Abstract
The authors begin by positioning themselves firmly in the positive dementia care camp, putting the person before the dementia, and operating groups which are inclusive and respectful, emphasising remaining strengths, promoting engagement and facilitating communication. They clearly have an understanding of the value of reminiscence and cite the usual sources to indicate how it is a natural part of the ageing process (Butler, 1963) and a ‘positive activity with educational, recreational, social and therapeutic benefits’ (Gibson, 1998). They also attempt to explain their concept of spirituality as addressing the core or ultimate meaning of life, covering relationships, creation/environment, religion, and the Arts. This definition of spirituality, even with accompanying diagrams, is far from clear and appears to accommodate almost every kind of reflection whether as retrospective or as experienced in the present. My understanding is that they see the four aspects of spirituality as different routes to spiritual experience and addressing the big questions in life concerning hope, fear, sorrow, religious faith and the meaning of human existence.
The learning guide goes on to explain how the authors run sessions for small groups of people with dementia in residential care facilities. There are six sessions which are repeated up to four times with the same group over a 24-week period. Each session addresses a particular issue. Examples are life meaning; relationships; hopes, fears and worries; growing older and transcendence; spiritual and religious beliefs; spiritual and religious practices. It is helpful that the contributions of the facilitator and responses of participants are included in their own words, which gives us a chance to share in the flavour of the sessions. Although the participants are clearly expressing frustration at no longer being able to use words effectively to say what they mean, it seems that only words are used to explore the big questions. However sympathetic the facilitators are (and we can see that they are from the session transcripts), there are many instances of participants feeling out of control of what they seek to convey. When there are so many other creative ways to explore meaning and share feelings, this seems a major limitation and omission.
The title of the book is really quite misleading, as there is very little recognisable reminiscence activity discernable and the emphasis is much more on discussion of feelings, beliefs, hopes and fears. Reminiscence, as widely practiced and sensitively adapted for people with dementia, is a means for participants to engage with their own past and reconnect with their own life stories through a wide range of creative approaches (Schweitzer & Bruce, 2008). In projects which use this approach, reminiscence is about celebrating people’s lives and stories; giving people the chance to express themselves in different ways; fostering self-expression by doing small group and one-to-one work as well as larger group discussion and activity; accepting enthusiastically whatever stories the participants want to tell, not worrying too much whether they are off topic or not. The overall aims of MacKinlay and Trevitt’s work and reminiscence work may be similar, but the methodologies are extremely different and the perception of the ‘content’ of each session is not at all comparable. Nonetheless, there is clearly a place for exploration of feelings, beliefs, hopes and fears, and the detail supplied on this area is helpful and may well meet a need for those seeking to raise the ‘big issues’ with their clients. However, I am not convinced that a discussion-based approach to rather abstract topics is the most appropriate starting point for people who may well feel anxious about successfully conveying their own ‘meaning’.
Many of us explore the big questions which MacKinlay and Trevitt seek to address in ways which are not exclusively verbal. In my experience of reminiscence work, providing non-verbal channels of expression enables participants with dementia to succeed in conveying what matters to them, and feel heard and acknowledged without needing to put everything into words. In a secure environment, with scope for small group or one-to-one time as well as whole group activities, there can be a rich mix of emotional recall, sharing of experience, self-revelation and reflection even when the memories and experiences evoked have been painful or challenging. MacKinlay and Trevitt have shown that many people with dementia want to engage with the big questions and have provided a useful framework for starting to explore them. However, I believe that their approach would be greatly strengthened by including creative reminiscence activities designed to elicit participants’ memories of other aspects of their lives, as well as the spiritual dimension, and by making more use of non-verbal channels of communication.