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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.

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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Table of Contents

Being in-between: A model of cultural identity negotiation for emerging adult immigrants. - March 15, 2018
This qualitative study explored the cultural identity negotiation of young adult immigrants. Using a grounded theory research design, 10 semistructured interviews were conducted with emerging adult immigrants (EAI), ages 19–27. Results yielded a substantive model of cultural identity negotiation (MCIN) for EAI and posited that One’s Motivation and Sense of Agency to Negotiate Cultural Identity is at the core of how participants navigate their cultural identities. This model included 6 major categories: (a) Family Cultural Rigidity; (b) Connections Specific to Canada; (c) Connection to a Same Cultured Community; (d) Sense of Permanency; (e) Desire to Preserve Culture of Origin; (f) Desire to Fit in to Canadian Culture, as well as 2 overarching factors (Dimension of Time and Dimension of Age), which were found to be influential on participants’ cultural identity negotiation. The model also included the identification of 4 approaches to cultural identity negotiation: (a) Blended; (b) Dual; (c) Disconnected; and (d) Intermediate. The MCIN for EAI is discussed in terms of the current literature on cultural identity formation as well as implications for counseling psychology training and practice. Recommendations for further research are also suggested. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Helping others increases meaningful work: Evidence from three experiments. - May 11, 2017
The aim of the current research was to examine whether manipulating task significance increased the meaningfulness of work among students (Study 1), an online sample of working adults (Study 2), and public university employees (Study 3). In Study 1, students completed a typing task for the benefit of themselves, a charity, or someone they knew would directly benefit from their work. People who worked to benefit someone else, rather than themselves, reported greater task meaningfulness. In Study 2, a representative, online sample of employees reflected on a time when they worked to benefit themselves or someone else at work. Results revealed that people who reflected on working to benefit someone else, rather than themselves, reported greater work meaningfulness. In Study 3, public university employees participated in a community intervention by working as they normally would, finding new ways to help people each day, or finding several new ways to help others on a single day. People who helped others many times in a single day experienced greater gains in work meaningfulness over time. Across 3 experimental studies, we found that people who perceived their work as helping others experienced more meaningfulness in their work. This highlights the potential mechanisms practitioners, employers, and other parties can use to increase the meaningfulness of work, which has implications for workers’ well-being and productivity. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Change in post-traumatic cognitions mediates treatment effects for traumatized youth—A randomized controlled trial. - March 15, 2018
Posttraumatic stress symptoms (PTSS) are associated with serious impairments in psychological, social, and academic functioning in youth. The aim of this study was to investigate whether changes in posttraumatic cognitions mediate treatment effects. Participants were multitraumatized youth (N = 156, mean age = 15.1 years, range = 10–18; 79.5% girls) randomly assigned to receive trauma-focused cognitive–behavioral therapy (TF-CBT) or treatment-as-usual (TAU). Mixed-effects models were applied to investigate the impact of treatment conditions on posttraumatic cognitions. Mediation analyses were applied to examine whether changes in posttraumatic cognitions mediated the relationship between treatment conditions and outcome in posttraumatic stress symptoms, depressive symptoms, and general mental health. Participants receiving TF-CBT reported significantly lower levels of negative posttraumatic cognitions at the end of treatment compared to participants in TAU. Change in posttraumatic cognitions mediated the treatment effect difference found for PTSS. When the overall change in cognition was divided into early and late changes, it was only the late change that significantly mediated the PTSS treatment effect. A mediation effect of posttraumatic cognitions was also found for the treatment effect difference in depressive symptoms and in general mental health symptoms. Traumatized youth report having many negative posttraumatic cognitions and changes in negative cognitions plays a key role for treatment outcome. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Discrimination, work outcomes, and mental health among women of color: The protective role of womanist attitudes. - March 15, 2018
With a sample of employed women of color (N = 276), we tested the associations of sexist and racist discrimination with poor work outcomes (job-related burnout and turnover intentions) and mental health outcomes (i.e., psychological distress). Drawing from the Theory of Work Adjustment, Organizational Support Theory, and scholarship on discrimination, we tested perceived person-organization (P-O) fit, perceived organizational support, and self-esteem as mediators of the associations of workplace discrimination with the outcomes. Based on intersectionality scholarship, womanist attitudes were tested as a moderator. Participants provided cross-sectional data via an online survey. Latent variable structural equation modeling results indicated that a second-order latent workplace discrimination variable yielded better fit to the data than modeling sexist and racist discrimination separately. Workplace discrimination was directly and indirectly (via the mediating role of self-esteem) associated with higher psychological distress. Furthermore, workplace discrimination was indirectly associated with poor work outcomes through the mediating roles of perceived P-O fit, perceived organizational support, and self-esteem. Last, moderation analyses indicated that higher womanist attitudes weakened the direct association of workplace discrimination with psychological distress. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Associations among psychological distress, high-risk activism, and conflict between ethnic-racial and sexual minority identities in lesbian, gay, bisexual racial/ethnic minority adults. - July 06, 2017
In this brief report, we present results from a study exploring the associations of high-risk activism (HRA) orientation in lesbian, gay, and bisexual (LGB) issues; HRA orientation in racial/ethnic issues; conflicts in allegiances (CIA) between one’s ethnic-racial and sexual minority identities; and anxiety among LGB racial/ethnic minority adults. A racially and ethnically diverse sample of 208 LGB racial/ethnic minority adults (age: M = 27.52, SD = 8.76) completed an online survey. Bivariate correlations showed that HRA orientation in LGB and in racial/ethnic issues, as well as CIA, were each positively associated with anxiety. However, regression analyses indicated that CIA moderated the association between anxiety and HRA orientation in LGB issues (but not racial/ethnic minority issues) such that this association was significant and positive at low levels of CIA and nonsignificant at high levels of CIA. These findings can be used to not only inform psychological practice with this population (e.g., by encouraging practitioners to be more attentive to these issues as potential sources of stress), but also more broadly, as knowledge that can inform the burgeoning psychological literature on collective action. We highlight, for example, the importance of distinguishing between types of activism (i.e., high- vs. low-risk types) in relation to mental health outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

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