In psychotherapy, particularly narrative therapy, it is understood that narrative plays an important part in how personal identity is formed, understood, and changed. In the field of narrative medicine, there is substantial research that shows that outcomes of treatment are significantly impacted by not only the client’s stories of their illness and symptoms, but also by the narrative framework of the medical and other care providers, family, and friends. As noted in Rita Charon’s book, The Principles and Practice of Narrative Medicine (Oxford University Press, 2020):
“Narrative medicine began as a rigorous intellectual and clinical discipline to fortify health care with the capacity to skillfully receive the accounts persons give of themselves – to recognize, absorb, interpret, and be moved to action by the stories of others. It emerged to challenge a reductionist, fragmented medicine that holds little regard for the singular aspects of a patient’s life and to protest the social injustice of a global healthcare system that countenances tremendous health disparities and discriminatory policies and practices.”
The client’s illness narrative strongly influences their relationship to their illness, but it is also strongly influenced by the treatment culture itself, as well as by the broader social and cultural frameworks within which the person is living. The same can be said for a client’s entire life narrative, including their trauma narrative. The story of each person’s life is literally constructed over time, held as their individual autobiographical history – but that is done within the contexts of the external structures that may influence the person’s beliefs and experiences. Our life, illness, and trauma narratives are the stories we tell ourselves, and others, about how our experiences unfolded, how we were affected by those experiences, and the insights we gained from them.
These narratives create a framework within which we also make meaning of new experiences. That framework will influence our beliefs for what we consider successes or failures, about symptoms and challenges, about how our future is likely to unfold.
What we each – as practitioners – need to understand, is that we bring our own narratives with us into the relationship with the client. Part of our role as practitioners is to be respectful and skillful listeners, who are willing to hold broad and inclusive perspectives that account for the differences in our own narratives as compared to those of our clients.
In Charon’s earlier book, Narrative Medicine; Honoring the stories of illness (Oxford University Press, 2006), the author describes four types of “divides” that all practitioners need to be mindful of, since they can erode trust if the client feels their experiences and stories are not being skillfully received. In the context of narrative medicine, those divides are: relation to mortality; context of illness; beliefs about disease causality; shame, blame, and fear.
As therapists and health care providers, practitioners necessarily learn about categories, patterns, and identifiable indicators of specific conditions. In that process, we can inadvertently create professional belief systems – about cause and effect, about our role and responsibility for reducing symptoms or preventing distress, about what constitutes success or failure – which may actually undermine our ability to understand the client’s relationship to their own narrative, or put pressure on their narrative to match our own.
The divides cited by Charon are relevant in all forms of narrative, since the client’s lived experience will most typically not match the professional structures that we learn as practitioners as a way to help us serve our clients. It will be up to us to reach across those divides to more deeply understand the ways in which the client’s narrative not only tells their story, but also holds them back from accessing healing and change.
Fortunately, somatic practitioners have an additional form of narrative to use to help us understand our clients, and support their change process – what I call the somatic narrative. The somatic narrative is an additional aspect of the record of each person’s history, held not in the mind but in the body. Our lived experience is shown in our gestures, in our physiological responses, in how much ease or tension we have in our muscles, in the ways we know how to stand and move, in how we breathe.
Our bodies and selves are not separate, even though our treatment culture tends to treat them that way. The somatic narrative is often left out when practitioners skilled in working with narrative are using it as a way to better support their clients. However, our somatic selves will speak as eloquently about our history as our cognitive and emotional selves will. As practitioners, if we know how to deeply listen to all aspects of the client’s narrative – including their somatic narratives – we will be more prepared to bridge the divides with our clients and more truly understand their experiences. In turn, that will provide another doorway into helping them create the changes they long for.
