Sharing stories: Transforming lives

Counselling and Transformation4th Annual Keele University Counselling Conference

26th- 28th March 2010

Michael Murray

The prologue

• Performance of Canterbury Tales by Northern Broadsides at New Vic Theatre

• Enthusiastic reception

• Integral role of narrative in everyday life

• Performative nature of narrative

The writer

• Geoffrey Chaucer (1343-1400)

• Wrote the tales in parts

• Work was unfinished

• Included details from different sources including references to the author

• Like life itself, it was accumulative and unpredictable

– Peter Ackroyd

Canterbury Tales

• Tales told by group of 28 pilgrims as they make their way from Southwark to Canterbury

– … to Canterbury they wende The holy blissful martir for to seke

– And made forward erly for to ryse, To take oure wey ther as I yow devyse

• All agreed to tell a tale and the best was would receive a meal paid by the others

– The best sentence and moost solaas

Big tale

• Big narrative is that of the pilgrimage

• It is a metaphor for the journey to the new Jerusalem

• Life is seen as a pilgrimage

– This world nys but a thurghfare ful of wo And we been pilgrymes, passynge to and fro

Little tales

• Within it there are many small stories – 24 tales in all

• Each tale is shared with the others

• These tales are drawn from a variety of classic, religious and other sources

The Wife of Bath’s Tale

• Through a variety of amusing anecdotes considers the role of women in marriage

– Experience, though noon auctorittee Were in this world, is right ynogh for me To speke of wo that is in mariage

• Her experiences with five husbands

• Men have to pleasure their wives and wives have to keep control of their husbands

The Miller’s Tale

• Tale of a young woman who is married to an old man

• She develops relationship with young man

• Tale is full of bawdy humour– Derk was the nyght as pich,

or as the cole, And at the wyndow out she putte hir hole

David SalleThe Millers Tale

Different types of tale

• Smaller tales– Tales as entertainment– Moral tales on the role of

women– Tales about how things are

not what they seem

• Bigger tale– Life as a journey to a

heavenly paradise– Life as being full of woe– Need for entertainment– Stories as source of moral

truths

General principles

• Human’s view the world in the form of narratives

• Narratives are organised sequences of events

• Events occur in time

• Narrative provides an understanding of how events are linked

Philosophical background

• Humans live in a temporal world

• The construction of narrative is a means of organizing and making sense of the temporal flux

• Paul Ricoeur contrasts the “discordance of time” with the “concordance of the tale”

Psychological background

• Stories are a form of thinking

• Stories organize our everyday experiences

• Forges links between the exceptional and the ordinary (Bruner, 1990)

• Stories help orient us to the world

Social psychological background

• Stories are part of everyday conversation

• Stories are a means of accounting to others

• Stories can help or hinder interaction

• Stories are influenced by others and in turn influence others

Socio-cultural background

• We construct stories about our past (histories)

• We also live within those broader social narratives

• “Stories are habitations. We live in and through stories. They conjure worlds. We do not know the world other than as story world. Stories inform life. They hold us together and keep us apart.” – (Miller Mair, 1989)

The stories

with paintings by Frida Kahlo(sometimes inspired by her relationship with

Diego Rivera)

Illness and narrative

• Advent of serious illness is a major crisis in our lives both socially and psychologically

• The study of narrative can help us understand how people react to serious illness

Illness and narrative: People bleed stories

• “My initial experience of illness was as a series of disconnected shocks, and my first instinct was to try to bring it under control by turning it into a narrative. Always in emergencies we invent narratives. We describe what is happening as if to confine the catastrophe. Storytelling seems to be a natural reaction to illness. People bleed stories and I’ve become a blood bank of them”

• Anatole Broyard (1992)• Intoxicated by My Illness: And

Other Writings on Illness and Dying ; A Critic Writes About Being Critically Ill

Narrative analyses

• Meaning of illness • Interpersonal context

• Plot of illness • Societal context

Cancer stories

Nina: a 50 year old single mother with three children: two older and one younger

Jane: a 47 year old married woman with one young adopted child

Lucy: a 35 year old woman with one young child

Bonnie: a 52 years old woman with two grown children

Meaning of illness

• Going beyond content of the illness to consider the social and emotional meanings

– Loss of sense of invulnerability• We may try to deny that life is finite but

serious illness reminds us otherwise– Loss of function/identity

• Serious illness can threaten our ability and our very identity

– Loss of appearance• Illness can also impair our appearance

which then involves various concealment strategies

• Meanings linked to identity

Meaning of cancer: loss of social function/identity

Nina – threat to motherhood/ threat to children

• “My kids were more important and I didn’t want them to be raised by somebody else like I was raised by somebody else”.

• “I had to get up, go have chemo and come home and look after three children and it was like wicked, wicked.”

• Challenge to maternal responsibilities• Motherhood central to identity

Meaning of cancer: loss of physical functionJane – threat to bodily capacity

• “I figured I wasn’t going to use my breasts per se (laughs) … I’ve never had a child. We couldn’t have one, so that was really sort of wasn’t on the cards.”

• “for some reason or another the thing that worried me or worries me was the possible loss of the use of my arm”.

• Work is central to identity

Meaning of cancer: loss of appearanceLucy – threat to physical appearance

• “I got it [breast] off and instantly I felt like a little girl again. I really did because you don’t have your breasts. I was like … I felt like a little girl. … You even look at yourself different. You look like a little girl.”

• “but that passes. That goes. … It doesn’t bother me not to have breasts.”

• Importance of breasts for female identity

Narrative structure/plot

• The meaning is enmeshed in a particular plot line which gives a broader sense of meaning

• Detail the background to the event

• Detail the prospects and the overall orientation to the future

• Transform loss into gain

Narrative structure:Classic types of narrative

• Comedy: – Ongoing challenge and

counter-challenge

• Romance: – Initial challenge is

overcome

• Tragedy: – Ongoing struggle against

adversity, but ultimately fails The Little Deer

Types of narrative:Jane: Cancer as comedy

ó Hard work and good fortune

ó Life a series of challenges and successes

ó “It happened. There is no sense in crying over spilt milk”.

ó “I think that you … at least me anyway … I’m almost at my most vulnerable when I think I’m through something. It’s like I’ve done it. I’ve made it but I don’t think you feel you’ve got the reserve to handle anything else.”

Types of narrative:Lucy: Cancer as romance

ó Transform challenge into an opportunity for growth

ó “I’m going to pass on some day. I know that and I can deal with it. I’m not afraid. That changed. I came to that realization. And, like I said, just how you perceive yourself. Like you don’t need breasts to be a woman.

ó I’ve matured that way, I guess … just my whole outlook on life, you know. You go for life, you don’t go for the other way.There’s no point. So I’m just happy. I’m a happy person.”

Types of narrativeBonnie – Cancer as romance - opportunity

• “I’m very positive about life. I’m a positive person anyway. I tend to look on the bright side and hope for the best. I try to see the best in everything really. It’s the only way. Otherwise, like I’ve said earlier, there’s lots of doom and gloom out there. Try not to look at it, focus on the positive.”

• Transform tragedy into opportunity

Types of narrative:Nina: Romance to tragedy

• Many challenges overcome

• Phase I: Difficulty, struggle, transcendence

• Phase II: Diagnosis and treatment

• Phase III: Edge of decline– “if it happens tomorrow and

he’s only twelve I will flip, I will really go crazy … because what’s going to happen to him … welfare would come and take him, always worry about all that kind of stuff.”

Narrative context:Personal and Interpersonal

• Personal– Stories told connected to

previous life experiences

• Interpersonal– There is always a listener

or an assumed listener

• "I must say I find it difficult talking about myself. Umm … I don't know what to say."

The Two Fridas

Stories in context

• We live and share stories in context

• The stories we tell are influenced by and influence those around us

• Cancer stories– Handle with Care

• Based upon narrative interviews with women who have had cancer, their partners and doctors

• Development of dramatic performance

Interpersonal context: Lucy – need to be positive

• “When I was going through it I was too busy to think about anything negative because like I said I was taking care of, trying to take care of, myself and a brand new baby. … I just had that mindset that I’m going to be OK because I have to be now that I’m a mother.”

• “Well my husband was totally devastated. I think that’s what really helped me so much … I had to play the reverse role. Because he was so devastated I felt I couldn’t be.”

Interpersonal context Bonnie – Not able to disclose feelings

• Opportunity to tell stories and to disclose feelings depends upon the immediate context

• Often relatives do not know how to handle situation. The sick person often feels they cannot express their emotions

• “I know that the day I was diagnosed when I came home my sister-in-law called and when I gave her the news, of course, she was so upset she started to cry and I became very emotional but I thought I can’t talk now, I can’t cry because my son was writing an exam that night and I didn’t want to let him know.”

Narrative context:Societal

• Stories mesh with broader societal stories of myths

• Popular image of cancer patient – Hero myth– Victim myth

Narrative context:Bonnie: No hero but acceptance of recovery

• “When you know you’ve had any type of major illness you’re thankful for good health,

• so you tend to … well I do anyway. I take one day at a time. And I try to be very happy that I’m healthy.”

Narrative context:Lucy: Combatting victim myth

• “I’m right into the swing of things again. I feel fantastic about it all. So for me it wasn’t a terrible thing. You know. All of it. It wasn’t a terrible thing. I’m not making light of it but in my opinion I have no choice but to look on the up side. Look towards life because there is no other side.

• That’s just the way I looked at it and that’s the way I still look at it. So I’m … you know … I mean I have people say to me “Oh my god, you poor thing. You’ve been through so much. I’m praying for you. . I’m like, you know, I’m OK. Until they tell me I’m not, I’m OK.”

Cancer and narrative

• People with cancer tell stories about their illness

• The opportunity to tell these stories is important for recovery

• These stories tell us about the person but also their interaction with the social world

The epilogue

Transforming stories

• Looking back: past events can be reorganized such that the person is more comfortable with the memories

• Looking forward: the future is open and can be plotted in different ways

• The aim of therapy is to not only look back but to consider the future options

Stories and mental health

• “Persons experience problems, for which they frequently seek therapy, when the narratives in which they are ‘storying’ their experience, and/or in which they are having their experience ‘storied’ by others, do not sufficiently represent their lived experience, and that, in these circumstances, there will be significant aspects of their lived experience that contradict these dominant narratives.”

– (Michael White & David Epston, 1990– Narrative Means to Therapeutic Ends)

Work of narrativeBiographical work

• Attempts to integrate challenge into broader life story

• New stories are developed in dialogue

• Explore opportunities for biographical work

Work of narrative Normalizing events

• Narrative provides meaning through organization and systematization

• Process of normalization difficult because others are often unaware

The Love Embrace of the Universe

Work of narrative Bonnie: Normalizing events

• “I was always aware of the feelings of others. I always tried to please people. I didn’t go out of my way to cause trouble.”

• “I think you accept it and try to deal with it the best you can because what else can you do?”

• “Its sort of been an up and down battle since chemo but I’m happy to say that things have finally straightened themselves out…But anyway, it happened and I’m doing OK now. It was rough but I made it through.”

Role of therapist

• Provide opportunity for telling and re-telling of narratives

• Challenge and confront certain narrative accounts

• Discuss value of new narratives

• Validate changes

Alternative stories

• “Insofar as the desirable outcome of therapy is the generation of alternative stories that incorporate vital and previously neglected aspects of lived experience,

• and insofar as these stories incorporate alternative knowledge,

• it can be argued that the identification of and provision of space for the performance of these knowledges is a central focus of the therapeutic endeavour.”

• White and Epston, 1990

Therapeutic goals

• Enable client to articulate stories

• Challenge the inevitability of narrative structure

• Develop and try new narratives

Therapist-client interaction

• “The analyst finishes a piece of construction and communicates it to the subject of analysis so that it may work on him;

• he then constructs a further piece out of the fresh material pouring in on him, deals with it in the same way and proceeds in this alternating fashion until the end”

• Freud, 1937

Role of client

• Articulate narrative accounts of experiences

• Explore new narratives in words

• Try out new narrative directions

New plots

• “In contrast with cognitive therapists who seek to dismantle distorted automatic thoughts, irrational beliefs, and illogical inferences in a piecemeal fashion,

• [narrative] therapists attempt to articulate the subtext that undergirds the plot of the client’s life

• and to help him or her experiment with new plots that open possibilities for fresh chapters.”

– ( Robert Neimeyer, 1995)

Coda – a return to Chaucer

• Life is a journey within which we tell and share stories• This world nys but a

thurghfare ful of wo And we been pilgrymes, passynge to and fro

• These stories not only provide entertainment but an interpretation of events and a guide to the future

Chese another tale

• Narrative therapy can provide a forum for telling stories about certain experiences and considering alternative stories

• And therfore, whose list it nat ytheere, Turne over the leef and chese another tale – The Miller’s Prologue

References

ó Murray, M. (1997). A narrative approach to health psychology: background and potential. Journal of Health Psychology, 2: 9-21.

ó Murray, M. (1999). The storied nature of health and illness. In M. Murray & K. Chamberlain (Eds.). Qualitative Health Psychology: Theories and methods. London: Sage. Pp. 47-63.

ó Murray, M. (2000). Levels of narrative analysis in health psychology. Journal of Health Psychology, 5(3), 331-342.

ó Murray, M. (2002). Connecting narrative and social representation theory in health research. Social Science Information, 41(4), 653-673.

ó Murray, M. (2003). Narrative psychology and narrative research. In P.M. Camic, J.E. Rhodes, & L. Yardley (Eds.) Qualitative research in psychology: Expanding perspectives in methodology and design. Washington, DC: APA Books, pp. 111-131.

ó Murray, M. (2004). Challenging narratives and social representations of health, illness and injury. In M. Murray (Ed.) Critical Health Psychology. London: Palgrave, pp. 173-186.

ó Murray, M. (2007). “It’s in the blood and you’re not going to change it”: Fish harvesters’ narrative accounts of injury and disability. WORK: A Journal of Prevention, Assessment and Rehabilitation, 28, 165-174.

ó Murray, M. (2007). Narrative psychology. In J. Smith (Eds.), Qualitative Psychology: A practical guide to research methods, Second edition. London, UK: Sage, pp. 111-132.

ó Murray, M. (2009). Telling stories and making sense of cancer. International Journal of Narrative Practice, 1, 25-36.