Copyright holder: Tyndale University, 3377 Bayview Ave., Toronto, Ontario, Canada M2M 3S4 Att.: Library Director, J. William Horsey Library Copyright: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Copyright license: Attribution-NonCommercial-NoDerivatives 4.0 International License Citation: Poon, Vincent H.K. “Narratives and Therapy.” Canadian Family Physician 53, no. 11 (November 2007): 1881-1882. ***** Begin Content ****** TYNDALE UNIVERSITY 3377 Bayview Avenue Toronto, ON M2M 3S4 TEL: 416.226.6620 www.tyndale.ca Note: This Work has been made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws of Canada without the written authority from the copyright owner. Poon, Vincent H.K. “Narratives and Therapy.” Canadian Family Physician 53, no. 11 (November 2007): 1881-1882. Narratives and therapy I enjoyed reading the various Commentary articles on storytelling and narrative medicine in the August 2007 issue of Canadian Family Physician (pages 1265-89). The articles illustrated the wonderful integration of disciplines in family medicine—anthropology to spirituality, biological approaches to psychosocial-cultural-spiritual approaches. The use of narrative underlines the importance of teach- ing behavioural science in medical training. The authors, however, did not fully elaborate on the origin of narratives and the development of narrative therapy. This is an area I am passionate about, and I hope my sharing will add to their contributions. While Charon said that she and her colleagues brought nar- rative into the medical discipline in 2000, its origins are much earlier and are rooted in the philosophy of social constructivism. Social constructivism started in the sec- ond half of the 20th century, in the postmodern age. The previous modernist worldview claimed that knowl- edge was objective and fixed and that human beings could learn this knowledge and thus find answers to everything in the world. In the postmodern age, where we find ourselves, people believe that knowledge is not objectively learned but is subjective and socially constructed. Therefore knowledge and the knower are interdependent. To acquire knowledge, the knower will have to understand the interrelationship of context, cul- ture, language, and personal experience. People are able to derive meaning from their subjective experien- tial world. Their stories or narratives about their expe- riences, problems, and concerns are ultimately more important than determining whether objective facts sup- port their beliefs. The early pioneers of narrative medicine include Harry Goolishian and Harlene D. Anderson.1,2,3 They developed the constructivist theory in the 1970s at the University of Texas Medical Branch. Their primary focus was on understanding the client’s worldview and values through his or her use of language. Psychotherapists tried not to impose their own language but rather would adapt to clients’ points of view. The client would subsequently feel understood and would be willing to make changes on his or her own. In therapy, the client and therapist worked together and communicated in a common lan- guage familiar to the client. Together they created a meaning-generating system. They talked with each other instead of to each other. The therapist assumed a “not- knowing” stance, willing to be informed by the client of his or her situation. In the early 1990s, Michael White in Australia and David Epston in New Zealand further developed these concepts and established narrative therapy.4,5 They adopt an approach that recognizes that each person’s life is a story in progress that can be viewed from a vari- ety of perspectives and that can have any number of outcomes. The counselor attempts to understand the problems the client faces from the client’s perspective. Change occurs when the counselor and the client, work- ing together, find new and alternative ways of looking at things and explore new possibilities about life and the way the client relates to others. So how do we apply this in family medicine? I have been advocating that family doctors should include counseling in their practices.6 They are in a unique position to help patients change. In medi- cine there are many ways to help our patients. At one end of the spectrum there is science, objective and precise. Take the case of a patient presenting with an acute abdomen: we know exactly what to do— perform proper investigations, establish the diagnosis, and then, for example, consult the surgeon to have the inflamed appendix removed. At the other end there is art, with psychosocial, cultural, and spiritual dimen- sions. This is where narrative therapy belongs. It takes time and involves the art of listening and understand- ing patients in their contexts. Family physicians are trained in both the science and the art of medicine in order to serve their patients well. Therefore, fam- ily doctors realize the interrelatedness of the biopsy- chosocial approach and the roles they need to assume in managing patients and their families. They do not just provide diagnoses, physical healing, and disease eradication. They also journey with patients suffering from chronic diseases, psychiatric illnesses, personal problems, and issues accompanying death, dying, and relationships. These conditions interfere with normal physical, psychological, and social functions. When family physicians fully understand the perspectives and circumstances of patients, they can more effec- tively help them to process and accept what is hap- pening to their bodies and work with them to find alternative ways of perceiving their situations. Patients can then continue to write their life scripts and stories. Physicians can also explore spiritual meaning with patients and their families. This can bring hope and new perspectives to difficult life situations. When fam- ily physicians integrate these things into their prac- tices, they will be able to use both the science and the art of medicine to serve patients and their families in a holistic way. I believe physicians themselves would also benefit in their own life storytelling by adopting this mode of narrative medicine. —Vincent H.K. Poon MD PsyD FCFP AAMFT Approved Supervisor Toronto, Ont by e-mail [ Page ] 1881 References 1. Anderson H, Goolishian H. Systems consultation to agencies dealing with domestic violence. In: Wynne L, McDaniel S, Weber T, editors. The family therapist as systems consultant New York, NY: Guilford Press; 1986. p. 284-99. 2. Anderson H, Goolishian H. Human systems as linguistic systems: evolving ideas about the implications for theory and practice. Fam Process 1988;27:371 -93. 3. Anderson H, Goolishian H. The client is the expert: a not-knowing approach to therapy. In: McNamee S, Gergen K, editors. Social construction and the ther- apeutic process. Newbury Park, CA: Sage Publications: 1992. p. 25-39. 4. White M. Re-authoring lives: interviews and essays. Adelaide, Australia: Dulwich Centre Publications: 1995. 5. White M, Epston, D. Narrative means to therapeutic ends. New York, NY: Norton Press; 1990. 6. Poon VH. Model for counseling people in relationships. Can Fam Physician 2007;53:237-8. [ Page ] 1882 ***** This is the end of the e-text. This e-text was brought to you by Tyndale University, J. William Horsey Library - Tyndale Digital Collections *****