Healing through Story: A conceptual framework for narrative therapy in artistic podcast narratives

Back to table of contents Previous article Next article Book ReviewFull AccessMaps of Narrative PracticeSuEllen Hamkins M.D.SuEllen Hamkins M.D.Search for more papers by this authorPublished Online:1 Aug 2008https://doi.org/10.1176/ps.2008.59.8.941AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Narrative therapy offers effective psychotherapeutic approaches for every kind of mental health problem, and in his rigorous and graceful new book, Maps of Narrative Practice, Michael White has created a definitive text of theory and practice. White first began exploring narrative practices in the 1970s when working with families and children with long-standing problems, such as encopresis, by attending to how they experienced their lives through stories. By noticing their earliest, most tentative steps toward well-being and offering questions that made it possible to incorporate these "sparkling moments" into meaningful new stories of self-development, he discovered powerful ways to help people free themselves from their problems and find the health and happiness they desired. Over the next three decades, while working with people dealing with problems such as agoraphobia, bereavement, depression, psychosis, attention-deficit hyperactivity disorder, and trauma, he further developed and fleshed out how and why these emotionally moving, often playful "re-authoring conversations" work so well. Unrelated to "narrative medicine" or therapies that use stories in a general way, narrative therapy as developed by Michael White and his associates brings particular breadth, rigor, subtlety, and clinical acumen to working with the stories of people's lives, attending meticulously to which stories are focused upon and what effect those stories have. His prolific body of work stands as a foundation of narrative therapy, summarized and systematically presented for the first time in this brilliant new book.White maps out key territories of narrative practice, deftly linking theory with sentence-by-sentence analysis of therapeutic conversations. The book begins with the core narrative concept "externalizing the problem." White says, "When the problem becomes an entity that is separate from the person, and when people are not tied to… negative 'certainties' about their lives, new options for taking action to address the predicaments of their lives become available." Relinquishing a shameful "spoiled" identity, for example, an identity of a "crazy" person, to claim an identity as a person who is resisting and trying to overcome a challenging problem, such as "habits" or "voices," energizes and inspires clients and the clinicians working with them. Continuing in this "re-authoring" vein, the smallest successes in limiting a problem are elicited, named, fleshed out, and historicized, making available a new story of the person's knowledge and skills in coping that can be drawn from and built upon. Furthermore, discovering why a person wishes to overcome the problem (such as, "because I want to contribute something to the world") opens up new possibilities for positive developments.Narrative therapy brings the "why?" back to psychotherapy as a means to honor the importance of intentions and values in the creation of our lives, rather than examining only states, traits, drives, or biochemistry. Although White acknowledges the ways in which naturalistic explanations for people's behaviors may be beautiful (such as "it's only human to long for acknowledgement"), he sees these conclusions as therapeutic "cul-de-sacs." Rather, narrative therapy seeks to "spark a heightened state of mental activity" in which people are "stretching their minds" and "exercising their imaginations" in creating new possibilities for their lives, on the basis of what they personally give meaning to. These practices lead to movement from a problem-saturated identity to a value-based identity that supports actions that move a person closer to living as he or she prefers. Unprecedented change and growth can result. The metaphor of maps, used throughout the book, aptly captures White's detailed but nonprescriptive approach, in which he offers guidance for fruitful therapeutic inquiry while encouraging practitioners to allow conversations to be "unruly" and nonlinear.Maps of Narrative Practice is an important text by a master. Beautifully organized and a pleasure to read, it brings theory alive with colorful transcripts of therapy in every chapter and offers examples and instructions for applying narrative practices with the full range of mental health challenges that psychiatrists and therapists may be called upon to address. Although it is an excellent, accessible introduction to the field, experienced narrative therapists will draw upon its thoroughness, precision, and subtlety to invigorate and hone their craft. Dr. Hamkins is a psychiatrist at the Carson Center, Westfield, Massachusetts, and has a private practice in Northampton, Massachusetts. FiguresReferencesCited byDetailsCited byNone Volume 59Issue 8 August, 2008Pages 941-942PSYCHIATRIC SERVICES August 2008 Volume 59 Number 8 Metrics PDF download History Published online 1 August 2008 Published in print 1 August 2008

Background: Empathy and emotional expression, as important psychological elements, significantly impact couples’ marital satisfaction. Premarital counseling models are designed to increase positive couples’ communication behaviors and emotional style. Accordingly, this study compared the effects of marriage preparation based on Satir’s communication model and narrative therapy on empathy and emotional expression in single young adults. Methods: This quasi-experimental study employed a pre-test, post-test and a control group design. The research population included all girls and boys on the age of marriage who were referred to Vesta Counseling Clinic in Kashan City, Iran, from March 20th, to September 22nd, 2019. The study participants were 45 individuals who were selected by convenience sampling method. Then, they were randomly assigned to three groups (narrative therapy intervention, Satir intervention, and controls) of 15 clients. The research participants in the two intervention groups attended 11 sessions of narrative therapy and Satir communication therapy; however, the controls received no intervention. The data collection instruments were the Emotion Expression Scale (EES), and the Questionnaire Measure of Emotional Empathy (QMEE). The research hypotheses were tested using the Multivariate Analysis of Covariance (MANCOVA) by SPSS. Results: The present study results suggested that narrative therapy (F=53.97, P=0.0001) was more effective than Satir’s communication model (F=33.82, P=0.0001) in terms of emotional expression. Both intervention groups obtained higher mean scores on emotional expression, compared to the controls (F=29.005, P=0.0001). Besides, the narrative therapy group gained a higher Post-test mean score for empathy (F=101.12, P=0.0001), compared to the Satir group (F=84.93, P=0.0001). Besides, both interventions were more effective in the test groups, compared to the controls (F=68.27, P=0.0001). Conclusion: Narrative therapy was more effective for improving emotional expression and empathy, compared to Satir’s communication model. Family and marriage counselors are recommended to apply these premarital models for young single adults in counseling centers.

Background Patients with chronic mental illness often experience fragmented self-identity and impaired social functioning. The traditional biomedical model has limitations in promoting the reconstruction of patient agency. Narrative medicine provides a humanistic framework for understanding illness experiences through attention, representation, and belonging. Painting art therapy, utilizing nonverbal expression, facilitates the exploration and integration of the self. Existing research predominantly focuses on symptom relief, with limited exploration of art therapy's profound impact on self-identity reconstruction from a narrative medicine perspective. Against this backdrop, this study investigates the effects of painting art therapy on self-identity reconstruction in chronic mental illness patients from a narrative medicine framework. It aims to validate whether painting art therapy integrated with narrative medicine principles can effectively promote self-identity reconstruction in chronic mental illness patients, offering a new pathway for mental health interventions that combines clinical efficacy with humanistic care. Methods Employing a mixed-methods design, the study recruited 60 patients diagnosed with stable chronic schizophrenia or bipolar disorder from a mental health center. Participants were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group received 12 weeks of narrative medicine-guided art therapy (twice weekly), featuring structured activities such as illness story illustration, emotional symbol creation, and life map integration, supplemented by narrative interviews and reflective discussions. The control group maintained routine rehabilitation activities. Quantitative assessments were conducted using the Sense of Identity Scale (SIS), General Self-Efficacy Scale (GSES), and Symptom Checklist-90 (SCL-90) at baseline, post-intervention, and 3 months post-intervention. Semi-structured interviews were conducted with intervention group participants, and thematic analysis was performed on the textual data. Results Experimental results indicate that following the intervention, the total scores on the self-identity scale were significantly higher in the intervention group than in the control group (68.42 ± 6.31 vs. 58.15 ± 7.24, t = 5.892, p<.001), and their general self-efficacy scores also showed a marked improvement (28.50 ± 4.16 vs. 23.21 ± 4.80, t = 4.576, p<.001). The SCL-90 scale revealed that the intervention group exhibited more significant reductions in depression, anxiety, and interpersonal sensitivity factor scores compared to the control group (all p<.05). Qualitative analysis identified three core themes: “visual reconstruction of illness narratives,” “transformation of trauma symbols,” and “emergence of new self-narratives,” indicating that painting facilitated patients' acceptance of illness experiences and integration of personal life stories. Follow-up data showed stable self-identity scores in the intervention group, with sustained improvement in some indicators. Discussion This study confirms that art therapy grounded in narrative medicine effectively promotes self-identity reconstruction in chronic mental illness patients, yielding sustained effects in enhancing self-efficacy and alleviating psychological symptoms. By facilitating visual storytelling and reflective dialogue, this intervention helps patients transform fragmented illness experiences into coherent life narratives, holding significant clinical and public health implications. Future community mental health rehabilitation services should incorporate such humanities-art integrated intervention strategies. Multicenter, large-scale studies are recommended to validate long-term efficacy and underlying mechanisms, thereby providing evidence to advance holistic and humanized mental health service development.

In this article, the authors will describe a creative writing therapeutic group program they developed based on narrative therapy and narrative medicine principles. This was a Social Science and Humanities Research Council—Partnership Engagement Grant funded project, the aim of which was to develop a facilitator’s manual for people interested in offering this group, titled “Journey through Words”. The link to the agency partner’s website, where the manual is available, is provided. The group program is structured over 6 weeks and includes a writing prompt each week, focusing on the storyline of resilience rather than the storyline of diagnosis or disease. Using a narrative inquiry approach, the facilitators kept brief field notes following group meetings. These field notes indicate that although spirituality was not planned as an identified focus of the program, due to the space narrative therapy provides for people to describe their values, preferences, and hopes during hardship, the experience of the group was that members shared reflections which were deeply spiritual in nature.

Purpose: The purpose of this scoping review was to catalogue the current research on narrative medicine in the field of audiology. Furthermore, we aimed to identify future directions for research emphasizing the value and effectiveness of narrative medicine as a clinical technique leading to person-, child-, and family-centered care in hearing health care. Method: A scoping review of narrative medicine literature published between January 1, 1996, and March 5, 2023, was conducted across MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Articles included in the review were published in English and employed narrative medicine as an intervention technique in hearing health care. Multiple researchers reviewed the articles in three stages: (a) title review, (b) abstract review, and (c) full-text review based on the inclusion and exclusion criteria. Results: A total of three peer-reviewed case studies that employed narrative medicine in hearing health care met inclusion criteria for our scoping review. The three studies included implementation of the following narrative therapy techniques: (a) narrative building ( n = 3), (b) deconstructing ( n = 3), and (c) externalizing ( n = 2). Conclusions: Narrative medicine, specifically narrative therapy techniques, seems to hold promise for guiding patients toward change and more positive perspectives on their hearing health care since narrative techniques can lead to person-, child-, and family-centered care. However, with only three case studies uncovered in our search, further research is needed to better understand and quantify the value of narrative medicine in hearing research and care.

Chance and the prepared mind. This aphorism favored by the great psychologist Henry Murray best captures the serendipitous set of circumstances that led to the "Psychoanalysis and Narrative Medicine" conference I organized at the University of Florida on February 19-22, 2004. A long-standing interest in psychoanalysis prompted me to propose a conference on this topic to the Thomas H. Maren Foundation, which responded with a munificence that allowed me to build my field of dreams without cutting any corners. Although I am not a scholar of narrative medicine, it seems to me that in proposing a conjunction with psychoanalysis, I was inviting this exciting new discipline to claim an insufficiently acknowledged portion of its own history. For whereas narrative medicine, as I understand it, arose from a desire to bring "literary competence" (and the benefits of literary study generally) within the purview of the medical-school curriculum, it is, of course, psychoanalysis that is known as the "talking cure," and thus distills the essence of what narrative medicine is all about. From the standpoint of psychoanalysis, conversely, an alliance with narrative medicine offers the prospect of basking in the reflected glory of this revival of humanism within the bastions of science, and thereby strengthening its own beleaguered position both intramurally within the mental-health profession and in American culture at large. In tracing the psychoanalytic genealogy of narrative medicine, three prominent names come to my mind. The first, of course, is Freud. Freud's fundamental theoretical contribution is to have elucidated the influence of unconscious mental processes, and the defenses against them, on the whole of human life, while his greatest invention is of a new kind of human relationship, that between analyst and patient, in which people can seek a "soul cure" through exploring the meaning of [End Page 252] their (often painful) experiences with a trained professional in a secular context. Strikingly, although Freud was himself a neurologist before he became a psychotherapist, he insisted that "psycho-analysis is not a specialized branch of medicine," but rather belonged to psychology; and that the education of future analysts should "include branches of knowledge which are remote from medicine and which the doctor does not come across in his practice: the history of civilization, mythology, the psychology of religion and the science of literature."1 Without Freud, there would have been no psychoanalysis, but in at least one important respect he impeded rather than abetted the contemporary rapprochement with narrative medicine. I refer to his notorious recommendation that the analyst should cultivate an "emotional coldness" and model his or her technique on that of "the surgeon, who puts aside all his feelings" while performing an operation.2 For whereas it has been a principal thrust of narrative medicine to encourage physicians genuinely to listen to their patients, and in doing so to learn to look upon them not simply as a collection of symptoms but as fellow human beings, Freud's own espousal of a surgical model of psychoanalytic therapy paradoxically steered his movement in the opposite direction, a wrong turn from which it is only now, nearly a century later, definitively being rescued. The other two psychoanalysts who can be regarded as progenitors of narrative medicine, Georg Groddeck and Michael Balint, are central figures in the relational tradition that has, in my understanding, succeeded in rectifying many of Freud's mistakes, including his minimizing of the need for genuine compassion and empathy on the part of the analyst in order for emotional healing to take place in the patient. Both Groddeck and Balint were closely associated with Sándor Ferenczi, Freud's great Hungarian disciple, who, as Paul Stepansky has shown in his outstanding study of the vicissitudes of the surgical metaphor in Freud's work, effected the "only bona fide transformation" in Freud's conception when Ferenczi redefined the analyst not as a surgeon but as an obstetrician: The doctor's position in psychoanalytic treatment recalls in many ways...

Writing therapy usefully creates, or makes explicit, common ground between literature and medicine, arts and sciences, and between clinical and community sectors and the academy. It draws upon multiple theories of language, memory, pain, subjectivity, identity, creativity, and the unconscious and is a site at which the concerns of established and emerging disciplines and interest groups coalesce; for example, literary studies, psychoanalysis, narrative therapy, narrative medicine, trauma studies, human rights, life-writing, and testimony studies. This article maps the field to indicate the breadth and potential of writing therapy as well as its risks and difficulties, and also suggests ways in which the practice and theory of therapeutic writing relates to and might be compatible with the practice and theory of creative and life-writing. Research suggests that writing may be most beneficial to health if it moves through developmental stages typical of writing designed for a readership. Transformation in the writing over time is relevant to both literary and health assessments. The article concludes that writing therapy presents a fascinating challenge for the discipline of creative writing and that there is potential for university writer-teachers to investigate writing therapy in academic, health science and community settings.

Objective To analyze the research hotspots of domestic narrative nursing and explore its related research trends which provide reference and guidance for its application and development in China. Methods Wanfang, CNKI, VIP, CBM and other databases were retrieved from inception until October 2018. Word frequency analysis and graph cluster analysis were performed on the main information using Excel, Bicomb, Ucinet, Netdraw and gCLUTO software. Results A total of 649 articles were included. The result of visual analysis showed that the annual amount of publications showed an upward trend. The articles distributed abroad in many different journals which educational journals account mostly. The study regions were distributed in 34 provinces except Taiwan of China, Hainan, Tibet, and Macao Special Administrative Regions where mainly concentrated on East China and North China. The cooperation among authors and institutions both were not close; A total of 25 high-frequency key words were intercepted,and three hotspots of narrative nursing research in China were obtained,which respectively were: (1) The application of narrative medicine and the cultivation of narrative ability; (2) The application research of narrative therapy in humanistic care; (3) The application of narrative nursing in nursing practice. Conclusions Narrative nursing has attracted the attention of domestic scholars, but the depth and breadth of research still need to be improved. It is necessary to strengthen cooperation between inter-regional institutions, individuals and scientific research groups and pay attention to research hotspots in this field. Also,there is a need to conduct more high quality studies to verify the significance of narrative nursing. Key words: Narrative nursing; Hotspot; Bibliometrics; Cluster analysis

Clinical clerkship directors and faculty undertake the challenge of teaching patient-centered communication to students who face the enormous doctor-centered task of learning diagnostic medicine. The authors examined students' written reactions to the narrative exercise, which, drawing from narrative medicine and narrative therapy, challenges students to be more patient-centered by writing a patient's life story and sharing it with that patient. During one-half of an academic year (2008-2009), the authors used qualitative methods to explore the range of medical student experiences with the narrative exercise in the psychiatry clerkship. During the study period, 46 medical students completed the exercise, and 44 (96%) submitted 367 comments for the research team to analyze. Four broad categories emerged: (1) communication, (2) insight, (3) hope, and (4) mixed or negative reactions. The most common theme was improved communication, which comprised the subcategories of enhanced active listening, opening up, and relationship building. Improved insights included student insights into their patients, as well as the facilitation of patient insights into themselves, especially regarding their own strengths and relationships. The exercise was well received by students: Only five comments were categorized as negative, and all of these related to difficulties selecting patients. Students reported many examples of improved patient-centered communication facilitated by the exercise. The narrative exercise may also promote a greater understanding of patients as complete human beings rather than diagnostic entities. The approach may be useful in educational settings beyond the psychiatry clerkship.

I can (truly) say that this book opens up new and exciting territory for art therapy, an invisible wall has at last been dismantled. It is a very brave book as well as a very scholarly book. Linnell introduces poststructuralist ideas, primarily from Foucault, Derrida and Butler, examines similarities and differences between two therapeutic practices, art therapy and narrative therapy with their convergent theoretical underpinnings, and in expressive detail, poetically explores her clinical practice in relation to the ideas. Top of the agenda are relations of power in a postcolonial context, in gender and race and between therapist and client.

Background: Community medicine increasingly integrates interdisciplinary approaches to address complex determinants of health, including biological, psychological, and social factors. Art-based interventions (ABIs, such as music therapy, visual arts, narrative medicine, and performance) have shown promise in promoting community health, yet their underlying biological mechanisms remain underexplored. Objective: This study aims to examine the contribution of neuroscience in elucidating the mechanisms through which ABIs exert health benefits, thereby reinforcing their scientific legitimacy within the field of community medicine. Methods: A total of 10 peer-reviewed articles were selected based on relevance, methodological quality, and alignment with inclusion criteria. Thematic synthesis and content analysis were used to extract and categorize data on neurological, psychological, and immunological effects of ABIs. Results: The review identified consistent activation of key brain regions, such as the prefrontal cortex, amygdala, anterior cingulate cortex, and insula, during artistic engagement. These neural activities were linked to improvements in emotional regulation, cognitive flexibility, and empathy. Conclusion: Neuroscience provides a biologically grounded explanation for the efficacy of ABIs, validating their integration into community medicine. By influencing neural, endocrine, and immune pathways, ABIs contribute to psychosocial resilience, health promotion, and disease prevention. These findings support the strategic inclusion of arts in public health frameworks, particularly in underserved or culturally diverse communities.

By 2060, almost 25% (98 million) of the population is expected to be aged 65 or older. Health care professionals who provide hospice and palliative care are overtasked and demonstrate symptoms of burnout. Narrative medicine and mindfulness interventions create meaningful connections with patients, improve the delivery of patient-centered care, and enhance the health of the caregivers. In this pilot program, health care professionals in hospice and palliative care settings were invited to participate in a study to evaluate the impact of narrative medicine or mindfulness on measures of burnout and empathy. Participants completed baseline and 12-week post-intervention surveys of burnout and empathy, as well as weekly journals of their experience. Mean overall scores for depersonalization were significantly reduced at 12-week post-intervention. There were no significant changes in emotional exhaustion or empathy compared to baseline. This brief, weekly intervention may be beneficial for both patients and health care professionals in the hospice and palliative care setting.

The possible effects of violent video gameplay on adolescents are intensely debated, highlighting the difficulties in the violent media research. The current dissertation posits that media may sort effects in more subtle and less direct ways than thus far studied. It employed a novel perspective to investigate the possible effects of violent video games on adolescents’ social outcomes, by looking beyond aggression and by focusing on four social-cognitive skills: emotion recognition, inhibitory control, perspective-taking, and empathy for pain. The development of these skills is particularly salient during early adolescence. If such development would be disturbed by exposure to violent video games, it may underlie antisocial behavior. Integration of insights from media psychology, developmental psychology, and neuroscience led to an expectation that exposure to violent video games would be negatively related to and would have a negative impact on the four social-cognitive skills. To investigate how exposure to violent video games may influence these social-cognitive skills, we took a multi-level approach, by investigating possible effects on a self-report level (questionnaires), a behavioral level (reaction times), and a brain level (ERP responses). To test our hypotheses, we performed four studies employing various study designs: correlational, experimental, and quasi-experimental in different adolescent samples and in one young adult sample. The outcomes of this project indicated that the possible impact of violent video game exposure on adolescents’ social-cognitive skills is limited and may be observed only in terms of short-term effects: less accurate perspective-taking and lower empathy for pain reactions measured immediately after the game. Further, habitual exposure to violent video games was related to lower empathy for pain reactions, but only in young adults, not in adolescents. Contrary to our expectations, more frequent habitual exposure to violent video games was related to better inhibitory control over emotional expressions in adolescents. Moreover, we also tested the possible effects of exposure to antisocial content in other media, beyond video games, and found that it was related to less accurate emotion recognition and lower empathy for pain reactions in adolescents. While this project brings new insights which could enrich scientific and public debates on violent media effects on youth, future longitudinal studies are needed to better understand possible ‘traces’ of violent video games in adolescent development, considering individual developmental trajectories and differences between young people.

Art Psychotherapy and Narrative Therapy: An Account of Practitioner Research by Sheridan Linnell is the first in Bentham's e-book series, Rethinking Research and Professional Practices in Terms of ...

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