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Applications of narrative theory and therapy to the practice of family medicine


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This article presents narrative theory and therapy as an approach with significant potential for providing family physicians with additional tools to assist them in dealing with difficult clinician-patient encounters. We first define narrative therapy, then briefly describe its theoretical assumptions in relation to psychosocial concepts already familiar to family physicians. Important aspects of narrative therapy are examined, including the unique role of questioning in the narrative process; understanding and helping patients change their problem-saturated stories; renaming and externalizing the patient problem; and the use of rituals, documents, and audience in recognizing and reinforcing patient change. The article concludes with thoughts about how narrative approaches can contribute to more-healing doctor-patient relationships.
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February 2002
Family Medicine
Narrative therapy is a form of psychotherapy, pioneered
in Australia and New Zealand in the 1980s,
that em-
phasizes the importance of story and language in the
development and expression of interpersonal and
intrapersonal problems.
It uses therapeutic question-
ing to help clients recognize and reflect on the discrep-
ant but positive elements of their current problem-
saturated stories and to empower them to reformulate a
more-preferred life direction.
Clinical experiences with family practice residents
and their patients have convinced us that narrative ap-
proaches have much to offer the specialty of family
practice. In particular, patients who we label as
noncompliant, difficult, somatizing, self-defeating, de-
pressed, or anxious
can benefit from the incorpora-
tion of narrative elements into their encounters with
In this article, we use the case study of a patient who
initially was not able to comply with treatment recom-
mendations for diabetes to illustrate basic concepts and
techniques of narrative therapy that have application to
the practice of family medicine.
Narrative theory stresses above all the importance of
language in shaping people’s realities. It is important,
therefore, to make a contextual point about the language
used in this article. Narrative therapists do not like to
refer to themselves as therapists, and they rarely call
the people who consult with them patients or even cli-
ents. This is because therapist-client language contains
many assumptions about authority, power, and exper-
tise that narrative therapists wish to question. We sus-
pect that narrative therapists might have similar, even
stronger, feelings about the terms doctor and patient,
which are heavily freighted with symbolism and ex-
pectation. Nevertheless, for the sake of clarity, this ar-
ticle will continue to refer to doctors and patients as a
shorthand for roles deeply ingrained in the social fab-
ric. We hope that readers will begin to ask themselves
questions about what these labels convey both nega-
tively and positively about the individuals who assume
Theoretical Framework
The basis of narrative therapy is social construction-
or the idea that the way people experience them-
selves and their situation is “constructed” through cul-
turally mediated social interactions. Through story and
language, cultures send powerful messages to their
members about the meaning of important concepts that
sustain the culture, including gender, race, class, and,
Special Article
Applications of Narrative Theory and Therapy
to the Practice of Family Medicine
Johanna Shapiro, PhD; Valerie Ross, MS
From the Department of Family Medicine, University of California-Irvine
(Dr Shapiro); and the Department of Family Medicine, University of Wash-
ington (Ms Ross).
This article presents narrative theory and therapy as an approach with significant potential for provid-
ing family physicians with additional tools to assist them in dealing with difficult clinician-patient
encounters. We first define narrative therapy, then briefly describe its theoretical assumptions in rela-
tion to psychosocial concepts already familiar to family physicians. Important aspects of narrative
therapy are examined, including the unique role of questioning in the narrative process; understanding
and helping patients change their problem-saturated stories; renaming and externalizing the patient
problem; and the use of rituals, documents, and audience in recognizing and reinforcing patient change.
The article concludes with thoughts about how narrative approaches can contribute to more-healing
doctor-patient relationships.
(Fam Med 2002;34(2):96-100.)
97Vol. 34, No. 2
of course, health.
For example, the psychiatrist/anthro-
pologist Arthur Kleinman distinguished between dis-
ease and illness by defining the latter as “how the sick
person and the members of the family and wider social
network perceive, live with, and respond to symptoms
and disability;”
in other words, what a disease means
to the patient and family. Kleinman realized that such
meaning is made or constructed on the basis of per-
sonal beliefs about health and illness that are strongly
influenced by cultural norms and standards. Narrative
ideas offer a useful framework to help patients and phy-
sicians access this process of meaning construction and,
in cases of dysfunctional meaning, work to change it.
The Patient
Mr A was a 51-year-old white male with adult onset
diabetes mellitus and secondary complications, seen by
a third-year family practice resident, Dr B, in a univer-
sity-based outpatient clinic. Initially relying on a dis-
ease model, the physician tried to manage Mr A through
a treatment plan of blood sugar monitoring, medica-
tion, diet, and exercise. The patient, however, seemed
to ignore the physician’s recommendations. Dr B de-
scribed the patient as chronically noncompliant and in
denial, and Dr B was frustrated by his care. In particu-
lar, Dr B complained of being “tired of telling him what
to do” with so little result. An initial narrative-based
intervention invited Dr B to switch from making direc-
tive statements to Mr A to asking him questions—lots
of questions.
Questioning: the Basic Tool of Narrative Therapy
Physicians use questions to identify the chief com-
plaint, clarify pertinent symptomatology, elicit the his-
tory of present illness, and formulate a differential di-
agnosis. This type of questioning seeks specific answers
and generates information used to corroborate or modify
the physician’s conclusions. The format of this ques-
tioning tends to privilege the knowledge of the doctor
over that of the patient, by inferring that the patient can
offer either right or wrong responses, relevant or tan-
gential data.
Narrative questioning has the intent of uncovering
meaning and generating experience rather than creat-
ing information.
This type of questioning emphasizes
patients making their own interpretations of events and
formulating their own insights. The result is a process
in which patient self-discovery and understanding are
central, and the physician’s role is facilitator and ally.
Narrative therapists use different kinds of questions to
achieve these effects (Table 1). For example, questions
are used to invite people to see their stories from dif-
ferent perspectives and to understand how they are in-
fluenced by sociocultural factors. Other questions ask
patients to envision different, more-hopeful outcomes
for themselves, to probe the significance of rare but
hopeful events in their lives, and help them recognize
that they are constantly making choices for or against a
particular problem-saturated story.
The Problem-saturated Story
Narrative therapy involves working with people who
are stuck in problem-saturated stories that they tell
themselves, and that society has told them, about who
they are and what their lives signify. These stories have
become “disabling”
in the sense that the individuals
feel they have lost control of their stories and are un-
able to change their meaning. For example, one day,
Mr A told us, “Everybody knows you have to be very
compulsive to control diabetes, like Mary Tyler Moore.
I’m not that kind of person, so I’m sunk. This “story”
is based on prevalent beliefs within both the culture of
medicine and the larger society about “good” and “bad”
diabetic patients. It may not be the story the teller wants
to tell but is perceived as the only story available.
Renaming the Problem
Technical medical language emphasizes pathologi-
cal processes and deficits and often makes it difficult
for patients to accept more preferred or desirable sto-
ries about themselves.
Noncompliance, for example,
is a term rooted in the medical model of disease that
has been criticized as pejorative, coercive, and
Narrative therapists encourage the use
of patient, rather than medical, descriptions of the prob-
lem. When the patient creates a personalized “working
label” for his/her problem, he/she gains power and con-
trol. For example, rather than view himself as
noncompliant, Mr A preferred to talk about his attitude
of not caring.
Externalizing the Problem
A major premise of narrative therapy is that the per-
son is not the problem; the problem is the problem. A
narrative approach advocates externalizing the patients
problem by locating it outside the individual and within
the culture. Working as a narrative physician, Dr B be-
gan to wonder which aspects of her patient’s world and
belief system had encouraged this problem of not car-
ing. Specifically, she asked, “Where did the idea that
you have to be like Mary Tyler Moore to control diabe-
tes come from?” Questions such as this help patients
realize that what they conceive of as their problem is
tightly woven into the social and cultural fabric. In the
case of Mr A, we learned that societally supported views
about how men should handle illness (being “macho,
“ignoring,and “not being compulsive” about sickness)
influenced his not-caring responses. Through a series
of such questions, Mr A (and Dr B) began to think of
not caring not as some kind of personality flaw at the
core of his being but as a problem that existed outside
himself and was created in part by societal expecta-
tions and pressures about gender roles.
Special Article
February 2002
Family Medicine
When faced with seemingly intractable patient prob-
lems such as noncompliance, physicians may feel, as
did Dr B, that patient and disease are in league against
them. Externalizing helps reset this boundary by creat-
ing an alliance of doctor and patient on one side versus
the problem on the other.
If physician and patient can
become paired against a challenging but ultimately
beatable problem, the patient-physician coalition has a
better chance of remaining intact.
A common concern about externalizing is that such
an approach will cause patients to take less responsi-
bility for their problems. Paradoxically, narrative thera-
pists insist that just the reverse occurs. When people
are freed from self-blame and guilt, they are more likely
to take responsibility for the effects the problem has on
their lives and more likely to assume a position of re-
sistance and overcoming toward a problem they view
as something distinct from themselves. At one point,
Mr A confided with a conspiratorial grin, This not
caring thinks it’s smarter ‘n me. But I can out-trick it.
Exploring the Effects of the Problem
By asking questions not about the cause of the prob-
lem but about the influences or effects it has on the
patient’s life, it is possible for the patient to clearly iden-
tify the problem story. For our patient, some of these
reverberations of the problem included frequent doctor
visits, pain, hospitalizations, and neuropathies, as well
as a sense of hopelessness and failure. Sometimes it is
helpful to ask patients, “What will happen if the prob-
lem were to continue on its present course?” The pa-
tient can even provide a name for the plot of the prob-
lem story.
As Mr A put it, “Unless I start paying atten-
tion to this darn thing, my story will be called ‘How to
Let Diabetes Kill You.
Table 1
Types of Narrative Questions
Term Purpose Example
DECONSTRUCTIVE Show how stories are constructed; situate narratives Who told you “real men” don’t pay attention to their health?
in larger systems
RENAMING Support patient efficacy by sharing authorship What would you call this problem of not paying attention to
and expertise with patient your diabetes?
PERSPECTIVE Explore other people’s views of patient Does everyone agree that you’re not capable of managing
diabetes, or does someone have a different idea?
OPENING SPACE Allow hopeful thoughts, actions to surface and be Are there ever times when not caring doesn’t control you?
explored; highlight patient efficacy regarding problem Tell me about these.
HYPOTHETICAL Stimulate patient’s imagination to envision different, Suppose a miracle happened and not caring was solved,
(MIRACLE) more hopeful futures how would your life be different?
PREFERENCE Check to make sure that exceptional moments How did you feel when you got the trucking job? Is this
are actually preferred to the problem story; something you really want?
establish patient preferences
STORY DEVELOPMENT Explore and linger on elements of the preferred story Tell me more about how you were able to resist that fast
food? What exactly happened?
REDESCRIPTION Help patient recognize preferred qualities in themselves What does it say about you as a person that you were able to
and probe implications for identity test your blood sugars daily last week?
BIFURCATION Encourage patient to align him/herself against the problem Is the event you’re describing on the side of not caring or
against not caring?
STOPPER Refocus patient when he/she seems to be getting stuck Which story are you telling now?
in old story
AUDIENCE Identify supportive witnesses to the new or developing story Who in your life would be least surprised that you are able
to make this change?
Many different authors have created questions and question types that assist the main tenets of narrative therapy: deconstruction, externalizing, and restorying.
White and Epston’s
work laid wide-ranging groundwork; Freedman and Combs
also provide extensive examples. This table suggests a few types of
questions that were helpful in the case at hand.
99Vol. 34, No. 2
It is equally important to explore the effects of the
patient on the problem. In other words, in what areas
does the patient have influence over the problem? In
what ways can the patient still stand up to the prob-
lem? Here is an example of a typical patient-effects
question asked by Dr B: “Can you tell us about a time
when you have been stronger than not caring?at which
point Mr A recalled occasions when he had chosen to
follow his diabetic diet. Such questions help make vis-
ible the positive ways the patient may be acting or plan-
ning on acting in relation to the problem.
Searching for Hopeful Exceptions
to the Problem
The overarching goal of narrative therapy is to help
the patient replace the problem-saturated story by con-
structing a preferred story.
The building blocks for
this new story are found in the discovery of hopeful
moments, thoughts, or events that do not fit with the
problem story. For Mr A, holding a job, beating co-
caine, and wanting to see his 2-year-old son grow up
were examples of such occurrences that, when discussed
with the physician, reflected back to Mr A possibilities
of hope and transformation.
Patients are often dismissive of these sometimes
small and initially uncharacteristic glimmers. At one
point, Mr A told us, Anybody can have thoughts about
wanting to change. The narrative physician can play
an important role by questioning this perception. In-
stead of ignoring such hopeful moments, Dr B chose to
focus intently on them. “Wait a moment! Are you tell-
ing me you’ve been thinking about tackling your dia-
betes? How did you manage to do that? How did that
make you feel? How is that in line with what you want
from your life?” Lingering over such occurrences, and
asking the patient to reflect on their details, helps them
grow in importance and power.
Patient Preference
Because it is easy to become impatient about identi-
fying hopeful moments and building a preferred story,
narrative physicians should remember two cardinal
rules: (1) don’t try to convince the patient to rewrite
his/her story and (2) stay behind the patient.
A narra-
tive approach does not involve physician persuasion or
coercion. Rather, it encourages the patient to find his/
her own voice and to make choices about how he/she
wants to live. Opposing the patient’s viewpoint simply
results in an escalation of defensiveness and resistance.
Narrative therapists also caution that rather than be-
coming cheerleaders for patient change, their role is to
stay behind the patient’s progress, recognize it, empha-
size it, but always ensure that it is being pursued and
desired by the patient. With Mr A, Dr B learned to
switch from praise (“That’s great you’ve started to eat
more regular meals.) to respectful interest in the be-
havior (“How were you able to come up with a more
organized schedule for eating?”). In this model, rein-
forcement takes a back seat to understanding how suc-
cessful change occurs, is in line with Mr As values,
and supports the image he has of himself.
Although narrative therapy relies primarily on ques-
tioning and listening in the search for preferred mean-
ings, it also uses other techniques that have relevance
to a family practice setting. Note-taking stresses the
incorporation of exact patient language, a willingness
to share these observations with the patient, and en-
couragement of the patient to take his/her own notes
during a session, implying that the patient’s observa-
tions are as valid and important as the physician’s.
Letter writing from physician to patient is another pow-
erful technique to summarize key points of a session
and, with the advent of e-mail, not excessively time-
consuming. Documents, such as certificates, awards,
and diplomas specifically created to commemorate sig-
nificant patient developments, are also meaningful.
When Mr As blood sugars started regularly hovering
around 150, we drew up a Certificate of Unbelievable
Progress,which we all laughed about but that he
proudly showed his son. All these approaches take ad-
vantage of the power of ritual
in solidifying and me-
morializing significant life changes.
Generating Support
One of the most effective ways of strengthening the
new, developing story is by creating a receptive audi-
ence who serve as “witnesses. The doctor is an impor-
tant member of this potential audience, but it is useful
to have patients identify other audience members as
well. A key aspect of a successful audience is that it be
comprised of people who are supportive of and opti-
mistic about the patient. Members of Mr As audience
included his girlfriend, his mother, and (symbolically)
a deceased aunt and Joe Namath. Mr A was a big foot-
ball fan.
The patient’s new story is built by linking together
hopeful thoughts and actions over time (past and fu-
ture) and space into a coherent narrative. Building these
links is not easy but can be facilitated by paying care-
ful attention to the details of change, the effects of even
small increments of change on the patient and his/her
significant others, and specific steps leading up to these
hopeful moments. In the construction of the patient’s
new story, the physician is less coauthor than light-
handed editor.
The physician’s goal is not so much
“selling” interpretations to the patient
as assisting to
deconstruct problematic behavior, note contradictory
occurrences, and wonder about their significance. The
patient puts together the pieces.
Special Article
February 2002
Family Medicine
In a narrative approach, the emphasis between doc-
tor and patient is on creating space for multiple per-
spectives to emerge and coexist, developing horizontal
collaborative relationships, openness, and optimism.
The narrative physician can develop a relationship not
just with the patient’s disease but with the patient’s life
in ways that surprise and please. As Dr B stated, “Be-
fore I began working with Mr A in a narrative way, I
really didn’t like him. When we became a team against
not caring, I stopped disliking Mr A and started to dis-
like his problem. Then, as Mr A started to care more
about himself, I started to care about him too.Mr A
created new possibilities for treatment of his diabetes,
but Dr B also created a new story about both her pa-
tient and the meaning of noncompliance. In this case,
incorporating narrative ideas led to a healing and em-
powering dynamic among doctor, patient, and the prob-
lem of not caring.
Corresponding Author: Address correspondence to Dr Shapiro, University
of California-Irvine, Department of Family Medicine, 101 City Drive
South, Bldg 200, Rte 81, Orange, CA 92868-3298. 949-824-3748. Fax:
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... To guide their work, many of the researchers used the Theory of Culture-Centric Narratives in Health Promotion [26,34,35,42] and two authors combined this theory with the Social Cognitive Theory [33,37,43]. Other authors used the Theory of Planned Behavior [38,44], Indigenous epistemology and ontology [34], the Bioecological Model of Human Development [39,45], the Tool for Health and Resilience in Vulnerable Environments (THRIVE) Policy and Engagement Framework [36,46], Freire's Theoretical Framework of Empowerment [40,47], and social constructionism in the context of narrative therapy [41,48].The researchers also utilized several different study designs to assess the impact of the intervention that used DS including quasi-experimental study [26,33,38,40], case study [34-36, 39, 41], and crosssectional study [37]. Within these designs, the authors employed diverse methods: five qualitative [34-36, 39, 41], two quantitative [26,38], and three mixed methods [33,37,40]. ...
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Background It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants’ permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. Methods We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. Results Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). Conclusions Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.
... A narrative denotes telling a story from personal experiences with a particular point of view which may explain or describe "interpersonal and intrapersonal problems" [20]. [13] In their book considered "reflective thinking as a part of the critical-thinking process that refers specifically to the processes of analyzing and making judgments about what has happened". ...
... Sorun-doyumlu (problem-saturated) olarak adlandırılan bu hikayeler, toplum tarafından danışanlara dayatılır ve danışanlar hayatlarını bu hikayeler üzerinden anlamlandırır. Dayatılan bu hikayeler, danışanların yaşamları üzerindeki kontrolü kaybetmelerine neden olur (Shapiro & Ross 2002). Aile terapisi bağlamında değerlendirildiğinde hikayeler aileler için de önemlidir, çünkü aileler hikayeler sayesinde hayatlarına, ilişkilerine anlam verir ve onları şekillendirir. ...
... Governments, law enforcement agencies, human rights advocates, social workers, and others who work with disadvantaged groups know from firsthand experience that context matters. Supporting and nurturing ICH contributes to a positive sense of identity, belonging, and place and creates the conditions and environments for engaged citizens to work collaboratively to address global issues at the local level (Shapiro and Ross, 2002;Merill, 2007;Hyden, 2008;Gottschall, 2012). This includes revitalizing our democracy through the facilitation of public dialogue and conversations about Canadian values. ...
... Governments, law enforcement agencies, human rights advocates, social workers, and others who work with disadvantaged groups know from firsthand experience that context matters. Supporting and nurturing ICH contributes to a positive sense of identity, belonging, and place and creates the conditions and environments for engaged citizens to work collaboratively to address global issues at the local level (Shapiro and Ross, 2002;Merill, 2007;Hyden, 2008;Gottschall, 2012). This includes revitalizing our democracy through the facilitation of public dialogue and conversations about Canadian values. ...
... Moreover, narrative therapy has been used in dealing with various encounters such as treatment of adolescents at high risk for early childbearing, or adolescents with Asperger's disorder (Aloi, 2009;Charon, 2008;Cowley et al., 2002;Shapiro & Ross, 2002), which aligns with medical family therapists' experiences in IBHC settings. Being mindful of narratives of patients from different backgrounds with various experiences, traumas, and triggers can help medical family therapists provide more effective treatment. ...
Integrated behavioral health care (IBHC) provides patient-centered care, which assures full considerations of patients’ needs and promotes patients having a voice in decisions about their own health care. In this article, we consider narrative therapy as an empowering, nonpathologizing, and collaborative approach for medical family therapists and behavioral health practitioners to better help patients, families, and health-care systems in IBHC settings. Clinical examples are provided for effectively utilizing narrative therapy in IBHC settings across various stages of treatment. Using narrative medical family therapy informed by cultural humility, therapists can empower patients, help them reauthor their story through the lens of their experience, and validate their worldviews
... The basics of narrative therapy were first laid in the 1980s in Australia and New Zealand. Nowadays, it has gained a respectable place as a recognized therapy worldwide (Shapiro & Ross, 2002). ...
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The use of technology in all aspects of life while taking place in all areas of crime and crime perpetrators are also of great importance. Technology and Information show progress in the methods used in the discovery of crime, depending on technological development. The discovery of physical damage suffered by a patient from a glass piece on the offender’s belongings, the determination of the effects of the firearms used in the crime, the discovery of evidence through damaged paper pieces, the discovery of a possible physical appearance from human remains in real life with the 3D resurrecting software, and the visual access to confidential files, a number of new methods and techniques are used, , the rapid and reliable identification of disaster victims, and chemical analysis in fire research.
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ackground and Objectives: This study was carried out with the aim of comparing the effect of diet therapy and narrative intervention on the extent of body mass index (BMI) reduction in overweight and obese women. Subject and Methods: This was a quasi experimental-interventional study, in which 30 overweight women were selected by random sampling from among those consulting the Diet Clinic and randomly assigned to one of 2 intervention (group 1, diet therapy alone group 2, diet therapy plus narrative therapy) and a control group (receiving no intervention). The period of intervention was 5 weeks. Weight of all the subjects with light clothing was measured by a Seca scale to the nearest 0.5 kg and their height by a stadio-meter to the nearest 0.5 cm. The BMI was calculated by dividing weight (in kg) by squared height (m2). The data were analyzed using the SPSS 16 software, the statistical test being covariance analysis and paired t- test. Results: Data analysis showed that diet therapy alone (group 1) had no significant effect on the BMI (P>0.05), while in group 2 (diet therapy plus narrative therapy) BMI decreased significantly (P<0.001). Inter-group comparison (among the 3 groups) showed that there were no significant difference between diet therapy and narrative therapy with regard to BMI. Conclusion: The findings show that in the first phase of intervention life narratives about overweight help obese women correct their Nutritional habits. This is followed by BMI reduction in the second phase. Since diet therapy is not consistent with the women’s life narratives, it plays no role in correcting life narratives for more successful dieting. Considering the efficacy of narrative therapy in body mass index reduction and no effect by diet therapy alone, further studies on the life narratives of overweight women and their correction are recommended Keywords: Narrative therapy, Body mass index (BMI), Diet therapy, Overweight
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Introduction: The present study was conducted to investigate the effect of teaching to avoid cognitive errors through narrative therapy on depression and dysfunctional attitude in primary-school girls. Methods: This experimental study was conducted with a pretest-posttest design and a one-month follow-up. The assessment tool consisted of the Depression Self-Rating Scale (DSRS), and DAS-C and clinical interviews were used to evaluate dysfunctional attitude among the students. The sample population consisted of 36 fourth-and fifth-grade, female, primary-school students with depression in Shiraz. The experimental group was exposed to narrative therapy, the placebo group to selective stories (without educational content on avoiding cognitive errors) and the control group received no treatment. The ANCOVA was used to analyze the data. Results: The three groups were not different in terms of their depression score in the posttest (F=2.36, P=0.11), but the difference between them was significant in the follow-up stage (F=5.53, P=0.009). Significant differences were observed among the groups in terms of dysfunctional attitude and depression in the posttest (F=4.84, P=0.001) and the follow-up (P=0.0001, F=12.08). Conclusion: Narrative therapy was found to be effective in reducing depression and dysfunctional attitude in the students. Declaration of Interest: None.
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This book describes the clinical application of the growing body of ideas and practices that has come to be known as narrative therapy. The primary focus is on the ways of working that have arisen among therapists who . . . have organized their thinking around 2 metaphors: narrative and social construction. [This book is a text] for anyone curious about narrative, ready to have customary ways of seeing the world challenged, and eager to adopt clinical practices that give precedence to people's voices and stories. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In this article, I contrast assumptions of a modernist worldview and a postmodern worldview as they relate to clinical practice. Two exercises are described that help therapists develop insight into and practice with the kind of thinking that is consistent with a postmodern narrative clinical practice. Particular attention is paid to the ways that even the small and the ordinary — single words, single gestures, minor asides, trivial actions — can provide opportunities for generating new meanings. Five concepts that I routinely use in my professional and personal life and that are consistent with a postmodern narrative practice — discourse, externalizing the internalized discourse, exceptions, power as the means to produce a consensus, and characteristics of narrative — are illustrated.
This book presents a respectful, often playful approach to serious problems, with groundbreaking theory as a backdrop. The authors start with the assumption that people experience problems when the stories of their lives, as they or others have invented them, do not sufficiently represent their lived experience. In this way narrative comes to play a central role in therapy.
connection between normative life cycle-event derailment and the emergence of symptoms therapeutic rituals / transition rituals / healing rituals case examples (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There are three principal sections to this book. This first section is an introduction that provides the theoretical and political frame for the material presented in the other two sections. In this first section, I have presented an overview of some of the more recent developments in social theory that David and I have found of compelling interest, and some of what we believe to be the implications of those ideas for therapy. The discussion of theory includes some of Michel Foucault's thought on power and knowledge. It is our hope that the material that we have included in this book adequately reflects our exploration of practices of the literate tradition in a therapy that is situated in the text analogy and in Foucault's thought, and fairly represents the experience of these practices on behalf of those persons who have sought therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this essay I attempt to map the dimensions of my own move away from a cybernetic-biologic analogy for "family-systems" therapy. Central to this shift has been social construction theory augmented by two other lenses: a second-order view, and a sensitivity to gender. These conceptual tools have helped me to distance myself from my previous therapeutic stance and to envision a very different model, one that is less strategic and instrumental, and more collaborative and unconcealed.
Howard Brody is Professor of Family Practice and Philosophy and Director of the Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing. As indicated by his recent books, Stories of Sickness (1987) and The Healer's Power (1992), his research interests have included the importance of narrative and power as underexplored themes within medical ethics. * Two anonymous reviewers for this journal made several helpful recommendations for clarification and expansion. 1. The most comprehensive overview of placebo research and theory is Leonard White, Bernard Tursky, and Gary E. Schwartz, eds., Placebo: Theory, Research, and Mechanisms (New York: Guilford, 1985). See also Howard Brody, Placebos and the Philosophy of Medicine: Clinical, Conceptual, and Ethical Issues (Chicago: University of Chicago Press, 1980). This research documents at great length that the bodily changes produced by placebo responses and related mechanisms are real and measurable. Thus, the term symbolic healing, as used in this paper, refers to those aspects of the physician-patient encounter that bring about measurable bodily responses; the term is not intended to suggest that the responses themselves are imaginary or fleeting. 2. For further discussion of what I have termed the meaning model, see Howard Brody and David B. Waters, "Diagnosis Is Treatment," Journal of Family Practice 10 (March 1980): 445-49; Howard Brody, "The Placebo Response, Part 1: Exploring the Myths" and "The Placebo Response, Part 2: Use in Clinical Practice," Drug Therapy 16 (July 1986): 106-18, 119-31, respectively; and Howard Brody, "The Symbolic Power of the Modern Personal Physician: The Placebo Response under Challenge," Journal of Drug Issues 18 (Winter 1988): 149-61. Other very influential treatments are Arthur Kleinman, The Illness Narratives: Suffering, Healing, and The Human Condition (New York: Basic Books, 1988), and Barbara F. Sharf, "Patient-Physician Communication as Interpersonal Rhetoric: A Narrative Approach," Health Communication 2 (1990): 217-31. 3. See Dennis H. Novack, "Therapeutic Aspects of the Clinical Encounter," Journal of General Internal Medicine 2 (September-October 1987): 346-55. 4. George L. Engel, "How Much Longer Must Medicine's Science Be Bound by a Seventeenth Century World View?" in The Task of Medicine: Dialogue at Wickenburg, ed. Kerr L. White (Menlo Park, Calif.: Henry J. Kaiser Family Foundation, 1988), 113-36. 5. Martin J. Bass et al., "The Physician's Actions and the Outcome of Illness in Family Practice," Journal of Family Practice 23 (July 1986): 43-47, and Martin J. Bass et al., "Predictors of Outcome in Headache Patients Presenting to Family Physicians-A One Year Prospective Study," Headache 26 (June 1986): 285-94. 6. See, for example, Barbara Starfield et al., "The Influence of Patient-Practitioner Agreement on Outcome of Care," American Journal of Public Health 71 (February 1981): 127-31. 7. John Ladd, "Medical Ethics: Who Knows Best?" Lancet ii (22 November 1980): 1127-29. 8. Howard Brody, The Healer's Power (New Haven, Conn.: Yale University Press, 1992). 9. Eric J. Cassell, "The Nature of Suffering and the Goals of Medicine," New England Journal of Medicine 306 (18 March 1982): 639-45. 10. This discussion makes it appear as if a few simple moves on the physician's part will assure that the patient accepts the meaning that the physician feels is the best explanation of the symptom. Of course, the real world is not so simple: sometimes a protracted process of negotiation is required for physician and patient to arrive together at a satisfactory meaning (assuming that the patient doesn't simply go out shopping for a more agreeable physician). One case of my own comes to mind in which the negotiation as to whether a recurring problem with eye pain and double vision meant "undiagnosed brain tumor, like my mother had" or "emotional stress triggered by unresolved grief over your mother's death" lasted for several years and had not finally been resolved when the patient moved to another state. 11. Warren Thomas Reich, "Speaking of Suffering: A Moral Account of Compassion," Soundings 72 (Spring 1989): 83-108.