The Power of the Personal Narrative as a Therapeutic and Educational Tool
by Jeff Roth
The ancient Greeks recognized the connection between writing and emotional benefit, naming Apollo the god of both poetry and healing. It has been said that the great English playwright, William Shakespeare would have been an equally great psychologist. Shakespeare’s uncanny understanding of the most lofty and the darkest aspects of human nature is remarkable. His portrayal of human needs, folly, and humor are vivid and clear. In his tragedy, Macbeth, Shakespeare writes, “Give sorrow words. The grief that does not speak, whispers of the o’er-fraught heart, and bids it break.” Centuries after the bard, psychologists recognized the healing power of the “talking cure” — telling the story of traumatic events as a means toward recovery. It is generally recognized that creative expression, whether through the spoken or written word, art or dancing, can enhance self-esteem, create feelings of self-worth, and support the quest for meaning and healing.
Existential psychologist Rollo May, in The Courage to Create (1975), describes how creative work allows us to accept, articulate, and understand our vulnerability and suffering, providing a sense of release and joy. For James W. Pennebaker, talking about trauma is a natural response, which when blocked or inhibited can lead to stress and illness (Pennebaker, 1997a; Pennebaker, 1997b; Pennebaker, 2004; Pennebaker & Beall, 1986). Conversely, confronting upsetting experiences can lead to positive outcomes. Allen Wolfelt (2002) believes that creative expression also helps children to acknowledge the reality of death when given opportunities to “talk”, “play”, and “act” the perceptions and feelings about death. “Diverse psychotherapies have at their core techniques that promote identification, exploration, and expression of stress-related thoughts and feelings” (Lepore & Smyth, 2009).
Therapeutic Talking after Traumatic Events
Beginning in the late 19th century, Sigmund Freud developed the “talking cure” as a theory based therapeutic approach (Breuer & Freud, 1895; Freud, 1901; Freud, 1917; Freud, 1948). Freud tried to provide a relaxed state in which patients could talk about their deepest thoughts and feelings, reversing adverse health effects by bringing to consciousness memories of traumatic experiences. Client-centered therapists, influenced by Carl Rogers , believe that the act of describing problems with an accepting, empathic listener, allows clients to arrive at their own insights and solutions (Rogers, 1942; Rogers, 1951; Rogers, 1961). The sensitive listener can recognize, understand and normalize feelings associated with a traumatic incident, encouraging the client’s perception of positive personal qualities, actions, and coping.
Jeffrey Mitchell recognized the occupational hazard of post-traumatic stress disorder for first responders such as police, firefighters and emergency medical transport (EMT) workers (Mitchell, 1983; Mitchell, 1993; Mitchell & Everly, 1996; Mitchell & Everly, 2001). These service providers are especially at risk for the phenomenon variously termed vicarious trauma, compassion fatigue, or secondary traumatic stress disorder. These terms describe stress reactions of responders who often witness severe trauma as part of caring for victims of terrible events. Mitchell’s contribution was to recognize the need for proactive approaches to ameliorate the damaging post-trauma effects. Mitchell’s approach enabled responders to tell their stories, “normalize” their response, and plan positive ways to manage stress and seek systems of support. Social support networks and the opportunity to talk with a trusted person to vent feelings and gain perspective after an incident are viewed as extremely beneficial (Brock et al., 2009; Feinberg et al., 2004; Figley, 2002; Johnson, 1998; Stamm, 1999).
Stephen Brock et al. (2009) emphasize resilience as “the ability to adapt to difficult, challenging, stressful or traumatic life experiences.” They view this ability for school crisis team members as “an ongoing process that can be learned and developed. It can be enhanced by accessing social supports, being self-aware, recognizing professional challenges, providing self-care and for many, connecting to something larger than themselves.” The opportunity to give voice to concerns, to discuss feelings about what happens in crises, to develop strategies to manage stress, and to understand when to seek a trusted listener or team support, builds the qualities of resilience.
In the latter part of the 20th century, constructivist theorists developed an approach called Narrative Therapy, which utilizes clients’ stories to understand their perceptions and address identified problems (Freeman et al., 1977; Marner. 2000; Neimeyer, 2000; Neimeyer, 2009; Raskin & Bridges, 2008; Schneider et al., 2008; Steinberg, 2000; White, 2007; White & Epston, 1990). Techniques include reauthoring or reframing the story to promote change, highlighting aspects of the narrative that constructively address the problem, externalizing the problem as separate from an individual, writing alternate or positive narratives that explore not only the difficulties, but client strengths and solutions being utilized. Support for therapeutic change comes from a variety of sources, including empowering letters from therapists to clients, certificates of recognition for children, and social networks such as family, friends, teams and organizations. Narrative Therapy provides validation and ideas for the use of narratives and storytelling to support those who experience and respond to traumatic crises.
Given the prevalence of calamities and severe trauma world-wide, Stephen Madigan (2011), discusses both the relevance of Narrative Therapy and the importance of finding ways for people to speak safely about experiences without being re-traumatized. An appreciation of children’s reactions to trauma and their vulnerability is especially necessary. People should not be required to speak directly or immediately about their traumatic experiences. The child or adult should never be shamed, blamed, or forced to tell particulars of trauma, and safety factors should always be considered. Given these cautions and with cultural sensitivity to norms of expression, children and adults can discover alternate story lines, a secure territory, and safe, unique ways to articulate the experience of trauma and find renewed hope for the future.
Written Personal Narratives about Traumatic Events
Viktor Frankl’s book, Man’s Search For Meaning: An Introduction to Logotherapy (1997), is a remarkable personal narrative that describes his survival in Nazi concentration camps during World War II. He emphasizes the vital role of finding meaning in life for surviving extremely traumatic experiences, and for emotional well being. Frankl’s book is an example of how therapeutic narratives lend themselves to both the spoken and written word. Another example, The Comfort Garden: Tales from the Trauma Unit (2011), by Laurie Barkin, is a personal narrative about her service and distress as a hospital trauma unit psychiatric nurse suffering from vicarious trauma. Her writing and insights were an integral part of her recovery.
It is clear that telling one’s story is incorporated into psychological first aid and many therapeutic approaches. Storytelling or writing about what happened can help the person who has experienced a traumatic incident and also help the first responder who has witnessed the pain of an event. Lepore and Smyth (2009) point out the profound influence of writing “on the feelings, thoughts, and behaviors of individuals and entire societies.” There exists a body of literature about the benefits of written personal narratives. Therapeutic writing can explore cognitive, emotional and spiritual realms not easily accessed.
James W. Pennebaker takes the position that the writing paradigm is an exceptionally powerful therapeutic means of expressing emotional experiences (Pennebaker, 1997a; Pennebaker, 1997b; Pennebaker, 2004; Pennebaker & Beall, 1986). He and his associates tested the hypothesis that repressing thoughts and feelings about traumatic incidents was linked to illness, while expressing them through writing was linked to improved health. Pennebaker’s research demonstrated that writing about thoughts and feelings associated with trauma resulted in improved mood, greater physical health, and a more positive outlook.
Susan Zimmermann (2002) identifies simple techniques that facilitate the healing benefits of writing:
- Write about your deepest thoughts and feelings
- Write in a place where you will not be interrupted
- Write frequently – daily if possible – not less than three or four times a week
- Write for yourself only, not for an audience
- Seek professional help if you are dealing with serious depression — writing might be a part of broader therapy, but should not be relied upon alone.
Zimmerman suggests keeping a simple notebook or journal and using the DHB rule: “Don’t Hold Back” or be constrained. An essential element is to write freely and to overcome inhibition of thoughts and feelings.
Louise DeSalvo (1999) cautions that while writing about traumatic events can be a “helpful way of integrating them into our lives, of helping us feel happier, of improving our psychic and physical well-being,” there are special challenges and concerns. Writing about extreme trauma that has caused deep psychological pain or post-traumatic stress disorder poses the risk of the author being re-traumatized. It is recommended that writers who have histories of extreme trauma or appear emotionally vulnerable have skilled professional assistance. It is suggested that authors have a writing plan, monitor their emotional responses, have a network of support, and if necessary, seek professional help.
Narratives as an Educational Tool
Personal narrative case studies appear not only therapeutic for storytellers describing traumatic incidents, they can also inform and help prepare prospective crisis responders for similar incidents. The educational aspect of narratives is most effective when the writer or readers reflect upon and discuss the event and the lessons learned. While evidence-based frameworks such as the PREPaRE Model significantly contribute to the practical application of school crisis interventions, more guidance is needed on how to operationalize the concepts and skills learned in workshops and apply them to real crisis situations (Brock, 2011; Brock et al., 2009; Reeves et al., 2011).
Narrative case studies that illustrate the problems presented by traumatic incidents in schools can encourage reflection upon practice and help to educate and strengthen both new and experienced crisis responders. These narratives, in the compassionate voice of the responder, combine an intellectual, “in the head” understanding of how to implement response with an emotional, empathic, “in the heart” understanding of how it feels to do it. They provide a powerful training tool for the preparation of both college students and experienced practitioners, taking them into the trenches to confront the unique challenges, decisions and problem-solving demanded for effective practice. Personal narratives written about a variety of traumatic incidents from a variety of perspectives provide a common frame of reference for training and team development.
Student study groups or school response teams can empathize, think about how to resolve problems or conflicts, or adapt the narrative to conduct a “table top” drill. Narrative case studies also provide psychoeducation for the training and preparation of school psychologists, counselors, social workers, nurses, administrators and other responders. Psychoeducation provides direct instruction and disseminates information that helps survivors and caregivers prepare for, and respond to crises, and the problems and reactions they generate (Brock, 2011). In her book containing narratives of catastrophic school crises, Mears (2012) states that its purpose is “to help you prepare for the worst that you can imagine, so if it occurs, you will find yourself able to make the kinds of decisions that need to be made.”
George Isaac Brown (Brown, 1990) advocated for confluent education, which provides the learner with both information about a topic and an emotional experience associated with that topic. The learner identifies with the subject matter on a more personal, feeling level, derives more meaning, and more effectively retains the lessons of what has been presented. First-person narratives that portray traumatic experiences are prime examples of confluent literature, describing both the facts and feelings associated with these events. The narrative case study can be powerful source of learning about what it is like on a visceral level to engage in crisis response.
Pennebaker (1997b), observes that when people write about the same trauma over several days, their description of the event is gradually shortened and summarized. During this process, “irrelevant issues and tangential impressions are dropped; central features of the traumas are highlighted and analyzed.” When the writer engages in this kind of compacting of the traumatic experience, the reader is provided with an organized, summarized perspective of essential elements which may be helpful in a future response. Pennebaker proposes that when people confront traumas by talking or writing about them, they can recognize resulting psychological and physiological reactions, their stress levels are reduced, and they are better able to reorganize and assimilate the events. Essentially, Pennebaker believes that writing about traumas can be an effective tool to discover meaning and self-understanding. Similarly, the reader has the opportunity to understand the meaning of an event, to empathize with those affected, and to learn how to help them recover.
DeSalvo (1999) recognizes the broad range of emotions experienced while writing about trauma, and the importance of expressing emotions without becoming overwhelmed by them. Writers must learn to, and sometimes get help to manage difficult feelings. She describes the benefits absorption -– becoming deeply immersed in writing, which quiets and calms the writer. She believes that writing regularly promotes resilience, enabling people to bounce back when coping with difficult events. The prospective crisis responder reading narrative case studies may similarly become absorbed in a devastating story, while at the same time cultivating a quiet, calm physical and psychological space. This emotionally regulated space may also be cultivated when the reader or a team of responders reflect upon process and internalize the facts and feelings of the narrative. They may develop resilience and the capacity to function more calmly and effectively in the midst of chaotic circumstances.
According to DeSalvo (1999), “storytelling teaches and reteaches us empathy.” First person narratives that share the perspective of the storyteller provide opportunities for the reader to experience and observe the expression of empathy. Because the capacity for empathy may be enhanced or diminished in extreme situations, crisis responders must be aware that the ability to express empathy during interventions may be very different from one individual or situation to another. Responders can learn to express genuine empathy for affected individuals, that is regulated, supportive, and consistent with their level of need, rather than labile, intense emotions that can lead to the responder becoming enmeshed or immobilized. Stories of crisis response can provide cautionary tales, reminding responders to monitor the depth of their empathic and emotional reactions.
The writing of narrative case studies about traumatic events can support care for the caregiver in a variety of ways. Preparation for what to expect, what to do, and how to care for self and other caregivers during and after a traumatic event is vitally important. Reading and reflecting upon narratives provide a means of learning about ways to meet the emotional needs of responders and reduce the risk of vicarious trauma. Bolton et al. (2004) point out that “practitioners can…use much the same writing processes to enable them to reflect effectively upon their practice for professional development.” Personal stories can prepare prospective responders who will experience similar incidents, improve practice, and enhance the network of responder care.
Barkin, L. (2011). The comfort garden: Tales from the trauma unit. San Francisco, CA: Fresh Pond Press.
Bolton, G., Howlett, S., Lago, C., & Wright, J.K. (Eds.). (2004). Writing cures: An introductory handbook of writing in counseling and therapy. New York: Routledge.
Breuer, J. & Freud, S. (1895). Studies in hysteria. (Standard Edition, Vol. 2).
Brown, G.I. (1990). Human teaching for human learning: An introduction to confluent education. (2nd ed). Gestalt Journal Press.
Brock, S. (2011). PREPaRE: Crisis intervention & recovery: The role of the school-based mental health professional (2nd ed.). Bethesda, MD. National Association of School Psychologists.
Brock, S.E., Nickerson, A.B., Reeves, M.A., Jimerson, S.R., Feinberg, T. and Lieberman, R. (2009). School crisis prevention and intervention: The PREPaRE Model. Bethesda, MD: National Association of School Psychologists.
DeSalvo, L. (1999). Writing as a way of healing: How telling our stories transforms our lives. Boston: Beacon Press.
Feinberg, T., Pfohl, W., & Cowan, K. (2004). Crisis: Tips for Caregivers. In A. Canter, L. Paige, M. Roth, I. Romaro, & S. Carroll (Eds.), Helping children at home and school II: Handouts for families and educators. Bethesda, MD: National Association of School Psychologists.
Figley, C.R. (2002). Treating compassion fatigue. New York, NY: Brunner-Routledge.
Frankl, V. (1992). Man’s search for meaning: An introduction to logotherapy.Boston: Beacon Press.
Freeman, J., Epston,D., & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton.
Freud, S. (1901). The psychopathology of everyday life. (Standard Edition, Vol. 6).
Freud, S. (1917). Introductory lectures on psycho-analysis. (Standard Edition, Vols. 15 and 16).
Freud, S. (1948). Group psychology and the analysis of the ego. London: Hogarth Press.
Johnson, K. (1998). Trauma in the lives of children: Crisis and stress management techniques for counselors, teachers, and other professionals. Alameda, CA: Hunter House.
Lepore, S.J., & Smyth, J.M. (Eds.). (2009). The writing cure: How expressive writing promotes health and emotional well-being. Washington, D.C.: American Psychological Association.
Madigan, S. (2011). Narrative Therapy. Washington, D.C.: American Psychological Association.
Marner, T. (2000). Letters to children in family therapy: A narrative approach. Philadelpia: Kingsley.
May, R. (1975). The courage to create. New York: Norton.
Mears, C.L. (Ed.). (2012). Reclaiming school in the aftermath of trauma: Advice based on experience. New York, NY: Palgrave MacMillan.
Mitchell, J.T. (1983). When disaster strikes: The critical incident stress debriefing process. Journal of Emergency Medical Services, 8, 36-39.
Mitchell, J.T. (1993). Critical Incident Stress Management: The First Decade. Life Net, A Publication of the International Critical Incident Stress Foundation, Inc., 4(4), 1, 2.
Mitchell, J.T., & Everly, Jr., G.S. (1996). Critical incident stress debriefing. Ellicott City, MD: Chevron.
Mitchell, J. & Everly, G. (2001). Critical incident stress debriefing: An operations manual for CISD, defusing, and other group crisis intervention services. Ellicott City, MD: Chevron.
Neimeyer, R. A. (2000). Narrative disruptions in the construction of the self. In R.A. Neimeyer & J. Raskin (Eds.), Constructions of disorder (pp.. 207-242). Washington, D.C.: American Psychological Association.
Neimeyer, R. A. (2009). Constructivist psychotherapy: Distinctive features. New York: Routledge.
Pennebaker, J.W. (1997a) Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162-166.
Pennebaker, J.W. (1997b). Opening up: The healing power of expressing emotions. New York: Guilford.
Pennebaker, J.W. (2004). Writing to heal: A guided journal for recovering from trauma and emotional upheaval. New Harbinger Publications.
Pennebaker, J.W., & Beall, S.K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274 – 281.
Raskin, J.D., & Bridges, S.K. (Eds.). (2008). Studies in meaning 3: Constructivist psychotherapy in the real world. New York: Pace University Press.
Reeves, M., Nickerson, Conolly-Wilson, C., Susan, M., Lazzaro, Jimerson, S., Pesce, R. (2011). Trainer’s Handbook. Workshop 1. Crisis prevention and preparedness: Comprehensive school safety planning (2nd ed.). Bethesda, MD. National Association of School Psychologists.
Rogers, C.R. (1942). Counseling and psychotherapy. Boston: Houghton Mifflin.
Rogers, C.R. (1951). Client-centered therapy: Its current practice, implications, and theory. Boston: Houghton Mifflin.
Rogers, C.R. (1961). On becoming a person. Boston: Houghton Mifflin.
Schneider, B., Austin, C., & Arney, L. (2008). Writing to wellness: Using an open journal in narrative therapy. Journal of Systemic Therapies, 27(2), 60-75.
Shakespeare, W. (1977). Macbeth. London: Oxford University Press.
Stamm, B.H. (1999). Secondary traumatic stress: Self-care issues for clinicians, researchers & educators. Baltimore, MD: The Sidron Press.
Steinberg, D. (2000). Letters from the clinic: Letter writing in clinical practice for mental health professionals. London: Routledge.
White, M. (2007). Maps of narrative practice. New York: Norton.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.
Wolfelt, A.D. (2002). Children’s grief. In S.E. Brock, P.J. Lazarus, & S. R. Jimerson (Eds.), Best practices in school crisis prevention and intervention (pp. 653-674). Bethesda, MD: National Association of School Psychologists.
Zimmermann, S. (2002). Writing to heal the soul: Transforming grief and loss through writing. New York: Three Rivers Press.