Symptoms are Stories That Can be Re-Told

Narrative therapy is a form of psychotherapy and now also life coaching that focuses on understanding and reshaping the stories or narratives that people construct about themselves and their lives. storytelling is considered a fundamental psychological process that plays a significant role in shaping and determining human cognition, communication and behaviors. Stories we tell ourselves give meaning to our world. Throughout history, storytelling has been an essential aspect of human culture, used to pass down knowledge, traditions, and values from one generation to another. Just think about ancient myths about gods and spirits that, to this day, remain a part of the popular imagination and a source of inspiration. Narrative approach to change was developed in the late 1970s and early 1980s by Michael White and David Epston, two prominent family therapists.

The fundamental premise of narrative therapy is that individuals interpret their experiences through the lens of stories they create, which then determine their choices and overall wellbeing. These stories can be both helpful and limiting, depending on their content and the meanings attached to them. Narrative therapy aims to explore and challenge these narratives to empower individuals and help them construct more positive, constructive, and empowering stories about their lives.

In this approach to therapy and life coaching, we encourage clients to externalize problems, seeing them as separate from their identity, and challenge dominant narratives by questioning underlying assumptions and beliefs. Clients are guided through the process of re-authoring their stories, generating alternative, preferred narratives that align with their values and strengths. We encourage our clients to explore unique outcomes, past exceptions to the problems they face and hidden, underdeveloped but emancipating elements of their existing narratives, to highlight their existing capacities to cope, abilities, and resilience.

This approach considers cultural context as very important, acknowledging the impact of societal norms on personal narratives. If you know me, you know that I have about zero tolerance for restrictive cultural narratives, and you know that I take particular pleasure in dismantling them and setting myself and my clients free to develop in ways that are right for them. For me, cultural norms are particularly insidious because we internalize them growing up and they don’t usually appear to us as foreign agents of oppression, but as integral parts of reality itself: you can’t question something that seems as real as a tree or a rock. Of course, there are many instances when cultural conventions help us communicate more efficiently and bring us closer together, but those are usually not the aspects we deal with in my work. No one comes to me and says “please help me, I’m benefiting from a cultural convention”.

Narrative therapy's focus on understanding and reshaping the stories or narratives that individuals construct about themselves, and their lives reflect the constructivist emphasis on personal meaning-making. If you’ve read my previous blogs you know that if there’s one identity, I cling to it’s that of a constructivist, so I assume it wasn’t too far-fetched to assume that this too is a constructivist approach to therapy. What are stories we tell ourselves if not our subjective interpretations of reality?

In this blog, I want to give an example of how you can re-write a narrative and transform a symptom from an adversary into an ally. I will use my work with Betty as an example. She was kind of enough to allow me to share her story and she chose the pseudonym herself.

Stage I – Understanding the existing narrative

We use the word “narrative” and that usually implies that it’s an actual story told with words. Sadly, this is not always the case, otherwise my job would be much easier. Personal narratives can take on a multitude of forms that extend beyond mere words, and even when we use words, we can usually tell elements of stories, but we have a hard time expressing its core. People often communicate their life stories through written accounts, such as autobiographies, diaries, blogs, and letters. If you take a look at these narratives, you will see that they don’t involve a structured plot, but a series of episodes that usually reflect and overarching theme – and that is the core of the narrative. That theme isn’t always easily expressible in words and may be more easily symbolized through visual mediums like paintings, drawings, photographs or other creative ways. Nonverbal communication, including body language, facial expressions, and gestures, can also play a significant role in sharing narratives. How far away you stand from your partner or your friends and coworkers conveys some unconscious elements of your narrative that regulates boundaries or closeness. Moreover, music, lyrics, and dance serve as powerful channels for expressing emotions and experiences. To this day, after years of personal psychotherapy, there are still some emotions that I express better through music. Rituals and cultural ceremonies are yet another means by which individuals communicate personal narratives.

Only small parts of Betty’s narrative were expressed in words. When we started working together, she was able to give me only small elements of it verbally: she is a strong woman, independent. She is in control and she is very efficient. Her life is busy but she can manage all of it with ease because she is that capable. She has two little kids and she is a busy, working mother. She has a husband and they have a good marriage, but – Betty emphasized – she doesn’t really need him. She is perfectly capable of going through life on her own.

Why did I start working with Betty? Because of her panic attacks. Suddenly, she complained, for no reason and without a trigger, she would feel her heart racing, she would run out of breath and she would be absolutely certain that she is having a heart attack and that she is dying. This is, of course, where the verbal part of her narrative stops. She described seeing several doctors and how disappointed she felt in herself that is so weak to have a psychological, rather than a physical issue. Successful women have heart attacks, not panic attacks, she said jokingly, but only partially joking.

Betty described herself as practical, so our work had to be partially adjusted to this. We worked on practical techniques to manage her panic attacks when they would rear their ugly heads. In addition to that – all in the name of science because Betty did her research – she began practicing mindfulness under my guidance. Betty felt it was important to use science, because science isn’t “touchy feely” and, lucky for me, mindfulness has more than enough evidence to show that it’s beneficial for anxiety, stress and panic attacks. For me, mindfulness was much more than just a tool that would help Betty regulate her emotions. It was a unique window into her psyche and a chance to reveal and put into words the story that her panic attacks were telling me. Here’s the story.

Stage II – Limitations

Yes, Betty was a mother, but a reluctant one. She deeply loved her children, but, as she confided, she only had them because her husband pressured her into it. She was quick to defend him saying that his pressure was implicit. She knew he always wanted to be a father and she loved him and didn’t want to disappoint him.

Yes, Betty was strong but the story she created around strength had to do with her father’s work ethic. Her father had passed away while she was in 8th grade (from a heart attack) and her memories of him are few and far in between: he was absent, but only because her mother didn’t work and her father had to make money to support the family. Double shifts, overtime, being constantly overworked and impatient with occasional angry outbursts are parts of her father that she remembers best. Her mother struggled to adjust to being a single parent and was never able to keep a job, which is why Betty shaped herself to be strong like her father and not weak like her mother. She graduated college, got her master’s degree while supporting her sibling and helping her mother.

Yes, Betty was everything she said she was. But there were also her panic attacks. From her stories, I noticed that when she would have a panic attack, she would turn to her husband. He would be able to stop an attack simply by giving her a hug and sitting with her in silence. Holding her hand or putting her head in his lap while watching TV would be enough to calm her down. Betty would tell me about these instances with a facial expression that almost emitted disgust. I was able to notice it every time she would tell me about a panic attack, but I didn’t ask about it, until she said the following: “Of course, the only reason why I agree to these ridiculous childish games is because I’m obviously seriously ill. I could have a heart problem that doctors didn’t figure out and if I must engage in this behavior to feel better, I will.” After that, I shared my impression about her facial expressions and she confirmed my suspicions: “Disgust is maybe a strong word, but I’m not some pathetic, weak loser child that needs her daddy to cuddly with. Of course, I don’t like it.”

There was a whole set of needs that Betty would write of as “weak”, “pathetic”, “for losers”, and “childish”. We envisioned this part of her as a child (Betty Bear) as opposed to the “real Betty” that she called Mrs. Walsh (last name changed). That allowed us to create a dialogue between Betty Bear and Mrs. Walsh which we did for a long period of time. Mrs. Walsh’s first reaction to Betty Bear was “can we kill that part of me?” so it was clear that there was a long road ahead for all three of us together!

Stage III – Pieces and hints

Mrs. Walsh was the mother of two and a successful businesswoman, Betty Bear was a co-dependent child Mrs. Walsh never wanted to have. But seeing how they had to share the same body, it seemed logical to Mrs. Walsh that she would have to find some common ground with this “obnoxious brat”. Reframing Betty Bear from “obnoxious brat” to a “lonely girl” was the first part of our work. Once Mrs. Walsh was able to accept Betty Bear’s existence and feel some compassion for her loneliness, we were able to unfold Betty Bear’s narrative.

Betty came to our session one day and shared a memory. Betty Bear, the name she had chosen for the part of her that manifested as panic attacks, was actually her father’s nickname for her. Surprise, surprise! This was quite helpful as Betty Bear suddenly became more acceptable and her story clearer. Betty Bear was lonely and sad because she had no one to talk to, and she had no one to talk to because her only friend was her father. And her father was gone for years. When her father died, Mrs. Walsh showed up to help Betty live through a tough period where the “real Mrs. Walsh”, her mother, wasn’t available, suffering from depression herself and unable to appropriately provide for her family.

Betty Bear saw Mrs. Walsh as unnecessarily strict. Over the years, Mrs. Walsh had to take care of her siblings, her mother, later her employees too, her own children, and she wasn’t able or willing to provide any more care to Betty Bear. After all, why hasn’t she grown up, what is wrong with that child? Lonely, and now uncared for, Betty Bear had no choice but to cry to get attention. And when Betty Bear cries, my client Betty gets a panic attack.

After we conceptualized Betty Bear’s crying as the narrative underpinning of Betty’s panic attacks, we were able to – very carefully and slowly – shed a more positive light on some aspects of Betty Bear. We were able to understand her role as point towards important needs. And if Mrs. Walsh would be more willing to listen to Betty Bear, perhaps panic attacks would occur less frequently. We then framed these needs in pragmatic terms: how would Betty’s life benefit from taking better care of these needs? Here is a brief summary of some of our findings:

1.       Betty Bear needs to cuddle and feel physical closeness with Betty’s husband. This would ultimately improve her marriage and Betty almost loudly gasped when her husband welcomed this need with – quite literally – open arms. She was reluctant to call her husband “weak” like she would call Betty Bear, but was surprised that a “man’s man” like her husband would want to do something so childish like cuddle.

2.       Betty Bear wanted to play with Betty’s children and wanted to do it badly. She was so lonely and here she had two kids roughly her age that she could play with. As a result, Betty would develop a healthier emotional connection with her children, instead of just making sure their physical needs are met. In fact, Betty’s younger had struggled with separation anxiety and introducing regular play time helped with this quite significantly.

3.       Mrs. Walsh is a practical woman, and she is most easily convinced by physical things, scientific evidence, and practical possibilities in life. She had read somewhere that stronger interpersonal relationships are beneficial for physical health too and that engaging in “touch feely” activities like self-compassion meditation or playing with her kids or finger painting (another activity that Betty Bear loved to do) could – to her surprise – help her lower blood pressure, reduce the effects of stress on her body and preserve her heart, the true concern Mrs. Walsh had, especially because of genetics. That is what Betty’s father had died from, a heart attack. “We don’t need to read into this heart thing too much”, Mrs. Walsh once told me when I mentioned how similar her own panic attacks were with the condition that took her father’s life.

Stage IV – New story

Even though this is a long blog, it’s a short and superficial summary of our work together. We used many creative techniques that involved writing stories and essays, drawing, painting, making collages, taking photographs… We had ups and downs, movements forward and backward, but implementing Betty Bear’s needs in a way that’s sustainable helped her panic attacks to the point that she was able to say that she no longer has panic attacks as a problem.

Then we started finalizing a new narrative, through a series of dialogues with Betty Bear. Mrs. Walsh insisted that if she agrees to attend to some of Betty Bear’s urgent needs even by “being silly”, then Betty Bear has to grow up. Betty Bear agreed although she insisted that growing up can’t be rushed and she outlined some conditions and a path she sees for herself. We talked about what Betty Bear wants to be when she grows up and Mrs. Walsh promised that she will do everything in her power to help her become that, so long as she eventually grows up.

Betty Bear said she wanted to become a nurse so she could take care of people, that she wanted to be a journalist so she could inform people, that she wanted to be a therapist like me (transference is a fascinating topic, but for another blog), or that she wanted to be a kindergarten teacher, so that she could play all day and never feel lonely. In the end, Betty Bear settled on becoming a translator, someone who helps people communicate better. Someone who makes connections. In this case, she would translate Betty’s needs to Mrs. Walsh and help Mrs. Walsh lead Betty toward a more fulfilling and healthier life.

Our work from that point revolved around telling a new story, a story of a stern but benevolent Mrs. Walsh and her cheerful, if somewhat annoying, assistant, Betty Bilingual. And so, a part of Betty’s psyche that started of as a symptom became the very tool that helps her live a more fulfilling life. That’s what changing narratives is all about.