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Enhancing Your Therapy with Gestalt Approaches
Gestalt Therapy continuing education psychology CEUs

Section 17
Implementing Gestalt Reminiscence Therapy with Older Adults

CEU Question 17 | CEU Answer Booklet | Table of Contents | Gestalt
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

The Cork Older Adult Intervention Project is based on a developmental model of the person in which the emotional, social and spiritual growth of older adults is viewed as continuing until death. The particular therapeutic method used is gestalt reminiscence therapy (O'Leary and Barry, 1998; 2000). This approach uses storytelling as a means of identifying unfinished business (O'Leary and Nieuwstraten, 1999). It develops intrapersonal and interpersonal contact and considers environmental contexts. Because this integrative approach views development as a lifelong process, merely facilitating older adults to recall the past would not be considered sufficient. Participants are also challenged to continue to develop themselves in the present. Gestalt reminiscence therapy is primarily used as a group approach, thereby creating a greater opportunity for interpersonal contact and feedback and the formation of new friendships.

Recall of the past can enhance identity as participants relive former achievements. Reminiscence can develop self-esteem by increasing the level of self-referent knowledge (Kovach, 1990). Buffer (1963) viewed storytelling as a method which allowed older adults to come to terms both with their past lives as they were and with their own mortality. However, unexpressed feelings and unvoiced thoughts often arise as individuals remember unpleasant incidents in the past. Within gestalt reminiscence therapy, a supportive environment is created which allows participants to experience feelings associated with such events and come to terms with them.

Participants in gestalt reminiscence therapy increase their awareness, become more responsible for themselves and free themselves from shelved issues. Awareness is focused on the `here and now' and may involve either a current, recent or more distant event. Increased responsibility for themselves allows older adults to have a greater sense of empowerment, even within a nursing home setting. Group members are enabled to live more fully in the present by coming to terms with unfinished business. Emotions accompanying a particular story can be identified, expressed and completed.

Memories can be triggered in social interaction: being asked about memories will spark off memories (Sacks, 1995). However, memories can also be `objectified'. Particular articles can trigger memories because of their associations--when and where they were acquired or from whom they were received. Fairhurst (1997) stated that these type of objects are not just material things, they `are memories' (Fairhurst, 1997, p. 69). Memories can be embodied in places as well as possessions especially if the people associated with them are deceased.

Butler (1963) saw memories as a potential fount of mastery, wisdom and gratification. Reminiscing, therefore, has a therapeutic potential that goes beyond its social function. Recounting memories can be a way to approach talking about and appraising one's own life. Watt and Wong (1991) outlined a taxonomy of reminiscence as a first step in developing the therapeutic use of memories. They identified six different types: integrative, instrumental, transmissive, narrative, escapist and obsessive. The function of integrative reminiscence is to attain meaning and reconciliation with regard to one's past. It may involve working through feelings of guilt, failure and depression. Instrumental reminiscence acts as a buffer against emotional distress, as the person recalls past efforts in coping with difficult situations, sometimes in order to help solve a present difficulty. Watt (1986) found that this type of reminiscing is associated with `successful ageing' (cited in Watt and Wong, 1991). An instructive aspect identifies transmissive reminiscing: the speaker can `hand on' some enduring values acquired when growing up in a different era. These reminiscences, therefore, always concern `a moral'. They differ from purely narrative reminiscences, which are restricted to `descriptive or factual accounts of the past for the purpose of providing biographical information' (Watt and Wong, 1991, p. 49).

The two forms of memory-sharing which are not as adaptive in a coping sense are escapist and obsessive. The former has a fantasy/daydreaming quality, which can be viewed as beneficial by the speaker. Since the accent is on the `good old days', it allows an escape from a possibly much more gloomy present. The relief experienced is usually only temporary however. Obsessive reminiscing shows the preoccupation with disturbing past events and the speaker may be haunted by feelings of `guilt, resentment and despair' (Watt and Wong, 1991, p. 51). This type of reminiscence would be viewed as a marker of `unfinished business' in gestalt reminiscence therapy. Watt and Wong (1991) coded their subjects' recollections according to 11 themes: childhood memories; dating and marriage; domestic life; children and grandchildren; significant others (including relatives and friends); education and career (including personal accomplishments); societal events; health; relocation; death; and existential beliefs (including religious or philosophical beliefs regarding life and death).

Memories are the raw material of gestalt reminiscence therapy. Memories emerge through a number of different avenues, such as linking to objects and people, locations, past achievements, historical events, private events and public occasions, sensitive issues, a particular word, past and recent events. Recounting them can have a number of different functions from a social and therapeutic point of view. Memories can link people's experiences, giving group members a common ground and providing important interpersonal contact. The feeling of `shared experience' this type of reminiscing provides may then develop into subsequent interpersonal bonding. The group process is also facilitated through the linking of themes between group members. Memories can also serve to boost either the self-esteem of the speaker or another group participant by concentrating on past achievements. They can furthermore help to identify unfinished business, which may need to be worked on within the group setting or in one-to-one therapy. From a social-historical point of view, the act of relating memories can give the teller a sense of `empowerment' as a personal expert on the times they lived in.
- O'Leary, Eleanor; Nieuwstraten, Inge M.; The exploration of memories in Gestalt reminiscence therapy; Counselling Psychology Quarterly, Jun2001, Vol. 14 Issue 2
The article above contains foundational information. Articles below contain optional updates.


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Personal Reflection Exercise #3
The preceding section contained information about implementing Gestalt reminiscence therapy with older adults.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 17
What are four benefits to using Gestalt reminiscence therapy with older adults? Record the letter of the correct answer the CEU Answer Booklet.

 
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Latina/o adolescents’ family undocumented-status disclosures directed at school counselors: A latent transition analysis. - April 19, 2018
For adolescents from undocumented families, school counselors may serve as a resource to draw upon for support should the adolescents decide to disclose their family status. In this study, we identified psychological factors that were associated with adolescents’ decisions to disclose (or not) their own or a family member’s undocumented status to a counselor and examined corresponding mental health implications. Utilizing latent transition analyses with a sample of 410 Latina/o immigrant high school students, four profiles emerged in Wave 1: (1) indifferent nondisclosers, (2) concerned revealers, (3) anxious revealers, and (4) secure revealers. By Wave 2, we identified the same profiles, except anxious revealers were no longer present, and anxious nondisclosers emerged as a new profile. At Wave 3, we only identified three profiles: (1) indifferent nondisclosers (2), concerned revealers, and (3) anxious revealers. As Latina/o immigrant students experienced greater fear of deportation in the middle and end of the year, they were more likely to be concerned revealers (i.e., reporting moderate perceived risk of disclosing, low communication efficacy, and moderate levels of disclosure) compared with most profiles. Anxious revealers reported higher levels of depressive symptoms than several other profiles in the beginning of the year, and concerned revealers reported higher levels of depressive symptoms than several other profiles in the middle and end of the year. This study emphasizes the importance of considering the diverse experiences of family undocumented adolescents, and it sheds light on the extent to which family undocumented adolescents confide in a counselor. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
An examination of the Psychology of Working Theory with racially and ethnically diverse employed adults. - April 19, 2018
The present study tested key tenets of the Psychology of Working Theory (PWT) in a sample of 526 racially and ethnically diverse employed adults. The authors investigated how economic resources and marginalization predicted decent work through experiences of work volition and career adaptability. Support for the hypotheses was mixed. There was a direct, negative relation between marginalization and decent work; a direct, positive relation between economic resources and work volition; and a direct, negative relation between marginalization and work volition. There was a positive relation between work volition and career adaptability as well as with decent work. Work volition was also found to significantly mediate the relations between marginalization and economic resources to decent work. These results suggest that the primary reason why greater economic resources and lower experiences of marginalization predict engaging in decent work is attributable to an increased sense of choice in one’s career decision making. Results suggest the need for further investigation using the PWT to understand how racially and ethnically diverse employed adults secure decent work. Practical implications are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Testing the predictions of the existential constructivist theory of suicide in a college student sample. - April 19, 2018
There is a lack of empirically supported theories explaining suicidal ideation and few theories describe how suicidal ideation can be prevented in the context of normative human development. Rogers (2001) proposed an existential constructivist theory of suicide (ECTS) wherein existential distress and the inability to reconstruct meaning from adverse life events contribute to suicidal ideation. The ECTS includes a distinct focus on meaning reconstruction from adverse life events, which is congruent with existing research on college students and developmental frameworks used by counseling psychologists. Thus, in the present study, we tested the predictions of the ECTS in a college student sample. We collected data online from 195 college students (i.e., ages 18–25) attending a large, Midwestern university and analyzed the data using structural equation modeling. Findings provided partial support for the original ECTS. Post hoc analyses of an alternate ECTS model indicated that existential distress mediated the negative association between meaning reconstruction and suicidal ideation. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Transgender people of color’s experiences of sexual objectification: Locating sexual objectification within a matrix of domination. - April 19, 2018
The purpose of this grounded theory study was to investigate transgender people of color’s (TPOC’s) sexual objectification experiences (SOEs). Fifteen TPOC were interviewed about their experiences with sexual objectification. Using intersectionality and objectification theories as our research paradigms, results suggested that participants’ SOEs were shaped by the intersections of cissexism, sexism, and racism, and that participants experienced various levels of privilege and oppression based on their specific identities. Results revealed similarities with previous sexual objectification research as well as unique sexual objectification experiences for TPOC, including racialized sexual objectification, fetishization, genital- and gender transition-based comments, and body policing. Results also suggested that self-objectification may manifest as a desire to affirm one’s gender identity and result in physical safety anxiety. TPOC may engage in body surveillance to achieve transgender congruence and reduce potential victimization experiences. Mental health practitioners are encouraged to attend to how intersections of cissexism, sexism, and racism may encourage SOEs, and the ways in which such experiences may impact TPOC. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Predicting PTSD severity from experiences of trauma and heterosexism in lesbian and bisexual women: A longitudinal study of cognitive mediators. - April 19, 2018
Sexual minority women (SMW) are at high risk of trauma exposure and, subsequently, the development of posttraumatic stress disorder (PTSD). The authors extended a theoretical model explaining the higher risk of mental disorders in minority populations to the maintenance and exacerbation of PTSD symptoms among young adult SMW specifically. This study used observational longitudinal data from a sample of 348 trauma-exposed 18- to 25-year-old individuals assigned female sex at birth who identified as either bisexual (60.1%) or lesbian (39.9%) and met screening criteria for PTSD. Participants identified as White (82.8%), Hispanic/Latina (12.4%), American Indian/Alaska Native (13.5%), Black/African American (13.8%), and/or Asian/Asian American (4.9%). The authors investigated whether distal stressors (i.e., criterion A traumatic events, daily experiences of heterosexism) produced proximal stressors (i.e., trauma-related cognitions, internalized heterosexism) that maintained or exacerbated PTSD symptoms. Findings indicated that daily heterosexism longitudinally predicted trauma-related cognitions (i.e., cognitions related to the self, world, and self-blame). Internalized heterosexism and cognitions about the self longitudinally predicted PTSD symptom severity. In addition, a significant indirect effect was identified between daily heterosexism and PTSD symptoms via self-related posttraumatic cognitions. These findings suggest that exposure to minority-specific distal stressors appears to promote nonminority-specific cognitive processes that, in turn, may maintain or exacerbate PTSD among young adult SMW exposed to trauma. Clinicians should consider addressing daily heterosexism in young adult SMW presenting with PTSD and evaluate how these experiences might promote clients’ global, negative views regarding themselves. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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