What if you could remember where you were on nearly every day of your life? Impossible, you say? Not for a handful of people, including actress Marilu Henner, perhaps best known for her role in the 1980s television series "Taxi." Henner astounds audiences with her ability to associate specific dates with where she was, what she was doing, and various other details that would have been lost to forgetfulness by most (ABC News, 2012).
Henner is gifted with highly superior autobiographical memory, or hyperthymesia, the rare and uncanny ability to recall a remarkable number of significant personal experiences. To observers, it seems as though Henner is visualizing and referring to a detailed and highly organized autobiographical timeline as she recalls the stories of her life. Hyperthymesia is such an intriguing phenomenon that it recently has been co-opted into the storyline of the CBS television series "Unforgettable," in which the main character taps into her superior memory to help police solve crimes.
The use of memory has also been incorporated in clinical treatment, though the focus here is on autobiographical recall by the average person, as most people lack hyperthymesia. For five decades or more, clinical geriatric practitioners have used life review as a therapeutic approach (Webster & Haight, 2002) for the treatment of depression and other affective disorders. Speech-language pathologists, too, have joined the cadre of professionals who are creatively using autobiographical recall as a culturally appropriate approach to communicative intervention, primarily for older adult clients with mild-to-moderate cognitive-linguistic disorders.
Autobiographical memory, a normal cognitive ability, supports the recall of personally significant past experiences. These memories are distinctive, significant, rich in content, and relatively well preserved, even in old age. You don't need hyperthymesia to appreciate the benefits of autobiographical memory. SLPs, and others versed in facilitated reminiscence, can use autobiographical memories, along with relevant themes and props, to increase conversation in clinician-client dyads or in small groups (see example).
Researchers have discovered that autobiographical memory is characterized by "multiple types of knowledge" (Conway, 1996), including:
- Semantic memory, long-term memory of ideas, meanings, and concepts.
- Episodic memory, long-term memory of specific events and experiences.
- Autobiographical memory, a particular type of episodic memory that includes memory of personally meaningful experiences. Autobiographical memories also include information about the experiential context, including sights, sounds, and other sensory and perceptual information. A song, a scent, or simply a word can evoke autobiographical memories.
Most people have vivid memories of their first kiss, their wedding day, or the birth of their first child. Autobiographical memories also may include collectively shared public events, such as JFK's assassination, 9/11, or Obama's inauguration, events marked by their uniqueness and emotional impact. Such mile-marker events are called flashbulb memories (Schacter, 1996).
Perhaps not surprisingly, autobiographical and flashbulb memories are more robust and less likely to dissipate than memories for commonplace experiences. For example, remember the first time you ate, say...sushi? Where were you? What was the occasion? How did you like it? Now, try to remember what you had for dinner on this same day last week. Autobiographical and flashbulb memories may be accessed more easily and with greater frequency in old age, precisely because they are more robust than memories of what you had for dinner last week.
Life review, a process believed to occupy the thoughts of older adults, is a psychodevelopmental phenomenon driven by autobiographical memory. Butler (1963) observed that older adults invest ever-increasing amounts of time recalling aspects of their past. According to adult development theorists, life review is the psychological work of old age that involves putting a lifetime of experiences into some meaningful perspective. As such, life review is regarded as a universal aspect of adult lifespan development. Reminiscence is a by-product of life review, making facilitated reminiscence an age-appropriate intervention for older adults.
Nearly 15 years ago, I wrote that facilitated reminiscence answers the need for an intervention that is "...simultaneously engaging, relevant, cost-effective, culturally sensitive, and, above all, functional" (Harris, 1998). Then, as now, the search was on for creative therapeutic approaches to appeal to an increasingly culturally and linguistically diverse aging population. The mismatch in age, life experiences, and culture between majority-culture clinicians and older adults from nonmainstream populations remains constant (ASHA, 2010), as does the need for engaging, culturally appropriate, and fiscally conservative programming options.
Personally relevant, ecologically valid interventions are more engaging to clients. This level of engagement may be particularly important to older adults from culturally diverse backgrounds, who may not understand the purpose of clinical procedures, many of which lack relevance to their experiences and interests. Although not a panacea, facilitated reminiscence is suitable for many of these clients.
As a language intervention, facilitated reminiscence is a social, interactive activity designed to encourage the recall and discussion of pleasurable past experiences. Facilitated reminiscence strategies can be used with individual clients. However, the approach is especially well suited for group treatment because it encourages communicative interactions. Thus, facilitated reminiscence is a practical programming solution for nursing homes, adult daycare, and other communal living facilities. Reminiscence material is self-generated, retrieved from the memory stores of the older adult client, and facilitated by the clinician. The cultural experiences and values of all clients are ensured by reminiscence-evoked topics that are self-generated and autobiographical.
Older adults enjoy telling their stories, often prefacing them with "Did I tell you about the time that I...?" Conversations based on reminiscence topics are more naturalistic, because participants who share autobiographical information are no longer relegated to passive partners in the communicative exchange. Perhaps, more important, facilitated reminiscence acknowledges, affirms, and values older adults' life experiences as topics of conversation—a boon to their self-esteem and well-being—even for older adults with restricted cognitive-communicative abilities.
Running a Reminiscence Group
During my tenure as the staff SLP at a residential extended care facility, I facilitated a weekly reminiscence program. The goal was to encourage socialization and meaningful communication among the residents. An open-door format meant that group size and composition varied from week to week and included many regular participants who sometimes recruited newcomers. This experience taught me the value of facilitated reminiscence as a framework for communication-based interventions. You can do the same work with your older clients, using some of the same clinically tested, socially validated approaches I used with mine.
SLPs possess a uniquely appropriate skill set for designing and implementing communication activities for older adult clients, such as knowledge of developmental aspects of typical aging and understanding of cognitive-communicative disorders in aging (ASHA, 2004). As a reminiscence facilitator, the SLP manages the selection of topics, scheduling, group composition, and communicative interactions between and among group participants. Some guidelines may be helpful (see box above for more facilitation tips); in leading sessions, facilitators may want to:
- Steer away from topics likely to evoke negative affect. Keep in mind that the goal of facilitated reminiscence is to provide opportunities for meaningful communication, not psychotherapy. Understanding the participants' shared historical experiences provides a viable starting place for topic selection. As an example, you might consider those mile-marker or flashbulb memories shared by particular age cohorts. People in their 70s and 80s were young adults when President Kennedy was assassinated, and are likely to remember this historic incident as a significant life event. An alternative strategy is to draw from universally experienced developmental life events, such as early childhood, school days, adulthood, marriage, work life, and retirement. Yet another approach is to draw reminiscence topics from national, regional, religious, and ethnic holidays to prompt sharing of information about various cultures and traditions.
- Choose props and materials that appeal to a variety of senses and support the selected topic or theme. Props and materials not only provide contextual support, they also enhance the pleasurable aspects of reminiscence. Moreover, appealing to various sensory abilities increases the likelihood that each group member participates to the fullest extent possible. For example, an accommodation for a participant with visual impairment can include auditory, tactile, or olfactory stimulation. Music, environmental sounds, scents, artifacts, and photographs are all readily available and, in many cases, are free or of negligible cost.
- Provide visual support for facilitated reminiscence work. For example, use a digital camera to bring the outside indoors. This support is especially useful for people who may have limited ability to travel outside a residential facility. Think about the memories that could be evoked by photographs of infrequently visited, but familiar venues, such as a city center or the countryside. These photographs could give rise to conversations about differences between then and now. As an extension of the "then and now" comparisons, a perennial favorite is a discussion about jobs, places, and things that no longer exist, such as elevator operators, TV repair shops, and carbon paper.
Facilitated reminiscence exploits relatively well-preserved autobiographical memories to enhance communication opportunities for older adult clients who may differ in abilities, cultural background, and life experiences. The approach is particularly appropriate for people whose cultural orientation may differ from that of the SLP, as reminiscences are inherently autobiographical and therefore always culturally appropriate.
In an age of increasing cultural and linguistic diversity—against a backdrop of a rapidly aging population—facilitated reminiscence emerges as a viable option for an appropriate, effective communicative intervention. You may rest assured that hyperthymesia is not required.