Do Shared Narratives Result in Better Client Function? Posted on June 23, 2008 Steven R. López (bio) sees great value in listening to clients' stories.

I don't see myself as an expert on qualitative work. I have no training in qualitative methodology, but I have an ear for people's stories. I have an ear for key ideas from the point of view of the subject or the participant, whether they're the clinician or whether they're the client.

And so in my work over the years I have reported brief vignettes, or I did a "study" in which I taught a course on minority mental health and had the student therapist keep a journal of their considerations of cultural issues with a given case, and we turned that into a paper and talked about the development of cultural sensitive psychotherapists.

One of the things that I've learned is the importance of the narrative, as well as the work of Cheryl Mattingly, the shared narrative, between the consumer, the client, and the therapist. And so one of our goals, well, one of the messages of our training is that the clinician has to develop a shared narrative with the client.

Instead of the clinician saying, "I'm going to help you with your depression by changing your negative thoughts, and that's going to lead to you feeling less sad," well, did the client say they were depressed? No, the client may have said, "I'm nervous, so I don't want treatment for depression," and then, "I never mentioned I had negative thoughts. I have a lousy relationship with my husband," and then, "I don't want to be less depressed. I want to get a job."

So the therapist sometimes imposes their narrative about what the problem is, about what the explanation is, and about the methods, and what we try to do in our cultural competence training is to teach the therapist to access the clients' narratives about the problem and the methods that they've used in the past and their explanations. Access them. Make transparent the clinicians' models, and then come up with a shared narrative. "Okay, you're saying your nerves. All right. Let's work on your nerves. I agree. That's important." That's a shared narrative.

Shared narrative about the direction of the therapy and the explanation. So that's what we're focusing on is really does the therapist, as a function of our training, end up developing more of these shared narratives with the client? And our guess is they're going to get more buy-in, better engagement, better function. So that's the role of the narrative in terms of our work.

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