By 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.
Useful tool
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.
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I agree that this would be a fantastic thing to do with an older person and with other client groups too. In my experience of adult social work everyone has a story to tell, and it is often fascinating and gives a whole new insight into what a person is like and what sort of help and support they need. Families could be involved too, and given the chance to come to terms with a relation’s decline or move into residential care. In my early days as a social worker we used to complete a huge form (a 347A, I think) if an older person was entering residential care either short or long term, and that had the effect of going over events in their lives as well as their likes and dislikes and personality traits. You could only complete it in discussion with the person and relatives or carers and it was always a useful exercise. Took time though, and I guess that may be the problem these days. I’ve changed career and am a priest now and when I am involved in funeral arrangements for an older person I hear much about their life and experiences; sometimes when carers come to the funeral if the person had home care or residential care, they tell me they did not know these stories and it could have been helpful to them.
This is wonderful to see someone acknowledge this essential part of social work.
I have been working in the field od social work with substance dependency for 21 years and all this time we start with the social history/timeline. This has helped us to help our clients /service users to understand their lives and how they have coped through self medicating on their life events. This also helps us to be able to understand what support they would benefit from.
A number of years ago l managed a service for adults with learning disabilities. A number of people had originally lived in long term institutional care. They came with very little history and what little information they had was more medical rather than personal. When l look back at my life the things that give me most pleasure are my memories and photos of those l love. Sometimes it feels sad looking back but nonetheless it all helped to make me who l am today. So l accept the sad memories/photos along with the happy ones.
I feel it needs to be made mandatory that everyone carries a ‘life history’ with them – even if it starts as soon as s/he moves into a supported service. Photos of staff – present and those who have moved on. Pictures of where they grew up in the community. All gives the person the same dignity, value and worth as a human being – the same as us who are not dependent on others to peice fragmented lives together.
We offer this service through our therapy team. It’s great. Lovely to pass down through families
As a mental health social worker, this used to be common practice in the 90’s. Now there is not time time due to packages of care, outcomes, and time pressures. We have lost a valuable resource using social workers as care managers rather than utilising the skills we possess.
I wondered about this Glenys- I have worked in various MH roles for 4 years and from my observations of CMHTs, the generic care manager/MH practitioner role has many benefits but does seem to have pushed out rather than integrated and shared unique SW practice and knowledge, making services more clinical and NHS specific than integrated with the LA. I think this is one of the reasons why care act duties are taking a while to cement into community MH teams also. It would be interesting to hear more about your view on this from your experience.
“no time ” . If any one phrase sums up social work today it is , “no time”. It’s the same in day care, home care and residential care, ” no time”. It’s the same phrase what ever the client group. Life stories are just another example. Social workers would be good at it but it’s not a priority, case loads are too big, time scales are too short and qualified staff have too many other demands on their time. Life stories are exactly what the “key worker”in residential and day care services was supposed to do but staffing levels mean life is dominated by must do practical tasks. Being a home care would be a lot more rewarding if there was time and opportunity to discover someone life story rather than simply dash in to feed, wash and toilet. But there is just , “no time”.
Great idea but not a new one. its being going in in Care Homes for years
The author’s statement “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” is such a sweeping statement with no suggestion of how this conclusion was made and actually not true of most care homes.
Many care homes including the group I work for has been creating life stories for a very long time. This is not new in good dementia practice. It is key that these are developed with the person and their families so that staff can use them effectively in their work to enhance the wellbeing of our residents. We have had some very detailed books and memory boxes created by families but we must remember that not all people have a life history they want to remember and for the person living with dementia this can be distressing. In my view life story work must be unique to the person and benefit their wellbeing and wanted. For those that do not want them then we should develop a good social care plan that concentrates on the “here and now” and what gives the person fulfilment and enhances their wellbeing.
We use My Life Story for anyone with a diagnosis of Dementia. This has proved invaluable for everyone from the service users, families and carers. We encourage the families to complete it with the service user rather than it being a worker led exercise. I don’t think it is fair to say it is not big in Adult Services.
I have had the privilege of working in MH Swk for over 10 yrs & have also, worked in a substance misuse team for nearly 5yrs. I have always embedded life story work within my assessments; no matter the pressures of workload because of its therapeutic-cartarthic nature; even though it sometimes evokes v powerful: albeit, negative feelings! If it becomes unhelpful; you strategise, you revisit & you adopt & adapt! Again, you use collateral info to build up a well, rounded picture of the individual for a better working relationship & to help others who would offer future care needs.
I believe that we continue to bring such issues repeatedly into supervision if you’re not getting the time. And also, to go back to complete assessments instead of completing the exercise in one go. Substance misuse service users have taught me a lot! One intervention is certainly not enough & you gain a lot going through the various high & low scenes of life with them. You get to know the person behind the condition; so with stable, MH clients Let’s promote this area of practice, as it’s not the exclusive rights of Chn Services. N I remember my swk training encouraged it too; though easier said than done. The crunch is, childhood experiences certainly has a bearing on our twilight yrs.