Working with an older person to help make sense of their life has real value but is conspicuous by its absence in adults’ services, says Matt Bee.
Life story work is a big part of social work with children in the care system. In adoption, there’s actually a requirement in statutory guidance to complete this therapeutic intervention.
Hop over the fence into adult services, though, and you’ll discover we aren’t accustomed to creating life story books at all. Although it may be an enjoyable and rewarding task helping a service user explain their life through words, photos and art, this is rarely seen as an essential undertaking. Instead, many of our clients’ life histories amount to a solitary page in a wider assessment – sometimes just a few paragraphs carried forward from one historical record to the next.
Holding onto identity
For children, then, who are searching to establish an identity in the world, a life story book is crucial. But does the same not hold true at the other end of life, for an older person struggling to hold onto the identity they once had?
To me the absence of life story work in adult services seems like an oversight. Sitting down with an older person so they can talk about their life, putting events in order and explaining the path they’ve taken through jobs, careers, births, deaths and marriages, right up to the point that led them into care services, is not only helpful for them but also for any care staff working with them.
For one thing, it would counteract the phenomenon of ‘elderspeak,’ where older people are spoken to as though they never mastered the English language. Instead, they are addressed as infants, with simple words, short phrases, spoken loudly and slowly. You wouldn’t bring a lawyer a beaker of warm tea, saying: ‘There you go, sweetie!’ So why, with the best will in the world, would anyone talk to an ex-lawyer like this?
In older people’s services, one of our greatest crimes is dismissing our clients’ backstories. We have a tendency to treat older people as if they have always hobbled, stooped and struggled. But this is just how they are now, and it is not who they are anyway.
Life story work is a useful tool for bringing their lives back into focus. It helps restore, and preserve, an identity that the ageing process, and dementia in particular, eats away at.
Meanwhile, in drugs services, this same intervention can be used to help clients discover a new identity entirely. Andrew Irving, a former drugs worker who is now a research associate at Sheffield University, has written about the use of life story work as a tool for ‘identity reconstruction’ for residents in a therapeutic community.
Having worked in such a setting, I’ve seen this first hand. Residents dredge up difficult memories, grapple with past mistakes, grieve for lost years or broken relationships, and experience a lot of hurt and pain. But, slowly, they begin to tease out from the mess who they are. They move from a place of despair to one of acceptance – and from this, they start laying the foundations for a new life.
Yet, when my social work career took me into mental health services, the whole notion of life story work with drug users was a dead loss. No-one had even heard of it.
Lack of dementia provision
And in relation to dementia care, the University of York concluded a study last year estimating that whereas 62% of in-patient dementia assessment services in England offer life story work, this figure drops markedly to 48% in dementia specialist care homes, 23% in general care homes, and just 14% in dementia support services in the community. Even where this therapy is more commonly used, however, the quality of the work can be variable, with some institutions resorting to a standard template filled out in a single session instead of investing the time the therapy really warrants.
Sadly, in care homes, it is far easier to offer bingo or board games than it is to have a member of staff spend quality time with an older person, discovering the life they’ve lived and then compiling this into a book for the benefit of them and everyone involved in their care.
No time in social work
In adult social work teams, I’m not sure we have time to offer the therapy at all. We aren’t expected to complete this work, and without such requirements as there are in adoption, we don’t – not as far as I can tell. Instead, we tend to refer on for any therapeutic intervention.
Yet, social workers would be well-suited to delivering this therapy, with its focus on the person, their life and relationships.
Given that the same study from the University of York estimates that the average cost of creating such a book in a care home (once staff have been trained) is just £37.42, you do have to wonder if this isn’t a therapy we should be promoting more – particularly when you consider the importance attached to it by our colleagues in children’s services.
Story courtesy of Community Care