A Brief Case Study
Martin (not his real name) was a 37-year-old man who came to counseling to grieve over his mother’s death and address powerful feelings of shame and anger, and what he termed a “budding alcoholism.” Martin was highly intelligent and sensitive to those around him. He had grown up in a family full of addiction, conflict, broken trust, and insecurity. He was grappling with the legacy of his mother, who was both very dear to him and alternatively a source of great pain.
Martin’s story was that he had come from poor genetic source material, as evidenced by his family’s struggles with addiction and the broken home to which he was accustomed. Martin believed he was destined to be an angry alcoholic, like a few people in his family. We discussed much of the arc of his life, from early memories to current events. He could easily recall that when he was a child, he still believed in himself. He was able to recognize that as a teenager, this confidence began to slip, and as he accumulated the large and small traumas of adolescence, the story he told himself began to change. He began to lower his expectations of himself as his awareness of his family’s dysfunction became clear. As the story changed, so did his behavior in the world. He began to skip school more often, which resulted in his grades suffering. His parents’ addictions further alienated him from them, despite his attempts to stay in relationship with them. He was physically abused at times.
When Martin came in, he believed he was no good, and that just by having born into the family he was, he had no chance of happiness or success. A large part of our work involved rewriting his story and bringing his adult life experience and perspective to bear on his upbringing. Ten-year-old Martin had a very hard time understanding why his parents were unreliable and alternatively loving or abusive. In many ways he blamed himself, crafting a very damaging narrative for himself in the absence of a more obvious one…one that the older Martin could grow to see. The grown version of Martin spent significant time in sessions contextualizing his experience, taking numerous incidents from his past and processing them. I would ask him things like, “What if that ten-year-old kid was your nephew? Would you blame him for the dysfunction of his parents?”
Like so many of our clients do, he was able to conclude that kids aren’t responsible for what their parents do. His work then became about telling versions of his origin story that incorporated his present insights. He started to believe that despite his suffering, he had done the best he could, and his tumultuous upbringing became a source of connection with others. He was capable of a very deep level of empathy based on his experiences, and his peers sensed and valued this. He also desired connection with people; having been deprived of it for much of his life, he was a ready and willing friend to most. The difficulty of his early life had instilled these qualities, and hard-won as they were, he came to appreciate them.
What Does It All Mean?
It is important to help our clients from the very beginning of therapy to craft meaningful stories that assist them in regaining control or that foster some sort of learning, and therefore adaptive behavior. In Martin’s case, the story he ultimately crafted was that his difficult upbringing had helped him develop into a better human being in relation to others. He could have easily landed on any number of conclusions that would have fostered healing in him. There are in fact innumerable adaptive options to almost any problem. Adaptive learning weaves in with healthy changes and progressions in narrative quite beautifully, and this can all occur when our clients understand what conditions were present and how sequences of events in their lives have played out. I am fond of diagramming aspects of any story or event with clients, as once an event is thoroughly examined, numerous opportunities for learning and growth present themselves organically. Anything with a beginning, middle, and end can be comprehended. Patterns can be interrupted, future mistakes can be avoided, future opportunities can be seized.
EMDR makes great efforts in the direction of making sure the client lands on a healthy story, which is healing in and of itself. It is critical that clients actually change their beliefs (story) about how the trauma happened and what it means for them to successfully reprocess it. We can wave the wand around all we want, but if the client still thinks “I am unlovable” at the end of the session, not much healing is going to take place. We simply must get to “I am lovable,” and other positive cognitions ad infinitum.
Conversely, we need to be vigilant and cautious to not overinterpret our clients’ narratives or inject too much of our thinking and biases into that process. This can be a very fine line indeed. Our desire to help can become its own blind spot, and managing our own countertransference is critical to fostering positive narrative outcomes in therapy. Clients do not need to overcome our traumas as clinicians, nor do they need to satisfy our own narrative expectations. I really like my own ideas, but they may not be the best for my client. I will often ask how my clients come to the conclusions that they do, and inevitably, the answer comes back in story form. This provides a wonderful opportunity for strengthening therapeutic alliance, as we acknowledge and validate the client’s experience. Our empathy for our own clients is deepened as we encounter more and more of their story. We can understand how a person who experienced x can easily end up believing y and, significantly, engaging in behavior z as a result. This also provides ample opportunity to put those CBT and/or Narrative Therapy caps back on and start to draw connections between the clients’ thoughts, feelings, behaviors, and decisions.
For example, I might say to a client, “I’ve noticed that every time you think [x], you tend to feel [y], and then you often go and [z] to try and get some relief. From where I’m sitting, I am wondering about what if you decided to think about [a], and then feel [b], which would likely lead you to go do [c]. People mostly come in because of their [z]’s and [c]’s, so it’s important to make sure those are good.”
Or, “Ok, so the story is you can’t walk down that street anymore. Some people would conclude they should study martial arts, or that walking down the street on Tuesday is the real problem, or that they should only go if they are with friends. Tell me more.”
I am putting the client in a position to give external voice to their internal reality, where we can examine it together in a safe and supportive way. I’ve also not-so-sneakily thrown in the possibility that there could be several ways to interpret whatever they are about to tell me, which might prompt some reflection prior to the tale’s coming out.
Bringing it Home
What’s really exciting about utilizing a storytelling approach in therapy is at least partially that it is easy, and it works. Personally, I find the following question to be layered and motivating: What story do I want to tell about my life?
It really should not be too hard for us to help anyone become interested in the story of their own lives. The complexity captured in that question is unmistakable, but it is also imminently attainable. Because we humans are all good at stories, therapists have a natural, inherent strength to draw on from the first minute of the first session. People are desperate and willing to rewrite their stories; they are positively crying out for it. As one of the oldest known mediums for communication that we have, story is beautifully layered with significance, feeling, and memory. It is infinite in the sense that there is no limit to how many ways it can be interpreted or integrated…even if it has a grand finale, as all our stories do.
I believe therapists do exceedingly well in how they continually draw out their clients’ stories, week after week. Where I aim to orient the reader is this: perhaps we should not think of storytelling as a smaller intervention to use in the course of CBT, or Narrative Therapy, EMDR, and DBT. Rather, we should think of those disciplines as interventions to use during the course of storytelling.