Applied Narrative Psychology

APPLIED NARRATIVE PSYCHOLOGY
Narratives are grounded in everyday life, from our conversations

to films to books. We all create and tell stories, and we listen to
other people’s stories. Using narrative approaches is both meaning-
ful to people and clinically effective. This book provides a broad-
ranging introduction to narrative psychology and applies narrative
to professional contexts to help people develop efficient techniques
to use in practical situations, including clinical and occupational
psychology. It offers a rationale for the use of narrative approaches,
translating core research into accessible techniques, and illustrates
these approaches with practical examples across a range of areas. In
turn, it details how practitioners can help people change or develop
their narratives to enable them to live their lives more effectively.
Nigel Hu n t is a health psychologist and associate professor at

the University of Nottingham, UK. His research focuses on narra-
tive psychology and traumatic stress. Alongside his collaborators, he
has tested and applied narrative techniques in many countries. He
has written nine books, including Memory, War and Trauma (2010),
Guided Narrative Techniques (2012) and Landscapes of Trauma (2019).
Published online by Cambridge University Press

A PPL I E D N A R R AT I V E
P S YC HOL O G Y
N IGE L H U N T
University of Nottingham

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DOI: 10.1017/9781009245333
© Nigel Hunt 2024
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Names: Hunt, Nigel, 1963– author.
Title: Applied narrative psychology / Nigel Hunt, University of Nottingham.
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Contents
Preface page vii
1 Introduction 1
2 What Is Narrative? 16
3 Narratives in Psychology 22
4 Master Narratives 42
5 Narrative Methods 63
6 Life Interviews 73
7 Narrative Writing 91
8 Narrative Therapy 99
9 Narrative Exposure Therapy 121
10 Narrative Medicine 133
11 Narrative Health Psychology 147
12 Narrative Work Psychology 151
13 Narrative Coaching 157
14 Conclusion 164
References 170
Index 187

Preface
Since drafting this book, I have experienced a diagnosis of terminal

bowel cancer for which, at the time of writing, I am undergoing treatment
to try to control. It is an experience that has enabled me to put narrative
into practice. Cancer is a difficult illness to deal with, and we all respond in
different – yet similar – ways. One of my main responses has been to start a
blog, a narrative account of my experiences. The blog is about my thoughts,
feelings and behaviour in relation to what I am going through regarding my
cancer. It is (I hope) explicit, honest and detailed. It covers everything from
the experience of a sigmoidoscopy to my reflections on being an atheist and
my lack of fear of death. I am terrified of pain but death is non-existence, so
it would be absurd to be frightened of being dead. It is not how everyone
would respond to a cancer diagnosis, but it is the way I am responding,
and as a narrative approach, I find it very successful. What follows will,
I hope, show you how other people may draw on narrative approaches
to help them not only with health-related problems but also with other
problems associated with human experience, such as work.
The book is structured to provide an account of what narrative is
and various ways of doing it. These methods can be adapted to different
circumstances, but they are all practical ways of applying the ideas of
narrative to psychology-related problems. This is not a book preaching
particular methods or philosophies. In the end, these do not matter to
the applied psychologist: what matters is what works. Nevertheless, where
possible, I have presented the evidence relating to the various methods.
The problem is that several of these methods have a limited evidence base,
which does not mean they have no value, but does mean that we need
to be careful in how we interpret and use them, and that we should, as
psychologists, be trying to build up the evidence base. Narrative is central
to what we do as humans, so it should be central to psychology.
I would like to thank all my colleagues and students who have worked
with me on narrative-related topics over the last couple of decades. I would
vii
https://doi.org/10.1017/9781009245333.001 Published online by Cambridge University Press

viii Preface
also like to thank the staff at Cambridge University Press for turning a
rough manuscript into a book. Personally, I would like to thank my wife,
Sue, and all my family and friends for being so supportive in this difficult
time, and finally the wonderful staff at the Royal Derby Hospital, who
have helped me stay alive long enough to get the manuscript finished. The
staff at the hospital, my GP practice and in the community are amazing,
highly dedicated people who have to put up with a lot from so many ill
and frightened people. I would like to dedicate this book to them.

Chapter 1
Introduction
There are arguments over what it is to be human. Aristotle argued that

it is the power of speech and the sense of good and evil or justice and
injustice. Descartes, with his ‘cogito ergo sum’, argued in his Meditations
that humans were the only animals with minds. Kant argued that with
our technical, pragmatic and moral skills that we can join our minds with
mechanics to manipulate things, we can treat other people pragmatically
for our own purposes and we can treat each other according to principles
of freedom under a set of laws. Linked to this is the idea that the opposable
thumb gives us the ability to use tools in ways no other animal can. For
Charles Darwin, the difference between humans and other animals was
one of degree rather than kind, that things such as emotions, curiosity and
reason are just better developed in people than they are in other animals.
All these have some truth, but while language is a critical component
of what it means to be human, our narrative ability is what makes us
stand out from other animals, our ability to tell stories, not just stories that
are fictional, but stories that tell us something about the world, whether
through the arts, the humanities or the sciences. Aristotle was right about
the importance of speech. Other animals use speech to some degree, but
they don’t have complex systems of semantics and syntax, or the complex-
ity of memory that we have for stories. Narrative is a universal human
activity. We are intrinsically story creators, story tellers and listeners to
stories. It is what we do every day. Roland Barthes, in his classic essay
on narrative (Barthes, 1975), said ‘There are countless forms of narrative
in the world…. Among the vehicles of narrative are articulated language,
whether oral or written, pictures, still or moving, gestures, and an ordered
mixture of all those substances; narrative is present in myth, legend, fables,
tales, short stories, epics, history, tragedy, drame [suspense drama], com-
edy, pantomime, paintings, stained glass windows, movies, local news,
conversation. Moreover, in this infinite variety of forms, it is present at
all times, in all places, in all societies; indeed narrative starts with the very
1

2 Introduction
history of mankind; there is not, there never has been anywhere, any peo-
ple without narrative’ (p. 237).
Barthes was writing from the perspective of art and literature. The
comments are applicable to the science of psychology. What is difficult
to understand is why, in the 150 or so years of the history of psychol-
ogy, so few psychologists have concerned themselves directly and explicitly
with narrative. It is discussed in several areas such as language develop-
ment, some aspects of reasoning and some memory studies, but its gen-
eral absence is inexplicable. Narrative is at the heart of human endeavour.
Jameson (1981) describes narrative as ‘the central function of the human
mind’ (p. 13), and he is right. Memory, attention, perception and so on all
depend on us putting information together in narrative form.
One of the problems with studying narrative is that many psychologists
believe it is non-scientific. It falls into the area of qualitative psychology
which many psychologists still believe is beyond the bounds of science.
This is something that needs to be addressed. There are narrative research-
ers who exclude themselves from traditional notions of science and have
strong views about the importance of the political imperative when con-
ducting human research using qualitative methods including narrative. I
don’t want to get into those arguments here. My perspective is that narra-
tive is, or should be, central to the scientific study of people, central to psy-
chology. Science in its broadest form is about the systematic development
of knowledge through the use of systematic methods and the development
of testable theory. While narrative and qualitative methods generally may
create some difficulties relating to both method and theory, there is no
good reason why they should not be firmly in the camp of good science. It
is about the ways we do narrative research, which I will return to through-
out the book. The focus here is on applied narrative psychology, which is
a particular perspective, but if we are going to apply narrative psychology,
then we need to know that it is having a positive effect, or why bother with
it? We need evidence that it works in the real world. The problem is, as
we shall see, that while there is good evidence for some aspects of narra-
tive work, in particular narrative exposure therapy (NET) and expressive
writing, the evidence for several other applied approaches is often limited,
or in some cases virtually absent. This means that you are reading a book
that claims to base itself on science, yet the science for many of the claims
is limited. My argument is that we are at an early stage of narrative sci-
ence – partly because many narrative psychologists have not obtained the
appropriate evidence – but that does not mean that what we do is of no
use, it means we should start collecting some good data to provide support

Introduction 3
for our ideas on narrative so that we can develop narrative theory, method
and application.
What is narrative? This is part of the problem. When doing science,
we need clear definitions of our constructs. We do not have good agree-
ment about the construct of narrative. There are different definitions, for
instance, about whether a very simple language structure can be called
a narrative or whether language needs a number of characteristics to be
called a narrative. Abbott (2008) makes the point that the basic narrative
could be just putting a verb and a noun together (‘Drink tea’), which
young children achieve when around 3–4 years old, which is the age from
which we retain our earliest memories, so perhaps memory itself may
depend on basic narratives. Mnemonic systems often rely on creating
meaning by putting information into some form of story (e.g. making a
list and putting the items along an imaginary walk, or turning them into
the components of a story). Memory is usually improved for information
that has some meaning attached to it, and narratives provide meaning.
It is also difficult to look at a picture without imparting some meaning.
We don’t just process information; we make sense of it. If we look at the
Mona Lisa, a picture most people in the West are at least somewhat famil-
iar with, we don’t just look at a head and shoulders picture of a woman.
We wonder whether she is smiling, why she appears to be looking at us.
We wonder where she is from, what the background represents. We won-
der what her story is.
Herman (2007) has a slightly more complex definition of narrative.
Informally narrative is a synonym for a story, but she proposes more for-
mally that a narrative is a representation of (a) a structured time course of
particular events that (b) introduce conflict into the storyworld (whether
actual or fictional) conveying (c) the qualia – what it is like to live through
the disruption. This is a helpful definition as it has a place, a series of
presumably interconnected events and – which is important to make fic-
tion interesting and to provide psychologists with a role – there is conflict
which somehow needs to be resolved.
Are stories the same as narratives? We often use the terms interchange-
ably but there is no real agreement. At its most basic a narrative is perhaps
a representation of an event or a series of events. The event (or action) is
the critical element. Without something happening, the event, then we
just have a description (‘the book is red’), which many would argue is not
sufficient to be a narrative. To create a narrative we need something to
happen (‘The red book was read by a person’). Barthes (1975) suggests that
a single event is not enough, that there needs to be two or more events.

4 Introduction
Others suggest that there needs to be some causal relationship. Abbott
(2008) argues that this overcomplicates it, and we should stick with the
simplest definition rather than a more restrictive one that demands causal-
ity or multiple events.
Whichever way we define narrative we are unlikely to have a single defi-
nition that fits all cases. I favour a pragmatic approach – which is generally
the way to approach applied science. If it works use it. Rather than having
a specific definition of what is and what is not a narrative the important
element is that it has some value in relation to what we are doing. If ‘the
book is red’ is sufficient for purpose, then it is a narrative. If we need an
event such as the book being read by a person, then we will use that as
the basic narrative. When we are looking at the narratives created by, for
instance, traumatised people, we may need more complex narratives to
make psychological and scientific sense. For instance, we have been argued
that traumatised people have problems constructing a coherent narrative
(e.g. Burnell et al., 2006) and that their accounts of traumatic incidents
are so disjointed they cannot be called narratives. For us to come to this
conclusion, the narratives of these people must be complex. They are likely
to include a narrator, multiple characters (who have explicit characteristics
and relationships with each other), detailed plots and possibly subplots,
several elements of causality derived from chronology and so on. A lot
more than ‘man bites dog’ or ‘the book is red’ – though we should not
reject these as narratives if the setting is appropriate. The critical point is
that defining narrative for the purpose of applied psychology depends on
the context in which it is to be used.
Chatman (1990) argues there is the chronologic of narrative. He argues
that narratives have a doubly temporal nature. In the first place, a narra-
tive moves through time ‘externally’, that is, the duration of the reading
of the novel, the telling of the story and so on. In the second place, it
moves through time internally, in terms of how long the plot itself takes
to unfold. For instance, it might take several hours to read a novel (exter-
nal), but the novel itself is set over several years (internal). According to
Chatman, the first is discourse and the second is story. He argues that texts
such as an essay or a description of a rocket engine do not have this inter-
nal time sequence and so are not narratives. I disagree. A student essay is
a narrative about the construction of an argument. It has no internal time
element. Neither does this book. It would be unusual to say that a book
such as this is not a narrative. Of course, Chatman was arguing from the
arts, where the story element may need to be separated from the discourse;
but I am a psychologist, and so see stories as narratives, whether or not

Introduction 5
there is a distinction between internal and external temporality (which are
useful concepts in certain circumstances).
While our understanding of narrative is not entirely operationalisable,
which is usually not a good thing in terms of science, we all know what
a narrative is, from formal narratives such as a book, a magazine article
or a lecture, to less formal narratives, such as a conversation in a café or a
discussion about football. The main point is that narratives are not the sole
province of professional writers and speakers, they belong to everyone. We
all understand narratives, we can all create and adapt narratives, we can all
express narratives to others and we can all listen to and understand other
people’s narratives.
If we accept what has been argued earlier, the terms narratives and sto-
ries are roughly interchangeable in practice. They tell us about something
that happened. The ones we are interested in as psychologists generally
provide characters, how characters interact, some sort of plotline, cause
and effect and some sort of change. Normally, something has to happen
for a narrative to be a narrative. It should also be reasonably coherent, so
that an audience can understand what the narrator is trying to put across,
their point, the meaning of the story. Narratives have both universal and
cultural aspects (Hunt, 2010), enabling us to cross the bridge between real-
ism and relativism, or naturalism and constructionism. Narrative processes
themselves are universal; the stories we tell are told by all cultures across
the world. The expression of these narratives does vary, enabling cultural
expression to take on different senses in different parts of the world. The
universality of narrative processes means we can understand narrative from
a neuroscience perspective, though the evidence as yet remains limited.
We are trying to understand the mechanics of narrative, the theory, the
method and its applications within the context of psychology, particularly
within the context of applied psychology. It is all very well saying that we
all use narratives, but what does that mean in psychological terms? What
is the purpose of a narrative? How might it benefit a listener or the person
who constructs the narrative?
Having established a very general definition of what we mean by narra-
tive (this will be explored in more detail in Chapter 2), we need to think
about how we can use narratives in psychology. We use narratives all the
time. We use a range of different narrative styles. We not only construct
and employ narratives, we are the audience for other people’s narratives.
Without narrative we would not be human. If we used language with-
out narrative, it would be no more sophisticated than the sign languages
learned by chimpanzees in the experiments of the 1950s and 1960s. Of

6 Introduction
course, some humans, due to some form of disability, are not able to use
narrative. Such dysfunction does not negate the argument for the critical-
ity of narrative as the norm.
As applied psychologists, we use a range of methods to try and help peo-
ple. Clinical psychologists use a range of therapies to try and reduce men-
tal health problems, health psychologists try to reduce the psychological
impact of ill health, forensic psychologists try to understand how the crimi-
nal mind works and occupational psychologists try to make the workplace
a better place to be. They are all using narratives of one sort or another,
even if these narratives are neither explicit nor even acknowledged. A key
aim of this book is to demonstrate how we as psychologists use narrative in
our work, both implicitly and explicitly. The other key aim is to show how
using narrative approaches explicitly can improve the work we do.
Narrative theorists, therapists and others draw on a wide range of
approaches to narrative psychology. It is an area where ten experts will
come up with fifteen approaches. This can get very confusing. This is an
applied book. We want things that work. We are less interested in the deep
theoretical and methodological conflicts and debates that occur within
narrative psychology and more interested in how we can make use of nar-
ratives in our work, irrespective of our specialisms. That does not mean
we can ignore theory. If we are going to use narrative approaches, then
we need an understanding of theory and method, but this book will not
provide a detailed explanation of the many approaches. The approach used
is meant to be coherent but not completely explanatory. We need a scien-
tific explanation for why people use narrative and how and where they use
it. As I have already noted, and will emphasise throughout the book, the
evidence for the effectiveness of many narrative approaches is rather weak.
We need to develop a coherent set of methods for using narrative, but this
does not yet exist. What I hope to do here is provide a way of understand-
ing and using narrative, not the only way, but it is, I hope, a reasonably
coherent and useful way – even if I am asking that if you do use narrative,
try to employ it in such a way as to be able to collect empirical evidence
for its effectiveness.
Empirical Problems
One of the main problems working in the area of narrative psychology is
that, apart from the notable examples of NET (discussed in Chapter 9)
and Expressive Writing (Chapter 7), the evidence for the efficacy and
utility of narrative approaches is at best weak, often contradictory and

Empirical Problems 7
sometimes virtually non-existent. As a scientist this creates a problem. We
cannot go around saying we are doing science if the evidence for our theo-
ries is weak, contradictory or non-existent. How are we to deal with this?
In the first place, acknowledging a lower level of evidence will – for the
moment – have to be acceptable. For many of the approaches discussed
in the book, there is at least some evidence. This will be described and
evaluated. Furthermore, the area itself, narrative, has emerged from the
arts, through sociology, to psychology, and in the arts, evidence is of a very
different kind to evidence in science. Over the years, the evidence regard-
ing the ontological status of narrative, its very existence and nature, has
been built up, theorised and well-established. There are few people who
would argue that the concept of narrative is not immensely valuable when
understanding the nature of people and the way they express themselves.
On the other hand, artistic theorising is not acceptable to most scien-
tists, though perhaps they should be more open to developing understand-
ing through the arts. Novels tell us a lot about the human condition. I have
written elsewhere about the psychological understanding we can derive
from Remarque’s All Quiet on the Western Front (Hunt, 2004). There is
ample scope for developing psychological understanding through the arts.
What is acceptable now is showing how narrative approaches can inform
our psychological understanding and how, in the context of this book, it
can inform our understanding of applied psychology.
While there is a distinct lack of evidence for some applied narrative
psychology, there are well-organised procedures that can be tested, such as
narrative therapy and narrative coaching. One of the purposes of the book
is to provide a detailed account of where we stand with regard to these
procedures (and the evidence base) to act as a heuristic for further research.
Finally in this section, we need to be aware of how widespread narrative
approaches are across the whole of psychology – even though sometimes
they are not explicit, as in much of clinical psychology. The purpose of
clinical psychology is to help people with mental health problems make
sense of their problems and find ways of overcoming them, or at least man-
aging them, that is, to create new stories by which to live. Forensic psy-
chology likewise. Occupational psychology is, in the end, aimed at making
organisations coherent and ensuring the people within these organisations
function well, that is, ensuring that the overall story of an organisation
coheres with the stories of the people employed by that organisation.
Coaching psychology is a relatively new area, which is about how people’s
stories are problematic and need to be changed to create improved stories,
more effective ways of being, whether at work or in one’s personal life.

8 Introduction
The Rest of the Book
The book is presented in two main sections. Chapters 2 to 4 explore what we
mean by narrative. These chapters are not applied, but they provide useful
background understanding of ideas in narrative thought, with some practi-
cal examples. The second part of the book is concerned with applying nar-
ratives to psychological problems in various ways from more generic ideas
round interviewing and analysis to addressing specific applied examples.
Chapter 2 examines the nature of narrative in more depth. Most nar-
rative research has been conducted by people interested in understanding
the nature of story and narratives through fiction. These provide important
insights into how narrative works not only in fictional accounts but also
in real life narratives. The rules governing narrative – such as they are – are
discussed in some detail, particularly how they apply to the narratives we
use in everyday life. There are fundamental disagreements among theorists
about what constitutes a narrative, and as already suggested, I will take a
liberal approach here. Nevertheless, the key linguistic ingredients of a nar-
rative, character, plot, action and so on, all will inform our understanding.
Narratives are not only defined by the facts that are contained in the story
but also by the structure and function of the story that is told, that is what
makes narrative interesting to psychologists.
Chapter 3 examines the core reasons why narratives are important to
psychologists. When someone is using a narrative, it is not just the facts
that are important but also the structure and function of the story. As
psychologists we recognise that narratives are universal, but we want to
understand why people use the narratives they do in certain situations, and
why narratives sometimes fail. Why does a person with depression focus
on negative aspects of their life story, and how can we help them change
that and in so doing perhaps lessen the impact of their depression? Why
do people who are traumatised have such difficulty describing what hap-
pened to them, often reverting to non-narrative forms of expression, using
ellipsis, or omissions from speech to avoid talking about certain subjects,
or describing past events (analepsis) in what appears to be a random fash-
ion, or demonstrating a lack of agency? This chapter brings together nar-
rative theory as it is understood by psychologists. For instance, McAdams
(2008a) argues that there are a number of key concepts necessary for narra-
tive understanding in applied psychology. These include coherence, mean-
ing, agency, construction, redemption and contamination. Psychologists
are interested in how the self is constructed, identity and identity change,
and the limits of construction itself with respect to human behaviour.

The Rest of the Book 9
Chapter 3 will also examine the role of key psychological theorists who
have brought narrative into psychology such as Bruner (1986), Sarbin
(1986), Reissman (2005) and others, and how their ideas have influenced
psychological thinking. In the early days of narrative in psychology, Bruner
argued that psychology can be split into paradigmatic and narrative psy-
chology, with the former being traditional experimental approaches. This
distinction is problematic and may be one reason why narrative has not yet
become mainstream, mainly because narrative psychology itself is paradig-
matic, something not recognised by many psychologists.
The emphasis in narrative psychology has often been on how to do it
rather than doing it. There is a diversity of theories in narrative psychol-
ogy. It is also essential to examine the relationship between the individual
and the social world. Narratives function at several levels: the personal,
interpersonal, social and cultural. At the top level, these are known as mas-
ter narratives. The distinction between these categories is somewhat fuzzy,
but it can be argued there is no such thing as a personal narrative as all nar-
ratives are influenced by the world around us, and by our audience. Not
only friends and colleagues but also the media plays an important part in
constructing and reconstructing narratives. Moscovici’s (1984) theory of
social representations provides a good example of how these issues have
been discussed in psychology for a long time without necessarily draw-
ing on narratives explicitly – even though narratives are essential to social
representations. Narratives provide the best approach to understanding
how we understand ourselves, our interactions with others and the world
around us and how we make sense of all this.
The constructs we use in psychology are part of the master narratives of
the subject, the interaction between psychologists, the users of psychology
and society itself. There are two key points to be made here. The first is the
nature of psychology itself and the second is how many of our theories are
narrative in nature, at least implicitly. This is not to undermine psychol-
ogy, but to point out the importance of narrative across the subject. The
narrative of mainstream psychology in the UK for many people is that
it is a scientific subject, accepting the scientific method, with the experi-
ment as the best approach, and theories and methods derived from the
natural sciences. While this has advantages, it also has disadvantages. In
terms of specific theories, post-traumatic stress disorder (PTSD) provides
a good example. PTSD was created in 1980 by the American Psychiatric
Association (APA, 1980) to describe the responses people have to trau-
matic events, specifically at the time the response to war trauma, though
in subsequent years, this has developed to include the response to other

10 Introduction
forms of traumatic incident such as rape, sexual abuse, manmade or natu-
ral disasters, road traffic accidents and so on. There is a debate about which
events should be included or not included, and over the years, the defini-
tion of PTSD in different editions of DSM has changed several times as
a result of developing narratives. The fundamental problem is that PTSD
is a constructed disorder. It is based on evidence relating largely to US
veterans of the Vietnam War, and over the years, it has been adjusted to
hone the symptoms more effectively to what is seen as the response to a
traumatic incident. At the level of the narratives involved (narratives about
trauma, PTSD, individual responses to trauma, emotions associated with
trauma and so on), these narratives are not universal, and they are con-
stantly changing. This fundamentally challenges the medical model. It is
not that we are simply finding out more about PTSD, it is that the narra-
tive of PTSD constantly changes to bring in more people, more traumatic
event types, yet at the same time fails to account for the genuine problems
people face as a result of challenging life-threatening experiences. People
with a diagnosis of PTSD usually have a comorbid diagnosis of some other
constructed disorder such as depression or anxiety (e.g. Ginzberg et al.,
2010). If we have this constantly changing narrative, then in what sense are
we understanding the nature of mental illness?
Chapter 4 will explore master narratives, the overarching narratives that
determine how cultures function. Every culture has one or more master
narratives, which determine how participants think and behave to a large
degree. While not everyone will agree with all elements of the master narra-
tive – there are often subcultures, particularly in modern sophisticated lib-
eral societies – the concept is essential for understanding the social world.
The interaction between the individual narrative and the master narrative
is essential for both social and individual change. We will see the effects of
master narratives in certain societies and some of the problems associated
with them, such as the problems of multicultural societies where there are
fundamentally conflicting master narratives.
Chapter 5 looks at narrative methods. It examines where and how nar-
ratives can be used in psychological research. It includes a general outline
of the ways narrative is used as a method, the different conceptualisations
and the limitations of narrative as a method. There are many accounts of
how to use narrative as a method – perhaps too many, as some are contra-
dictory, and the multiplicity of approaches makes it difficult to establish
best practice.
Narrative analysis is, as to be expected, mainly a qualitative approach
(e.g. Wong & Breheny, 2018), where the researcher attempts to make sense

of a script in narrative terms and draw conclusions about, for instance, the
coherence of the narrative, or the meaning that is being put across. This
is inevitably a difficult task due to the complexity of narrative. There are
examples of attempts to quantify narrative analysis, but these are fraught
with difficulty – providing a good example of how many aspects of psy-
chological life cannot be reduced to numbers – whatever some psycholo-
gists might say.
Moving on to the second part of the book, general approaches, Chapter 6
will examine life interviews, their characteristics and how they differ from
other qualitative interviews. There are two main approaches examined
in some detail. Don McAdams (2008b) has worked for many years on
an effective life interview which examines individual narratives, which
also examines how we can interpret interviews in terms of, for instance,
redemptive narratives and contaminated narratives. This is a very detailed
and sophisticated method and theory and is useful in practice. The other
approach is one I have been developing called the Narrative Life Interview
(NLI), which draws on McAdams’ work and others and is intended as a
means of exploring transitions in people’s lives and to help people come to
terms with, to manage, some of the problems they have faced in life.
The NLI involves two interviews, a main one and a follow up. The
purpose is to explore significant transitions in a person’s life. It does not
matter what the transition is, but the NLI explores its effects on behav-
iour, cognitions and feelings. Any transition in life can have an effect on
a person, and we as psychologists should be trying to understand these
effects. The NLI has been used on subjects as broad as traumatised refu-
gees and young adults transitioning to university. It is a useful research
tool. The first interview, which can last a number of hours depending
on the person and the topic, is designed to obtain as much information
about the transition as possible, what life was like before the transition,
during the transition and afterwards, including any longer-term changes.
Through the interview, the person is asked about behaviour, cognitions
and emotion, to obtain a broader and deeper picture. At the end of the
interview, it is transcribed and turned into a story by the interviewer. This
is the significance of the narrative element. The resulting document is not
just a transcription of the interview but, using the interviewee’s words as
much as possible, it is the story of the transition, written from the perspec-
tive of the interviewee. This story is then given to the interviewee so they
can look for inaccuracies, lack of detail, elements they wish to remove
and so on. At the same time the interviewer thinks about any questions
they might have, for instance, to obtain more detail at some points, or for

12 Introduction
clarification. At the second interview, these areas are dealt with. Anything
the interviewee wants removed is removed, anything they want changed
is changed. The interviewer asks for detail or clarification. After this inter-
view, the account is revised and sent to the interviewee for confirmation
that it is an accurate and complete account. Emerging evidence suggests
that this process, again perhaps as it is helping develop the narrative, is
beneficial to people who are traumatised or otherwise affected by their
experiences. It is not a substitute for therapy but can be helpful. Therapy
versus research will also be explored in this chapter. There is a distinction
among psychologists between the two, that people conducting research
should not be doing therapy. This ignores the well-established fact that the
process of being a research participant, particularly in interview studies,
does have therapeutic benefits.
Chapter 7 builds on the work in Chapter 6 and examines narrative writ-
ing, where people are asked to write their story, or elements of their story.
Narrative writing is often used as therapeutic writing. For instance, expres-
sive writing is a particular method of writing about a subject on a number
of occasions. The writing is not analysed, it is thrown away. People may be
asked to address a specific problem in a particular way or they may simply
be asked to write about it. The evidence is variable, suggesting that the
technique works for some people but perhaps not for others.
Chapter 8 focuses on narrative therapy, a name given for a range of
therapeutic approaches. The term may be employed loosely to describe
any approach that encourages people to tell or restructure their story – at
the extreme all talking therapy is narrative therapy because it is intended to
help people make sense of their lives and the events in their lives. Narrative
therapy has several components (White, 2004), such as examining the sto-
ries that shape a person’s identity, an externalising focus, whereby naming
a problem can help a person see how it works and how to fix it, and a focus
on unique outcomes (Goffman, 1961), which are central to a person trans-
forming themselves through changing their life stories. Through narrative
therapy, people identify their particular skills and abilities and use these to
transform their life stories. Narrative therapy has been used in a range of
situations such as eating disorders (Weber et al., 2007), domestic violence
(Allen, 2007) and conflict resolution (Winslade & Monk, 2000).
One important problem with narrative therapy is that it is a construc-
tionist approach where there are no absolute truths, which might lead to
a conflict between a person’s post-therapy narratives and the dominant
cultural master narratives. This suggests a fragility of narratives whereby
post-therapeutic experiences may undo any positive benefits. There are

also few controlled trials examining the efficacy of narrative therapy, so the
evidence base is weak.
The next chapters examine narrative approaches in applied contexts.
Chapter 9 focuses on NET, which has gained popularity over the last few
years, has a growing evidence base and is now accepted as an effective
clinical practice in a number of countries (e.g. NICE in the UK, APA in
the USA) as a frontline treatment for PTSD. NET was introduced around
20 years ago as a treatment for traumatic stress, particularly in difficult to
reach populations such as refugees and people in the developing world
who have survived war, child abuse or severe human rights violations. It
is a manualised treatment that can be employed quickly and by and for
people with limited expertise in the field of trauma.
The reason NET has become so popular since its introduction is that
it draws on innate human attributes and good psychological theory. It
is not a complex procedure and it is easily understood by those who are
being treated with it – which is what gives it its advantages over other
approaches. For example, if people understand an approach, they are more
likely to engage with it – less likely to drop out. NET draws on our innate
desire and need to construct narratives. It is about telling one’s life story
to a receptive audience. People who are traumatised can have difficulty
putting their experiences into words, the procedures of NET help them
do so. After experiencing trauma, many people, though they do have dif-
ficulties verbalising their experiences without help, do want to bear witness
to their experiences, to tell others and perhaps to gain some comfort for
themselves or to see perpetrators punished for their behaviours. A good
narrative enables a person to bear witness, and one outcome of NET is
that the person has a signed account of their experiences that could be
used as a witness statement in court. NET is built mainly around the criti-
cal importance of narrative and telling one’s story, but it also draws on
good psychological theory about traumatic stress. The chapter will go into
detail but fundamentally a negative response to trauma involves traumatic
memories (so-called ‘hot’ memories in NET theory), which are difficult
to control, have conditioned negative feelings and cognitions and cause a
range of symptoms. NET focuses on addressing these hot memories in the
context of the person’s lifeline (a series of the most positive and negative
events in a person’s life), enabling the hot memories to lose their traumatic
power and become part of the person’s life narrative. The chapter will
examine this process in detail and the evidence relating to NET.
The chapter demonstrates the benefits of using a narrative approach in
therapy, and there is very good evidence for its effectiveness. NET is now

14 Introduction
considered appropriate by NICE in the UK for the treatment of PTSD.
People who are traumatised often have difficulty undergoing therapy as it
can be a painful process. The dropout rates are often very high. This is alle-
viated by NET itself being a natural narrative storytelling process. It is not
in itself difficult. The subject matter is painful, but the therapeutic process
is a natural one, which means that the dropout rate is very low.
Chapters 10 to 14 explore research in a specific range of areas, narra-
tive medicine, narrative health psychology, narrative work psychology and
narrative coaching. The research on narratives in these areas is relatively
limited, but there is great potential for the future. The chapter will look
at research evidence but will mainly focus on this potential. In health
psychology, much of the research has focused on telling stories of illness
(Sools et al., 2015) such as childhood cancer (Moore et al., 2015) and eating
disorders (Papthomas et al., 2015) rather than in trying to make them deal
more effectively with their illness, though – as noted earlier – just the act of
telling a story can help someone feel better. There is not a specific chapter
on narrative clinical psychology as this is sufficiently covered in specific
chapters on NET and narrative therapy. There is relatively little research
within occupational psychology on narrative. I have written about intro-
ducing narratives into the performance and appraisal system (Hunt, 2011),
with a focus on how narratives function at different levels: individual,
interpersonal (e.g. manager/worker relations) and organisational. Boudens
(2005) used a narrative perspective to identify clusters of emotions associ-
ated with prototypical work situations, arguing that narratives were the
best way to approach this topic. Scott (2019) explored how people make
sense of their work, how they develop meanings using narratives.
Narrative approaches are increasingly popular in coaching. The basic
position is that people need to change or adapt negative narratives about
their lives to substitute more positive ones. The most extensive account of
narrative coaching is by Drake (2010, 2017), who discusses the importance
of the narrator, their narrated stories and the narrative field. He recog-
nises the instinctive nature of storytelling and how it is helpful in bringing
about change.
Chapter 14 draws conclusions about the narrative approach, what has
been achieved and what can be achieved in the future. Unlike a lot of psy-
chology, which focuses on the negative in an (often futile) attempt to make
it positive, narrative psychology is inherently positive. It is what we all do;
it is how we make sense of the world. This final chapter will look back
on the book, how narratives have made a difference in psychology and
the ways in which we can develop new narrative approaches throughout

psychology. Narrative psychology, because it has come from the arts and
social sciences, has suffered from being under the umbrella of postmod-
ernism and social constructionism, and so has alienated many mainstream
scientific psychologists. It is time that this changed. Narrative psychology
is scientific psychology. It is based on good evidence about how the brain
is structured and how the mind functions. It is what we do naturally and
so it must be brought into mainstream psychology. The book will focus
largely on areas of applied psychology, but throughout this will be based
on the best science we have for the narrative approach.

Chapter 2
What Is Narrative?
Narrative is rather a messy area. This chapter and the next two will try
to make sense of it first in terms of what we mean by narrative, narrative
psychology and narrative and culture. Narrative is messy partly because
it is employed by a number of disciplines, which define the construct
differently according to their own theories and methods. Disciplines use
narrative for different purposes, so it is not surprising that there are areas
of disagreement. This is not the place to examine all these areas of dis-
agreement, as the purpose of the book is to enable psychologists to make
practical use of narrative. I will largely ignore the applications of narrative
in other disciplines except insofar as they are helpful to understanding
narrative psychology. Anyone who wishes to have a linguistic, sociologi-
cal, or other explanation of narrative should look elsewhere. We need
a workable theory of narrative that can be applied in a consistent and
useful manner.
In this chapter, I will attempt to define narrative, examine the key con-
cepts associated with narrative, explore some elements of differing theoret-
ical perspectives across disciplines to show ways in which they are helpful
for psychologists and outline the general theoretical perspective employed
in this book.
While there is much disparity between narrative approaches, as we have
already seen, they do have common foundations. They centre on the nar-
rative or story as a unique form of discourse.
Narrative and Story

There is little consensus regarding the uses and meanings of the terms nar-
rative and story. They are often used interchangeably. For the purposes
of this book, as we are discussing narrative psychology, there is a clear
distinction. A story is a specific tale that people tell. Narrative refers to
the resources and skills that we have that are used to construct the story.
16

Narrative and Story 17
Narrative is a series of biological, cultural and social resources that provide
the means by which people can construct stories. We can discuss the nar-
rative components that make up stories. Narratives are about temporality,
coherence, plots and so on, and the result is the story. This distinction will
not be acceptable to everyone but it has practical utility. Stories matter
when we are discussing the application of narrative. It is through inter-
preting stories that we examine people’s mind and behaviour, sometimes
through examining the effectiveness of their narrative processes, processes
which can break down or fail under certain circumstances.
Narratives and stories are important because without them language is
just a sequence of sounds, little more useful than crude grunts and gestures
were to the first homo sapiens. Our ability to make language meaningful
is the work of storytelling, an ability that allows us to recognise and make
meaningful patterns of words, phrases and inflections, to make and rec-
ognise common story forms and archetypes, and to be responsive to those
patterns when they are communicated to us in fragments.
Narrative itself can be split into two elements: first, the narrative skills
and processes that we all have, the brain components that enable us to con-
struct the second, the stories or narratives themselves. A story is a sequence
of related events that are situated in the past and recounted for rhetorical/
ideological purposes. Events are composed of multiple elements, includ-
ing actors, times and other entities which relate to one another through
actions that occur. The term ‘story’ is often used in a colloquial sense to
refer to a wide range of resources ranging from official and unofficial news
stories to family stories to online postings and blogs. Stories can emanate
from a variety of places and serve a variety of purposes; they all share a
similar structural integrity: a sequence of related events situated in the past
that is recounted for a rhetorical or ideological reason.
Are narratives and stories the same thing? Stories are relatively unam-
biguous. We all know what a story is, a sequence of words describing
series of structured events with characters, actions and so on. Narratives
can be stories but narrative also refers to the skills we have in construct-
ing stories. There are implications of narratives and stories not being the
same thing.
We all have our narrative skills, but there are individual differences in
how effectively we can use them and we tell different stories of the same
event. Two people may have a similar experience but the stories they tell
may be very different. This is partly because of how they focus the story,
what is important to them, what they remember and partly because of the
audience they are aiming at. A story is not a perfect reflection of experience,

18 What Is Narrative?
but an interpretation derived from not only what happened but also per-
sonal memories, interests, personality and so on. In psychology, the study
of narrative skills is important. It is often assumed that we all have effective
narrative skills, that we can all produce coherent stories about the world
in which we live, but this is not necessarily so. People differ in their abil-
ity to use narrative skills. Some people have very good narrative skills and
some have poor skills. This is why narrative therapy may not be suitable
for everyone. The key question here is whether we can get those with less
effective narrative skills to produce good narratives. Can we train narrative
skills? Is this why we have creative writing courses? When psychologists
are using narrative exposure therapy (NET, see Chapter 9), they are not
relying particularly on the narrative skills of the client, but on the ability
of the therapist to help the client construct the story. This might work for
verbal forms of narrative, but can it work with narrative writing, where the
therapist is not providing that level of guidance? This is not clear, as we
shall see in Chapter 7, on narrative writing.
In general usage, narrative and story are interchangeable, and this is in
part due to the connotations of the words and the ways they are used in
everyday speech and writing. These connotations are used throughout the
book in order to be pragmatic and avoid awkwardness. This is an applied
book, not a deep consideration of the finer points of narrative theory. In
the end, someone who says they are describing a narrative are describing a
story, and vice versa.
Characteristics of Narrative
Narratives are characterised by sequence (temporality) and consequence
(point, message; Reissman, 2008). Narratives also have characters, plot,
space and genre (Randal, 2017). The ability to capture time means narra-
tives are essential to human existence (Ricoeur, 1984). This will be explored
further in Chapter 3, but without narratives, we would have only limited
access to the past (as memories would have limited organisation) and pos-
sibly no meaningful access to the future. Without the past and the future,
there is a limited or no sense of being human.
Bruner (1991) proposed ten features of narrative, a list which is adapted
below as twelve points.
1. Universal. All people use narrative for most of their thoughts and
interactions with others. Narrative does not constrain interaction
between people, language does. Narrative enables translation of one
language into any other language.

Characteristics of Narrative 19
2. Temporal. Narrative is irreducibly durative. Time is essential to
narrative. Without time, all we have is an event.
3. Generic. There are conventionalised representations, both of
narrative itself and the forms of telling. Stories are told in particular
ways and not other ways. It is from generic stories that we then
develop into particular stories.
4. Intention. What happens with narrative in a social setting is
relevant to people’s intentions. Social settings are affected by what
people do in those settings; social settings derive from people’s
stories.
5. Meaning. Narrative helps provide individual and social meanings
for events.
6. Canonicality and breach. There are canonical scripts for situations
(e.g. restaurant and classroom). For a story to be worth telling, this
script must be breached in some way.
7. Referentiality. There is always reference to truth in narrative, both
in factual accounts and in fiction. Both use reference to truth and
so it can be difficult to differentiate truth from fiction. For truth,
we rely on trust.
8. Normative. Narrative is essential normative because it relies
on breaches of these norms for a story to be worth telling. This
illustrates the importance of narrative as scaffolding for stories,
providing the essential components of a story on which the actual
wording of the story is based.
9. Context sensitivity. Stories are not just about individuals, they are
about the context in which the individual exists.
10. Negotiability. It is usually possible to tell several different versions
of the same story. There is socio-cultural negotiation which depends
on the context and the people involved.
11. Accrual. Stories are grouped together and eventually become culture
or history (as master narratives, see Chapter 4).
12. Audience. Without an audience, there is no story. Narrative
requires participants. Sometimes, the audience may be the person
creating or telling the story, but on most occasions, there is an
audience or an intended audience or at least an imaginary intended
audience.
Wright (2002a) argues that there is an interplay between three terms, nar-
rative, story and myth, with a preference for the word myth as the medium
through which religion, neuroscience and mental well-being all interact.
This illustrates the terminological difficulty we experience when studying

20 What Is Narrative?
narrative. As established, narrative consists of the set of rules and skills for
creating stories, and so functions at a higher level than stories and myths,
terms that are in many ways interchangeable as all stories are myths, they
mostly contain some truth and some fiction, with a broad sweep of inter-
pretation included. Shannon (2005) made a similar mistake, arguing that
if rational explanations such as quantum physics and evolution are fully
adequate explanations of our origins and realities, then why do we continue
to read, create and reformulate myths? This is a misunderstanding of the
nature of science. Quantum physics and evolution do not provide fully ade-
quate explanations of anything, they are just the best stories we have at the
moment. Science is narrative (Prickett, 2002). Indeed, according to Niels
Bohr, and he should know, quantum theory is not telling us what is, but
what we can say to each other. Presumably, at some point in the future, bet-
ter stories will replace our current science stories. Personally, though with-
out evidence, I am looking forward to the story that removes the story of
the Big Bang, which is just another term for God in the sense that humans
need to have a beginning. Genesis or the Big Bang? Both are interesting
stories. Neither are good representations of the ‘truth’, whatever that means
in this context. Humans have very limited cognition and require begin-
nings and ends, not only to our own stories, which always have beginnings
and ends, whether formal, for example, novels, or informal, for example,
describing what happened today, but also the stories of the universe.
Discourse is, according to a Wittgensteinian approach, a rule-based
manipulation of symbols in multi-person episodes that unfold in mate-
rial settings, that is, human narrative capabilities, enable us to talk to each
other in the real world and interpret that real world in different ways.
This approach, central to this book, relies on the work of Wittgenstein,
Vygotsky and Garfinkel, all of whom focused on the importance of the
social in the development of the human mind; and to be social, we need
narrative.
Herman (2007) outlined five key concepts that inform narratological
research.
1. Positioning, for example, powerful/powerless or admirable/
blameworthy people. We use position-assigning speech acts in our
everyday speech.
2. Embodiment. This is a critical scientific position. Unlike during
the first cognitive revolution, we accept that the mind is embodied,
minds are a nexus of brain, body and environment. The mind is put
on the same footing as the environment. This helps avoid making

Characteristics of Narrative 21
cognitive processes wholly explanatory of behaviour and ensures that
narrative approaches are grounded in a scientific realist position.
3. The mind is distributed. Minds are in an essential way spread out
among the participants in discourse, speech acts and objects in the
environment. There is transindividual activity across participants and
groups.
4. Emotion discourse and emotionology (Stearns & Stearns, 1985).
There are collective emotional standards of a culture rather than the
individual experience of emotion itself.
5. The problem of qualia. Qualia are qualitative experiential properties
of mental states. Are they reducible to physical brain states or are
they an unbridgeable explanatory gap between accounts of brain
physiology and the phenomenology of conscious experience?
Fludernik (1996) argues that experientiality or the impact of narrated
situations on consciousness is a core property of narrative itself. The
position here is that qualia are reducible to brain physiology but how
it happens is as yet unknown.
We continue to propagate myths because intrinsically humans love sto-
ries. They love stories that provide an explanation, any sort of explana-
tion, even God, and stories that appear to provide an explanation, and
stories that do not provide anything other than entertainment. We run
our lives through stories, we love stories, we love making them up, telling
them and listening to them. The story is often more important than any
truth or falsehood behind it. Gottschall (2012) argued that ‘Religion is the
ultimate expression of story’s dominion over our minds’ (p. 119). A little
like Marx’s opium of the masses. We care less about truth than we do
about a coherent explanation, which is why religion remains popular in a
scientific enlightened world. Prickett (2002) argues that ‘we are concerned
with models of reality – and such models are usually verbal and almost
invariably narrative’ (p. 71).

Chapter 3
Narratives in Psychology
Chapter 2 addressed narratives in general. This chapter focuses on the

uses of narrative in psychology. There are several reasons why narrative is
important in psychology. As we have seen, the use of narrative is universal
among humans (excepting perhaps some people with severe mental health
problems, but they are not the focus here) and it is surprising that psy-
chologists in general have not focused more on this area. We use narrative
in most things that we do. We tell stories about many aspects of our lives,
most of our thoughts have some sort of narrative structure, our working
lives are full of narratives, we use narratives when we go on holiday, when
we talk to each other and when we are working out problems in our heads.
Just as importantly we listen to other people’s narratives across all these
situations and more. We learn through listening to or reading narratives,
we read books, magazines and social media sites, we listen to our spouses,
children and friends, we attend lectures, the theatre and the cinema. All
are forms of listening to narrative. Narrative is central to our lives; we
could not function without it. Along with the opposing thumb, narrative
is at the heart of what it is to be human.
We create narratives, we co-create narratives, we use narratives and we
listen to narratives. The opposable thumb enables us to make and use com-
plex tools. Narrative enables us to remember and understand the past, the
present and the future, and enables us to control emotions and to have
rationality. Rational thought is narrative thought. Bruner was wrong in
differentiating paradigmatic and narrative psychology. Narrative is the root
metaphor of all psychology. Every interpretation of behaviour, whether
neuroscientific, cognitive, behavioural, psychodynamic, etc., is based on
our ability to employ narrative skills. Sarbin (1986) also argues that narra-
tive is the root metaphor for psychology. Central to his argument is that
human life is inherently contextual, things happen to people at specific
times in specific places. Sarbin argues that Bruner’s paradigmatic positivist
science seeks general laws and is rather ill-suited for understanding human
22

Narratives in Psychology 23
functioning. Narrative thinking builds explanations specifically relating to
a particular context in which human intention is enacted, so is more read-
ily applicable to understanding human functioning.
As psychologists, we should be concerned with all aspects of narrative.
Without narrative, we cannot do psychology. We should understand why
we use narrative and how we use it. We should understand why it usually
works and how it can fail. We need to know why someone with depression
focuses on negative narratives about their lives while most of us focus on
both positive and negative narratives. Why is the glass seen as half full or
half empty? If we can understand why some people focus on negative nar-
ratives, then what can we do to help them be more positive in their stories?
In my research, I have focused a lot on traumatic stress. Why do people
who are traumatised have such difficulty describing what happened to
them, often reverting to non-narrative forms of expression? What blocks
narrative processes, those processes that enable us to build and tell a story,
from functioning?
Psychology has employed several theoretical approaches in order to
understand human behaviour and the mind. These have been more or less
useful depending on the problem addressed. Behavioural approaches and
cognitive psychology have been particularly popular for many decades,
and they have made useful insights into how the human mind works – or
doesn’t work. What is surprising is that narrative has been largely ignored,
at least until recent years, and it is still ignored by many psychologists even
though it is the critical element of the human psyche, one that must be
understood if we are to progress in psychological science. Indeed, much of
what psychologists do and say is narrative in nature, if not in word. When
we discuss memory, we may discuss how we are better able to remember
items when they are built into a story rather than as a list. The whole
theory around mnemonics is built around this simple fact. The concept of
stress in the workplace is best explained using stories, exploring the causal
reasons why people are stressed, how it relates to their experiences, co-
workers, work activities and so on. We have to build a story to understand
how stress works. It is the same for any theory in psychology. A theory is
a story, an attempt to provide a coherent narrative about some aspect of
the mind or behaviour. Narratives enable us to understand, to make sense
of, what we see and hear around us. Narratives enable us to make sense of
the environment.
All psychologists study narrative, it is just that some may not be aware
of it. While many animals are social, it is narrative that enables us to
devise and develop culture. It is the ability to reflect back to the past

24 Narratives in Psychology
and forward to the future that enables us to have and develop ideas
about how we should live as individuals and together. Narrative gives
us memory, the ability to think about previous behaviour, about our
relationships and how they have developed and about society and cul-
ture. Memory enables us to think about the future and how previous
behaviours impact on how we choose to behave in the future (not that all
behaviour is about choice, much of it is instinctual, much of it is trying
to avoid the instinctual).
Narrative skills give us rationality and cognition. Without narrative,
we are just emotional creatures of habit. Narrative content and narrative
structure both promote flexible, adaptive functioning (Richert, 2006).
Some researchers de-emphasise the role of causality in narrative simply
because it uses qualitative approaches, though one of the critical aspects
of narrative is temporality, that one thing precedes another, and that
without a logical sequence of events, there can be no narrative. While this
may be causal, and often is, different consequences may be derived from
the same set of circumstances, with human intention playing a key role.
This is the heart of the argument for free will, our ability to make choices
given a fixed set of circumstances. Narrative explanations are never based
on exact and precise recounting of all preceding events that might be
relevant but instead are based on partial, often selective, recounting of all
relevant preceding events. Another way of looking at this is that only nar-
rative explanations provide causal explanations. With narratives, we are
trying to find explanations. Rationality and logic are forms of narrative
where we attempt to be more precise, but throughout science, whether
we are considering the difficulties of understanding human action or the
origins of the universe, it is very difficult to determine causality with
precision, except in relatively simple circumstances. Part of our grow-
ing scientific understanding involves the recognition that our causal
explanations are inadequate and that we need to replace them with ones
that better fit the data. Even in science we have incomplete and biased
explanations.
Several authors have discussed the centrality of narrative to psychology.
According to Schiff (2017), narratives should be central to psychology
otherwise the subject is ‘in danger of being irrelevant to the understand-
ing of persons and everyday experience’ (p. 4). Narrative provides a
unifying theory and method that provide insight into ‘how persons, in
context, interpret themselves, others and the world’ (p. 43). According
to Sarbin (1986), we function via the narratory principle, that ‘human
beings think, perceive, imagine, and make moral choices according to

Stories and Narrative Processes 25
narrative structures’ (p. 8). Narrative brings order and meaning into
our ever-changing world. We use it to constantly interpret, re-interpret
and understand what is going on around us. We are born into a story-
shaped world and experience life through this constant development and
modification of stories. Creating stories helps provide a coherent and
plausible account of how and why things happen (Polkinghorne, 1988).
Bruner (1990) argues that narrative cognition is the organising principle
of humans, rather than logic or scientific empiricism – we live in a world
of possibilities rather than certainties. According to Bruner, without nar-
rative schemas, we would be lost in a murky world of chaotic experience
and may not have survived as a species. Our predisposition is to organise
our experience into narrative.
As narrative psychology is rightly concerned with the storied nature
of human conduct, with people creating and telling stories and listening
and responding to the stories of others, narrative should be the main root
metaphor for psychology, not cognition, neuroscience or behaviourism,
but narrative psychology. Life is more about meaning than it is about
logic (though logic is a form of narrative). If we were as logical as the
cognitive psychologists would have us believe, then there would not be so
much trouble in the world and we would not be such emotional beings.
It is narrative that helps us make sense of our emotions, meaning-making,
not logical thought. The distinction made by psychologists over so many
years between logical thought and emotion is a false distinction. We are
driven by emotions, but we control them through meaning-making and
stories, not by logic. We are more concerned with meaning and c oherence
than logic.
Stories and Narrative Processes

Psychologists should be interested in narrative in two ways: to examine
stories and to examine the nature of narrative processes. Psychologists tend
to focus on examining stories, their meanings and the ways in which they
might change to have an impact on a person’s identity or roles. Narrative
processes concern the nature of the underlying processes by which we can
tell and understand stories. While there is a good understanding of the
psychological nature of narrative processes, there have been only limited
attempts to understand the underlying neuroscientific nature of narrative.
This is in part because psychologists have shown little interest in narrative,
and partly because narrative processes are complex and have complex neu-
roscientific bases. I will return to this later.

Individual Differences
If we are to study narrative, we need to acknowledge individual differences.
We do not all have the same narrative skills; indeed some people have very
limited narrative skills. These tend to be people with limited cognitive
abilities generally. Our genes are likely to be important in understanding
individual differences in narrative ability. People have inbuilt character-
istics that affect the ways they develop narratives. There are personality
characteristics that remain largely unchanged throughout life. People have
varying levels of functional intelligence that remains largely unchanged
throughout life. These factors will all have a huge impact on behaviour
above and beyond narrative skills.
There is relatively little research attempting to draw together the vari-
ous aspects affecting behaviour, including narrative. In part, this is due to
the politics of psychology; there has generally been a separation between
mainstream psychologists and narrative psychologists. This is not only a
problem with mainstream psychology, but also many narrative psycholo-
gists prefer not to become involved in mainstream research because they
prefer not to acknowledge the importance of these key individual differ-
ence factors, for example, denying cognitive ability differences or the rela-
tive permanence of personality styles. There is an assumption among many
psychologists that variation in human performance is about opportunity
and environmental factors rather than intrinsic factors. This is a serious
limitation not only of narrative psychology but also of psychology in gen-
eral. It is a dangerous position to take as it fails to recognise genuine dif-
ferences between people.
I do not wish to go into the arguments around this, but the key point is
that human functioning, while reliant on narrative processes to be human,
is not just about narrative, it is about other individual characteristics.
Together these factors help determine the nature of self and identity.
Psychology Is All about Narrative

All psychology is narrative psychology. Psychology is the root metaphor
of psychology. There is no psychology without narrative. At its core, this
takes us to the nature of science itself which, no matter how many people
might argue about it existing outside culture, its objectivity and so on, is
still a narrative about understanding the world. The cosmologist attempt-
ing to understand the universe is not standing outside human understand-
ing, outside human narratives. Our perceptions of the universe depend

Psychology Is All about Narrative 27
on our current understanding of the world, our current narratives. Key to
this is one element critical to narrative, temporality, and with temporal-
ity, we want beginnings and ends. The cosmologists of the past, we called
them theologians, understood the universe in terms of God. God created
the universe and God will end the universe. The modern cosmologist has
a different narrative. The universe started with the Big Bang, the universe
will end with the Big Crunch or – depending on your point of view – the
Big Blackout. The modern cosmologist/theologian has an explanation that
is essentially the same as the ancient theologian/cosmologist. There is a
universe that has a beginning and an end. It is just that they say there are
different causes to the beginning and the end. In reality, God and the
Big Bang are just different names for the same thing. They are alternative
narratives with the same underlying structure. These explanations reflect
not the increasing wisdom of the human race but the absolute necessity of
the human race to provide a narrative explanation which includes causes,
beginnings and ends. We are born, we die; we build a house, it eventually
falls down. There is a beginning and an end to everything. That is about
how the human mind works, not how the universe works. It demonstrates
the narrative nature of the mind and also the limitations of the mind to fail
to go beyond time, that key narrative concept. It demonstrates our cogni-
tive limitations, our inability to think outside being human surviving on
planet Earth.
To pull back from the rarefied nature of the universe to more mundane
psychological understanding, there are a number of key schools of thought
in psychology, such as behaviourism, cognition, neuroscience, psychoanal-
ysis and so on. These schools have developed and changed over time and
have varying levels of respectability within the psychological community
(the master narrative of psychology) and different points. The argument
here is that they are all forms of narrative psychology. This is because sci-
ence is narrative. Each is telling a story. The behaviourist tells the story of
how variables relate together, how one behaviour causes another behaviour
and how operant and classical conditioning function. Cognitive psychol-
ogy has stories about memory, attention and perception. Psychoanalysis
has stories about the id, the ego and the superego. Neuroscience has stories
about how particular parts of the brain are linked to particular behaviours.
These are all narratives and this is why all psychology is rooted in narra-
tive psychology. In the end, all psychologists want to tell a story about the
nature of human behaviour, the human mind and the human brain. As
people with scientific narratives, we recognise the strength of these narra-
tives and we recognise their limitations. We know behaviourism works. It

has been applied to understanding and treating phobias, post-traumatic
stress disorder (PTSD) and anxiety generally. We know cognition pro-
vides a good model for understanding the mind.
Narrative as Science
This is not intended as review of the literature on narrative psychology,
more an attempt to show that the range of narrative research, certainly
theoretical narrative research, has been rather narrow and limited in its
scope. Much narrative psychology research, at least outside of therapy,
has, instead of examining psychological processes, limited itself to issues
that are more sociological than psychological, for instance, race and sex,
and interpreted story in terms of power rather than psychological process.
The concept of narrative is linked to postmodern thinking, so many
psychologists with a scientific bent might view it with doubt. This is unfor-
tunate, and the scientific study of narrative is the basis of this book, nar-
rative as science rather than narrative as morality or politics. As Laszlo
et al. (2007) claim, the systematic linguistic analysis of narrative discourse
may – I would say should – lead to a scientific study of identity construc-
tion. We need a method of narrative psychological content analysis, with
programmes to identify compositional features in narrative texts and test
the validity of these programmes with large-scale empirical studies.
From Cognition to Narrative

The dominant paradigm within psychology for much of the post-war
period has been cognition, with the mind as an information processing
device, for instance, Chomsky’s theory regarding the language acquisi-
tion device, or Baddeley and Hitch on working memory. The first cogni-
tive revolution was a reaction against behaviourism which suggests the
mind is epiphenomenal, an explanatory fiction. According to Harre and
Gillett (1994), the second cognitive revolution places the mind in mate-
rial contexts of action and interaction without reducing mental activity to
bodily activity. Cognitive narratology (Herman, 2007) explores the nexus
between narrative and the mind. In discursive psychology, there is a theo-
retical distinction between cognitivist approaches where texts depict an
externally given world and the discursive approach, which has an action
orientation of talk and writing and is concerned with the nature of knowl-
edge, cognition and a certain flexibility of human reality. Narrative serves
as a series of resources for constructing one’s own as well as others’ minds.

Evolution and Culture 29
In the end, all models of human psychology are narrative models. They are
all telling stories of how the mind is structured and how it works. These
stories can then be subjected to testing and contribute to the further devel-
opment of theory. At the basic level, cognitive processes relating to, for
instance, language and memory exist to serve narrative processes. They are
part of what it is to do narrative.
Narrative and Neuroscience

In recent years, neuroscientific research on neuroplasticity and neurogen-
esis has completely transformed our understanding of the brain. If one
area is damaged, then other areas can be retrained to do their tasks, brain
cells appear and grow throughout life, rather than experiencing slow
decay and death. Stories help the brain to negotiate the never-ending
conflict between the need for pattern synthesis and constancy on one
hand, and flexibility, adaptive ability and openness to change on the other
(Armstrong, 2019).
The key brain structure for narrative is the Default Mode Network
(DMN), which is the circuitry or network of brain regions that is more
active during passive tasks and used for remembering, thinking and mind
wandering (Raichle et al., 2001). It is the brain’s most comprehensive net-
work for the integration of information. It is also critical in enabling peo-
ple to construct and tell stories and to create shared experience. The DMN
includes, for example, the midline frontal and parietal structures, medial
and lateral temporal lobes, the angular gyrus and the lateral parietal cor-
tex. There is good lesion evidence for the function of these structures. For
instance, lesion studies to medial temporal lobes lead to deficits in mem-
ory and the capacity to imagine possibilities that do not yet exist. DMN
provides the infrastructure to reflect on the past, present and future and
on the minds of other people (Mehl-Madrona & Mainguy, 2021). When
emotional narratives are used, there are lingering after-effects described
in the DMN, the amygdala and in sensory cortical areas. The precuneus
appears to play a key role. Activity in this region seems to differ for real and
fictional narratives (Jaaskelainen et al., 2020).
Evolution and Culture

The basic proposition in evolution is that there is a mechanism of redupli-
cation with transmittable variations and competitive selection of those that
prove to have a better chance of survival. Evolution is a story unfolding

in time with conditions, with scheme-like rules. In evolutionary terms,
we initially had instinctual behaviours, we then developed emotions and
then learned to control these emotions through what we like to think of as
rationality or cognition, but is in actuality narrative processes.
We will never really know how narrative emerged in humans, but there
is speculation. Marschack (1972) argued for an agriculture-time-memory-
narrative model, that the cognitive ability to narrate evolved under particu-
lar ecological and cultural pressures in the process of adapting to changing
social conditions and the organisation of ethnic groups. The question of
the development of the mental abilities needed for narrative justifies a sci-
entific, biological evolutionary attitude from both phylogenetic and onto-
logical points of view. Narrative is affected by space and time. Ricoeur
(1984–1987) noted that the past, present and future are closely related to
narrative ability. Heidegger (1971), using a hermeneutic approach, said
that it is through narrative that we are able to bring past experiences or
future events into the present and make them part of present experience.
With time as key did narrative skills develop from a need to integrate and
interpret past, present and future, and enable humans to move beyond an
understanding of their immediate environment?
Unfortunately, many people resist the integration of science and the
humanities that is required to ensure progress in our understanding of
narrative (Comer & Taggart, 2021). There has been an assumption that
biological evolution in humans has somehow finished and we are now in a
stage of cultural evolution. The reality is that we have evolved a wide range
of behaviours that are functional and useful in evolutionary survival, from
mother–infant bonding, reproductively differentiated sex differences, male
and female cooperative groups, reciprocity, dominance hierarchies, inter-
nalised norms and the introjection of group identity into individual iden-
tity (see Chapter 4 on master narratives [Carroll, 2022]). We can argue
that it is uniquely human – biologically evolved human – to produce fic-
tional narratives and create symbolic images to imagine the world and the
place of humans in the world. Cultures might combine these elements in
different ways, use them in different ways, but underlying cultural differ-
ences, there are a wide range of human behaviours that are common to
every culture, including the use of narrative. While some constructivists
might reject evolutionary ideas, there are commonalities across all human
cultures which suggest otherwise. The concept of cultural evolution, while
appealing and suggesting that humans can fundamentally change their
nature, is not such a powerful force as some might think. Nevertheless,
understanding the role of culture and the social world is important.

Evolution and Culture 31
One fundamental evolutionary question is the relationship between lan-
guage and thought. Bruner’s (1991) argument, building on Vygotsky, was
that cultural products such as language mediate thought and place their
stamp on our representations of reality. This in turn leads to what Brown,
Collins and Duguid (1989) call ‘distributed intelligence’. Intelligence is
rarely just about the individual, it depends on a network of friends, teach-
ers, books, computers and so on. Research is needed regarding how we go
about constructing the social world, that intrinsically narrative-based social
world. The idea that language mediates thought is an important argument
for narrative, it puts it at the centre of human abilities and psychology.
According to Hegel, becoming or self-realisation is at the centre of
human existence. We all want to have meaning in our lives, whether that
is having an explanation for the universe, or understanding the point of
our own existence (even if we conclude there is no point). Thinkers vary
about what this entails. Atomists such as Pinker suggest that beliefs and
desires are information incarnated as configurations of symbols, and that
symbols are the physical states of matter, that is, the key level to develop-
ing understanding (Pinker, 1997). Atomistic thinking has the advantage
that it lends itself to traditional scientific methods and attempts to build a
picture from the ground up. Unfortunately for humans, it is not enough.
We need to see the complete picture and analyse its components.
According to holists such as Wittgenstein and Ryle, the major accom-
plishment of mind and language is rationality. This is not a biological but
a social phenomenon. This distinction between the biological and social
will keep appearing and is a somewhat artificial distinction, human culture
does not exist without human biology, and so we need to understand both.
Nevertheless, Rorty (2004) claims that explanations of human behaviour
that tie it with neurology or with evolutionary biology will only tell us
what we share with chimpanzees, not with those who painted pictures on
the walls of caves or sailed the ships to Troy.
Another limitation of the term ‘cultural evolution’ is that it implies
some sort of progression. If we are to use cultural evolution at all, we
should see a sense of cultures developing in a positive manner, somehow
getting better over time, making mistakes and learning from them, using
the principles of biological evolution and gradually improving. Instead,
we see cultures or civilisations rise and fall, cycles of change, changing
fashions, where any sense of improvement or ‘good’ is subjective and open
to interpretation. It might be argued that the Enlightenment and perhaps
the Industrial Revolution in the West have led to positive change. We
can now think more freely in the West and we have technology which

supports and apparently improves our lives. Yet these changes are neither
objectively good nor permanent. The internet has provided us with a won-
derful source of information but perhaps at the expense of cognitive abili-
ties. People sit inside playing online games rather than going outside and
kicking a football around or going for a walk. It might be argued we are
changing for the worse. In terms of the Enlightenment, we have had sev-
eral hundred years of increasing freedom of thought with awful periods of
reaction such as the Inquisition or Hitler’s Germany, but this is constantly
challenged. In the West, free thinking is being encroached upon, we are
expected to have certain views about the world and reject others. The cur-
rent culture wars or wokeism is a good example. We are constantly being
told to think in certain ways rather than to think freely. For instance,
we are expected to accept and respect Islam, a religion which resembles
Christianity before the Reformation, a dangerous religion which often
allows little free thinking (perhaps Islam is ready for its equivalent to the
Protestant reformation). In the universities and elsewhere, we are expected
to accommodate Ramadan and multiple daily prayers which interfere with
student learning and assessment. Islamic beliefs are at odds with scien-
tific endeavour, yet we are expected to have respect for them instead of
challenging people who hold Islamic or other religious beliefs. We are
constantly attacked by modern unenlightened crypto-fascists, who do not
allow multiple views relating to a range of subjects, not only religion, such
as transsexuality, race or sex/gender.
These issues and others indicate that cultures do not evolve, they change,
they do not always change for the better, and positive change is not always
permanent. Cultural evolution is not evolution in the way it is under-
stood in the scientific world. While Darwin may not have been happy
with Spencer’s notion of the survival of the fittest, there is still a sense that
evolution is, in the end, about positive change.
Dominant Narratives
In Chapter 2, I briefly discussed the difference between story and narrative
and the importance of narrative skills in human functioning. Here I focus
more on what narratives mean for human existence and culture. We all
have a series of narrative resources that we draw on to create our stories.
These resources are biological, cultural and social. The stories themselves
can have different foci. For instance, someone may say, ‘Yesterday I was
well, today I am ill, but tomorrow I will be well again’. This is what Frank
(2012) called a ‘medical restitution narrative’. It may be a dominant illness

What Is Reality? 33
narrative of the kind that some people have. Stories are not passive, they
can do things and act on, in and for people. They can shape the beliefs,
feelings and actions of those caught up in them, affecting lives positively or
negatively, depending on our interpretation (Frank, 2010). This is a critical
matter for psychologists. A person may focus on a depressive narrative, an
anxious narrative or a lonely narrative, and they may benefit from help in
changing those narratives. These narratives are dominant narratives. While
some are positive, many have negative effects as they dominate people’s
lives. A well-balanced person will use a range of narratives in accordance
with the people they interact with and the cultural master narratives in
society (see Chapter 4). People with a negative dominant narrative may
experience problems adjusting to their social or cultural situation. This
happens with all of us at times. We become out of step with what is hap-
pening. We worry about something and we cannot stop worrying even
though we are out socialising with friends. It is not usually a problem if it
happens occasionally, but there are some people who have a single domi-
nant narrative that they use most of the time. We (as individuals, friends,
family and psychologists) can challenge these narratives (Nelson, 2001), we
can challenge a person’s central dominant narrative by telling and living
counter narratives.
There are other characteristics of the way we use narratives. The resources
we have (the various narrative skills and abilities) are usually stable, but our
personal stories can change over time. This can be changing from a domi-
nant depressive narrative to a dominant contented narrative, or it may be
more general aspects of our life stories, our biographies. For instance, nar-
rative resources may be affected by physiological or psychological trauma.
Our stories may appear to be derived culturally or socially (see Chapter 4
for details), they are also biological, they are embodied. Our stories are
told with our bodies. We feel the stories, we use not only our voices but
also our hands and eyes to tell stories; we communicate with ‘gut feelings’.
What Is Reality?
Rather than a sense of objective reality, narrative theorists argue that – for
humans – there is a genuine sense that reality is constructed. According
to Sonnenschein and Lindgren (2020), reality is rendered conceivable by
language that constructs the world not as it is, but as retrospectively inter-
preted and imagined in terms of future goals. This is critical to the nature
of reality. Narrative psychologists do not deny the structure of the world,
they are not pure social constructionists, but they recognise that we, as

human beings, can only understand the world in terms of the narratives we
create about it. This has been called critical realism, but that term implies
a logic to the way we understand and interpret the world that is not always
the case. The reality we usually experience is messy, undisciplined, unfo-
cused and with unclear purpose. This is the nature of many of the narra-
tives we employ. The critical element is absent from much of what we do
and think.
Self and Identity

We can draw a distinction between self and identity. The self is the rel-
atively unchanging permanent element that provides continuity in our
lives. I am the same person I was several decades ago. There are characteris-
tics that do not change, irrespective of the environment in which I live and
the relationships I have with other people. Identity, on the other hand, is
changeable. Identity changes through narrative construction and recon-
struction. It changes when we get a new job or change our relationships.
It changes when we redefine elements of ourselves. Erikson (1968) defined
identity as an integration of conscious and unconscious experiences which
arise in interactions with the social world. It changes with age and chang-
ing environments. If we did not have the ability to change our identities,
then there would be little point in studying narrative as an applied element
of psychology.
Narrative Identity
Narrative is central to the formation of personal (and social) identity
(McAdams, 1996). Narrative identity is the internalised and evolving life
story, which integrates the reconstructed past and imagined future to pro-
vide our lives with an element of unity and purpose (McAdams & McLean,
2013). As I will discuss later, narrative identity relies on culturally available
narratives, narratives that we share. As there is a purpose to our narratives,
there is intentionality and hence an ethical dimension. We can choose the
structure of our narratives and the impact they have on behaviour.
Sarbin (1986) called this the narratory principle, that humans think, per-
ceive, imagine and make moral choices according to narrative structures.
There is a case for reimagining James’ (1890) distinction between I and me.
I is the author and me is the actor of the narrative. In this metaphor of self,
the person’s agency (I) is revealed in the authorship process, it is the person
who narrates (me) the life that is lived (and performed as an actor).

Redemption and Contamination 35
Identity can change. While there is a strong element of unity regarding
the self, we see ourselves in many ways as the same throughout life; we do
change. There is an evolving nature of identity; it is a progressive process
(Singer, 2004). From a developmental perspective, this helps us to gradu-
ally develop the abilities to narrate stories about the self in culture – so
narrative plays a critical role in child development.
Reischer’s (2021) study of narrative identity has provided a rich con-
ceptualisation of adult personality and important insights about the sto-
ried nature of meaning-making, particularly in younger and middle-aged
people. Older adults may have phenomenologically different experience of
autobiographical authorship than younger adults, for example, a traumatic
breakup of relationship in youth is looked back on fondly. It is worth test-
ing for age-related differences in narrative identity. Perceptions of norma-
tive behaviour change over time, and this may affect one’s narrative, for
example, a ‘career woman’ in the 1980s is just a woman with a job now.
A young man may be a seducer, whereas an older one lecherous. Social
norms influence behaviour, so we need an understanding of how these
norms can differ across the lifespan.
According to McAdams (2015; McAdams & Pals, 2006), a person’s nar-
rative identity is one of three layers of personality alongside dispositional
traits (e.g. The Big Five) and characteristic adaptations (i.e. a person’s dis-
tinct set of values, goals and motivations as an agent). For Bruner (1986),
narratives are not just stories, they involve intentional agents pursuing val-
ued goals over time. Narrative identity is an implicitly held and explicitly
told story of how someone came to be the person they are, including their
triumphs, failures, dreams and regrets.
Redemption and Contamination

Redemption and contamination are important concepts in narrative psy-
chology that Dan McAdams and others have discussed in detail. They are
particularly important when we are talking about transitions and the way
people deal with transition. For instance, when someone is traumatised
by a terrible incident, how they respond over time can affect their general
health and well-being. This isn’t the place to go into details about PTSD
(see Chapter 8), but redemption and contamination are useful explanatory
concepts for the way we deal with traumatic stress and difficult times in
life generally.
Dan McAdams is a US psychologist, and the concepts of redemption
and contamination can come across as quite culturally bound to the US

way of thinking (the US master narrative of psychology), but they still
have relevance elsewhere, though it is not necessarily the dominant script
in the UK and elsewhere. This is an example of the difficulty of developing
universal psychological theories. If they are problematic between such rela-
tively similar cultures as the USA and the UK, which have broadly similar
cultures and a similar language, there may be serious difficulties where the
cultures are very different. This does not clash with the idea that humans
are biologically very similar. It just shows that cultures can be quite differ-
ent, and they can have a major impact on behaviour.
Redemption is a useful mechanism for helping someone cope with
their problems. Recuperation is the gradual lessening of symptoms over
time and the ability to cope with any lasting emotional and physical scars.
Redemption involves actively exploring our experiences and making sense
of them, tying them into new narratives that incorporate the negative or
traumatic experiences. According to McAdams (2006), redemption for
people in the USA involves initially learning a series of positive values by
which one should live. As one progresses through life, bad things hap-
pen, but these may lead to positive outcomes (redemption of suffering).
Redemption occurs through atonement, recovery, emancipation, enlight-
enment, basically through growth and progress, hopefully with a happy
ending. This has similarities to religious redemption, ideas that Europeans
as a whole tend to be negative about. Nevertheless, the idea of redemption,
that one can learn from negative experiences, is a universal one, one that
is linked to the development of life stories or narratives. Redemption is a
coping mechanism (Breen & McLean, 2017).
On the other hand, while redemption is about moving from a negative
position to a positive one, contamination is about moving from a gener-
ally positive position to a negative position. The good is spoiled by what
happens and the interpretation of the outcome is negative. Again, this has
importance for the development of the life story.
Together, redemption and contamination can help explain at least
part of why some people look on life in a positive way (using redemp-
tion) and some have a more negative point of view (contamination). This
is a little like the dominant narratives discussed earlier. The aversion of
many Europeans to such ideas relates more to these ideas being related
to heaven and hell, eternal bliss versus eternal damnation; religious ideas
rejected by most people in Europe over the last few centuries because of
Enlightenment ideas that have significantly changed the way we think
about the world (and has contributed to the difficulties of modern multi-
culturalism, see pages 54–57).

Memory Construction 37
What these ideas do tell us is that the way we interpret our lives signifi-
cantly affects the narratives by which we live, either through a contami-
nated or a redemptive narrative, or – as it probably is for most people, a
little of both. The conflict between redemption and contamination may be
a helpful mechanism through which we resolve life conflicts, the way we
develop meaning in our life stories.
The whole notion of traumatic stress is that one’s life story is shattered by
the experience. A person may have positive beliefs about the world, about
other people, about themselves, but a traumatic experience can shatter these
beliefs (Janoff-Bulman, 2010). Our ideas about a benevolent world, one that
is meaningful and positive, can be broken. From this, there is a need to
find meaning from these negative events through the resolution of conflict
(McLean & Thorne, 2003; Thorne et al., 2004) and on to effective meaning-
ful narratives that account for the new information we have about the world.
We have to reconcile the present with pre-trauma identity (Park, 2010).
The reconciliation of narrative identity is shaped by cultural scripts that
detail the most adaptive and socially acceptable means to draw meaning
from trauma (Adler & Poulin, 2009), the master narratives we consider in
Chapter 5.
Memory Construction
Many years of research on memory has established that most memories,
apart from simple memories, are constructed rather than accurate repre-
sentations of the past. Pleh (2020) argued that constructive memory pro-
cesses are not the exception but the rule. Bartlett (1932) used stories and
folk tales to support his constructionist theory. His most famous story,
‘War of the Ghosts’, was a narrative account of a battle that breaks many
of the rules regarding narratives in the West. It is a Native American
account. Bartlett found that when people attempted to remember the
story, they reworded it to make more sense, that is, so that the memory
conformed to their own narrative.
Whereas early memory research – with the notable exception of
Bartlett – focused on remembering simple information, strings of numbers
or individual words, there is now a much stronger linguistic and structural
emphasis. It has been repeatedly demonstrated that Bartlett, writing all
those years ago, was right. Our narratives (or in Bartlett’s term, schemata)
provide key anchor points for remembering information. This suggests
that elementary sociality is a basic, rather than a constructed, feature of
the human mind. Memory is not just about remembering the past. It has

a purpose. It is about remembering what has happened so that we can use
that information constructively in the future. We should be studying the
function of remembering rather than, for example, recall errors. Bartlett
treated the mind as active and so was an early constructionist. If he was
working now, he might describe himself as a narrative psychologist.
Meaning and Narrative

Lazslo et al. (2007) see narrative as a fundamental tool for constructing
meaning, a way of organising experience rather than mere knowledge con-
struction. We should expand the horizons of scientific psychology and
look at meaning patterns through history and cultural change. We need
to access historical narratives, working like archaeologists when examining
older narratives to understand cultural psychology and evolution.
Life narratives may be conceived as an outcome of dialogical process
of negotiation, tension, disagreement, alliance, etc. between difference
voices/perspectives of self (Goncalves et al., 2009). People are authors nar-
rating their own stories, so narratives of life are multifaceted and multivo-
cal. Hermans’ (2002) distinction between author and actor means that the
person’s self is a multitude of authors (or I positions) narrating their sto-
ries while enacting as actors (me position) these different positions. Each
voice or I position can tell a story from its own perspective, this trans-
forms the self into a space of potentiality where meaning is constructed
and reconstructed as different positions gain or lose power. There are lim-
its to this argument, we see ourselves as primarily coherent selves, acting
different roles in different situations – Goffmanesque actors with many
masks. There is some choice to the life stories we use but it doesn’t gener-
ally change the underlying self. Alternatively the self changes very slowly.
Perhaps we can just change the perspective within a given social situation;
we can learn to behave more appropriately in a situation, without chang-
ing the underlying self.
Narrative Psychology and Complexity

Narrative may present straightforward explanations and ways of doing
things but it is intellectually complex. According to Laszlo et al. (2007),
narrative psychology is an attempt to handle phenomenal complexity in the
psychological domain, complex psychological phenomena such as think-
ing or personality. Group processes are embodied culturally and also in an
evolutionary sense in narrative, therefore scientific narrative psychology,

Universal and Constructed Narratives 39
when striving for cultural and evolutionary explanations, must reject both
atomistic and holistic approaches – instead narrative represents a phenom-
enal level where only patterns are meaningful, for example, the nature of
identity or memory.
Integration is represented by the life story, it has continuity, security
and integrity. Knowledge of these does not predict behaviour, just ways of
adaptation, which can be evaluated against the background of social envi-
ronment and culture. These contents create the life story, which is ame-
nable to scientific study (Lazslo et al., 2007). The life story with continuity,
security and integrity is that of a healthy person. The problems occur when
this life story breaks down, when it lacks continuity, security or integrity.
This is where the applied narrative psychologist comes in, to help rebuild
or reconstruct the life story, a relatively simply structured task, though
often not simple to achieve, within the complex field of narrative.
Universal and Constructed Narratives

We have touched on whether narratives are universal or whether they are
constructed. By now the reader will be aware that the approach taken here
is that it is both. Narrative processes are universal in humans, but we must
also be concerned about how these processes are employed across different
cultures, how we use our narrative abilities to create stories about the world.
Fundamentally, the universality of narrative is that we all use it. The ques-
tion is which of our narratives, if any, are universal. People in all cultures
across the world use narrative, so there is no question that the fundamentals
of constructing narratives are the same for everyone. As we have seen, neu-
roscientific evidence also supports this idea. Narrative is embodied.
While narrative processes are universal, are there stories that people
across all cultures will agree on? The key element here is how the body
impacts on the development of narratives. An example of this is the work
of Schachter and Singer (1962) on emotion. They argue that emotions con-
sist of a combination of physiological arousal and cognitive interpretation.
From this perspective, all humans have similar physiological arousal, but it
is possible that the cognitive interpretations of this arousal are interpreted
culturally, that is, using different narratives. This interaction between the
universal and constructed narratives is important to understand.
The second key question is an examination of how narratives are con-
structed and the kinds of narratives that people have. We want to under-
stand the narratives that people create, adapt and use, and how these affect
the relationships between people.

Conclusion
Narrative is the root metaphor for psychology. Our lives are built around
narrative, and if we want to understand human behaviour, we must
employ a narrative perspective. Other approaches can add to understand-
ing, but in the end, we must build and understand human narrative and
human stories. Richert (2006) noted that several authors have argued
for sweeping changes to the ways we think about psychology. Looking
for the perspective of therapy, he argued that there are four assumptions
implicit in narrative psychology that are important to general psychologi-
cal understanding. These assumptions apply not only to therapy but to
psychology generally.
1) Although a first-order reality probably exists and constrains our
constructions, it is not directly knowable, so people live in terms
of a ‘second-order’ reality (Watzlawick, 1996). This is in the criti-
cal constructivist tradition and needs tweaking for narrative sci-
ence. All behaviour can be understood at the neurological level,
but for psychologists, it is essential to draw on narrative skills as the
first-order reality.
2) Second-order reality is constructed through the process of telling
stories, that is, it is narrative in structure. We make sense out
of living by developing stories that order events through time
and within delimited contexts to show how the current situa-
tion is plausible. We live in and through our stories (White &
Epston, 1990).
3) Different people generate different stories and therefore differ-
ent realities in which they live. This is most apparent in people’s
situation-specific stories with their unique ways of construing and
dealing with challenges and the constraints of a common culture
(e.g. perceiving the glass as half full or half empty). Richert’s differ-
ent realities are different interpretations of reality. Narratives do not
create different realities; this is where the social constructionists get it
wrong. We interpret reality, we do not create it.
4) Specifically relating to therapy, people have difficulties with living,
they have problems that are effectively ‘broken stories’ (Howard,
1991; Monk, 1997; Neimayer & Raskin, 2000). Most of what we
do in applied psychology, whether it is psychotherapy, occupa-
tional and organisational psychology, forensic psychology, is about
broken stories, the broken stories of individuals, groups and society
as a whole.

Conclusion 41
Narrative psychology has a lot of potential. Up to now it has mostly been
the province of minority groups within psychology, mostly away from the
mainstream. As this chapter has hopefully made clear, narrative psychol-
ogy needs to become mainstream. We are all story constructers, story tell-
ers and listeners, and this is central to much of our behaviour. We cannot
move towards good general theories of human behaviour without drawing
on the narrative perspective.

Chapter 4
Master Narratives
Culture is a tool produced by mankind to evolve its own mind.

Vygotsky
The important thing is not what society has done with us, but what
we do with what it has done to us.
Sartre
The term ‘master narrative’ has been used in many and inconsistent ways
over the years (McLean & Syed, 2016), it is used particularly in the USA,
but it is a useful universal concept. The purpose of this chapter is not to
go into historical differences among definitions, but to find practical ways
in which the construct of master narrative can be used. There are two key
points to be made about master narratives. First, they are overarching, func-
tioning at a level above that of personal narratives (which leaves scope for
considering master narratives at sub-cultural levels). Second, they are, in a
way, compulsory, that is, people within a master narrative must make use
of them, both explicitly and implicitly. Master narratives provide a storied
language that we internalise and reproduce to maintain a particular social
order. Of course, this is not the whole story, and much of the interesting
theory and practice surrounding master narratives is where people subvert
them, ignore them and change them. In practice, while we are beholden to
the master narratives within which we live, we do have the ability and free-
dom to fight against them or ignore them. Nevertheless, for most people,
most of the time the master narrative strongly guides behaviour. Master
narratives provide the social structures and rules which enable people to live
together in relative harmony. Without master narratives, we would have no
society, no ability to get on with each other. Narrative is a critical tool for
organising thought. Experiences develop in a cultural context, these narra-
tives define individual experience (Fivush et al., 2019, p. 157).
Master narratives exist to define culture, resolve conflict and ensure
peaceful co-existence among members of a society. They also, in many
42

Master Narratives 43
societies, dispute culture, create conflict and ensure there is no peaceful
co-existence among members of society. In some ideal world, the master
narrative will define what is ‘good’ and what is ‘bad’, how to behave and
how not to behave and we will all live happily ever after. Master narratives
are very powerful. They do dictate the way we behave, from which side of
the road we drive on, to what words are unacceptable in polite society, to
accepted (and contested) history, to the nature of literature, the freedoms
and constraints within society and everything from formal laws to informal
norms and values. Master narratives are an essential part of who we are.
Master narratives are those narratives that are shared by many or most
people within a society or culture. They are the cultural scripts or domi-
nant discourse by which we live (Hammack, 2009). These dominant
scripts can be identified in cultural discourses such as the media, litera-
ture and law. They contain collective storylines that can include anything
from the history of a society to ideas about what it means to inhabit a
particular social category or class (Hammack, 2010). They are about events
(history) and groups (social identities). McLean and Syed (2016) provide
a slightly different, slightly less controlling definition of master narratives,
suggesting that they are culturally shared stories about a particular culture
that provide guidance for how to be a ‘good’ member of that culture or
society. This appears to be less constraining than the definition provided
by Hammack in that it includes the element of choice, though how much
that is the case when the master narrative is internalised and inevitably
guides behaviour without conscious thought is not clear, possibly not
operationalisable. McLean and Syed (2016) do provide some clear guide-
lines regarding how and why we internalise master narratives and how they
are useful, universal and rigid.
Master narratives are rarely or never shared by everyone, as there are
people who will not agree with the narrative. Master narratives can be
dominant, where they are shared by the vast majority, or they can be con-
flicting, where there are two or more conflict narratives held within a soci-
ety at any one time.
One of the purposes of a master narrative is to explain the stories that
exist at a lower level, for example, the individual or interpersonal. It might
be easier to use the analogy of sports. The master narrative is the set of
cricket rules and expected forms of behaviour, and the individual lower-
level narratives include particular matches and the behaviour of the play-
ers. In other words, master narratives create conceptual models that bring
the lower-level stories together, they order and explain knowledge and
experience. They are coherent systems of interrelated and organised stories

44 Master Narratives
which share a common desire to establish and meet the expectations of
people who live with those master narratives.
It is too simplistic to say that there are two levels of narrative, the individ-
ual and the master. There are numerous levels which are difficult to classify.
There are narratives that are mainly personal, though as we have seen these
often have interpersonal elements. There are narratives that are interpersonal
or joint, for instance, many people comment on how long-married people
communicate in what appears to others to be a form of shorthand; they share
a joint narrative. There are narratives that are interpersonal among a group of
friends or colleagues that work in a similar way. There are narratives that are
common to classes of people, such as the ways miners or builders or bankers
communicate, and then there are the society-wide narratives, the genuine
master narratives, which while they may not be shared by everyone within
the society, they are commonly shared. The higher up the hierarchy of nar-
ratives, the fewer the number of narratives. At the highest level, there are
narratives that are shared by all or nearly all members of society. These are
based on knowledge of history, the philosophical positioning of a society,
education and so on. Sharing a language is one of the base components of a
societal master narrative, and without that it is not possible to have a cogent
joint master narrative. As Weber et al. (2007) suggested, master narratives
define the principles of a particular social order, which cannot just appear out
of nowhere. It is constructed and shaped by the people within society as they
interact and communicate, arguing which behaviours and ways of relating
to one another are preferable to others. In this way, master narratives evolve.
There are other terms for the master narrative. These include canonical
narratives (Bruner, 1990), dominant cultural narratives (Andrews, 2004)
or hegemonic tales (Ewick & Silbey, 1995). Master narratives provide guid-
ance about how to be a good member of a culture (McLean & Syed, 2016).
They are the blueprint for all stories, how we understand ourselves and
others (Hochman & Specot-Mersel, 2020).
The implicit nature of master narratives both makes it difficult to study
them scientifically but also makes them powerful in examining how people
construct their worlds. They are invisible yet appear quite natural, ensur-
ing the status quo. A master narrative within an oppressive regime ensures
that the people remain oppressed and behave as they are expected to
behave. They rely on most people not wanting to upset the apple cart, not
wanting to cause trouble. One danger for researchers is that we can unwit-
tingly collude in this process by reifying social categories by taking them
for granted, and through this undermining possibilities for social change
(e.g. Haslam & Reicher, 2012).

Psychology and the Master Narrative 45
Bruner argues that culture is itself narrative. Culture has an essential role
to play as the glue that keeps human societies together and functioning, a
necessary means of survival, and narratives provide common themes that
we use to interact with. Symbolic systems exist to enable us to construct
meaning. As Shore (1996) puts it, epistemogenesis is a collection of cultur-
ally regulated processes of socialisation and self-development by which our
knowledge becomes consciously available through language – rather than a
developing objective knowledge of the world. We could go further and say
that we only have culture because we have narrative. Narrative underlies
the development and expression of culture.
Master narratives are those narratives that are shared by many or most
people within a society or culture. They are rarely or never shared by every-
one, as there are people who will not agree with the narrative, who have
their own master narratives, subcultures or ways of living that are in some
way outside the norm. Master narratives can be dominant, where they are
shared by the vast majority, or they can be conflicting, where there are two
or more conflicting master narratives held within a society at any one time.
For example, Brexit in the UK, with the country evenly split at the time
of the referendum in 2016 between wanting to stay in the EU and wanting
to leave (hardly a democratic mandate for leaving, but that is an argument
for elsewhere). In the years before the referendum, there was a growing
narrative supporting leave. At the time of writing (2023), it appears there
is a growing narrative supporting rejoining the European Union, showing
how the influence and power of a master narrative change over time, in
relation to several factors such as the influence of the media, the economy
and individual personal narratives. This is a good example of how conflict-
ing master narratives can cause serious problems within a society, which
may play out in several ways over the long term, the most serious being
civil war – though hopefully that won’t happen over Brexit, the levels of
anger – on both sides – were and are extreme, demonstrating the utter
incompatibility of some conflicting master narratives, and the danger such
conflicting narratives can have in society.
Psychology and the Master Narrative

Master narratives are not just about grand narratives that exist across the
whole of a nation or society, they can occur within a particular field or
discipline. For instance, within psychology, there is a master narrative
that the medical model of mental illness is the best model to use to help
people who have mental health problems. There is, though, a significant

group of practitioners who reject the medical model approach and want
to explain mental illness in other ways – often rejecting the term mental
illness itself. Sometimes the conflict between master narratives can be
productive, leading to positive change, for example, the development of
theory or practice. At other times, the conflict appears irresolvable, with
two or more groups working differently but in parallel, often using differ-
ent terminology, practices and theory, finding it difficult to persuade and
compare with each other because they are using fundamentally different
languages to describe similar phenomena. This is where narrative explana-
tions come into their own.
One of the problems with the science of psychology is that it is cul-
turally bound. For instance, on the continents of Europe and North
America, psychoanalysis and its offshoots have been relatively important,
whereas in the UK, they are very much outside the mainstream. Another
problem is that it is often difficult doing social psychology across cultures
as people in different societies do not have the same ways of behaving.
A key question in social psychology is about understanding which ele-
ments of behaviour are universal and which are cultural. Even between
two apparently similar societies with apparently similar cultures and –
supposedly – the same language, such as the UK and the USA, there
are many differences. While the general joke is that we are two nations
divided by a common language, there is a lot of truth in the differences,
and it is not just the language, it is the norms of society, the ways we
behave, the general philosophy of life, everything from gun culture to
notions of religion. While many of these differences are superficial, there
are key critical differences regarding the way we think. For instance, the
influence of religion in the USA can mean that morality is more explicit,
or the idea of individualism in the USA is much stronger than in the UK,
the latter may be why we have the National Health Service in the UK and
there is nothing similar in the USA. These are key elements of the master
narrative that is dominant in a particular country. In much of psychol-
ogy, we have assumed that findings from the USA translate easily to the
UK. As we shall see in Chapter 6 – Life Interviews with the work of Dan
McAdams, this is not always the case.
As applied psychologists, why should we focus on master narratives? It
is because individual narratives make no sense without master narratives.
We are story tellers that rely on the social and cultural world to create our
stories. Master narratives help us answer key questions such as how we
make sense of events around us, how we integrate new information into
existing information, how we provide justifications for what we do and

Difficulties for Science 47
perhaps even how we manage our general aims and ambitions in life, even
how we construct and tell our stories. We can’t do anything we like; we
have to work within the constraints of the master narrative. The master
narrative might be flexible; we have the free will to ignore it, but usually we
don’t. Behaving within the master narrative is generally implicit. It takes
an active will to work against the master narrative.
The master narrative has both formal and informal elements. The formal
elements consist of rules and laws, that we do not kill people, or we drive
on a particular side of the road. The informal elements are more flexible
but are still constraining. Examples might include good manners, how and
when we speak to other people and what it is acceptable to say or not to
say. The informal elements also include how we think about the world. In
Europe, we are generally liberal-minded, secular people who often reject
or at least ignore organised religion (though see below relating to religion
and the problems of multiculturalism or the clash of master narratives).
Polkinghorne (1988) noted that personal stories are always some ver-
sion of the general cultural store of stories regarding how life proceeds.
McAdams (2001) added to this by saying that stories live in culture, they
live according to the normal rules and traditions in society. When we are
telling a story, there is an implicit understanding of what can and can-
not be in a tellable story. Master narratives regulate not only what can be
told but also how, why and when (Ewick & Sibley, 1995). Narrative is a
critical tool for organising thought. Our experiences develop in a cultural
context; these narratives define individual experience (Fivush et al., 2019).
For these reasons, psychological theory must incorporate ideas from the
master narrative to make sense. We are not individuals; we are part of a
social world.
Difficulties for Science

Science requires clear definitions and common methods (science is a mas-
ter narrative in its own right). This can create difficulties. While at one
level, it is obvious what a master narrative is, when an attempt is made to
clearly define the term, then we run into difficulties. Does a master nar-
rative have to be common to all people in a society? No, we have already
seen that doesn’t happen. What degree of disagreement can be acceptable
within a master narrative? I don’t know. It probably varies according to
circumstances. Not everyone will agree with all elements of the master
narrative (not that we really know what those elements are). Individual
differences are critical in a functioning society. We all have our slightly

differing personal narratives, which form the basis for interesting disagree-
ments in society, but what are the implications for master narratives? Part
of the problem is that they are used in different ways. McLean and Syed
(2016) distinguished between three types of master narrative: biographical
(cultural life scripts about how life should unfold), structural (how stories
should be structured) and episodic (concerned with given past events).
The other problem is how we study master narratives. This is going
to be difficult if we don’t have an agreed definition, but master narra-
tives are usually studied top down. Bamberg (2004b) examined US mas-
ter narratives of masculinity reproduced in adolescents. Hammack (2006)
examined polarised Israeli and Palestinian master narratives. Both of these
assume a certain master narrative and then look at how it influences per-
sonal narratives. Perhaps we should think about how we can study com-
monalities between people from the bottom up. Ask people what they
share, how they agree and disagree and develop the structure of the master
narrative in this way. It is a method that is likely to generate stronger find-
ings than the top-down approach, which assumes that the researcher has
some a priori idea of the master narrative.
What Is a Master Narrative?

According to Halverston et al. (2011), a master narrative is a transhistorical
narrative that is deeply embedded in a particular culture. Master narratives
do not just appear, they grow and change over time, they are repeated
and gradually attain a key status within a particular culture. They are con-
stantly changing and evolving, and we as individuals are greatly influenced
by them. They dictate the ways we think and the ways we interact with
one another. Culture is an ill-defined term, but will be taken to mean
an inter-related set of shared characteristics claimed by a particular group
(e.g. ethnic, national, social) of people. In the end, culture is a collection
of stories that are passed between generations, changing all the time, but
generally in an evolving rather than revolutionary manner.
Master narratives help determine the nature of the narratives that we
use with each other. These narratives range from reflecting simple interper-
sonal interactions such as the rules regarding how we speak to each other
(e.g. good manners and how we dress) through to major philosophical
concepts around what we mean by good and evil, the nature of religion
and so on. The stories we use within the context of master narratives pro-
vide a sense of coherence, an understanding of the shared past and a set of
principles for future behaviour.

Myths 49
Myths
A key element of master narratives is that of the archetype, the typical char-
acter within our stories. The archetype can be a hero figure, a hate figure
or any other form of typical character that is used within our stories. These
archetypes can, according to Campbell (2018) with his notion of mythic
narratives and the universal myth, help to inspire, direct and inform every
aspect of our lives. Campbell’s mythic narratives are fundamental histori-
cal artefacts that are so deeply embedded in culture that they cannot be
separated from it. They determine our understanding of who we are and
how we behave with other people. Vladimir Propp (1928/1958) realised
that strict rules or regularities are hidden behind the fantasy rich world of
European folktale heritage. They perform a limited number of roles and
functions. Colby (1973), exploring Eskimo folktales, found a generative
grammar and developed a theory for the role of stories in culture. From
repeated patterns, we extract schemata and templates, including the story
template, and use these in turn to interpret new events. Cultural models
are patterned and ready-made in a coded condensed form, that is, myths
and folklore are forms or parts of the master narrative.
Religion can play a key mythical part in the master narrative. It can dic-
tate how we live our lives and provide a purpose for otherwise meaningless
lives. As Marx would have it, religion can be the opium of the people, a
drug to ensure that people behave appropriately, that is, a master narrative
in itself. The Catholic master narrative in Europe was the dominant. This
was the dominant narrative until the fifteenth century, when it began to lose
its influence with the rise of Protestantism and liberalism, the Reformation
and eventually the Enlightenment, with new ideas where religion is seen as
irrational, and religious practice becomes confined to individuals and the
private sphere, rather than dominating society. Religion lost much of its
role in the master narrative across much of Europe, enabling civilisation to
progress in ways that were impossible under the strictures of Catholicism.
This separation of church and state across Europe (including in the UK,
though formally there is no separation) depoliticised religion, and it lost
its key role. Europe, particularly Northern and Western Europe, moved
from being a religious Catholic society through the reformation and liber-
alisation to Protestantism, and religion moving from being the dominant
master narrative of society to play a more minor role. One of the prob-
lems we are currently facing is the rise of illiberal Islam in Europe (many
Moslems are liberal) and elsewhere which has many of the characteristics
of pre-reformation Catholicism, with its strict rules about behaviour, dress

and punishments for disobeying those rules. It is very different to Muslim
Spain where Islam was at times the liberal religion, not in the modern
sense but certainly providing some freedoms for other religions along with
promoting knowledge. There is a danger here, with the master narrative
of enlightenment Europe clashing with the illiberal constraints of Islam,
which causes problems not only in Europe but also in Islamic societies
which are clamouring for a more liberal approach. In terms of the master
narrative, and an examination of how they can change across the years, per-
haps it is time that Islam found its own Martin Luther, who might liberalise
the religion and make it more acceptable to the modern world.
Identity
Narrative identity is both personal and cultural, individuals follow scripts
that constrain agency by privileging certain types of stories (Hammack,
2008; McLean & Syed, 2016). Identity is a psychosocial construction and
master narratives are the main conceptual framework for describing the
influence of culture on personal stories.
According to Hammack (2008), identity development forms the link
between self and society and the content is inherently political and ideo-
logical. Meaning arises through fusing personal and collective historical
and cultural narratives. For instance, belligerent antagonists might make
sense of conflict by telling credible stories reflecting the master narratives
of the groups they belong to. Hammack emphasises the importance of
religious master narratives as templates for social structure and culture life.
As we see in the West, the removal of religious master narratives can have
a significant negative effect on ethical behaviour if they are not replaced by
something that provides clear moral and behavioural guidelines. As yet, we
don’t seem to have provided the alternative.
Hammack (2011) discusses the perennial problem of Israel versus
Palestine in terms of the establishment of the conflicting master narratives.
He argues that the Jewish-Israeli master narrative has four main themes:
1. A sense of persecution and victimisation leading to the Holocaust
2. Existential insecurity, leading to Israel having a siege mentality
3. Moral exceptionalism. The Jews are the Chosen People
4. Delegitimisation of the Palestinian people
These themes persevere for several reasons. They are in essence why Israel
continues to exist as a specifically Jewish nation surrounded by, as it perceives
and with some reality, hostile people. If we believe that the Jewish people who

Politics 51
‘returned’ from Europe after the war are genetic Jews, then in one sense all the
peoples around the area are semites, Arabs and Israelis, which in itself suggests
they should get on well together. Inevitably, if there are ‘blood’ links between
Arabs and Jews, it is the stories, the master narratives, that contribute signifi-
cantly to the continuing wars and hatred, not any genetic reality. The sense
of persecution experienced by the Jews has a historical reality. Jews have been
persecuted in Europe for centuries, culminating in the Holocaust, which led
to the deaths of an unknown number of Jews (probably between 5 and 6
million – we simply do not know because so many records were destroyed in
the war). This is at least in part because of their self-defined otherness, their
refusal to integrate into the societies in which they live (which has potential
negative implications for the modern master narrative of multiculturalism).
This is associated strongly with the Jewish sense of being the Chosen People,
as expressed in the religious writings regarding Judaism, the idea that ‘we are
better than you’. It arises directly through the dominance of the Christian
religion, where Christians took on the Jewish Jesus and made him their own,
when the Jews themselves had rejected his godhead.
Hammack’s other themes are also linked. Israel’s existential insecurity
and siege mentality have arisen directly because of the way in which Israel
was formed, through war and the ejection of many of the indigenous peo-
ple of what became Israel. This act, which has no international or moral
legitimacy, forced the Israeli people to delegitimise the Palestinian people.
They were forced to argue that there were no indigenous people, and those
that were there were nomadic tribes who had no land ownership.
The above two paragraphs have no sense of objective truth, they are
purely narratives, master narratives, but they are powerful master narra-
tives that have enabled Israel to exist as a Jewish state since 1948. They have
a sense of truth to the Israeli people, even though those master narratives
are rejected by others. This sense of power and truth shows the power of
master narratives. On the Israeli side, these master narratives justify the
existence of Israel as a Jewish state. On the opposite side, these master nar-
ratives are illegitimate and demonstrate that Israel as a Jewish state has no
right to exist. No international declaration of the Jewish right to a state can
override the power of master narratives.
Politics
Master narratives can have a powerful effect, as we have seen regarding
Israel. In more general terms, political violence arises out of certain mas-
ter narratives. Master narratives can enable the radicalisation of certain

elements of a population which can lead to changes in the master narra-
tive. Sonnenschein and Lindgren (2020) discuss radicalisation as a social
process, arguing that it evolves through interactions between the individ-
ual, the group and state actors, and it is through this process that mas-
ter narratives can change. In one sense, radicalism is just about trying to
change master narratives. Narratives are important in providing a dynamic
exchange between the social context and the mind for constructing, struc-
turing and maintaining realities when a few, a small proportion of a popu-
lation, engage in political violence.
Master narratives are, through political thought, words and action, con-
tinuously configured and reconfigured to define and redefine individuals,
groups and nations. Radicalisation has three clear conditions. First, there
is a perceived need for meaning (Hogg et al., 2010). Second, a perception
of injustice and humiliation (Pargament et al., 2005). Third, a need for
belonging. When these conditions are met, there may be an attempt by a
group that does not accept the current master narrative to create funda-
mental change, to replace the master narrative with a new one. At its most
radical, this is seen in rebellions and revolutions, such as the Bolsheviks
in Russia in 1917. It can be seen in civil wars where one group wants fun-
damental change, such as Bosnia in the 1990s during the breakdown of
Yugoslavia. Within a democracy, it can be about how a newly elected
political party introduces radical changes to policy, such as Margaret
Thatcher’s election in 1979.
Framing theory (Wiktorowicz, 2005) shows how people see themselves
as part of a group. We can characterise political positions and religious
positions as frames. These frames identify movements’ struggles, show-
ing one’s own group as the ingroup and adversaries as the outgroup
(Israelis and Palestinians are a good example, Loyalists and Nationalists
in Northern Ireland another). Framing others as the outgroup provides a
legitimacy for action. These frames provide powerful narratives connecting
the group to the past, present and future.
Master narratives are created in the interests of the dominant classes
and institutions (Harris et al., 2001), preserving the superior position of
elites (Delgado, 1989). The power of master narratives derived from five
principles: utility, ubiquity, rigidity, their compulsory nature and invis-
ibility. Invisibility is about the internalisation of master narratives, which
is a key vehicle for their reproduction. If people don’t notice changes, then
they can occur without a great deal of conflict. In many cases, this is not
problematic, sometimes it creates problems, but these problems may not
be noticed at first. For example, in the UK, the notion of trespass, which

Politics 53
is when someone goes on another person’s land without permission. This
was relatively rare when land was held by lords but was used in common;
but with successive enclosure acts, there was less and less land available for
use in common. This may be seen as the gradual stealing of land for the
use of the few. It is now accepted that there are boundaries and very few
people are allowed into most of the land. As master narratives are largely
implicit, people are not aware of them, though they largely behave accord-
ing to the ‘rules’ of the master narrative. To make changes, individuals or
groups publicise what they want to do and try to persuade people to want
and fight (literally or figuratively) for change.
Master narratives can occur within a particular field or discipline. For
instance, within psychology, there is a master narrative that the medical
model of mental illness is the best model to use to help people who have
mental health problems. There is, though, a significant group of practitio-
ners who reject the medical model approach and want to explain mental ill-
ness in other ways – often rejecting the term mental illness itself. Sometimes
the conflict between master narratives can be productive, leading to posi-
tive change, for example, the development of theory or practice. At other
times, the conflict appears irresolvable, with two or more groups working
differently but in parallel, often using different terminology, practices and
theory, finding it difficult to persuade and compare with each other because
they are using fundamentally different languages to describe similar phe-
nomena. This is where narrative explanations come into their own.
A good example of a master narrative, indeed a master narrative that,
though based on prejudices already extant in the society, is that of Hitler
the story teller, as described by Burke (1939, in Halverston et al., 2011).
Burke interpreted Hitler’s Mein Kampf and outlined a theory of narra-
tive form as symbolic action – as communication. For Hitler, symbolic
action was rooted in the standard storytelling device of defining a common
enemy, in this case the Jews. Hitler used anecdotes regarding the Jews to
create identification among his readers. His argument was that Germans
have an inborn dignity (as a mythic Aryan race) that is sullied by people not
of the same race, and that a German utopian society can only be founded
by ridding the nation of these enemies. It is essential that the Germans
fight the Jews to achieve this idealised society. The rhetorical organisation
of the narrative is based on the belief that the present is defined by chaos,
and that the very soul of the nation was tainted by Jews, bankers and
immigrants, and that if the reader identified with the personal experiences
of Hitler the story teller, they would also see themselves as having a place
in the fight to purify the nation and establish the Aryan supremacy. Here,

Hitler invoked God’s will, knowing that people will conform to religious
ideals. Halverston et al. argue that the relationship between narrative form
and political/ideological action is useful for three reasons:
1. They allow us to understand how many story forms follow the same
master narrative (a story form is a standard pattern on which stories
can be based, defining characters, actions, sequences of events).
2. They point out the critical role of archetypes (standard characters) as
sources of cultural information relevant to narratives.
3. They show how abstract ideas of myth and social order can inform
attempts to persuade others to accept a point of view.
An integrative theory of human development involves engagement with
the master narrative. People and settings are mutually constituted through
a dynamic engagement with the symbolic meaning system of language
within a society (Hammack & Toolis, 2015). This draws on a number
of theoretical perspectives including Mead’s (1934) symbolic interaction-
ism, Tajfel and Turner’s (1986) social identity theory, along with narrative
approaches such as Bruner (1990) or McAdams (2001). This integrative
theory enables an understanding of the power of social structures and social
categorisation to shape individual subjectivity (not just behaviour but the
way we think and feel). Hammack and Toolis (2015) note that their fun-
damental premise is that it is through a dynamic engagement with master
narratives that both individual and cultural development occur; there is an
evolution of thinking and behaviour in societies.
This is an important concept when examining master narratives, seeing
how the individual and the social interact to lead to societal development.
It is when these processes are disrupted that there is significant conflict
within society and between people. It is a reason why multiculturalism is
problematic.
Problems of Multiculturalism
If we apply the master narrative to some of the problems in society, we
may begin to understand why there are problems. A good example is mul-
ticulturalism. By definition, if we have a multicultural society, we have
two or more master narratives, which by definition are conflictual simply
because there will be key elements of the two (or more) master narratives
that are not in agreement. It may be a better strategy to have a single mas-
ter narrative and encourage the integration of migrants. This is not to say
that people should not bring their useful and interesting cultural elements

Problems of Multiculturalism 55
to a new society. It is perfectly possible and normal to integrate new ele-
ments into the dominant master narrative.
One problem of multiculturalism is that it restricts a sense of belong-
ing to a particular nation state or culture with all that entails, not bigoted
narrow nationalism, but the legal system, mores, norms and expectations
regarding behaviour. While there are many problems with the nation state,
most of us buy into the ideas of its culture and laws. It is impossible to
have this sense of unity if some people see themselves as belonging to a
particular ethnic or racial group rather than citizens of a common country.
While there is an elitist view, one that is widely accepted among the
liberal classes, that multiculturalism is a good thing, there are several prob-
lems with this. The first is that multiculturalism privileges certain groups
over the common good, which has the potential problem of eroding the
values of a society in favour of minority interests. The example of Islam in
the West given earlier is a good example of this. If we privilege the anti-
liberal elements of Islam over our liberal society, we create the possibility
of negating liberalism itself which has many – largely negative – implica-
tions. There is a strong illiberal movement in Western society, led by the
liberal left, which appears to negate elements of the Western master nar-
rative such as the benefits of European civilisation and progress in favour
of strongly defending minorities, encouraging the employment of certain
groups above the majority, encouraging diversity at the expense of equal-
ity, arguing for systematic racism (whatever that is), considering virtually
any criticism of minorities (in its broadest sense) as fundamentally wrong,
thus limiting free speech. While most of us would accept that free speech
has limitations, certainly that we should not encourage the harm of others,
this should not be to the extent that we cannot criticise – for instance –
religion. Criticisms of religion in many ways led to our enlightened society.
Fundamentally, restricting free speech through a defence of multicultural-
ism undermines the idea that we have equal rights. Giving more rights to
certain groups, whoever they are, weakens the moral and political value of
equal treatment in a fair society. By restricting the rights of some people in
favour of the rights of certain groups, we are undermining the fundamen-
tal values that are part of the master narratives of our societies.
Multiculturalism also raises the question of which cultures are to be
recognised within a multicultural society. After all, they must be recog-
nised otherwise, by definition, society is not multicultural. We may end
up with different groups vying for recognition which further highlights
the differences between cultures, further separating us and perhaps leading
to clashes between cultures, which is another potential problem. Social

psychology tells us that we have ingroups and outgroups (Tajfel & Turner,
1979), and that conflict between groups is common, with people cohering
within their group at the expense of other groups. The more we have this
within a society, the more problematic it may become. In the end, the
dominant culture may see itself as endangered and in need of protection.
This is happening across Europe in the form of growing numbers of people
belonging to far right groups who are unhappy that Europe has become
multicultural and see a genuine risk to traditional notions of liberal and
open Europe. There is a further complication that we may be in the strange
position whereby far right non-liberals are in effect trying to preserve lib-
eral society while liberals are effectively destroying it!
Which aspects of particular cultures should be recognised? In the West,
feminists have fought for years to obtain parity in the social and political
spheres with men, and this has generally (with exceptions) been achieved,
though it was never so simple that men had power and women didn’t.
Women have always had more power in Western society than is recog-
nised. Other cultures do not recognise the equality of women. What
should we in the West do about that? We only undermine our own culture
if we enable certain groups to differentiate men and women, and this hap-
pens in mosques and synagogues where men and women are separated, or
in situations where women are compelled to wear some form of head cov-
ering. I recognise there is an argument that women choose to wear head
coverings, but this itself may be a demonstration of how master narratives
become part of personal narratives; in this case, the master narrative of tell-
ing women to wear head coverings becomes part of the personal narratives
of many women. Personally, I learned something important when flying
into Tehran. As we approached the airport, all the Iranian women covered
their hair. A few days later as we flew out of the airport, the women aboard
all took off their head coverings. This is not rigorous evidence, but it may
be an indication of how many women feel about head coverings.
The main point is that if a multicultural society means adopting or
accepting practices that are considered unfair, then that is a good argu-
ment against multiculturalism.
Logically, if there are aspects of another culture that is acceptable to a
given culture, then it is likely to be assimilated. A good example in the
UK is Indian food. From being very rare immediately after World War II,
it is now ubiquitous; it has become part of British food culture. Instead
of accepting multiculturalism, we should be assimilating parts of other
cultures into our own, which means assimilating the people into our own
culture. In the UK, this is generally what we have done in the past. We

Counter Narratives 57
take the best of different cultures and call it our own. It has only become
difficult to do this with mass immigration, where people of a particular
culture tend to congregate together and hence delay their absorption into
society. This is often exacerbated by not learning and using the language
of the dominant culture.
These arguments could fill a book in themselves. The point here is to
illustrate the importance of employing master narratives to help us under-
stand social behaviour. In a multicultural society, there are several master
narratives that must, by definition, conflict. If they did not conflict, then
there would not be a multicultural society because everyone would accept
similar norms and rules of behaviour. In essence, multiculturalism is pri-
marily about conflict. Within a given society, it is not possible for multiple
cultures to co-exist without conflict, as they, again by definition, have at
least some conflicting elements.
Counter Narratives
Counter narratives are not the same as conflicting narratives, though there
is a point at which a counter narrative could become a conflicting narrative
if it starts to undermine the traditional structure of the dominant master
narrative. A counter narrative exists within a master narrative, disputing
elements of the master narrative, trying to change elements, yet fundamen-
tally not trying to undermine the whole structure in the way a conflicting
master narrative might. A counter narrative may want to change elements
of society. For instance, the punk movement of the late 1970s in the UK
wanted to change parts of society. In some ways, it claimed it wanted fun-
damental change (Anarchy in the UK), but in reality, the changes reflected
some of the problems facing society and offering solutions (Alternative
Ulster, White Riot).
There is less attention on how personal narratives influence and change
master narratives (Hochman & Spector-Mersel, 2020). Andrews (2004)
explored how in counter narratives, people’s personal narratives are active
players in shaping and reshaping culture. Individuals can transform master
narratives through narrative resistance (Ronai & Cross, 1998), and coun-
ter narratives become vehicles of de-stigmatisation (Toolis & Hammack,
2015), so people can still fit into the higher-level master narrative in order
to function (crudely, punks wanted an Alternative Ulster, but they didn’t
mind driving on the left and drinking beer in pubs). Counter narratives are
defined ambiguously. What do they contain? When do they become coun-
ter narratives? Other terms such as subversive stories (Ewick & Silbey, 1995)

are used. The only agreement is that they challenge received wisdom, and
that they always function in relation to other narratives; they are positional
categories that involve a stance towards master narratives.
Counter narratives can have two meanings:
1. Oppositional – counter narratives are told by people belonging
to marginalised groups and they contradict master narratives
(Delgado, 1989; Solorzano & Yozzo, 2002). They are a means of
political agitation.
2. Relational – counter narratives and master narratives are not
dichotomous entities – whether a social/individual narrative relates to
a master narrative or a counter narrative depends on context, who is
telling and why, when and to whom (Harris et al., 2001).
While there may be elements of both in most challenges to the master nar-
rative, most research has focused on the relational view, with most counter
narratives accepting some aspects of the master narrative and rejecting oth-
ers, rather than two monolithic narratives colliding as we get with conflict-
ing master narratives.
The diverse forms in which individuals do narrative resistance is under-
studied. Most research focusses on the content of the counter narrative
rather than how they counter. Cordell and Ronai (1999) examined three
discursive strategies of narrative resistance by overweight women: reject-
ing deviance, distancing the self from others marked by similar stigmas
and excepting self from deviance by describing factors contributing to
their being overweight. Saguy and Ward (2011) examined another form,
that of coming out, such as coming out as homosexual or choosing to
come out as fat.
Constraints
People are inevitably fundamentally constrained by master narratives,
including during identity development, and so we take on the expecta-
tions of society through socialisation. The debate within psychology is the
extent to which we employ free will to develop and change, and the extent
to which the master narrative dictates who we are. This goes beyond the
inevitable constraints arising from our genetic heritage. The concept of
agency is important in applied psychology. If our applications are going
to be of any value, we have to assume that people and social structures can
change, and we need to know how they can change. The construct of mas-
ter narratives can aid the development of occupational, clinical, health and

Postmodernism 59
forensic psychology through employing specific methods acknowledging
the importance of these constraints.
When people are telling us a story, whether that is about their personal
biography such as mental or physical health, or about social structures
such as their workplace, they are not free to tell any story they like, they are
constrained by the master narrative. For instance, the language of mental
illness has gradually crept into the mainstream and people will discuss
their experiences and feelings in terms of the categories of mental illness
used professionally by psychologists and psychiatrists, for example, post-
traumatic stress disorder (PTSD), anxiety and depression. They use these
terms without necessarily understanding them as medical constructs, and
so end up simplifying their described experiences using concepts they do
not fully understand, thus weakening their argument. Mental health is a
stigmatising master narrative, no matter what we are told in the media
and by health workers and politicians that there is an equivalence between
physical and mental illness.
The key interpretative point from the professional’s position is to rec-
ognise that when people are telling them stories, these stories are not
just personal, but dictated by the master narrative, and the professional
should – where possible – take account of this.
Postmodernism
There is debate around the modern versus postmodern conceptualisa-
tion of master narratives. Traditionally, master narratives are understood
within a modernist perspective; they provide a pragmatic explanation
regarding the commonalities that occur across members of a society. If
we wish to counter these master narratives, then, it might be argued, the
postmodern approach provides the means to criticise not only the content
of master narratives (for example, we live in a multicultural world that has
multiple legitimate narratives) but also the concept of the master narrative,
in that if we are free-thinking individuals, then we have the right to make
decisions freely without the constraints of a master narrative, and that
in effect, the concept of master narrative has little relevance because we
are free-thinking and can easily overturn traditional ways of thinking and
replace them with others.
In reality, the debate between modernism and postmodernism is a little
artificial, we live in an actual world (as Bruner might say), where nor-
mal people go around generally within the constraints of social pressures,
though sometimes bending or breaking the rules in order to achieve some

goal. Effectively, the master narratives exist (though they may conflict)
and they evolve. Rejecting master narratives as some sort of postmodernist
argument may be suitable for philosophical debate in academia but is not
practical in the real world, and as this book is about applying psychology
in the real world, we accept the concept of the master narrative.
The terms meta-narrative and grand narrative are sometimes used when
describing master narratives, particularly in critical theory. It is from here
that Jean-Francois Lyotard (1984) claimed that the postmodern world was
characterised by a mistrust of the idea of the grand narrative, that such nar-
ratives are inappropriately constraining in the real social world. Foucault
(see Gutting, 2007) criticised the grand or master narrative because it
rejects the naturally existing chaos and disorder of the real world and the
importance of the individual and their behaviour. Lyotard argued that
instead of grand narratives, we should focus instead on more ‘localised’
narratives, local context and the diversity of human experience. This leads
to the argument that there are a multiplicity of theoretical positions rather
than a small number of all-encompassing theories. We could get bogged
down in arguing about these theories, but the notion of master narratives
has its uses.
Ethics and the Master Narrative

There are clear ethical implications around the construct of master narra-
tive. Ethical behaviour depends on making ethical choices, and the compul-
sion of the master narrative means that many of those choices are made for
us. To take an extreme example, in Nazi Germany, the antisemitism of the
leadership, which was ingrained into policy, meant that the populace as a
whole, whether or not they were personally antisemitic (and many of them
were, not just in Germany but across Europe, just as now many people are
racist regarding various groups), were directed as necessary into antisemitic
behaviour, whether that was at the relatively low level (compared with
what came later) of refusing to use Jewish shops and other businesses in
the 1930s or the extreme measures implemented in the Final Solution such
as working at or with extermination camps or the Einsatzgruppen who
systematically murdered Jews and others in Eastern Europe. The master
narrative of Nazism determined which kinds of behaviour were ethical.
As the master narrative was not universally accepted, there were protests
and people did work against it, but there were surprisingly few resistance
movements to the Nazis as they very quickly took complete control over
most aspects of society, from education to international policy.

Conclusion 61
This raises the question over the extent to which ethics is a personal
choice or one dictated by society. In Germany after the war, a common
rationale for antisemitism was that ‘I was only following orders’, thus
attempting to absolve one of personal ethical responsibility. For many
years after the war, there was a debate about this, culminating in Stanley
Milgram’s series of experiments which did appear to show that people
would be willing to inflict harm on others just on the basis of being given
an order.
McLean and Syed (2016) advanced three propositions about the rela-
tionships among master narratives, ethics and morality:
1. Master narratives are fundamentally about ethics in that they outline
and convey culturally held ideas about the nature of a good life.
2. While all master narratives are grounded in ethics, not all master
narratives are moral.
3. Despite proposition two, master narratives can come to exert moral
force.
Personal narratives are fundamentally entwined with ethical and moral
reasoning, at least in part because narratives and autobiographical reason-
ing make sense of behaviour. Logically, the master narrative must play a
part as it is the master narrative that provides the general set of rules gov-
erning morality and ethics, it tells us in general terms what we should and
should not do in given situations. There is no objective idea about what is
right and wrong, these ideas change over time, that is, the master narrative
changes. While it was acceptable to have legal sex differences regarding
employment in the past, it is no longer acceptable. While it was acceptable
to demonstrate sexuality or racial bias, that is no longer the case. These two
examples apply in the West and in some other countries, but they do not
apply in many places. Many countries, particularly in Africa and the Arab
world, retain strong laws against homosexuality and against the equality
of the sexes.
Conclusion
Master narratives are crucial to understanding human behaviour. They are
largely implicit in what we do. If we live within a given master narrative,
we simply know how to behave. We learn how to do so as children through
socialisation. A term used by Anthony Giddens is that the narrative is so
deeply embedded in a social system that it is ‘chronically reproduced’, told
again and again over time, and it is resistant to change.

Master narratives can have a powerful effect, as we have seen regard-
ing Israel. In more general terms, political violence arises out of certain
master narratives. Master narratives can enable the radicalisation of certain
elements of a population which can itself lead to changes in the master
narrative. Sonnenschein and Lindgren (2020) discuss radicalisation as a
social process, arguing that it evolves through interactions between the
individual, the group and state actors, and it is through this process that
master narratives can change. In one sense, radicalism is just about try-
ing to change master narratives. Narratives are important in providing a
dynamic exchange between the social context and the mind for construct-
ing, structuring and maintaining realities when a few, a small proportion
of a population, engage in political violence.
Master narratives are, through political thought, words and action, con-
tinuously configured and reconfigured to define and redefine individuals,
groups and nations. Radicalisation has three clear conditions. First, there
is a perceived need for meaning (Hogg et al., 2010). Second, a perception
of injustice and humiliation (Pargament et al., 2005). Third, a need for
belonging.
In the end, narrative identity is both personal and cultural; individuals
follow scripts that constrain agency by privileging certain types of stories
(Hammack, 2008; McLean & Syed, 2016a). Identity itself is a psychoso-
cial construction. Master narratives are the main conceptual framework
for describing the influence of culture on personal stories. Other terms
include canonical narratives (Bruner, 1990), dominant cultural narratives
(Andrews, 2004) and hegemonic tales (Ewick & Silbey, 1995). Master nar-
ratives provide guidance about how to be a good member of a culture
(McLean & Syed, 2016). They are the blueprint for all stories, how we
understand ourselves and others (Hochman & Specot-Mersel, 2020).
Master narratives are critical to psychological understanding, not only
in social psychology, because the master narratives in society affect our
behaviour, thinking and feeling at all levels, including the individual. We
respond to everything at least in part due to master narratives.
We have a reasonably good understanding of the nature of master nar-
ratives though, as is the case within much of narrative psychology, testing
these master narratives has been limited. As applied psychologists, we need
to take master narratives into account when we are trying to understand
the problems we are dealing with, whether that is at the individual or the
social level. Master narratives function in organisations, prisons and the
social world generally.

Chapter 5
Narrative Methods
There are no fixed rules for how we should obtain narratives, for example,
through interviews, looking at journals or watching films. And there is
no agreement on how to analyse narrative data. This is rather a difficult
position, for a practical applied book. Nevertheless, we can find practical
solutions to practical narrative problems.
Narrative analysis is usually qualitative, where we attempt to make sense
of a script in narrative terms and draw conclusions about the coherence of
the narrative, the meaning of the script or some other factor. This can be
difficult due to the complexity of narrative and the lack of objective meth-
ods, but by focusing on the key aspects of narrative as discussed in earlier
chapters, we can make sense of the stories that we see. Narrative is some-
times analysed quantitatively but this involves translating an essentially
qualitative story into numbers, which is not always practical or desirable,
and inevitably loses the essential point of narrative understanding. Many
aspects of psychological life cannot be reduced to quanta and may be a les-
son for other areas of psychology where human behaviour is oversimplified.
Earlier I discussed how we can look at narrative as a fundamental basis
for human existence. We all use narrative processes and in principle, we
can identify these processes as part of brain functioning. At another level,
narrative is socially constructed, and so narrative analysis must be derived
from narrative constructionism (Smith & Monforte, 2020). Stories do
more than simply reflect or recount experience, they act in people’s lives in
ways that matter deeply. Any narrative analysis must recognise this.
What is narrative analysis and how is it differentiated from other forms of
qualitative analysis? There are philosophical assumptions such as ontologi-
cal relativism, which recognises the real physical world, but psychological
phenomena are multiple, created and dependent on us, as opposed to exist-
ing independently. Epistemological constructionism (Smith, 2013) suggests
knowledge is constructed and fallible. Fundamentally, we live in a world
subject to the laws of physics but we have minds that – at least according to
63

64 Narrative Methods
our current understanding – have elements that are continually constructed
and reconstructed. Our stories do not depend solely on physical reality, but
on the content and structure of our thinking and feeling.
Narrative constructionism sees humans as meaning-makers who use nar-
rative to interpret, direct and communicate life, configure experience and
give a sense of who they are. Meaning-making is central to narrative and
so must be central to any narrative analysis. Narratives are passed down in
people’s social and cultural worlds. These are important constructs, enabling
us to differentiate between a socially constructed world which rests on very
little, and a social constructed world which is subject to scientific laws and
procedures. It forms the link between realism and relativism.
What Is a Narrative Interview?

The narrative interview is the main technique used in narrative research. In
this chapter, we examine the general principles; later chapters explore spe-
cific types of narrative interview. Not all interviews are narrative in style or
function, so the researcher must ensure that the data produced are in story
form. The narrative interview is inevitably a narrow focus, and there are
other narrative approaches, particularly analysing extant narratives such
as novels, journals or other accounts. Fundamentally, a narrative analysis
analyses narrative data, irrespective of its derivation.
Messy Data
Narrative research is messy. This may put some people off, but it is true.
It is not always even clear what constitutes data (Andrews, 2020). Data are
everywhere, from written stories to interviews to talks in the pub to pictures
on a wall to films on the TV. Even when we have the most straightforward
data source, the interview, we have to take into account not only what
someone said but also the way they said it, their emotional reaction and so
on. Narrative depends on context and so requires a subtle approach, not
only considering what is said but also non-verbal elements of communica-
tion, hesitations, emotions, etc. We also have to take into account also the
world around the interviewee, as this provides context. When we speak,
we take many things for granted, there are often nuances in the choice of
words and phrases, not only idiomatic language but also words that have
several meanings depending on how they are used, and words that have
different meanings for different people, which is why someone from a dif-
ferent culture may have difficulty fully understanding someone.

What Is Narrative Analysis? 65
Another form of messiness is the nature of the stories themselves. They
are often not objectively true. They may be entirely false. This may or may
not be known even to the speaker, let alone the interviewer. Elements of
the story may be accurate, but others are not accurate. There is a whole
subjective dimension to narrative that cannot and should not be removed.
It is part of the nature of narrative.
Somehow in the narrative analysis, we have to sort this mess out. When
conducting a narrative analysis, we have to make decisions about what is
important and what is not important. For instance, in my own work (e.g.
Hunt & Robbins, 2001), I interviewed World War II veterans about their
experiences in the war and the impact these experiences had on them. I
quickly realised that not everyone told the truth about their experiences,
either enhancing or demeaning their role, or simply not being able to
remember, or, in one memorable case, one veteran paratrooper told me
in great detail about what was happening several miles from where he was
fighting. As a sergeant, there is no way he would have such an overview.
It was only when I saw all the books and films he had about the battle in
question that I realised that he had blended his experiences with what he
had later read and seen. This is not necessarily untruthful, it is the way
narratives work, drawing together stories derived from real events, what
one has been told, what one has read and seen and how one interprets the
information. We do not remember things in isolation. The paratrooper
(probably) genuinely thought he remembered incidents he could only
have learned about afterwards. Memories are not fixed; they are manipu-
lable by the development of narratives. We remember what is useful to
us – and we also selectively forget.
The importance of this in terms of the narrative method is that we – as
psychologists – have to realise that we are interested more in psychological
processes than in objective historical truth. When we carry out a narrative
interview to explore some aspect of a person’s life, we are interested in
their interpretation of what happened and the impact it had on them and
others more than we are interested in what actually happened. We are not
historians or police officers.
What Is Narrative Analysis?

Narrative analysis claims to be holistic, analysing a text at the macro
level. Nevertheless, as we have seen in earlier chapters, we must examine
the elements of a narrative in order to explain the totality. Narratology
describes the limited number of elements and variations of elements in

narrative composition (Onega & Landa, 1996). Time, structure charac-
ters, agency, coherence, evaluation and spatial and interpersonal rela-
tions of characters are all important. There are a limited number of
elements which correspond to limited number of psychological con-
structions, whereas the text itself can be endlessly variable at the surface
level. Quantitative approaches to narrative based on the narrative com-
positional elements use algorithms that are able to automatically detect
and process each feature. This is radically different from most narrative
analysis and will not be considered here (see Franzosi, 2010, for details of
quantitative narrative analysis).
There are several problems when studying narratives. For instance, there
are no agreed start and end points for many stories (Andrews, 2020); this
is usually the case when we are studying human stories. We do not want
to study the whole of someone’s life. We are probably interested in a tran-
sition. In this case, we may look at three elements, before the transition,
during the transition and after the transition – but who determines which
elements of life we examine before or after the transition? Who determines
what is or might be important? There is no clear answer.
According to Riessman (2008), narrative analysis is a family of meth-
ods that share a common focus on stories. This needs to be unpacked
further. When looking at the types of narrative analysis, we should not,
as some may do, restrict ourselves to a particular approach, we should be
employing the best narrative method for the job in hand. As Smith and
Monteforte (2020) argue, ‘a researcher does not have to pledge allegiance
to one standpoint only and see the other as a family enemy’ (p. 2).
It is important to differentiate between the story teller and the story
analyst (Bochner & Riggs, 2013; Smith & Sparks, 2006). Do we even need
to analyse the story or can we just tell it and leave it at that? The decision
regarding analysis should be made at the outset of the research. The story
itself may be the analysis. Outside the story, we may be interested in the
impact of telling the story (see Chapter 9 on Narrative Exposure Therapy).
Story analyst and story teller may describe a particular form of constructiv-
ist narrative analysis, dialogic narrative analysis. Dialogic narrative is a mir-
roring of what is told (the content) and what happens as a result of telling
(effects), that is, includes what stories do (Frank, 2010, 2012). When oper-
ating as a story teller, the analysis is the story and the story is communi-
cated in the form of a creative analytic practice (CAP) to produce the tale
as a story. The researcher retells parts of the story to share the participants’
experiences. The result is a story rather than a traditional research report.
The story itself is the analysis. One example is CAP (Richardson, 2000).

Indicators of Quality of Narrative Research 67
CAP is an umbrella term for research cast into evocative and creative non-
fiction where findings are conveyed in the form of fictional tales grounded
in empirical data.
Indicators of Quality of Narrative Research

Any scientific approach must have appropriate indicators of quality such
as reliability and validity to ensure that the research has been conducted in
the best possible way, and that any potential problems are highlighted and
can if possible be rectified. These qualities include:
1. Trustworthiness. According to Reissman (2008), a narrative
account must be plausible, reasonable and convincing. These are
difficult qualities to quantify or operationalise, but the researcher
can examine different accounts or negative cases, and can explore
alternative interpretations of the data.
2. Critical reflexivity. The researcher should take a reflexive stance,
examining the nature of the participants (are they the right ones?
Did they answer the questions as truthfully as possible?), how did
the researcher approach the topic, the people, the narrative accounts?
How are the researcher’s biases showing in the research and how
are they dealt with? Are the results interpreted appropriately,
are they reliable? Is there any sense in which they have broader
generalisability (not necessarily relevant)?
3. Co-construction of meaning. As we will see in Chapter 9, where
co-construction is explicit, most narratives, and certainly those
that are interviews, are co-constructed. There is no meaning that is
pure to the participant; it is always affected by the people around
them and their environment. Meaning is always created, modified,
contested and resisted. The researcher must be sensitive to how
meaning is created.
4. Related to co-constructionism are those elements that are not said,
that may be implicit in the construction of the narrative. There may
be characters that are not discussed but impacted the formation of
the narrative (e.g. a teacher or respected colleague). As Freeman
(2004) notes, this is the presence of what is missing.
5. Temporal fluidity. Stories do not stand still. They are constantly
changing, whether this is explicit or implicit reconstruction. Life does
not stand still for the person, new information is constantly brought
into the life narrative and new interpretations of past events are created.

6. Multi-layered stories. Stories are told in different ways to different
people (including oneself). Stories may be explicitly about a single
person, yet above this are social and cultural levels of understanding.
7. Stories are always told contextually. This is not only about broader
cultural aspects but the immediate context of the story. Someone
tells their life story different to a spouse, to a group of friends in a
pub or to work colleagues. The audience matters.
8. Scholarship. Good narrative research should be contextualised
within other scientific work within the area (both of narrative and
the topic under consideration).
9. Ethics. As with all psychological research, there are ethical
considerations with narrative research. These will depend on the
specific research and the context, but should always be taken into
consideration.
Practicalities of Narrative Analysis

There are numerous strategies suggested for how to conduct narrative
interviews and carry out the analysis. It is essential that the interview pro-
cess and the analytic strategy are matched to ensure that the researcher is
collecting data that can be analysed in a narrative fashion. Several authors
have discussed issues around narrative analysis. What follows is a hopefully
straightforward account of how to conduct such an analysis. Narrative
researchers will undoubtedly disagree on some of the points, and may
argue for a more theoretically or philosophically driven approach, but in
the end, this is an applied book, and as such it is best for the reader to
provide a practical means of conducting the analysis which works. I am
not arguing that this is the only right way nor that it accounts for the work
that exists in narrative theory, but it should help the beginning narrative
researcher, and provide a practical guide to interviewing and analysis.
Analysis of narratives may involve grounded theory (GT) (Strauss &
Corbin, 2014), thematic analysis (TA) (Braun & Clarke, 2019) or inter-
pretative phenomenological analysis (IPA, Smith, 2011). It is acceptable
and appropriate to use these techniques as part of your analytic strategy
depending on the purpose of your study. In particular, IPA is very useful
with narrative work as it focuses on the particular experiences of the indi-
vidual and enables an examination of the process of events and experiences
in the person’s life – which is central to narrative.
The analytic process for narrative interviews is cyclical and iterative
rather than linear and fixed, so expect to go backwards and forwards

Practicalities of Narrative Analysis 69
through the process. Depending on the way you are doing your narrative
interview, this could involve the interview itself (See Chapters 8 and 9).
This is broken down into four main sections:
1. The interview
2. Familiarisation
3. Research questions
4. Pulling it together
1. The Narrative Interview
First of all, the narrative researcher has to decide what the story is and how
the story can be collected (if extant) or constructed. Extant stories can be
things such as books, journals, diaries or blogs, while constructed stories
are usually constructed via one or more interviews. We will be exploring
types of interviews in this and in future chapters. The interview is tran-
scribed, the level of transcription, what elements are included (e.g. pauses,
emotion and volume). The transcription itself is an active process, and the
researcher should be noting down anything that comes to mind as they do
the transcription. The researcher often has the transcription done auto-
matically or by others. This is not a problem, but the researcher should go
through the interview in detail, checking the accuracy of the transcription.
Narrative interviews ask big questions, prompting participants to look
backwards and make evaluations about the past and forward to share pre-
dictions and hopes about the future (McAdams, 2007) or to describe ‘self-
defining memories’ (Singer et al., 2013). People report on major life events
and personal evolution across the lifespan, and to make meaning, interpret
these experiences.
2. Familiarisation and Initial Analysis
The researcher should be highly familiar with the story. While it will
become familiar during the interview, it is essential that it is read and
reread several times, with the researcher immersing themselves in the data
and making notes as they go along. How they deal with this will depend
on how they are wanting to analyse the information, and this varies.
As already noted, sometimes the story itself is the analysis. It is pre-
sented as a whole or in significant chunks. On other occasions, the story
is subjected to further analysis, and this can be using general principles of
qualitative analysis, for example, IPA or TA, as long as the end result is the
story is retained (otherwise it is not a narrative analysis).
During this phase, the researcher gets to grips with the stories, perhaps
looking for classic elements such as orientation, coherence, characters,

relationships, temporality and so on. It is about identifying narrative
themes and narrative tone. What are the commonalities within and some-
times between stories? While it is important to highlight key points, it is
equally important not to overcode. Don’t code line by line, don’t lose the
story, look for the bigger patterns. Identify the structure, how the story
is put together and shaped. Look for the directions the story goes, any-
thing that suggests structure, reflections, evaluation, changes in tone, the
objectives of the story, changes to characters and significant interactions
between characters.
3. Research Questions
This is a means of opening up the dialogue further, addressing specific
questions of interest in relation to the stories. How do people construct
and shape their stories? What narrative resources do individual participants
have access to? Not all people have equal narrative resources. Do they need
assistance in constructing narratives? What about identity? How do the
stories inform about the identities of the participants and of the characters
in the stories? What about the body? There is a close link between stories
and the reactions of the body to the story. What thoughts and feelings are
generated in relation to the story?
4. Pulling It All Together
For publication in traditional journals, which is what most academic nar-
rative researchers wish to do, the standard academic structure of an arti-
cle must be, at least to some extent, adhered to. Fortunately, increasing
numbers of journals are accepting of qualitative research in general and
narrative research in particular, so the choice for publication is widening.
The actual structure of the article will depend to some extent on the type
of analysis used, and whether there is a need to integrate the results and
discussion sections. It will also depend on the extent of quotations given.
For narratives, the quotations are often long and may be at least partly
self-explanatory.
Another way of distinguishing types of narrative analysis is via codi-
fied (Chamberlain, 2011) and prescriptive (Frank, 2010). Both include a
set of prescribed steps or procedures that the analysis should follow, for
example, IPA, TA or GT. Frank (2010) provides a heuristic guide, a guide
to interpretation, rather than leaving the analysis as a vague guess at the
meaning of a narrative. This is useful for narrative analysis as, according to
Frank (p. 73), ‘too many methods seem to prevent thought from moving’.
Systematic and rigorous guidance can help the analyst with fresh direc-
tions and encourage theoretical curiosity and movements of thought.

Reliability and Validity of Narrative Analysis 71
Narrative Coherence
As an example of how narrative analysis can be specific to a particular
situation, we conducted some research examining the importance of nar-
rative coherence in traumatic stress, exploring the assumption that when
someone is describing their difficult experiences in the past, the greater the
degree of narrative coherence, the lower the level of post-traumatic stress
disorder (PTSD) or trauma (Burnell et al., 2006, 2009a, 2009b, 2010).
Narrative is used within mental health to understand how people make
sense of events that challenge their ideas about the self and the world. The
narratives here focused on narrative form and narrative content in rela-
tion to British war veterans. Narrative form is concerned with how people
tell their stories. Narrative content consists of what people say relating
to plot, characters and so on. For this study, which looked at the role of
social support in veterans, narrative content focused on the social support
experiences of the veterans. Narrative form concerned the coherence of the
narrative, which was defined as an oriented, structured, affectively con-
sistent and integrated narrative. In order for a narrative to be considered
coherent, it has to have all the characteristics listed.
Burnell et al. (2010) described the narratives of ten British World War
II veterans in relation to social support experiences. Veterans with coher-
ent narratives were less likely to have experienced (or reported) traumatic
memories compared with those with reconciled or incoherent narratives,
but they reported more positive perceptions of their war experience, more
positive experiences of their families and of society.
Reliability and Validity of Narrative Analysis

All analysis, whether qualitative or quantitative, is subjective and open to
various forms of interpretation. How can we know what the ‘right answer’
is? This is important for applied psychologists, who want to get it right so
they can have confidence that they are helping people.
Fisher (1989) defines two tests of narrative validity (which he also calls
rationality). The first concerns probability, whether the narrative ‘hangs
together’, whether it is coherent and makes sense. Fisher uses the example
of stories from the Bible. Some stories show that God cares if humanity
believes in him, and others show that he doesn’t care. This is not consis-
tent; it doesn’t make sense (though many religious people don’t seem to
care). To be coherent, a collection of stories must be systematic, they must
relate to one another in consistent ways and they must have a common

theme. They must form a coherent structure where each story reinforces,
elaborates or combines with the others to form a whole that is greater than
the sum of the parts.
Fisher’s second test of validity is narrative fidelity. Does the narrative
relate to the reality of the world as most of us understand it? Despite impor-
tant cultural differences, we all share basic desires for survival, security,
safety, happiness and so on. There are also common situations where these
are threatened (war, violence, etc.). We make narrative sense of these situ-
ations by establishing archetypal characters and relationships that ration-
alise these threats. For instance, a natural disaster can be explained as the
action of a deity to publish sinners, or unusual weather patterns brought
about by climate change. War could result from a villainous leadership of
a country which wants to exploit the people of another country. A narrator
makes sense of these negative events by framing them in this way.
In the end, a narrative analysis cannot usually be expressed in a number
indicating reliability or validity. An analysis depends on whether it appears
appropriate. Nevertheless, there are times when numbers are appropriate,
such as when we have used narratives to help reduce mental health symp-
toms (for instance, see Chapters 7 and 9), but this is one step removed
from a narrative analysis, it is the analysis of the impact of constructing or
reconstructing a narrative.
Conclusion
This chapter has briefly examined the key practical elements of narrative
analysis. These elements will be explored in further detail in the next few
chapters, where we will see how researchers, clinicians and others use nar-
rative analyses. There is no single way of doing narrative analysis. There is
no textbook solution. Narrative analysis is about understanding stories.
Stories take many forms, and researchers and clinicians analyse stories for
many different reasons. While it might be thought to be practical to have a
systematic proscribed approach, in actuality this would have serious prac-
tical limitations. We can add to the basics of analysis described above by
looking at some real examples.

Chapter 6
Life Interviews
Life interviews have been used for many years in a variety of ways for
many different purposes. Biographies of famous people, or people who
have achieved something significant, are common, and in recent decades,
it has become more common for other people to provide their life stories
to researchers for a variety of purposes. Providing a life story is not a simple
matter. It is hardly possible to talk through one’s life, remembering the
important points, dealing with key events, thoughts and feelings, without
some structure. Often, a researcher might not be interested in a whole life
story, but in some particular event or series of events, or a particular time
in a person’s life, or they may be interested in finding out more about why
a person thinks in the way they do, or how their thoughts and feelings
link to important personal, social or national events. A life story is not
necessarily about the whole of life, it can be, and often is, focused on more
specific things.
Many authors have used narrative storytelling in one form or another
to indicate its effectiveness at reducing trauma-related symptoms and
enhancing well-being. Storytelling itself appears to provide the person
with an insight into the problems they are facing and helps them generate
meaning from their experiences.
A life story is a story in which an individual reflects on and engages
with their experience and memories and tells the story to an audience
(McLean & Syed, 2016). McAdams (2006) argues that the stories someone
tells are embedded in our unique past and can also provide an insight into
their current and future well-being.
Burnell, Coleman and Hunt (2010) argued that the structure of the
stories produced can predict whether someone is suffering from trauma-
related symptoms. The more coherent a person’s narrative, the less likely
they are to be suffering from trauma-related symptoms. This indicates that
if a person’s narrative can be made more coherent, then perhaps this may
reduce their trauma-related symptoms.
73

74 Life Interviews
The distinction often drawn between research and clinical practice, that
a researcher should not be involved in therapy, is rather an artificial distinc-
tion in this kind of research. If a researcher is interviewing a person who has
been through a traumatic experience about that traumatic experience, there
is often an implicit therapeutic component. Talking about something really
does make someone feel better. This is perhaps an example of how the thera-
peutic industry has attempted to isolate therapy and keep it to themselves,
when the reality is that most therapy is informal and carried out by friends
and family. The distinction between informal and formal therapy is fuzzy.
Narrative is about opening up the process, to normalise it, to make it more
natural, in the way that humans have done since they started to use narra-
tives. That is not to say narratives can help with every psychological problem,
but talking really does help with problems such as anxiety and depression.
In this chapter, the focus will be on two specific ways of addressing the
life story through interviews, MacAdams’ life story interviews (LSIs) and
the narrative life interview (NLI). The two approaches are complementary,
indeed the latter is partially based on the former, but they do offer differ-
ent techniques to dealing with aspects of a person’s biography. They have
different aims and are analysed differently.
McAdams Life Story Interview (LSI)

The LSI was devised by McAdams (2006) to develop detailed and in-depth
understanding of an individual’s life. The LSI encourages people to pres-
ent their life story in chapters and to describe key elements within these
chapters; moving on to explore high and low points in their lives, poten-
tial turning points, challenges faced, hopes for the future and to gain an
insight into their personal beliefs and values, exploring the central themes
in their lives (McAdams, 2008b). The LSI has been used in a variety of sit-
uations, but predominantly to understand transitions and turning points
in people’s lives and the impact these have on lives. Leonard and Burns
(2006) used this approach to investigate how, over several years, the life
stories of middle-aged and older women shifted from a focus on transition
(largely around the menopause) to a focus on personal growth and looked
at the adverse situations they had faced. Adler et al. (2019), also focusing
on adversity, examined people with mental health problems and how a
positive life story can turn into a negative one, and how these stories are
narrated in relation to the adversity experienced (a contaminated narra-
tive). Alternatively, a negative event can be transformed through reflection
and evaluation to have a positive outcome or develop into a redemptive

Procedure for the LSI 75
narrative (Dunlop & Tracey, 2013; McAdams & McLean, 2013). Dunlop
and Tracey also showed the importance of how a change to the narrative
can lead to behavioural change and improved health.
Procedure for the LSI

The LSI is a story about a person’s life, and so the questions that are
addressed in the interview examine different aspects of life. The interview
can take place over several sessions and several days, depending on the detail
required, and is in several sections (for more detail see McAdams, 2007):
A: Life Chapters
Life is broken down into a number of chapters, usually between 2 and 7.
Imagine a book with the titles of chapters. The person is asked to briefly
describe the content of the chapters.
B: Key Scenes in the Life Story
The person is asked to describe certain key scenes in some detail. These
include a high point in life, a low point, turning point, positive childhood
memory, negative childhood memory, vivid adult memory, religious, mys-
tical or spiritual experience, and wisdom event.1
C: Future Script
What is the next chapter? How would the person describe their future?
What do they hope to accomplish? What are their dreams, hopes and plans?
Is there a life project? This might be a project about work, family or a hobby.
D: Challenges
What is the greatest single challenge in life? Where did the challenge come
from, how did it develop and how was it resolved (if it was)? What was the
greatest health challenge? What was the greatest loss of a person? What is
the most important failure or regret in life?
E: Personal Ideology
This contains questions about fundamental beliefs and values in life. What
is the person’s religious or ethical values? What are their social and politi-
cal values? How have these values changed over time? What is the most
important single value in life and why? Is there anything else to add about
fundamental values, about the person’s fundamental philosophy of life?
1
The LSI can come across as very US-biased to the European mind. Many Europeans would say they
haven’t had ‘religious, mystical or spiritual experiences’. The interview should be adapted accord-
ingly. This may apply to several of the questions.

76 Life Interviews
F: Life Theme
This would probably be unanswerable at the outset of the interview pro-
cess, but does the person have a central theme, is there an idea that runs
through the life story?
G: Other
Is there anything else that the person wishes to say that might add to the
life story?
The LSI does not attempt to cover everything in life. The purpose is to
highlight the most important events and ideas, to give a flavour of the per-
son’s experience and views. Once the interview is conducted, McAdams
provides a series of ideas regarding the analysis of the LSI which enable
a deeper understanding of the person. The key elements of this analysis
are redemption and contamination. To some extent, these ideas are very
North American, specifically USA, but to some extent, they are applicable
to and useful for an understanding of narratives in general. This type of
analysis was discussed in Chapter 5, Narrative Methods. Here the utility of
such methods is briefly examined.
Redemption and Contamination

McAdams (2001) discusses a number of concepts relating to narrative analy-
sis. Perhaps the most useful of these are the ideas of redemption and con-
tamination, though at times they do appear, at least to the European reader,
a little – for the sake of a better word – American. Nevertheless, they do pro-
vide a useful way of examining narratives for positive and negative elements.
The two strategies show how people make narrative sense of their expe-
riences that involve a significant transition (McAdams & Bowman, 2001).
In a redemptive sequence, the storyteller narratives a transformation from
a negative life scene through to a good (or at least better) scene, with life
improved in some way. In a contaminated sequence, the storyteller does
the opposite, demonstrating a transformation from a positive scene to a
negative one, with life spoiled in some way.
McAdams et al. (1997) discuss generativity, with highly generative peo-
ple narrating their lives in terms of commitment, and is related to a posi-
tive family life as a child, being sensitive to others’ suffering, being guided
by a clear and stable personal ideology, wishes to benefit society and tends
to transform bad scenes into good ones (redemptive sequence). Highly
generative people were also less likely to narrative their lives in terms of a
contamination sequence.

The Narrative Life Interview 77
Redemption
The coding scheme for redemption relies on the work of a number of
people, particularly writings on redemption scenes and commitment
(Carlson, 1988; Tomkins, 1987) and also the literature relating to traumatic
growth (e.g. Tedeschi & Calhoun, 1995).
A redemption sequence in a narrative may involve four separate elements:
1. Redemption imagery
2. Enhanced agency
3. Enhanced communion
4. Ultimate concerns
Redemption imagery is when there is movement in a story from a clear
negative scene to a clear positive scene. Negative scenes are often described
in terms of a person’s emotional state, for instance, feelings of anger, sad-
ness or grief. There may also be physical symptoms of pain or sickness.
The event itself might relate to experiences such as the loss of a friend,
an accident or losing one’s job. This is not about minor setbacks, but sig-
nificant negative events in a person’s life that have negative outcomes for
the person. It is, like all narrative analysis, a very personal and subjective
decision, but this is inevitable when we are dealing with stories, no two of
which are the same, though many are similar.
If a redemptive sequence is present, once a negative scene is estab-
lished, there needs to be evidence that the person has moved from this
negative scene to a more positive one. This might be indicated through
positive emotions such as happiness or love, or by cognitive elements such
as increased self-awareness or positive thinking. This may also include
events or scenes that most people would see as positive, such as being in
a good relationship, getting a new desired job or being fully recovered
from an illness.
Another characteristic of determining whether there is a redemptive
sequence is establishing causality. If there is a simple time lapse between
the negative and positive scenes, this is not redemptive; there has to be
some form of causal link (e.g. recovery from illness, developing a new
relationship, gaining an understanding of suffering).
The Narrative Life Interview

The NLI is a technique designed as a means of enabling people to tell
their stories. It is an autobiographical technique derived in part from

78 Life Interviews
narrative exposure therapy (NET) (Schauer et al., 2011) and McAdams’
LSI (McAdams, 2007). It is derived from our understanding of how people
construct, listen to and relate to people’s life stories, with the listener (the
interviewer) playing a key role in that process, explicitly recognising the
double hermeneutic present in narrative construction. It is a recognition of
how it is common for a story to be constructed by two (or more) people,
how stories are created within the social milieu of which they form part.
The purpose of the NLI is not to cover in detail all aspects of a person’s
life, but to focus on transition and the elements of the transition that have
had the biggest effect on a person.
The NLI can be used for any area where we wish to understand something
about how people are affected by transitions. The focus around trauma will
involve the lead up to the event or events, what actually happened (war,
disaster, sexual abuse and rape, etc.) and the consequences of the event. For
instance, for traumatic stress, it might involve a refugee’s experiences in their
home country that led to becoming a refugee, the transition process and the
experience of living in the host country. In occupational psychology, the
focus might be a transition within an organisation, involving interviewing
employees about their work experiences before, during and after the transi-
tion. In health psychology, the focus could be the experience of illness, or
in forensic psychology, the experience of crime. It is always about the events
leading up to the event, the event itself and the period after the event.
The critical aspect of NLI is the focus not only on the person’s biograph-
ical details but also to focus on key behaviours, thoughts and feelings relat-
ing to the experience. If the focus is traumatic stress, then in terms of NET
this would involve dealing with the ‘hot’ memories in detail, enabling the
person to discuss them in detail and make the memories more bearable.
As psychologists, we are interested in the details of the experience and the
person’s response to the experience, so it is important for both research
and practice to get information about behaviour, thoughts and feelings
in as much detail as possible, which will have a benefit for knowledge
and understanding regarding the human reaction to difficult events and a
therapeutic benefit for the individual.
NLI Interview
The interview has several elements: (a) assessment and psychoeducation.
The NLI may have therapeutic benefits, so it is important for the person
to be aware of the normality of the symptoms they may experience and to
have the means (e.g. relaxation techniques) to cope during the interview,

Details of the NLI Procedure 79
(b) a long interview to obtain all key details of the interviewee’s experi-
ence, including behaviours, cognitions and emotions; (c) the interviewer
writes up the story in the first person, noting where there are gaps, incon-
sistencies or other problems and sends the life story to the interviewee;
(d) in a second, shorter, interview, the interviewer has the opportunity to
complete the story, to fill in the gaps, clarify inconsistencies, etc., and the
interviewee has the chance to add, remove or clarify information. The final
transcript is then signed off by the interviewee.
The purpose of the NLI is twofold. First, it is to enable the person to
develop their autobiography more effectively, to make sense of their expe-
riences and to integrate these into their autobiography. In this way, it is
similar to NET, though as it only has two sessions, it should be used with
people who have less serious problems, and who may benefit from this
short technique. Second, to provide a transcript for researchers to analyse,
using some form of narrative analysis (e.g. White, 2000) or interpretative
phenomenological analysis (IPA) (Smith, 2011).
The NLI is conducted across two sessions, with sufficient time between
for the life story to be written up and critically analysed by both the
interviewer and the interviewee. Based on evidence from other narrative
procedures (e.g. McAdams, 2006; Schauer et al., 2011), people who have
symptoms of trauma or anxiety may experience a reduction of those symp-
toms, simply by telling their story, so it may be important to have assess-
ments before and after the procedure.
Pilot research has examined the impact of the transition to university,
with a focus on changes to, for instance, friendship, diet and attitudes. In
this case, the NLI examined participants’ lives before, during and after
the transition to university life, but with a focus on the changes to behav-
iour, cognitions and emotions. Similarly, other pilot research has exam-
ined changes to diet and to physical health. While these examples have a
focused transition period, the principle of NLI only requires the detailed
examination of behaviours, cognitions and emotions regarding the topic
of interest, rather like NET. NLI focuses on a particular topic rather
than on a participant’s whole life, which moves away from McAdams
notions of examining life through chapters towards a consideration of
the impact of critical events.
Details of the NLI Procedure

The NLI has been piloted on several populations: war veterans, refugees,
trans-people, people with autism and students transitioning to university.

80 Life Interviews
The advantage of the NLI is that it can be used with a wide variety of
populations and not just with people who have mental health problems;
so it is a highly versatile research tool. As already discussed, the NLI draws
strongly on NET, the LSI and IPA to produce a co-constructed narrative
based on the participant’s life, with a focus on the areas of importance
(critical events, before transition, transition, after transition), whether it is
a research or clinical-focused study. The actual process, the questions that
are asked, depends to a large extent on the purpose of the procedure.
Diagnostic Elements and Psychoeducation

Procedures relating to informing the person about the purpose of the NLI
may be followed by measures relating to symptoms the individual might
be facing such as depression or stress and anxiety. This may be partly to
determine the extent of the problem and partly to examine whether the
NLI process leads to significant change by reassessing the person after the
procedure is complete.
Psychoeducation is important to the person to show them that any
symptoms they are experiencing are normal for their situation. If they are
experiencing symptoms, then they should be told about the symptoms so
that they understand their context, whether they might relate to any disor-
der, normalisation and so on. They need to know the context of any symp-
toms relating to cognitions, emotions and behaviour, along with potential
problems concerning relationships at home and at work. They also need
to be aware that talking about their feelings and thoughts can help them
feel better, that while talking will not remove their memories, it may help
them deal with their memories more effectively and live a more satisfactory
life. Psychoeducation is not a matter of just handing over a document that
describes common symptoms (though this is helpful), it is about talking
to the individual about their feelings and thoughts, the problems they are
personally having and pointing out that these thoughts and feelings are
common to people who have been through such experiences.
First Interview
The first interview is the main interview. It should be recorded. The aim
is to cover all areas of the participant’s transition that are important to the
study. If it is necessary to cover more than the transition and its surround-
ing elements, then NLI is probably not appropriate and NET or LSI could
be used instead. The interview should normally, but not necessarily, be

The Second Interview 81
conducted in a single session which may take several hours. It can be a long
process due to the need to address key behaviours, thoughts and feelings
across all elements pre-, during- and post-transition. It is the detail that is
important. The person will benefit most by focusing on the key negative
and the key positive areas. The good points about life will help the person
come to terms with the bad things that have happened. It may be that the
interviewer pushes some of the positives to help the person realise that
there are these positives in life.
Every case is different, even within a single study. The interview is struc-
tured, the interviewer wants to cover several topics, but the course of the inter-
view – within these constraints – is guided by the person being interviewed.
Where the interviewer believes there is inadequate detail, it is impor-
tant to obtain that detail through repeated questioning. This particularly
applies to any trauma-related events. The interview may last several hours.
The Life Story

As soon as possible after the interview, the interviewer writes up the life
story. There does not necessarily need to be a full transcription of the
interview, though this may be helpful. The life story should focus on the
important aspects of the participant’s life story and write as much detail as
appropriate. For this study, the full life story is written. It is written in the
first person, so it belongs to the participant. This is an explicit means of
using the double hermeneutic.
The difference between this approach and other life story approaches
(including NET) is that the interviewer is rewriting elements to make the
story more coherent, to make sense and give meaning to what the person
has said. The person’s actual words should be used as much as possible, but
it is not always possible to do this fully. The interviewer needs to recognise
that they may need to add words, phrases and sentences to make sense of
the story. In the end, the person will own the words.
Once it is written up, the life story is sent to the participant so they can
address any changes they would like to see, for example, adding or deleting
material, or making changes.
The Second Interview

The second interview is about ensuring the life story is as complete as
possible. The participant can make any desired changes (it is their story,
after all). They can provide further details where necessary or where they

82 Life Interviews
think it is important. The interviewer asks about any aspect of the life
story that is ambiguous or where there is a need for further detail. This
might be particularly about the details regarding thoughts and feelings as
these aspects are often the most difficult to obtain. Once both the person
is happy with the content and the interviewer is happy that they have
obtained as much detail as appropriate, the interview is terminated.
The interviewer then completes the write up of the story and sends it to
the person, who confirms the accuracy of the story by signing it off. The
signature will need to be witnessed by the interviewer if the transcript is to
be used in evidence.
Checking and Reassessment

When a person has been interviewed in such detail about such difficult
personal issues, it is essential that the interviewer contacts them afterwards,
perhaps a few days later, to see how they are. Usually the person feels
much better, but there is a possibility that they will feel worse, and if so,
the interviewer must provide guidance for further help. This will already
have been provided on an information sheet but sometimes it is better
reinforced by the interviewer.
The NLI usually requires a person is reassessed on the same measures as
the start of the process, and sometimes again some months later, to deter-
mine whether any changes occur as a result of the NLI. Of course, in order
to determine whether any changes are a result of the NLI or the simple
result of the elapse of time would need a randomised controlled trial, but
that is outside the scope of this book.
I will look at two examples from our own research to illustrate the NLI,
refugees and transsexuality.
Refugees
In the case of refugees, it is necessary to look at the participant’s life before
becoming an asylum seeker, the incidents relating to why they became an
asylum seeker, details of life when seeking asylum and their experiences
in the host country (the UK). It is essential to examine the individual’s
behaviours, thoughts, feelings and emotions throughout the relevant
period. There is a clear transition which can have a significant effect on the
individual, from the home country to the host country.
The example is that of three refugees who relatively recently arrived in
the UK after harrowing experiences in their home countries. The potential

Method 83
benefits of enabling people to tell their story in detail justify the develop-
ment of this new technique of obtaining life interviews. For the example
given here, there is no attempt to determine whether there is symptom
reduction as a result of using the technique. That would require a larger
study. The key aim at this point is to examine the protocol.
The refugees were subjected to detailed questioning about their experiences
and about associated behaviours, thoughts and emotions using NET-style
questioning. The resulting transcripts were analysed using IPA (Smith, 2011).
The process of developing the story jointly was beneficial for the refugees
in enabling them to develop a coherent story about their experiences, and all
refugees indicated that they found the process beneficial, but this is just based
on comments. Future research will examine the impact of the NLI in reduc-
ing symptoms of trauma and anxiety, and in looking at different populations.
Method
Participants
Three refugees took part in the study. They recently arrived in the UK
from various home countries. Their details are listed in Table 6.1.
The three refugees all agreed to take part in the study. All were pro-
vided with a participant information sheet and signed a consent form. The
interviews all took place in a private room in a refugee centre. The proj-
ect was ethically approved by the Faculty of Medicine and Health Ethics
Committee at the University of Nottingham.
Interview Protocol
The interview protocol focuses on the key aspects of the participants’ lives,
particularly their lives in their home country, the transition to the UK and
life in the UK, including full details of behaviours, thoughts and emotions.
The initial questions are few but open, relying on the experience and skills
Table 6.1 Participants
Person Age Home country Length of time in UK (years)
A (Female) 52 Iran 1
B (Male) 38 Saudi Arabia 2
C (Male) 24 Syria 2

84 Life Interviews
of the interviewer to obtain sufficient relevant detail, as each participant’s
experiences will be different. The questions for the NLI have both a gen-
eral focus (e.g. on behaviour, cognitions and emotions) that relate to all
NLI interviews and are generally used as prompts, and questions that are
specific to the people being interviewed. For the purposes of this study, the
key specific questions include:
– What was your life like in your home country?
◦ Describe key events and people.
– What was it that led you to seek asylum?
– Describe what happened when you moved from your home country
to the UK.
◦ Full details, include behaviour, thoughts and feelings (including the
behaviour, thoughts and feelings regarding other key people)
– Describe your reception in the UK.
– Describe your life now.
The following prompt applies to all the key questions:
◦ Full details, include behaviour, thoughts and feelings (including the
behaviour, thoughts and feelings regarding other key people)
The participant is asked at the beginning to answer questions in as much

detail as they can.
The interviewer must be flexible regarding the actual questions, as these
will depend on the individual’s responses.
Interview Procedure
This followed the procedure described above, with the interviewer writing
out the participant’s life story between the two interviews. It is critical that
the interviewer has good interviewing skills, that they are active listeners
and can ask open-ended questions, the format of which depends on the
participants’ previous responses. It is essential that there is a level of trust
and rapport between the interviewer and the participant.
Analytic Procedure
This is a practical problem that arises when employing narrative
approaches. There are several approaches to use when employing narra-
tives. The approach that is used depends on the purposes of the research.
As indicated, IPA is a useful analysis when examining certain types of

Method 85
narratives, as it examines the unique experiences of the participants’ lives,
and explicitly recognises the double hermeneutic, the way in which a per-
son is interpreting their life and the way in which the interviewer is trying
to interpret that interpretation, which is critical to NLI as the method
of producing the final transcript explicitly draws on the memories of the
participant and the expertise of the interviewer.
The NLI can use different techniques of analysis, but a combination of
narrative, describing the person’s life in some detail to examine some of the
potential causal elements relating to their experiences of the transition, and
then employing IPA to dig deeper into understanding their lives, their choices
and their responses, provides a detailed account of individual lives. This is why
an NLI study which is focusing on research rather than therapy will inevitably
have a small number of participants; the individual experience is critical.
Results
The three refugees came from varying backgrounds and had different expe-
riences of becoming a refugee. The IPA focused on two key areas. The first
examined the practical experiences of home-transition-uk. The second on
memory, emotions and coping. The details of the first are described below
in the life stories of the participants. This is an example of storytelling
rather than story analysis.
Narratives of the Refugees (Storytelling)

A52F is a 52-year-old female from Iran. Her family was involved in revolu-
tionary politics before the Shah was deposed in the revolution of 1979. Her
own involvement in politics after the revolution was one of the reasons she
was imprisoned. The other was that she wanted to convert from Islam to
Christianity. In prison, she was treated very badly. She was beaten, there
was no safety, it was dirty and guards threatened to kill her. She remembers
that time vividly; it is a film that plays in front of her. She describes the hor-
rors of Sharia Law as it is applied in Iran. A woman who renounces Islam
will be tortured, possibly raped and stoned to death. She witnessed a ston-
ing. A woman who had sex with someone who was not her husband. She
describes the blood and how she had bad dreams about it. She came to the
UK via Turkey and possibly Bosnia. It took several months and she did not
have control of the process. She arrived in the UK unable to speak English
and was put in a dirty hotel. Fortunately, other people who had been asy-
lum seekers helped her, sometimes Iranians, who provided her with clothes

86 Life Interviews
and money. She received no psychological support. Her identity is mixed,
though she has integrated into UK culture. She has mixed feelings about
being in the UK, still missing Iran. Culturally, she cooks Iranian food, but
also food from all cultures. She volunteers for the asylum network and is
very happy with the work and the network. She sees herself as both British
and Iranian, and British people treat her well. She is happy with her mixed
identity. Her life has changed a lot but she has a positive outlook for the
future. She is now a Christian and a Labour Party supporter.
B38M is a 38-year-old male from Iran, who has only been in the UK for
around 2 years. He was born to a family that ruled a sultanate until 1967,
when it was taken over by Saudi Arabia. In Saudi Arabia, he did not have a
real identity and though he worked there for many years, he became effec-
tively stateless, the Saudi government would not give him a passport, which
is why he decided to move to the UK and claim asylum. His journey to the
UK was a plane flight. At the time of the interview, he does not have the
Right to Remain as the UK government has not accepted proof that he is
stateless. The refugee centre has been very helpful legally and in terms of
social support. He is not allowed to work but has volunteered as a translator.
He had never been in prison in Saudi Arabia but after living in a hostel for
some time, he was put in a detention centre in the UK because the UK gov-
ernment rejected his asylum claim. He was eventually released on bail but
still has to report every week. He is appealing the case with the support of
the asylum centre. He does not feel safe, though he feels supported. He has
had no difficulties integrating in UK culture, though continues with Saudi
traditions such as cooking. He left behind a woman he wanted to marry.
Her family would not let her marry him, and he regrets this. He is still a
practicing Muslim, but is not strictly observant. He supports freedom and
human rights and hopes that Saudi Arabia will become a more open society.
C24M is a 24-year-old male from Syria, who has been through many
horrific experiences in Syria before escaping and eventually finding his way
to the UK. As a child, he played football and swam at the highest lev-
els, worked as a metal worker and ran his own business. He was arrested
before the revolution and questioned regarding his knowledge of the oppo-
sition. Later, he was shot in the knee before being arrested again. A friend
was also shot. He was beaten while on the ground with his wound, then
taken to the hospital, again being beaten unconscious. The medical staff
tried to protect him by pretending he was still unconscious, but after a few
days, an officer stood on his knee. They then beat him, took him to prison
and tortured him. He was in a cell with two friends. One was ill but no
help was provided and he died. His body remained in the cell for 2 days.

Method 87
He remembers the torturer very well, down to the last detail of his tattoos.
He was returned to the hospital. There was an explosion and he escaped,
but shortly afterwards was rearrested and sent back to jail. More torture,
for example, being hung from a wall by his wrists, being beaten with soft
steel, electrocution. Now he was alone in a cell, not knowing whether it was
day or night. There was little to eat, for example, half an egg one day then
nothing the next. Another torture, hands tied behind his back and kicked
down a slope; or dropping him in a tank of water until he struggled, then
bringing him out again. There was little sleep. He wanted to die. He saw a
child tortured and killed to make his father speak. Then they brought the
man’s daughters to the prison and raped them in front of him, in front of
all the 110 prisoners. The father was forced to watch. Eventually, a ranking
officer paid to help him escape. He went to Jordan, then to Libya for 2
years, then crossed the Mediterranean by sea. The boat sank and he swam
to get help. He went via Italy, France and Calais and crossed to the UK
by refrigerated lorry. In the UK, he was in a hostel and then a detention
centre, with the threat of deportation to Italy. He was eventually released.
He is still badly affected by his experiences; bad dreams, inability to sleep
properly, no coping mechanisms, poor memory, physical pain from the
torture. The main thing is the loss of the feeling of being comfortable. He
still regrets not dying in the prison. He is integrating into UK culture, but
there is a language barrier and he missed Syria. He sees himself as having
a mixed identity, British and Syrian. He is a Muslim, believes in human
rights and is against Assad in Syria.
Brief Analysis (Story Analysis)

The analysis explored the psychological responses of the participants to the
experiences described above, focusing on the transition and its impact. The
participants did not just have difficulty coping with the memories of events
in the home country and the difficult journey to the UK but a key aspect of
why they may have problems with their traumatic memories is the way they
are treated in the host country. We have found this before (Hunt & Gekenyi,
2003) with Bosnian refugees who were experiencing traumatic symptoms at
least in part due to their being in the UK where there is a fundamentally
different culture, with different foods, language and climate and without
the support network that is often available in the home country. There were
similar results here, with some of the major difficulties relating to language
and culture, which were eased in all cases by the experiences with the refugee
centre they all attended. This positive experience at the refugee centre was

88 Life Interviews
emphasised by all three participants, how the centre had helped practically
and emotionally.
While the study did not explicitly examine symptoms of post-traumatic
stress disorder (PTSD) or other problems, the responses of all three par-
ticipants after the NLI was completed were positive regarding how they
felt better for having told their stories in this way.
The Experience of Being Trans

This pilot study (Holmes, 2022) concerns the experiences of people who are
transsexual or transgender, that is, they identify as not being of their genetic
sex – not sex assigned at birth, that is a meaningless concept used by certain
groups as a political statement. Sex is determined at conception. This is an
example of how it is important to establish the nature of the concepts that are
being discussed. While the people in this group all identify as a gender that
is not the same as their sex, they do not all identify as the opposite gender.
Participants
Six participants took part. All were aged between 18 and 22 years, which
is important for the study as, being such young adults, they may still be
in the process of building their life narratives. When asked to describe
their gender, they all used a range of terms such as transmasculine and
transfeminine to describe both binary and non-binary transgender people
transitioning from female to either male or a more masculine gender and
presentation, and from male to either female or a more feminine gender
and presentation. There are important implications for personal and mas-
ter narratives around gender.
The Questions
The questions focused on participants’ experiences as a trans/non-binary
person, that is, their gender story so far. This included exploring important
moments in that story, considering whether there are further milestones in
the story (e.g. surgical transition), particularly positive and negative experi-
ences, and questions around how identity and the sense of self have changed.
Findings
The final transcripts were analysed using IPA. Rather than discuss each
person as an individual, there were several issues raised that are relevant

Method 89
for the study of narrative. Taken together, there was a single overarching
theme of ‘transmedical narrative’, which refers to the experiences of the
participants as transgender and non-binary. Participants highlighted how
trans people are not taken seriously, even by other trans people, unless
they are certain types of transgender. For instance, if a trans man wants
to retain a sense of femininity or a trans woman a sense of masculin-
ity, then they are not taken seriously. The master narrative of trans has
already – even though the topic has only been mainstream for a short
while – developed expectations of what is right and wrong about trans,
that is, transnormativity. The normative is to go from male to female or
vice versa, not ‘somewhere inbetween’. The term transmedicalism arose
due to the importance of legitimacy in the eyes of medical professionals
who deal with gender dysphoria.
Other recurring ideas include the idea of ‘being born in the wrong
body’, and wanting the bodily features and functions of the opposite
sex. Nevertheless, participants discussed gender fluidity, genders which
do not fit into binary ideas of male and female. They wanted a label,
but didn’t believe one existed: ‘I don’t think there is ever going to be a
word that can truly represent how my gender feels … gender is differ-
ent for everyone’. Another element of the transmedical master narrative
is conformity to the stereotypical interests and features of the opposite
binary gender to the person’s biological sex. A final feature is the desire
to completely medically transition from one binary gender to the other,
usually driven by distressing experiences of gender incongruence that
was medically diagnosed as gender dysphoria. This is not a desire every-
one felt, with one non-binary participant suggesting they would like to
alleviate their dysphoria through social transition rather than medical
intervention.
Not all the participants fitted neatly into any category, perhaps as a
function of their still developing their life narratives. Several stated they
still have concerns about their identity status, masculine, feminine, non-
binary. One stated that they are ‘not trans enough to get hormones’, indi-
cating the problems faced in establishing a clear gender identity, perhaps a
reflection of the strength of the master narrative, built on clear biological
sex differentiation, that there are two sexes which correlate almost per-
fectly with two genders, male and female. It is very difficult to challenge
this master narrative, because not only is it built on social differentiation,
but also it is built on biological differentiation, and the numbers of people
who do not conform, either socially or biologically, are minute within the
population, so society has had little or no preparation for the discussions
that are now taking place regarding sex and gender.

90 Life Interviews
Comparing the Studies
While the NLI is a useful tool for dealing with transition, the example
of trans-people is different to that of the refugees described above, as
they are not all at the end of the transformation of their gender identity.
While we cannot be certain, it is likely that several of them will continue
to undergo the transition, and it is not possible at this stage to determine
which of them, if any, have completed the transition. This may be a prob-
lem because we need to study the transition, but there is no reason why we
cannot study the transition while it is still underway. In some ways, this
provides a more direct and immediate insight into the experience of the
transition, though it lacks the wisdom of reflecting on the transition.
Conclusions
This chapter has briefly considered two forms of the narrative interview.
There are others, and the choice will depend on the purpose of the inter-
view. McAdams’ life interview has been used for many years and there is a
lot of evidence to support its value. When used in conjunction with analy-
ses focusing on concepts such as redemption and contamination, it is an
extremely valuable tool. Beyond that, simply as a way of getting someone
to discuss the main aspects of their life as a whole, it is invaluable. If we
ask someone to describe their life, they are likely to get stuck because they
have to work out the structure and decide what is important and what is
not important. McAdams’ life interview provides this structure.
The NLI is a new technique that has not been fully tested, but pilot work
has indicated its utility for research purposes that involve examining transi-
tions in people’s lives. The analysis shows how it is relatively straightfor-
ward to obtain detailed information about a person’s experiences using this
technique. The key elements include (a) providing a structured approach to
obtaining transitional information, (b) explicitly focusing on the detail of
cognitions and emotions and (c) the potential therapeutic benefits.
The therapeutic benefits of NLI are as yet unproven, but the responses
of the participants and the use of the NET technique of detailed narrative
interviewing regarding emotions and cognitions are positive for further
examination in future studies.
Both forms of interview are available and can be used for a variety of
purposes. Narrative researchers do need to consider the structure of their
interviews and ensure that they will serve the purpose that is intended.
Interviewing for narrative is not the same as a general qualitative interview.

Chapter 7
Narrative Writing
Many of us do narrative writing. Some of us write a diary or journal about

our lives. This may range from a list of dates and events – which is not
really narrative writing – to detailed expositions of the events of the day –
which is narrative writing or autobiography. Blogs, social media, emails or
webpages can be examples of narrative writing, so can books and shorter
accounts (e.g. short stories), both non-fiction and fiction. Published nar-
ratives are the more formal end of narrative writing. Narrative writing
is used in psychotherapy. An individual may be asked to keep a diary of
their thoughts and feelings – perhaps relating to aspects of their perceived
problem. Narrative writing is also used in a specifically therapeutic man-
ner, as we shall see later. People who have been through difficult times
often feel they benefit from writing about it, whether informally – perhaps
with no intention of anyone else seeing what they have written, that is, the
writing itself is therapeutic, or formally – through books or articles. Some
people who have been through a difficult time write a book about it. After
a war, there is always a surge of publications about that war written by the
participants.
Writing itself appears to be therapeutic, this is partly because it takes
time to construct the sentences the person wants to say, which enables a
more thoroughly thought-out account than when one is just talking about
it, and partly because it is storymaking.
Writing as therapy is not new, its capacity to reduce tension in patients
was described as early as the eighteenth century (McKinney, 1976) and
commonly used throughout the twentieth century in combination with
spoken psychotherapy (Riordan, 1996). It has various names – expressive
writing (e.g. Smyth & Pennebaker, 2008), written emotional disclosure
(e.g. Frisina, Borod & Lepore, 2004), scriptotherapy (e.g. Riordan, 1996)
and therapeutic writing (e.g. Wright & Chung, 2001). All involve writing
freely about a topic or event without paying attention to grammar or spell-
ing. It is highly time-efficient, and low cost because often the therapist is
91

92 Narrative Writing
not directly involved (Smyth & Helm, 2003). Writing is a promising inter-
vention in online therapy (Wright, 2002b). It can be offered in combina-
tion with traditional therapy, for example, a written reflection of therapy
sessions (Riordan, 1996) or some other form of homework that may or may
not be examined in therapy sessions. Writing may offer rich information
to track mechanisms of therapeutic change (Cummings et al., 2014). The
literature is mixed regarding the effectiveness of writing, though Bolton
et al. (2006) were confident enough to produce a resource handbook for
therapeutic writing, and such writing is certainly growing in popularity, at
least among some therapists.
Expressive Writing
Perhaps the best-known technique of therapeutic writing is Pennebaker’s
expressive writing. Jim Pennebaker has conducted research in the area
for several decades (e.g. Pennebaker, 2018; Pennebaker & Beall, 1986;
Pennebaker & Seagel, 1999). Several specific techniques have been tested,
but the basic protocol involves a person writing anything they like about
a subject for 20 minutes on three separate occasions, usually on three con-
secutive days. The writing is then destroyed. It is important – according
to Pennebaker – that it is not read by anyone. This ensures that people are
free to write whatever they wish, and it will not be judged by anyone, yet
it will, it is hoped, still have a significant health benefit.
The original paradigm was to use college students as participants, have
three writing sessions and write about a personal stressful event or a neutral
event. There were no further specifications, though later studies changed
the gap between writing sessions and the timing, perhaps with additional
sessions spread over more days. Those in the expressive writing condi-
tion tended to report fewer doctors’ visits and fewer physical complaints
(Pennebaker & Beall, 1986) compared with controls. Later studies had
more specific instructions and focused on specific topics such as cancer
or divorce. Several randomised controlled trials (RCTs) have suggest-
ing examining the efficacy of expressive writing, with mixed results. For
instance, Zachariae and O’Toole (2015) examined it with cancer patients.
While they did not find any significant benefits, they did suggest that small
effects with particular subgroups of patients could be clinically relevant.
This is an important point. While there may not be benefits for everyone,
there may be benefits for some, and the technique is cheap and easy to
administer, so is probably worth trying. The difficulty is choosing those
who will benefit. What are their characteristics, and after what kinds of

Why Might Expressive Writing Work? 93
events might they experience positive change? Individual difference fac-
tors are important and have rarely been studied. This is not specific to
expressive writing, most of the research into other therapeutic techniques
has ignored individual characteristics that might predict when the tech-
nique is going to work. For any of these techniques, using them with the
wrong person may be psychologically damaging, so there is a good reason
to conduct such research.
Many of the studies have been conducted with students, and they often
demonstrate that writing itself can significantly reduce levels of stress and
increase well-being. Meta-analyses over the years indicate some positive
effect of expressive writing (Pennebaker, 2018). These positive findings are
far from universal, and this is why people have tried different forms of the
technique to make it more effective. Expressive writing can be a supple-
ment to psychotherapy, presumably also a replacement for those with less
severe problems. It is particularly interesting that it has an impact not only
on mental health but also physical health.
Why Might Expressive Writing Work?

In the 1980s, Pennebaker had a working theory that secrets were toxic, that
they were a form of active inhibition, which entails concealing and holding
back emotions, thoughts and behaviours. According to Pennebaker, this
is in itself stressful, and such long-term low-level stress could influence
immune function and physical health. Expressive writing with the destruc-
tion of that writing should be used because revealing secrets to other peo-
ple may have complications, so it makes sense to use writing instead.
Later, Pennebaker et al. (2007) proposed that writing is a window into
cognitive and emotional processes and personal identity, and that writing
about deep and personal issues can promote positive individual and psy-
chological health (Pennebaker & Chung, 2011).
Emotional inhibition, cognitive adaptation and exposure/emotional
processing have all been theorised to explain the physiological and psy-
chosocial results seen in expressive writing studies (Sloan et al., 2008).
Pennebaker and Graybeal (2001) suggest that expressive writing creates
opportunities for people to rehearse social behaviours that result in greater
connectedness. Cognitive change helps people understand themselves bet-
ter and see things in a new and different way by creating a coherent story
of the event (Pennebaker et al., 2000). In the end, the mechanism by
which expressive writing operates may be complex and not accounted for
by any one theory (Sloan et al., 2008), which is why, when we have no real

evidence for a particular theory, the general lesson is that we should not
trust theories that do not have empirical support. Instead, we should be
testing them.
Various researchers, including Pennebaker himself, have adapted the
expressive writing protocol in several ways, including writing for longer,
writing in response to specific questions, changing the number of times
or the time period writing takes place and various other techniques.
Researchers have attempted to analyse the content of the writing to see
whether specific words, phrases or ideas are more effective at reducing
stress in participant. Again, the findings are ambiguous.
Frattaroli (2006) examined potential moderators that could explain
the conditions under which expressive writing is most effective, including
more sessions, longer sessions and more directive instructions. He found
no effect for spacing between writing sessions, valence of topics and focus
of disclosure instructions (general vs. specific). The protocol tended to
work best for physical health outcomes rather than mental health, though
depression showed a small but significant effect.
Reinhold et al. (2018) conducted a meta-analysis to determine whether
expressive writing reduces depressive symptoms. Thirty-nine RCTs showed
that general expressive writing did not yield significant long-term effects
on depressive symptoms, but effects were present when there were more
sessions and the writing topic was specific. It was also more successful
with specific populations. They propose longer directed writing interven-
tions with additional therapeutic support. Rubin et al. (2020) argued that
the efficacy of expressive writing for bereavement remains unclear, though
some evidence suggests that writing about positive memories of a loved
one may be beneficial. They found no main effect of the positive writing
condition on mood change, but there was a greater positive emotion using
mediated positive affect among those in the positive writing condition.
Craft et al. (2013) examined expressive writing and quality of life in early
breast cancer survivors. Participants wrote for 20 minutes a day for 4 days.
This included focused instructions on writing about one’s life to help deal
with a diagnosis of breast cancer. This approach was recommended for
survivors as a feasible and easily implemented treatment to improve qual-
ity of life.
Mordechay et al. (2019), using the expressive writing paradigm, had an
experimental group write about emotion-laden experiences, while a con-
trol group wrote about everyday events. Both groups were measured on
the Impact of Events Scale (IES), which measures post-traumatic stress
symptoms, and the Brief Symptom Inventory (BSI), which measures

LIWC 95
psychological distress. There were greater reductions in IES for the experi-
mental group. Those with higher severity on the BSI had greater reduc-
tions. Those with high neuroticism experienced greater benefit, that is,
those with more negative feelings gain the most from expressive writing.
Zachariae and O’Toole (2015) evaluated the effectiveness of an expres-
sive writing intervention for improving psychological and physical health
in cancer patients and survivors. They reviewed sixteen RCTs. The results
did not support the general effectiveness of expressive writing in cancer
patients and survivors, though given it is practical and inexpensive, even
small effects could be clinically relevant. They recommended that research-
ers should test moderators, including pre-intervention distress levels and
context-dependent factors such as emotional support, when assessing
effectiveness.
Overall, the findings regarding expressive writing are – as stated by sev-
eral researchers – mixed. It sometimes works, it sometimes does not work.
Why is this? It may be the selection of participants. It seems likely that
writing will work for some people but not for others, and researchers need
to find ways to select the people for whom it will work. There is little point
in asking everyone to do expressive writing if it is not going to have a posi-
tive effect. Indeed, for some, it may have a negative effect, making them
feel worse rather than better.
LIWC
LIWC (Linguistic Inquiry and Word Count) is a computer programme
designed by Pennebaker that has been used to analyse the content of writ-
ings produced using the expressive writing paradigm. It does not carry out
a narrative analysis, but it does count the number of times particular words
have been used and can help group these words into categories. There are
around 80 different groups that relate to linguistic, psychological and topi-
cal categories including ones related to various social, cognitive and affec-
tive processes; so it is possible to use LIWC to ascertain the percentage of,
for example, negative emotions.
Stockton et al. (2014) conducted a study on post-traumatic growth using
internet-based expressive writing. Participants wrote for 15 minutes on three
occasions 3 days apart. Post-traumatic growth significantly increased from
baseline to an 8-week follow-up in the expressive writing group, but not for
the controls. Analysis of language use using LIWC showed a greater use of
insight words associated with an increase in post-traumatic growth. These
findings have implications for internet-administered expressive writing.

Allgood et al. (2020) used LIWC and found a relationship between
marital satisfaction and the use of (a) first-person plural pronouns (we,
us, our, ours), (b) positive affective language and (c) linguistic indicators
of anger when writing about one’s relationship. Gottman and Gottman
(2008) examined the relationship between marital satisfaction and expres-
sive writing. They emphasised the importance of couples enhancing their
understanding of each other. Couples develop an intricate love map of
one another, which allows them to understand and empathize with each
other’s experience. The down-regulation of negative affect is important,
as is the up-regulation of positive emotions. A comparison of the use of
LIWC versus in-person analysis (Landless et al., 2019) indicated that while
the computer-based analysis is quicker than human analysis, it lacked the
richness and nuance that people brought to the analysis.
Furnes and Dysvik (2012) examined therapeutic writing and chronic
pain management, using writing as a tool for managing difficult life
experiences. Thirty four outpatients were given an 8 week pain manage-
ment programme. A therapeutic writing tool was developed and included
as homework. A thematic analysis demonstrated the patients had an
increased understanding of chronic pain as a multi-faceted experience and
new insights into managing chronic pain. Different performances lead to
different experiences with therapeutic writing. This is a useful finding as
there are only limited medical ways in which chronic non-malignant pain
can be treated, so we need other ways to manage it. This is an important
finding as it suggests that writing can not only be used for specifically psy-
chological problems but also for the use of indirect psychological problems
such as pain management. In response to Furnes and Dysvik, Kelly (2014)
said that it is hard to resist the speculation that there are few among us
who would volunteer for the personal hardship of writing and that recruit-
ing people to conduct some writing tasks would be an exercise in futil-
ity. Nevertheless, the Furnes and Dysvik findings suggest it works, which
shows the importance of writing, at least for some people. It is not clear
what proportion of the population can write in this way, do so and gain
some benefit from it. It may just be the select few who benefit.
Narrative Writing Generally

There are other ways in which writing as therapy has been developed and
used. There are many different clinical interventions, such as journaling,
creative writing, reading literature or performing poetry (e.g. Alexander
et al., 2016; Mazza, 2003). Boulay et al. (2020) conducted a systematic

Possible Problems with Narrative Writing 97
literature review using writing in therapeutic settings with adolescents. This
showed there were positive effects of writing practices in both cognitive-
behavioural and psychodynamic settings. Sargunaraj et al. (2021) reported
a case report using therapeutic writing as an adjunct to psychotherapy.
A period of thirty writing sessions and seventeen in-person sessions were
held with a person with long history of emotionally unstable personality
disorder and socio-occupational dysfunction. They showed improvement
after therapy. Therapeutic writing shows promise as an adjunct to psycho-
therapy in addressing emotion regulation.
Ramsey-Wade et al. (2021) presented a systematic review of twelve studies
that assessed whether therapeutic writing could improve outcomes for clients
with disordered eating. The studies were mainly high to moderate quality
quantitative studies, with a positive trend for therapeutic writing, indicat-
ing it may improve outcome for clients. Qualitative results indicate writing
interventions can access a depth of emotional experience. They concluded
that writing is useful to enhance emotional expression or group cohesion.
Den Elzen (2020) use of therapeutic writing in psychotherapy through
the lens of the grief memoir. This technique draws on expressive writing
and links autobiographical writing to dialogical self theory. It identifies
how the authors voice subject positions such as the bereaved self and the
remembered other and how writing positions and repositions such selves to
facilitate the rebuilding of identify disrupted by loss and recovery from grief.
Overall, the research suggests there may be benefits to writing as therapy.
Writing in Groups
Group writing can be beneficial. A group can provide support where the
person is involved with writing about difficult, perhaps emotional, sub-
jects. Groups can be run by therapists, counsellors or other health profes-
sionals, writing tutors or they may be a formal or informal writing group.
There are no limits on writing in groups. Sometimes people read out their
work for comment and discussion, sometimes they don’t. Sometimes the
therapist will see the writing, sometimes they won’t. Tutors and therapists
can help people get over writers’ block.
Possible Problems with Narrative Writing

While writing can be illuminating and helpful, it can also be potentially
dangerous. It is not always a good thing to bring problems out into the
open. While some narrative writing is done in conjunction with others,

whether with therapists or other health professionals, or groups, some,
perhaps most, writing is done alone. This can be a problem if the writing
brings out difficult, perhaps emotional, issues that the person cannot find
a way to resolve. Who do they turn to? We like to think we have control
over our writing, trying to understand the way our minds are working, but
this can be destructive. We are often our most severe critic, and may draw
conclusions that are not helpful.
Landless et al. (2019) suggest that therapeutic writing benefits both
physical health and emotional well-being. They examined the usefulness
of clinical notes as a data source. Many participants reported therapeutic
writing as helpful, a relevant coping skill and enjoyable. Other participants
preferred to work on other tasks in the art therapy sessions, indicating that
writing benefits only certain people.
Sloan and Marx (2018) said that we have consistently seen how expres-
sive writing can be useful, but research in the area has suffered from a lack
of systematic focus and a weak theoretical foundation. Nevertheless, it is
a useful clinical tool, though clinicians need to be thoughtful about when
and why expressive writing is integrated into clinical care.
Another problem for expressive writing and therapeutic writing in gen-
eral is that we must take individual differences into account. Many studies
have just put people into groups irrespective of individual characteristics,
and it is inevitable that while some people may experience benefits from
writing, others may experience either no benefits or negative outcomes.
Few studies have taken this into account. Why does writing work for some
people and not for others? Who does it work for? Are there tests we could
administer that will help us differentiate who it will work for? Would it
be as simple as asking someone if they liked writing about themselves and
their feelings?

Chapter 8
Narrative Therapy
If you are distressed by anything external, the pain is not due to the
thing itself, but to your estimate of it; and this you have the power to
revoke at any moment.
Marcus Aurelius
The only way a talking therapy can hope to have any success is by chang-
ing a person’s story, by changing the way they think about themselves. In
order for this to happen, the person must recognise there is a problem,
they must want to do something about and accept – at least at some level –
that another person, the therapist, might be able to help them. If they
thought they could help themselves, they would not need the therapist.
This applies to any form of talking therapy, including narrative therapy.
The biggest problem with narrative therapy is that it is carried out in
many different ways, which immediately raises the problem that if we do
not have a definition and clear set of guidelines, then it becomes difficult
to use effectively and, most importantly for an applied method, difficult
to assess for scientific utility. This is not a problem unique to narrative
therapy. It can be argued it applies to all forms of talking therapy (cogni-
tive behaviour therapy (CBT), psychoanalysis, etc.) because each thera-
pist–patient relationship is different, and each session is different, with
different forms of communication and interactions.
The original form of narrative therapy, which has been used for around
30 years, was introduced by Michael White and David Epston, but there
are a multitude of other narrative forms which can be labelled as forms of
narrative therapy (Brown & Augusta-Scott, 2007; Freedman & Combs,
1996; Strong & Pare, 2004, White 2004). Some of these are built on
White and Epstein’s work, while others differ significantly, building in
new elements such as dialogical perspectives (Hermans & Dimaggio
2004; Lysaker & Lysaker, 2006; Osatuke & Stiles, 2006). This chapter
99

100 Narrative Therapy
will focus mainly on White and Epstein’s work and its developments as
it is the original and most studied, though the level of evidence is, as we
shall see, rather weak.
Narrative therapy is based on poststructuralist philosophy (Foucault,
1980; White 2000), in opposition to structuralism, where we assume struc-
tures are real things, and we look for underlying structures and universal
laws. Regarding therapy, structuralism assumes that we study people as
individuals with essentially stable characteristics that can be grouped and
graded according to universally applicable norms, such as the mental dis-
orders classified in Diagnostic and Statistical Manual of Mental Disorders
(DSM) or International Classification of Diseases (ICD). Poststructuralist
narrative therapists focus on contextualised meaning rather than universal
truths. People’s lives and experiences are shaped by their stories, but these
are not purely individual constructions; in any social group, we all partici-
pate in each other’s stories. As we saw in the chapter on master narratives,
we all participate in society’s discourses. For Hare-Mustin (1994), discourse
is ‘a system of statements, practices, and institutional structures that share
common values’ and ‘discourses bring certain phenomena into sight and
obscure other phenomena. The ways most people in a society hold, talk
about, and act on a common shared viewpoint are part of and sustain the
prevailing discourses’ (pp. 19–20). The norms of a culture are often taken
for granted but do change over time. For example, it was long held that a
man should earn more than a woman. If a woman earns more, both may
think something is wrong with their relationship. We may reproduce these
discourses in therapy without thinking about it, automatically, implicitly.
It is not something we generally have much control over.
The relationship between the individual and the social world also has
implications for power and power relations. Foucault (1980) used the term
‘modern power’, arguing that traditional power comes from some cen-
tral authority (king, dictator, etc.) and is enforced through often violent
authority, prison, torture, floggings, executions, etc. Modern power is
more pervasive; it is carried in discourses. At the central level, this might be
through lobbying, advertising or the media. Modern power helps us police
ourselves, which means that we don’t usually notice the power of modern
power. There are standard ideas about how to behave, from what we buy
to eat or wear to voting for democratic parties. Most of us tend to live up
to the dominant discourses and norms in society, we compare ourselves to
what is deemed good, normal and successful. This also applies to people
undergoing therapy. Once they learn to look for how they are influenced
by modern power, they can question its influence and perhaps change the

Narrative Therapy 101
way they look at aspects of the world, change their life stories. According
to White (2002), modern power, used well, can unsettle what is settled or
taken for granted, and provides new avenues of inquiry. This unsettling is
part of the ethos of narrative therapy.
As already mentioned, the focus of this chapter is on the approach of
White and Epston and how narrative therapy has developed from their
early writings. A word of caution, there are certain areas in psychology
where people provide a new means of trying to understand an area of
psychology, often with a practical element that claims to provide a solu-
tion to some problem. At the outset, there may be grand claims about the
effectiveness of these techniques. For some areas, the evidence eventually
becomes clear that there is some real benefit or real understanding, and it
becomes mainstream. For others, there is an element of the cult around
it. Those who proclaim its benefits are somewhat like priests, proclaiming
the benefits of a religion without a shred of evidence. Many areas are, of
course, somewhere in the middle, where there is some evidence of effec-
tiveness, but it is limited, though supporters may continue to shout from
the rooftops about its benefits. Homeopathy is a good example of an area
where the science suggests there is no real benefit (whatever the sellers of
these miniscule substances might claim). Freudian psychology is a theoret-
ical area which has limited support in the scientific literature yet continues
to be popular. Eye movement desensitisation and reprocessing (EMDR)
is a form of treatment for post-traumatic stress disorder (PTSD) which
initially was seen as somewhat off the wall but has since developed a good
scientific basis. What of narrative therapy?
According to White and Epstein, narrative therapy is used to evaluate
discourse, clients’ thoughts and behaviours in the contexts of their cultures
and social environments with regard to the stories they have constructed.
It is about re-authoring lives, fundamentally changing people’s perspec-
tives, life stories, for the better; but there is no judgement regarding the
initial life story, about why it might be good or bad, nor is there a judge-
ment by the therapist regarding the new story. Whether or not there is
improvement is the decision of the person undergoing therapy. This is a
problem. The standard method of assessing the effectiveness of a therapy
requires, first, that there is a recognised measurable problem (normally
defined by ICD or DSM) and second that there is a recognised definable
therapy. We can measure the problem before and after and see if there is a
positive change. People undergoing narrative therapy do not always have
a recognised measurable problem and so it can be difficult to measure the
effectiveness of the therapy. We need other means.

People cannot always be categorised in terms of the DSM/ICD cat-
egories. Narrative therapists tend to have a problem with this form of
categorisation, preferring instead to have a conversation so the client can
determine the problem. DSM/ICD categories can be a problem of fitting
a round peg into a square hole. This is an advantage of narrative therapy,
the therapist is not trying to force a person into a diagnosis of a mental
disorder. Of course, the difficulty that then arises is that it becomes more
difficult to assess the efficacy of the therapy, except in terms of whether the
client believes the problem has been resolved or at least that there is some
form of clinical improvement, however defined.
This may be the point to differentiate among mental health problems.
There is a political tendency to classify all mental health problems as being
of a similar severity. Not only are they politically ‘classifiable’, but each
should also be treated with similar care. While most people would agree
that psychotic problems such as schizophrenia can be severe and may need
medical treatment to enable the person to manage their lives, many of
what we used to call neurotic problems, anxiety, depression and so forth,
usually derive at least in part from the interaction between the person
and the environment and may be resolvable through psychotherapy. The
argument regarding whether many of these problems should be classified
as disorders is resolved in narrative therapy simply because the notion of a
classificable disorder is not central to determining what the problem is and
how it can be resolved.
Narrative therapy focuses on deconstructing the problems people bring
to therapy, examining people’s personal values and how they help con-
structing new productive stories. It is like coaching clients to realise what
they want to accomplish and getting them to the point of change by mak-
ing them decide what change they want.
What Are the Problems Clients Face?

But what changes do the clients of narrative therapists want? Why do they
want narrative therapy? If there is a problem with the medicalised clas-
sification of disorders, there still needs to be a recognisable problem that
needs to be resolved. Perhaps the best way to deal with this is to draw on
current practice in clinical psychology and use formulation rather than
diagnosis. Richert (2006) argues that the therapeutic alliance might be
improved and an integrative use of different theories might be made by
selecting therapeutic approaches and interventions based on the similar-
ity between the nature of the client’s life story and the story of human

What Is Narrative Therapy? 103
functioning incorporated in the theory, a kind of formulation approach
for narrative therapy. The initial stage of narrative therapy is, just the same
as in other forms of therapy, determining exactly what the problem is, a
clear diagnosis or formulation of the problem as the client sees it. That will
provide the substance that the therapist can work with. It is the story that
the client wants to change, the basis for deciding how narrative therapy
can be used in this instance. One advantage of narrative therapy is that
it acknowledges that people present with different problems, and it can
be difficult to group problems together into an overall classification (as
required by ICD/DSM). This advantage can become a disadvantage for
establishing evidence for efficacy.
What Is Narrative Therapy?

The term narrative therapy may be employed loosely to describe any
approach that encourages people to tell or restructure their story. At one
extreme, all talking therapy is narrative therapy because it is intended to
help people make sense of their lives and the events in their lives. This is
back to the argument that much general psychology is narrative or has nar-
rative elements. Applied psychology is about trying to make people’s lives
a little better, which in turn means helping people to make better sense of
their lives, or adjust their biographies to be a little happier, contented or
satisfied. We are not trying to make everything perfect, just a little better
than it was.
While it can be argued that all talking therapy involves narrative,
Richert (2006) argues that theories of psychotherapy are often cognitive
constructions rather than narratives, structured in accord with the tenets
of paradigmatic rather than narrative thinking. Even many that employ a
phenomenological stance do not discuss the client’s reality as being struc-
tured in a narrative manner. Many are mainly rooted in a post-positivist
tradition and accept a realist ontology and employ efficient causal explana-
tory frameworks where various forces and principles outside of the client’s
phenomenal field help shape the client’s functioning. Can these be inte-
grated into a narrative approach? Constructivism accepts multiple realities
so each theory can be understood as creating a reality for its adherents.
Perhaps we should look at the problem not in terms of approximation
to truth but in terms of characteristics of the reality it constructs about
human nature, causation and behaviour change. In this sense, even fun-
damentally paradigmatic approaches can be considered as highly abstract
stories about reality.

Getting the Story, Understanding the Problem
Clients bring stories of their lives to psychotherapy. In narrative, clients
transform themselves by changing the stories they tell about their lives.
There is always context, the context of other people, the environment,
work, leisure activities. This context is always changing, and so the stories
people tell are also always changing. One problem is that sometimes life
events resist storytelling (Guilfoyle, 2018), although turning conversion
into narrative form is recommended as a therapeutic strategy, particularly
for problems such as trauma, it can be a difficult and complex process.
There is a danger of the emerging stories being more stories of the therapist
than the client, and so may not be experientially resonant to the client.
Other clients may have habits that dispose them to problem-saturated sto-
ries and negative identity conclusions. This means that the therapist may
just be listening to chaos narratives (Frank, 1998).
Experience and story are not the same thing (Bakhtin, 1993), it is not
always easy to transform the experience into a story. A good example is
when powerful experiences overwhelm our narrative capacity to contain
or organise experience, leaving us lost and bewildered, without reference
points and the guidance stories usually provide. Some trauma stories frag-
ment stories and defy accommodation within culturally available narratives
and categories. Narratives can only go so far to help us through challenges.
The client should not be prematurely pushed towards order and mean-
ing. Listening to difficult stories is witnessing, which is constitutive rather
than just observational, contributing to the building of narrative. Frank
(1998) argues there are four orientations to this witnessing:
– Look, say what I see and don’t look away: initial feeling of
powerlessness in relation to horror etc., reflect what you see/hear.
– Historicise and legitimise the person’s experience: a person’s negative
sense of self is not indicative of failure but a legitimate consequence
of what they have been through.
– Stand in solidarity with the person: therapist cannot be a neutral
observer of events. Consider our position in society, power dynamics,
what is our stance on this.
– Find personal resonance while acknowledging difference.
For narrative therapy to be successful, people need to identify their own
skills and abilities and use these to transform their lives, their life stories, the
ways they interpret the past, present and future. Morgan (2000) describes
narrative therapy in several ways, particular ways of understanding identity,

Three Stages of Narrative Therapy 105
understanding problems and their effects on people’s lives, how we talk
with people about their lives and problems or understanding therapeutic
relationships and the ethics or politics of therapy. A narrative conversation
is always interactive, it is a narrative that is developed by both participants,
the client and the therapist, though it is always guided by the interests of
the client. As we will see in more detail, narrative therapy has been used in
a range of situations such as eating disorders (Weber et al., 2007), domestic
violence (Allen, 2007) and conflict resolution (Winslade & Monk, 2000).
As discussed throughout the book, our lives are dominated by stories,
some more important than others, and all affected by or grounded in
wider society, and cultural values relating to, for example, sex or gender,
class, race or disability. With narrative therapy, we need to determine
which stories are of interest to the client, what they want to talk about
in relation to a problem that has arisen and particularly how stories can
be changed. The important thing – again as for most types of talking
therapy – is that the person must want to change, they must realise that
there is a problem that needs solving and they realise that they need thera-
peutic help to sort this problem out. A person in need of help may have
a problem-saturated story.
Narrative therapy is a therapy of questions (Combs & Freedman, 2012).
The primary purpose of questions is to generate experience, very different
to simply gathering information. A question encourages a person to think,
to come up with answers that go beyond simply providing information to
the therapist. It is an essential process in narrative therapy.
Three Stages of Narrative Therapy

The number of stages of narrative therapy varies according to author, but at
its simplest, there are three: deconstructing problematic dominant stories,
re-authoring dominant stories and remembering conversations. This takes
the client through important elements of the therapeutic process. In the first
element, deconstructing problematic dominant stories, the person is asked
to name the problem, explore the history of the problem and its effect, to
situate it in the context of the rest of the person’s life and to explore unique
outcomes. This provides the context for the problem, the formulation if
you like. The second element, re-authoring problematic dominant stories,
is the part where the person attempts to make changes to improve the life
story, through determining the best unique outcomes and looking at previ-
ously more implicit elements of their identities and their experiences. The
person explores the history and meaning of the various unique outcomes

and names an alternative story. They then thicken this story, provide it with
substance, make it real and thoroughly link it to the life story generally. The
final element, remembering conversations, is about ensuring the changes
are not lost, that they remain, because it is difficult to sustain change. This
involves collecting therapeutic documentations, exploring appropriate ritu-
als or celebrations and engaging with support networks.
Key Components of Narrative Therapy

There are a number of broader components to narrative therapy, many of
which are linked, which can be subsumed under the three key elements
above but they don’t always fit within a single stage and given that therapy
involves going backwards and forwards through different elements, I have
not attempted to over-categorise as this is rather artificial and misleading.
Many of these components are the same as or similar to the components
of other types of therapy, others are genuinely novel, but together they do
form a fairly coherent and distinct package that is narrative therapy:
– Personal agency
– The problem is the problem
– Externalising focus
– Double listening
– Examine the stories that shape a person’s identity
– Thin and thick descriptions
– Double listening
– Dialogical disruption
– Focus on unique outcomes
– Maintaining a stance of curiosity, ‘not knowing’
– Asking questions you don’t know the answer to
– Clients as experts
– Culture and social environment
– Redescription
Key Components in a Little More Detail
Personal Agency
Narrative therapy always recognises the centrality of the individual and the
individual as the expert. Personal agency is the idea that the person is the
one who causes or generates an action. Someone with personal agency will

Key Components in a Little More Detail 107
perceive him or herself as the one who influences their own actions and
circumstances (Gallagher, 2000). The person is making decisions about
their life, not the therapist. Both parties must recognise this. The choices
lie with the person, not the therapist. As Morgan (2000) notes, it is only
the person who knows their own life intimately and has the skills and
knowledge to change their behaviour. This does not mean that we should
fail to acknowledge the skills and experience of the therapist in enabling
the individual to make substantive changes to their perceptions of life, to
their life stories.
The Problem Is the Problem

According to White (2000), the person is not the problem. The problem
is the problem and is separate from the person. This means we can support
and help people, which is better than suggesting people are the problem.
If a person is the problem, then it may be difficult to help them change.
If they are separate from the problem, then it can be resolved more easily.
It is important to externalise conversations to separate the person and the
problem. If the latter is externalised (not part of the individual), then the
therapeutic relationship is with the problem. We can then address how
it can be examined. What feeds it, who benefits from it, in what settings
might the problematic attitude be useful?
The person is not the problem. The problem is separate and should
be dealt with as such. This is not to say that the problem does not have
a profound impact on the person. Of course it does, and the interaction
between the person and the problem needs to be evaluated.
Externalising Focus
This is closely linked to the previous statement. It is important to sepa-
rate the problem from the person. Externalising focus involves nam-
ing a problem to help a person see how it works and how to fix it.
Externalising ensures that people see themselves as separate from the
problem where the problem is no longer part of their identity or per-
sonal truth. The problem is that by the time people go for therapy, they
often think they have something wrong with them, the problem is a part
of them. Part of the aim of an externalising focus is to show the client
that the problem is not part of them, but is linked to society and history,
to the environment, to the ways they interact with the environment and
other people.

Double Listening
Double listening is an idea promoted by White and Epston (1990) that
provides an opportunity to learn about the client from both sides, that is,
what works and what doesn’t work. It is the practice of hearing a person’s
dominant story while simultaneously remaining open to the possibility of
other important stories that are hidden by the dominant story. It is similar
to active listening but more, because it is actively looking for these hidden
stories (Meyer, 2015).
The Stories That Shape a Person’s Identity

These are life stories. They are not about the whole of life, which is a story
that can never be told in full, but about specific elements of life, such as the
problems associated with a relationship, living in particular accommoda-
tion, having a certain job or going through some form of important tran-
sition such as having a baby, getting married or becoming unemployed.
Life stories about events are different to life stories about transition. It is
important that life stories for narrative therapy are about transition. They
are not just about the description of a particular life event, but the impact
that life event has on one’s thoughts, behaviour and emotions. Having a
baby is about the initial decision (or not) to have a child, the experience
of pregnancy, birth and learning to live with an infant. It is the transition
from not having a child to having a child. Narrative therapy deals with
problems associated with transition.
Thin and Thick Descriptions

We often start with what narrative therapists call a ‘thin description’ of a
particular problem. For instance, the almost throwaway descriptions we
have of ourselves or others and why we behave as we do. It is all too easy
to say someone is stealing because they are a bad person, or because they
had a difficult upbringing, but these phrases do not really mean very much
in themselves. They are throwaway descriptions used inappropriately to
describe why people act as they do. ‘Thick descriptions’ are the much more
detailed accounts we use to provide a more detailed explanation of some-
thing, the type of description used in narrative therapy. We rarely delve
deeply into our lives if we are left alone. We only usually dig deeper if
someone (a friend, a therapist) starts asking questions, or if we are experi-
encing a significant life event.

People experience their lives through stories, but usually these are thin
stories. We usually have no need to dig deeper into the ways we think
about our lives, we just get on with things. Geertz (1973) discussed ‘thick
descriptions’, rich meaningful multistranded stories of lives. When thera-
pists meet clients, they also generally use thin stories that focus on just
some of their experiences and have limited detail. It is the therapist’s job
to look for things that are missing, events that are not predicted by the plot
of whatever the problematic story might be, listen for literal exceptions or
counterexamples to the problem. Then ask questions about the event that
is outside the problematic storyline. Over the course of therapy, people tell
more and more detailed life stories, they develop multiple storylines that
speak of multiple possibilities for lives. It is out of these that the solutions
to the problems are found.
White (2000) discussed the ‘rich story development’ role of narrative
therapy, that is, developing thick descriptions. People do not invent prob-
lems; they are recruited into actions and ways of thinking that create prob-
lems. Narrative therapy helps bring these to light, and let people see gaps
in their problem stories. This can only be done by ensuring that the person
tells a rich and detailed story.
Double Listening
The meaning we make of an experience comes from contrasting it with
some other experience. There is a need for double listening, listening for
ground as well as figure. Then we can hear experiences being drawn on as
background for the present experience; these implied or implicit experi-
ences are a rich source of preferred stories. For instance, if a person experi-
ences frustration (figure), they may be pursuing dreams or goals and not
attaining them (ground). The therapist can then ask about these goals.
White (2006) introduced the term, to describe how people talk about
trauma and its aftermath. The story about the person’s response to trauma
may be hidden in the shadows of the more dominant trauma story. White
says that it is important to actively support people talking about trauma,
while listening for the ways they have responded to the trauma as well as to
what they value. The stories of how they responded are often dismissed or
diminished, which can lead to personal desolation or shame. Developing
their stories of trauma can be a powerful counter story to the idea of being
a trauma victim. Acknowledging this counter story can help the person
develop a preferred sense of self.

Dialogical Disruption
In the dynamic struggle between voices, a dialogical disruption can
occur when the diversity of voices regarding a problem collapses into the
monologue of a single voice; the other voices are silenced, making differ-
ent constructions of events difficult. This is normal. We generally have
a single fairly simple story about the world, and this usually works, so
we stick to it. The narrowing of perspective, of story, may become more
extreme when there are mental health problems. This is similar to White’s
ideas about problem-saturated stories, where all accounts other than the
problem one are undermined or silenced. This never totally happens. As
Bakhtin (2000) argues, attempt to suppress the other (external or inter-
nalised story) is never totally accomplished given the dialogical nature
of existence. There are always alternatives ways of expression. White and
Epson (1990) recognise that life is more than what is narrated, so there
are episodes outside of the problem-saturated story – exceptions we call
‘unique outcomes’.
Focus on Unique Outcomes

This is an older idea which comes from Irving Goffman (1961) but is cru-
cial to narrative therapy. Each person is unique, there are no one-size solu-
tions that fit everyone. Our stories are all different, which is why it is
important to get all the relevant details before trying to make any changes.
In the narrative metaphor of psychotherapy, clients transform them-
selves by changing their life stories. For White and Epston (1990), the con-
struction of change occurs from the expansion of unique outcomes, the
development of episodes outside the problem-saturated narrative. Some
unique outcomes provide temporary release from the problem but also
facilitate a return to it. One type of unique outcome, reconceptualization,
facilitates sustained change (Goncalves et al., 2009). This facilitates the
emergence of a meta-level perspective about the change process itself and
in turn enables the active positioning of the person as an author of the new
narrative. In this way, the person is not just changing their individual nar-
rative but they are understanding the process of change more fully, which
could potentially have significant longer-term gains.
The therapist maintaining a stance of curiosity and always asking questions they
genuinely don’t know the answer to.
Morgan’s (2000) two main principles of narrative therapy are: maintain-
ing a stance of curiosity and always asking questions that you genuinely do

not know the answers to (these are principles that therapists of all perspec-
tives will use). The therapist needs to remain curious and ask questions
with unknown answers because they are helping the person to understand
their own stories, particularly elements of the stories that they may be find-
ing difficult. It is not the role of the therapist to provide the story, but to
help the person find their own story. Curiosity and questioning are critical
to this.
White (2000) suggests it is helpful to take a ‘not knowing’ stance. This
means not assuming or pre-judging what a person needs to achieve. If the
person gives directions in the discussion, they can lead the therapist down
the route that is most helpful. A therapist might ask about the person’s
hopes, and the person may not initially be able to answer this question, but
through the process of therapy, it will hopefully become clear.
Clients as Experts
The assumption is made that clients know what is good for them. This may
be a questionable assumption, but it is important in narrative therapy. It
is only the client who knows their own life intimately and has the skills
and knowledge to address the issues and change their behaviour (Morgan,
2000). It is up to the client to decide that their current life story could be
improved upon, and it is up to the client to decide whether a particular
new story is better. An obvious problem with this is that many people have
difficulty understanding their lives to a sufficient extent to make active and
sensible (to them) changes. This limits the people who will benefit from
narrative therapy, but it does not undermine it as a therapy.
Culture and Social Environment

As we have seen, narratives are usually developed in specific social and cul-
tural conditions, and to some extent, depend on these conditions. Effective
narrative therapy must take these conditions into account, whether they
are about the people the client knows, the place they live, where they work,
their education, training and so on. Without this wider context, any nar-
rative development has little meaning as the narrative has to make sense
within the environment.
According to Bruner’s (1986) narrative metaphor, people’s identities
are defined and constructed through stories, some of which are com-
mon across individuals and groups. There is power involved in deciding
which stories will be told and retold and which will not. The sharing

and circulation of different stories contribute to building communi-
ties. Stories give meaning to lives, privileging some people and relation-
ships and making others invisible. According to Combs and Freedman
(2012), narrative therapy is useful for therapists who wish to work for
social justice, because by changing individual narratives, there is the scope
to change social narratives, the general ways we think about the world.
Identity is relational, distributed, performed and fluid. Who we are and
can be cannot be determined outside our relationships with others and
how we think they perceive us. The social world is very important when
it comes to the resolution of problems.
Redescription
Redescription is a powerful tool that is fundamental to narrative therapy.
Instead of describing themselves in the problematic ways they did before
therapy, clients begin to describe themselves differently, representing
themselves in a different way to the world, creating a new presentation of
the self, a new life story. It is about helping the client to recognise their
preferred qualities in themselves and to probe any implications for their
identity.
Solution-Focused Narrative Therapy (SFNT)

One of the problems faced in narrative therapy (indeed in many aspects
of life) is that some therapists may feel a need to jump in and offer aid
too quickly. This is well-intentioned but may lead to problems because
the therapist’s assumptions may be wrong, partly because they are based
on too little information. This may lead to a restriction of opportunities
within the therapeutic situation before the person has had the opportunity
to consider the wider picture. It is often a similar problem in coaching.
Buddha noted that ‘what we think we become’, so it is important not to
make judgements too early.
In solution-focused therapy, clients reflect on the times they had suc-
cessfully devised solutions to problems, or times when the problem occurs
less often. Rather than talk about the problem, the therapist guides the
client toward seeking out a preferred future.
Solution-focused narrative therapy (SFNT) can be summarised as ‘lis-
ten, select and build’ (Metcalfe, 2017). SFNT encourages clients to look at
their presentation of the character that appears in the stories that brought
them to therapy. Through a blend of solution-focused and narrative

questions, the therapist seeks new presentations that will lead to new
results for the client – without knowing anything about the problem that
brought them to therapy.
Metcalfe (2017) presented the following guiding constructs of SFNT:
– Invite clients to see events in life as chapters
– Assist and encourage clients to see out successful events
– Integrate complains as situations that interfere in a client’s preferred
life, rather than diagnosing the client
– Write down all key words the client uses in a session and use those
words when talking to them
– Follow wherever the client wants to go in therapy, refrain from
assuming they are avoiding the key issues
– Capitalise on successes in clients’ work, hobby, profession that can
lead to solutions elsewhere
– Convince clients that the problem-saturated map they focus on is full
of tributaries of success
– Promote hope by suggesting the client forgot to be competent,
assertive or responsible during problem-saturated times
– Avoid revisiting traumatic events as may be retraumatising
– Instead of praising, be enamoured of clients’ successes – ‘how did you
do that?’
– Hear every goal the client provides you with as one that will make a
positive difference
– See your role as keeping track of exceptions, meaning and values
throughout the session. Write them down and give them to client at
end of session
– Write to clients in their language about success
– Use scaling questionnaire to measure where they are in reference to
their preferred future
– If they say what they don’t want, ask what they do want
– If they talk about the past, ask how it is helpful
– Ask how relationships might change as they change
– Go slowly
The Odyssey and Narrative Therapy

Literature – novels, plays and so on – is underused in psychology gener-
ally, and this is the case in narrative psychology. Christensen (2018) sug-
gests that we, both therapists and clients, can look at Homer’s Odyssey

from the perspective of narrative therapy, particularly regarding agency
and responsibility as recognised by Homer. Christensen suggests that
Odysseus’s retelling of his own tales reflects an understanding of the func-
tion of narrative and a need to tell a particular type of story before he can
journey home – that Odysseus undergoes a therapeutic process, changing
his own narratives to negotiate the relationship between the gods and his
own responsibility, and challenging readers to reconsider their own sto-
ries and their own lives. There is a recognition of the power of traumatic
memories and how retelling them can be beneficial, in narrative therapy
terms, re-authoring conversations. This ensures that Odysseus can redefine
his sense of self, gains agency and can plan for the future. Christensen’s
argument is that the Odyssey represents narrative therapy and that those
interested in narrative therapy (either as therapists or clients) may benefit
from a reading of the book.
Christensen (2018) argues that the key element in the Odyssey is the
Apologoi. Before this, Odysseus has little agency and is incapable of act-
ing. The Apologoi, in the middle of the book, is a transition point, and
that following this retelling of his tales, Odysseus becomes powerful, with
intentional control over his life. Specifically, Odysseus is isolated without
agency on the island of Ogygia. Later, he is shipwrecked where he dis-
covers he has some control over his fate. This is the first step to gaining
control, in reclaiming self and agency. He then tells his stories, identifying
the mistakes that led to his suffering. Instead of this all being the fault of
the gods, Odysseus recognises his own agency, thus demonstrating the
importance of how a changed narrative can enable a person to take control
over their life.
According to Christensen (2018), examining the Odyssey enables a third
strand of narrative therapy to be added to re-authoring and externalis-
ing; remembering conversations. These allow the person to revise their
constructions of identity with respect to identities of the past, present and
future. This acknowledges the importance of identities not being indepen-
dent of others, but a part of those around us, and the culture we live in.
Evidence for Narrative Therapy

The information in the chapter so far is all very well, but where is the sci-
ence behind narrative therapy? The theoretical positions adopted by nar-
rative therapists and theorists is complex and to a large extent coherent,
but the question remains as to whether it works. When people undergo
narrative therapy, do they feel better at the end of it? Do they understand

themselves better? Have they dealt with the problem and changed their
narratives? We need to know not only whether they are in some way bet-
ter but whether it is narrative therapy that has had the effect. To deter-
mine whether this is the case, we need to compare narrative therapies with
appropriate controls, including other forms of therapy. The well-known
Hawthorne Effect suggests that people will report positive effects simply
because someone has attended to them, has listened to them and it may
have nothing to do with either therapy or the therapeutic approach.
This is where it becomes difficult to support narrative therapy. While
the approach is intuitively positive, based on the relatively simple idea that
a person with a problem just needs to change their story about life, we do
need the evidence that it works. While the theory is relatively strong, the
evidence for narrative therapy is relatively weak.
The evidence for the effectiveness of narrative therapy, at least evidence
in the traditional sense, is somewhat limited, but there are an increasing
number of studies which do suggest it works. There are a few randomised
controlled trials (RCTs). The problem for narrative therapy is that in order
to be accepted by the general therapeutic community, such evidence is
important, and we need to encourage such trials.
Some studies examining narrative therapy does not achieve the required
level of evidence. For instance, Cashin et al. (2012) conducted a study to
see whether narrative therapy is effective in helping young people with
autism who are presenting with emotional and behavioural problems.
They do note this is a pilot intervention, but there is only one group. Ten
young people aged 10–16 with autism had five 1-hour sessions of narrative
therapy, using a variety of measures. The study found significant improve-
ment in psychological distress and in emotional symptoms; but without
a comparison group, we cannot say whether it is narrative therapy having
the impact or some other factor such as the Hawthorne Effect, or just time.
There is a lot of similar evidence, much of which seems to show narrative
therapy having an effect, but with no control. Vromans and Schweitzer
(2011) provided narrative therapy to forty-seven patients with depression
and found improvements. Again, no control group for comparison.
McKian et al. (2019) conducted an experimental study to assess narra-
tive therapy with overweight women. Ten women in a diet therapy group
received a weight loss diet for 5 weeks, another ten women received weight
loss diet and narrative therapy (ten sessions, twice a week, each lasting 50
minutes). Finally, there was a control group. The results showed that diet
therapy with narrative therapy had significant effects on body image and
significantly decreased body mass index (BMI), but this was not clinically

significant. McKian et al. concluded that this is a useful intervention for
improving body image, with a focus on positive experiences. The problem
is that it is not really a test of narrative therapy. It is not comparing nar-
rative therapy to another talking therapy, something that is equivalent.
It is providing diet information along with talk. As we know, people will
change or improve their behaviour because someone pays attention to
them. This study is not evidence that narrative therapy works. It is evi-
dence that paying attention to people works.
Sun et al. (2022) conducted an RCT to see whether narrative therapy
may help to relieve stigma in oral cancer patients. One hundred patients
with oral cancer were randomly allocated to either standard care (control)
or standard care plus narrative therapy. The level of stigma was assessed
before and after treatment and it was found that narrative therapy effec-
tively relieved patients’ sense of shame, it reduced overall stigma and
improved self-esteem and relationships. This is a good sign, but it has the
problem of the McKian study in that participants were getting standard
treatment or standard treatment plus narrative therapy, which means that
it may again be an effect of therapists paying attention to patients rather
than active elements of narrative therapy.
This is a difficult situation. We need to conduct RCTs to test narrative
therapy, but if we are going to show that narrative therapy is having a
specific effect on people’s health and well-being, then we need to do this
by making comparisons with other similar, equivalent, treatments. It is
not enough to compare treatment with absence of treatment because this
does not tell us that it is the treatment itself that is having the effect unless
a waitlist design is used. It would be better to either compare narrative
therapy with another form of talking therapy and see whether it works
better or to employ a waitlist control, so that people effectively act as their
own controls. I do find it frustrating because I do want to see that narrative
therapy works, as intuitively it should – but while intuition is helpful in
science, it is not enough.
Lopez et al. (2014) conducted an interesting study comparing the effec-
tiveness of narrative therapy and cognitive-behavioural therapy for treating
depression. The attrition rates for both conditions were similar, and both
groups showed a similar success rate, with CBT slightly better. Scores on
the Beck Depression Inventory (BDI) were similar at 31-month follow-up.
While the authors did not discuss the effectiveness of narrative therapy in
detail, the evidence shows that it has a similar effectiveness to CBT.
One recent study employed a waitlist control to explore the effective-
ness of narrative therapy in vulnerable African children, orphans and

abandoned children with attention deficit and hyperactivity disorder
(ADHD) and anxiety disorders (Karibwende et al., 2023). Half the par-
ticipants (n = 36) were allocated to the narrative therapy group and half
to the waitlist control group. The results indicated that narrative therapy
improved both anxiety and ADHD. While the longer-term effects were
not examined, this does show that narrative therapy can be effective.
Difficulties
Part of the problem is the relative newness of narrative therapy and its lack
of widespread acceptance. It is a difficult situation for a new therapy to
become mainstream as therapists will, quite rightly, ask for evidence that
it works before they train to use it, but in order to see whether it works, we
need therapists to use it!
A further problem is that the efficacy of narrative therapy may be dif-
ficult to demonstrate using traditional methods, in part because the prob-
lems dealt with by narrative therapists may not conform to traditional
ideas of disorders of mental health, and so may not be measurable in the
same way. This may mean that alternative ways of validating narrative
therapy may be necessary, particularly qualitative methods. The problem
here is that asking someone whether a therapy they have used (and usu-
ally paid for) is effective is hardly objective, and many will state that it has
helped because they do not want to think they have wasted their time and
money.
A controversial problem with narrative therapy is that it has some of
the characteristics of a cult (as do many forms of therapy, but that is for
a discussion elsewhere. It is perhaps in the nature of therapy to acquire
cult status). Many people have been trained in the techniques of White
and Epston and claim great successes in their treatment, but as we have
seen the evidence base for narrative therapy is weak. This does not mean
that narrative therapy does not work, but it is difficult to establish good
evidence using traditional techniques such as RCTs. The key problem is
that any benefits of narrative therapy may not be recognised through tra-
ditional methodological approaches. The benefits of narrative may be dif-
ficult to measure using traditional instruments. Many narrative therapists
reject DSM and ICD, arguing that we should not medicalise mental health
problems. If we cannot classify a disorder, how can we know whether that
disorder has been ‘cured’? These are problems with narrative therapy that
need to be highlighted and resolved. It does not mean that narrative ther-
apy and the techniques used in narrative therapy are not valuable, just that

they should be considered with caution, though they may be useful tech-
niques to use in psychological therapy, counselling and coaching.
Narrative therapy assumes that people are experts, that they are effec-
tive at knowing and constructing narratives, that they are open thinkers
who will change their ways of thinking as the situation dictates, that they
can change their life stories even though they may have been thinking the
same ways for many years. This may be the case for some people, but many
people are unable to think in this way, whether because they have never
been trained, they have never tried it or they are intellectually or emotion-
ally incapable of such thought.
For instance, if we ask a person about their hopes for the future, a person
may answer that they do not have any. Some people will eventually come
round to realising that they do have hopes, but others will not. It is dif-
ficult or impossible to use narrative therapy with the latter group. Another
problem for narrative therapy is that there are many people who do not
wish to talk about their problems, who believe – rightly or wrongly – that
they will not benefit from such methods. This is an issue associated with
all forms of talking therapy, but it has not been properly researched. We
simply do not know who is suitable and not suitable for receiving therapy,
narrative or otherwise.
Conclusion
Narrative therapy is appealing. When you read about it, there is a sense
of meaning, a sense that it must work, because the fundamental meaning
of life is expressed through stories and if these stories can be constructed
or reconstructed in positive ways, then this must have a positive effect on
the client. The problem is, as we have seen, that the evidence for narrative
therapy is, let’s face it, weak. It has been written about extensively, and a
few studies have been conducted that seem to show that narrative therapy
works, but there is not enough good scientific evidence that it works.
That does not mean that narrative therapy does not work, but it does
mean we need to be careful in its use and we need to conduct the studies
to show whether it works or not. There are problems with the evidence
for most kinds of psychological therapy, partly because the key technique
used, the RCT, is designed to be used in medicine where it is relatively
straightforward to introduce experimental and control groups and keep all
participants blind to which arm of the study they are in. This is very dif-
ficult in psychology. If you are receiving therapy, then you usually know
you are receiving therapy. If you are receiving therapy, then you want it

to work, so you are more likely to report that it does work. Furthermore,
there are often problems with people dropping out of treatment because
they find it too difficult, they don’t enjoy it, they think it is not work-
ing, it is too difficult and a host of other reasons. These dropouts are not
always recorded in therapeutic trials, which means that only enthusiastic
patients may succeed in completing the trial and so the therapy will appear
successful, which it is, but only for a subset of those who have problems.
Another difficulty with assessing the value of psychological therapy is that
only a certain subset of the population will be suited to such techniques,
and they only work with certain mental health problems. Talking therapy
is useful to some, but also useless to others. I have no idea what propor-
tion of the population affected by mental health issues will benefit from
psychotherapy, but it is a subset, not everyone.
This is not the place to go into these issues in great detail, only to high-
light the dangers of interpreting psychological evidence relating to psycho-
therapy, and to indicate that just because there is limited good evidence
for the utility of narrative therapy, that does not mean it does not have
its uses. I argue that (a) psychotherapists can draw on the techniques of
narrative therapy as part of an eclectic approach and (b) that we should
be designing good studies to test the usefulness of narrative therapy as a
technique in its own right. To do that, we need controlled studies (even
though there are problems with the method).
Another important concern is that narrative therapy is seen as a con-
structionist approach where there are no absolute truths, which might lead
to a conflict between a person’s post-therapy narratives and the dominant
cultural master narratives. This suggests a fragility of narratives whereby
post-therapeutic experiences may undo any positive benefits. The use
of a constructivist approach limits the extent of narrative therapy. The
notion that the self is a changeable and changing construct, dependent on
people’s experiences, outlook, relationships and so on, is fundamentally
flawed. Ask anyone and they will indicate that there is a commonality
throughout their lives, a sense of selfhood that does not change. While
we acknowledge our identities develop and change – both for the worse
and for better – we have to also acknowledge that there are key elements
of our selfhood that remains the same, and that is perceived to remain the
same, throughout life. Narrative therapy, if it is to be successful, needs to
show how it can impact on the stable elements of our personalities. There
may need to be a theoretical development that explicitly recognises that
there is a fixed self and elements of person characteristics that are also
fairly fixed.

While narrative therapy instructs that ‘the person is not the problem,
the problem is the problem’ and that arguing, for instance, that someone
who regularly acts in an aggressive manner and calls themselves an ‘aggres-
sive person’ is providing a thin explanation, the answer is not necessarily
that a thick explanation will remove that construct and replace it with an
explanation around how and why someone behaves in an aggressive man-
ner in certain situations and not others. The reality is that aggressiveness
can be part of a person’s character, part of their biological and psychologi-
cal make-up, and will not be changed. The job of the therapist here is to
help the person control the way they behave to others, so that they dis-
play aggression less frequently. Whether narrative therapy has a role here
remains to be seen. Like all therapies, it is likely that narrative therapy may
be effective for some kinds of problem and not for others.
The causal explanations provided by narrative are usually incomplete
and biased. Critical to understanding the narrative approach to psycho-
therapy is that it allows new stories to be constructed from a given state of
affairs, stories which may be more empowering and useful to the patient,
increasing their options for the future and their sense of agency. If we can
establish that narrative therapy can actually do this, and that it does make
a difference, then it could be a powerful therapy.

Chapter 9
Narrative Exposure Therapy
The problem in many areas of the world, especially war-torn countries and
countries seriously affected by natural disasters, is that they are often rela-
tively poor and tend to have few psychological practitioners to deal with
the often significant problems relating to traumatic stress. While the first
requirements of anyone affected by war or disaster are safety, shelter, food
and water, it is also important to deal with psychological problems in a
timely and practical manner. While it is not always possible or desirable to
bring in psychological practitioners or counsellors, it is possible for people
to help themselves. Throughout this book, I have emphasised the central-
ity of narrative to human existence. It is something we all do every day, so
if we can develop a therapy for traumatised people based around narrative,
then it could be highly effective. This is precisely what narrative exposure
therapy (NET) has been devised for. It is a form of narrative therapy that
can be administered not only by highly trained practitioners, but also by
people who have received fairly basic training as it is a fully manualised
and practical form of therapy. As it is based on narrative, it is already
familiar to those practising it and those being treated with it. The other
advantage NET has over narrative therapy as described in the last chapter
is that there is a very good evidence base that it works as a treatment for
post-traumatic stress disorder (PTSD). Indeed, it has been accepted as a
valid form of treatment under the The National Institute for Health and
Care Excellence (NICE) guidelines in the UK and also in the USA and
elsewhere.
NET (Neuner et al., 2004a, 2004b) was developed as a short-term psy-
chological therapy for people with PTSD (APA 2013). It was originally
proposed to find a suitable method for treating refugees in camps that may
be difficult to access for mental health professionals and was manualised
in order to provide a means of training people in the use of the technique
where there are limited resources available (see Schauer et al., 2011, for full
details).
121

122 Narrative Exposure Therapy
NET is a well-evidenced approach to dealing with psychological trauma.
It is based on the principles of cognitive behaviour therapy (CBT) and
testimony therapy (Cienfuegos & Monelli, 1983). Over the years, it has
become widely used across a range of trauma-related situations across the
world, not only in refugee camps and in disaster and war-torn areas. NET
can be delivered by non-mental health professions following a short train-
ing programme, using the oral tradition of storymaking and storytelling,
which is intrinsic to the human experience (Onyut et al., 2004).
Traumatised people often have difficulty making sense of their experi-
ences, understanding what has happened and placing the experiences and
their behavioural, cognitive and emotional responses in the context of
their personal autobiographies. NET’s manualised procedure is designed
to help people develop a consistent and coherent narrative of these experi-
ences, whether they result from war experiences (either as a soldier or civil-
ian), rape and sexual abuse, disaster or other life-threatening events. The
paradigm is based on cognitive behavioural models relating to PTSD (e.g.
Ehlers & Clarke, 2000), which describes a key set of symptoms, including
intrusive thoughts, avoidance of reminders about the traumatic event, neg-
ative alterations in mood associated with the events and marked alterations
in levels of arousal and reactivity. People with PTSD experience a current
sense of threat or danger. The model contains information about a number
of domains including memory, appraisal and behaviour. The person with
PTSD has problems with memory relating to involuntary recall, fragmen-
tation, high levels of vividness, emotional and sensory re-experiencing, with
a sense that the events are recurring now rather than at some point in the
past. The appraisals people make relate to creating a sense of current threat
and appraisals relating to the world (‘the world is a dangerous place’), other
people (‘other people are a threat to me’) and the self (‘I am incapable of
sorting out this problem’). The resultant behaviours are dysfunctional, and
may include avoidance, for instance, avoiding people or places that remind
them of the event, or emotional numbness, with the inability to experience
not only negative emotion but also positive ones such as love or happiness.
These strategies can prevent positive change and lead to chronic PTSD.
This is where NET comes in, as a means of helping the person to change
the ways they think, feel and behave, drawing on narrative.
The NET manual (Schauer et al., 2011) provides detailed information
about PTSD and the process of administration. NET usually consists of
eight to twelve sessions (though it can be reduced to four and sometimes
two sessions if necessary and possible, e.g. Zang et al., 2013), which involves
a number of processes. This starts with diagnosis and psychoeducation.

Narrative Exposure Therapy 123
It is important that the person realises that their traumatic symptoms are
normal for people who go through similar events. In the next session,
the Lifeline is laid out, which provides an overview of the key moments,
positive and negative, in a person’s life. After this, the narration proper
starts. While the whole of the person’s life is addressed, the focus is on
the traumatic incidents where very detailed accounts are obtained. The
focus is on ‘hot’ memories, traumatic memories that trouble the person,
memories that the person finds difficult to manage because they are so
traumatic. While most normal memories are dealt with quickly, these hot
memories are dealt with in a lot of detail. Each session focuses on a single
traumatic incident, and it is important that the whole of the memory is
dealt with in a single session. Subsequent sessions focus on other trau-
matic memories. During a session, the person is likely to experience high
levels of arousal. Sessions should only end when this level of arousal is
significantly reduced.
An important aspect of creating the narrative is writing down the story
for each session. The therapist takes a record of the narrative account, and
at the beginning of the subsequent session, the story is read out to the
person to ensure its accuracy and to fill in any details. In some cases, this
will mean the person again experiences high levels of arousal, but this helps
with habituation, coming to terms with the memory.
In the final session, the whole written report is read to the person and
final corrections are made. By this time, the narrative should have lost its
arousing impact. Hopefully the person will have a sense of distance from
the traumatic memories. This report is signed off by the person as an accu-
rate account of their experiences. This could be used as testimony against
any perpetrator of the traumatic events. See Table 9.1 for a summary of
the NET process.
The therapeutic elements that have proven effective using NET include
the active chronological reconstruction of the autobiographical memory,
exposure to ‘hot spots’ through detailed narration and imagination of
traumatic events through high levels of emotional involvement, cognitive
re-evaluation of behaviour and patterns and re-interpretation of meaning
associated with negative, fearful and traumatic events, revisiting positive
life experiences to activate resources and to adjust basic assumptions and –
importantly – regaining dignity. It is in telling the story in detail that the
person regains a more coherent and positive sense of self. It is the nature
of storymaking and storytelling that in itself is beneficial. The role of the
therapist is to be an active questioning audience to facilitate the person’s
reconstruction of their autobiography.

Table 9.1 Manualised NET process
Session 1 Informed consent Establish voluntary consent, build rapport, gain trust
Session 2 Psychoeducation Normalisation (normal to have such reactions after
trauma)
Legitimisation (the symptoms are a result of
responses to the traumatic situation
Description of trauma reactions
Explanation of therapeutic procedure (imaginative
exposure and habituation, step-by-step
explanation of process
Session 3 Lifeline Physically construct the life story to highlight
highly arousing, positive and negative/traumatic
events across the life in a chronological manner
Session 4, etc. Narrative exposure Focus on context, detail, emotional engagement,
context, chronology, description of sensory,
emotional and physiological and behavioural
experiences
Structure and record testimony between sessions
Exposure through re-reading narrative from
previous session for corrections, further detail
and reprocessing
Repeat procedure until final version is reached
Penultimate Future Positive discussion regarding hopes and aspirations
session for the future
Closing Testimony Re-reading and signing the complete testimony
session after correcting inaccuracies and making changes
Evidence Base for NET

Unlike the evidence based for narrative therapy, NET has been evaluated
through randomised controlled trials (RCTs) in a range of populations
in a variety of settings. A systematic review by Robjant and Fazel (2010)
examined studies conducted with several traumatised groups in different
cross-cultural and income contexts, including Sudanese refugees in Uganda
(Neuner et al., 2004a) to asylum seekers and refugees in Germany and
Norway (Halverson & Stenmark, 2010). NET improved symptoms more
effectively than psychoeducation, trauma counselling, supportive counsel-
ling and group interpersonal therapy. There were also positive effects over
the longer term. Gwozdziewycz and MehiMadrona (2013) examined seven
trials, showing NET was more effective than treatment-as-usual, interper-
sonal therapy and other techniques. More recently, two meta-analyses, one
by Lely et al. (2019) and one by our team (Raghuraman et al., 2020), taking
into account the risk of bias estimates and quality appraisal of the included

Evidence Base for NET 125
studies, have highlighted limitations of NET including low study quality
and high heterogeneity between trials. These limitations arise at least in part
because of the difficulty of validating a procedure mainly used in difficult
circumstances such as refugee camps. They also highlight the difficulty of
RCTs generally as a means of validating psychological procedures which are
inherently highly variable between those receiving the treatment.
Nevertheless, NET fulfils the criteria for treating PTSD and has been
recognised as such in the UK by NICE (2018) and in the USA by the
American Psychological Association (2017).
There is evidence that NET provides more effective treatment for
PTSD than for a number of other treatments, including stress inocula-
tion training (Hensel-Dittman et al., 2011), treatment-as-usual (Stenmark
et al., 2013), emotional freedom technique (Al-Hadethe et al., 2015) and
waitlist controls (Alghamdi et al., 2015; Hijazi et al., 2014; Jacob et al.,
2014). There is some evidence that NET has lower dropout rates (Morkved
et al., 2014), which is not surprising as the process is one of storytelling, a
natural human process, rather than the more obscure techniques used in
many treatments. Morkved et al. (2014) also found that fewer sessions were
needed for NET, something we found when treating Chinese earthquake
survivors, who benefitted from four, or sometimes even two sessions (Zang
et al., 2013, 2014). This is important in situations where there are limited
resources, and will be further discussed in Chapter 10.
One of the main advantages of NET is that it can be and has been
used in a variety of contexts across the world, including Rwanda, Somalian
Uganda, Iraq, Iran, Saudi Arabia, China, Romania and the UK. There is
an adaptation for forensic offenders (FORNET; Hermenau, et al., 2013;
Hinsberger et al., 2019; Kobach et al., 2017), and it has been used not
only with adults but also has been adapted for children (KIDNET; Catani
et al., 2009; Onyut et al., 2005).
Though storytelling is a universal human trait, there are limitations to
the NET procedure, which is based on Western conceptions of PTSD
and the response to traumatic events. Mundt et al. (2014) noted the lack
of connectedness of NET trials to the local psychosocial care systems and
questioned whether it was effective as a standalone intervention in set-
tings where the political context, collective healing mechanisms, family
and social dynamics and community functioning were not properly con-
sidered by the studies. In many cultural situations, psychosocial prob-
lems are dealt with through social connections and are considered a part
of social life, rather than in the disconnected way treatments are dealt
with in the West.

In our research, we have identified problems with NET. We conducted
a study with Saudi firefighters and found that NET did reduce symptoms
(Alghamdi et al., 2015) but the procedure did not provide the skills nec-
essary to deal with future traumatic events. After a series of serious fires,
post-treatment symptoms among the firefighters increased. In discussion,
the firefighters would have liked the NET procedure to be used as a ‘top
up’ on a regular basis to deal with continuing events. This idea may suit
emergency and military groups but so far has not been tested.
We also used NET in Iraq (Al-Hadethe et al., 2015) and found lim-
ited effectiveness in dealing with the problems of continuing violence. The
NET treatment was conducted in Baghdad while high levels of violence
continued, with car bombings, shootings and kidnappings. While there
was some limited short-term effectiveness, symptoms of PTSD did not
significantly reduce over time.
Both these studies tentatively indicate that while NET is effective at
reducing symptoms of PTSD, it does not provide support for the individ-
ual to deal with future traumatic experiences. It does not provide the skills
necessary for such support. While there is no evidence around this, it is
likely to be because NET is using a storytelling procedure which is to deal
with past stories. The narrative skills an individual has are not enhanced
by NET. It is the story itself that is enabling improvement in traumatised
people. For future traumatic events, though the person has the storytelling
abilities, they still need to construct the story to deal with the symptoms.
The idea of a ‘top up’ NET for certain groups has a strong appeal and
should be tested.
Testimony
This testimony element is important as telling stories is a natural pro-
cess, and in a way testimony as a therapeutic intervention has probably
been an informal way of helping people deal with difficult circumstances
for thousands of years. Many people who go through NET see it as a
means of telling their story or making it public rather than just as ther-
apy. Testimony therapy was described by Cienfuegos and Monelli (1983).
During Pinochet’s dictatorship, they collected the stories of former politi-
cal prisoners of the regime. They were attempting to document the repres-
sion, but they also found that enabling these people to tell their stories had
therapeutic value. The purpose of testimony therapy is to enable people
to tell their stories, particularly the traumatic elements. The stories are
recorded and transcribed. They are then signed off and people can do what

Testimony 127
they wish with them, keep them private, give them to family and friends
or send them to courts or human rights organisations, potentially as tes-
timony for court action. Testimony therapy has been used with various
groups such as refugees (Agger & Jensen, 1990; Weine et al., 1998) and
Holocaust survivors (Laub, 1995).
Dignity, the Danish Institute against Torture, published a manual for
testimony therapy (Dignity, 2014), suggesting that testimony therapy has
a number of healing elements, including regaining dignity and self-esteem,
integrating a fragmented story, re-experiencing fear in a safe environment
leading to diminished anxiety, understanding how present events can gen-
erate thoughts and emotions relating to the traumatic event and adding a
mindfulness element to further reduce stress and anxiety.
Dignity proposes a four-session testimony process which opens with
mindfulness and psychoeducation, and then a monitoring and evaluation
questionnaire is completed, before moving on to the person providing
details of the story with questions from the therapist, the story is written
up and in the next session, read aloud to the survivor (giving voice to the
story), the person discusses their feelings, and again mindfulness is used.
Afterwards the therapist corrects the story to provide a final version. In
the third session, the final version of the story is read aloud to the survi-
vor, signed and then presented to the survivor, preferably on good paper,
bound, and with a photograph of the person on the front page. This could
be a public event with several survivor stories. The final session takes place
a month or two later and the monitoring and evaluation questionnaire
is again completed to make a comparison with scores at the outset. The
results are analysed and discussed.
Van Dijk et al. (2003) described how they used testimony therapy with
Chilean former political prisoners, and how the procedure helped reduce
post-traumatic symptoms. With testimony therapy, the person describes
their story over twelve sessions. The narrative is then transcribed into a
written document that can be given to family and friends or added to a
historical archive. More recently, studies have continued to demonstrate
some benefit to testimony therapy (Agger et al., 2009, 2012; Curling 2005;
Jørgensen et al., 2015).
There are few studies using RCTs to examine testimony. One exception
is Esala and Taing (2017) who conducted an RCT to test the effective-
ness of testimony therapy among Khmer Rouge survivors from Cambodia.
They found that significant benefit was obtained when testimony therapy
was combined with a culturally adapted ceremony rather than with testi-
mony therapy itself, suggesting the importance of social ritual, of sharing

the story with others. The ceremony included a Buddhist ceremony and a
truth-telling event. What is difficult to tease apart in this study is whether
the benefit was gained through testimony therapy or the ceremony.
The evidence so far for testimony therapy does suggest that it has some
benefits for people who have been traumatised. A difficulty is that there
is no set format for the testimony, and the stories told can have different
formats. An important element, as noted elsewhere in the book (e.g. nar-
rative therapy and narrative life interview), is that the person needs to talk
about feelings and thoughts regarding the traumatising event. Without
that element, the benefits may be limited. It is the usual story in psychol-
ogy, the difficulty of comparing different methods, different approaches,
to similar questions. This is why NET is easier to examine, because it has
a set format, though there is still a problem with RCTs – as there is across
psychology.
A More Detailed Examination of the Evidence for NET

As already noted, it is difficult to conduct full RCTs to examine the effi-
cacy of NET. It is difficult to do so with any psychological treatment for
any psychological disorder as it is functionally impossible to control all
the variables necessary to conduct a trial with the same level of validity
as, for example, when testing a drug. Any psychological treatment will
involve variation in the treatment as people are involved. The treatment of
one person for depression using any form of talking therapy will never be
the same as for another person. Individual clinicians always take different
approaches and make different decisions regarding their patients. Patients
are always different. They have different backgrounds, problems and needs.
For these reasons, we can only ever use RCTs as one tool among many in
determining whether our treatments are effective. Also, there are problems
with the classifications of the ‘disorders’ that are treated by psychologists.
PTSD, depression and anxiety are all contentious classifications as already
discussed. This is not medicine.
Having said that, RCTs are still one of the better tools we have for
determining whether a psychological treatment is helpful, and as we have
seen, NET does appear to be helpful. The evidence is fairly consistent
on this. It is worth pointing out though, that the evidence has a number
of serious limitations, as we discovered when conducting our systematic
review (Raghuraman et al., 2020).
NET is an unusual technique because it is meant to be used by people
without full psychotherapeutic qualifications in places where it can be

A More Detailed Examination of the Evidence for NET 129
difficult to find psychologists with people who have been through terrible
experiences and who live in difficult circumstances, often having lost loved
ones and homes. NET begins from a difficult position, and for it still to
work given these conditions demonstrates the power of narratives, and
the power of constructing systematic narratives focusing on people’s most
difficult memories.
The review, published in 2019, demonstrated the efficacy of NET across
a range of situations and populations, but also highlighted some of the
problems. Some of these problems result from the application of NET and
the procedure itself, but others relate more to the problems of using RCTs
with this kind of treatment.
Overall, the review demonstrated that NET works with a variety of
populations in a variety of situations. Using strict systematic review crite-
ria, our review included twenty-four studies with a total of 1,391 partici-
pants. The populations were varied, including refugees and asylum seekers,
firefighters, former street children and former child soldiers, veterans, ex-
prisoners, survivors of partner and sex abuse, orphans of genocide and
earthquake, Iraq, Romania and Burundi survivors. They came from around
the world, including China, Germany, Saudi Arabia, Norway, Uganda,
Congo, USA, South Africa and Rwanda. The effectiveness of NET here
indicates the universality of narrative. It is not culture-dependent, narra-
tive is used by everyone.
The outcome measures usually included PTSD, but also depression and
anxiety, and other negative symptoms. Participants ranged in age from
seventeen to seventy (children were excluded). The trials used either NET
in its original form, FORNET, a forensic offender rehabilitation form of
NET or a brief form of NET.
The studies were controlled in several ways such as waitlist control,
treatment-as-usual, psychoeducation, emotional freedom technique, stress
inoculation training and various other forms of therapy, some of which
have limited evidence of utility.
Most of the trials measured severity of PTSD as one of the primary
outcomes. Measures of PTSD included the Clinician-Administered PTSD
Scale (CAPS; APA, 1994), PTSD Symptom Scale (PSS-I; Foa et al., 1993;
Foa & Tolin, 2000), the Composite International Diagnostic Interview
(CIDI; WHO, 1990), Post-traumatic Stress Diagnostic Scale (PDS, Foa
et al., 1997), Scale of Posttaumatic Stress Symptoms (SPTSS), the Impact
of Events Scale – Revised (IES-R; Weiss & Marmar, 1997), among others.
This introduces a further problem, regarding the status of PTSD and how
it is measured. As previously discussed, the diagnostic criteria for PTSD

are contentious. Many people working in the narrative area would not
accept the validity of the diagnosis, nor of the means of assessment. Be
that as it may, in pragmatic terms, the studies assessed a construct we call
PTSD and found that in most cases, NET had a positive effect on it.
What the findings indicate is the difficulty of conducting studies using
a manualised procedure with therapists of limited training and clients with
severe and variable difficulties in situations that are often dangerous or
difficult for other reasons. Given all these potential problems, and the still
consistent finding that NET works is an indicator of the power of both the
NET procedure and the narrative approach generally.
Unusually for psychological therapies, there was a very low attrition
rate, with a mean of 7.43 percent during treatment, which is lower than
most treatments. This is likely to be because NET is using the natural pro-
cess of narrative rather than asking people to do extraordinary abnormal
things during treatment. Just telling a story does not introduce unneces-
sary stress or effort into the process, and most people like to tell their sto-
ries (if they are too difficult to tell, they are not going to undergo any form
of psychotherapy). The higher dropout rates for these studies occurred in
the more sensitive areas such as refugees and asylum status. Many people
dropped out because their refugee camp closed, they disappeared or were
transferred. Some dropouts were for the reasons people drop out using dif-
ferent treatments, such as a lack of motivation or trust, psychosocial prob-
lems, spontaneous remission and lack of time. In Orang et al. (2018) study,
three participants dropped out because of the high intensity of emotions
experienced when reliving traumatic memories. It is usually much more
common for dropouts to leave because they are experiencing these difficult
memories. Something about NET means that they usually continue with
the treatment, probably again because of the storytelling nature of the
procedure. People like telling stories.
E-NET
There is scope for NET to be presented online. At least in part because
only a few people have access to appropriate trauma treatment, even using
a technique such as NET. With digital developments, it is no longer nec-
essary for therapists to be in the same location as patients. Robjant et al.
(2020) presented E-NET. E-NET is eco-friendly and economically via-
ble. E-NET mirrors NET as much as possible, uses live therapists and
it is important to obtain the emotional attunement between therapist
and patients. The therapist needs to be present to listen to the testimony.

Conclusion 131
Ideally, there should be an assistant near the patient in case they dissociate
or there is a clinical emergency. If there is no one, then they should provide
emergency contact details. E-NET includes: (1) assessment and psycho-
education, (2) lifeline and (3) narrative exposure. Additional requirements
for patients include client safety and a confidential space, any medical
requirements, emergency phone number and what to do if disconnected
(e.g. chat functions and telephone). Include Shut-D in assessment and
consider the likelihood of dissociation during treatment, and regularly
attend to suicide ideation. The therapist must teach the patient skills to
counter dissociation. The lifeline is co-constructed. During exposure, there
is an increased use of contrasting past and present, ask patient to delineate
seen and unseen physiological manifestations, therapist focuses on bodily
expression as well as face, re-orient client to the here and now, for example,
plan for the day, etc. For the testimony, the therapist can screen share,
directly type modifications (Lifeline – Yourlifeline.NET).
Comparing Narrative Therapy and NET

Apart from narrative therapy and NET dealing with different problems
in different ways, the key difference between narrative therapy and NET
is that the scientific evidence for NET is much stronger, which is why
this chapter is much more substantial regarding evidence. As we saw in
Chapter 8, the evidence for narrative therapy is weak at best, which is not
to say that it doesn’t work, but that the evidence for its efficacy has not
been collected. Perhaps because NET is a manualised fixed procedure, the
evidence base is good and is growing. The effectiveness of NET may dem-
onstrate that we should be collecting better evidence for narrative therapy,
as it is clear that narrative procedures do work. The other problem is that
NET is dealing with a specific problem set out in a clear scientific man-
ner, with well-defined concepts and outcomes, whereas narrative therapy
is more of a constructionist approach, where the concepts are not so well-
defined, sitting outside the medical model, and so it is more difficult to
provide evidence.
Conclusion
NET has been around for a couple of decades now and has a very good
evidence base across a range of different patient groups. It is relatively easy
to administer by people who only need limited training, and it works,
which is the main thing for any psychological therapy. It works for many

different kinds of traumatic experience, from war to sexual abuse. The
next question we need to ask is whether NET, or an adaptation of NET,
could be used in other circumstances. For instance, could it be used to
treat generalised anxiety disorders by focusing on the problems faced by
people? Could it be effective in the workplace as a means of alleviating
stress? Could it be used to help deal with depression? All these problems,
and others, are effectively problems relating to the individual narrative
and so could, theoretically, be dealt with by developing a more effective
narrative. The actual procedure will have to be adapted for specific circum-
stances, but the overall principle of a formal fixed method of dealing with
an ineffective narrative is the same.

Chapter 10
Narrative Medicine
The sort of disease a person has is much less important that the sort
of person that has the disease.
Hippocrates
Narrative medicine has been around as long as medicine has been linked to
stories, and as long as people have tried to find explanations for why peo-
ple are ill. There have always been stories about illness and cures because
doctors and patients have attempted to understand the context of the ill-
ness or disease, what it means to the patient and the best means of dealing
with it. This is as true for explanations relating to the evil eye, miasmas and
other medieval viewpoints as it is for today’s stories about the efficacy of
drugs, the need for exercise and for good food.
The developing relationship between a doctor and patient is a story
that changes over time as illnesses and diseases emerge, are treated and are
alleviated or lead to chronic problems or death. Sometimes, there is only
a short relationship between a doctor and a patient, for instance, when
someone sees a specialist to obtain a resolution of a short-term problem.
On other occasions, a relationship can last for many years, for instance,
between a patient and their local general practitioner (GP). In the latter
case, the GP may see the patient numerous times and come to understand
not only the illnesses that they bring, but also how the person is psycho-
logically, how they deal with illness and how they are best treated.
Patients visit their GP and tell stories about a symptom or concern, the
context, how it affects them and why they came to visit the doctor. There
are infinite variations in content, the person telling it and how the story is
told (coherent, disjointed, incomplete, etc.). This reflects the uniqueness
of the person and their experience. Doctors too have own stories, their
understanding, the diagnosis being formulated, ideas about causation and
management. These derive from the type of training they have received,
133

134 Narrative Medicine
the articles they have read, the conferences they have attended, the other
doctors they have talked to, the time and resources available and their
general philosophy of medicine.
The stages of discussion, assessment and diagnosis are followed by the
communication of the diagnosis to the patient and the development of
a joint narrative between doctor and patient to determine the course of
treatment, if any, and the potential time period for the course of the illness
and recovery (‘come and see me in a week’s time and we will see how you
are getting on’).
There are problems with these narratives, problems on both sides.
Doctors are trained – at least to some degree – in communication skills
and patient-centredness but patients frequently complain doctors don’t lis-
ten, appear disinterested, interrupt, make assumptions and do not address
their concerns. Patients in hospital may perceive that their consultant is
spending more time talking to the other doctors on the rounds rather
than to them. Doctors may think – with some justification – that patients
would not understand even if the details of the illness were explained to
them. Patients believe – rightly or wrongly – that they are experts, that
they have a clear idea of the problem and how it should be treated because
they have read articles on the Internet which they believe makes them as
expert as their doctor partly because they know about their illness because
they, unlike the doctor, are experiencing it. Patients may think that doc-
tors do not appreciate that illness can change everything. The experiential
aspect of any illness is important, but patients need to recognise that a doc-
tor’s expertise goes far beyond this regarding understanding their scientific
and medical knowledge and the more implicit basis of clinical experience.
There are endless ways in which miscommunication can and does occur
between doctors and patients, and with miscommunication, we have a
failed narrative.
All these issues concern narrative medicine. In the end, both the doctor
and the patient want the patient to be cured. They have the same goal, but
often the means to achieve this goal is fraught with difficulties on both
sides.
The Arts and Humanities

One of the reasons that narrative is not given a more active focus in medi-
cine is because of a focusing of education. Zaharias (2018b) notes that
in the nineteenth and early twentieth centuries, the arts were considered
essential to a good education, but that has changed. Now there is a more

Narrative Medicine 135
narrow focus. Scientists tend not to receive an education in the arts and
humanities. This may be because there is more to learn, or for another
reason, but it means that the educational background of most people is
rather limited.
By bringing back arts and humanities subjects into medicine, there can
be a return to humanity. There are many advantages to having an educa-
tion that contains the arts. The arts and humanities tend to encourage peo-
ple to reflect on their experience rather than just provide a logical response.
They enable people to interpret messages in different forms rather than
looking for a single ‘correct’ answer, considering different ways of per-
ceiving and understanding. They enable people to better understand the
subjective experience of others, to find meanings, to increase tolerance to
ambiguity, encourage creativity and the imagination. They help tap into
and respond to feelings and emotional responses. They help people distin-
guish between the objective and the subjective, encouraging the value of
both, and consider questions of why, not just how. In sum, an education
in the arts enables doctors to think more broadly, and to better take into
account the subjective emotional states of the patient.
A study by Doukas, McCullough and Wear (2012) explored the role of
humanities subjects in medical education, specifically ethics, history, lit-
erature and the visual arts. A panel of experts was put together to describe
the major pedagogical goals of these subjects in medical education and
how they could be integrated into both undergraduate and graduate
medical education. They found three key areas. First, that ethics and the
humanities attempt to promote humanistic skills and professional con-
duct in medical practitioners; second, they teach patient-centred skills;
and third, they teach critical appraisal and the implementation of medical
professionalism.
Narrative Medicine
In terms of a subdiscipline, narrative medicine was introduced in the 1990s
at Columbia University by Rita Charon and others who argued that medi-
cal practice should be structured around the narratives of the patients and
the clinicians. Narrative medicine came about because of the reasons given
above and because the biomedical model fails to provide a full explanation
of doctors’ clinical competence and experience. Charon (2007) first used
the term narrative medicine in 2000 to refer to clinical practice fortified
by narrative competence – the capacity to recognise, absorb, metabolise,
interpret and be moved by stories of illness.

We can differentiate the study or discussion of how narratives are used
in medicine in general terms and the subdiscipline developed at Columbia.
The former is an attempt to demonstrate the necessity and practicalities
of employing narrative approaches in medicine. The latter is a more for-
malised approach which attempts to bring together conceptual frameworks
and practical clinical methods to improve clinical practice, specifically to
improve clinicians’ understanding of their patients and develop the thera-
peutic partnership (Charon et al., 2016).
According to Zaharias (2018a), the healing power of narrative is repeat-
edly attested but the scientific evidence for this is sparse. We need more
research to define the role of narrative medicine, to understand the specific
skills required for practice and to determine narrative medicine’s outcomes
with respect to illness and disease.
The process of how a person talks about their illness, and how the doc-
tor asks questions to aid understanding, is similar to the narratives that
have been discussed throughout this book. The account has a plot (what
is happening), characters (the patient, the doctor and any other relevant
people such as relatives), metaphorical ways of speaking and coherence.
Using narratives explicitly in medicine is a way of attempting to deal with
the psychological factors relating to illness as well as the physical prob-
lem. It attempts to validate the patient’s experience and also to encourage
reflection and creativity in the clinician.
According to Charon (2006), there are four divides that contribute to
the disconnect between the doctor and the patient:
1. The relation to mortality. Illness is unexpected and elicits
many emotions, including the fear of death. Patient attitudes
are linked to previous and current experiences, doctors have
different experiences from patients, a more theoretical and clinical
understanding. Patient fear is very real, and it is important that
doctors recognise this, and acknowledge the impact it may have on
the patient.
2. The context of illness. Doctors view illness as a biological
phenomenon requiring medical intervention. Patients view illness in
the context of their entire lives.
3. Beliefs about disease causality. Patients don’t have the knowledge
of doctors and so their notions of illness and causes can vary
widely. This can be particularly affected by the Internet, which
makes knowledge – both accurate and inaccurate, accessible and
unaccessible – more widely available.

The Clinical Method 137
4. Shame, blame and fear. Patients are often embarrassed revealing
intimate aspects of themselves; illness makes them vulnerable. They
may blame themselves because the illness may result from past
actions. They might blame the doctor because the doctor failed to
cure them on a previous occasion. The doctor may be embarrassed
to ask personal questions. They may blame the patient for being
demanding or for not looking after themselves.
When trying to understand the nature of the relationship between the
doctor and the patient and the importance of narrative, it is important to
explore these four divides. Narrative understanding develops through the
interaction between the doctor and the patient and the different perspec-
tives they bring to the situation.
The Clinical Method

Medicine relies on both science and clinical judgement, with the science
of objective theory, research and measurement and clinical proficiency and
judgement (Greenhalgh, 1999), which requires a different, more subtle,
expertise that can only be built over time and experience. Another way
of putting it might be to consider the integration of objective evidence-
based science with subjective narrative experience, demonstrating the lim-
its of objectivity in the clinical method and the need for subjective (at least
partly implicit) clinical judgement.
The clinical method is an interpretive act which draws on narrative skills
to integrate the various stories told by patients, clinicians and test results
(Greenhalgh, 1999). The stories of scientific evidence should be added to
that list. A good clinician is someone who, over time, accumulates knowl-
edge (evidence), experience with patients and experience with illness
scripts. These are all stories that integrate into the story of the clinician.
The success of the narrative paradigm is when the clinician successfully
integrates these elements and becomes an expert (though always with limi-
tations and room for error and misinterpretation – human stories are never
perfect!). This involves implicit as well as explicit processes, and the clini-
cian will not be able to recall all the patient stories they have heard over
time, but each new patient story draws on the wealth of expertise in terms
of evidence, experience with patients and illness scripts. Clinical judge-
ment is a good example of how knowledge can be implicit, how an indi-
vidual may be unable to make the knowledge explicit, to describe it fully
to another person. In other words, elements of the clinical narrative are

implicit and unexplainable. This has huge implications for the functioning
of a health-related organisation, where managers may seem to think that
productivity is always measurable. Expertise is not always measurable.
While doctors apply scientific principles to their work, using the best
data available, they do not always have the answers, they cannot always
save a life or cure a disease and the work they do has to fit in with the life
narratives of the people they are treating. If someone has a life-changing
illness or accident, then they will have to adjust their life narrative accord-
ingly and the doctors who are treating them, while making every attempt
to effect a cure, a reconstruction or just attempting to make the future as
comfortable as possible, should help them through this process. As Charon
and Wyer (2008) note, ‘the question is not simply whether medicine is
instrumental or imaginative, or whether it requires compassion along with
competence, or whether humanities should be required in the medical
school curriculum. It has, rather, to do with the nature of health, the prob-
lem of pain, the sources of suffering, and the fact of death’ (p. 296).
Clinical decisions are based on trustworthy, or least the best available,
evidence by clinicians who use their expert judgement and attempt to take
into account patients’ values and personal circumstances.
Evidence works at several levels, and the traditional scientific perspective
is that randomised controlled trials provide the best evidence and anecdotal
stories provide the worst. The reality is that these stories, accumulating
over time, enable the practitioner to develop sound clinical judgement, a
judgement that considers the scientific evidence, but also – critically – the
accumulated wisdom developed through many interactions with patients
who, despite the scientific need for precision and the removal of error,
are all individuals with different stories. The good practitioner takes these
stories into account when forming judgements.
This is not to say the stories are more important than the science, but they
have a critical role to play in clinical judgement. In reality, clinicians con-
sider both the evidence (which itself is often ambiguous) and the narratives
and on the whole do a good job. One without the other would not work.
Narratives are part of clinical judgement, and so is evidence-based medicine.
According to Charon and Wyer (2008), there are three fundamental ten-
sions in medicine: known/unknown, universal/particular and body/self.
Clinical evidence is concerned with what is known and unknown, clini-
cal circumstances integrate the universal and the particular and patients’
values reflect both body and self. Narrative medicine recognises the ten-
sions arising from these issues and provides evidence-based medicine with
methods of respecting these three circles of attention.

Power and Decision-Making 139
Charon and Wyer further argue that narrative medicine, along with lit-
erature and related subjects, has informed doctors that life is a story, peo-
ple have lived experiences, illness unfolds in stories and that clinicians are
as much witnesses to suffering as they are ‘fixers of broken parts’ (p. 297).
Clinicians are encouraged to write about their experiences, patients can see
their medical records and, in some cases, contribute to them, which chal-
lenges traditional ideas of clinical practice. Ideas around patient-centred
care or narrative medicine are becoming more common.
Power and Decision-Making

Mahr (2015) illustrated the potential difference between a doctor mak-
ing a simple diagnosis of an illness such as pneumonia and the problems
associated with assessing a patient’s mental health, for example, their
decision-making capacity. Pneumonia has reasonably well-agreed signs
and symptoms, so a diagnosis is usually fairly straightforward, as is the
treatment strategy. While the treatment of pneumonia has power and
authority elements in it, with the doctor being the powerful one with the
medical knowledge and the authority to decide on a treatment strategy
(a patient can refuse treatment but will usually trust the authority of the
doctor), the assessment of whether a patient has decision-making capac-
ity is much more difficult and has far-reaching implications. There is an
acceptance of the power of the doctor for what is an agreed physical illness,
but this becomes more difficult when there are potential legal implica-
tions for the patient. We currently have a doctor-centred approach. Even
when there is something as complicated as whether a person can make
their own decisions, we generally accept the doctor’s privileged position
of power and medical knowledge. We assume there is an objective truth
to the doctor’s approach, that they are using reason and are up to date
regarding the classification of disorders and the appropriate treatment. It
is a very doctor-centred approach. The doctor is almost godlike in their
powers. The question is whether this is right or acceptable, and whether it
is right or acceptable for some problems but not for others. Most societies
do recognise these issues at least to some extent, and it is one reason why
there are multidisciplinary teams making decisions about complex medical
cases. Having a variety of views can help make the best decision. If there
are significant legal consequences of a medical decision, people in many
societies will listen to the views of more than one doctor and, depending
on the situation, bring the material to court to try and make the best pos-
sible decision. It is not just a matter of legality, there are societal norms

and the personal relationship between the patient and the doctor, the trust
the patient puts in the doctor (or not). The underlying question here is
whether the patient has expertise to contribute and what the limits are of
that expertise.
Narrative medicine as practiced by Charon presents a model which
insists on the primacy of the patient’s narrative or story in the doctor–
patient interaction. The plot, the structure and the style of the patient’s
story are at the centre of the clinical encounter. The doctor is no longer the
authority figure in the same way. Narrative medicine rejects the authori-
tarian model, instead recognising disparate but concurrently valid view-
points. In a sense, the narrative medicine model about the mental state of
the patient is more objective than the traditional assessment of capacity.
Under the traditional model, the patient, in order to have decision-making
capacity, must understand the information they are given about the treat-
ment, appreciate their current medical situation, use reason to make a
decision and communicate the choices consistently. It is a doctor-centred
approach, but there are problems with this. It assumes that there is a sin-
gle truth (the patient has decision-making capability or not). There is the
imbalance of power – it is difficult to argue with the doctor. There are the
inferences made about the patient’s mind, and we know such inferences
are often erroneous.
Narrative medicine explicitly addresses power issues and recognises
that there are multiple versions of the truth. Narratives help provide a
personal and meaningful connection. This was understood by Jung who,
considering psychoneurosis, talked of understanding the suffering of a
human being and that the doctor must provide the healing fiction, what
the patient longs for. People are seeking help with their health. What
they experience, certainly for complex problems, are not (just) symp-
tom clusters, they include the patient’s expectations, fears and hopes.
Narrative provides a core means of given meaning to experience. It
acknowledges power. According to Mahr (2015), there is a need to sepa-
rate the privilege of knowledge (that the doctor has) from the privilege
of power (which the doctor need not have). The privilege of knowledge
is essential for the doctor, the privilege of power is a social role granted
to the doctor by society.
Mahr (2015), in the example given, suggests that there should be a nar-
rative assessment of the patient’s decision-making capacity, that there is a
need to give equal weight to both the doctor’s and the patient’s narratives.
A patient with decision-making capacity will present a narrative that is
coherent, acknowledges the doctor’s (possibly different) narrative and the

Bringing Narrative Medicine to Clinical Practice 141
doctor’s privilege of knowledge, is consistent and self-authored, flexible
and potentially open to new data ideas and interpretation. These elements
avoid a covert judgement of the patient’s mental state yet recognises the
doctor’s knowledge. It allows for a clear and practical approach to the
assessment of decision-making capacity without the hidden problems of
the traditional model.
While recognising that in the past, the doctor perhaps had too much
power regarding medical decision-making, it may be going too far to sug-
gest that there should be an equal balance of power. While patients often
need a say in medical decisions, particularly complex decisions where
there are several choices to be made and where there may be serious con-
sequences for the patient (whether treated or not), in the end, it is the
medical practitioner who has many years of training and experience in
dealing with medical problems, and most practical people, both doctors
and patients, generally recognise the importance of acknowledging this
expertise. This does not detract from the need to keep the patient informed
and involved, and the need to develop an effective narrative around the
medical problem – but the doctor and the patient are not equal partners.
The doctor has power because they have knowledge and experience, the
patient has power because it is their body that is being dealt with. This is
never going to be a balanced power relationship, and to complicate it fur-
ther, the type of power held by the doctor and the patient is different and
so difficult to compare, but acknowledging this means that an effective
narrative has a better chance of being developed.
Bringing Narrative Medicine to Clinical Practice

While Charon may have a clear definition for narrative medicine, others
would disagree, which may pose a problem when trying to define the
skill set for practising narrative medicine, but researchers and clinicians
have proposed ways in which clinicians can begin to actively use narra-
tive in their clinical work. The power of language should not be under-
estimated (Zaharias, 2018a), and how using language differently can lead
to significant changes in the doctor–patient relationship and to clinical
practice.
To practice narrative medicine, doctors need to have a sense of affili-
ation, where there is an authentic connection between the doctor and
the patient. The doctor needs to develop a sustained habit of clinical
reflection. Clinicians strengthen their therapeutic alliances with patients
and deepen ability to identify with others’ perspectives. Change is

not imposed on the patient, but both doctor and patient consider the
options so that the patient is empowered, that the clinical situation is
co-constructed. A narrative approach fundamentally changes the doc-
tor’s stance by shifting the focus more to the patient, with the doctor
listening attentively. The doctor is trying to understand the patient, not
just solve the problem.
We need a conceptual framework for understanding why narrative skills
matter for clinicians and patients. For Rita Charon and her colleagues, the
teaching of narrative medicine involves three steps: the close reading of a
text, writing about the text (personal reflection and creative writing) and
discussing the text and reflection with others.
Narrative medicine in this context refers specifically to the training in
interpreting literature and applying that skill to understanding patients’
accounts. The key elements are mindfulness, observation and concentra-
tion. In writing sessions, participants are invited to describe complex clini-
cal situations, conferring form on chaos, with focus not on what is written,
but how it is configured, how the information is turned into a narrative.
An alternative perspective was put forward by Launer (2013), who pro-
posed seven Cs for conversations inviting change. These seven Cs underpin
his approach to narrative (or narrative-based) medicine. The seven Cs are:
1. Conversations. The patient is encouraged to express themselves in
their own words, exploring connections, differences, options and
possibilities, which helps facilitate understanding without being
controlling.
2. Curiosity. The doctor should show a genuine interest in the patient
and want to know more about them and their circumstances.
3. Context. Both the patient and the doctor need to understand the
role of family, work, community, beliefs, values, etc., with regard to
the patient and their illness.
4. Complexity. Nothing is straightforward. If one thing changes (e.g.
change of job, change of drug), then there is a ripple effect to other
things. Everything is interconnected.
5. Challenge. The doctor should challenge both themselves and the
patient to consider new ideas, examine alternatives, to contemplate
change and think about how it might come about.
6. Caution. The doctor should be aware of their limitations and be
sensitive to the patient and their needs.
7. Care. The doctor should be non-judgemental and accept patients for
who they are.

Bringing Narrative Medicine to Clinical Practice 143
Zaharias (2018b) presents practical ways for GPs to start using the skills
of narrative medicine and the methods for developing these skills further,
including methods for broadening awareness, learning to decipher mean-
ings and developing reflective skills. The arts are a powerful means for gain-
ing these skills, in addition to stimulating the imagination and promoting
creativity. Listening, exploring, deciphering and reflecting are tasks which
have the common aim of developing joint understanding, ultimately
leading to new narrative that enables and facilitates management.
1. Listening and exploring. This may appear daunting, but it is not
difficult. It is like painting a picture, something not completed in
one sitting. It is often never finished – revisited, retouched and
started again.
2. Deciphering. This is not just about obtaining more information, but
finding hidden meanings.
3. Reflecting. Again this is like painting, spending time thinking about
the situation.
Zaharias (2018b) proposes a number of practical strategies that those inter-
ested in narrative medicine should consider employing:
– Show interest in the patient
– Listen attentively
– Do not interrupt, especially at the beginning of the consultation. Let
the patient finish their train of thought
– Ask open-ended questions
– Silence is good
– Listen for and follow cues
– Observe body language
– If the narrative is stopped, perhaps because the consultation has to be
terminated, ensure it can continue at next opportunity
– View noncompliance as a blocked narrative, not as the product of a
difficult patient
– Do not make assumptions
– Do not be judgemental
– Do not be in a hurry to manage the problem
– Be mindful of Charon’s four divides (relation to mortality, context of
illness, beliefs about disease causality and shame, blame and fear)
– If it is not clear why the patient has presented, ask why they are here
at this moment with this problem
– Reflect questions back to the patient for their opinion

Zaharias (2018b) also discusses the benefits of practising narrative medi-
cine. In terms of the doctor–patient relationship, this includes improving
communication, exposing fear and prejudice, improving and enriching
the doctor–patient relationship (e.g. through enhanced trust and empa-
thy) and fostering shared decision-making. Regarding the medical side,
it is likely that there will be more detailed medical information available
which may improve accuracy or patient history, there will be an increased
awareness of how evidence can be interpreted in different ways, how med-
ical errors are made and can be avoided and how medical information
is often transient so there is a need to be up to date. Finally, a narra-
tive approach could lead to improved relationships between colleagues,
so a more effective health team, and also increased work satisfaction and
decreased burnout through increased self-awareness, attention to self-care
and the development of resilience.
Criticisms of Narrative Medicine

In the first place, narrative medicine is practiced by every doctor who deals
with patients. The aim of a consultation is to develop a narrative, to under-
stand the patient’s story. A good doctor will enable the patient to tell their
story in a sophisticated manner to ensure that all relevant information is
available for assessment and diagnosis. The contribution of researchers in
narrative medicine is that it makes the narrative element conscious and
detailed. The focus becomes the narrative rather than the diagnosis which
aims to help improve the quality of the diagnosis. Providing the explicit
skills relating to narrative will enable the doctor to improve their relation-
ships with their patients.
There are problems with the narrative approach. Perhaps the biggest
of these is time. It takes a long time to bring out a detailed narrative of a
person’s life and in practice, most doctors do not have time in their con-
sultations to obtain that level of detail. Nevertheless, in the time available,
it is possible to obtain sufficient details of the narrative using narrative
techniques. It is an argument beyond the scope of this book to suggest that
GPs and consultants should have longer consultations with their patients
to improve patient care.
Another potential problem is the imbalance of knowledge and power.
As we have discussed, part of the purpose of narrative medicine is to give
the patient a stronger position in the relationship. The difficulty is, as we
see when patients look up information about illnesses on the Internet

Conclusion 145
and think they have a sophisticated level of understanding and take this
information to their doctor and demand a particular course of action,
the patient is often wrong. The knowledge obtained from the Internet by
someone not medically trained is limited in a number of ways. Not only
is it sometimes wrong, it is often simplistic, and if it is sophisticated, it is
unlikely to be well understood by someone not trained in medicine. It
gives the patient the illusion of knowledge, which they take to the con-
sultation and the doctor may have to spend valuable time arguing about
the validity of the information the patient has. It is important to get the
balance right between respecting what the patient is saying and respecting
the generally much superior knowledge of the doctor which derives from
years of education and usually years of experience. It is usually better for
the patient to provide the detailed understanding of their situation than to
argue for a particular treatment based on readings from the Internet. This
raises the issue of power. Real power is largely in the hands of the doctor.
Narrative medicine attempts to change that balance of power so that it is
shared. This is a good thing as long as it does not undermine the superior
knowledge and understanding that the doctor has about the illness. It is
easier to employ narrative medicine when the patient is intellectually capa-
ble of rational debate. If their ability is limited, then traditional approaches
are likely to be more effective.
Charon rejects what she calls the authoritarian model of the doctor–
patient relationship, with the doctor being the authoritarian figure who
dictates the treatment to the patient on the basis of an assessment and
diagnosis. This is an extreme view, and fails to recognise the medical exper-
tise that the doctor brings to the relationship. The best narrative developed
between the participants is one of mutual respect and an acknowledge-
ment of the other’s position and understanding.
Conclusion
Narrative medicine as a subdiscipline has been dominated by the work
at Colombia University in the USA. This chapter has attempted to show
that there is a broader approach necessary to incorporating narrative into
the relationship between the doctor and the patient, with the patient rec-
ognising the importance of the doctor’s medical expertise and the doctor
recognising the importance of the patient’s position as the person with
the illness and all that implies. An illness, particular a serious illness, is
not an isolated experience, it is not divorced from the rest of life. A serious

illness can impact on all aspects of life, from work to relationships to the
future generally. When the doctor is making decisions, they must account
for this broader perspective. Of course, for a simple illness that will get
better in a few days with a certain drug, this is less important, but with
chronic disorders, disabling disorders or disorders that potentially lead
to death, the narrative approach can add significant value to the doctor–
patient relationship.

Chapter 11
Narrative Health Psychology
The techniques of narrative interviewing and narrative writing are intrin-

sic to any discussion of narrative health psychology and these have been
looked at in some detail, and the reader will see how they can be applied to
their work in health psychology. This chapter briefly presents some exam-
ples of where narrative can be and is used in practice.
It is surprising that narrative approaches are not used more widely in
health psychology, which is focused on helping people deal with physi-
cal health-related problems, from serious physical illnesses such as heart
disease or cancer through to helping people give up smoking or having
a healthier diet. These work best with a narrative approach, particularly
because people understand narratives. When people get ill, they turn to
stories. They tell stories about their experiences, their symptoms, the per-
ceived causes of the illness and how they will get better. Narratives enable
an understanding of the embodied experiences of people from their own
perspective, rather than a medicalised version. This also has a wider perspec-
tive, the stories can tell of the workings of the medical system (‘I couldn’t
get an appointment at my GP’ or ‘I had to wait six months for a consul-
tant appointment’) or the desire for health and longevity (Stephens, 2011).
Narrative health psychology functions at various levels (Murray, 2000).
At the personal level, it examines the lived experience of the person with a
health problem; at the interpersonal level, it involves the construction of
narratives between the patient and the doctor, or the patient and the fam-
ily; at the positional level, it examines the often very different perspectives
of the patient and the listener; and at the societal level, there is the concern
with narratives that are shared and characteristic of a society (e.g. people
in the UK and their mostly positive attitude towards the National Health
Service).
According to Sools et al. (2015), narrative health psychology is a form of
qualitative research in health psychology and a psychological perspective
that falls under the interdisciplinary term narrative health research. It is
147

148 Narrative Health Psychology
a small and emerging field and involves studying the lived experience of
health and illness through storied accounts of lay people, patients and pro-
fessionals. It involves taking the voices of patients and professionals seri-
ously. There is more to health problems than being ill, there are people’s
strengths to consider, their social connections, well-being, spirituality and
imagination regarding the future.
Sools et al. (2015) position narrative health psychology in three ways: as
a variety of narrative psychology, a form of qualitative research in health
psychology and as a psychological perspective under the term narrative
health research. They recognise that narrative health psychology is still a
small and emerging field but has the capability of breaching mainstream
health psychology in terms of approaches, methods and topics. They see
the goal of narrative health psychology to provide people with a voice in
telling their stories about the lived experience of health and illness. Stories
of illness and suffering can be used to successfully understand people’s
experiences of health and health care, and not only health itself, but
also the social context, perhaps in terms of inequalities and social justice
(Stephens, 2011).
Kaptein et al. (2015) considered the representation of respiratory dis-
orders by artists. The nature and severity of respiratory disease is typically
expressed using biomedical measures – pulmonary function, X-rays, blood
tests – but the personal impact of the illness on the patient is reflected in
the stories patients tell. Kaptein et al. argue that novels, poems, movies,
music and paintings can represent a rich experimental understanding of
the patient’s point of view. Examining how illness is represented in art
forms may help patients and health care providers cope with illness while
at the same time humanising medical care. They argue that it would be
beneficial to include art in the medical curriculum.
Using Narrative in Health Psychology: Examples

While narrative health psychology is not universal, there are many health
psychologists who use a narrative approach. Here are just a few examples.
Gunaratnam and Oliviere (2009) edited a book examining narratives in
health care, with a focus on people who are seriously ill and dying. They
used a multidisciplinary approach to try and understand palliative care
from a broad perspective, examining some of the methods and models that
can be used in the area, and how practical and ethical dilemmas influence
health care. They provide a positive outlook on the importance of stories
in palliative care.

Using Narrative in Health Psychology: Examples 149
They argue (Gunaratnam & Oliviere, 2009) that stories and narratives
are integral to the provision of palliative care, that the holistic nature of
the experience is important. This began with the founder of the modern
hospice movement, Cicely Saunders. She worked among the dying, col-
lecting stories of illness and pain, turning the patient narratives into a
philosophy and practice of holistic caring for dying people. This enabled
her to practise medicine in a way to facilitate meaningful connections with
patients. She said she was fortunate to be a doctor who wasn’t in a hurry,
taking time to get to know her patients.
Devery (2009) also examined how narratives might contribute to the
evidence base in palliative care. Palliative care should be committed to
holistic and person-centred care and so demands multiple sources of evi-
dence. It does not lend itself to a set of clear symptoms and is not acces-
sible to evidence in the form of randomised controlled trials. Providing
health care for those who are dying raises profound clinical, psychosocial
and ethical challenges and so a broad and complex knowledge is required.
There are many factors to consider: psychosocial, family and biomedical.
Decisions matter when you are dying. There is a need to consider not only
the clinician’s knowledge but also, in particular, the patient’s viewpoint
and their narrative, along with evidence across the patient population
regarding, for example, mean survival rate over time and disease trajectory
(Devery, 2009). Some people want a rapid death. Some want to survive as
long as possible.
A clinical case study by Mundle (2015) examined pain in rehabilita-
tion therapy in an interview with an 82-year-old female patient in geriat-
ric physical rehabilitation. It provided a detailed example of recognising,
assessing and addressing spiritual distress as a symptom of physical pain.
It focused on narrative content as well as on the interactive and performa-
tive aspects of narrating spiritual health issues in a close reading of two
attachment narratives. Mundle argued that we need a narrative turn in
healthcare, including exploring the therapeutic benefits of empathic listen-
ing through narrative care in geriatric rehabilitation and in healthcare in
general.
Finally, Papathomas et al. (2015) studied eating disorders in athletes.
Most research ignores the families of those with eating disorders, but they
are crucial in the management of the problem. The study examined a sin-
gle case, a 21-year-old elite triathlete who was interviewed along with fam-
ily members (separately) on several occasions over one year. The interviews
encouraged storytelling through an open-ended participant-led structure.
Family difficulties arose when personal experiences strayed from culturally

150 Narrative Health Psychology
dominant narrative forms and when family members held contrasting nar-
rative preferences. The athlete’s narrative evolved over the course of illness,
but the parents were less malleable. The study found that when family
members were constructing different narratives, where there were con-
flicting narratives, there was frustration, anger and poor communication.
Papathomas et al. argue that we need to be aware of how broad cultural
narratives impact on the experience of eating disorders. They initially sug-
gested a joint restitution narrative, but this eventually became a source of
frustration to all those involved. A narrative therapist needs to recognise if
there is a problem of commitment to restitution and could manage expec-
tations by educating people with eating disorders and their families as to
the protracted nature of eating disorders. Alternatively, search for alterna-
tive narratives to live by, such as a quest narrative, or recognising the eating
disorder as a chronic illness that the participants have to live with.
Conclusion
These examples provide a brief outline of some of the areas in which narra-
tive health psychologists have worked. There are many others that have not
been considered, such as serious chronic conditions such as heart disease
or cancer. Narrative approaches may also help where we are looking for
behaviour change, such as stopping smoking or improving diet. There is
scope for research in all these areas. The future of health psychology will
inevitably be largely about narrative health psychology.

Chapter 12
Narrative Work Psychology
Unlike narrative medicine or narrative health and clinical psychologies,

narrative work psychology has a relatively limited profile. There is not
much research into the use of narrative in the work context, at least not
explicitly, though inevitably much work psychology has narrative ele-
ments. This chapter provides examples of how narrative psychology has
been used and how it could be used in the future.
Narrative psychology can be helpful within the occupational setting.
While most occupational psychologists do not use explicitly narrative
approaches, there is a growing acceptance of the importance of narrative.
One of the benefits of thinking narratively in the workplace is the rela-
tionship between individual, interpersonal and group narratives, along
with recognising the disparities between the narratives of the worker and
the narratives of the organisation (Hunt, 2011). Occupational psychology
could more effectively address the impact of these narratives.
The traditional disparate narratives of workers and managers, though
less important in many workplaces than they once were, are still impor-
tant in many settings. The traditional drivers of these disparities, that the
workers feel that management does not recognise workers’ achievements
nor reward good work effectively, and the management view that workers
may be lazy or troublesome, may not be as crude as they once were but
they still apply across many situations. This is inevitable in a society driven
by economy, when the owners (represented by managers) are seen to keep
much of the profit for themselves rather than distribute it appropriately
to those who do the work. This element of Marxism, the idea of surplus
value, may not be popular among many – including occupational and
work psychologists – but it does apply, and it is one of the key drivers of
enmity between worker and manager.
151

152 Narrative Work Psychology
Examples of the Use of Work Narratives
An important element of work is that of identity and identification. When
we work for a company, we should (in an ideal world) identify with that
company and with its values. This is one element of job satisfaction. We
are happier working in a company that we perceive shares the same values
as us than one with conflicting values. Narrative is critical here, both at
the personal and interpersonal levels and at the more macro or even master
narrative levels. If an organisation has an agreed master narrative, then the
people who work for it will be more effective, have better job satisfaction
and lower stress if they approve of and identify with that master narrative.
Companies need coherent organisational narratives that employees on the
whole accept. To be successful, this narrative must incorporate the desires
and needs of the employees. Success is more likely if both the employer
and the employee are being satisfied with the narrative.
People generally want to identify with the organisation they work for.
Humphreys and Brown (2002) suggest that this identification with an
organisation works at several levels. First, an organisation’s identity nar-
rative evolves over time and participants identify with it in various ways.
Second, we need to understand how the individual-collective identifica-
tion process works and evolves. Third, managers play a key role in legiti-
mising organisational and individual identity. Humphreys and Brown,
using the example of an institute of higher education trying to develop
university status, show how senior managers tried to redefine the identity
of the institute and the problems they faced along the way. They found
that senior managers had less power than they initially thought regarding
the change of identity, so the master narrative of the institute was not mal-
leable in the ways they thought, showing that the organisational identity
consists of ongoing dynamic processes driven by power and legitimacy.
In the end, senior managers could not simply ride roughshod over the
often complex narratives extant in the institute, for instance, views about
being locally focused, teaching-led and student-focused being overridden
by university values such as research and taking a broader national focus.
Simply deleting old values and overwriting them with new values may not
be effective because it can alienate those who work in the organisation,
who live by those values (Pratt & Foreman, 2000). Where senior managers
wish to introduce large-scale changes to the identity of the organisation,
they need to consider how the narratives of the workers, how their identi-
ties as workers in the organisation, are often closely linked to the master
narratives, the values and in the end, the identity of the organisation.

Examples of the Use of Work Narratives 153
One study explored narrative in the selection interview, concluding that
while behavioural interviews are not conducive to storytelling, where an
applicant does produce a narrative response to questions about past behav-
iour – in 23 percent of the interviews analysed – recruiters will respond
positively (Bangerter et al., 2014), perhaps because people enjoy listen-
ing to stories. While this study is brief and not conclusive, it does sug-
gest a need to consider the role narratives might play in job selection.
Encouraging people to tell stories relevant to the job, particularly about
their previous job, might enable recruiters to be better able to select the
right people.
More broadly, a person’s career as a whole can be considered in narra-
tive terms. Bujold (2004) described how we can see career as narrative. The
classic approach to career attempts to match a person’s attributes with ‘suit-
able’ careers. While this can work very well, understanding career is more
complex and nuanced. Career choice and development require numerous
decisions, there are many risks, limitations and opportunities, and each
individual has different ways of dealing with these, and with unforeseen
events, personal circumstances and obstacles. This is a creative process that
is at least partly unpredictable. Some people have highly planned careers.
For instance, at my son’s school, there were children at the age of 11 who
had already decided to be accountants or solicitors (which brings in exter-
nal motivators regarding career choice, in particular parents!). Other peo-
ple have careers that appear more random, unplanned or ill-thought out.
Careers may be more or less satisfying. They may follow a predicted course
or an unpredicted one. What once led to high job satisfaction suddenly
becomes tedious. With all these complications, the narrative approach is
likely to present a good theoretical and practical solution to understanding
career.
Identity is critical to career. Along with our personal identities, we have
career identities. It is very common to ask someone we have just met,
‘What do you do?’ as though work is central to the core of identity (‘Tell
me about yourself’ seems a little strange and intrusive – at least in the UK).
Bujold (2004) suggests that a constructionist approach can help us con-
ceptualise career through narrative. Constructionism is primarily about the
individual (rather than social constructionism which is about interactions
and social discourse) and can be helpful in understanding career narratives.
The work of Kelly (1955) on personal constructs is important. Constructs
are representations of the world, ways of interpreting the world, that is,
the perceived world is not just a series of events but how we construe these
events. These constructs are important in helping us make career choices as

it involves our constructs about ourselves and our constructs about particu-
lar careers and expectations of particular careers, and how these constructs
match. We interpret our work using constructions and that narratives are
relevant for career choice as they provide a means of articulating needs and
goals and for examining life patterns (Savickas, 2001).
Using narrative in career and career choice inevitably has implications
for the practice of careers, for how career counsellors discuss options
with people. Narrative-focused career counsellors are facilitators of the
meaning-making process, enabling clients to make sense of what they
want from their career. Cochrane (1992) notes the importance of Kelly’s
constructs in narrative career development. He notes that by engaging in
a career project, a person can construct various elements that can be inte-
grated to guide a future career. In this sense, the counsellor will co-author
the person’s intended life story.
Lainé (1998) discusses how starting or changing a job, being unem-
ployed or retiring are experiences that allow people to reconstruct who
they are, who they were and what they aspire to. Through these processes,
we can undergo many transformations throughout life. Narrating life is a
way of constructing one’s identity. Lainé suggests that autonomy is related
to the degree to which an individual identifies their dependences, and nar-
rative helps with this explanation. Again, we have narrative as related to
the construction and development of identity.
Cochrane (1992) suggests narrative is a paradigm for career research
because story reflects human reality in the sense that life is lived and made
comprehensible through story. Critically, in order for narrative to be
important for career, meaning must be the central subject of a career, that
is, distinguishing between a job, just earning money because one has to in
order to live and actively choosing a career because it provides meaning in
life. This raised the question of what is a good career, a question that will
undoubtedly be answered in many different ways by people depending on
their perspective on life.
In my work (Hunt, 2011), I have examined the utility of a narrative
approach in the field of staff appraisal. As above, this entails examining the
narratives of the people who work in the organisation and the master narrative
of the organisation itself. Two key elements in a successful organisation are
production and job satisfaction. An organisation needs to produce whatever
it produces and its personnel need to be satisfied with their jobs. Appraisal
can play a large part in this by examining and ensuring the fit between the
needs of the employees and the needs of the organisation; in other words,
the narratives of the employees and the organisation, respectively.

Examples of the Use of Work Narratives 155
Traditionally, staff appraisal has, largely through performance ratings,
examined the performance of the workers and (possibly) explored how
the workers’ performance can be improved, either through threats or
incentives. A more sophisticated approach using narrative will enable the
employer to understand how the workers narrate their experiences of the
workplace, examine whether there are differences between those narra-
tives and the master narrative of the workplace and find ways to narrow
the gaps. This might be as straightforward as recognising that employees
are not receiving a fair share of the profits of the organisation, it might be
regarding working conditions or hours or it might be problems between
colleagues. Obtaining narratives from employees in the appraisal situation
can help identify where these problems lie and enable people (workers and
managers) to find ways to address them.
The 360-degree appraisal is a useful tool for obtaining narrative feed-
back. Gillipsie et al. (2006) used experts to code narrative comments, find-
ing that comments provided by supervisors and subordinates were clearer
than those provided by peers, which has implications for such appraisals,
that is, whether it is worth obtaining peer comments, or whether they
should be obtained in a different way. Smither and Walker (2004) found
a link between the characteristics of comments provided by direct reports
and later performance. Basically, the number and specificity of the com-
ments had the most effect. These studies suggest that appraisals should
make more effective use of narratives, that appraisal systems should be
based not only on performance ratings (where they are relevant) but
also on detailed and specific comments by colleagues, whether they are
supervisory or subordinate. Appraisal systems should be designed around
obtaining these narratives more effectively. Brutus (2010) examined the
literature around narrative comments in appraisal, concluding that nar-
rative appraisals can profoundly alter the structure of traditional appraisal
systems, particularly the ways performance information is collected and
presented to participants. Narrative comments in an appraisal can play
a very important part in appraisal systems. Further research is needed
to examine whether it is sufficient to collect qualitative comments or
whether more profound changes might be more effective in matching the
narratives of the employees and the organisation. For instance, Boudens
(2005) looked at emotions at work using a narrative perspective, to iden-
tify clusters of emotions associated with prototypical work situations. She
argued that narrative analysis was the best way to explore this topic. At
another level, Scott (2019) examined how people make sense of their work,
how they develop meaning using narratives. These examples and others

(e.g. relating to stress, appraisal and performance) will build a picture of
how we can use narratives in the workplace across a range of situations,
from understanding the individual through to changing organisational
culture (or the master narrative of work).
Conclusion
This brief chapter has looked at a few examples, but there is scope for
further research and application. In particular, this could involve explor-
ing the nature of master narratives at work, examining how organisations
functioning at a macro level could provide insights into why some organ-
isations are dysfunctional, perhaps because the aims and norms of employ-
ers and employees conflict. Designing organisations to reduce this conflict
could have significant benefits both in terms of organisational efficiency
and job satisfaction. In addition to this, narratives regarding people’s
career choices could provide insight into what it is to obtain a successful
job or otherwise – something further explored in Chapter 13, on coach-
ing. Finally, explaining many of the concepts used in organisational psy-
chology, from job satisfaction to stress, in terms of narrative, would also
provide insights and the means to improve the functioning of organisa-
tions. This is not a job in progress but rather a job that has hardly pro-
gressed. Employers and researchers take note.

Chapter 13
Narrative Coaching
The field of coaching has expanded enormously over the last few decades.
It is one of the relatively rare areas of psychology where the focus is on
positive outcomes rather than resolving negative problems.
There seems to be as many definitions of coaching as there are coaches.
The purpose depends on the coach’s perspective, the style of coaching and
who is being coached and why. Fundamentally, coaching is about conver-
sations between two people, where one person (the coach) is attempting
to influence the other person’s (the coachee) understanding, learning and
behaviour in some way (Starr, 2016). This is a little vague, as it does not
specify who is being coached nor the specific coaching techniques that are
being used. What is common to most coaching is that the coach does not
offer advice, but enables the coachee to think through the issues them-
selves and come up with a solution. Coaching is about becoming rather
than being, developing a meaning, a purpose, whether at work or in one’s
personal life. Coaching should nurture development and growth in peo-
ple, and this is where it links with narrative.
Over an often fixed period of time, the coach facilitates enquiry and
discussion through listening to the coachee, questioning them and provid-
ing feedback. The end of the process is that the coachee has (hopefully)
changed the way they think about whatever the topic of the coaching is,
for example, how to work better, how to manage their time, create a better
work–leisure balance and so on. The coachee should have increased their
clarity of thinking and thought about how to act with regard to the future,
how to change their behaviour and perhaps their thinking patterns.
Coaching is both complex and simple. It is complex because it is focused on
the richness of human relations and the ways we try and support one another,
yet simple in that it is a demonstration of the richness of relationships and
the positive elements of what it is to be a person (van Nieuwerburgh, 2017).
Coaching refers to how we unlock the potential of a person to maximise their
157

158 Narrative Coaching
own performance (Whitmore, 2009). Du Toit and Reissner (2012) suggested
that coaching is the ability to increase and improve the sensitivity and aware-
ness that the coachee has within him/herself. A critical component of this is
honest feedback, which might be difficult to obtain at both an organisational
level, though most coaching is at the individual level.
Coaching Theory and Method

There are numerous approaches to coaching which do not really merit the
term ‘theory’, which is where we come back to the problem with some other
narrative approaches, an appealing looking description of the world and
how to deal with it, but limited research support. The difficulty with coach-
ing is that it is difficult to test, to prove or disprove, which means it is not
theoretically coherent. Often the best way we can determine the usefulness
of an approach is to ask the coachee whether they think they have benefit-
ted from coaching. The problem with this is that the coachee does not pro-
vide the best data. As discussed earlier in relation to narrative therapy, the
Hawthorne Effect may be present, whereby the coachee feels better simply
because they have received attention rather than it has made any difference.
They may also think that they have benefitted because the coaching cost
money – and who wants to waste money? There are relatively few studies
that effectively demonstrate the validity or otherwise of coaching. That is
not to say coaching has no benefits, just that it is difficult to establish those
benefits to an appropriate level of scientific proof. As Theeboom et al. (2014)
noted, there is very little good research on the effectiveness of coaching.
In the end, all coaching techniques are about narrative; they are designed
to change a person’s narrative in a positive manner. We have seen throughout
this book the variety of techniques used by psychologists and others when
dealing with the problems people face in life, and coaching is no different.
One of the most popular approaches to coaching is the GROW model,
which was introduced in the 1980s (Whitmore, 2009). It has been argued
that GROW is a proven model (Mukherjee, 2014), though this is debat-
able. There are four stages to the theory, Goals, Reality, Options, Ways
Forward (I always worry that when people try to create neat acronyms, it
is to cover up inadequate theory), which refer to the stages that the coachee
must go through to create fundamental change. The first stage is establish-
ing the coachee’s goals. It is important to do this at the outset so there is a
clear aim. The goals should be SMART (specific, measurable, acceptable,
realistic, timely – another example of the acronym problem). The second
stage is reality, where the coachee discusses the situation as it is now. The

Narrative Coaching 159
third stage is exploring the options that may be available, and the final
stage is selecting the best option to move forward. At each stage, there
must be a full and frank discussion so that the coachee becomes aware of
what they want, what is the current situation, what are the possibilities and
which possibilities are chosen to act on.
GROW is a narrative technique because it is explicitly working to help
the coachee move from one life story to another. The coachee has a life
story that they are not happy with and wish to change. The coach enables
them to develop and change that life story so it is one they are more happy
with. As long as they act on the changes suggested, then, so the theory
goes, they will become happier and more fulfilled.
Narrative Coaching
We could examine other approaches to coaching, which all have the same
problem regarding evidence, but this is a book on narrative. The person
who has written more on the subject is David Drake, particularly with his
book, Narrative Coaching (2018). There is little real scientific evidence
that it works, which is not to say it doesn’t work, it is just that the current
evidence is limited.
Drake is ambitious in his hopes for narrative coaching, arguing that it
relates to self-defining memories that have emotional power. ‘Narrative
coaching is designed to help people de-stigmatise these memories,
de-energise them as reactive behaviours, and de-couple them from their
identity. In doing so, they are deconditioning their neural circuitry to cre-
ate more space for learning, change and growth’ (Drake, 2018, p. 39).
The first thing someone does within narrative coaching, according to
Drake, is to reflect on a recent experience that is relevant to the issue they
are working on, and then to rewind the narration to help them construct a
new way of framing the experience, what is the story, how they see them-
selves, how they change and what outcomes they want. Fundamentally,
the narrative coach uses the coachee’s stories as the resource for change. A
basic narrative coaching model has four stages:
1. Situate (what is going on?)
Finding out what is true for the individual, their explanations.
2. Search (what if?)
What does the person really want? What kinds of experiences would
they like to have? Obtaining greater clarity about the coachee and
their situation.

3. Shift (what matters?)
What matters most in terms of what they want to try. At this
stage, it is not only the story but also the key characters who are
important.
4. Sustain (what works?).
What works for the coachee? What do they need to sustain their
changes?
This model is similar to many models of coaching and does not present a
specifically narrative way of doing coaching. Drake does claim that stories
are at the core of what it is to be human and that his approach draws on
five important domains:
1. Anthropology
2. Learning and development
3. Jungian psychology
4. Mind and body
5. Narrative practices
Again, this does not make his approach specifically narrative in style, and
indeed, Drake does acknowledge that narrative coaching does have ele-
ments in common with other coaching approaches, and also with various
forms of therapeutic practice. This is because in the end all coaching is
narrative coaching, replacing one story with another. Where Drake does
present a specifically narrative approach is to state that narrative coaches
invite people to:
– Experience and reflect on their ‘movies’ (stories)
– Realise that any story they choose is but one alternative
– Explore new stories that will enable them to flourish
– Notice old stories in which they are stuck
– Reconfigure key elements so they can tell new ones
These are the key elements for ensuring that we are doing narrative coach-
ing rather than any other sort of coaching. There is the acknowledgement
that people are living by a particular story that they believe is not the most
effective one (otherwise why are they visiting a coach?) and that there are
alternatives for them to explore, with the aim of changing the old story for
a new, better one. Through this process, the person must not only change
their story, they must also show how they can change their behaviours to
live with this story and so change their lives for the better.
Drake uses a number of questions to unpack how people see the world.

An Alternative Narrative Approach 161
– Why this way of seeing things?
– What do you gain by seeing it this way?
– What do you lose by seeing it this way?
– How else could you see it?
– What other perspectives might you take?
– What keeps you from considering these possibilities?
– What might you gain if you did?
These are good, sensible questions to help people think about their cur-
rent stories and how they might go about changing those stories but take
the word ‘story’ out and the questions are simply the type of question any
coach might ask, they are not specifically narrative-related.
There are a number of problems with Drake’s approach to narrative
coaching, which are not criticisms of a narrative approach to coaching per
se, but his specific approach. The main one is that there is very little or
no evidence of its efficacy, apart from Drake telling us it works. As noted
earlier, this is a problem with coaching generally, it is difficult to develop
the scientific evidence, partly because many coaches are not scientists, do
not work scientifically and at one level do not care about evidence beyond
their own beliefs that the approaches they use work, partly because science
has not yet developed the means of effectively testing the efficacy of coach-
ing. How do we operationalise the various aspects of coaching? What are
the outcome measures? The second problem with Drake’s approach is the
way he claims it as his approach. It is not the approach, or a approach, it is
as though narrative coaching belongs to him. This does not bode well for
narrative coaching as science; science is lost in the mythology of narrative
coaching.
Drake’s approach is good at bringing in a diverse range of psychological
theories, which provide a helpful theoretical underpinning to this approach
to coaching, but there is no real reason why this approach is specifically
narrative coaching any more or less than other approaches. It is similar to
arguments made elsewhere in this book. In the end, perhaps because we
are storytellers and storymakers, most psychology is about narrative, even
though it is not necessarily explicitly narrative.
An Alternative Narrative Approach

Drawing on the useful work of Drake, but extending the paradigm a little,
we could look at narrative coaching from an explicitly narrative perspec-
tive. That is, we explicitly use stories to help the coachee transition from

one place to another, from one story to another. To do this, we don’t need
to draw on a range of psychological perspectives as Drake does, but instead
keep it simple.
The focus of narrative coaching here is the simple proposition that a
person has one story (about life, work, a relationship, whatever is the focus
of the coaching) and they want to change that story. While everything
that is suggested here is part of normal coaching practice, throughout the
process the person is encouraged to think about their stories. The process
is carried out through a series of coaching sessions, that are a little like the
interviews that were discussed in earlier chapters. The stages are as follows:
1. The first interview focuses on the world as the person sees it now.
This takes into account all important factors. For instance, if the
coaching experience is about work, then the person will describe
their job, the tasks they carry out, their feelings regarding these
tasks and so on. They will also be asked about other aspects of their
lives that are affected by their work. This might be anything from
spending time commuting to turning to alcohol because they are
unhappy, or the impact on their relationships with partners, children
and so on. The aim is to get the story as detailed as possible, drawing
on the coachee’s behaviours, feelings and thoughts.
2. This is written out as a story and is used as the basis for the next
discussion.
3. On the basis of the story, the coachee reviews the elements and
determines which parts should be changed.
4. The coachee is encouraged to think about the kinds of changes they
want to make, what the alternatives are and so on.
5. The new story is constructed by the coachee making decisions about
how to go about making the changes that are required, deciding
explicitly what needs changing, how and when. This might mean
looking for a new job (what type of job?), or it might mean changing
the hours of work, dealing with the workload, discussing the actual
workload with the manager and so on. These changes are of course
decided by the coachee in discussion with the coach.
6. The coachee makes the changes and at a future date reviews these
changes in line with their story, making changes as appropriate,
for example, that certain elements could not be changed or were
changed differently. This becomes the new story.
The important point about this process is that it is all about stories, tell-
ing stories, creating stories and at all points, the coach is involved with

Conclusion 163
the development of these stories through the conversation, so telling and
making stories is carried out in the normal way, with an active audience.
This approach is not proposed as a novel and tested way of conducting
coaching experiences, but as a means of demonstrating how a narrative
approach to coaching might work. For coaching to be narrative coaching,
it must focus on stories, storytelling and storymaking. It is hoped that this
is just an early stage in developing an effective narrative approach to coach-
ing that will eventually have evidence of effectiveness.
Conclusion
While narrative coaching is a promising approach, as it fits with how we
actually think, in stories, there is a distinct lack of evidence for its effective-
ness. This tends to be true for all forms of coaching, despite its popularity,
as it is difficult to establish whether it has had a significant impact on a
person’s life. It can be said to work at the basic level, that is, that coachees
say it helps, and this should not be dismissed. We all have conversations
with other people about what we are hoping to do with life, coaches are
just formalising the process and taking care over the kinds of questions
they ask. Intuitively, it should work. Now we need to establish an evidence
base, something I seem to be saying about many narrative approaches.

Chapter 14
Conclusion
Narrative approaches are slowly gaining popularity. They have many

applications within psychology. Indeed, a lot of applied psychology that
does not claim to be using narrative does use narrative. That applies to all
the practical areas examined. Clinical psychology is an attempt to help
people create new and better narratives for their mental health. Health
psychology is an attempt to enable people to create new and better stories
for themselves in relation to the physical health. While these may not be
explicitly narrative, most approaches have narrative elements. I hope that
the arguments in the book demonstrate that narrative approaches have
numerous benefits within applied psychology, and the methods can be
employed to benefit a lot of people in an efficient manner. As I stated at
the outset, one of the key benefits of narrative work is that the act of sto-
rymaking and storytelling is such a natural process to people that they find
narrative work relatively easy compared to other approaches, though this
in itself is enough to argue for the use of narrative.
Narrative approaches need to be incorporated into general psychologi-
cal science so we can develop good evidence for its effectiveness. Until now
such approaches have largely been under the umbrella of postmodernism
and social constructionism. The book attempts to show how we can look
at narrative scientifically, and to explore the ways we can improve the evi-
dence for the various approaches.
What Do We Think We Know?

We all use narrative. We all tell stories. These stories have an impact on our
lives. Narrative as it has been studied in psychology suggests there are real
benefits in applying it across a range of situations. I have outlined what we
mean by narrative both generally and within psychology, briefly explored
method and analysis (life interviews, narrative writing and narrative
therapy) and then argued for a range of narrative approaches, including
164

What Is the Evidence? 165
narrative exposure therapy (NET), narrative medicine, narrative health
psychology, narrative work psychology and narrative coping. Clinical psy-
chology is covered by narrative therapy and NET. There are many topics
not explored in the book but there should be sufficient information for the
interested reader to explore these areas. I have not looked at developmental
psychology from a narrative perspective. I have barely touched narrative
neuroscience. These and other areas do need greater attention.
What Is the Evidence?

I would like to see narrative firmly within the scientific paradigm, cre-
ating testable theory, designing well-controlled studies and developing a
solid evidence base. There is no reason narrative cannot become central to
scientific psychology. Indeed, people can only benefit from the transition
from the postmodernist to the empirical base, drawing on effective theory.
There are significant benefits not only for applied narrative psychology but
also general psychological theory. NET is a good example of how narrative
can have a strong empirical base.
The difficulty lies in evidence for the theoretical, methodological and
practical utility of the approach. Theoretically, there is disagreement among
researchers regarding the nature of narrative. This is not inherently a major
problem, as this is the case throughout psychology. Methodologically, there
is no real agreement regarding how narratives should be used and how they
should be analysed. In terms of application – the heart and purpose of this
book – while there is good evidence for some narrative approaches, many
approaches, such as narrative therapy or narrative coaching, have limited
evidence in support of them. On the plus side, there is also no good evi-
dence suggesting they don’t work. It is important to carry out research into
these areas to rectify this.
Narrative exposure therapy (NET) is a key exception that has gone main-
stream in the last few years. NET has a strong theoretical grounding, a clear
method and application and very strong evidence regarding its efficacy. NET
is effective at treating post-traumatic stress disorder (PTSD) and trauma.
There is also a lot of evidence around expressive writing. Pennebaker and
his colleagues, and many researchers around the world, have used expressive
writing with various groups and under different conditions. While the evi-
dence is not conclusive, it does suggest that the technique does work under
particular conditions and can lead to a significant benefit for those who use it.
While the evidence for other approaches is not as strong, that which
does exist suggests that we should be continuing with our research and

166 Conclusion
hopefully we will see that they work. One of the problems is that not all
narrative approaches lend themselves to using standard randomised con-
trolled trials (RCTs) to assess utility. For an RCT to be effective, we need
clear outcome measures based on sound theory and methods. Narrative
theory, for instance, is difficult to assess using RCTs because it is not
dependent on accepted classifications of mental disorders (International
Classification of Diseases (ICD) and Diagnostic and Statistical Manual
of Mental Disorders (DSM)). Instead it is based on the individual cli-
ent’s definition of their problem. This should not stop researchers from
determining the success or otherwise of narrative therapy, but it is not
enough to ask clients whether it has worked because they are likely to say
yes because they have put time and money into it. We need measures of
the problems they define which we can employ pre- and post-treatment.
We can use standard measures of depression, anxiety and so on because
they are the accepted norm. Narrative therapists can work with current
theory, expanding on ICD/DSM definitions by continuing to encourage
clients to think about how they define their own problems, and looking at
these in relation to ICD/DSM definitions. This may be helpful in provid-
ing more sophisticated explanations than ICD/DSM currently provide.
This also enables direct comparisons to be made between different forms
of therapy. Similar arguments apply across many areas of applied narrative
psychology, including health and work psychology.
One area of difficulty is that of narrative coaching. The problem here
is not specific to narrative coaching, but to coaching generally. How can
we assess the efficacy of coaching? How can we know that the coaching
procedures we use are working? It is similar with narrative therapy. We
can draw on standard measures to determine outcome. If a person is dis-
satisfied with their career and part of the problem is stress, we can measure
stress levels at the outset of coaching and some time later when the results
of the coaching have been applied and – perhaps – the person has changed
the nature of their job.
One of the problems with applied narrative psychology – and with
other approaches to resolving psychological problems – is that we are
not good at differentiating who will benefit from it. We are aware that
therapies such as cognitive behaviour therapy work for some people
and not for others. The same is likely to be true for narrative therapy.
Based on the evidence, it is also true for expressive writing. This failure
to select the right clientele applies across most areas of applied psychol-
ogy generally. In terms of narrative, some people like to speak or write
about their problems, broadcasting them to others or just throwing
away their writing, but others prefer to keep things to themselves and

What Is the Evidence? 167
not talk about them. Throughout psychology, we are poor at differen-
tiating these groups.
The problem is not so much that we cannot assess the value of these
empirical approaches, it is sometimes that the practitioners are loathe
to employ them as they prefer to stand outside the mainstream. This is
another argument for bringing narrative into the mainstream, instead of
accepting the zealotry that sometimes comes with the subject, the idea that
narrative works because it must work. We are all guilty of these kinds of
thoughts. Whatever our favoured approach, we like to believe it works.
That is not good enough, we need the hard evidence to show that it works.
I too believe that narrative approaches can work, in the right way, with the
right people, but I withhold my judgement until the studies are conducted.
Nevertheless, I wish to highlight the potential of narrative, to bring it into
the mainstream and to scientifically assess its benefits.
The other problem about accepting narrative as a mainstream topic in
scientific psychology is the need for clarity regarding narrative methods
and analysis. As we have seen, there is disagreement about the right nar-
rative approaches to take given particular circumstances. There is a funda-
mental problem for many scientists, that narrative analysis is always going
to cause trouble as any narrative analysis has a subjective element as it
has to be a top-down analysis carried out by people who understand the
nature of stories. While some argue for a quantitative narrative analysis,
it is not possible to fully conduct a narrative analysis quantitatively and it
is arguable that this is not desirable as it would involve losing too much
information in the analysis. Tools such as Linguistic Inquiry and Word
Count (LIWC) (used with the expressive writing paradigm) are not doing
narrative analyses, they are just counting the use of certain words. The
nature of narrative lies in the ways in which words are combined. There
may be scope for complex computer analyses in the future, but it is not
clear whether this will become possible or desirable given the need for
human interpretation.
It is here we need to reflect on what we mean by science. Many people
seem to think science is about using the ‘scientific method’ to acquire
understanding and knowledge, whereas it is about acquiring understand-
ing and knowledge in a systematic manner. This does not preclude the use
of subjective narrative analyses as long as they are systematic and follow a
series of standard rules.
Applied narrative approaches may have little support in some parts of
the psychological community but in the end they are not that different to
other applied approaches. As already noted, all forms of talking therapy are
in one sense narrative therapy as they are intended to make people change

168 Conclusion
their personal narratives or stories. The difference lies in the techniques
that people use. Narrative therapists have a specific set of tools that they
employ to help people.
Future Development and Application

Where do we go from here with applied narrative psychology? As you will
have seen, I am somewhat of an enthusiast for narrative psychology and I
would like to see it everywhere in psychology. I would like it to be a key
theoretical approach within the subject, with other areas such as cognition,
etc., subsumed within an overall narrative approach. That is unlikely to
happen in the near future.
On the positive side, while there are discrepancies, theoretical ideas
about narrative are reasonably coherent. Notions of personal and master
narratives make sense. They are logical, implicit and accepted. What we
don’t know is the detail of how they impact on people’s behaviour. We
need to do more work on master narratives, how they link to, for instance,
cultural memes, how they link to personal behaviour, how powerful they
are and how they may link to the evolution of culture, which requires both
a top-down and a bottom-up approach to understanding the relationships
between the individual and the master narratives. There is a lot of basic
research to do as well as applied research.
NET is the best researched approach in narrative psychology. It has an
excellent evidence base. Many studies, including systematic reviews, show
that it works with people suffering from PTSD. There is scope for using or
adapting NET for other problems that people face. Where there are clear
environmental links with anxiety and depression, an adaptation of NET
might be useful.
Narrative interviews have many potential uses beyond those already dis-
cussed. Not only psychologists but biographers and historians make extensive
use of interviews with relevant people. Drawing on narrative techniques can
improve the quality of the information obtained. The narrative life interview
(NLI) may help focus attention of the impact of specific events or relation-
ships in people’s lives. We have to be tentative about the NLI because at the
time of writing, there are no published studies regarding its use although we
have conducted extensive student work with various groups of participants.
Sometimes RCTs may not be the most appropriate way of assessing the
value of a particular approach. They tend to be crude. They are very useful
in the area for which they were designed, medicine, where it is straight-
forward to conduct a fully controlled study. It is more difficult in any area

Conclusion 169
of psychology, as the nature of the experimental method does not easily
allow for the complexity of either the participants or the techniques being
tested. A person will know if they are in the experimental or control group
if the comparison is between having a therapy and not having a therapy.
The therapist will be aware of which group someone is in. It can be quite
difficult to ensure the experimenter is blind to the group.
The evidence for narratives in applied psychology, in medicine, coach-
ing and elsewhere, is sometimes not meant to be drawn from RCTs, but
is based on the broader experiences of the people involved. It is widely
accepted that people who work with narratives are confident in the
approach, simply because narrative work is what we normally do in life. If
we accept the proposition that we are constantly creating stories, manipu-
lating stories and listening to stories, and this is central to human activ-
ity, then it is logical that using narrative approaches with applied areas is
going to, at least at some level, work. Instead of artificial approaches using
cognitive psychology, psychoanalysis, etc., we are using what people use
naturally every day of their lives. A narrative approach will make people’s
lives better simply because it is normal.
Conclusion
Narrative approaches belong to the scientific tradition of psychology. They
belong where the theory can be tested, the methods can be tested and the
applications can be tested. If they do not somehow fit within this tradition,
then what is the point? Any scientific endeavour must involve observation
and empirical testing. We can observe that narrative approaches work, and
that is a good start, but we need to thoroughly test them to show that they
have benefits. We have done this with NET, and to some extent with ther-
apeutic writing (particularly expressive writing), but we have not done it
sufficiently with the other areas of applied narrative psychology. Without
this testing, without a solid scientific foundation, narrative approaches will
not enter the mainstream.
This overview of applied narrative psychology has been an introduction
to a fascinating and productive area. Psychologists and others who apply
narrative techniques may see real benefits from doing so. While it is an
area with severe limitations, not least the limited evidence for many of the
approaches, the future looks promising.

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Index
applied psychology, 6, 164 evolution, 29

archetype, 49 expressive writing, 6, 12, 92–95, 165, 166
arts, 7
familiarisation, 69
Big Bang, 27 free will, 24
becoming rather than being, 157
general practitioner (GP), 133, 143, 147
career, 153 god, 27
career counsellors, 154 grounded theory, 68
clinical judgement, 137 group writing, 97
clinical method, 139
clinical psychology, 164 health psychology, 147
clinical reflection, 141
coaching ICD/DSM, 166
GROW model, 158 identity, 35, 50–51, 152
co-construction, 67 illness, 136
cognition, 28 individual differences, 26
coherence, 71 interpretative phenomenological analysis (IPA),
communication skills, 134 68, 69, 84, 88
constructionism, 153 interview, 69
constructive memory, 37 interview protocol, 83
contamination, 36–37 Iraq, 126
critical realism, 34
critical reflexivity, 67 journal, 91
culture, 30
master narrative, 42 KIDNET, 125
culture wars, 32
life interviews, 11, 164
deconstructing problematic life story interview, 74–76
dominant stories, 105 LIWC, 95, 167
Default Mode Network, 29
depression, 8 master narrative, 9, 10
diagnosis, 133 conflicting, 43, 58–59
diary, 91 constraints, 59
DSM/ICD, 102 culture, 42, 45
religion, 49
earthquake, 125 meaning, 38
eating disorders, 149 medicine
E-NET, 130 humanities, 135
enlightenment, 31 memory, 24
ethics, 60–61, 68 methods, 10
evidence, weak, 6, 7 multiculturalism, 36–37
187

188 Index
narrative pneumonia, 139
characteristics, 18, 20 politics, 36–37
coaching, 14, 159 postmodern, 59
coherence, 73 post-positivism, 103
definition, 3 poststructuralist, 100
dominant, 32 post-traumatic stress disorder (PTSD), 88, 121
healing, 136 power, 139, 140, 144
integration, 39 powerlessness, 104
non-scientific, 2 psychotherapy, 91
root metaphor, 25, 26
root metaphor of all psychology, 22 rationality, 31
science, 2 RCT, 128, 166
unifying theory and method, 24 re-authoring problematic
writing, 12 dominant stories, 105
narrative analysis, 63, 66 redemption, 77
narrative and story, 16 refugees, 82–88, 124
narrative as science, 28 rehabilitation therapy, 149
narrative exposure therapy (NET), 6, 14, 121, reliability and validity, 67, 71
165, 168 remembering conversations, 106
narrative interview, 64
narrative life interview, 11, 77–82, 168 science and humanities
narrative therapy, 12, 165 integration, 30
clients as experts, 111 scientific method, 167
components, 106 scientific paradigm, 165
cult, 101 self, 34
dialogical disruption, 110 self-realisation, 31
double listening, 108, 109 social psychology, 46
evidence, 117 social representations, 9
externalising focus, 107 staff appraisal, 155
personal agency, 106 stories, 3
problem is the problem, 107 story analyst, 66
redescription, 112 story teller, 66
social and cultural conditions, 111
solution-focused, 112–113 temporal fluidity, 67
thick descriptions, 109 testimony, 126–128
thin description, 108 thematic analysis, 68, 69
unique outcomes, 110 therapeutic writing, 97
natural disasters, 121 therapy
neuroscience, 29 formal and informal, 74
NICE guidelines, 121 transsexuals, 88–90
trauma, 8, 104
Odyssey, 113–114 traumatic stress, 23, 121
palliative care, 149 wokeism, 32

paradigmatic, 9 World War II, 65, 71

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Narratives are grounded in everyday life, from our conversations

Nigel Hu n t is a health psychologist and associate professor at

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Preface page vii

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Since drafting this book, I have experienced a diagnosis of terminal

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There are arguments over what it is to be human. Aristotle argued that

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Narrative and Story

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Chapter 2 addressed narratives in general. This chapter focuses on the

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Stories and Narrative Processes

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Psychology Is All about Narrative

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From Cognition to Narrative

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Narrative and Neuroscience

Evolution and Culture

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Self and Identity

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Redemption and Contamination

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