Look, we don’t love like flowers with only one season behind us; when we love, a sap older than memory rises in our arms. (Rainer Maria Rilke, 1939)

During our first session together, Samuel (a pseudonym), a divorcee in his 70s, said “I want to find out what I can remember about my life”. This introduced an important aspect of the work we would be doing together over the following months: exploring Samuel’s burgeoning autobiographical consciousness, woven together with fragments of memory. Memory is the foundation of one’s sense of self and operates at conscious, unconscious, explicit, and implicit levels (Fivush, 2022; Ewald Hering, 1870, as cited in Meares, 2013).

This article offers a narrative exploration of the intersection between memory, autobiography, self, ego integration, and psychological wellbeing in older clients using the case example of Samuel. As the population of older adults increases, therapists will likely encounter individuals from this demographic in their work (Australian Institute of Health and Welfare, 2024). While various approaches and theoretical frameworks promote understanding of the unique developmental challenges that accompany the later years, therapy with older adults remains under-explored (Greenwood, 2014). I hypothesise that working with older clients to compose and expand autobiographical consciousness that can be narrated and witnessed by an empathic other could be an important aspect of ego integration (E. H. Erikson, 1959). Ego integration is the final stage of Erik Erikson’s stages of psychosocial development and spans from age 65 until death (E. Erikson, 1963). It entails the examination of a life with the end in mind, wherein it is judged as either full, productive, and meaningful (resulting in a harmonious integration of ego) or unaccomplished and destitute (resulting in dis-integration of ego, disharmony, and despair) (Miller, 2023). Narrative could assist in the process of ego integration because it is a meaning-making tool that facilitates one’s sense of self and promotes the process of reconciliation with the past and direction towards the future. This exploration is situated within the framework of the Conversational Model of psychotherapy, developed by Robert Hobson (1985) and Russell Meares (2012). I outline the clinical observations I made when sitting in the room with Samuel, empathically attuned to his conscious and unconscious mental activity mediated through language and bodily cues, thereby contributing to the discussion about how to work meaningfully with older adults.

The Conversational Model and Stream of Consciousness

The Conversational Model of psychotherapy posits that the two primary goals of therapy are to potentiate the emergence of self and integrate traumatic memory systems (Meares, 2012). Self is conceptualised in an experiential and phenomenological way as “the ongoing flux of feelings, sensations, images, memories, and imaginings that we sense as uniquely our own” (Meares, 2012, p. 13) and is heavily inspired by the writings of William James (James, 1892, as cited in Meares, 2016). The stream of consciousness evokes a sense of life going on inside us, and although our thoughts are constantly in motion, we retain a sense of who we are (Guthrie & Moorey, 2018). Self takes form in the early years of life in the relationships between the infant and her primary caregiver but continues to develop throughout the lifespan. The infant becomes aware of her self by the caregiver “amplifying and representing her feeling states with words and expressions, providing a coherence and structure to what is experienced” (Guthrie & Moorey, 2018, p. 283).

A positive experience of self is accompanied by a subjective feeling of warmth and intimacy; however, if the individual receives neglectful or abusive care, the self will be impoverished, creating a sense of alienation and estrangement. Self is fostered in therapy through the therapist coupling with, representing, and amplifying what is most alive in the client (Meares, 2013). The other aim of the Conversational Model is the integration and dissolution of trauma by transmuting unconscious thoughts, feelings, and memory systems into conscious awareness through the use of metaphorical language and empathic resonance (Korner, 2021).

Autobiographical Memory: Reawakening the Past Self

Just as the self is realised in an attuned caregiving relationship, autobiographical memory is scaffolded and strengthened by elaborative parental reminiscing (Fivush, 2022). The children of parents who reminisce with them about the near and remote past, prompting details of memories and guiding and shaping a coherent narrative structure to the titbits of information recalled, score better on various developmental processes such as, according to Fivush (2022), “memory and narrative development, self-concept, theory of mind, and emotional regulation” (p. 27). These children are also more advanced in their development of autobiographical skills (Wu & Jobson, 2019). Reminiscing allows young children to re-present their experience in the symbolic form of language, and this sharing creates coherent patterns of activation that allow for subsequent remembering (Fivush, 2022). Therefore, children who have practised this skill in the parent–infant dyad can better recall memories throughout their lives.

The amalgam of episodes of autobiographical memory enables a sense of self-continuity over time, despite the many ways in which an individual changes (Prebble et al., 2013). In healthy individuals, autobiographical information can be organised conceptually, chronologically, and thematically (H. L. Williams et al., 2008), can contain elements of history and metaphor, and should be viewed as both biography and poetry (Bruhn, 2019).

Many varying conceptualisations exist of the intersection between autobiographical memory, self, and cognition. William James distinguished between the I-self (subjective experiencing self) and the me-self (mental representation of self that entails autobiographical consciousness; James, 1890, as cited in Prebble et al., 2013). This framework has an additional temporal dimension, distinguishing between the aspects of self that relate to the present moment and those temporally extended into the past and future. This extended aspect of self is maintained by episodic memory systems which enable a vivid sensory-perceptual recalling of a past event with an emotional dimension (Tulving, 1984). Damasio (2000) explained that this kind of extended consciousness gives rise to a sense of self through the constant reactivation of personal memories. Each memory generates a “pulse of core consciousness” which leads to “a sense of self-knowing” (p. 197). Additionally, Levine and van der Kolk (2015) emphasised the narrated aspect of episodic memory, noting that this memory system is made of “poignant stories we tell ourselves and others to make sense of our lives” (p. 16).

Remembering is an inherently relational process. For example, Fivush (2022) stated how “autobiographical memory is a broad integrative system that bridges memories of our past with our sense of self, other, and the world in the present and into the future” (p. 36). We do not realise a memory, its shape, texture, or meaning, or how it shapes our sense of self, except for in the interpersonal activity of its retelling.

On a developmental level, the first remembering is done dyadically, typically with the primary carer and at a level more advanced than the infant’s ability to remember alone, in what Vygotsky would call the “zone of proximal development” (Vygotsky, 1978). Not only is this remembering scaffolded by another, but the subject of autobiographical reminiscing tends to be self and other.

In the Conversational Model literature, Meares (2016) touched on autobiographical consciousness in his exploration of the complexity of feeling hierarchy. Meares outlined how, towards the top of the hierarchy, the experience of personal existing incorporates a feeling of both time and memory that is more complex than autobiographical memory (Meares, 2016). He named this self-sustaining memory system poetic memory and described it as an elaborate and multi-faceted version of autobiographical memory that is organised by “analogical correspondence between scenes experienced at various times in the past” (p. 81) which are superimposed on the present. As I understand it, this memory is organised less by chronological order and more according to the feeling tones of particular memories which are (consciously or unconsciously) sensed as being so alive that they seem to be experienced in the present moment. This calls to mind the writing of Frederic W. Meyers (1895), a researcher from the Victorian era who corresponded with William James. Meyers (1895) posited the thought experiment:

Let us imagine that a whole earth-life is in reality an absolutely instantaneous although an infinitely complex phenomenon. Let us suppose that my transcendental self discerns with equal directness and immediacy every element of this phenomenon; but that my empirical self receives each element mediately. (p. 593)

In Meares’ poetic memory, there is an acute awareness of the passing of time, or durée (Bergson, 1913, as cited in Meares, 2016), accompanied by a concurrent momentary erasure of time whereby consecutive events appear as simultaneous. My experience with Samuel was that poetic memory offered a route to a shared, expanded, atemporal intersubjective consciousness: we were simultaneously in the therapy room and his parents’ destroyed hometown in Poland. His imaginative world overlapped with an awareness of a time before he was born, and this was transmitted to me in the therapeutic space (see Vignette A).

Trauma and Memory: The Constricted Narrative

According to Sotgiu (2021), Sigmund Freud was the first psychoanalyst to suggest that forgetting or the absence of memory in one’s childhood is psychologically motivated as a way to cope with trauma. More recently, Habermas and Bluck (2000) proposed that deficits in life-story coherence might be linked to a history of trauma, such as attachment insecurity, which has been thoroughly studied by means of the Adult Attachment Interview (Hesse, 2008). During this interview, participants verbalise deeply embedded emotional representations of attachment experiences, and the absence or incoherence of early memories indicates a traumatic attachment style.

A well-studied link also exists between the impact of psychiatric illnesses, such as depression, and diminished autobiographical memory (Lemogne et al., 2006; J. M. G. Williams & Scott, 1988). Specifically, depressed individuals are less able to retrieve life memories. Moreover, Damasio (2000) posited that the autobiographical self shrivels in the acute stages of depression. John Hughlings Jackson (1931-1932, as cited in Haliburn, 2017) conceptualised this shrivelling in the face of trauma as a descent down the hierarchy of memory function. Since autobiographical memory is a more evolutionarily advanced memory system, it is often the first to be lost during an assault on the brain–mind system.

Additionally, trauma causes dysregulation in which one’s system continues to perceive threat even in its absence (Porges, 2011). Polyvagal theory explains this evolutionary response to safety and perceived threat through autonomic functions that attempt to restore homeostasis (Kolacz & Porges, 2018). For this reason, establishing interpersonal and bodily safety is a prerequisite for any meaningful therapy. Sympathetic nervous system responses (fight, flight, and freeze) are inhibited by activation of the social engagement system which is why the therapist needs to provide and promote an embodied sense of safety for the client (Kolacz & Porges, 2018).

When trauma overwhelms the system, standard memory systems fail, leaving the client with a flurry of incoherent memories, bodily sensations, pain, and emotions (van der Kolk, 2014). The Conversational Model of psychotherapy acknowledges the healing power of verbalising traumatic experiences in a therapeutic relationship in which there is safety and trust. The model’s emphasis on using symbolic language and focusing on what is alive in the room helps clients connect with incoherent, often inexpressible parts of themselves and their history (Haliburn, 2017). My work with Samuel, whose story is the focus of this essay, involved creating a therapeutic container built on safety and trust. While sitting with him in this space, I noticed our conversations meandered through his past with various levels of coherence. The next part of this essay outlines the work we did together.

Case Study: Samuel

Samuel is a retired doctor in his mid-70s of South African origin who was referred to me by a colleague for twice-weekly psychotherapy. He had received no diagnosis and this was his first experience of therapy. After a brief marriage and subsequent divorce in his 20s, he had not been able to experience a long-term romantic relationship; a primary therapeutic goal was to cultivate this kind of intimacy in his life. A secondary goal was for Samuel to make peace with the direction his life had taken to this point and approach the future unburdened by past regrets.

What struck me about Samuel was that he was acutely aware of how much time he had left on Earth. He regularly made comments such as “My dad lived to 83. If I follow the same path, it means I have seven years left”. This instilled in me a sense of urgency to “do the work”, but as a Conversational Model therapist, I balanced this urge with a passivity to wait and see what would emerge.

Underscoring Samuel’s awareness of his impermanence was a fascination with the lives of his late parents, Jewish refugees from Poland. While sitting with Samuel, I developed the tentative hypothesis that therapy could be a corrective experience of having memories scaffolded and woven together, thereby creating a sense of intergenerational autobiographical consciousness and intimacy with one’s life story. Additionally, therapy provided an opportunity for Samuel to welcome exiled parts of himself and his family story, as in Schwartz’s Internal Family Systems model (Schwartz, 2021, as cited in Brenner et al., 2023), especially regarding his ambivalent relationship with regret.

Intergenerational Remembering: Autobiography That Extends Beyond a Lifetime

Damasio (2000) writes how extended consciousness, the function that comprises the autobiographical self, may span “the entire life of an individual, from the cradle to the future” (p. 195). However, I argue that there is an intergenerational aspect to the autobiographical self and that consciousness can extend beyond our lived, embodied experience on Earth. During my sessions with Samuel, recollections of stories of his parents and grandparents emerged and, through our discussions and thinking, were woven into the emotionally rich tapestry of his own life stories. It seemed important for Samuel to remember them; remembering helped him to make sense of the trauma and discrimination they had experienced and the process supported his awareness of where they fitted into his understanding of himself.

The following vignette depicts a moment when Samuel connects with his parents by sharing stories of their lives and bringing it into the relationship between us. He acknowledges the pain this brings up and tries to understand what it means for him and how it connects with his own story.

Vignette A

Samuel: I know the towns where my parents grew up, in Poland. My parents lived in villages a few kilometres from each other, but never met until they came to South Africa.

Therapist: Oh wow. Did you go to Poland?

S: Yes, I visited 15 years ago. All the houses and schools were destroyed by the Nazis. They’ve built, like, ugly grey brutalist apartment blocks everywhere. There are no Jews there anymore, but there is an old shul still. I went up to it, took a picture in it. I thought, “maybe that’s a shul my grandfather went to as a young boy”.

T: Yes, it’s very possible. I guess this is another layer of your history. We were talking about the layers of your history last week.

S: Yes.

T: And this is maybe a new layer.

S: Yes, the Klezmer music I grew up listening to.

T: Oh, you enjoyed Klezmer music?

S: Yes. My mother had a beautiful voice. She sung traditional Eastern European songs around the house.

[Moment of reflective silence]

T: I guess we’ve gone back quite a bit in your history. We started with talking about childhood memories. And then we went even further back into your parents’ childhoods in a way.

S: Yes, and very poor. Lots of poverty. When my father’s father was 21, I don’t know how, but he was injured somehow, very seriously. Broke his leg. He never recovered … he could never really work.

T: Oh.

S: And he spoke a lot about that. About the poverty. They didn’t have toys, they used scraps of fabric and wood to fashion rough toys. He was smart, but he couldn’t do his homework—they had no lights. Especially during the winter. He tried to use a candle. And then, when the Nazis invaded, like all the Jewish kids, he was forced to leave school in fifth grade. That’s when his education stopped.

T: Oh, they were forced to leave school.

S: Yeah. My dad went to school one day, and they said, “All Jewish kids have to go home”. The beginning of the Second World War.

T: Oh wow.

S: But they did well despite that …

T: They did …

[Reflective silence]

T: I wonder what comes up talking about your parents and their stories? Is it difficult?

S: I feel emotional … I heard the stories, seeing what happened to my parents, seeing what they missed out on. Understanding what it means for me. How it fits in with my story.

Why is it important to remember the experiences of our ancestors? The Jewish theologian Abraham Joshua Heschel answered this question by asserting that “to us, recollection is a holy act; we sanctify the present by remembering the past” (2005, p. 334). Our ancestors’ lives are inherently linked to ours, and remembering them can imbue the present moment with an immense sense of meaning. On a more psychological level, family stories that are dissociated from the collective familial consciousness become handed down as unconscious traumatic memories that will “impoverish the next generation” (Pickering, 2019, p. 113). When these stories are remembered, they assume symbolic form through the process of narration and can be psychically metabolised and integrated. Samuel appeared to have some consciousness of this process and the importance of “understanding what it means for me. How it fits in with my story”.

Working with Older Adults and Ego Integration

Psychotherapists can expect to encounter an increasing number of older adults seeking psychotherapy (Lederman & Shefler, 2022). Although these individuals will present with varying issues, such as anxiety, depression, and bereavement, it is important that therapists are familiar with the general developmental pressures and challenges that accompany the later years. One framework through which this essay seeks to understand these pressures is Erikson’s final stage of psychosocial development termed ego integration.

Samuel was acutely aware of the finite time he had left on Earth which created a sense of urgency to share his previously untold life history. The developmental pressures that arise from entering the latter stages of a lifespan (age 65 to death) are outlined in Erikson’s (1959) stage of psychosocial development known as ego integration. If ego integration is not achieved, the result is a sense of despair (E. H. Erikson, 1959). To some extent, the individual’s narrative is also woven into the larger culture and society in which they are embedded (Lifton, 1996). My observation is that there appears to be a gap in the psychotherapy literature regarding the process through which this kind of integration is achieved in the therapeutic dyad. I hypothesise that working with our clients to compose and express an autobiographical consciousness that can be witnessed by an empathic other could be an important aspect of a harmonious integration, since narrative is a meaning-making tool that facilitates one’s sense of self and promotes a process of reconciliation with the past and direction towards the future (Bruhn, 2019).

Weaving the Threads: Ego Integration and the Self in Relationship

What is the purpose of collecting these strands of personal and trans-generational stories and how are they woven into an integrative whole? In Samuel’s words,

I don’t know how to make sense of my life … it feels so complex … such a difficult childhood, so much trauma in the family, my parents’ displacement and immigration … the bullshit, the divorce. How am I going to move past that? I feel so overwhelmed, it’s too hard.

In the months we worked together, our conversations meandered through the decades of his life in which the seeds of both generative and soul-destroying memories were buried. It appeared as though Samuel needed to cultivate an intimacy with his own life story, to know himself, before he would be able to share it with another outside the sanctum of the therapeutic dyad.

The concept of ego integration was selected for this case study because it depicts the process that occurs towards the end of the life cycle, as explained in Erikson’s (1959) stages of psychosocial development. Ego integration contains elements of contextual and temporal integration but is “greater than the sum of its parts” (Syed & McLean, 2016, p. 114). It entails integrating a story about the important components of a life and how they fit together over time (McAdams, 2013). Syed and McLean (2016) noted that the aspect of the ego integration process most true to Erikson’s writings is that the individual should “reflect on the process through which all that complexity (the self moving through context and time) came to be” (p. 114). Storytelling and life-narration is one way this integration occurs (McAdams, 2013) and has a particular pertinence for adults in later life.

Research has demonstrated many positive psychological benefits of possessing a coherent conception of the self in time and an overarching autobiographical narrative to structure this. For example, one study showed that using autobiographical retrieval practice with depressed older adults led to a significant decrease in symptoms compared with a control group (which was also being treated; Serrano et al., 2004). Other studies have suggested that maintaining a coherent autobiography protects the individual from mortality concerns by imbuing experience over time with significance and order (Landau et al., 2009). A certain kind of remembering known as nostalgic remembering (a sentimental longing for the past) may help people find and maintain a sense of meaning in life (Routledge et al., 2012).

The following vignette displays Samuel oscillating between broad, conceptual thinking (how things could have been different) and a sequence of specific autobiographical memories (his friend David, receiving a letter from David, playing soccer on the school team). It concludes with a comment about the “self-actualising” power of his sporting experiences.

Vignette B

Therapist: I wonder if you’ve ever asked yourself the same question?

Samuel: About?

T: About what you would have done … if things had been different.

S: Well, if I was, when I was a kid, and if I had the freedom and no pressure … I really liked sports, especially soccer.

T: Oh, you did! You liked soccer.

S: Anything related to sport. I remember when I left South Africa in '59 and my friend, my best friend from school, David, he—in those days we still wrote letters and hid them in each other’s backpack to find later, once we’d arrived home.

[Mutual laugh]

S: We wrote a couple of letters but then … lost touch. I can’t even find him on Facebook. I lost touch with him. David. He may have made his profile unsearchable, or maybe he never made one, so I will never find him. I don’t know. But I remember the last letter I got from him, 'cause we were in high school, I think. How old are you when you start high school here?

T: I think you’re around 12 years old.

S: In South Africa we left primary at, um … 13 years old. He wrote me a letter, and he said, “We played a great game on the weekend and we were thinking of you”. So that was, yeah, it was something I always liked. Playing soccer, on the wing. I loved the audience, the adrenaline, the way they cheered, the feeling of all eyes being on me … completely present. But I stopped playing. I was really good. Maybe I wouldn’t have been professional but it could’ve been a hobby, a life commitment … I don’t know.

T: It’s something you really enjoyed.

S: Enjoyed. Not anymore. It’s died already.

T: It died?

S: Yeah, I can’t play soccer now. I’m too old. But it was fun …

T: It was fun … I wonder, what was fun about it?

S: Just being in the moment. It’s not about survival, but it feels exciting. To be a part of something bigger than yourself. It’s just, you know. It’s that, that kind of self-fulfilment. Knowing teammates depend on you. I don’t know what … Self-actualisation. Just something that comes from within. That need to push yourself to your limits.

T: It sounds quite freeing and communal. To self-actualise but in a team.

In this moment, I felt the sorrow at losing contact with David was mirrored in Samuel’s alluding to having lost contact with part of himself—the part that was present and self-fulfilled while playing soccer. He illuminated this lost relationship in therapy, and, for a moment, David was present, along with fond memories of Samuel playing soccer at school with the rest of his team. There was a shared feeling of the self-actualising power of being able to recall, of reawakening the past, of sharing what is transmissible with an empathic other.

Conclusion

In this article, I have offered a narrative exploration of the intersection between memory, autobiography, self, ego integration, and psychological wellbeing in older clients through the case study of Samuel. As the population of older adults increases, therapists will likely encounter individuals from this demographic in their work. Therefore, therapists and researchers must work towards deepening their understanding of the unique developmental challenges accompanying older adulthood and promote psychological health in light of these challenges. This article has outlined the role of autobiographical memory, self-narration, and intergenerational storytelling using Erikson’s (1959) psychosocial stage of ego integration within the Conversational Model of psychotherapy framework.

My work with Samuel ended one week before the planned date after eight months of twice-weekly sessions. He still had not achieved his goal of finding a long-term romantic partner but was well on the way towards making peace with his past and moving, unburdened, into the future. Five months into our work, he mentioned he would “cherish this time we had spent together”, and at our parting he said he hoped to feel the benefits of therapy into the future. I am confident that our time together was a soulful and meaningful experience for him, and I feel genuinely privileged to have witnessed his life story in such an intimate way.