The narrative reconstruction of psychotherapy

Abstract

Going to psychotherapy represents an atypical, usually unanticipated, and often emotionally significant experience in the life course. As with many such events, people construct stories about therapy experiences in order to make sense out of them and to provide their lives with a sense of unity and purpose. Yet beyond these purposes, the storying of psychotherapy is also central to the maintenance of the therapeutic gains achieved during the course of treatment (e.g., Frank, 1961; Spence, 1982). In the present study, the psychotherapy stories of 76 community adults are assessed using grounded theory methodology to determine narrative patterns that distinguish between individuals who currently show different constellations of psychological health. Two dimensions of current psychological health — ego development, or complex meaning making processes, and psychological well-being — serve as the basis for comparisons between participants. Four ways of storying psychotherapy are described, and preliminary interpretations for these types are suggested. In summary: participants high in ego development and high in well-being emphasized their personal agency throughout their stories; participants high in ego development and low in well-being prominently featured their therapists and pointed to the therapeutic alliance as the mechanism of treatment; participants low in ego development and high in well-being adopted components of dominant cultural narratives of therapy; and the stories of participants low in ego development and low in well-being presented an interpretive challenge, lacking a certain standard of narrative coherence. The themes we identified lay the groundwork for future research on the narrative construction of psychotherapy and may prove useful to clinicians as they strive to help their clients to co-construct successful stories about their therapeutic work together.