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The risks of memory work
While reminiscence can be highly enjoyable, it can evoke negative memories for some people. Various forms of memory work are enjoyed by people with dementia and known to be effective, but these activities are not without risk.
Reminiscence, life–story activities, music and singing are all very positive for people with memory problems but they can also dredge up sad memories or disclosures of abuse. This does not mean that reminiscence should be avoided but being conscious of the risks and how to handle them is important. It can be beneficial when upsetting issues are dealt with sensitively, but facilitators must be aware of their limitations and their responsibilities.
Memories can be upsetting and those supporting activities need to be able to handle sadness and grief. Music is a particularly evocative medium but a poem or discussing a particular event or topic can also evoke sadness. This is often a short–term response and should not be a reason to avoid a particular piece of music, poem or topic.
If this happens, it is important to validate the person’s feelings by acknowledging his or her current emotion. For example, you might say, “I see that you have tears in your eyes. Does this music/poem/topic make you feel sad?” Then ask if he or she would like to continue participating/listening or move on to a different song/poem/topic.
Most of us have wanted to listen to a song that made us cry. Persons with dementia are not always capable of verbally expressing how they feel, and they sometimes need to release their emotions as a form of catharsis. This is a perfectly natural human response and can actually be therapeutic.
People who have blamed themselves for years might find comfort in exploring something that they had no control over or that they did for the best of reasons at the time. Those who feel failures can be helped to look at what they have achieved in their lifetime in a more positive way. Equally if that is not appropriate they may find support and comfort from others around them.
Loss of inhibitions
However the loss of inhibitions often associated with dementia may loosen memories which have been buried for years. These have to be handled carefully but not exploited. There is a danger that people might be put through the pain again. It would not be appropriate to stop somebody from talking about them but it may be best to try and move on for the sake of the person. There is also a danger that family secrets will come out into the open.
It is important to be aware of what is private and what is public and be able to negotiate this. The consent, privacy and dignity of those involved in the story as well as those of the person with dementia must be a prime consideration. It may be necessary to edit recordings in life–story work. The key consideration is to remember what the person with dementia wants or what might be best for them.
Some of these disclosures might benefit from professional help and this should be discussed with appropriate members of staff or volunteer coordinator and the person signposted accordingly. However if current abuse is revealed it must be addressed under safeguarding procedures. This does not have to be overly bureaucratic but cannot be neglected.