Giving voice to our aging narrative: An experiential writing workshop

1. Giving voice to our aging narrative: An experiential writing workshop Paula E. Hartman-Stein, Ph.D. WISDOM CONVERSATIONS: Our Narratives of Aging Ruth Frost Parker Center for Abundant Aging January 7, 2019

2. Background of presenter • Consultant on behavioral health of older adults, journalist, educator, public speaker • Education: Univ. of Pittsburgh; West Virginia U; Ph.D. in clinical psychology, Kent State University Geriatric Clinician Certificate from GREC, Case Western Reserve University • Work History: • Therapist in hospitals, primary care, long-term care, private practice • Medicare correspondent, The National Psychologist Relevant Publications: • Editor, Enhancing Cognitive Fitness in Adults (2011) & Innovative Behavioral Healthcare for Older Adults (1998) • The Handkerchief, poem in online journal, Soul-Lit Primary professional Interests Conducting writing workshops on guided autobiography & healing power of nature; teaching basics of geriatric behavioral health to multiple disciplines. Paula E. Hartman-Stein, Ph.D.

3. Objectives • Review unique challenges that adults face as they age. • Gain epiphanies (i.e., “illuminating discoveries, realizations, or disclosures”) about aging. • Review the evidence for physical, psychological, & cognitive benefits of reflective writing with OAs. • Experience how reflective writing can be useful personally and as a pastoral tool. www.centerforhealthyaging.com

4. Today’s format didactic lecture, discussion, group writing, individual writing and sharing of writing. www.centerforhealthyaging.com

5. Today’s Theme “They can be like the sun, words.They can do for the heart what light can for a field.” www.centerforhealthyaging.com

6. Faces of Baby Boomers: 28% of population, born between 1946-1964 www.centerforhealthyaging.com

7. One end of the age spectrum: The Centenarians www.centerforhealthyaging.com

8. How do you know you’re an older adult? • Young old (65-74) or (55-65) • Middle old (75-84) or (66-85) • Old-old (85+) www.centerforhealthyaging.com

9. Perspectives on Aging: Group Exercise Together let’s compose a poem, the CBT of aging (Challenges, Benefits, and Tips). Let’s do a speed round, taking a few minutes to write a list of words, phrases, or sentences describing your perspective about the CBTs of Aging. www.centerforhealthyaging.com

10. Social/psych dynamics of aging • Normative life transitions, retirement, new identity (encore careers), relocation, widowhood. • Late life challenges:grandparenting, adapting to age-related physical changes, planning for end of life. • Trend is away from thinking “retire and die 2 yrs later.” www.centerforhealthyaging.com

11. Social & psych dynamics of aging Stressors: • loss of persons, objects, pets, occupational roles, driving, independence. • Loneliness, difficulty finding one’s “tribe” • decline in energy, hearing, vision, memory skills. • Adapting to physical changes • Family/marital discord. • Adapting to having a home caregiver. • chronic illness; worry about health of spouse/partner. • Feeling unwanted, no longer useful, invisible. www.centerforhealthyaging.com

12. One way to react to invisibility • Grace and Frankie meltdown www.centerforhealthyaging.com

13. Aging consciously • Conscious aging: A social movement begun in the first decade of the 21st C: A choice as to how well we enjoy the physical journey of getting older and how aware we become during the process. • Opportunity to leave the world of middle age goals & enter time for personal & spiritual growth. • In late life we can invest in more satisfying social relationships. www.centerforhealthyaging.com

14. What is Conscious Aging? Rabbi ZalmanSchachter-Shalomi, Ph.D.: “A major part of this work involves an examination of one's life and an understanding of how apparently negative events often lead to positive outcomes. Inner work is also essential to relieve oneself of the burden of resentment and anger that can accumulate over a lifetime." www.centerforhealthyaging.com

15. Using narrative to find meaning Guided autobiography and life review are examples of interventions in Narrative gerontology, a sub-field of the study of aging, coined in 1994 by Jan Eric-Ruth, meaning “life as story” that deepens our understanding of how we change internally in the later years of life in psychological and spiritual ways. de Medeiros, K. (2014). Narrative Gerontology in Research and Practice. New York: Springer www.centerforhealthyaging.com

16. What is meant by “narrative”? • Narrative: communicating of an aspect of the self through the use of ordered symbols that may include language, gestures, images, movements, artifacts. • Narrative requires action; i.e., the speaker/writer reveals something to the listener/reader. • Narrative has a purpose. De Medeiros, K. (2014). Narrative Gerontology in Research and Practice. New York: Springer www.centerforhealthyaging.com

17. Written narrative through the ages • Autobiographical writing: credited to St. Augustine, the 4th Century theologian, who wrote about his growth in spirituality. • Journals and diaries are in Eastern & Western traditions. • American culture popularized self-narrative through Julia Cameron’s The Artist’s Way (1992) to enhance spiritual awareness and increase creativity. • Amherst Writers & Artists (AWA) begun by Pat Schneider—group programs world wide. www.centerforhealthyaging.com

18. What is achieved from written narrative? Epiphanies and Healing! www.centerforhealthyaging.com

19. Core construct Underlying principle of guided autobiography and life review: www.centerforhealthyaging.com

20. Narrative gerontology Interventions Explore the “Inside” of Aging : Life review & legacy writing Stanford Letter Writing Project Guided Autobiography (visiting life stages or themes) Memoir Oral history Group reminiscences www.centerforhealthyaging.com

21. Narrative Medicine • Reflective writing is becoming part of medical school training in order to “aid doctors to recognize patients’ lived experiences.” • Support awareness of the meanings of their own experiences. • Why: To improve the effectiveness of health care and the process of learning how to give it. • Writing is discovery; it teaches reflective skills. • Charon, R. & Hermann, N. (January 2012). A Sense of Story, or Why Teach Reflective Writing? Academic Medicine, 87, 5-7. www.centerforhealthyaging.com

22. Personal Narrative: A Mind-Body Healing connection “For although therapy is seen as a healing science and autobiography as a literary form, there have always been intimate links between psychotherapy and the restorative powers of personal narrative.” Rainer, T. (1998). Your life as Story. www.centerforhealthyaging.com

23. Nature connection through writing and reflection Example from an enplein air writing workshop:The Source of Life. www.centerforhealthyaging.com

24. Case example:Enplein air writing example 75 y.o woman with hx of depression, past suicidal thoughts. Close reading exercise of The Sourceof Life 1. Identify underlying themes 2. What does the writing tell us about the author? 3. How do you think writing the piece changed the author? 4. What will you remember from this narrative? www.centerforhealthyaging.com

25. The role of listening Adding the element of being listened to in story telling/written narrative acknowledges that the person is worthy of being heard, a powerful feeling that contributes to well-being. Benefits to the listener: The listener is changed in some ways. www.centerforhealthyaging.com

26. Evidence of Benefits of Reflective Writing • Coping with conflicted relationships, enhancing decision-making skills, aid to memory. (Brady & Sky, 2003 in study of older adults) • Pennebaker & Beall (1986): 1st randomized control trial showing health benefits of writing about traumatic events in three 20 min sessions. • Over 200 studies on expressive writing, with large numbers showing positive health benefits. www.centerforhealthyaging.com

27. Benefits of reflective writing • Stuckey & Nobel (2010) summarized health benefits: frequency of MD visits, immune function, blood pressure, pain severity, depressed mood, working memory. • de Medeiros et al (2007) found improvement in memory in cognitively intact OAs in 8 wk structured writing workshop www.centerforhealthyaging.com

28. Why offer a narrative group? • Therapeutic not therapy • Supportive but not a support group • Source of cognitive stimulation • Increases a sense of connection & reduces loneliness • Boosts creativity • May enhance spirituality • Modality for helping individuals to acknowledge their worth, make meaning of their lives, & achieve a vision to the future. www.centerforhealthyaging.com

29. Importance of Meaning in life Accd to Viktor Frankl, humans’ main motivation is finding meaning in life, as opposed to striving mainly for pleasure or power. Meaning emanates from: • engaging in creative work or deeds of kindness, • appreciating love, goodness, truth or beauty • Taking a courageous stance toward life’s difficulties www.centerforhealthyaging.com

30. Tips about writing groups “Groups don’t happen; they have to be created and nurtured.” (Bolton, 1999) • Confidentiality • Expect unexpected emotions, have boxes of tissues and warn emotions can bubble up. • Writing can be done in the group or outside the group. No laptops! • Role of facilitator: In narrative medicine and the Amherst method, the facilitator writes along with the participants. www.centerforhealthyaging.com

31. Guided autobiography themes (Birren & Cochran, 2001) • branching points • family of origin • role of money • life work • health • sexual identity • ideas about death • spiritual life • goals/aspirations www.centerforhealthyaging.com

32. Tasks of life review from Stanford Letter Writing Project 1. Acknowledge the important people in your life 2. Remember treasured moments from your life 3. Apologize to those you love if you hurt them 4. Forgive those who love you if they have hurt you 5. Express your gratitude for all the love and care you have received 6. Tell your friends and family how much you love them. 7. Take a moment to say "goodbye" www.centerforhealthyaging.com

33. Life story-telling 1. (If you are age 50+): Write a letter to your younger self describing a lesson you’ve learned as you’ve aged. Or 2. Using first person, write about a branching point in your life, i.e., what was it; who was involved; whose decision was it; how did it impact your life journey? www.centerforhealthyaging.com

34. Life story-telling • Think of archetypes or characters from myth, fairy tales, biblical stories or literature that exemplify traits you admire. • Write a “once upon a time” story (in third person) from your life that characterizes a similar course or theme. OR • Write about a challenging example from your pastoral work in which you believe you made a positive difference. (Use first person). www.centerforhealthyaging.com

35. Contact Info Thank you for your participation! To contact Dr. Hartman-Stein E-mail: paula@centerforhealthyaging.com Website: www.centerforhealthyaging.com Cell phone: 330-671-6241 www.centerforhealthyaging.com

36. Resources/references Birren, J.E. & Cochran, K.N., (2001). Telling the Stories of Life through Guided Autobiography Groups. Baltimore, MD: The Johns Hopkins University Press. Bohlmeijer E. & Westerhof, G. (2011). Reminiscence interventions: Bringing narrative gerontology into practice. In G. Kenyon, E. Bohlmeijer & W.L. Randall (eds.) Storying Later Life: Issues, Investigations, and Interventions in Narrative Gerontology. (pp. 273-289). New York: Oxford. Bolton, G. (1999). The therapeutic potential of creative writing. London: Jessica Kinglsey Publishers. Brady, E.M. & Sky, H.Z. (2003). Journal writing among older learners. Educational Gerontology, 29, 151-163. www.centerforhealthyaging.com

37. Resources/references Burack-Weiss, A., Lawrence, L.S. & Mijangos, L. B. (Eds.) (2017). Narrative in social work practice: The power and possibility of story. New York: Columbia University Press. Cameron, J. (1992). The Artist’s Way. New York, NY: G.P. Putnam’s Sons. Campbell, R. & Svensson, C. (2015). Writing your legacy. Cincinnati, OH. Writer’s Digest Books. Charon, R. & Hermann, N. (January 2012). A Sense of Story, or Why Teach Reflective Writing? Academic Medicine, 87, 5-7. de Medeiros, K.(2014). Narrative Gerontology in Research and Practice. New York: Spring Publishing Company www.centerforhealthyaging.com

38. Resources/References Hartman-Stein, P.E. (2011). “Creative Writing groups: A promising avenue for enhancing working memory and emotional well-being” In P.E. Hartman-Stein & A. LaRue (eds.), Enhancing Cognitive Fitness in Adults (p 200). New York: Springer Science & Business Media. Kenyon G., Bohlmeijer, E., Randall, W.L. (2011). Storying Later Life: Issues, Investigations, and Interventions in Narrative Gerontology. New York: Oxford. Klein, K. & Boals, A. (2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520-533. Mackenzie, C.S., Wiprzycka, U.J., Hasher, L., Goldstein, D. ((2008). Seeing the glass half full: Optimistic expressive writing improves mental health among chronically stressed caregivers. British Journal of Health Psychology, 13, 73-76. www.centerforhealthyaging.com

39. Resources/references Meuser, T. (2011). Oral life review in older adults: Principles for the social service professional . In P.E. Hartman-Stein & A. La Rue (Eds.), Enhancing Cognitive Fitness in Adults: A guide for use and development of community-based programs. New York: Springer Phillips, D., Linington, L., & Penman, D. (1999). Writing Well. London: Jessical Kingsley Publishers. Pennebaker, J W. & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 3, 274-281. Schneider, P. (2003). Writing alone and with others. New York: Oxford University press. Stanford Medicine (2017). Stanford Letter Writing Project, Complete the Seven Vital Tasks of Life Review. retrieved from https://med.stanford.edu/letter/friendsandfamily.html  Stuckey, H. L & Nobel, J. (2010). The connection between art, healing, and public health: A Review of the current literature. American Journal of Public Health, 100, 254-263. Yogo, M. & Fujihara, S. (2008). Working memory capacity can be improved by expressive writing: A randomized experiment in a Japanese sample. British Journal of Health Psychology, 13, 77-80. www.centerforhealthyaging.com