Finding Meaning in Later Life Janet Anderson Yang, Ph.D. Krista McGlynn, Breanna Wilhelmi, Heritage Clinic, a division of the Center for Aging Resources [email protected] 1 Helping Clients develop Meaning • Meaningful roles in family & the community • Meaningful activities in the community and/or individually at home • Meaning as an attitude • Meaning & Hope intertwined 2 Later life’s losses can make it harder to find meaning: • Can make it harder (physically & mentally) to follow past meaningful pursuits • Can make it harder to develop new meaningful activities/roles • Can make it harder to find hope 3 Existential Meaning in the face of loss How can we help older clients build meaning and hope when faced with loss or decline? 4 Existential Meaning in the face of loss How can we help clients improve their mental health and quality of life through development of altered perspectives, existential meaning, wisdom, integrity, spirituality? 5 Viktor Frankl (1980) stated that there are 3 avenues to meaning 6 Existential Meaning • Victor Frankl (1980) stated that there are 3 avenues to meaning: – Creating a work or doing a deed; – Experiencing something or encountering someone; – Attitudes: “Even if we are helpless victims of a hopeless situation, facing a fate that cannot be changed, we may rise above ourselves, grow beyond ourselves and by so doing change ourselves.” 7 Existential Meaning in the face of loss Developing meaning is one approach which may help. 8 Meaning • Robert Neimeyer counsels helping bereaved clients develop and internalize sense of attachment security with newly constructed meaning. • Martin Horrowitz recommends following trauma, helping clients create new meaning in a world which allows/permits such trauma to occur. 9 • What types of meaning might older adults find? 10 Types of meaning • Facing & accepting death • Self discovery/Life • Creative expression Review • Appreciating beauty • Forgiving self & others • Honoring and sharing • Self transcendence wisdom, experience • Mindfulness, “Being” • Community • Contemplation • Enhanced relationships • Connecting with nature • Altruism, Charity • Spirituality / Religion • Guiding younger generations • Grappling with the finitude of life • Creating a legacy 11 Self Discovery Forgiving Self & others Erik Erikson 12 Stage (age) Psychosocial crisis I (0-1) -- trust vs mistrust infant II (2-3) -- autonomy vs shame and doubt toddler III (3-6) -- initiative vs guilt preschooler IV (7-12 or so) -- industry vs inferiority school-age child V (12-18 or so) -- ego-identity vs role-confusion adolescence VI (the 20’s) -- intimacy vs isolation young adult VII (late 20’s to 50’s) -- middle adult generativity vs self-absorption VIII (50’s and beyond) -- old adult integrity vs despair 13 Self Discovery Forgiving Self & others • Erikson: the 8th stage, conflict between integrity and despair; the approach of death stimulates review of life to prepare for death. 14 Erikson’s Eighth Stage • The primary task in old age is to come to an: “acceptance of one’s one and only life cycle as something that had to be and that, by necessity, permitted of no substitutions.” 15 16 Erikson’s Eighth Stage This involves: a consolidation of one’s understanding of the life one has lived, to be achieved through the struggle between integrity and despair, including “mourning for: – time forfeited and space depleted, – autonomy weakened, – Initiative lost, – generativity neglected, – identity potentials bypassed, – too limiting identity lived.” • E. Erikson: The Life Cycle Completed, 17 p.63. Life Review • Robert Butler suggested that later life is a time for people to review their lives, allowing a return to consciousness of past experiences, especially unresolved conflicts; this can bring serenity and wisdom: “Life Review.” • The goal of life review is to expiate guilt, resolve internal conflicts, reconcile relationships, and renew one’s ideals. 18 James Birren • The purpose of life review is to develop an acceptable image and leave behind an acceptable legacy. • Awareness of coming of death can stimulate a person to review one’s life to integrate the actuality of his/her life with what might have been and to reorganize attitudes towards one’s life 19 Life Review &/or Reminiscence Therapy • Structured activity to access and process thoughts about past experiences; • Done individually or in groups • May include writing assignments • Integrative reminiscence refers to reappraisal of losses, shortcomings and difficulties, reviewing values, and personal meaning • Instrumental reminiscence refers to recall of problem solving and positive adaptation, and reactivating positive self concept 20 Life Review Techniques • Time Line – Mark years and ages of the person – Ask person to recall important personal events, e.g., educational events, family events, work, accomplishments, loves, losses, hopes, regrets, pleasures – Use important world events as markers – Use aids to evoke memories (Photos, picture books, letters, diaries, scrap books, mementos, music, foods, smells, textures) 21 Life Review Techniques • Trace client’s experience based on a theme – E.g., pets, money, education, religion, family, love relationships, places of residence • Encourage client to take a pilgrimage to an old home, neighborhood, workplace, reunion • Family Life Review • Family Tree • Write an autobiography 22 Finishing Unfinished Business • Family relationships • Terry Hargrave & William Anderson: Finishing Well: Aging and Reparation in the Intergenerational Family 23 Transcendence • Transcendence: Within aging there may be an increased emphasis on internal processes or inner experiences facilitating expanding consciousness. Older adults may have more time to meditate, contemplate & reflect (Newman, 1987). Life satisfaction may increase as person shifts towards increased focus on the cosmic world versus the material world (Tornstam, 1994). 24 Transcendence: • The ability to move beyond the immediate circumstances (Brennan, 2009). • Connection beyond the self; Transcending the gulf between people or between the person and the universe, or between the person and the creator of the universe (McFaddon, 2009). 25 Transcendence • Lars Tornstam: Gerotranscendence is “cosmic communion with the spirit of the universe” • Ram Dass: “aging provides the greatest opportunity to develop inner wisdom, compassion, spiritual insight and balance.” – Perceiving illness as a blessing rather than a misfortune. – “heavy grace:” “the stroke was unbearable to the Ego, and so it pushed me into the Soul level also…and that’s grace.” 26 Contemplation/Meditation • Mindfulness practices – E.g, Acceptance and Commitment Therapy (ACT) Hayes, S & Strosahl, K. – Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behavior Research and Therapy, 44(1), 1-25 27 Mindfulness • Concentrating your awareness on moment to moment experience with a nonjudgmental attitude of acceptance. • Example 28 “An 86 year old woman once recounted to me how severe arthritis brought her kicking and screaming into the domain of her own soul: ‘One morning, I was sitting at my kitchen table, staring into space. It was one of those windy days when the sun keeps coming out and going in. All of a sudden, a sunbeam crossed my kitchen table and lit up my crystal salt shaker. There were all kinds of colors and sparkles. It was one of the most beautiful sights I’d ever seen. But you know, that very same salt 29 shaker had been on the kitchen table for over fifty years. Surely there must have been other mornings when the sun crossed the table like that, but I was just too busy getting things done. I wondered how much else I’d missed. This was it, this was grace. I needed crippled hands before I could sit still. Sometimes you have to be stopped right there in your tracks before you can see that all the beauty in life is right in front of you.’” 30 Connecting with nature • Looking at the night sky • Listening to the birds • Looking at the clouds • Gardening • Caring for a plant • Watching birds 31 Spirituality • Spirituality: Includes a set of beliefs which may include love, compassion, respect for life, existence, relationships with ourselves, others, the universe, the sacred; extends beyond the physical & material to a state called transcendence. • Religion: the practical expression of spirituality; the organization, ritual, practice of one’s beliefs. 32 Spirituality • When is it appropriate for mental health professionals to initiate conversation about spirituality and/or religion? • When and how? • Necessity of not proselytizing 33 Spirituality Consider: • Assessing religious and spiritual coping on Initial Assessment. • Assessing childhood and younger adult history of client’s thoughts, feelings, experiences of God, religion, spirituality. • Encouraging previous positive spiritual / religious coping; gaining new spiritual or religious experiences, as desired by the client. • Exploring & diffusing negative experiences with spirituality / religion. 34 Joint Commissions on Accreditation of Healthcare Organizations (JCAHO) 1. I was wondering if spirituality or religion is important to you? 2. Are there certain spiritual beliefs and practices that you find particularly helpful in dealing with problems? 3. I was also wondering if you attend a church or some other type of spiritual community? 4. Are there any spiritual needs or concerns I can help you with? 35 Los Angeles County Department of Mental Health guidelines • 4.15