Narrative Therapy

Narrative therapy emphasizes the patient's personal story or narrative of their illness. It has been shown to be strongly associated with psychological adaptation (Leventhal et al. 1980). The therapist encourages the patient to relate his or her illness narrative, which in children typically centers on five pervasive themes: 1) identity (the symptoms the child sees as part of their illness); 2) cause (the child's personal ideas about the etiology of the illness); 3) timeline (how long the child feels that the illness will last); 4) consequences (the child's anticipated effects of the illness); and 5) cure/control (how the child expects to recover from or control the illness) (Walker et al. 2006). In physically ill children with co-occurring depression, damaged self-concept, illness-related fears, and passive coping mechanisms with respect to disease are common narrative themes (Polanec and Szigethy 2008).

Weingarten (1998) described three illness narrative types: 1) stable (the illness trajectory is unchanged with regard to outcome, i.e., the person is neither better nor worse); 2) progressive (improvement over time); and 3) regressive (deterioration over time). The therapist's role is to help patients identify their themes and help reframe negative narratives into those that are more positive and progressive (Rabinowitz et al. 1994).

The therapist helps patients "make meaning" of their stories and correct misperceptions or misattri-butions in each of the five illness themes. Studies have shown positive effects in patients who have the opportunity to narrate their stories (Suedfeld and

Pennebaker 1997). For instance, Pennebaker (1997) had participants write about a traumatic or stressful event for 15-20 minutes each day for 3-4 days and found that the writing task helped subjects improve emotional regulation by facilitating attention to and habituation to uncomfortable emotional experiences. Schwartz and Drotar (2004) have shown that patients who experience greater feelings of control over their emotions are better able to integrate difficult emotional experiences and report lower levels of distress. Although the sharing of illness narratives on appropriate Web sites (e.g., www.experiencejour-nal.com) has not been tested for efficacy, parents who have read Web-based stories of others experiencing similar illness difficulties report increased feelings of satisfaction (DeMaso et al. 2006).

It is feasible to implement narrative strategies utilizing a family systems perspective. The illness narrative becomes the family's story of their child's illness and its impact on the family system. Although there are few empirical data, many clinicians and family members report benefits from a narrative therapy approach in terms of improved family communication and adaptation to the challenges faced by the family.

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