Knitting together some ripping yarns

Abstract

Psychologists Richard Nisbett and Timothy Wilson (1977) once posed as marketing researchers, asking department store shoppers to evaluate which of four pairs of nylon stockings were of the highest quality. After the shoppers chose their favorite pair, they justified their decision with reference to the quality of the fabric, the weave, the color, the texture and so forth. All the shoppers’ explanations were extremely reasonable—except that the four pairs of nylons were, in fact, identical. Many other social psychology studies demonstrate the remarkable ability of human beings to offer sincerely believed, rational-sounding, culturally acceptable but wildly inaccurate explanations for their behavior (Nisbett & Wilson 1977). Are the UK Alcohol Treatment Trial (UKATT) participants’ stories therefore nothing but ‘ripping yarns’, from which we cannot knit together any substantively meaningful conclusions? (Orford et al. 2005). In an absolute sense, all life stories contain inaccuracies stemming from socially instilled attributional biases, narratives available in the culture (e.g. that of psychotherapists), the limits of human introspection, memory lapses, cognitive distortions and affective needs (Ross 1989; Rappaport 1993). Had the UKATT team compared the characteristics of participants who invoked different explanations for positive change (e.g. men versus women, religious versus non-religious, MET versus SBNT) it would very probably have highlighted how attributional accounts are distorted by subjective experience. Yet more subjectivity would have been evident had the analysis covered attributions for negative changes: some putatively self-made men who cast their successes as a hero's journey magically transform into fatalistic hostages to fortune when apportioning blame for their failures. We none the less applaud the UKATT team's attention to participants’ stories of change for two reasons: (1) even a ripping yarn may contain important truths and (2) what clients believe influences their health and life, irrespective of its truth value. Several elements of the participants’ stories can be tested objectively and have garnered significant empirical support. Social networks do indeed influence the course of drinking problems (Beattie et al. 1993). The participants’ assertion that assessment and brief intervention alone can significantly affect drinking behavior has also been confirmed objectively (e.g. Wallace et al. 1988). One wonders if the addiction field's decades-long underestimation of the power of brief interventions—which stemmed from some subjectively distorted narratives of our own—would have been corrected sooner if we had adopted the UKATT team's approach of consistently listening carefully to how alcohol treatment study participants described the change process. Of course, neither of these objectively confirmed elements establishes the veridicality of the participants’ stories in their entirety. A growing body of research attests that narratives reflect a complex process of meaning-making informed by an individual's understanding of addiction, and his or her knowledge of cultural resources for interpreting change (Hanninen & Koski-Jännes 1999). The literature on recovery narratives suggests that the truth value of one's life story has less impact than does the extent to which it is believed. Many psychotherapists appreciate this principle. Irrespective of whether a patients’ objective contribution to change in psychotherapy is enormous or small, many therapists will encourage individual credit-taking, as this augments the confidence and self-efficacy that support maintenance of change (Kanfer & Schefft 1988). In that sense, part of successful treatment may involve persuading clients to believe in a ripping yarn that has a happy ending. Preparation of this paper was supported by the US Department of Veterans Affairs Health Services Research and Development Service.