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Guided autobiography for older adults 1997

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GUIDED AUTOBIOGRAPHY FOR OLDER ADULTS by CANDICE A. HUNTER B.A., University of British Columbia, 1977 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Department of Counselling Psychology We accept this thesis as conforming the the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1997 © Candice A. Hunter, 1991 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of C-OU AJ S e UC I Aj 67 P$> yc Ho CO L> y The University of British Columbia Vancouver, Canada Date OCToB^K t O, I 9 9 7 DE-6 (2/88) Abstract Guided autobiography for older adults is a promising tool for helpers interested in working with this population. Outlined by Birren & Deutchman (1991) this method of group work enables older adults to reflect on and review life as lived through sharing written reflections in a confidential small group setting. An ethnographic case study was designed to better illuminate how guided autobiography impacts older adults and to help determine whether it is a promising group design for counsellors and other professionals working with older adults. Seven older adults from West Vancouver participated in a guided autobiography group using Birren & Deutchman's (1991) methodology, focusing on the theme, "the major branching points of life". After the completion of the group each participant was interviewed individually. The interviews were audio- taped, transcribed and then analyzed for evidence of the outcomes reported by Birren & Deutchman (1991). Evidence was found in support of the following outcomes: reconciliation with the past and resolution of past resentments and negative feelings; resurgence of interest in past activities or hobbies; development of friendships with other group members. No evidence was found in support of these outcomes: sense of increased personal power and importance; recognition of past adaptive strategies and application to current needs and problems; greater sense of meaning in life. New outcomes were identified as: recognition that one's life is not yet completed; satisfaction with one's life course; a new perspective and/or appreciation of one's life through comparison with others; and a new awareness or heightened awareness of one's contributions and/or abilities. iii Table of Contents Abstract ii Table of Contents iii Acknowledgments v In Memorium vi Chapter 1— Introduction 1 Statement of the problem 1 Purpose of the study 10 Significance of Study 12 Chapter 2 — Literature Review 13 Life review 13 Reminiscence 23 Guided autobiography for older adults 31 Chapter 3—Methodology • —38 Research Design 38 Data Collection Strategies 41 Data Analysis 45 Participants 47 Ethical Considerations 49 Limitations of Study 50 Chapter 4 -- Results 53 Biographical Synopses 53 Art's Biography ; 53 Drew's Biography 55 Glen's Biography 57 Kathy's Biography 59 Mary's Biography 61 Norma's Biography 64 Patricia's Biography 66 Evidence of outcomes 67 Sense of increased personal power and importance 68 Recognition of past adaptive strategies and application to current needs and problems 68 Reconciliation with the past and resolution of past resentments and negative feelings : 68 Resurgence of interest in past activities or hobbies 71 Development of friendships with other group members 72 Greater sense of meaning in life 73 IV Ability to face the nearing end of life with a feeling that one has contributed to the world 73 New awareness or heightened awareness of one's contributions and/or abilities 73 A new perspective and/or appreciation of one's life through comparison with others 75 Recognition that one's life is not yet completed 78 Affirmation of identity 80 Satisfaction with one's life course 81 Comments and suggestions on group structure 82 Comments on group format 82 Comments on writing and reading process 84 Comments on group formation 86 Benefits of participation 88 An opportunity to reflect 88 To tell one's story 89 Chapter 5—Discussion 90 Discussion of the findings 90 Implications and recommendations for future research 92 Implications and recommendations for counselling 95 Impact of the group on the researcher 99 Contributions of guided autobiography 101 References 103 Appendices '. 109 Appendix A—Letter of Initial Contact 109 Appendix B—Agency Consent Form 110 Appendix C — Participant Consent Form 111 Appendix D—Group Interview Consent Form 112 Appendix E—Interview Schedule 113 Appendix F—Summary of Findings 116 V Acknowledgments Ms Muriel Brown-Shaw, mentor, colleague and friend who has consistently inspired and impressed me with her love of learning, her enthusiasm for life review and her dedication to bringing a successful concept of aging into the "public sphere" Dr. Marvin Westwood, Thesis Chair, who has been supportive, encouraging and helpful throughout this project Dr. Frank Echols and Dr. Norman Amundson, Committee Members, who have contributed ideas and suggestions The participants of this study who have generously given of their time and shared their lives with candor My friends, who have cheered me on in numerous ways And especially my parents, Roland and Shirley Hunter who have been unfailingly supportive and encouraging of my studies and who, each in their own unique way, model life-long learning and a successful concept of aging vi In Memorium "Drew" February 19th, 1921 - August 16th, 1997 1 Chapter l~Introduction I. Statement of the problem The past decade has seen a burgeoning interest in autobiography as a means of understanding and informing human development. This interest spans the social sciences—sociology, anthropology and psychology. Within the field of psychology, autobiography is considered by many researchers to be "a rich source of data for theory development" (Birren & Hedlund, 1987, p.397). The study of autobiographies and diaries has spawned several theories of human development among them Murray's (1938) theory of personality, White's (1952) theory of personality development and Levinson's (1978) theory of adult male development (Birren & Hedlund, 1987). Murray (1938) stated, "The history of the organism is the organism. This proposition calls for biographical studies" (p.39). Murray's call is now being heeded in the social sciences as developmental psychologists recognize the valuable perspective afforded by autobiography. Developmental psychologists are concerned primarily with a lifespan perspective of development—examining general patterns of both stability and change and seeking to see if universal patterns exist (Kimmel, 1990). While the general is important, individual variation is not ignored. The fact that individuals have a history that is uniquely their own is also recognized (Kimmel, 1990). Autobiography is becoming recognized as an important "window" into the individual's developmental world. Valuable information about the processes of "growing up and growing old"(Birren & Hedlund, 1987, p.395) can be gleaned from life stories - information that might be overlooked or missed entirely if other data methods were used (Birren & Hedlund, 1987). Autobiography affords 2 important glimpses into an individual's inner world, glimpses that are often overlooked through quantitative research methods. For theorists of human development, autobiography can assist in refining what is known and increasing our understanding of what is yet unknown. Berman (1995) argues convincingly for how autobiography can increase our understanding of older adulthood, describing autobiography as "an opportunity to have a sustained encounter with an older person" (p.xx). Reading the autobiographies of older adults can be informative for professional and nonprofessionals alike. Those who are service providers can relate to older adults free from constraints of job descriptions, younger adults can experience "anticipatory socialization" (p.xx) , and older adults themselves can learn through the "windows and mirrors" (p. xx) provided by others' autobiographies. It is not coincidental that the recent rise in interest in autobiography parallels the interest in and practice of qualitative research methodologies to understand human development. Hermenutical approaches in the social sciences continue to develop, "each of which construes human lives and other social phenomena as texts to be interpreted" (Campbell, 1983). This postmodern perspective, in contrast to the modernist emphasis on empiricism, sees knowledge as a social product, constructed by individuals and constantly changing. The behaviourist paradigm, which dominated psychological research in the 1960's and 1970's viewed narrative as inaccurate and unreliable (Gergen, 1996). With development and refinement of qualitative methodologies, autobiography and other forms of narrative are considered by many researchers to be both accurate 3 and reliable, providing rich sources of data to understand human development, particularly aspects of life already lived (Alexander, 1988). It is this latter aspect of the possibilities of narrative that has piqued the interest of several developmental psychologists. The past thirty years has seen a significant increase into research of the aging process (Kimmel, 1990). Whereas previously the aging (here defined as men and women over the age of 65) were often viewed "as useless, a drain on the nation's productivity and a hindrance to advancing technology" (Kimmel, 1990, p. 465), now the aging are viewed more positively—as members of society who have contributions to make and who can inform researchers about the life course. In the field of gerontology, there is an increasing call for lived experience to take its rightful place as a "subject" worthy of study. Hermeneutic gerontology embraces the study of "the personal meaning of aging" and "values the investigations of lived experience" (Berman, 1995, p.3). Butler (1963) in his research on the life review process in older adults urged developmental psychologists to include the aged in their work. Without their inclusion he believed the life cycle could not be properly understood (p. 76). He also emphasized the need for researchers to be informed about the life cycle by those who know best—those who have lived it out: "The personal sense and meaning of the life cycle are more clearly unfolded by those who have nearly completed it" (p.72). That those who "have nearly completed it" are rising in numbers has been well documented. The population of older adults is increasing dramatically over the world (Kimmel, 1990). It is estimated that by 2020 approximately 20% of the population of Canada will be over 65 (Thornton, 1992). The level of formal 4 education is also growing. By 2000 70% of older adults in the United States will have completed high school while a further 20% will have completed some college (Kimmel, 1990). The Western view of the older adult has largely been based on deficiency (Botella & Feixas, 1992/93). This will likely change however as educated older adults in such numbers will not be content to be relegated to the "backroom" of society or of developmental theories which stress decline and loss. It is likely that their call will be for a successful concept of aging, one which acknowledges the gains in aging, the contributions and unique perspectives of older adults. The developmental theories of Erikson (1968), Levinson (1986), McAdams (1988), the work of Butler (1963), and Lewis & Butler (1974) have contributed significantly to our understanding of human development. More importantly, each theorist has outlined key developmental tasks of older adulthood. The oldest and most prominent theories of aging focus on the many physical changes that accompany the aging process and therefore are more biological in nature (Lanum & Birren, 1995). Each of the above theorists has focused more on psychosocial factors and thus has helped expand our understanding of human development across the life span. Erikson's psychosocial theory of development Erikson was the first psychologist to extend Freud's psychosexual stage concept of development from childhood to adulthood (Lanum & Birren, 1995). Erikson outlined eight stages from infancy to old age (Erikson, 1976). At each stage the individual faces a critical task involving tension between two forces (i.e. basic trust vs. mistrust). If the tension is worked through a synthesis emerges (i.e. 5 hope) (Kimmel, 1990). Healthy development involves resolution of the tension at each psychosocial stage. According to Erikson, the developmental task of old age is to resolve the conflict or struggle between integrity and despair. If the conflict is adequately resolved, the value of wisdom will result. Integrity is understood as appreciating the meaningfulness of life as lived and knowing the contributions one has made to society (Erikson, 1968). Despair, the opposing force, results in regret, frustration and discouragement (Stevens-Long & Commons, 1992). Erikson (1982) defined wisdom as "an informed and detached concern with life itself in the face of death itself (p. 60). A critical task therefore for this stage is to evaluate one's life and review one's accomplishments (Kimmel, 1990). Levinson's theory of adult development Levinson views development as occurring in age-linked periods called "eras" (Levinson, 1986). Ten age-linked periods from early adulthood (ages 17- 45) to late adulthood (age 65 +) are proposed. A "cross-era transition" of a five year period is included in each era. These transitions mark the ending of one era and the beginning of another (Levinson, 1986). Within each era the "life structure" is being defined and redefined. A life structure can be understood as an individual's answer to the question, "What is my life like now?" (Levinson, 1986, p. 6) The relationships of the individual (to a person, place, object, group or institution ) are the key components of the life structure (Levinson, 1986). Levinson (1978) conceived of late adulthood as beginning at age 60 with late adulthood transition occurring from age 60 -65. Late adulthood is seen as a time of coming to terms with bodily decline (p.34); accepting that a younger 6 generation is now center stage; (p.35) developing the self (p.36), and evaluating life as lived: He must arrive at some appraisal of his life not simply of his virtue or achievement but of his life as a whole. If he succeeds in this, he can live without bitterness or despair during late adulthood. Finding meaning and value in his life, however imperfect, he can come to terms with death" (p.37). McAdam's developmental course for the formation of identity McAdam (1996), drawing on the work of William James (1892) and others, sees the development of the self as beginning in the first year and a half of life when a sense of "I" as a "separate, continuous, volitional agent" first emerges (p. 133). The "I" is distinguished from the "Me" which is the "I's" concept of itself, commonly known as the self-concept. The "Me" or the self-concept begins developing in the second year of life due to a growing awareness of a bodily self and a verbal self. As the "I" continues to grow and develop through childhood and early adolescence the "Me" becomes "progressively more complex and nuanced "(p. 133). McAdams has delineated three developmental stages: the premythic, mythic and postmythic. Premythic refers to the stage of childhood and early adolescence where experiences provide rich narrative material for use in adulthood and where the "Me" first begins to form. The mythic begins in adolescence or young adulthood when a "self-defining life story" is first created (p. 136). Further creation and refinement of life story (the story of "Me") continues throughout adulthood. Midlife is characterized as a time of seeking harmony and balance in the life story and creating a "satisfying ending for the 7 narrative" (p. 143). The postmythic stage may occur in older adulthood and is similar to Erikson's eighth stage of integrity versus despair. This stage is described as a time of reflecting on life as lived and either accepting (integrity) or rejecting (despair) the story that is reviewed: ...the elderly person looks upon his or her life as something that has been and must now be reviewed or evaluated as a near-finished product, a story that may be accepted (integrity) or rejected (despair) but which can no longer fundamentally be changed (p. 136). Butler's theory of life review According to Butler (1963) reviewing life as lived is a universal process of older adulthood. Reminiscing in older adults is often dismissed as mere garrulousness. In contrast, Lewis & Butler (1974) see reminiscing as an important and purposeful developmental task enabling the older adult to "reflect on his life in order to resolve, reorganize and reintegrate what is troubling or preoccupying him" (p. 165). Life review occurs because of time available to the older adult for self-reflection (Butler, 1963) and because of the awareness that death is looming: I conceive of the life review a as naturally occurring, universal mental process characterized by the progressive return to consciousness of past experiences, and, particularly, the resurgence of unresolved conflicts; C simultaneously, and normally, these revived experiences and conflicts can be surveyed and reintegrated. Presumably this process is prompted by the realization of approaching dissolution and death, and the inability to maintain one's sense of personal invulnerability (Butler 1963, p. 66). 8 While reviewing one's life occurs at all ages, and often in response to crisis (Butler, 1963), this process is seen as taking on "striking intensity in old age" (Lewis & Butler, 1974, p. 165). A successful life review would be marked by resolution of resentment, guilt and distrust while an unsuccessful life review could result in mild regret, anxiety, depression and in the extreme, possible suicide (Butler, 1963). Lewis & Butler (1974 ) developed life review therapy, using the reminiscence of older adults in intentional and deliberate ways . Individual and group therapeutic methods are outlined (i.e. autobiographies, pilgrimages, reunions, genealogy, memorabilia) to help evoke memories in older adults and assist in the life review process. The therapeutic benefits from life review in the presence of others who will support, accept and listen include: confronting fears of death, developing pride in one's life, making sense of life as lived, developing acceptance of self and others and reexamining and restructuring identity (Lewis & Butler, 1974). Erikson, Levinson, McAdams and Butler each view older adulthood as a time of reflection and review. This review is seen as a crucial developmental task of older adulthood which can either end in resolution or fragmentation. Birren and Deutchman's (1991) use of guided autobiography with older adults has been developed to provide an opportunity for participants to review their lives and work towards resolution in that process. This method uses autobiography in a group setting to enable older adults to review live as lived. The group is designed to promote reflection on life as lived through the use of evocative themes and sensitizing questions (Birren & Deutchman 1991). Participants use the questions 9 as a guide for writing and then later share these written reflections in the group setting. Each group is facilitated by a group leader familiar with the life review process as outlined by Birren & Deutchman. Their group design has been influenced by Butler and the developmental theories of Buhler, Erikson, Levinson and Gould (Birren & Deutchman, 1991). Guided autobiography therefore gives older adults an opportunity for life review, described by the cited theorists as a critical developmental task of older adulthood. Moreover guided autobiography can also contribute to a successful concept of aging as older adults not only purposefully reflect on and review the past but also plan for the future (Birren & Deutchman, 1991). Implicit in this aspect of guided autobiography is that olders adults have not finished living with purpose. And while the primary purpose is life review, clearly an important use of autobiography is utilized as group leaders are given a valuable opportunity to learn about human development through the participants' reflections. Birren & Deutchman (1991) have listed the positive outcomes of the guided autobiography process. Older adults who have participated in guided autobiography groups have reported the following: • Sense of increased personal power and importance • Recognition of past adaptive strategies and application to current needs and problems • Reconciliation with the past and resolution of past resentments and negative feelings • Resurgence of interest in past activities or hobbies • Development of friendships with other group members 10 • Greater sense of meaning in life • Ability to face the nearing end of life with a feeling that one has contributed to the world, (p. 4) Several studies of life review interventions with older adults in group settings have showed positive results, among them an increase in self knowledge and improved social relationships (Lewis & Butler, 1974; Birren & Hedlund, 1987, and Norris & Abu El Eileh, 1982) However such benefits may be due to the social aspects of the group, not the life review itself (Watt & Wong, 1991). It is possible that similar benefits could result from groups of older adults meeting for a different purpose (i.e. to discuss current events). This method of life review is relatively new and as a result there is little published research. As will be documented in Chapter Two, published studies on life review interventions are often anecdotal in nature without adherence to a particular research design or methodology. B. Purpose of the study The purpose of this study then is to contribute to further understanding of the putative value of guided autobiography for older adults by interviewing older adults who have participated in a guided autobiography group. Birren & Birren (1996) stress the need for research focused on how guided autobiography changes participants: "The primary question from the individual's point of view, would be what changed during the course of writing their autobiography and whether or not they view their lives differently after the guided autobiography experience" (p.296). This study has been designed to explore this question. A guided 11 autobiography group of seven older adults (three men and four women ages 70 - 80 years of age) from West Vancouver was facilitated by the researcher. The first theme, "The Major Branching Points in Your Life, "in Birren and Deutchman's (1991) group design was used (See Appendix for definition and sensitizing questions). After completion of the six sessions each participant was interviewed individually and asked about his or her experience. Each participant was asked questions designed to determine if the outcomes listed by Birren & Deutchman (1991) had been realized. Key questions were: "Is guided autobiography effective for older adults and if so what makes it effective? If older adults report viewing their lives differently after participating in a guided autobiography group, what causes this? Are the outcomes listed in the literature reported by participants?" As mentioned earlier, the beneficial results of group life review interventions (such as guided autobiography) that have been reported in the literature could be due to other factors, such as the opportunity for social interaction, forming friendships and learning about oneself and others. These are some of the therapeutic factors of group counselling (Yalom, 1985), potentially shared by all therapeutic groups. It is possible that guided autobiography for older adults does not achieve the intended outcomes as outlined by Birren & Deutchman (1991). These issues are critical to both our understanding and use of guided autobiography with older adults. 12 C. Significance of Study As already mentioned there is little research on guided autobiography for older adults . This study therefore contributes to development of knowledge about this group design. Moreover, several of the studies that have been published are anecdotal and have weak methodology. The current study adopts a systematic qualitative methodology so more definitive statements can be made about the findings. The majority of cited research on guided autobiography which is not anecdotal describes quantitative methodology which often results in little or no information about the group from the participants' perspective. As well, many studies of life review interventions have been conducted with older adults residing in nursing homes or hospitals, using a more clinical population (i.e. Busch, 1984; Hay, 1995; Weiss, 1994 and O'Connor, 1994). This study will be more similar to the North American older adult population as nearly all older adults (95%) live independently in a community or with family (Stevens- Long & Commons, 1992). It is hoped that this study will better illuminate how guided autobiography impacts older adults and whether it is a promising methodology for counsellors and other professionals working with older adults. As the population of older adults increases it will become increasingly more important to develop methods of helping that are effective and promote a successful concept of aging. Guided autobiography groups for older adults have the potential for both. 13 Chapter 2 ~ Literature Review When examining and discussing theories and concepts it is important to know what research support has been garnered for these theories and concepts. Questions that are germane here are, "What exactly is life review?"; What evidence is there that life review is a key developmental task of older adulthood?"; "What have we learned about reminiscence?" and, "What evidence is there that guided autobiography is helpful for older adults?" Life review Butler's (1963) paper on life review and life review therapy (Lewis & Butler 1974) led to a slight increase in research on this subject in the 1970's, followed by a tripling of published research in the 1980's (Webster, 1994). A further increase in published articles has continued into the 1990's (Haight, 1991). A significant body of research on reminiscence has also developed. Practitioners such as nurses and social workers have led life review groups for their clients (Watt & Wong, 1991). Both theorists and practitioners of gerontology have shown interest and respect for the life review process (Moody, 1988) While this research has furthered our understanding it has also "muddied the waters" as a multitude of terms have been used interchangeably often with no operational definitions provided (Merriam 1993a). As a result, research results are often conflicting, due in part to this absence of a common terminology or taxonomy (Webster, 1995). Merriam (1993a), in her analysis of the life review literature, reported a "fair amount of confusion with respect to terminology" compounded by studies which are often weak in design and methodology (p. 168). Not only are conceptual terms such as reminiscence and life review poorly defined or not 14 defined at all, but benefits and criticisms alike are often reported as global impressions and anecdotal comments (for example, Hewett, Asamen & Dietch, 1991; Shute, 1986 and Norris & Abu El Eileh, 1982.) Brennan & Steinberg (1983/84) illustrate this lack of conceptual clarity in their study of reminiscence. They reported that reminiscence (defined as involving a review of one's past) was not found to be positively correlated with morale in their study of 40 older women ages 64-88. However, their results were based on a one hour interview which is a far cry from the tenets of life review therapy proposed by Lewis & Butler (1974). Similarly Shute (1986) warned against the use of life review based on an adverse reaction of an 85 year old woman who had participated in life review with a paraprofessional. No information was given regarding the process of life review used or the qualifications of the paraprofessional. As well, Hewett, Asamen & Deitch (1991) reported negative results with a structured reminiscence group for nursing home residents. Thirty residents were randomly assigned to three groups: (1) active reminiscence to explore past memories; (2) reminiscing to cope With current "daily living issues", and (3) no-treatment control group. Members of active reminiscence group were reported to "become more depressed" and to "demand more personalized care" (p.71). The second treatment group, in contrast, was noted to have resulted in "increased perception of personal control" (p.72). The authors concluded that "structured reminiscence interfered with feelings of resolution and acceptance" (p.72). Several methodological flaws are evident here. As with Shute's (1986) case study, no information was given as to the training of the group leaders. One assumes each group was led by a different leader, 15 however, this is not explicit. It is possible the results were a reflection of the group leader's skills (or lack of). The request for more individualized attention from the active reminiscence group members was interpreted as indicating depression, however other interpretations could be given — such as an increased desire to talk about past experiences with a caring listener. The authors do not state how "increased personal control" was measured, either before or after the intervention. More importantly, no information is given as to what "structured reminiscence" means and how structured reminiscing activities were designed or facilitated. Moore (1992) reports successful results (defined as a "decrease in depressive symptoms of some of the participants," p. 173) and improved attendance in social activities from a reminiscence therapy group of eight older adults living in a retirement complex. However no information is given as to how these depressive symptoms were measured, pre or post group, and no information is given as to what the "non-directive approach" used actually is (p. 172). Again we are confronted with an absence of operational definitions and adequate methodology. Over the past decade there has been a more concerted effort to delineate terms, to refine and sharpen definitions. As a result, the terms life review and reminiscence are now understood as different constructs. Both processes can be understood as existing under the "umbrella" of recall (Haight & Burnside 1993, p.91) but with each having different purposes and functions. Webster & Haight (1995) have summarized what has been learned about these purposes and functions. They have outlined the differences between reminiscence and life review as well as autobiography and narrative following their survey of the literature. While their summary is not 16 definitive, it is most helpful in highlighting the distinguishing characteristics between reminiscence processes that previously have been understood as one construct: Reminiscence: high in spontaneity, relatively unstructured and low in comprehensiveness. Evaluation may be present but is not integral. Occurs with high frequency across age groups (p.276). Life review: less spontaneous, but more structured and comprehensive than reminiscence. More likely to occur as a result of "specific triggers" such as crises or transitions (p.277). Evaluation is integral. Often the recalling is sequential in nature, from childhood to the present. The outcome is "an appreciation of the magnitude of one's life" (p.277). Autobiography: occurs only when planned. Evaluation is often included but not necessary. Major life themes are examined such as family, work etc. A developmental or sequential sequence is not necessarily followed. Similar to life review, this is a comprehensive undertaking. When completed in a group setting reintegration and acceptance of difficult aspects of life can occur (p.278). Narrative: story telling or relaying information to listeners. Compared with reminiscence it is less spontaneous, more structured and less frequent. A more comprehensive description of the similarities and differences between reminiscence and life review interventions has been provided by Haight & Burnside, (1993). Both interventions evoke memories and feelings. The authors stress that it is therefore important that helpers are qualified to handle emotional distress. However, the differences between the two interventions are far greater in number. These include contrasts in goals, the role of the listener, processes used, and expected outcomes: 17 Reminiscence Intervention: Characterized as a spontaneous, individual or group process that focuses primarily on pleasurable memories. The role of the helper is to support and facilitate positive group interaction but not to encourage evaluation or exploration of feelings. Outcomes for both one-to-one and group reminiscence include decreased loneliness, increased socializing, improved self-esteem, alertness and communication skills. Group reminiscence can also result in formation of friendships (p.95). Life Review Intervention: A structured process between one therapeutic listener and reviewer, designed to result in Integrity (as defined by Erikson, (1968), and involving a "critical analysis of one's past" (p.96). Evaluation is a key component. The role of the listener is to encourage exploration and evaluation through acceptance, caring and empathic understanding (p,96). The focus is on the self, not the event being remembered. The above description of life review is in sharp contrast to Lewis & Butler's (1974) conception of life review as spontaneous in nature. This is an important distinction and one that helps clarify some of the conflicting findings on life review. Research findings and current conceptualization of reminiscence processes suggest that life review as Butler (1963) and Lewis & Butler (1974) originally defined it, may occur only when a structured opportunity is provided. This type of "review" is qualitatively different from reminiscing or reviewing past events and should not be confused with it. Such a distinction is helpful when considering the research of Merriam (1993a) who was highly skeptical of the universality of the life review process based on her research with older adults. Merriam interviewed centenarians (n=105), 80 year olds (n=94) and 60 year olds 18 (n=90) regarding the life review process. Each older adult was given a questionnaire asking if s/he had or was currently participating in life review. Participants who had engaged in life review were also asked what caused this. All subjects were asked if they were satisfied with their past life. Life review was described as the process people may engage in in order to "review and evaluate their past in order to get an overall picture of their life" (p. 170). All of the subjects were living in the community and were "cognitively intact" (p. 169). Merriam found that 46.4% of the total sample had not participated in life review, and of this group 89.9% reported being "satisfied" with their past. Over 40% (43.8%) of the centenarians had not engaged in life review, neither had 44.7% of the 80 year olds or 51.1% of the 60 year olds. No one single cause was given for precipitating the life review and no subject mentioned "impending death" as the cause (p.171). She therefore called into question Butler's description of life review as a "universal phenomenon "(1963, p.66) of "striking intensity in old age" (Lewis & Butler, 1974, p. 165) and necessary for resolution and integration. Merriam concluded that "being satisfied with one's life appears independent of having conducted a life review" (p. 171). Merriam gives no information on the selection of the interviewers or their training. It would be important to ensure that interviewers were skilled at creating a trusting environment in order to facilitate candid responses to what are hardly typical questions for a first meeting between strangers. Furthermore it is interesting to note Merriam's emphasis—on the percentages who had not participated in life review. If the percentages are given in the affirmative, 56% of the centarians, 55% of the 80 year olds, and 49% of the 60 year olds reported 19 reviewing and evaluating their past. The argument could be made that this is fairly compelling evidence for life review, particularly considering the personal nature of the interview questions. It would also appear significant that as age increased so did the likelihood of life review. If life review is understood as being comprehensive, structured and evaluative, with opportunities for resolution and reintegration of past conflicts, it is quite conceivable that some older adults do not enter into this type of reflection spontaneously or for that matter, readily. This however does not mean that the life review is not an important developmental task of older adulthood. It is possible that for some older adults such a review occurs only when an opportunity is provided. Such an opportunity was provided by Haight (1988) in her study of life review comparing an experimental group (Life Review ) with a control group (Friendly Visit) and a No-Treatment group. Fifty-one homebound older adults (ages 50 -79) were randomly assigned to one of the three groups. The Life Review group participated in a structured life review process (1 hour for 6 weeks), the Friendly Visit group discussed current events and topics of interest with the interviewer (1 hour for 6 weeks). Interviewers for the experimental groups were trained to use micro-counselling skills. Life Review interviewers were instructed in the life review process using the Life Review and Experiencing Form (LREF) as a guide. All participants were given pre and post-tests measuring life satisfaction (measured by The Life Satisfaction Index), positive and negative affect (measured by Bradburn's Affect Balance Scale), depression (measured by Ziing's Depression Scale) and activities of daily living (measured by 15 questions 20 from Older Americans Resources and Services Multidimensional Assessment). Haight reported that life satisfaction and psychological well being improved significantly only for those subjects who participated in the Life Review group. She also noted that life review did not produce depression in this sample which addressed concerns of some researchers (i.e. Shute, 1986) that depression could be precipitated through life review. Four years later, Haight retested her subjects. Of the 35 subjects retested she found no significant changes in all three groups. Those who were in the Life Review group showed a slight gain in life satisfaction. While this difference was not statistically significant it is interesting to note that the control and treatment groups showed no change in scores, resulting in Haight's comment that "there may be some promise for the lasting effects of life review" (Haight, 1992, p.315). As a result of further research conducted by Haight & Dias (1992), the senior author and Coleman & Lord (1995) characterized life review as guided by a "purposefulness and force" that places it in an entirely different category than reminiscence (p. 179). They described it as a directed process, not a spontaneous one as reported by Butler. Central to this process is the presence of a "listener" who helps in the process of "investigation and reorganization" of memories (p. 180). The listener leads the individual through a structured review of his or her life from birth to the present, asking questions that reflect the developmental stages outlined by Erikson. Their research has resulted in three "linchpins" of a successful life review: structured, evaluative and individual (p. 182) . These key descriptors were determined in their comparison of five different interventions: Structured Evaluative Life Review (birth to present with evaluation of events and 21 exploration of feelings); Structured Life Review (birth to present reviewed but without evaluation of events and exploration of feelings); Random Reminiscing (randomly selected events reflected on without evaluation of events and exploration of feelings; Evaluative Random Reminiscing (randomly selected events reflected on with evaluation of events and exploration of feelings and Current Events (discussion of present happenings). Ten interventions were designed in total: 5 group and 5 individual. Each intervention was conducted for 6-8 weeks. Participants were older adults living in nursing homes or housing for seniors. Subjects were tested pre- and post-intervention on four measures: Life Satisfaction Index A, Rosenberg Self-Esteem Scale, Bradburn's Affect Balance Scale and the Beck Depression Inventory. Results showed significant improvements for those subjects who participated in the individual structured evaluative life review. The importance of "one listener only" (p. 184) is described as essential for establishing a therapeutic environment where personal material can be freely shared. This recommendation however would seem to refute much of the research on the benefits of therapeutic groups which include the realization that one is not alone and that comfort can be derived from sharing problems in a group setting (Yalom, 1985). Two research assistants were trained to conduct the interventions. It is unfortunate that limited information is given regarding the training of the individual listeners or the group leaders. It is possible that the results reflect a difference in the skills of the respective leaders rather than the intervention per se. It would therefore appear to be premature to state that a successful life review must be conducted individually. The authors state that groups "have an important place and are especially important for socializing new 22 residents to nursing homes" (p. 184). The latter comment would appear to reveal a rather glaring absence of familiarity with the diversity of groups for older adults. Group work with this population is extremely varied ranging from orientation groups to group psychotherapy (Buraside, 1994). As well, Birren & Deutchman's (1991) research on and review of guided autobiography in group settings contradicts these findings. They state that the group setting in fact enhances the life review. In their experience recall is increased and memories are evoked more readily as members listen to one another. Clearly more research is needed comparing equally trained and experienced group leaders and individual "listeners" before one can unequivocally state life review is best conducted on an individual basis. From the previous discussion we can conclude that life review and reminiscence appear to be substantially different from each other, both in process and in outcome. The literature is clearly not conclusive but suggests that life review is more purposeful and structured in contrast to the spontaneous, unstructured nature of reminiscence. It is also possible that some older adults may enter into life review only when an opportunity is provided (as with life review interventions). As has been illustrated, both positive and negative results have been reported in the literature. These results appear to be more a reflection of the methodology and design than the interventions themselves. As well, little research has been conducted to see whether life review is unique to older adults. Merriam's (1993a) research suggests that the tendency increases with age, but her questions were not posed to those under 60 years. 23 Before discussing guided autobiography as a method of life review it will be helpful to review the reminiscence literature in order to uncover what has been learned about this construct. The reminiscence literature is critical because it informs and deepens our understanding of the life review. Reminiscence It was Lewis and Butler (1974) who first stated that reminiscence in later years had a function far more important than mere story-telling. This function was described as "psychotherapeutic" (p. 165). As we have seen, considerable research has resulted. However, assumptions have been made that have clearly guided the questions, or lack of, that researchers were asking. For example, because reminiscence was assumed to occur only in older adulthood the majority of studies have centered on middle age and older adults (Webster, 1994). Reminiscence has also been examined largely as a "uni-dimensional construct" (Watt & Wong, 1991, p.40). And as we have seen, researchers have frequently treated reminiscence and life review as the same process. Recently, researchers have challenged some of these assumptions and a clearer understanding of reminiscence is emerging. This research has also resulted in a sharper delineation of the differences between life review and reminiscence. As a result, each construct in and of itself is more clearly understood. For example, the question as to whether older adults reminiscence more frequently than other ages has been explored by several researchers among them Webster, (1994) who has reported evidence of reminiscence across the life span. In this study reminiscence was defined as "any autobiographical recall of 24 personal memories older than one month," (p. 69). Reminiscence behaviour in 94 adults ages 18-82 was measured by a questionnaire . The results showed that while older adults recalled more distant memories than younger respondents, all adults reminisced. Based on his results, Webster speculated that reminiscence in older adults may "serve different purposes" (p.75) and concluded that research needs to be directed towards determining the function of reminiscence in different age groups rather than focusing on its frequency (Webster, 1994). In an effort to design a psychometric instrument to measure such reminiscence functions, Webster (1993) conducted a factor analytic study of the reminiscence behaviour of 710 men and women (ages 17-91 years). Seven reminiscence functions resulted: Boredom Reduction (to provide stimulation); Death Preparation (coming to terms with one's morality); Identity/Problem Solving (to understand self/ use strengths to solve current problems ); Conversation (to create ease in conversing); Intimacy Maintenance (to keep memory alive of a lost loved one); Bitterness Revival (remembering hurts from past); and Teach/Inform (sharing what one has learned with those who are younger). These factors were confirmed in later research (1994) with one change only — the separation of Identity/Problem Solving into two functions: Identity (maintaining a unified view of self and to create purpose and meaning) and Problem Solving (reviewing how past problems were solved in order to cope with current dilemmas). The Reminiscence Functions Scale, a 43 item questionnaire, was designed to measure each of these functions. Webster's research (1993), (1994), reveals a remarkable absence of age differences in the total Reminiscence Functions Scale score. He concludes that this affords "compelling evidence that 25 reminiscence is a life span process that begins quite early in life" (Webster, 1995, p.97). However, slight differences were seen in subscale scores. While these are not statistically significant, the results suggest that reminiscence purposes may differ with age. Those differences pertinent to this discussion are summarized below: Death Preparation: increases with age Teach/Inform: steady increase from adolescence into the 30's and then frequency is even across the decades Boredom Reduction: younger and older adults scored higher than those in the middle years Bitterness Revival: declines with age Intimacy Maintenance steady increase from the 20's Identity/Problem Solving: adults who were 60 years and older scored lower than the other subjects. However, because of the confounding of factors it was not known which factor caused the result. These findings suggest that while all adults engage in reminiscence, the frequency may vary at different ages. This has important implications for researchers and practitioners interested in life review. If life review is an important developmental task of older adulthood, one would expect to see higher frequencies in reminiscence functions that relate to the purpose of life review. The Identity /Problem Solving reminiscence function needs to be assessed as two separate factors in order to determine the frequency of Identity reminiscence in older adulthood. Proponents of the life review would hope to see an increased frequency in Identity reminiscence in the later years. In terms of the life review, 26 the reported increase in Death Preparation reminiscence functions in older adults is somewhat encouraging. Merriam (1995) also reported that reminiscence frequency in older adults does not increase with age, giving further evidence of the "uncoupling of age and reminiscing" (p.81). She compared reminiscence frequency of centarians (n=107), 80 year olds (n=93) and 60 year olds (n=91). Participants were asked to respond on a 5 point scale (never [1] to always [5] to the question, "How often to do your thoughts and conversations turn to past experiences and events?" (p.81). She found no significant difference in frequency of reminiscence between the three groups. However she reported further evidence in support of the multifaceted nature of reminiscence. Merriam devised a Uses of Reminiscence Scale (17 items) which asked the centarians to answer questions about the purposes of their reminiscences, again using a 5 point scale. The results were factor analyzed and three factors emerged: Therapeutic (defined as understanding self, coping with difficulties and engaging in tasks outlined in Butler's life review, p.82); Informative (telling others about the past, making plans and passing on values, p.83); and, Enjoyment (a "pass-the-time-of-day" lighthearted form of remembering, p.83). Centarians engaged predominately in Therapeutic reminiscence. When Merriam conducted similar data analysis with the 60 and 80 year olds, the same three factors emerged. As well, Therapeutic reminiscence was most frequently engaged in (Merriam, 1993b). While Merriam (1995) emphasizes that these results indicate a lack of difference between frequency and use of reminiscence in, 60 year olds and centarians one could equally emphasize the 27 evidence of reminiscence functions in older adulthood which suggests both the presence and importance of life review. Wong & Watt (1991) have also devised a taxonomy of reminiscence, outlining six types . Their taxonomy construes reminiscence as a "multi- dimensional construct" (p.40) These six categories were devised following semi- structured interviews and subsequent data analysis of the reminiscences of 460 men and women ages 65 - 95: Integrative: similar to Butler's concept of the life review where the reminiscer is focused on making meaning of life as lived and achieving reconciliation with regard to the past (p.44) Instrumental: focusing on past experiences to solve current dilemmas and remembering how difficult situations have been managed in the past (p.45) Transmissive: concerned with legacy: transmitting to a younger generation the reminiscer's values and wisdom (p.46) Narrative: providing biographical information of the past or sharing information for the pleasure of the audience or the narrator (p.49) Escapist: fantasy or daydreaming in which the reminiscer often exaggerates past accomplishments and deprecates the present (p.50) Obsessive: preoccupation with unhappy aspects of the past. The reminiscer frequently feels despair, hopelessness and guilt (p.51) In this model, integrative, instrumental and transmissive reminiscence are seen to contribute positively to successful aging whereas escapist and obsessive reminiscence do so negatively. Wong & Watt (1991) tested their taxonomy in a comprehensive study of 400 community living and institutionalized elderly men 28 and women ages 65-95. The subjects were rated and ranked as successful or unsuccessful "agers" (p.274) by an experienced interviewer and a panel of three professionals (psychologist, psychiatrist and geriatric nurse). The interviewer asked questions regarding the interviewee's attitude to life and afterwards used a rating scale to measure physical well-being, mental well-being and adjustment. The three professionals used the same rating scale following their interviews. Subjects were then rank^rdered. Those in the top 40% comprised "successful agers" and those in the bottom 40% comprised the "unsuccessful agers" (p.274). Random selection from the "successful agers" and "unsuccessful agers" resulted in four groups: successful community dwellers (n=45), unsuccessful community dwellers (n=45), successful institution dwellers (n=45, and unsuccessful institution dwellers (n=36). Each subject participated in a "reminiscence interview" (p.275). Reminiscence was understood as "personal memories of a distant past" (p.272). The interviewer asked the subject to share about his or her past and one or two events that were life-shaping. Interviews were audiotaped, transcribed, analyzed and coded using the previously described taxonomy. Results showed that instrumental and integrative reminiscences were more characteristic of successful agers than unsuccessful agers. As well, unsuccessful agers reminisced obsessively more frequently than successful agers. There was no significant difference between successful and unsuccessful agers in the frequency of transmissive and narrative reminiscence. Wong & Watt (1991) hypothesize that the subjects may have perceived the interviewer to be an authority figure and as such not an appropriate audience for the transmission of wisdom. 29 Their study clearly demonstrates that instrumental and integrative reminiscence are correlated with successful aging, but as the authors stress this does not signify causation. They propose different hypotheses for the correlation (i.e. integrative and instrumental reminiscence may be an outcome of successful aging rather than a cause). Suggestions for further research are given, for example, studying reminiscence groups which encourage integrative and instrumental reminiscing. These groups could then be compared with unguided reminiscence or control groups (to discuss current events, for example). If their theory is correct one would expect to see greater life satisfaction and sense of well-being for those adults who had used integrative and instrumental reminiscence. A further refinement of this taxonomy resulted in Wong's (1995) distinction between "active life review" and "actualized life review "(p.30), a refinement that is very pertinent to this discussion. He describes life review as an "active, on-going process" (p.30) which can result in the achievement of Erikson's ego integrity. Wong (1995) agrees with Butler (1963) that the life review is the "mechanism" for achieving this integrity (p.30). When acceptance of self and others has occurred, when a sense of meaning and self worth has been realized, when conflicts have been resolved, and when the past and present have been integrated, ego-integrity has been achieved, and the life review has been actualized. The presence of integrative reminiscence in an older adult indicates this actualization. The premise here is that a successful life review can also be facilitated by encouraging integrative, instrumental, and, transmissive reminiscence (Watt & Wong, 1991). Life could be reviewed through narrative, 30 obsessive and escapist reminiscence, but integrity will be not be reached and the life review would not be actualized. It is interesting to see that Watt & Wong's (1991) taxonomy, Webster & Haight's (1995) description of 8 factors of reminiscence functions, and Merriam's (1995) 3 reminiscence factors are complementary as illustrated by the following table: Boredom Reduction — Identity—Integrative— Problem-Solving— Escapist —Enjoyment Therapeutic Instrumental Conversation—Narrative Bitterness- Revival— Teach/Inform— Obsessive Transmissive— Informative Such parallels are promising indicators that progress is being made on categorizing types of reminiscence and understanding their functions. It is also encouraging to note the similarity between frequency of use of Merriam's (1993b) factor of Therapeutic reminiscence in older adults and Watt & Wong's (1991) integrative reminiscence in successful agers. It will however be important to examine the reminiscence activity of younger adults using Watt & Wong's (1991) taxonomy and Merriam's (1995) three factors of reminiscence. It is of course possible that integrative and Therapeutic Reminiscence are engaged in by all age groups with similar frequency. If life review is the important developmental of older adulthood that some theorists and researchers believe it to be, then one would expect to see an increase in reminiscence activities associated with life review. The above discussion has outlined the concept of reminiscence as it relates to older adulthood. While reminiscence appears to occur at all ages, there is some 31 evidence that its function may vary with age. There are also indications that reminiscence activity associated with life review occurs with greater frequency in older adulthood. Guided autobiography has been described and suggested as a method of life review, which, using Watt & Wong's (1991) taxonomy, encourages the use of integrative, instrumental and transmissive reminiscence. Guided autobiography for older adults Guided autobiography has been described as the "first attempt to operationalize the concept of life review in a comprehensive way" (Malde, 1988, p.290). This group method gives participants the opportunity to integrate life experiences (Birren & Hedlund, 1987), maintain a sense of continuity of the self over the passage of time, resolve past conflicts, review and affirm values and goals (Birren & Deutchman, 1994) and become more connected socially (Birren & Hedlund, 1987). In reviewing their lives participants are reminded of contributions they have made which may have been forgotten. A heightened awareness of the significance of one's life can therefore result (Birren & Deutchman, 1994). While the group process is not group therapy, therapeutic benefits can result (Birren & Hedlund, 1987). To review, the outcomes purported to result from guided autobiography are: • Sense of increased personal power and importance • Recognition of past adaptive strategies and application to current needs and problems • Reconciliation with the past and resolution of past resentments and negative feelings 32 • Resurgence of interest in past activities or hobbies • Development of friendships with other group members • Greater sense of meaning in life • Ability to face the nearing end of life with a feeling that one has contributed to the world, (p. 4) These outcomes result from both the structure and content of the group process. In contrast to Haight & Dias, (1992) the group structure is considered essential in eliciting memories and gaining new insights and perspectives in comparison with others (de Vries, Birren & Deutchman, 1995). The heart of the group process is the "developmental exchange" ( Birren & Deutchman, 1991, p.44). This describes the sharing of important experiences and emotions that occurs between group members. This results in greater acceptance of self and others and an increase in self-disclosure (Birren & Hedlund, 1987). A skilled facilitator who is familiar with group process leads the group. No more than five or six members participate and meet together for a minimum of 20 hours; usually 2 hours a week for 10 weeks (Birren & Deutchman, 1994). The content of the life review is organized around "guiding themes "(p. 59) and "sensitizing questions" (p.63). These themes were selected because of their saliency to adult development (Birren & Deutchman, 1994). Formulated by social science practitioners, they have been refined and changed over the years through feedback from both leaders and participants. The themes are: the major branching points in life; the family; one's career and/or life work; the role of money in one's life; health and body image; loves and hates; sexual identity; experiences with death 33 and loss; aspirations, goals and meaning (Birren & Deutchman, 1991, p.59). A 10th theme, the role of music, art, and/or literature is described as "elective." What then does research reveal about guided autobiography groups? Birren & Deutchman (1991, 1994) have listed the benefits of guided autobiography following their research review. The outcomes listed previously are based on reports ("follow-up letters and comments") from participants in guided autobiography groups. Unfortunately, information as to how these outcomes were formulated is not reported or available (J. E.. Birren, personal communication, January 22nd, 1997). As well, in their overview of the research, additional benefits are given for "life review/autobiography" (Table 1-1, p.5). But as has already been illustrated, life review interventions can vary widely. The guided autobiography method is quite specific and prescribed in nature. One cannot assume that positive outcomes (such as increased meaning in life) which may result from a particular life review method will also result from guided autobiography. When the focus is narrowed to guided autobiography research there is little literature to review. Most guided autobiography groups have been conducted in university settings with adult men and women of varying ages, occupational and educational backgrounds (de Vries et al., 1995). Research findings are meagre and give conflicting results. Those studies that have been published often indicate weak methodology. For example Hatley, (1985) conducted a group for 45 adults ages 20-80 (half the group were ages 40-50) called, "Telling Your Story, Exploring Your Faith: Autobiography for Personal Insight and Spiritual Growth." The group format consisted of lectures, written assignments and small group 34 discussions. Hatley states that comments of the participants on completion of the course showed "a significant degree of success in achieving the goal of enhanced personal insight and spiritual well-being" (p.69). Examples of these comments are included, however no information is given as to, how "personal insight "and "spiritual well-being" were measured. In addition, no information was given regarding how many participants responded favorably, unfavorably or not at all. Birren & Hedlund, (1987), citing Reedy & Birren, reported an increase in integration between the real self, ideal self, and social self following a guided autobiography group. A battery of tests was given to the 45 participants pre and post group: the Leary Interpersonal Checklist, the Tredway Mood Scale; and the Speilberger State-Trait Anxiety Scale. Sixty per cent of the participants showed increased integration. The greatest change was in the perception of the social self; others were seen as being more similar to themselves. The researchers reported that a benefit of guided autobiography is the social connections that result. No information is given to document the accuracy with which these tests measure changes in the self-concept. A clear weakness of this design is that there is no control group; most effective groups promote social interraction which results in an increased sense of belonging and connection to others. It would be erroneous to assume this is unique to guided autobiography. One wonders why the researchers did not assess an outcome more directly related to the stated purposes of guided autobiography, such as measuring life satisfaction, pre and post group. Birren & Hedlund (1987) reported an analysis of follow-up questionnaires given to 46 participants of two autobiography courses held at the University of Southern California in 1978. The age range was 22-81, with an average age of 53 35 years. Eight males and 38 females comprised the sample. Of the 23 participants who responded at the end of the course and again two years later, 90% reported the experience "had a positive effect" (p.407). However, "positive effect" is not defined. The authors report that participants were asked about their experience in the autobiography course. Members reported feeling "more centered in themselves, more introspective, more self-confident, more self-accepting, more comfortable about their lives, more able to express themselves and more open about sharing their values" (p.407). The questionnaire is not included nor is any data analysis given, again illustrating poor research design. Published studies on guided autobiography for older adults are meagre. A recent survey of the literature revealed only two published studies which are reviewed here. In a well designed study, Malde (1988) reported no significant differences in self concept (measured by the Tennessee Self-Concept Scale) , purpose in life (measured by the Purpose in Life Test) and time competence (measured by the Time Competence Scale of Personal Orientation Inventory) between adults who had particpated in a guided autobiography group and those who had not. Thirty-nine women and three men, ages 60-82, with an average range of 70 were assigned to one of three groups: (1) Group A: guided autobiography with small group discussion and sharing of writings (n=13); (2) Group B: guided autobiography with large group discussion only and no sharing of writings (n=13); and (3) Group C: a waiting-list control group (n=13) who were given the tests before the course and thus provided the data for comparison with Groups A and B post-group test scores. Malde's hypotheses that participants in Groups A and B would score higher on the posttests than Group C and that 36 partipants in Group A would score higher than members of Group B (due to the benefits of small group sharing) were not substantiated. Several reasons are suggested for these findings including a small sample size; failure of the testing instrument to detect changes; that changes may be detected over time rather than immediately after the completion of the group; and the obvious, that guided autobiography does not result in changes in the constructs tested. One year later Malde sent out questionnaires to her subjects to see whether change was evident after the passage of time. Questions were designed to measure the same areas assessed by the tests. Sixty-two per cent of Group A, 69% of Group B and 62% of Group C returned the questionnaires. The responses revealed positive change or no change rather than negative change for a significantly greater number of participants (p.292). While she gives other hypotheses for these results, Malde concludes that, "autobiography can promote changes in these areas" but that time is needed for "digestion and integration" before change can be detected (p.292) Her hypothesis may be correct, but the supporting evidence is weak. Wacks (1989) reports benefits of guided autobiography with older adults through anecdotes and unsupported claims. For example, he describes nine groups he has led in a four year period under the rubric of "guided autobiography." However, historical autobiography and reminiscence groups are included. Each has very different goals, structure and processes and can hardly be compared to guided autobiography. Wacks reports that "guided autobiography is an effective method for accomplishing this immense task of old age" (p.522), yet his claims are unsubstantiated. He reports that evaluations were "positive as many participants felt they had gained much self-understanding" (p.518). He does not 37 explain what data collection and analysis method, if any, he used to come to this conclusion. Obviously more research is needed in order to determine whether guided autobiography is beneficial for older adults in terms of completing, or assisting in, the process of a successful life review. Research that has been reported is anecdotal or quantitative in nature. It would therefore appear to be beneficial to conduct qualitative research that seeks to learn what the outcomes of guided autobiography are from the participants' perspective. 38 Chapter 3~Methodology Research Design The preceding literature review has revealed obvious weaknesses in the methodology used to examine life review interventions. It is also apparent that the majority of studies on life review have been quantitative in design, paralleling the methodology predominately used in gerontological research (Berman, 1995). The topic of life review seems to naturally suggest qualitative research (understanding participants' meanings through the medium of language). Yet there is a glaring absence of qualitative research in this area. Change in participants has been measured largely with tests used which may or may not be valid and reliable instruments. If we want to learn more about what changes, if any, ensue from participating in guided autobiography, why not ask the participants? This is the heart of qualitative research—seeking to understand the meaning people give to their experiences; information or meaning that is expressed in words not numbers (Schumacher & McMillan, 1993). This chapter will describe this qualitative research design, including the procedures, the selection of participants, the role of the researcher, ethical considerations, data analysis and limitations of the study. Ethnographic case study Ethnography, field research or naturalistic inquiry is characterized by observation and interviewing of participants in natural settings. Naturalistic inquiry includes those methods of observation and data collection that do not interfere with the "natural flow of events or action" (Schumacher & McMillan, 1993, p.594). Ethnography has its roots in anthropology (Tesch, 1990), focuses 39 on one phenomenon (in this case a guided autobiography group for older adults) and seeks to understand and address the participants' interpretations of experience or their meaning system (Reker, 1995). The assumption made in this type of research is that reality is socially and individually constructed (Schumacher & McMillan, 1993; Guba & Lincoln, 1989). The focus of qualitative research then is primarily to seek to understand these constructions. The data in qualitative research is derived from interviews yielding information-rich narrative. "Qualitative mining" (McCracken, 1988, p. 17) results in a deeper understanding and refinement of the "categories and assumptions" (McCracken, 1988, p. 17) people hold regarding the topic under investigation. This is in sharp contrast to quantitative research which focuses on discovering "how many and what kinds of people hold these categories and assumptions" (McCracken, 1988, p. 17): Qualitative researchers stress the socially constructed nature of reality, the intimate relationship between the researcher and what is studied, and the situational constraints that shape inquiry. They seek answers to questions that stress how social experience is created and given meaning. In contrast, quantitative studies emphasize the measurement and analysis of causal relationship between variables, not processes (Denzin & Lincoln, 1994, p.4). In this qualitative study therefore what is of most interest is not how many participants "enjoyed" the group or showed significant differences in test scores pre and post-group. The key questions of utmost interest are, "If the group experience was enjoyable or beneficial, what made it so? Certain benefits are reported to result from guided autobiography. Are these reported by participants 40 when interviewed? If not, what is reported?" The researcher asks questions of the data (Alexander, 1988) in order to understand the perspective of each participant. Various viewpoints are then synthesized in order to better illuminate what is being studied (McAdams, 1988, p. 12). These viewpoints or categories emerge during data analysis, in contrast to quantitative research design which defines categories or variables beforehand (McCracken, 1988). Qualitative research design can is therefore defined as "emergent" (Schumacher & McMillan, 1993, p.374). A case can be understood as a "specific, unique bounded system" (Stake, 1994, p.237). In this research design the case being studied is a guided autobiography group for older adults and is an example of an instrumental case study. This type of study entails the examination of "a particular case...to provide insight into an issue or refinement of theory" (Stake, 1994, p.237). As a researcher I am wanting to learn more about guided autobiography for older adults—in particular if it "lives up to" the claims outlined in the literature. In order to assess this the participants' interviews were analyzed for evidence of the outcomes listed by Birren & Deutchman (1991). This is an example of using a pre-determined coding scheme, a characteristic of the instrumental case study: The methods of instrumental case study draw the researcher toward illustrating how the concerns of researchers and theorists are manifest in the case. Because the critical issues are so likely to be known in advance...such a design can take greater advantage of already-developed instruments and preconceived coding schemes (Stake, 1994, p.243). 41 As a result of this type of research design, the under girding theory (that guided autobiography for older adults is beneficial in the process of life review), will be more clearly understood (Stake, 1994). Interviewing, a characteristic of ethnography, is the chosen method for yielding the data for this analysis. Data Collection Strategies Ethnography is also characterized by triangulation, or the use of multiple methods or data to discern participants' meanings (Janesick, 1994) and to corroborate the data (Schumacher & McMillan, 1993). A "wide range of interconnected interpretive methods" (Denizin & Lincoln, 1994, p. 12) are used in order to access different "windows" into the participant'sjexperience and meaning system. Ethnographic interviews Interviewing, or "asking and getting answers" is "a much harder task than it may seem at first" (Fontana & Frey, 1994, p.361). Firstly, there will always be ambiguity when language is used and sought to be understood (Fontana & Frey, 1994) because the interviewer does not come to the interview as an "empty slate." A set of filters provides company: gender, social class, race and ethnicity (Denzin & Lincoln, 1994, p. 12). The challenge for the interviewer then is to be acutely aware of his or her filters, biases and assumptions and then to ask questions in "as unobtrusive and non-directive manner as possible (McCracken, 1988, citing Brenner, 1985). The goal is to seek to capture the respondent's view of the world. Without such concentrated effort the researcher may end up "capturing nothing more than the investigator's own logic and categories so that the remainder of the 42 project takes on a dangerously tautological quality" (McCracken, 1988, p.21). In order to minimize the risk of tautology, the researcher must "manufacture distance" (McCracken, 1988, p.31). This distance enables the interviewer to "step back" from his or her world view in order "to see with new detachment the categories and assumptions that organize [his or her] world" (McCracken, 1988, p.23). Self-awareness is therefore key in creating distance: "This clearer understanding of one's vision of the world permits a critical distance from it" (McCracken, 1988, p.33). The literature review provides another means of distance-making. Through a comprehensive review the interviewer is armed with "a set of expectations that the data can defy" [italics added] (McCracken, 1988, p.31). In other words, the interviewer must know what needs to be set aside so the respondent can be listened to with clear eyes and open ears. And this is no mean feat: the very act of listening accurately is "extraordinarily draining" (McCracken, 1988, p.39). The interview is also designed to create a space for accurate listening. Questionnaires are constructed through the use of open-ended questions (in contrast to closed or dichotomous -response questions which can only be answered yes or no, Schumacher & McMillan, 1993). Designing the questions ahead of time permits the interviewer to focus on understanding the narrative. In this study, a combination of standardized open-ended and interview guide approach was used. The opening question was standardized: "I would like to hear about your experience in the guided autobiography group. What thoughts, feelings, reactions do you have regarding your experience?" An interview-guide approach (topics outlined in advance with sequence and wording decided during 43 interview) characterized the reminder of the interview (see Appendix). All participants were interviewed in their home. The length of each interview varied slightly. The shortest interview was 45 minutes; the longest 90 minutes. Each interview was audio-taped and then transcribed. Micro-counselling listening skills (active listening, paraphrasing, summarizing, probing and empathic reflections) were used to understand participants' meanings in order to give them opportunity "to tell their story in their own terms" (McCracken, 1988, p.34). I have completed graduate level skills training in individual and group counselling and believe I possess a certain degree of the "native talent" deemed necessary for skillful interviewing (McCracken, 1988, p.62). However, despite training and experience I was often conscious of my novice status as an interviewer. This was especially apparent as I transcribed the interviews and became aware of missed opportunities and incomplete reflections . This is the challenge for the interviewer: to be able to sift and sort through what is said, know what is important to expand on, and what is not: The [interviewer] encounters salient data in the midst of a very crowded and complicated speech event. There is virtually no opportunity for unhurried identification or reflection. There is also the pressing knowledge that this opportunity will never come again. Whatever the interviewer does not capture in the moment will be e lost forever. This is a challenging occasion because mistakes are both easy to make and impossible to rectify (McCracken, 1988, p.38). After transcription and data analysis was complete, each participant was asked to read a biographical synopsis of him/herself and make any necessary 44 changes. Each participant was also asked to comment on the researcher's summary of the outcomes and comments gleaned from the interview ( see Data Analysis). Field Notes Descriptive and reflective field notes were kept throughout the study. After each group I wrote field notes describing both content and process. Content notes included what was stated by the participants in their reflections and to each other. Process notes included reactions to the sharing, my own and those of the group members, and observations on group development. The field notes also included reflections on my role in the study, my strengths and weaknesses as an observer-participant, and as a group leader. The notes also described various steps in the research process. This journal became an important written record of my candid reactions to the group and what I was learning. Here I recorded the biases and assumptions that I brought to this project. I came to this project with a keen interest in life review and guided autobiography in particular. I was far from a disinterested researcher. I hoped that the group experience would confirm the potential of guided autobiography to be a helpful counselling tool for those interested in working with older adults. It was essential that I be aware of this bias for without it I would be more likely to "lead" interviewees and select only certain aspects of their comments for elaboration and probing. Participant Journal Each participant was asked to record his/her thoughts, feelings and experiences at the end of each session. This was suggested in order to give 45 participants material to reflect on in preparation for the interview at the end of the group. Group Interview After the completion of the individual interviews, a video-taped group interview was held, moderated by myself and Dr. Marvin Westwood, the research supervisor and a skilled group leader. Group interviews are a recognized method of data collection when used "in conjunction with other data gathering techniques" (Fontana & Frey, 1994, p.365). An interview guide approach was used. The challenges of group interviews are many: making sure one person does not dominate, that all members share, that "group think" does not prevail preventing opposing viewpoints from being expressed (Fontana & Frey, 1994, p.365). It is also essential that a leader skilled in group process and dynamics facilitate the interview(Fontana & Frey, 1994). Data Analysis Inductive data analysis is a characteristic of qualitative research. The categories and patterns emerge during data analysis; they are not formulated beforehand. This type of analysis involves synthesis, interpretation, selection, categorization and comparison of data collected(Schumacher & McMillan, 1993, p.480). Field notes and interview transcripts were read and re-read in order to gain clarity on the participants' experience in the group. This immersion in the data is an essential part of the "process of refinement" (McCracken, 1888, p.45). The challenge for the researcher is to remain faithful to the participants' meanings and to represent these views accurately and clearly. This is no easy task. Obviously not everything can be reported: 46 It is the researcher who decides what is the case's own story, or at least what of the case's own story he or she will report. More will be pursued than was volunteered. Less will be reported than was learned...The criteria of representation are ultimately decided by the researcher (Stake, 1994, p.240). The "criteria of representation" I have chosen are the outcomes of guided autobiography listed by Birren & Deutchman (1991). The transcripts were analyzed for evidence (or lack of) the following outcomes: a sense of increased personal power and importance; recognition of past adaptive strategies and application to current needs and problems; reconciliation with the past and resolution of past resentments and negative feelings; resurgence of interest in past activities or hobbies; development of friendships with other group members; greater sense of meaning in life; ability to face the nearing end of life with a feeling that one has contributed to the world, p. 4). Quotes from the transcripts were used in order to document these outcomes and to make "participants' meanings unmistakable to a reader (Schumacher & McMillan, 1993, p.506). Other outcomes that appeared significant were also described and documented. The outcomes were highlighted in each transcript, extracted, and then compiled. After this analysis each participant was asked to read their biographical synopsis and a descriptive summary of the outcomes identified from their interview. Out comes were listed with supporting narrative taken verbatim from the interview. Participants were asked to comment on the outcomes that had been identified and make changes to the synopsis and summary as needed. As well, three of the transcripts were read by Ms Muriel Brown-Shaw, a doctoral student 47 familiar with life review, as a validation check. She was asked to look for evidences of the outcomes and to note others she found significant Her analysis was then compared with my own. Participants Purposeful Sampling Purposeful sampling involves seeking "information-rich key informants for study in depth'? (Schumacher & McMillan, 1993, p.378). The participants were initially recruited from the Kiwanis Club of West Vancouver. Kiwanis is a worldwide social service organization of men and women. This group was selected because (1) at least 50% of the members were over the age of 65; (2) it was accessible to the researcher through a family member and, (3) its members live independently in the community. As mentioned earlier this is important as much of the life review research has been conducted with older adults who live in hospital or other institutions (5% of the older adult population). The president of the club was contacted via letter (see Appendix). A presentation was then made on August 26, 1997 to the members by myself and Ms. Muriel Brown-Shaw. At this meeting we explained the purpose of the study, the structure of the guided autobiography group and the expectations of group members. The requirements for volunteers were also described: to be 65 years of age or older, willing to attend group sessions regularly, to maintain confidentiality, and participate in activities and discussions. Participants also were not to be receiving treatment (i.e. medication or counselling) from a psychiatrist or other professional for emotional problems (i.e. depression). 48 At this introductory meeting, both myself and Ms. Brown-Shaw were unprepared for the reaction of several members following our presentation. We had expected a positive response and were quite surprised, and frankly taken aback, at the questions and comments we received. One member asked, "Why should we want to review our lives? I'm befuddled. We're happy." Several members indicated that they did not perceive themselves to be older adults, instead viewing the frail elderly (living in nearby Kiwanis Lodge) as "old" and those who could benefit from such a group: "We're successful here, why not try this at the Lodge?" We interpreted these reactions as indicating that negative stereotypes about aging persist throughout the life span — no one seems to want to be viewed as an "older adult." There is always someone else who is "old;" its never you. It was also apparent to both Muriel and myself that the term "reminiscence, "which was used in our presentation, had conjured up images of garrulous old people boring listeners. We determined in future presentations to. use the terms "life story," "life review," or "guided autobiography." Three members volunteered after the meeting. Through one member a "snow-ball" sampling emerged as she recruited two friends from her apartment complex and one of these friends in turn recruited two more. Another volunteer was recruited from the North Vancouver Kiwanis Club, bringing the numbers to eight in time for the first meeting. One participant did not come to the first meeting, having forgotten. He decided not to join the group, resulting in seven committed members. 49 Demographics It is important to note that an ethnographic case study is not concerned primarily with generalizability but with access: "It is to gain access to the cultural categories and assumptions according to which one culture construes the world" (McCracken, 1988, p. 17). In other words, what is important in this study is to understand the experience of this particular group of older adults in this particular guided autobiography group. It is important therefore to describe the case thoroughly so comparisons can be made (not generalizations): "The purpose of the case study is not to represent the world, but to represent the case" (Stake, 1994, p.245). With this in mind, the following statistics describe the community of West Vancouver, where each group member resides: 40% of the residents are over age 50 (12% ages 65-74); 83% speak English, males ages 15+ earn an average income of $60,613; females ages 15+ earn an average income of $26,979. Over half (55%) of the population have post-secondary training. (Statistics Canada Census Data 1991). Ethical Considerations "Qualitative researchers are guests in the private spaces of the world. Their manners should be good and their code of ethics strict" (Stake, 1994, p.244). In keeping with these guidelines, participants were ensured of "informed consent, the right to privacy and protection from harm" (Fontana & Frey, 1994, p.373). Each participant signed a consent form both to participate in the group, to be interviewed individually and in the group setting (see Appendix). Each consent form was explained verbally. The participants were informed verbally and in 50 writing that they could decline to participate at any time in any aspect of the study. Pseudonyms were used in the reporting of the interview results. The participants saw only their own biographical synopsis and interview summary. Counselling support as needed or requested was also offered. Both myself and Dr. Westwood welcomed participants' questions and comments; again this was stated verbally and in writing. Limitations of Study Limitations of quantitative research design usually involve discussions of reliability and validity. However, this vocabulary is rejected by many qualitative researchers, who instead use criteria which judge "trustworthiness" ( Tesch, 1990, p. 47, citing Lincoln & Guba 1985). "Parallel or foundational criteria" (Guba & Lincoln, 1989) have been designed to replace the "rigor criteria" (p. 233) of internal and external validity, reliability and objectivity. These foundational criteria have been designed to assess the "credibility," "transferability," and "dependability" of qualitative research. Each term parallels the traditional criteria of internal validity, external validity and reliability respectively: • Credibility: this entails seeking "mutual meanings" between the participants and the researcher (Schumacher & McMillian, 1993, p. 391). The likelihood of this increases through "substantial involvement at the site" (Guba & Lincoln, 1989, p. 237). As the group leader I spent over 20 hours with group members before the interviews. The interviews were conducted in a natural setting. The language of the participants was used to document the outcomes. As evidence of 51 credibility the participants reviewed and commented on my analysis of their interviews, an example of "member checks"(Guba & Lincoln, 1989, p. 237). • Transferability: "thick description" (Guba & Lincoln, 1989, p.241) of the case in its entirety can enable "extensions of understandings" to occur (Schumacher & McMillan, 1993, p. 394): "What he or she does is to provide as complete a data base as humanly possible in order to facilitate transferability judgments on the part of others who may wish to apply the study to their own situations" (Guba & Lincoln, 1989, p.242). This includes adequately describing the study and the theoretical concepts used (Schumacher & McMillan, 1993). These have been important objectives of this study. • Dependability: the focus here is on documenting "changes and shifts in constructions" as they occur throughout the research process (Guba & Lincoln, 1989, p. 242). Such changes in hypotheses are viewed as a natural outcome of the qualitative research process. Detailed field notes documented each step of the research process. Traditionally, reliability in this type of research has been concerned with maintaining consistency in "interactive style, data recording, data analysis and interpretation of participant meanings" (Schumacher & McMillan, 1993, p.385). Audio-taping, verbatim transcription and participant review certainly helped lessen the likelihood of bias and distortion in interpretation. However, consistency in "interactive style" may not be a realistic goal. An interview is a relationship between interviewer and respondent. No one interacts consistently across relationships. Just as each relationship is unique so is each interview. Interviewers certainly should seek to create a safe and comfortable space for people to respond, to fully understand and then give faithful testimony 52 to the viewpoints of those interviewed. However the process of achieving this will vary. Identical questions may be asked but how an interviewer responds should be tailored to the very unique person being interviewed. If the focus is primarily on "consistency" the human, personal element that results in rich narrative may be lost: "As long as many researchers continue to treat respondents as unimportant, faceless individuals ...the answers, we, as researchers, will get will be commensurable with the questions we ask and with the way we ask them" (Fontana & Frey, 1994, p. 374). 53 Chapter Four -- Results Evidence of the outcomes reported by the members of the guided autobiography group are identified and documented in this chapter. The chapter begins with a brief biography of each participant. The chapter concludes with a summary of comments and suggestions on the structure of the guided autobiography group gleaned from the interviews. Biographical Synopses Art's Biography Art currently works full-time as a self-employed labour relations arbitrator. He is the father of seven children, 13 grandchildren and four great- grandchildren. Art is a member of his local Kiwanis group, an honorary member of the local library board and until recently the past president of the board of a non-profit counselling agency. Born in 1917, Art was raised in Saskatchewan to immigrant parents who left England to find "acres of mother earth to call their own." He left school at the age of 12 "to be a man" and work on the family farm. His life consisted of farm work, from sun up to sun down. In 1929 the Great Depression hit the prairies with a vengeance: "Loam turned to sand before my eyes." At the age of 15, Art became "a knight of the road," travelling the railways with hundreds of other men searching for work . He learned about the goodness of human nature travelling freight trains: "Kindness, kindness, kindness." Through his dedication and beliefs, Art, a prolific reader, improved his employability by pouring over books and training manuals. Throughout the Depression he continued to send money 54 home to help his family. The 1920's were extremely hard years but Art describes then in terms of what he had, not what he didn't have: "A male could dash outdoors for quick relief, we could light the oil lamps and read, read, read, saddle a horse to visit our neighbour and melt snow for a wash tub bath." His travels took him to BC which he describes as "a garden of Eden with no snake." Here he completed his matriculation by correspondence. A dedication to life-long learning and a strong belief in the value of work are two self-defined branching points: "As the twig is bent, so grow the tree. As the roots are set, life's challenges are met." He married Diane in 1939. At this time he was employed as a forest fire fighter in the Kootenays earning up to $4.00 per day. Art served with the Royal Canadian Air Force in WW II as an aeronautical instructor. Following the war he had the opportunity to study chemical engineering at UBC with educational credits given by the RCAF, but instead decided to work at a smelter in the interior of BC in order to provide a home for his family. He became active in municipal politics. Three children were born over the next ten years. In 1957 tragedy struck when Diane died. Art was faced with his "powerlessness to bring her back." Now his primary goal became creating a warm and loving home for his three children. These were difficult years but Art endured "through the help of an unseen presence." In 1960 he married Cindy, who had three children of her own. A daughter was born and so their combined family consisted of one son and six daughters.. They also raised four of Diane's siblings - 11 children in all. During this busy time Art developed in his career, becoming vice president of a large mining 55 company. He served for 4 years as a councillor in municipalities in which he lived. Art retired from the mining company in 1982 but was sought after as an arbitrator and appeal commissioner so "retirement" has never been experienced. Art describes his attitude to living as being similar to Newton's law: "When I was cold I knew I would be warm; when I was wet I would be dry; when I was in despair there would be hope; when I was hungry I would be fed; where there was distrust there would be trust; and were there was sorrow there would be joy." Art attributes this philosophy to creating the "base" which has provided him with "a long, happy and, hopefully, useful life." Drew's Biography Drew celebrated his 76 birthday this year. He is a member of the local Kiwanis Club, attends church regularly and is active politically. He is the proud father of two children and greatly enjoys being a grandfather. Damage to his Achilles tendon has put an end to golf and curling but he still enjoys pitch and putt. He has retired from his career as a professional realtor Drew was born in Edmonton, Alberta in 1921, the middle child of four boys and one girl. His father was the local bank manager. During the Depression, Wall Street crashed and Drew's father was told by management that he had to call the loans in. When he refused he was told he must, or the bank would foreclose. Drew's father flatly refused and so he was replaced. The town of Trent was subsequently ruined. This had grave consequences for Drew's family. They had been living in a home owned by the bank and his father received a salary of 56 $12,000, lucrative for those days. Now they had no home and no salary. The family relocated to Toronto where Drew's father was employed in the stationary department of the Bank of Toronto at an annual salary of $6000. Drew reports that this was a "tough and difficult " time. A significant event, one that Drew describes as "making a difference to life and my whole outlook on life" took place at the age of 10. He was at the beach, enjoying digging a cave for himself in the sand when suddenly the cave collapsed and he was buried: "I prayed to God to help me. I promised that if He did I would be a good boy from then on." Miraculously, his dog, Rags, began digging overhead and Drew was rescued, unscathed but with a certainty that God had heard him: "I was a strong Christian from then on." As a young man Drew enlisted for naval duty in 1939, training in England, at Dartmouth College. In 1941 he returned to Canada, on Atlantic convoy assignment. Three years later he was married, the wedding having been postponed for a year due to the war. He had considerable responsibility during the war, training and supervising junior officers and crew. He takes pride in the role he played and particularly in the lives of two of his seamen. As the war ended these officers asked Drew, "What should we do with our lives?" Drew replied, "I'll take a flyer. Both of you are clever. I think you should apply to McGill university and take commerce and become charted accountants;" Over thirty years later, Drew learned that both men had followed his advice and were successful accountants. In 1946 at the age of 24 he was discharged at the end of the war, in Toronto: "I realized I had been in the navy for six years, and 10 months and at sea 57 for five and a half years." Opportunities were abundant - two uncles offered to pay his medical school expenses, a scholarship was available for him to study theology and he was offered the position of commander of the newest vessel being built in Victoria. He and Barbara stayed up all night discussing the choices. Barbara was firm - she didn't want to be a navy wife. Drew told the admiral their decision. The admiral was furious. He called Drew an "ungrateful pup" and ordered him out of his office. Drew began work as a sales manager. His career continued to develop as a notary public and property manager. Two children were adopted. During these busy years as a husband, father and realtor he served on numerous committees in a professional capacity and as a community member. Barbara died in November 1986 and Drew is adjusting to life alone. He retains a positive and optimistic attitude: "I am one of the luckiest people in the world!" Glen's Biography Glen was born in England in 1919. He is a church member, is an active golfer and bowler and enjoys walking. Glen is a Freemason and, although he has not been attending meetings recently, is considering becoming involved again. Glen is adjusting to living alone, having lost his life partner, Jean, to cancer two years ago. He is the proud father of three daughters. Glen grew up in a small village, with "seven shops and two policeman", to a family who had little money. At the age of 10 Glen determined to join the Boy's Brigade. Membership in this group would enable Glen to have holidays 58 away with other youngsters, something his family could not provide. To qualify for the Boy's Brigade, Glen had to ride a horse over a hurdle. Although this task was far too difficult for him, he attempted it nonetheless, knocking his chin badly in the process. He emerged a hero in the eyes of the other boys. More importantly, he was accepted into the Boy's Brigade and had a wonderful holiday. This determination to move beyond his immediate circumstances is seen throughout his life story. At the age of 11 Glen won a scholarship to a school but was not able to use it, because of his parent's financial situation. Three years later he was working full time at a coal mine. These events were life shaping. When he became a father, he and Jean (who also left home at age 14), made certain that their daughters could have the educational opportunities that were not possible for them. Glen longed to travel, but living in a small village, with "strong parents" he saw little hopes of fulfilling this dream. Then World War II came: "This was my free ticket to get away." He waved good-bye to his parents in 1940, never returning home again, apart from one brief two month visit. He served as a seaman in the war, beginning in 1940 with anti-submarine detection in Dunkirk and in the Atlantic Ocean. In 1942 he was promoted and drafted to Canada where he was engaged in convoy, anti-submarine and patrol duties. His service in the war, recognized through medals and superior ratings are described by Glen as his "most momentous branching point." After the war Glen began his career as a bobby working for the Metropolitan Police Force in London. His first posting was at Whitehall, covering 59 Downing Street, Trafalgar Square, the Houses of Parliament and No. 10 Downing Street. He married Jean in 1946. During his career with the police force two daughters were born. He retired in 1954 with his certificate of retirement noting "exemplary conduct." Following his retirement, Glen joined the Canadian Armed Forces as a policeman. He had never forgotten Canada since his service and wanted to return. He worked at various bases in Canada which he enjoyed. In 1960 his third daughter was born and in 1963 Glen was transferred to Germany, policing a nuclear base. Glen retired from the RCAF at the age of 50 and on a return trip to England he and Jean decided to move there, selecting the spot by closing their eyes and putting a pin on a map of England. Exeter was where the pin landed, and there they moved. Glen worked for the local constabulary. During this time their two oldest daughters completed university education as accountants and the youngest as a teacher. By 1982 two of their three daughters had emigrated to Canada so Glen and Jean followed in 1984. Their third daughter followed in 1988. Glen and Jean enjoyed their life of retirement together, until Jean's death in 1995. As he reflects back on their experiences and adventures together he describes his life as "very good and happy." Kathy's Biography Kathy was born in England in 1916. She emigrated to Canada at the age of 65. Kathy is active in her community, volunteering at a neighbourhood care 60 facility and the local Seniors' Activity Centre. "I am still a volunteer, and have been for 45 years". Her only son, Robert, lives nearby. Kathy was raised in the small town of Datchet, a place she speaks of with considerable fondness. Here she grew up knowing an "inner security." She knew every person in the town by name. Special people were Helen ("Mrs.") a beloved neighbour who became more of a family member and Crutchy Bill, a one legged man who Kathy loved and spent hours watching. At the age of eight her family moved from the area, but Kathy visited regularly, staying with "Mrs." : "A part of me remained in Datchet." Whenever she returned she would revel in the unchanging nature of the town she loved. One of her fondest memories is of sitting on the same step she sat on as a child - worn comfortably away just to fit her. Her recollections of her childhood are full of closeness and warmth. Her maternal grandparents and her own mother and father instilled a love of learning in her: "They taught me more than any school." Kathy left school at 15 and worked in a local office. She lived at home until the age of 20 when she married. World War II soon followed, a life changing event for her: "Before the war the world was mine, well, mostly mine." With the coming of war she realized, "The world would be mine, but I would have to fight for it." During the war Kathy was active in the Women's Volunteer Service working long hours making soup in the open air and assisting in bomb shelters. Once a shelter was bombed where Kathy knew her husband and sister were located. She kept serving soup regardless. On the day peace was declared, Kathy organized a street party to celebrate. Kathy thinks often about the war and its effect on people and society: "It took a long time for it to dawn on me what the 61 war had taken away. What happened to the men that did come back? We hear so little about that." During the war Kathy was offered a position as nursery school teacher: "It was a once in a lifetime way of it happening." She continued in this position for almost 20 years, thoroughly enjoying it. One of the contributions she is proud of is establishing the first "Lollipop Man" [crossing guardj in Britain after six children were killed in traffic. In the 1960's Kathy's son emigrated to Canada and she and her husband visited him there. It was a memorable trip: "I could write a book on my memories." At the age of 51 Kathy retired from teaching and worked for British Airways . She enjoyed frequent trips across the Atlantic to visit her son. At the age of 60 she "officially" retired, then compulsory in Britain. In 1977 her husband died suddenly on a tour of Scotland. She continued to "count [my] blessings" because he did not suffer. She felt, and continues to feel, his loss deeply. This had been a satisfying, close relationship for 40 years. Following Tom's death Kathy kept busy with temporary work. Her son was living on Vancouver Island and Kathy decided to join him there. She then relocated to the Lower Mainland. Being active has been "good therapy for [her] because [she has] no time to worry." She recently enjoyed her 80th birthday: "I celebrated counting my blessings." Mary's Biography Mary has recently moved to West Vancouver from Vancouver Island. At 75 years of ago she maintains an active lifestyle. She enjoys being a 6 2 grandmother, belongs to the Seniors' Activity Centre and attends church regularly. Mary was an only child born to her mother ("Mummy") at age 39 and her father ("Daddy") at age 46. She says she was spoiled and dearly cherished because her mother lost a previous child through a miscarriage. Her father and she were very close, so close that people, on seeing them, would say "there goes Bill and little Bill." Mary describes him a "a kind, gentle, bear of man," who would sweep her up in his arms for hugs and kisses. One Saturday a month she would have a special outing with her father. They would walk to the local bookstore and there she could buy two comics. At the age of eight and a half, on April 13th, 1930, "everything changed." That Saturday, Mary decided to stay at home and help her mother bake instead of walking with her father. Her father went for his walk but returned looking ashen and feeling ill. The doctor was called. He told Mary to go outside to play. When she returned, her father had died. Mary blamed herself for her father' death, thinking that if she had gone with him he wouldn't have died. After his death "nothing was ever the same again." The next five years were "rough" as Mary's mother struggled to support herself and her daughter. Then she remarried Harry, a Bostonian. Harry had been responsive and kind to Mary while courting Mummy "but after the marriage, things changed markedly: "I could feel hate building in my heart. I knew he did not want me." Harry complained loudly and frequently about Mary to her mother and then Mummy and Harry would argue. One day Harry raised his hand to hit Mary's mother. Mary kicked him. Harry beat Mary so badly that she could not go to school for several days: "It has taken me years to get over my hate of him." 63 After graduating from high school, Mary longed to fulfill her dream of becoming a nurse. The closest training school was in Vermont. Harry refused to allow her to attend, despite entreaties from Mummy and their minister. He insisted she attend secretarial school. Mary worked at the local Woolworth's but could not save enough money so she enrolled in Bixby's Business College. The war years were spent working for a textile company. She tried to join the army but was too young: "Another dream ended." She developed TB and consequently could not enlist for the Navy. After saving enough money to support herself in nursing school in Vermont, Harry finally gave his assent. Her application was refused because Canadians were required to stay in Canada and help with the war effort. During this time she met and married Fred. Six years later while awaiting the birth of their only child, Gloria, Fred became ill. He collapsed, was hospitalized and a malignant brain tumor was found. "With God's help he rallied." Six years later the cancer took over and he died at the age of 39. The next 10 years were spent in Northern British Columbia where Mary's sister lived. Here she found employment with the Federal Government. Moves to Vancouver and Victoria followed. She retired in 1986 which she describes as "the happiest day in my life." Her daughter lives nearby with her husband and son. Mary is proud of her daughter who has a Master's degree in Fine Arts. Mary views the difficulties and hardships she has endured as evidence not of her ability to survive, but of her ability to overcome: "I think I'm a very strong person, I've come through, and I think it has made me that much stronger." 64 Norma's Biography Norma is 75 years of age and is enjoying being a grandmother to her four grandchildren and three great-grandchildren. She is an avid knitter and taught knitting for many years for the Singer sewing company. She has a keen interest in dramatics, and has served as Special Events coordinator at her apartment complex. Her two daughters also live on the Lower Mainland. Norma grew up in England, the third of seven children. A close relationship with her mother developed from an early age. One of her earliest memories is of being "mollycoddled" by her mother who dressed Norma in layer upon layer of clothing, even when indoors. This continued until the doctor intervened, warning Norma would die through suffocation. Norma remembers the joy of being able to wear little clothing at the beach. An interest in swimming developed and although Norma was thought to be "delicate" she became a competitive swimmer, winning a district medal and later a medal for bravery when she rescued a boy from drowning. Norma left school at the age of 14 to enter domestic service, as a parlourmaid. Factory work followed where Norma moved "to the forefront as usual" and became a "Stargirl," representing her floor to management. She joined a fitness club and had hopes of becoming an instructor. Outbreak of war precluded this. Both fitness club and factory were closed. At this time she met her future husband. She married at the age of 17. Her father had to walk down the aisle first to sign the register as she was underage. She describes the war as a life-changing event. Her husband was unwell and Norma had to care for him and cope in a country at war. Two daughters were 65 born during the war years. Her eldest was born prematurely during an air raid. The cottage where Norma was delivering her baby was hit. Immediately after the baby was born, mother and child fled to safety: "I became a woman overnight.". Norma states that "an inner strength" enabled her to survive. After the war Norma worked as an usher in a cinema, taught swimming and was active for her local Council and Women's Guild where she became chairperson and was involved in drama productions as both director and performer. The most difficult period of her life occurred when her husband wanted to emigrate to Canada. Her mother was ill and Norma did not want to leave her. Her mother encouraged her to go to Canada and so she did, promising to return within the year. This was not possible. Norma returned one and a half years later and her mother died two days after her arrival: "I blamed myself. I was filled for a time with grief and hate for my husband." Her daughters helped her to stop blaming herself for the death of her mother. There were many challenges in marriage over the next 20 years: "We got through. When one door closed another always opened." In 1980 her husband died and Nancy for the first time found herself financially secure: "A yoke had been lifted." Norma now enjoys "life in the slow lane." As she looks back on her life she says she has learned many lessons. She has kept an optimistic attitude throughout: "I always liked to think; 'Oh well, its not that bad, something else will turn up.' There's always another side...Now, at 75, I am beginning the rest of my life." 66 Patricia's Biography Patricia is a retired administrator of a care facility for older adults. She has a Bachelor's degree in sociology and is a registered nurse with graduate training in operation room technique and management. At 71 years of age she belongs to a local Kiwanis group, serving as secretary for the Housing Society. As well, she is chairperson of the Tenants' Association for her apartment complex. Patricia's world was shattered at the young age of six when her mother died. The "real, honest story" of her mother's death was withheld from her. This has resulted in an anger at adults who do not speak truth to children, who slough off their questions and ignore their need for honesty. Her father later remarried a woman who Patricia never liked. It has been difficult for Patricia to trust women. "To this day," she says, I still "look for my Mum." At the age of 18 Patricia began nurse's training in Toronto, Ontario. Career choices were limited for women in the 1940's and so she chose the training that was least objectionable to her. She made the best of it, further developing her interest in theatre which had been sparked through her father's occupation as a theatre manager. During nursing training she wrote, directed and performed in a minstrel show. It was at the theatre her father managed that she met the man who would become her husband. Tom, twenty years her senior, and Patricia began a relationship described as "meet and part, meet and part" until their marriage iii 1954. Twenty years later, they divorced, due to Tom's alcoholism. They remained good friends however until his death, at the age of 80: "Alcohol destroyed the marriage but not the love." While there were many difficult times in her marriage, Patricia says, "I wouldn't have missed it. " 67 During her marriage to Tom she continued to pursue her interest in acting, performing in commercials and for CBC and TV Ontario. She was a member of ACTRA but allowed her membership to lapse when she returned to full-time work after her separation. In retrospect Patricia calls this decision to leave ACTRA "not wise." When she looks back on this chapter of her life she says, "It was an exciting time. I might have made it professionally. I am not sure if its total closure - could I do it again?" A recession in Ontario resulted in her moving west to BC where she obtained a nursing position at Shaugnessey Hospital in Vancouver. This position was far from satisfactory and despite an absence of job prospects she quit, telling herself to "take a risk." Shortly after she learned of an opening in administration at a care facility in North Vancouver. "This was the job for me." Patricia held the position of administrator for 10 years, until her retirement in 1989. Under her direction the facility grew from a room and board model to a nursing home model. What is important to Patricia as she looks back on her life is that she has lived by her values and kept her integrity. She now recognizes that she has had three successful careers, as a nurse, an actress and an administrator. She says, "What now?" and is currently looking for her fourth career. Evidence of outcomes Every participant reported enjoying the group and benefiting from it. Six of the seven members stated that they viewed their lives differently as a result of participating in the group. Interviews were analyzed first for evidence of the 68 outcomes listed by Birren & Deutchman, 1991, p.4. Quotes from the interviews support these outcomes. The descriptors "most" and"several," indicate that five or six participants and three or four participants respectively gave evidence of the citedoutcome. statement "No evidence" indicates the outcomes were not identifiable. Essentially, I was unable to "match" the language describing the outcome with the language of the participants. This difficulty is commented on in Chapter 5. Additional outcomes identified in my analysis follow. These new outcomes are indicated by an asterisk (*). Sense of increased personal power and importance No evidence. Recognition of past adaptive strategies and application to current needs and problems No evidence. Reconciliation with the past and resolution of past resentments, and negative feelings Several participants reported that the opportunity to explore and share painful episodes in their past resulted in a new found sense of inner peace. The process of sharing what was unresolved and painful to remember seemed to bring healing. Each person who had shared a situation in the group that had been both unresolved and emotionally laden reported feelings of resolution. One member in particular experienced this quite profoundly. She had been plagued with guilt 69 since her mother's death, convinced that she could have done more for her, and deeply regretting her decision to emigrate to Canada with her husband. The very thought of exploring this, despite the emphasis on the voluntary nature of such sharing, caused her such emotional turmoil that she was unable to attend one session and wondered if she could return to the group. She thought the memories coming back would disturb her peace of mind. She decided to "see [her] commitment through" and in the interview described the freedom that had resulted: It seemed to unburden me if that's a good word to use. I thought, '...All these years, you've been blaming yourself, knocking yourself to death or whatever' and it, as I say, the only thing I can think about is that I burdened it all into the group. And they talked about it and discussed it and made me feel better about it, you know. It was like a great weight being lifted off my shoulders, you know... Its been good. Its been good to talk about it. I've bottled it up for so many years, it unburdens you... Its been good to unburden yourself... [Without] the group I would have carried that burden for perhaps another ten years. I am feeling much, much better. Much better indeed... The process of sharing seemed to result in a new perspective, one that "eased [the] conscience" and resulted in "peace of mind:" It weren't as rough as I was making it, maybe I was making more of it...It made me think about it, I went over it, and reviewed it and I thought, 'Well, its true what they said, I had other sisters at home... Reflecting on it, I couldn't have done anything anyway if I'd have been there because she was in the hospital. They said she couldn't come home because we couldn't look after her at home... So out of that came a good thing as regards peace of mind about that. It sort of sorted all that out for me in my mind... Another participant spoke of a similar shift in perspective. She had experienced a series of significant losses from an early age, and while those events could not be undone, she reported being as able to view them "differently." I've had a lot of dramatic things happen, or traumatic things happen in my life, losing my mother in a rather stressful way, and then my husband, and 70 my father when I was young. And I've always had a great deal of anger in me, I thought it was me but I've found out that...this happens to people quite often when somebody, when someone you love dies that you get, — you're angry at the person for leaving you, you're angry at God for taking him, you can't quite understand why these things happen... And then I had a step-father that I didn't get along with and I despised...I don't think I'll . ever be rid of all of my anger at my father, but, I don't know, bringing everything back it sort of, —you look at things in a different way...I found that it made me more at peace with myself. One member was able to come to terms with her decision not to pursue a career in acting, something that had troubled her for years. She thought that despite her circumstances at the time that she had "chickened out." During her interview she spoke of the resolution she had reached regarding her decision: In a way I guess I'd always thought that with the acting I'd let it down because I was just such an emotional basket case there for a while with breaking up of my home and my marriage arid everything...In retrospect I also realize I don't think I could have handled anything more....I'm sure I couldn't have. The process of remembering and sharing was not easy for several of the members, but the release that resulted was reported to be worth it: "Yes, it brings up emotions that you had put down, it brings them all back...It freed me rather than making it more stressful. It was painful. There was freedom too." For one member, the group experience resulted in an awareness of a situation needing resolution. She reported that as a result of the sharing and discussion in the group she recognized an absence of this with her son. Her dissatisfaction with the nature of their relationship became clearer to her and she had decided to address this with him : I'm thinking that its something I ought to deal with instead of just putting up with it. I think, 'No I'm going to see to this and see to that and ask a few questions.' I think I have a right to do that...He hasn't got time. Arid time is something that older people— I think that's why probably I've enjoyed this group so much. You've had time to listen, time to talk to other people. 71 Resurgence of interest in past activities or hobbies Most respondents did not indicate any change in level of interest in activities or hobbies. One member did however express a desire to continue developing her creative writing skills and to pursue other interests that had lain dormant since her retirement. The group experience seemed to have given her fresh enthusiasm and energy: I had so many things I was going to do when I retired, and...when I retired I retired my brain too. I don't know what happened... Because I had made up my mind I was going to go to university and take courses and stuff and I've never done this. And I think maybe I will - in January there's a course at Capilano and Elderhostel or something. So I'm really thinking about this, seeing if my brain still works, if I can do it. She had wanted to try her hand at creative writing for some time, but lacked confidence. During the group she shared her writings with her daughter, who had encouraged her to pursue this interest: I told Anne [her daughter] what we were doing and she was, she said, 'Well, Mum, let me read it!' And I said, 'Well its terrible writing I don't write well.' She said, '1 don't think its terrible,' she said, T think its pretty good.'...But, I would like to, as I said its something that I've wanted to do for a long, long time. I've thought about it but [said] 'there's no way I can do this.' There is a creative writing class over at the Seniors' and ... I picked one up [calendar of courses] and I was looking at that and I thought 'Well, my writing's as good as that.'...Well I was thinking I should take, I've often thought about taking a creative writing class, I think they have one at Capilano. And then I thought, 'Aw, I can't do this,' but I think now that I can do it. This member also reported a new interest. Her reminiscences had made her aware of what she didn't know about her family and she wanted to begin researching her family roots: I know very, very little about it. And that has sort of got me thinking, I thought, now, I must send and get so and so birth certificate, I know I can do this, maybe I can find out something from this, I don't know...It sort of 72 made me think about it more and think now how can I go about this? What can I do? Development of friendships with other group members Several participants referred to a qualitative difference in the nature of the relationship between those group members who lived in the apartment complex. This was described by one member as "an unspoken but special feeling" that was now present, a "connection" that didn't exist before. Another appreciated the "greater depth of human nature" expressed during the group which had enabled her to know some of her friends and neighbours at a deeper level. She also noticed changes in the content and manner of discussion in the weekly coffee hour held at the complex: "Its given us something different to talk about and you discover things about your neighbours, that [is] nothing detrimental, rather fun and we've got to the stage at the coffee morning...[of] pulling each other's leg, you know." This participant also found she was more attentive in thought and deed to some of the members who might need "a little help." A bond appeared to have developed between group members, but evidence of development of friendships per se was scanty. This may reflect the fact that 5 of the 7 participants knew each other before the group started. The only indication of the possibility of a developing friendship was indicated by one of the members who did not live in the complex. He expressed a desire to invite a fellow participant out for lunch. In contrast one member stated she did not feel "any great pull to maintain any kind of a relationship" with the group members although she had wondered whether she "should:" 73 I like these people, but I didn't feel, I don't know whether it's me, this could be me, because once a job is done ... that's that, been there, done that. And I often wonder, should we be following through as a group? There's so many of us living in, should we be keeping contacts with each other and yet I don't like to impose on other people because they all have their lives to live too you know. It is interesting to note that while a few of the group members were personal friends before the group started, some of the more painful aspects of their histories had not been shared. One participant expressed her surprise at what she learned about her friends but she did not think further discussion of these areas would continue within the friendships: I know one or two of them that we had talked a little bit as friends, but they brought out more than we had talked about which was quite surprising...I got to know them [other membersj better and we haven't discussed it very much outside the group...I think what happened happened within the group and what they, let's use the word 'confess,' what they confessed to, its not for general discussion. If they wanted to talk about it and approach me, OK...We chat about it but very casually we don't go into depth like we do when we're within the group. Greater sense of meaning in life No evidence. Ability to face the nearing end of life with a feeling that one has contributed to the world. No evidence. * New awareness or heightened awareness of one's contributions and/or abilities Most group members referred to an awareness of their unique contributions, skills and abilities as a result of participating in the group. This seemed, for most, to have been a direct outcome of the opportunity the group 74 afforded to look back on certain aspects of their lives. This was a new awareness for some and for others a reclaiming of what had been known, but since forgotten: "I was aware of them, [abilities, contributions], but I'd never realized, I'd never thought about them anymore. It was something that had gone by - it was another book, a page in a book that was closed." This experience of remembering was described by one member as "gratifying." She described the tendency to be discounted by others and to discount oneself in older adulthood: You know we forget, we forget things that have happened in our lives and that we have been rather accomplished. And as you get older, and certainly when you get, what happens is people start inadvertently kind of discounting you and you start discounting yourself. So doing this it helped me realize that I had done some rather, some effective things in my life that I'm proud of. And that I...feel I went through life with my integrity intact. Another participant described a new awareness of her contributions which had led in turn, to a more positive self-appraisal. She stated that the group structure caused her to "think back over [her] life" and that this reflection had resulted in the realization that she had contributed: I've come away I think with a better understanding of myself, liking myself better. Figuring, I always figured...I'd never, I hadn't done anything during this life but when I think back I think I'm a very strong person. I've come through, and I think it has made me that much stronger....When I think back I've done quite a bit with my life. Maybe not in terms of way a lot of other people have done, but as far as helping people and being with people, it brought a lot of these memories that I had, that I had forgotten. That I realized that...over the years I have brought quite a bit of happiness to quite a number of people, which I hadn't realized before. She also now realized that she had "always been a very positive person," and as a result of the group both recognized and appreciated that she had been successfully "versatile" in her career path and described herself as "a woman of [her] time." One member who had regretted not pursuing an active career stated that, despite 75 not fulfilling this dream, she had shone: "I've been a shining light in my own way — I have contributed." For one participant it was the responses and reactions of his fellow group members that led to a new awareness of his abilities and strengths: The interesting thing that I found in the group [was that] looking backwards I've seen that some of the things that other members of the group thought was a mountain that I climbed and I hadn't looked upon it as mountain that had been climbed. I had looked upon it as just an evolutionary process in that period of time. He reported that he realized that he had "been able to make some contributions." This was echoed by another participant who stated he was "very pleased" about his achievements. Through the group process he recognized that he and his wife had achieved their goal of ensuring each child received post-secondary education: "I realized what we did for my children. My aim was to educate my children and we did this." Again for this member the group provided the chance to reflect and remember. New awareness resulted: "I'd looked in the mirror and shaved everyday but I'd never thought of what good I probably had done in my life really." * .c3.A new perspective and/or appreciation of one's life through comparison with others Most of the participants referred to a deeper appreciation of their lives as a direct result of hearing others' life stories. A process of comparison occurred for several participants. This was described by one member as a process conducted "not orally or verbally but quietly. Through participating each person sees his or herself a little differently." Comparisons were made as experiences and life events were shared. One participants described his perspective on this process: 76 I think...its very easy if somebody has...had an experience and speaks about that, that can trigger latent memories, you know, similar, not the same, but similar or maybe totally dissimilar but it can trigger...I guess most of us, in most of the things we think [or] do...that there's almost an element, of knowingly or unwittingly or not, of comparisons. I think that...at times when somebody was recounting something saying to myself, now, not quite as consciously but there, 'I wonder if I would have reacted that way.' There was a lot of contemplation you know in our thoughts down there. We were wondering, you could see ourselves wondering at times a little bit of 'what if.' For some the result was a shift in perspective, from feeling alone in hardship to an increased awareness of the universality of difficulties. Learning that others had suffered in a similar or greater degree brought a different perspective on the suffering they had known: It didn't matter what you had gone through, that other people had gone through as much or worse than you had gone through. And it made you think about this and realize that maybe what you'd gone through wasn't quite so bad after all. Another member said she now had a "different outlook " as she realized she was "not the only one in the world [that] had problems:" I started to think back on my past life and I thought, '...What are you worrying about, you've had nothing.' When I think about all the things that's happening in the world today, and hearing the other stories of the other people, I thought, 'Your life's been a duddle old girl, don't worry about it,' you know? This participant also described feeling "unburdened" as a result of learning others had also coped with adversity and struggle: [Others] have had the problems also, maybe in a different way, but they have had the problems„..And 1 think it helped me a lot to sort myself out, really, as I say I've been suffering needlessly, I really think that now. I think I've suffered needlessly. As I kept writing and writing I thought, 'Well you can get a lot out of that you know, its not been that bad.'...And as I say, give you a different outlook on other people's lives and made you realize that you're not the only one in the world that's had problems, you know. ! 77 Others expressed a new awareness of the blessings that they had experienced as they listened to the experiences of others. As comparisons were made several members realized that they had been "extremely fortunate." For one group member, this resulted in an increased appreciation for the diverse experiences he had enjoyed: I think really out of the group I was most fortunate because I had such an ordered life and so many variations. I'd been in uniform, and then I think I was in the Navy and I went from the Navy to the police and the police to the Army and so on. I had an ordered life like chapters in a book. Yes, who hadn't as much variety. I don't think any of them had had as much variety as me...And I thought to myself, '...You've a lot to be thankful for and you'd probably never had realized it had you not met these people.' For another participant, a greater appreciation for her childhood resulted as she leaned of some of the hardships others had known as children: "I was never like him, I never went without shoes or things like that, you know. I had a good childhood, a very good childhood." One group member referred to an increased awareness of her good fortune. She had known this "in [her[ heart" but being able to compare her life with others, deepened this conviction: I think I have been extremely fortunate...I think I've realized it for a long time but it brought it to the fore, thinking about it and talking about it with other people, where before you'd just been thinking about it yourself...I knew I'd been fortunate, but you sort of almost take it for granted but when you're talking about it to other people and you're comparing notes its quite a salutary thing. Similarly, another participant described his life as "good and happy" —a realization that occurred through contrasting his life experiences with those shared by others. He recognized the difficulty some of the members had in sharing more painful aspects of their lives within the group and that, in comparison, his history was quite different: 78 And I actually felt sorry for them, two or three of the ladies, because I think they really had to struggle a lot harder than what I did to bring themselves into talking about their own problems and their own biography....Yes, more difficult for them in the fact that they'd had - what to say - a sadder life than I had. Yes I had. I hadn't had all the good things but I'd had a very good and happy life really. And I was fortunate in, when I look back on it and think of the people I was with, especially in the services, I realize how much these young lads looked up to me and how they relied on me and you know, as you grow older you forget those things. Comparisons were also made of similarities in knowing great happiness in life, again resulting in a deeper appreciation of one's life course: Well, I think of Art, now I think of Art, what a wonderful life he had...And then I thought, 'Well Art had been a bit like me. We've both been through the mill at time but we've come out smiling. We've both had happy marriages, we've brought up children in the way we think they should have been brought up' and the more I look back - it did me good because I realized then what a good life I've had and how fortunate I was. * Recognition that one's life is not yet completed In sharp contrast to Birren & Deutchman's (1991) outcome "Ability to face the nearing end of life with a feeling that one has contributed to the world," several participants referred to an awareness that life was in fact not "nearing the end." There was, in essence, more life yet to be lived. This was not typically stated with a specific goal, or project, in mind, but as a realization that there was more yet to do: Not necessarily...saying tomorrow I have to climb Mountain X,Y,Z but the feeling and realization that there are just untold mountains out there, not necessarily specific, but untold mountains, mountain ranges if you will that are there. What I thought and think is that there was some satisfaction in our group of looking back at realizing that mountains had been climbed and there still were mountains to climb, but different mountains. But the feeling of the ability of climbing that mountain was not done away with. 79 Similarly another member described her growing awareness that there was more yet to "do." What form this "doing" would take had yet to be discovered: It [the group] ...made me look at myself more I think, and made me realize that I have done something with my life, and that I've still got something to do. I told my daughter I intended to live for another 20 years! Yes, I don't know what it is...I've been thinking about and thinking, 'Now there's something, there's something I'm supposed to do and I'm not sure what but I'll find it.'.. Another member described noticing a willingness to consider various opportunities to join in activities whereas before the group he would have declined: Pat came to me the other day and said, 'Would you accompany me on a dinner to Kiwanis and have a look and see what you can offer you know, see what it's like.' And I said, 'Pat, you know me.' And she said, 'No would you do it ?' And I said, 'Sure, I'll do it.'...This was something else you see I would never have entertained it before. I would have said no right away. I'd never give it any other thought. I would have made up my mind there and then. I think this group has made me realize that before a person says 'no' to anything or even 'yes 'he should sit down and think about it hard and not be so eager to write things off. To consider them all. He was not only more aware and appreciative of the life he had lived but that "life [had] still got a lot to offer." In fact most members who referred to this outcome did so with a sense of anticipation. It is important to note however that one participant, who stated she was looking for her "fourth career," described herself as "resentful" and "floundering" as she confronted a lack of opportunities and meaningful roles for older adults. Another participant described the group experience as engendering a pursuit of "unfinished tendrils....a continuation of learning which has to be a lifetime proposition." For this member, the group experience afforded the opportunity to examine some of those "tendrils" from the past that pointed to possibilities for the future: "Tendrils that are weaving together saying, 'You 80 know I did all right there, I did all right there, and there and there by golly. I still have lots of energy—maybe I can.'" * Affirmation of identity Two of the participants reported that the group provided an opportunity to remind themselves of who they were as individuals, irrespective of their age. It appeared that they came away with a stronger sense of their identity. The "discounting" of older adults that can occur in a society that places a premium on youthfulness was counteracted as they reflected back on who they were and what they had accomplished: As you get older, you start discounting yourself and others discount you. As, I think we were talking about, when you go into the park, when you go into stores, you know, bless their hearts at Safeway and they'll say, 'Can we help you out this article?' and this sort of thing. I know they intend to mean well, very well by it, but you think to yourself, 'God, do I look that frail? What's the problem here?' Do they not think I'm capable of doing this? Yes that's why it helped, to remember. 'Yeah, I've had my place and I did my bit, you should do as well.' It appeared that the group enabled these members to remind themselves of who they were, living in an aging body, but with an identity that was in essence, ageless: One of the things I think of advancing years is that people sometimes get categorized as being almost non-existent and any other way but a shriveled body and that's not a very satisfying thought. Because you know the woman of 65 that is going out for the evening and puts on her nice clothes, inside she's still that young girl that's 16, or 18 or 20 and the same with men. You know, we don't change inside, we change outside. And I think some of those realizations can come out of and I think did come out of there [the group] for myself. 81 * Satisfaction with one's life course Several of the participants gave a positive appraisal of the life they had lived as a result of their experience in the group. This appeared to be irrespective of the struggles and personal difficulties that had been experienced. In fact, one of the members who had known considerable losses during her lifetime commented on her realization that "the way [her] life has gone was it the way it was supposed to go." It seemed that as a result of the group she changed her opinion of the life she had lived. Whereas previously she would have regretted her choices and decisions she was now able to see that "what happened was the plan." This realization seemed to result not only in a sense of peace and resolution but also satisfaction with what had occurred: I thought my life was sort of maybe all vain, that I hadn't really done a great deal with my life. I still feel this, to a certain [extent] there were a lot of chances that I had that I didn't take. But then as I think back, I think, 'Well I guess maybe I wasn't supposed to have those, take those chances...That what I wanted probably would not have been good for me'...As I was writing and everything [I] realized what had happened in place of them, was probably, was better for me than what I had wanted to do. And so I put those memories behind me, things that had bothered me and just decided that what happened, the form that my life took was the way it was supposed to be. And that what I wanted it to be evidently was not, it was not to be and probably was not good for me. Another member described similar contentment with the course his life had taken. The experience for him resulted in a feeling of "satisfaction:" All in all I found each session very profitable....I think it gave me a feeling of, I'll use the word satisfaction, in looking at it in a backward, in a reverse way, looking back at the past that probably in the opportunities that had come my way or had been found. For one member, the retrospection resulted in feelings of contentment and pride. For her, the process of reflecting and think back was a reclaiming of what had been known: 82 I view my life now as a total success. I was kidding the other day and I said, 'You know when the last breath comes, I'll know I've lived it!' Which is a lovely way to feel... I had it before but I'd lost it...Which is very gratifying, let me tell you, very gratifying. Comments and suggestions on group structure During the interviews, participants also responded to questions pertaining to the structure of the group and the leadership. Their comments and suggestions are summarized below: Comments on group format The majority of participants expressed a strong preference for participating in a group to reflect back on their lives. While this could occur one-to-one, it was described by one member as being a "narrower view:" For you'd only talk probably about the good things. You know you wouldn't look back on the whole picture. You'd think about a certain night where you did this, and you did that...No and you wouldn't have shared anything that happened before you met this person or after this person - it would be very doubtful if you would talk about it. These participants believed that the sharing would be deeper and more comprehensive in a group. Several participants stated that this was because the group acted as a catalyst for memories and experiences that had been perhaps long forgotten: I think its much stronger with a group. And I think the group were reminded of some things in their lives by what other people had said and then said, 'Oh boy, that really affected me and I hadn't thought of that.' So I think the group is far better. This was echoed by another participant who described the group experience as providing the opportunity for a "different outlook" or perspective that would be qualitatively different from one-to-one sharing: 8 3 I think groups are better. I think the size that we had was very good. I think that was, you know seven or eight people... If there's just one other person, it doesn't give you as much of an outlook...If you have more people in the group...it gives you a different outlook...when you hear other people's ...viewpoints and what their life has been...A lot of the things that ...come up in a group make you think of things that you hadn't thought on yourself either. They bring back—you think, 'Oh, yes that happened to me,' or, 'Oh, I remember that!' Thus the individual experience became richer and fuller as a result. As another participant described it, "The group aspect...promoted the thought process, the remembering, the analysis that maybe we hadn't bothered to do too well...The group was getting the material that would provide the basis for the individual analysis." Two participants described the group experience as enabling them to share more openly and freely than they might with one other person: Its amazing what you will do in a group that you might not do on a one-to- one basis or just a couple, people that you don't really know because you think, 'Well, I'm not going to tell all these people that I have no, that I don't know who they are...' But you felt a great deal of trust in these people that you could bear your soul to them...There's something about a group, that for me, seems to bring me out of myself. Another member thought that the group format helped ensure participants would take time to adequately prepare. If the guided autobiography was conducted individually people would perhaps be less conscientious: In the group...you don't want to fall flat on your backside...So you put a little more effort into it you try to make a decent presentation ...If you're going to get up and speak to...a bunch of other people you're going to do some preparing, you're going to do some thinking about it. And I think there's that element of the group. Put it another way, it could be done one on one but I don't think it has the same value as the group. 84 Comments on writing and reading process All the participants found value in the guided autobiography method used in the group. Both the reading and writing were seen as providing the avenue for thorough reflection and remembering: I think that being in a group and reading it makes you think of more things too as you're reading. Because I know as I was reading what I had written at the time I'd think, 'Oh, I should have, such and such happened to me.' It really did a lot for me I know that. It brought back a lot of memories, happy and sad and whatever. The process of writing in particular seemed to reawaken both pleasant and unpleasant memories and enable deeper reflection to occur: I think you have to write. Because this is what brings things back, makes you remember things. As you're writing about something you think, 'Oh, yes, such and such happened.' And as I said I remembered things that I had buried, that I didn't want to remember. There's still a lot around my husband's death. There's still a lot of time there that just sort of, its gone but it did bring back some of it. And that's quite traumatic, but...it was good. And I remembered names that I'd been trying to think of for ages and ages and while I was writing the names just came to me, just like that. It refreshed my memory...I couldn't bring them out again,—but writing seemed to spur it on, and as I said, brought out quite a number of things...And since then [the group] I've been thinking a lot about this. There's been a lot of things that I had forgotten that I have now remembered. Implicit in the act of writing is the opportunity, if taken, to be thoughtful and reflective. All the participants mentioned their preference for writing as it gave such an opportunity: "But really nothing does replace the written word, does it? Not really— because then you can read it and think about it....But once its written down you can refer back to it. I don't think anything replaces that. " Several participants also expressed appreciation for being able to write and organize their thoughts into coherent shape: 85 Without the writing it would be mumble jumble. You'd say something and then you'd go back a few years and then come forward a few years -1 don't think we would have done it in sequence. It wouldn't have sounded right to the rest of the people. We'd have all been jiggly-piggly I think. One member was unable to write physically and so he audiotaped his reflections. He found himself at a disadvantage and recommended writing rather than taping: Certainly I did research before I took the tape recorder in my hand and I prepared what I was to say. I had difficulty in that I didn't know exactly what I had said before on the tapes and it would have been handy if I'd been able to...write it down and have in all in front of me so I could go back and see what I had said in my writing before...I couldn't do that so I had to go in blind each time...I would recommend whenever possible people should write it, because of that and maybe they can get better continuity than I was able to achieve. For several participants the method of writing and reading seemed to provide the means for resolution of experiences that had left very painful memories. One participant stated that writing about the death of her mother was a "release" and that reading outloud "eased [her] conscience." This member also spoke of the nervousness she initially felt when reading her reflections. This was short-lived however as she discovered that her writing was equal to others': The writing was easy. I didn't mind the writing so much but my stomach churned when I had to read it out, I thought, 'Is this going to sound ridiculous?" Is this going to sound right?' No the writing didn't bother me but the reading of it - I was dubious about it. 'Did they want to hear this? Should I write that or, you know, what should I do?' But after I'd listened to what the other people had written, after the two or three meetings when we'd, course I'd miss one, so, after the third meeting I thought, 'Oh, its OK, its OK, its not any worse.' For one participant the amount of writing required was problematic and the length of time required to hear from each participant. She recommended having fewer people read their reflections at each meeting: 86 I did not get from you nor did I pick up afterwards that there was going to be so much writing. I found that a bit onerous at times...I don't know if there's any other way of doing it, but I think it was kind of asking a lot, I really do...If you're going to maintain groups of six people and you're having six meetings, why could you not have two people do their story one night, two people and two people and then you could go back and even reflect on those. Rather than having all six people read a story, run over, most nights it ran over and I found that irritating...Because again, its a long sit...and its a long time. Comments on group formation Several participants stated that at the beginning they were unclear as to the nature of the group. They stressed the importance of clear explanations, expectations and definitions: The only thing was we really didn't know what we were getting into when we first started. We didn't know that until the first night and I think that sort of threw a lot of us and made us wonder now do we want to do this or not"? The word "autobiography" was understood differently by several members and initially caused some confusion. I guess possibly because I wasn't really sure just what you wanted, just what it was...Some of us had sort of talked it over, and we seemed to have different ideas of what an autobiography was...I think we were all a little bit confused...at the first. Although the process of writing was liked by the majority of group members, one participant stressed the importance of ensuring that people clearly understood the amount of writing the group entailed and that syntactic ability was not a requirement: I should warn them beforehand, 'warn' is an awful word to use, warn them beforehand that writing is involved. I don't think a lot of them realized that the writing was involved...Just say this, point out to them that there's no worry about the actual grammar, its just the information you want— because I know one or two people that would worry about the grammatical errors. 87 Two participants mentioned the importance of being "selective" in recruiting and screening potential group members. One respondent cautioned "people [could be] getting a little senile." He stressed it was essential for the leader to be proactive with group members who were not suited to the group, whatever the reason: I think you were fortunate with this group. I think that you...might just as easily have picked someone who turned out to be a dud. And I think you have to handle that carefully, not for the dud's sake but for the other's sake because they may clam up because of that. I think you have to try and pick it up at least by the second meeting and if they do, say, 'Look Tom Jones, you're not really enjoying this are you? I think maybe it would be better for you if you didn't get involved in this,' and try and talk him out of it nicely and then go on with the others who will grab it and run. Another participant emphasized the necessity of making sure group members did not confuse guided autobiography with group counselling: I'd be selective...One of the things that might have been crossing some people's minds to start with is, 'Is this a process of group therapy?' And I think that might have been holding us apart a little bit. Group therapy can have all kinds of connotations, can't it, real and otherwise...But it didn't take long for that to evaporate...You don't know that maybe in my mind I'm on the borderline of needing counselling...I may think that I need counselling, so here I am...It might be...something worth, with carefully chosen words, to maybe even sort of face up to...meet it head on before its there. This participant also expressed a desire for a "broadening out" from the theme of WW II which in his opinion, "became a predominant medium of discussion" within the group. He recognized that the war had "touched [everyone] in one way or another" but, in his opinion, the breadth of events shared was hindered as a result. He also thought a guided autobiography group of "mixed ages" would be worthwhile: I'm intrigued with the thought of mixed ages because that takes out the comfortableness...Maybe there's going to be a young person that's going to 88 question or is going to sort of look at things completely differently...If you have an opportunity sometime to do that I think you'll find it...interesting. The majority of the participants lived in the same facility and one member though in other circumstances that the group could become "unstuck as all being in the same building." She wondered, "Would you do better with people that hadn't met before?" Benefits of participation An opportunity to reflect Several participants seemed to greatly appreciate the opportunity to reflect and remember: "To have the ability to look back and to count your blessings is something quite wonderful." One member commented how surprised she was to find that names of people and places long forgotten were "coming back" with extraordinary clarity. This seemed to occur both within the group and when members were writing on their own. The busyness of people's lives was given as one important reason for the absence of this type of reflection: "We often don't take time to isolate the events of life - we move from one to another, back to back without taking time to think." What one member particularly appreciated was the chance to engage in what he described as "a holistic appraisal of a life time." He commented that the group experience resulted in "a better analysis, a more structured analysis of what [he] knew." For this member the difference was not that reminiscence occurred, but that there was a shape and structure to it. His life was reviewed in totality, rather than in "parts:" 89 I think that probably what participation with our group gave...is [to] suddenly take a little more cohesive look at the total rather than the reminiscences. Things we would like to remember or not remember and see what kind of satisfaction or dissatisfaction comes out of that....Looking at the whole rather that picking at parts. To tell one's story Implicit in the comments of several of the members was pleasure in being able to tell one's story and to have it valued and validated by others. For some this seemed to be a new realization — that one's story was in fact worth telling. One member spoke with enthusiasm about this aspect of the group. He thought it imperative that people recognize that their stories were worth telling and that an opportunity to tell those stories be provided: People ...are saying, 'Well nobody's ever asked me what I did in the war for instance and I've got something to tell!' And I think that in...our group, Glen said to himself, 'I've got a story to tell!'...I think Glen was at first [asking], 'Why am I here? What am I going to say?' And finally he realized, 'What the hell! I've got something to say just as much as anybody here!' You have to get that across to the people you've got. You've got a story to tell. 90 Chapter 5--Discussion In this concluding chapter the results of the study are discussed in relation to the literature review; implications of the results and recommendations for future research and counselling are suggested , the impact of the group on the researcher is described, and contributions guided autobiography can make to our understanding of older adulthood are outlined. Discussion of the findings Guided autobiography for older adults has been designed to facilitate the process of life review. As has been documented, research evidence for the universality of life review is not substantial. However, significant numbers of older adults report engaging in such a process and in reminiscence functions related to the theoretical purposes of life review. The purpose of this study was to determine if the positive outcomes from guided autobiography described in the literature were reported by participants and if such a process was enjoyed and/or beneficial. The findings demonstrated evidence of 3 of the 7 outcomes listed by Birren & Deutchman, 1991 with the addition of 5 new outcomes. Evidence for the value and benefit of guided autobiography was clearly demonstrated. Several key points related to the findings are highlighted below: • Evidence was seen for the process of life review as being structured and intentional as opposed to spontaneous. All of the participants reported never having reflected on their major branching points before with the kind of focus and deliberation experienced in the group. • The group gave opportunities for resolution, reintegration and restructuring of identity (tenets of life review as defined by Lewis & Butler, 1974). Evidence of 91 each was seen in the resolution and reintegration of a painful situation that had been a stranglehold for one participant and in the new identity realized by another who described herself as having enjoyed three careers and now searching for her fourth. Most of the participants reported a heightened awareness and appreciation of their contributions, one of the hallmarks of the attainment of integrity in Erikson's psychosocial theory of development. • Of great significance is the finding that not one of the participants saw themselves as more able to "face the nearing end of life" one of the purported outcomes of guided autobiography. In this study participants reported realizing that there was life yet to be lived. Theory is also refuted in this finding. The developmental theorists discussed in this study, Erikson (1968), Butler (1963), Levinson (1978) and McAdams (1988) all conceive of older adulthood as being predominately a time of preparing for death. One suspects this reflects more a circumscribed model of aging than an accurate description of a key developmental task of older adulthood. We have largely supported a deficiency model of aging (Botella & Feixas, 1993) and theorists are, by and large, no exception. • The overwhelming preference for group rather than individual guided autobiography refutes Haight, Coleman & Lord's (1995) recommendation that life review interventions be conducted by only one "therapeutic listener" (p. 185). This study affirmed the claims of Birren & Deutchman (1991) that the group experience enhances recall, evokes memories and "reinforces and sustains the motivation to review one's life" (p.44). • Only one participant stated that he did not view his life any differently as a result of participating in the group, and this was stated without equivocation. This 92 member taped his reflections and whether this is significant or not needs to be explored in further research (see below ). • The absence of evidence of the outcome "recognition of past adaptive strategies and application to current needs and problems" is notable, particularly in light of the research that indicates such reminiscence is associated with life review (Wong & Watt, 1991). This may reflect a lack of group leadership action skills (i.e. questioning, probing) which could have encouraged application of past lessons to current problems. Implications and recommendations for future research Since guided autobiography is in its infancy, there is obvious need for further research. There no shortage of possible research problems, several of which are suggested by this study: • The finding that the participants in this study recommended a group format must be tempered with the fact that they had no basis of comparison. It would be important to compare outcomes reported by participants in individually led guided autobiography with those reported by participants in group guided autobiography. Equally important is to ensure the leader or one-to-one "listener" is skilled. • A weakness in this study was that only one of Birren & Deutchman's (1991) themes was used. It is possible that had other themes been used the results would have been different. Another study could examine outcomes resulting from the use of all nine themes. • A longitudinal study, similar to Haight & Dias' (1992) retesting of reminiscence intervention participants, would indicate whether the benefits of guided 93 autobiography are lasting or not. It is important to mention that 8 months after the end of the group one of the participants gave promising evidence of the lasting effects of resolution. She reported still feeling "unburdened." She said , "I think you must have been sent to me to get it all out." • It is imperative to research the use of guided autobiography with independently living older adults, typical of the majority of older adults (Stevens-Long & Commons, 1992). Much of the reminiscence literature is comprised of studies with the frail elderly and thus gives information on a very small percentage of the population of older adults. This may also explain the outcomes documented in the literature that are concerned with "the nearing end of life" or "acceptance of death." • There is a preponderance of quantitative research in the life review and reminiscence literature. The absence of clear findings may reveal more about the drawbacks of using methodologies which can limit the information we obtain (Wrightsman, cited in Birren & Hedlund, 1987). The guided autobiography literature, meagre as it is, is replete with anecdotal comments and unsubstantiated claims. More qualitative research is needed which focuses on understanding the participants' experience and only then formulating outcomes. • The significance of writing in the guided autobiography process needs to be explored. It would be helpful to compare the results of two groups; one group writing responses to the sensitizing questions and then reading the responses outloud and one responding verbally only. • The importance of both using skilled group leaders and documenting this in future studies cannot be stressed enough. The literature review showed a glaring 94 absence of attention to the qualifications of those leading life review, reminiscence or guided autobiography groups. Since the "developmental exchange" is the heart of guided autobiography it is essential that those researching its efficacy are skilled in encouraging it. I would recommend that those interested in researching guided autobiography first participate in and then lead a pilot group first in order to become familiar with the process. • Researchers interested in qualitative methodology would benefit by taking a graduate level course in interviewing techniques. Despite training as a counsellor, I often felt woefully inadequate in the interviews. As I read and re-read the transcripts I saw firsthand how easy it is to reflect selectively and to miss opportunities to probe effectively. • Guided autobiography actively promotes the use of specific reminiscence functions which have been associated with older adulthood, among them integrative (Watt & Wong, 1991); Identity (Webster, 1993); and Therapeutic (Merriam, 1995). Comparing the reminiscence activity of older adults before and after a guided autobiography group could explore Watt & Wong's (1991) hypothesis that a "actualized life review" is indicated by the predominance of integrative reminiscence. • The advantages and disadvantages of intergenerational guided autobiography groups could also be explored. I was frequently sorry that younger adults were not present to benefit from the wisdom shared by the participants. My hypothesis is that intergenerational groups offer the greatest possibility for positive change in our perceptions of self and others as well as promoting a successful concept of aging, 95 • The validation check confirmed many of outcomes I had documented in my analysis. Ms Shaw's analysis concurred with mine with approximately 75% accuracy. However there were a few differences, underscoring the importance of further research to refine and sharpen the description of outcomes. As noted, I reported "no evidence" for several of the outcomes listed by Birren & Deutchman (1991). A few of the outcomes are, in my opinion, more "generic" (i.e. greater sense of meaning in life) and as a result are difficult, if not impossible, to substantiate. Implications and recommendations for counselling For both practitioners and researchers committed to a critical gerontology, which seeks to identify "positive ideals" for older adulthood (Moody, 1993, p. xv) guided autobiography has the potential to validate and empower those who often feel disenfranchised. The universality of human experience and age-related issues can help normalize the process of aging (Weiss, 1994, p. 22, citing Yost, Beutler, Corbishley & Allender). Meaningful roles for older adulthood can be explored and the future can be planned for. The group experience seemed almost to galvanize several of the participants into action, or at least, to promote the realization there was life left to engage with. This finding is encouraging, especially in light of recent findings that in BC the suicide rate for seniors is 50% higher than the provincial average and that adults older than 75 years of age have the highest suicide rate (Bell, 1996). The high suicide rate is attributed to a compounding of factors among them social isolation and reduced social status (Bell, 1996). Western society has predominately viewed older adulthood as a 96 time of "repose and disengagement" (Bianchi, 1982, p. 149). Such statistics would suggest that while it may be a time of disengagement for many it is hardly peaceful and that a new model of older adulthood is needed, one that focuses on meaningful roles for older adults in society: The challenge to those concerned with the well-being of the elderly, therefore, is to discover ways in the modern context to move from segregation to greater integration and from atomistic individualism to greater community. (Bianchi, 1982, p. 156) For counsellors "concerned with the well-being of the elderly" guided autobiography can be one of the "ways." Guided autobiography is not designed to be therapy per se, a fact which may attract older adults. Many older adults often show a reluctance to seek counselling but may do so when the focus is psychoeducational (such as writing your life story) (Malde, 1988). It is a sobering thought to realize the participant who reported feeling unburdened from the guilt she had "bottled up for years" might never have experienced release and resolution. She had never sought individual counselling, nor is it likely she would have willingly placed herself in a therapeutic group. Guided autobiography, because it is specifically defined as not being group therapy, was likely a comfortable setting for her to talk about certain aspects of her life, and then share more personal material as trust and safety were established. Clients are given the opportunity in a group context to reflect and make meaning of their experience. Especially appealing to counsellors drawn to client- centered and narrative approaches, the group leader is essentially a "coach instead of seer" (Vitz, 1992) in the process of enabling clients "to participate in the continuous process of creating and transforming meaning" (Gergen, 1996, p.215). 97 Through focusing on strengths, accomplishments and contributions rather than losses "new solutions to problems can become apparent, while for others a richer set of narrative meanings will emerge" (Gergen, 1996, p.223). I was encouraged by the "richer set of narrative meanings" that resulted for the majority of the participants who reported a new awareness of their contributions and abilities. This is one of the most empowering aspects of guided autobiography: "Many older adults find in their life review evidence of key lessons that were well learned, needed skills that were tested and honed and courage against overwhelming odds" (Magee, 1988, p.31). I was often amazed at the participants' apparent lack of recognition that certain qualities exemplified in their stories were anything other than mundane. Here the group leader is given a wonderful opportunity to reframe and shift perspective. This was illustrated in the comments of a participant responding to my reflection that the lessons she had learned were in essence examples of wisdom—wisdom that would benefit those who were younger: Isn't that interesting— you saw it as wisdom and we see it as experience of having lived through it. I never thought of it, of the learning processes that had taken place going through these things that could be passed onto others. This is where I've kind of missed the boat on this. The following discussion focuses on the role of the counsellor in the guided autobiography group; illustrating that the "central core of the group is the facilitator" (de Vries, et. al., 1995, p. 170). • Personal attributes for the counsellor interested in using guided autobiography include motivation, warmth, an ability to listen and to communicate effectively (de Vries et. al, 1995, p. 170) Training in group leadership skills is essential. Birren & Deutchman (1991) state only that the leader needs to be person who is 98 "caring and interested" in helping older adults conduct their life review (p.26). They stress that since guided autobiography is not therapy nonprofessionals should "not probe into the feeling and emotions of group members beyond those that emerge naturally" (p.26). This is misguided advice. The very nature of the sensitizing questions is to elicit memories that are often evocative and laden with emotion. A well-meaning but untrained group leader can inflict harm by responding inappropriately. Proper training is essential and to intervene without it is considered unethical (Westwood, Amundson & Borgen, 1994). • Adequate training and experience also helps the counsellor establish inclusion or belonging, foundational for all effective groups (Amundson, Borgen, Westwood & Pollard, 1989). Despite developed group leading skills I later recognized missed opportunities to probe and thus facilitate self-reflection. For example, several participants expressed regret over the "branch" that did not bud or grow fully. I realize I was unprepared for this and my respbnses did not encourage participants to explore this more fully. • Before leading a group counsellors should, if possible, participate in guided autobiography themselves. This lessens the likelihood that the leader sees self as "expert." Instead one becomes a "collaborator," in a shared journey. • While there are tremendous rewards for the counsellor interested in guided autobiography for older adults , there are also challenges. I was often surprised at how often I needed to use group management skills, particularly in the early stages of the group. I was initially surprised at the amount of interrupting and cross-talk . But this kind of behaviour should not be considered unusual as this was the first time most members had participated in a psychoeducational group. 99 We have a preponderance of activity groups for older adults; psychoeducational and therapy groups for older adults are comparatively rare. An important task of the counsellor then is to educate participants about the differences between activity groups and guided autobiography groups (Weiss, 1994). Impact of the group on the researcher While this study has documented the effect of the group on the participants it is essential to also document the effect of the participants on the leader. Their influence has been profound. My belief that I was free of stereotypical attitudes towards older adults was soon challenged. My biases and assumptions were evident as early as the first meeting. The field notes document one assumption clearly: Another stereotype I had was about older adults...and their sexuality. There were a few comments in a teasing way about men/women with a sexual overtone. I realized that I wasn't seeing Mr. Sands in this way at all. I was seeing him as an old man, not a sexual man. I wasn't seeing him or the others in their dimensions. This is a wonderful benefit of GA [guided autobiography] and one reason that intergenerational groups are so valuable —myths are challenged, stereotypes are confronted and real learning...can take place. How often are our narratives about older adulthood challenged? It has become apparent to me that guided autobiography (for older adults or in intergenerational groups) affords such an opportunity. Learning takes place for both leader and participant. Again and again I was both moved and impressed by the wisdom, courage and integrity demonstrated by the participants. Here were people who had coped with significant personal losses, survived the Depression 100 and drought, and lived through a world war. My field notes give testimony to the many "layers" of learning I was experiencing: I came away from this meeting feeling the poverty of my knowledge of history. Several times I did not know what was being described and it was apparent from the responses in the room from the other listeners that 1 was the only one 'in the dark.' I also feel a certain degree of shame over my softness as I consider what these people have endured, risen above. I share this in the group— my shame and my admiration. I have a new understanding and appreciation of the British people, their personal sacrifices in the war, their courage and bravery. I also see how the war brought both men and women a greater understanding of who they were, their skills and talents. As counsellors we can place ourselves with too much confidence in our roles of "helpers" and "service providers" and make the mistake of assuming we know what a client needs. When working with older adults we are on dangerous ground for our professional training is woefully lacking in both theory and practice of counselling older adults. Moreover, until recently, the trends in gerontology have been towards medicalization with the result that the majority of gerontological research has focused on the biological and medical aspects of aging (Moody, 1993). Thus the professional literature available to us will tend to support our view of older adulthood as a time of loss and decline. The counsellor who leads a guided autobiography group places his or her narrative under threat (Gergen, 1996) and transformative learning can result. Such learning has been referred to by Webster & Haight, 1995, in their report of positively changed attitudes in leaders of reminiscence groups. They recommend that this finding be researched more fully and be examined for possible use in changing negative attitudes of caregivers towards older adults (p.285). I would heartily support their recommendation. 101 Contributions of guided autobiography Guided autobiography gives opportunity for the listeners, whether they be counsellors, researchers or participants, to be personally and professionally challenged and changed through the telling. I would also like to present arguments for the contributions guided autobiography can make to increasing our understanding of older adulthood. Guided autobiography, through the sensitizing questions and evocative themes, provides rich material for those interested in learning more about the last developmental stage of adulthood. Researchers will be better equipped to refine and extend their understanding of older adulthood because they have invested time in seeking to understand the personal meaning of aging. The discipline of hermeneutic gerontology "values the investigation of lived experience" (Berman, 1995, p. 3) and has an important contribution to make to our understanding of older adulthood. For despite considerable research into the aging process little is known about the day-to-day experience of aging (Berman, 1995). Guided autobiography gives needed opportunity for these histories to be both documented and heard, providing an important "window" into the older adult's developmental world. As has already been stated, much of gerontological research has examined the process of aging from the tradition of positivism through the application of quantitative research methods (Berman, 1995). An essential piece has been missing: the perspective of older adults themselves: The process of aging is not just a matter of changes in the functioning of our bodies and concomitant changes in psychological functioning. The process of aging is in part a historical process involving not only the history of social policy toward the aged, but, equally, the history of older people's understandings of themselves. When people age, they are 102 necessarily involved in this historical process, the evolving history of the meaning of later life. Indeed, one of the most salient benefits of guided autobiography is the opportunity given for older adults to relate their unique history and to be empowered in the process. 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Webster (Eds.), The art and science of reminiscing: Theory, research, methods and applications, (pp.23-48). Washington, D. C : Taylor & Francis. Wong, P. & Watt, L. (1991). What types of reminiscence are associated with successful aging? Psychology and Aging, 6(2), 272-279. Yalom, I. D. (1985). The theory and practice of group psychotherapy. New York: Basic Books. 109 Appendices Appendix A—Letter of Initial Contact August 7th, 1996 Dear I am writing to request your assistance in research I am conducting for my Master's degree in Counselling Psychology at UBC. This research involves understanding more about older adults, in particular whether reviewing one's life is helpful as part of the aging process. I would like to lead a guided autobiography group for six older men (65 years or older). A guided autobiography group is designed to help people reflect on their life in a confidential setting. After the completion of the group each group member would be interviewed individually to ask what his thoughts, feeling, reactions are to his experience in the group. Each member will also be asked to read and respond to a summary of this interview. A group member can refuse to participate or withdraw from the group at any time without. I am hoping that Kiwanis members might be interested in volunteering to participate in the group. Unfortunately there is no monetary benefit for participating, but there are others. The research shows that participants in guided autobiography groups experience a greater sense of meaning in life and recognize and appreciate their strengths and the contributions they have made to the world. In addition each volunteer would be contributing to valuable research into the life review process . I would be very pleased if I could meet with you in person to explain the project in more detail and would appreciate a response to this letter at your earliest convenience. My phone number is XXX-XXXX Thank you for your consideration of my request. Sincerely, Candice Hunter I l l Appendix C — Participant Consent Form A Master's Thesis Research Study on: Guided Autobiography for Older Adults Researcher: Candice Hunter Department of Counselling Psychology Faculty of Education, UBC XXX-XXXX Faculty Advisor: Dr. Marvin Westwood Department of Counselling Psychology Faculty of Education, UBC XXX-XXXX The purpose of this study is to conduct a guided autobiography group for older adults and to interview participants after the group is finished regarding their experience in the group. The results of this study will help us understand whether such a group is valuable for older adults. A guided autobiography group is designed to help older adults reflect on their life in a confidential setting. Participants will discuss and reflect on the theme "The Major Branching Points of My Life." Each week participants will bring no more than two pages of written reflection on a major branching point which will be shared in the group. The group will be facilitated by the researcher and will meet once a week for three hours for six weeks . Each participant will be interviewed individually by the researcher after the completion of the group. This interview will be approximately one hour in length and will be audio-taped. The tapes will be transcribed by the researcher. Following this the researcher will ask each participant to read a synopsis of this interview and ask if any changes are needed to ensure that the summary accurately reflects the participant's experience. Each group member will agree to maintain strict confidentiality. One of the group guidelines will be, "What's said here stay's here." Only the researcher, research supervisor and two other thesis committee members will have access to the audiotapes and transcripts. Information that could identify a participant will be changed or omitted in any written or oral material resulting from this study. These tapes will be erased when the study is completed and the transcripts will be destroyed. In order to participate in this study you must be 65 years of age or older, be willing to attend group sessions regularly, maintain confidentiality and participate in activities and discussions. It is also important that you are not receiving treatment (i.e. medication or counselling) from a psychiatrist or other professional for emotional problems (i.e. depression). If you decide to participate in the study you may refuse to participate or withdraw at any time. This will not jeopardize your standing as a member of the Kiwanis Club of West Vancouver. The researcher and research supervisor welcome your questions regarding this study. If you would like to participate in this study please complete the following section: I, , have read and received a copy of this consent form. I agree to participate in this study. Signature: Date: 112 Appendix D—Group Interview Consent Form Consent Form A Master's Thesis Research Study on: Guided Autobiography for Older Adults Researcher: Candice Hunter Department of Counselling Psychology Faculty of Education, UBC XXX-XXXX Faculty Advisor: Dr. Marvin Westwood Department of Counselling Psychology Faculty of Education, UBC XXX-XXXX I am willing to participate in a video-taped discussion of my experience in the guided autobiography group Candice Hunter facilitated in October 1996 at Kiwanis Court in West Vancouver. This discussion will be facilitated by Candice Hunter and Dr. Westwood. I give permission for any taped comments I make to be used for teaching or educational purposes only. I also understand that I am free to decline to participate at any time during the video-taped discussion. I, , have read and received a copy of this consent form. I agree to participate in this video-taped discussion. Signature: Date: 113 Appendix E—Interview Schedule 1. Introduction 1.1 Establish rapport • i.e. "It is so great to see you. I have really missed everyone from the group. Personal chat for a few minutes, settle at table etc. 1.2 Establish purpose of the interview: • "Thank you so much for your willingness to be interviewed. You've already given a lot of your time coming to the sessions. And this interview is a really important part of the research because we're wanting to learn what people think of guided autobiography groups, whether they are helpful or effective. As I've said before, this is a relatively new type of group and your comments are going to be invaluable because you have just participated in a guided autobiography group. I'm not sure how long we're going to be - the last person I saw spoke for about 45 minutes - it might be more or it might be less. . I have several questions that I've written out ahead of time and I would like to tape record your responses. And the reason I'm tape recording is so that I'll be really accurate in reporting. Taping will enable me to transcribe word for word what you've said. 1.3 Obtain informed consent and ensure confidentiality: • "First I would like to go over this consent form with you. This form outlines my research project, including the group itself. The interview will be tape recorded and later transcribed. Only myself and the thesis committee members (Dr. Marvin Westwood, Dr. Norm Amundson and Dr. Frank Echols) will listen to the tapes or read the transcript but they're the only ones. Any information that could identify you will be altered - so I won't be using your name so they'll be no way for anybody to know who you are. You can choose what is known as a "nom de plume" if you would like or a name you might like me to use to refer to you when I talk about you in the thesis. And the other part I wanted to stress is that after my thesis is completed, the tapes are going to be erased. Similar to the group we were in where you could decline to participate at any time, you can decline to answer a question or say you'd like the interview to stop at any time. Are there any questions about the consent form? (answer and then obtain signature.) 2. Standardized open-ended question I'd like to start the actual questions now if that's OK 2.1. I'd like to hear about your experience in the guided autobiography group. 114 3. Semi-structured questions: 3.1 I wanted to ask you, had you reflected on your major branching points before the group began? 3.2 Do you view your life any differently since participating in the group? 3.3 You know that in our group people wrote first and then read aloud what they had written. So there were two parts - the writing on our own and then the reading. What do you think about this way of reflecting? 3.4 Reflecting on major branching points could occur with one other person rather than in a group. What are your thoughts on this? 3.5 What effect, if any, did the group members have on you? 3.6 I also wanted to ask you about the fact that for some people in our group it was difficult for them at times to look back on the major branching points. Some people found that emotionally hard. I'm wondering if that happened to you, either during or after the group. 3.7 I may lead similar groups in the future - I'm wondering if you have any ideas or suggestions about how to make a group like this more effective. 3.7 I'd also like to ask you if you would recommend participating in a guided autobiography group to a friend? 4. Demographic Data 4.1 I'd like to check a few facts with you. I need to be able to describe you accurately when I write my thesis. 115 4.2 (Education): I'm remembering you completed some schooling. I think you left school at Have you taken any further course work, training etc.? 4.3 (Age): I know you are in your 70's. Would you mind telling me your exact age? 4.4 (Work): I'm wondering what social groups you may belong to? volunteer work? hobbies? community involvement? 5. Conclusion 5.1 I really want to thank you for what you have shared with me today. I really appreciate your comments and the contribution you have made to research into this type of group. I truly thank you. Before we turn the tape-recorder off I wonder if there is anything I haven't asked that you think I should know. 116 Appendix F—Summary of Findings Benefits of Life Review (Birren & Deutchman, 1991) • Sense of increased personal power and importance • Recognition of past adaptive strategies and application to current needs and problems • Reconciliation with the past and resolution of past resentments and negative feelings * • Resurgence of interest in past activities or hobbies * • Development of friendships with other group members * • Greater sense of meaning in life • Ability to face the nearing end of life with a feeling that one has contributed to the world. • Evidence of outcome documented in "Guided autobiography for older adults" New Outcomes "Guided autobiography for older adults" • New awareness or heightened awareness of one's contributions and/or abilities • A new perspective and/or appreciation of one's life through comparison with others • Recognition that one's life is not yet completed • Affirmation of identity • Satisfaction with one's life course


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