Abstract
Memory loss and dementia can be devastating for both caregivers and care recipients. Narrative therapeutic approaches offer promise, as well as challenges, for social interventions with couples where one partner has dementia. The Couples Life Story Approach is a recently-developed method by which practitioners work with such couples to help them narrate the story of their life together. This narrative approach is augmented by mementoes (e.g., photos, cards) that are collected by the couple during the intervention. Significant memories are elicited from both partners and developed into a Life Story Book. Drawing on data from this clinical research intervention with 20 older couples, we ask: What are some of the challenges of conducting narrative-based therapeutic interventions with older couples with memory loss? Clinical themes were identified utilizing a multiple case study approach during weekly team meetings. Six of the most prominent themes are presented here. Specifically, how to: (1) construct a narrative from disparate stories, (2) tell a mutual story, (3) tell the story of a couple that has been in a shorter relationship, (4) incorporate others in the story, (5) include difficult life moments, and, (6) end the story. Within each theme, we utilize case examples to illuminate relevant issues and describe strategies that were developed to resolve these clinical challenges. Implications for practitioners and clinical researchers who are engaged in dyadic interventions are discussed.
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References
Allen, R. (2009). The legacy project intervention to enhance meaningful family interactions: Case examples. Clinical Gerontologist, 32, 164–176.
Allen, R., Hilgeman, M., Ege, M., Shuster, J., & Burgio, L. (2008). Legacy activities as interventions approaching the end of life. Journal of Palliative Medicine, 11(7), 1029–1038.
Basting, A. D. (2003). Looking back from loss: Views of the self in Alzheimer’s disease. Journal of Aging Studies, 17, 87–99.
Beard, R. L. (2004). In their voices: Identity preservation and experiences of Alzheimer’s disease. Journal of Aging Studies, 18, 415–428.
Budson, A. E., & Solomon, P. R. (2011). Memory loss: A practical guide for clinicians. Philadelphia, PA: Elsevier Inc.
Caldwell, R. (2005). At the confluence of memory and meaning—Life review with older adults and families: using narrative therapy and the expressive arts to re-member and re-author stories of resilience. The Family Journal, 13, 172–175.
Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4), 485–503.
Clark, P. (2001). Narrative gerontology in clinical practice: Current applications and future prospects. In G. M. Kenyon, P. G. Clark, & B. DeVries (Eds.), Narrative gerontology: Theory research and practice (pp. 193–214). New York: Springer publishing company Inc.
Cohen-Mansfield, J., Golander, H., & Arnheim, G. (2000). Self identity in older persons suffering from dementia: Preliminary results. Social Science and Medicine, 51, 381–394.
Creswell, J. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, CA: SAGE.
Davies, J. C. (2011). Preserving the “us identity” through marriage commitment while living with early-stage dementia. Dementia, 10(2), 217–234.
England, P. (2005). Emerging theories of care work. Annual Review of Sociology, 31, 381–390.
Epstein, C., Auclair, U., & Mittelman, M. (2006). Couples counseling in Alzheimer’s Disease: First observations of a novel intervention study. Clinical Gerontologist, 30(2), 21–35. doi:10.1300/J018v30n02_03.
Folstein, M., Folstein, S., & McHugh, P. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.
Gentry, R., & Fisher, J. (2007). Facilitating conversation in elderly persons with Alzheimer’s disease. Clinical Gerontologist, 31(2), 77–98.
Haight, B. K., Bachman, D. L., Hendrix, S., Wagner, M. T., Meeks, A., & Johnson, J. (2003). Life review: Treating the dyadic family unit with dementia. Clinical Psychology and Psychotherapy, 10, 165–174.
Hasselkus, B. R., & Murray, B. J. (2007). Everyday occupation, well-being, and identity: The experience of caregivers in families with dementia. American Journal of Occupational Therapy, 61, 9–20.
Hepburn, K. W., Tornatore, J., Center, B., & Ostwald, S. W. (2001). Dementia family caregiver training: Affecting beliefs about caregiving and caregiver outcomes. Journal of the American Geriatrics Society, 49, 450–457.
Hinton, W., & Levkoff, S. (1999). Constructing Alzheimer’s: Narratives of lost identities, confusion and loneliness in old age. Culture, Medicine and Psychiatry, 23(4), 453–475.
Ingersoll-Dayton, B., Spencer, B., Kwak, M., Scherrer, K. S., Allen, R.A., & Campbell, R. The Couples Life Story Approach: A dyadic intervention for dementia. Journal of Gerontological Social Work. (in press).
Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. New York: National Academies Press.
Judge, K. S., Yarry, S. J., Looman, W. J., & Bass, D. M. (2012). Improved strain and psychosocial outcomes for caregivers of individuals with dementia: Findings from project ANSWERS. The Gerontologist,. doi:10.1093/geronto/gns076.
Judge, K. S., Yarry, S. J., & Orsulic-Jeras, S. (2009). Acceptability and feasibility results of a strength-based skills training program for dementia caregiving dyads. The Gerontologist, 3, 408–417.
Kaplan, L. (2001). A couplehood typology for spouses of institutionalized persons with Alzheimer’s disease: Perceptions of “We”-“I”. Family Relations, 50, 87–98.
Kasl-Godley, J., & Gatz, M. (2000). Psychosocial interventions for individuals with dementia: An integration of theory, therapy and a clinical understanding of dementia. Clinical Psychology Review, 20, 755–782.
Kenyon, G., & Randall, W. (1999). Introduction: Special issue on narrative gerontology. Journal of Aging Studies, 13(1), 1–5.
Kuhn, D. (1999). Alzheimer’s early stages: First steps in caring and treatment. Alameda, CA: Hunter House, Inc.
Lawson, D. M., & Prevatt, F. F. (1999). Casebook in family therapy. Belmont, CA: Wadsworth Publishing Co.
Lewis, M. M., & Trzinski, A. L. (2006). Counseling, dementia, and death: Innovative suggestions for practitioners. Death Studies, 30, 777–787.
MacRae, H. (2010). Managing identity while living with Alzheimer’s disease. Qualitative Health Research, 20, 293–305.
McGovern, J. (2011). Couple meaning-making and dementia: Challenges to the deficit model. Journal of Gerontological Social Work, 54(7), 678–690.
Mittelman, M., Epstein, C., & Pierzchala, A. (2003). Counseling the Alzheimer’s caregiver: A resource for health care professionals. Chicago, IL: AMA Press.
Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., Ambinder, A., Mackell, J. A., et al. (1995). A comprehensive support program: Effect on depression in spouse-caregivers of AD patients. The Gerontologist, 35, 792–802.
Molyneaux, V., Butchard, S., Simpson, J., & Murray, C. (2011). The co-construction of couplehood in dementia. Dementia, 0, 1–20.
Padgett, D. (2008). Qualitative methods in social work research (2nd ed.). Thousand Oaks, CA: SAGE.
Plassman, B. L., Langa, K., Fisher, G., Heeringa, S., Weir, D., Ofstedal, M., et al. (2007). Prevalence of dementia in the United States: The aging, demographics, and memory study. Neuroepidemiology, 29, 125–132.
Rankin, E. D., Haut, M. W., & Keefover, R. W. (2001). Current marital functioning as a mediating factor in depression among spouse caregivers in dementia. Clinical Gerontologist, 23, 27–44.
Ryan, E., Bannister, K., & Anas, A. (2009). The dementia narrative: Writing to reclaim social identity. Journal of Aging Studies, 23, 145–157.
Stake, R. (2006). Multiple case study analysis. New York: Guillford Press.
White, M., & Epson, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton and Company.
Whitlatch, C., Judge, K., Zarit, S., & Femia, E. (2006). Dyadic intervention for family caregivers and care recipients in early-stage dementia. The Gerontologist, 46(5), 688–694.
Young, E. (2010). Narrative therapy and elders with memory loss. Clinical Social Work Journal, 38, 193–202.
Zarit, S. H., Femia, E. E., Watson, J., Rice-Oeschger, L., & Kakos, B. (2004). Memory club: A group intervention for people with early-stage dementia and their care partners. The Gerontologist, 44(2), 262–269.
Acknowledgments
The authors would like to express their appreciation to Becky Allen, Ruth Campbell, Barbara Haight and Yukiko Kurokowa for their assistance with intervention development, Louis Burgio and Joe Himle for their consultation on translational research methods, and to Minyoung Kwak and the other graduate students involved on the research team. We would also like to thank the Michigan Institute for Clinical and Health Research (UL1RR024986), NIA Training Grant AG0017, and the University of Michigan School of Social Work for their financial support. In addition, we appreciate the University of Michigan Alzheimer’s Disease Center, the Alzheimer’s Association (Great Lakes Michigan Chapter, Greater Michigan Chapter, and Northwest Ohio Chapter), and the University of Michigan Geriatrics Center Clinics for their assistance with recruitment.
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Scherrer, K.S., Ingersoll-Dayton, B. & Spencer, B. Constructing Couples’ Stories: Narrative Practice Insights from a Dyadic Dementia Intervention. Clin Soc Work J 42, 90–100 (2014). https://doi.org/10.1007/s10615-013-0440-7
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DOI: https://doi.org/10.1007/s10615-013-0440-7