Using narrative theory in practice

By Dan Mushens

From a social perspective, the most notable presentation amongst alcohol-related brain damage (ARBD) sufferers is the memory deficits – usually short-term but maybe longer, and this can affect their understanding of the chronology of life events.

Quite often, memories spanning decades of someone’s life can be irretrievable due to sustained and excessive alcohol use but helping someone piece together their history can help them to gain a sense of clarity and empowerment.

The use of narrative theory is maybe self-explanatory — it allows someone to describe their own life in their own words which means the practitioner can truly get to understand the situation from the perspective of the narrator.

Essential skills include active listening and not being tempted to disregard what may sound like ramblings, confabulation or going off-topic. It places importance on acknowledging life-experiences while circumventing the box-ticking culture.

‘Recount and document’

I’ve always attempted to avoid forming opinions of people based on what I might have read in reports and assessments, preferring to allow time spent in someone’s company to dictate my viewpoint.

Using a narrative approach allows me to help people recount and document what they can remember from childhood to the present day and then we work together systematically, to attempt to fill in any gaps. The objective is always to have their story written down on paper – something tangible they can hold and own and share with the people they choose.

Unfortunately, it’s often the case that childhood experiences involved parental alcohol abuse, exposure to domestic violence, sexual abuse, criminality or bereavement and grief issues. This in turn can lead to some signposting and referring to more appropriate services such as counselling providers. It’s ironic that these are the memories some people vividly remember, but dearly wish they couldn’t.

The years of employment are often hazy and tend to be described as a succession of work-dismissal-unemployment, with durations and timeframes often difficult to ascertain.

Pinpoint their whereabouts

In the absence of old payslips, bank statements or photographs, one useful intervention is to contact HMRC to request a breakdown of work history. These brief reports act as a great memory tool to prompt people to place themselves in accurate locations during years gone by.

Medical records are an effective way to support people to pinpoint their whereabouts throughout their lives. Most GPs are more than happy to share the information they hold about you during a scheduled appointment.

Once I’ve helped someone write down their recovery stories, I present them with the finished typed document and occasionally they are happy to share it with others in my organisation’s internal newsletters and associated literature.

Some people have voluntarily had their stories published online and in local and national newspapers with one person appearing on a radio show. On one occasion, the publication of a service user’s story in the local newspaper resulted in their child who they’d never met getting in touch, leading to a face to face meeting.

These resulting recovery stories can play another role in a service user’s life. Some people have decided to give a paper copy to new people or professionals they meet for the first time. This is to prevent repetition and having to tell their life story again, but it also acts as another form of memory aid.

From my own experience, the benefits of using a narrative approach is that it’s intrinsically person centred in its implementation – but it also branches off and leads to other good pieces of work and is great for building rapport and engagement.

It should be noted that some people choose not to accept support to write a recovery story. Reasons for this can include that they believe “the past should be left behind”, with more focus placed on their future. Also, some people consider the approach to involve “more paperwork”, preferring to spend their support on more practical and social tasks.

Dan Mushens is a Recovery Practitioner for Scottish mental health charity Penumbra