Life Review Therapy: Process and Benefits
THC Editorial Team November 22, 2021
- What Is Life Review Therapy?
- The Background of Life Review Therapy
- How Does Life Review Therapy Work?
- When Is Life Review Therapy Recommended?
- Potential Benefits of Life Review Therapy
- Further Considerations
- Summary/Key Takeaways
Older adults may often look back on their lives and wonder if they had any meaning or purpose. This is also true for people with terminal illnesses. Counseling is often recommended for individuals facing these issues, especially if these memories and thoughts lead to excessive negative feelings or forms of depression. One beneficial type of therapy that has shown effectiveness in treating these populations is life review therapy.
What Is Life Review Therapy?
In life review therapy, clients are encouraged to look back through their lives to remember past events—in essence, to tell their life stories. Counselors may suggest that clients focus on recalling certain life themes or time periods during each session so that they can better focus on a smaller range of related memories to explore more in depth. This process is known to evoke free association, which may dislodge memories buried in the subconscious. This may cause unresolved thoughts and/or emotions to resurface that carry associated pain or discomfort, but it also connotes a sense of “putting one’s life in order.”1
While older people are sometimes considered psychologically frail, they are, in fact, “master survivors” when compared to younger people. Therefore, they are able to confront guilt, find meaning, and reconcile their lives through life review therapy.1
This type of therapy uses reminiscence to resolve, reorganize, and reintegrate whatever is troubling or preoccupying the client.1
Life Review Therapy and Reminiscence Therapy
Life review therapy overlaps considerably with an approach called reminiscence therapy, and some scholars even use the terms interchangeably. Others, however, see them as distinct methods, believing that (1) life review therapy requires specialized training for the more in-depth processes involved, whereas reminiscence therapy involves simple memory disclosure;2 and (2) life review therapy focuses more on the meaning that can be found in reminiscences and the feelings they evoke than reminiscence therapy does.
The Background of Life Review Therapy
In 1963, Dr. Robert Butler wrote a paper regarding life review as a natural and necessary part of aging.3 Before this, there had been little psychotherapeutic theory regarding the developmental stages people encounter late in life. Older people were known to reminisce and were sometimes dismissed as living in the past, growing weaker in cognitive faculties, expressing loneliness, or holding firmly to a sense of identity. Butler posited that this tendency toward reminiscence has a positive psychotherapeutic function.1 He believed that for people to come to terms with their existence and impending demise, they would consciously or unconsciously think back on their lives.
Though Butler acknowledged that life review is not exclusive to older adults, he claimed it takes on a different intensity in the older population as they face their mortality.1 Butler believed that by providing therapeutic assistance during these recollections, older people would be able to resolve past conflicts and gain some meaning from their lives, allowing them to live their remaining days more at peace.
Life review therapy draws from renowned developmental psychologist Erik Erikson’s life-stage developmental theory.4 In the 1950s, Erikson theorized that all people go through eight stages of psychosocial development throughout their lifetimes, and within each of these stages, individuals experience opposition between a positive and a negative psychological tendency, allowing for either growth or maladjustment. During the eighth and final stage, individuals must deal with ego integrity versus despair. This means that people will either look back on their life accomplishments as a testimonial to their wisdom or live their final days with regret or other negative emotions.4
Joan Erikson, wife of Erik Erikson, added a ninth stage of development, which considered the challenges of continued aging and incorporated aspects of the other stages.4
How Does Life Review Therapy Work?
Individuals undergo life review therapy work with counselors or respite caregivers who encourage them to look back on their lives and share stories of their pasts. Clients may be asked to look back at certain time frames during these sessions, such as childhood, parenthood, or another specific period during their lifetimes. Alternatively, certain themes may be encouraged, like education, music, milestones, or life turning points.
Counselors might request that clients bring in some type of memento when discussing these time periods or themes to help with the recollections. This could be music recordings, family photos, collections, or anything else from individuals’ pasts that can help sharpen the memories and details. These methods also can help create a guide for further exploration.2 Once clients have shared and elaborated upon memories, the focus changes to how these memories make a client feel or what they mean to them. This can have an uplifting effect, or it may bring up some unresolved conflict that a qualified counselor can address to help clients gain acceptance and resolution.
Some methods used in life review therapy include memorabilia, reunions, pilgrimages, family trees, and the preservation of ethnic identity.2
Physical memorabilia like letters, diaries, scrapbooks, and photographs from the past are used in this method. They may evoke mixed feelings in the client, especially when compared to a current counterpart, like a recent photo. Some people are not used to thinking of themselves in their current state, and instead still identify with versions of themselves that look and feel younger.
Borrowing from occupational therapy, compiling these mementos, especially in a group setting like at a residential home for seniors, can be very beneficial; it can help make the client aware of unresolved issues they can action and foster the remembrance of both good and bad memories.2
Having clients see themselves in the context of loved ones, and people who have been important in their lives can help them make sense of where they stand in the life cycle. School reunions, which bring people together with others their age who have a shared past experience, can help clients see continuity and change in themselves and their lives. A family reunion incorporating several generations can evoke joy, celebration, and sadness at what a person has lost.2
Many have mental images of places they’ve lived or places that were important to them. Often these images are inaccurate, whether due to forgotten details or changes in the landscape. Visiting these places can bring mixed emotions, especially when the site is associated with an extreme emotion like joy, and often brings the client peace.2
Creating or studying a family tree that includes ancestors from many generations can help the client establish and recognize their own place in history. It can also aid the client in resolving fear of death, as it provides a reminder of loved ones and family members who have already passed.2
Preservation of Ethnic Identity
Often, older people have an ethnic identity that has been ignored or forgotten. Sometimes it is because a cultural identity was not passed down to the next generation for one reason or another. Many can feel this loss of cultural heritage, so resurrecting this aspect of their identity can have a positive personal and social value and contribute to restructuring their identity.1
Guided recollection can help individuals resolve past conflicts and live their lives with greater coherence and contentment.
When Is Life Review Therapy Recommended?
Although life review therapy was first used in older people to help bring about peace and prevent depression, this type of treatment can be effective for people at any age who are terminally ill to assist with psychological integration and acceptance. It may also be helpful for family members of older or terminally ill individuals.5
Additionally, this type of counseling shows promise for treating older adults who are currently diagnosed with depression or anxiety, anyone who suffers from grief due to the loss of a loved one, and those who suffer some type of memory impairment, such as Alzheimer’s or dementia. In the case of memory impairment, life review therapy is believed to trigger memories of long-forgotten events that can bring clients joy and contentment.
Potential Benefits of Life Review Therapy
Butler believed that all people would, in some way, naturally go through a life review process in Erikson’s eighth stage of development. Researchers have concluded that assisting people through this process can help them to have more favorable outcomes, allowing them to live more happily for the remainder of their lives.
Life review therapy is an effective type of counseling for older adults and those with terminal illnesses. Additionally, studies show this treatment’s benefit for people within those populations who also have depression or anxiety.6,7 Many older or terminally ill clients can better deal with their mortality after participating in this type of therapy. Following are several specific improvements that can result from life review therapy.
Improved Quality of Life
By retelling stories from their lives, many people show improvement in self-esteem and a reduction in depression and anxiety symptoms.7 Additionally, recollections may help individuals remember how much they enjoyed certain activities, allowing them to return to old hobbies or begin new ones, depending on their physical abilities. Once people accept their current life stage, they frequently acquire a newfound zest for the life that’s left for them to explore.
A 2018 research study at senior home care centers in Iran showed overall improved quality of life for people who engaged in life review therapy. Researchers from Shiraz University of Medical Sciences split 35 participants into two groups and treated them with life review therapy over eight 2-hour sessions. They measured quality of life using the quality of life questionnaire (WHOQOL-BREF) before and after treatment. They found that the experimental group experienced an improvement in their quality of life. The researchers recommended that both nursing home residents and the families of older individuals could benefit from this type of treatment.5
The storytelling aspect involved in life review therapy can be very cathartic for many individuals. Most people have a few regrets or some unresolved concerns with which they have yet to come to terms. By listening to individuals’ memories, counselors can determine where they may need some encouragement or other forms of therapy to better accept past situations or events. This allows people to overcome the potential for despair that exists at the end of life for some individuals.
Resolution of Conflict
Life review therapy, particularly the incorporated ideas of Erikson’s life stages, can help resolve conflicts. Reviewing life experiences can often foster conflict resolution because to move forward, at times, it is necessary to look back. A person cannot move forward in their psychological development if they still harbor conflicts and grudges from the past.8 Additionally, the temporal distance from an event may bring a fresh perspective.
Transfer of a Legacy
If life review therapy sessions are recorded, either through video, voice, or in writing, this information can, with the client’s consent, be shared with the family and close friends of the individuals to give them a deeper understanding of who they are and all they’ve experienced throughout their lives. Those near and dear at heart can learn about the joys, heartaches, struggles, and accomplishments of their loved ones so that all of the information doesn’t simply disappear once these individuals have passed on.
Additionally, engaging the client’s family in their reminiscence can harbor positive outcomes. A researcher from the University of Alabama details case studies from 2009 in which 17 people with chronic, life-limiting illnesses in a palliative care setting and their families embarked on a legacy project that encouraged reminiscence. Over 9 to 10 weeks, the participants developed projects like scrapbooks with pictures, cookbooks, or audiotaped stories of the ill individual’s life. The study found that people responded positively to this legacy project and improved family communication—something people near the end of their lives place in high esteem, even higher than symptom control.9
Whether young or old, many people have fears about dying or feel that their lives haven’t had enough meaning. With life review therapy, clients are encouraged to view death as a natural part of life’s process as it happens to everyone eventually.
By helping with clients’ recollections, counselors are able to point out that these people’s lives have had meaning and show where their lives made a difference, no matter how large or small. Individuals learn to take responsibility for their past actions and behaviors, allowing them to put their minds at ease.
Ego-Integrity / Self-Coherence
Ego-integrity, or the coherent sense of identity and wholeness, is part of Erikson’s eighth stage of development; a strong ego identity helps maintain one’s sense of identity and reduce anxiety.4
A 2018 study conducted by researchers from various institutions based in Amsterdam with cancer patients in palliative care found that life review therapy combined with memory specificity training improved ego-integrity compared to the control group. In this study, a 55-person intervention group received four sessions of life review therapy and memory specificity training to help them retrieve positive memories, reevaluate life events, and reconstruct the story of their lives to include their terminal cancer diagnosis.10
Life review therapy may not be appropriate for everyone. Those who have lived through severe trauma, for example, might benefit from a different type of therapy so that they don’t have to relive their negative experiences, or face retraumatization, which would be more detrimental to clients and may not provide the peace and acceptance that is expected from this treatment.
Additionally, Butler believed that pressing some people into a life review would be maladaptive, leading to potential depression and despair. Specifically, he thought that (1) people who focus on the future rather than the past or present might feel they have nothing to look forward to once they see that their future is indeed limited; (2) those who have harmed others may see no way to correct past wrongs or overcome guilt; and (3) narcissists may not be able to accept being face to face with their mortality.11
Many decades have passed since Butler published his life review theories. Current trends in the use of combined treatments may make it possible for people to utilize the benefits of life review therapy along with other forms of treatment to overcome the obstacles that could potentially hold them back from experiencing contentment at the end of their lives.
Life review therapy is a type of recollection that allows individuals nearing the end of their lives to achieve peace, find meaning and acceptance, decrease depression, and improve their quality of life in their final moments. Although people will naturally review their lives either consciously or through the unconscious mind, as noted by Butler, guided recollection with a qualified counselor can help individuals resolve past conflicts and live their lives with greater coherence and contentment.