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3-13-02

Autobiographical Writing: An Innovative Therapeutic Recreation Intervention

Autobiographical writing offers many benefits. Carolyn Heilbrun, the author of Writing a Women's Life wrote, "We are the stories we tell." We tell ourselves stories of the past, make fictions or stories of it, and these narrations become the past, the only part of our lives that is not submerged." An understanding about the way in which we think and who we are can be gained from writing down our life stories. May Sarton stated, "Everything I've every written is to understand something, some idea, some emotion." What we have learned about our lives can be shared with others. Harriet Lerner wrote, "We need to bear witness. Stories will be told, remembered, and recorded. The more of us who share our stories, the more the capacity for telling our stories is renewed in all of us." Life story writing can teach us to express ourselves in unique ways. Isak Dinesen stated, "All sorrows can be borne if you put them into a story or tell a tale about them." There are many meaningful ways to communicate our stories. Denis Ledux wrote, "A life story is a gift one generation bestows upon another."

Autobiographical Writing as an Innovative Therapeutic Recreation Intervention
In addition to the above inspirational passages, the gift of recording one's life story has gained respect and acceptance in university and clinical circles alike. For example, psychologists are beginning to understand the value of personal narratives in understanding growth and development (Atkinson, 1995). Robert Butler (1998) noted that the process of reviewing one's life is part of the normal aging process and takes place internally by the conscious returning to past experiences, reviewing unresolved conflicts and reintegrating these thoughts into a deeper understanding of oneself. This process then leads to self-awareness, and self-acceptance, hence a more meaningful view of one's life. Even though Butler did not originally conceive life review as part of a process done one-to-one, or in a group that is facilitated by therapists, the theoretical connection to autobiographical writing is clear. The purpose of this article is to present information on how Therapeutic Recreation Specialists can provide a meaningful intervention using autobiographical writing as the tool.

Autobiography is a formal written story of a person's life that can consist of shorter written exercises that focus on one event or memory in a person's life (Atkinson, 1995). An approach to writing autobiographically, based on the theory of life reviewing, was originated by Birren and Duetchmann in their book titled, Guiding Autobiography Groups for Older Adults: Exploring the Fabric of Life. The authors stated "autobiographical writing is a way for older adults to review their lives by following a proven series of evocative themes and responding to questions designed to promote reflection" (p.2). The autobiographical writing groups are facilitated by a leader who sequentially presents the themes in order to gently guide the participants into their memories and past experiences (Birren & Dutchman, 1991).

Even though the authors present a formalized group process they also suggest that the format can be adapted in a number of ways to benefit a wide variety of individuals. For instance, the use of poetry and music could be incorporated into their writings. Also, items such as food, fragrances, jewelry, and pictures can be used to evoke memories. Therefore, the autobiographical writing method as developed by Birren and Duetchman can be adapted to fit the needs of a variety of individuals in many settings such as; independent, assisted living, and skilled nursing facilities as well as community based agencies. For these reasons the autobiographical writing group would make a unique intervention for any therapeutic recreation program serving older adults.

The expected outcomes of autobiographical writing groups are increased self-esteem, self-awareness, and a greater sense of life satisfaction and well-being. The above outcomes are all important for older adults looking for meaning in their lives and places to share their experiences verbally and in writing, thus enabling them to leave written legacies.

Two Examples of Autobiographical Writing as an Innovative Therapeutic Recreation Intervention
When I was completing my doctoral training in Gerontology I fulfilled the practicum requirement by developing, implementing, and evaluating two autobiographical writing programs. The purpose was to become familiar with the intervention of autobiographical writing and to try-out an outcome measure that might be appropriate for this type of group. The first program used a pre-experimental design, the one-group pretest-posttest (Campbell & Stanley, 1963). The participants were a small group (n = 6) of older women (ages ranged from 67 to 105) living in low-income housing. I evaluated the program using the outcome tool, the Positive and Negative Affect Scale (PANAS), as a pretest and posttest measure of well-being (Watson, Clark, & Tellegen, 1988). The second program used a pre-experimental design, the one-shot case study (Campbell & Stanley, 1963). The intervention was implemented with a 67 year old woman living with cancer.

The first group met once a week for 2 hours over a 4 week time period. There were always healthy snacks, juice, and coffee provided. The first session followed a format that included a brief orientation activity, trailed by a short presentation of that weeks writing theme. Next, a learning activity was completed that stimulated the participant's memories and facilitated a five minute writing spree. The rationale was to provide the group members with some thoughts and writing ideas so that they could spend the next week writing their two to three page short story. The subsequent weeks followed the above format, but the participants were encouraged to verbally share their written stories with the group. Since this group did not have access to a computer I volunteered to word process their stories resubmitting them the following week. I chose the themes for this group based on research conducted by Birren and Duetchman. The themes were "the major branching points in my life", "my family", and "my major life work or career."

The evaluation tools did not suggest that any statistically significant differences occurred, but a slight increase in positive affect was noted. I was optimistic considering the small sample size, short intervention period, and the limited research methodology that had been implemented.

The second program was a one-to-one intervention. The point of developing a second type of intervention was to establish a variety of methods that would facilitate the process of life reviewing through writing autobiographically. I originally planned to meet with Virginia in her home once a week for 2 hours over a 4 week period, but her chemotherapy session interrupted our time, therefore, extending our work to 4 sessions over a 6 week time period.

The first week we discussed the possibility of working with her to write down some of her life stories. She agreed and we began by going through volumes of photo albums. These were used to stimulate her memory and facilitate story ideas. She had many thoughts. We talked about her cancer and how it was affecting her life. This was the first week her hair had begun to fall out, but her color looked good and her spirit was bright. After the first meeting the first story idea was generated - a story about her grandchild - Andrew.

The following week Virginia read her story out loud and I listened intently. She shared pictures and memories of Andrew. She had many funny stories about Andrew and she chose a few pictures to place with her story. Next, she made a list of possible story ideas for the following week and we reviewed her picture albums and talked more about her life.

Since she had completed a story I agreed to word process the written work and create a Life Story book for her. The Life Story book would have her stories and the pictures she had chosen. She then read her latest story titled, "Mother of the Bride." She reminisced about her daughter's engagement and wedding day. The next story proposal "My Heritage," was developed again from looking through her family albums. She began to view this process positively and stated she enjoyed writing down her life stories and feeling creative again.

The next visit was cancelled due to chemotherapy treatments, but we met the following week. Virginia was visibly tired and not as talkative as in past weeks. She was worried about being physically able to complete the next story, but I assured her that she could take her time with her writing. She did complete the last week's story, which was a detailed description of her family's heritage. We reviewed the story and discussed her life as a young girl.

For a second time our meeting was cancelled due to chemotherapy treatments. The next appointment was to be our last, as she felt too tired to continue. This had been a hard week for her and she did not feel well, but completed a story titled, "Den Mother - Brownie Leader." We read the story, discussed which pictures should go into her Life Story book and set a date for when her book would be completed. Virginia died a year after completing these stories. Her legacy continues in her book, dedicated to her grandchild Andrew, titled - The Stories of My Life.

I evaluated this intervention by recording her thoughts and moods each time we meet as these related to the goal, a sense of self-awareness and self-acceptance, the view that her life had meaning. Her comments included " I enjoyed writing these stories, It is amazing how much I have done in my life. I have tried my very best to raise my family the best way I knew how." Although this method of research design has limited scientific value the work done here has promise and Andrew can remember his Grandmother through her stories and pictures.

How to Begin an Autobiographical Writing Group
Therapeutic Recreation professionals working with older adults who are interested in developing autobiographical writing groups can begin by reviewing the literature in reminiscence, life-reviewing, and autobiographical writing. An excellent place to start would be Birren and Deutchman's book. Also, Dattilo's Leisure Education Program Planning: A Systematic Approach book will be useful. Dattilo's text will provide you with a guideline of how a group/educational sessions can be developed and implemented. Be creative in using orientation and learning activities that promote discussion and interest. The use of poetry and guided imagery is useful to center the group members and focus on their thoughts and feelings. A helpful book that has many activities that could be useful for autobiographical writing groups is, Journal to the Self by Kathleen Adams. Providing wrap-up activities to your sessions that are meaningful to the group will solidify their interest in completing their writing assignments. Soliciting family members to assist with recording their loved one's stories would be a great way involve family in this processes. In fact, Barry (1988) in his research on autobiographical writing discovered an unexpected outcome of strengthened family connection. Families shared stories and helped their older relatives in the writing and transcribing process.

Therapeutic recreation specialists can assist older adults in reviewing their lives. This may result in strengthening ego-identity and in the process leaving a written legacy for future generations to enjoy and share. While there has been limited research in autobiographical writing groups, the outcomes presented here look promising and more research using sound research methodology should be implemented.

Reference
Adams, K., (1990). Journal to the self: Twenty-two paths to personal growth. New York, New York: Warner Books, Inc.
Atkinson, R., (1995). The gift of stories: Practical and spiritual applications of autobiography, life stories, and personal mythmaking. Westport, Connecticut: Bergin & Garvey.
Barry, J. (1988, September - October). Autobiographical writing: An effective tool for practice with the oldest old. Social Work, 449-451.
Birren, J., Detuchman, D. (1991). Guiding autobiography groups for older adults: Exploring the fabric of life. Baltimore, Maryland: John Hopkins University Press.
Butler, R., Lewis, M., Sunderland, T., (1998). Aging and mental health. (5th Ed.) Boston, Massachusetts: Allyn and Bacon.
Campbell, D.T., Stanley, J. (1963). Experimental and quasi-experimental designs for research. Boston, Massachusetts: Houghton Mifflin Company.
Dattio, J., ( 1999). Leisure education program planning: A systematic approach. Andover, Massachusetts: Venture Publishing.
Dinesen, I. (1918). Letters from Africa: 1914-1931. Chicago, Illinois: University of Chicago Press.
Heilbrun, C. (1988). Writing a woman's life. New York, New York: .W.W. Norton.
LeDoux, D., (1993). Turing memories into memoirs. Lisbon Falls, Maine: Soleil Press.
Lerner, H., (1993). The dance of deception. New York, New York: Harper Perennial.
Sarton, M. (1973). Journal of Solitude, New York, New York: W.W. Norton.
Watson, D., Clark, L., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6) 1063-1070.

Author Biography:
Nancy Richeson received her Ph.D. in Gerontology in 2001. She is currently teaching at the University of Southern Maine.

Mailing Address:
Nancy Richeson, Ph.D., CTRS
University of Southern Maine
Recreation and Leisure Studies
G-26 Masterton Hall
96th Falmouth Street
P.O. Box 9300
Portland, Maine 04104-9399
(207) 780-4646 (work phone)
(207) 780 - 5654 (work fax)
richeson@usm.maine.edu

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