject matter, as far as possible, was in keeping with the person-centred nature of reminiscence and the Social Work Strategy (2017) aim of supporting service user autonomy and self-management of care.
MEASURING AND EVALUATING THE WORK
The five objectives set at the beginning of the pilot scheme were evaluated utilising a mixed methods approach to promote depth and breadth of understanding. This blended the use of two quantitative measurement tools with qualitative feedback questionnaires. This combined methodology was chosen with the aim of building a more complete picture of the experience of participants and facilitating the corroboration of data for a detailed analysis of the outcomes of the pilot scheme. Despite the small size of the study, the evidence gleaned provided a range of data and this enabled a comprehensive evaluation of each individual objective and the overall pilot scheme for the funders.
Quantitative methods consisted of Rosenberg’s (1965) self-esteem scale and Haight and Haight’s (2007) ‘Mood and Functioning’ assessment tool. These were initially planned to be administered at the beginning of engagement and upon ending the work. A mid-way measurement was later introduced, which widened our understanding of outcomes and enabled us to monitor the progress and well-being of participants during the programme.
The ‘Mood and Functioning’ (Haight & Haight, 2007) tool was a useful indicator of well-being, however close collaboration with colleagues and relevant professionals also helped to identify issues in a timely manner. Employment of the Rosenberg (1965) self-esteem scale was linked to the first objective, to improve the self-esteem of participants, enabling them to develop more pro-social identities and make positive changes.
Feedback questionnaires were dispensed to participants, as well as to referrers, other professionals and significant individuals identified by the participant, e.g. friends and family members. These were distributed after the programme to glean the views of participants relating to their experience and to document the observations of other interested parties regarding the impact of the work. It was hoped that widening participation in the evaluation process would lead to a more holistic and informed analysis, although, in practice, many questionnaires sent to professionals and significant others were not returned.
Qualitative feedback seemed to provide a more accurate representation of the experience of participants than simply relying on measurements. For example, feedback questionnaires illustrated how participants had begun to achieve the goals set out within the first objective, supporting Bender et al’s (1999) contention that the reminiscence function of creating a positive identity has significant therapeutic value. The Rosenberg scale highlighted an overall increase in self-esteem for most participants, however qualitative results suggested that this was the case for all.
This change in self-concept is illustrated by J, who reflects on his guided autobiography work:
“The person that came across turned out be quite interesting, very odd, certainly, but an interesting character. I felt that this person was likeable as a character and he had a story to tell. That was a unique and powerful, emotive experience.”
The second objective, to assist service users to adopt positive coping mechanisms in the face of the difficult transitions associated with community resettlement and reintegration, was also deemed to have been achieved. This was to be monitored through close liaison with the referrer to track integration and the participant’s ability to manage in the community. Qualitative data suggested that the work had had a positive impact in this area. Some referrers alluded to now being better informed regarding service user needs and coping mechanisms through their own informal discussions with participants regarding their experiences of the scheme.
Thirdly, the project aimed to offer service users the opportunity to tell their stories within a supportive environment, employing methods best suited to their individual communication needs. Qualitative data revealed that this objective was met for all participants. For example, in evaluating his experience J described feeling secure within the working environment, referring to a “pleasant and convivial” atmosphere. He discussed the warmth he felt from the facilitator, also referring to how the guided autobiography method incorporated his interest in writing, and linked these factors to positive outcomes the work had for him.
The fourth objective related to our anticipation that reminiscence work would increase our knowledge regarding the needs of service users through an appreciation of their unique life histories (Hewitt, 2006; Gibson, 2011). Findings would suggest that the information garnered from this work informed more holistic assessments, including risk assessments, contributing to care planning for the Floating Support service and its partner agencies.
It is now difficult to imagine another social work intervention which could better achieve this. It is also possible to envisage how these methods can promote goals of collaboration, a holistic and systemic approach to understanding individuals and the design and delivery of social work services around the needs of the people who use them, within the Social Work Strategy (2017). This outcome is significant and timely in light of the recent move towards “personalisation” within adult social care, promoting service delivery that treats people as individuals who have strengths and preferences and places them at the centre of their own care and support (SCIE, 2012).
Finally, it was hoped that this work would contribute to positive offence-free lives and that any reoffending during the programme would be highlighted and recorded. There was no evidence that participants who completed the programme reoffended during the period of engagement, however a longitudinal study would provide a more complete picture. Participants were questioned regarding any impact the work had had on their thoughts and feelings regarding their offences and positive changes were noted by all. For example, J alluded to how the more positive self-concept he had acquired will assist with rehabilitation.
In response to these positive outcomes, there is now an emphasis on taking reminiscence work forward. This has involved raising the work within the National Organisation for the Treatment of Abusers (NI) branch committee, meeting with key PBNI personnel to identify how these interventions relate to their treatment programmes and also exploring complimentary work with Nexus, around supporting perpetrators to deal with their own victim experiences. The overall objective now is to consolidate and develop reminiscence work as an ongoing programme of intervention which might relate to offender treatment programmes and complement existing programme delivery.
The planning and implementation of this pilot scheme has afforded immense learning, including overcoming a number of challenges. Overall, a degree of flexibility was required given the embryonic stage of the work and the diverse needs and abilities of participants. Four methods of reminiscence and life review were employed during the scheme, each linked to successful outcomes for participants, although questions surrounded whether the most appropriate approach was employed for some participants. Risk management concerns sometimes influenced decision-making, with the adaptation of some methods for individual work and safeguards factored into the planning process.
The innovative nature of this work has presented a limited evidence-base to inform practice, however creative application of the reminiscence literature in highlighting crossover of themes commonly emerging in work with sexual offenders, has provided a basis for this work.
Reminiscence interventions clearly align with those of the GLM of offender rehabilitation and our position within the voluntary sector has enabled us to develop this link. Critics have called for more empirical support for GLM interventions, whilst also suggesting that these might compliment more prevalent risk-based methods. We therefore welcome opportunities for exploring the potential of reminiscence work to operate alongside existing treatment programmes.
The importance of understanding memories within their social, cultural and historical context was pertinent during the scheme. In keeping with wider social work policy, an appreciation of the ongoing impact of the NI ‘troubles,’ was particularly relevant. Reminiscence work has the potential to offer a therapeutic vehicle for the sharing of experiences.
A mixed-method approach provided an in-depth perspective on the success of the pilot scheme, with evidence suggesting that the five main objectives were met. Overall, this has demonstrated how the holistic and strengths-based nature of reminiscence and life review align with the philosophy of the Social Work Strategy. Extern Floating Support’s position within the voluntary sector has enabled the project to address service-user needs with the creativity and innovation intrinsic to reminiscence and life review. We realise that, despite this success, the development of this work is at an early stage and we would welcome further research in this area.
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