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December 31, 2011

The Narrative Paradigm and the New Year

By Lewis Mehl-Madrona

I write about my enthusiasm for the narrative paradigm for psychotherapy as we enter into 2012. Within this paradigm, we understand that we don't necessarily know the reasons for our actions, but rather we look for the stories that create the roles that guide us to do what we do. We find that people mostly know what needs to change in their lives but have stories that stop them from making those changes.


It's New Year's Eve, almost 2012!   The year the Mayans ran out of space to keep going on their calendar and had a good laugh about what people in the future would make of that!   I wanted to begin the year talking about the narrative paradigm, which I have embraced wholeheartedly and hope to be helpful in its development.

The narrative paradigm arises from the realization that all things human exist in the form of stories.   Our brain stores and manages information in a storied form.   We communicate most effectively with others through telling stories.   We live our lives through the performance of roles that we come to understand through listening to stories that inform us about how we are supposed to live.   We change through hearing stories about other people's lives and trying them on for our lives to see if we could do what the hero in the story did.

Psychotherapy involves the negotiation of stories.   In my practice, I've learned never to ask "Why?"   I don't ask people why they do what they do.   I assume that they, like me, haven't a clue.   We like to ascribe motives to people and we imagine that they know why they do what they do.   We wait breathless at the end of crime dramas for the suspect to explain why.   We want a wrap up.   We want to know their motive. We need narrative closure.   We want to tie together the story into a neat package -- Bob killed Mary because she cheated on him and he was jealous, for example.     However, my actual experience is that most of us (including me) don't have a clue why we do what we do.   As children, when an adult asks us the "Why?" question, we try to make up an answer that will please or satisfy the adult or minimize our punishment.   Instead I try to ask "How?" questions.   "How does that work?"   "How did you know to do that?"

I've also learned not to give people advice.   People have actually explored all the possible answers that I could imagine without being in their lives.   They've already thought about everything I could suggest.   The only possible good suggestions could come from other people in their lives who have known them for years, which a therapist never will.   People don't need advice.   Rather, they need assistance to explore what stories they have about how to live that keep them from following the advice that they already know they should follow.

So, I try to find the story behind the position, belief, fear, stance, or attitude that people have that keeps them from changing.

Rather than interpret other people's lives and stories, I try to maintain a stance of appreciative inquiry -- asking lots of questions from a standpoint of appreciating how well the person has negotiated their life and wondering how they were able to do as   well as they did.   I try to balance the positives -- to find positives in stories that are presented as all negative.   Sometimes it's even important to find a negative in a story that's presented as all positive.   My hero in all this is the character, Columbo, a detective who never stopped politely asking respectful questions until he solved the crime.

There's no answers; just stories; no truths, just many perspectives.

What's liberating about this?   If we're shaped through stories and stories shape our brains (through in part our performance of the roles taught to us by those stories), then there are no diagnoses, no DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) as absolute truth or fact (rather, just one more classification system that's more or less useful depending upon the circumstances and situation), no defective people, just stories that work better or worse depending upon the circumstances and the situation.   Our job becomes helping people become aware of the stories that are shaping them and influencing them.   Then we can learn how to change those stories.

Let me tell you about a woman I am seeing.   We began our work together because of her anxiety about her heart.   She's had some coronary artery disease diagnosed, but not severe enough for treatment yet.   She's in her late seventy's and was full of criticisms about her life and her value and how she lives.   We began by exploring the stories about the critics in her life -- her father, primarily.   She grew up as the only daughter of the law school Dean at a major Eastern university who doted on his sons and ignored her.   The sons were expected to go to Law School and to become important contributors to the legal community.   Girls got married and had children.   This was the 1940's.   Rivka's stories were all about her trying hard to get noticed in this family of men and never succeeding.   Her mother had long before withdrawn into gin and tonics, the drug of that generation.   Over time, I was able to construct a different story for Rivka -- one of being a heroine of the gender wars of the 20th century.   Hearing my interpretation for the first time made her very uncomfortable.   She had a visceral reaction in her gut and her chest.   "Look at it," I said.   "Your daughters had a very different relationship to gender roles than you had.   They did what they wanted for work.   They weren't limited to becoming nurses, teachers, or wives like you.   You participated in the "Great War" that changed all that.  

Rivka had reasons to deflect my re-interpretation of her life.   She saw herself as having had two marriages that hadn't worked, one of which was still current.   Her first husband had been very much like her father -- partriarchal, domineering, controlling.   That was the dominant paradigm (aka story) for how men behaved toward women in those days.   I pointed out how Rivka had the courage to divorce him in a time in which divorce was uncommon and to create a new story for her daughters about gender relationships.   Her second husband, while problematic in other ways, was not patriarchal, controlling, or domineering.   Actually, he seemed the opposite.   She had gone too far in the other direction.   She viewed him as passive, weak, and indecisive.   However, I pointed out that she had radically shifted the balance of power by becoming the stronger one in the relationship.   This was a gender role triumph.   She could be proud of her work as part of the "Great Gender War".

She had more arguments about how others had been more visible and more important in changing gender roles; others like Gloria Steinem who seemed to singlehandedly transform gender in New England.   "No," I said.   "It was just waiting to change and she gave everyone permission to come out and do what they were already preparing to do.   She just got all the credit for being in the right place at the right time.   What about the countless numbers of people who fought in World War II.   Not all of them got the Medal of Honor, but weren't all of them heroes?"   Rivka had to agree.   She had been a part of that story about the returning warriors from the second Great War.  

We continued to work on Rivka's writing the story of her life from the perspective of a great granddaughter, seven generations removed into the future.   She was slowly coming to see herself as more heroic than she had ever thought and to see that her "Critic" was really the voice of her father's generation of men, an amalgam of all the men who sat around her father's exclusive, all-male club at the University, smoking their pipes, sipping their single malt whiskey, and sure of their supremacy in the world.   Progress consisted of her coming able to laugh at that image.   We accomplished that initially by turning them into animals, lounging in their suits at their club.   Her father was a badger.   His best friend was a wolverine.   All the Ivy League men from her father's cadre became animals.   Making people into animals is a good technique for seeing the story in which they are all living.   Rivka was taking an upcoming training with a man that intimidated her.   We turned him into a raccoon which made the whole issue hilarious.

                Here's an example of how narrative work addresses low self-esteem, especially the low self-esteem that an elder can have for herself at last portion of her life when she has judged herself by the stories of her birth time and place, despite the reality that all these stories have changed.   The patriarchy has melted.   Hilary Clinton is Secretary of State and Michelle Bachman can terrorize us with her radically conservative views as a potential President.   The world of Rivka's childhood only exists in old movies.

                How is this important to her worries about her heart?   That remains to be determined, but I suspect that being "hard-hearted" toward oneself can't be helpful.   Compassion and forgiveness for ourselves matters, and maybe even to our hearts.   In Cree, the word for fire translates literally as "the heart of a woman".   Compassion and forgiveness is thought to warm the heart, which could symbolically melt the cholesterol plaques in her arteries.   Of course, the better we feel about ourselves, the better we evaluate ourselves, the more likely we are to exercise, eat well, and do the other heart healthy behaviors that reverse arteriosclerosis.  

                Be that as it may, the narrative approach is a lot more fun than diagnosing Rivka as having an anxiety disorder, which is what the DSM would do.   The work we're doing is more productive for the last phase of life than being diagnosed, treated with drugs, or even an uninformed psychotherapy.   She still needs to learn and practice more mindfulness (who doesn't?) and to live more in the present moment, but that become so much more possible when we feel good about ourselves.

                On a personal note, I am in Times Square for New Year's Eve along with over one million other people which couldn't be more exciting.   I will be doing a hypnosis course with Peter Blum at All That Matters in Warwick, Rhode Island, January 6th to 8th and a workshop on healing with Deena Metzger in Topanga Canyon, California, the weekend of January 20th to 22nd.   For more information, visit my Facebook page or the websites of All That Matters or Deena Metzger.

Authors Website:

Authors Bio:
Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and Narrative Medicine.