Some psychologists use narrative therapy (not merely “talk” therapy but a closer look at the patient’s communication content), which at one time had a fairly structured modality that utilized exchanges of narratives between patient and therapist. The therapist’s record could become discoverable in litigation. Some psychotherapists videotape or audiotape their patient sessions or take voluminous notes. While initially protected by the therapist-patient privilege in most states, the patients mental state is placed at issue in litigation, these records may become discoverable, i.e., other parties may obtain duplicates to examine the person’s mental status history. Due to this, many therapists take no to few notes. Normal narrative therapy is consistent with social work values and practice in general. Narrative therapy should be collaborative in ways discussed herein, produce patient orientation, and promote insight. The collaborators to the therapy work to generate meaning in the stories and to access memories helpful to the patient’s specific needs. Narrative therapy is a product of the postmodernist movement and may not, as commonly structured, be the most helpful tool for an ABI survivor. An important type of psychotherapy using narrative, however, is behavior modification, which is widely used to help survivors learn to understand how they might act or react more appropriately in various relationships.
Poststructuralism (cultural creation of self) and postmodernism (internal self creation) are not inconsistent in narrative theory. While the postmodern views self as identity, and the structuralist views self as determined by culture, the views are not inconsistent for narrative therapy and analysis purposes. Postmodern ideas of psychotherapy comprise therapeutic progress of therapy modalities against or advancement beyond the former modalities. While many use postmodern, poststructuralist narrative theory is that which extends and criticizes, then deconstructs narrative, emphasizing the plurality of meaning, meta-narrative, and work to reveal previously unquestioned assumptions and inconsistencies.
In narrative therapy, the survivor of ABI works to revise her internalized cultural stories into stories that are more inclusive and show appreciation for the survivor's personal power and responsibility. This is a fundamental and crucial difference between story revision narrative therapy and other models. In this postmodern model, the survivor gains self-esteem and confidence and accepts responsibility for crafting and revision of stories. This should not be underestimated. The increase in self-esteem and acceptance of the responsibility and ability to change the story can manifest itself in dramatic healing. The importance of the impact of learning these concepts allowed me and my peers to begin reconstructing our identities, our selves, and our stories and relations with others.
Brain injury is a specific reason for self story changes. Injury produces uncertainty of recollection in the survivor and skepticism of accuracy in the patient and the treating listener. Memoirs and pathographies about recovery or death from injury or illness are more numerous in this century than ever before known. In these stories, self is an uncertainty, due to injury or illness, which perpetuate the story and the person's life.
What distinguishes collaborative narrative therapy from the more traditional therapies is the emphasis on story deconstruction and the externalization of problems to allow the patient to view her problems from a more objective perspective. Narrative therapy addresses the social aspects of our story constructs to question what we may have believed to be absolute truths and emphasizes deconstruction to those embedded truths that negatively affect our selves. ABI survivors learn to accept the permanent changes to their selves They reconstruct their selves by more objectively examining, in collaboration with the therapist, the post-injury deficits and changes. In narrative story therapy, we construct stories and develop our views of cultural and political realities consistent with our new values and beliefs.
An assumption of traditional narrative therapy is to assume the truth and legitimacy of the stories of a patient. With brain injury, the survivor questions accuracy of recall and is usually hesitant to disclose the story as fact, often temporizing the telling or writing. With ABI survivors, this assumption should be modified in favor of examining the intrinsic facts for reliability. This can be done by reference to accident reports, acute care reports, repeated recall of events in collaborative therapy, and interviews of family members and friends. While it is true that each time we access a memory, we make slight changes in it, this can be taken into consideration by a knowledgeable therapist. Survivors of ABI may be unsure whether they actually recall a fact or recall something someone told them. Their thought processes are slowed and their unconscious may produce confabulation to fill the gaps in stories.