Understanding Narratives in Occupational Therapy: Uncovering Meaning and Promoting Transformation

1. Chapter 8 Narratives as a Key to Understanding

2. “The object of the society shall be the advancement of occupation as a therapeutic measure; the study of the effects of occupation upon the human being; and the dissemination of scientific knowledge of this subject.” (Article I, Section 3, Constitution; National Society for the Promotion of Occupational Therapy, 1917)

3. Narrative and Story • Narrative and Story can be used interchangeably. • Stories: • are quite common (so “natural” that they need no explanation) • are told from the perspective of the speaker • provide a way of understanding and interpreting experience • share what is meaningful and important at a particular moment in time

4. Narrative and Story (Continued) • Stories: • are temporally and contextually situated • are open for new telling, interpretations and meanings • (same story may vary by story teller, when told, sequence, or purpose) • concern action and offer a way to make sense of experiences • offer us windows on social life and human character

5. Storytelling • Storytelling is central to human experience • Good storytellers can infuse their narratives with: • tension; • drama; and • suspense • It is human nature to tell or listen to stories • OTs, clients and family members have stories

6. Listening for Meaning • In listening to patients’ stories, health care practitioners bear witness to: • suffering, personal strengths and triumphs

7. Listening for Meaning (Continued) While client narratives are individual representations of the client’s experience and current perspective – they are shaped by dominant narratives in the culture.

8. Listening for Meaning (Continued) • Consequently, clients with the same diagnosis may tell very different stories • (based on clients’ life history including socioeconomic status, ethnicity, religion, cultural narratives and other individual attributes)

9. Frank’s Typology of Illness narratives • Restitution narrative • Chaos narrative • Quest narrative

10. Frank’s Typology of Illness narratives • Restitution narrative: Clients telling a restitution story illustrates how medicine has resolved their problems • A plotline might involve a major surgical intervention, (joint replacement) followed by rehabilitation and ultimate return to former occupation

11. Frank’s Typology of Illness narratives • Chaos narrative: are the most difficult to hear; often not sequenced by a plotline • (They represent a life that is out of control with no solutions in sight. Characterized by events connected by phrases such as “and then… and then … and then…”)

12. Frank’s Typology of Illness narratives • Quest narrative: These narratives show personal transformation that can occur • (Example: when clients confront serious illness and disability and make fundamental changes in their lives)

13. Master Narratives - Kirkpatrick • Master narratives represent the values of a culture • May reflect the power of dominant members of society and their prejudices

14. Master Narratives - Kirkpatrick • Master narratives may become stereotypes which suppress the individuality of people and convey negative attitudes and prejudices • people who lack power, (the poor, disabled, racial or ethnic minorities) may be vulnerable to negative narratives • oppression and lack of opportunity may result

15. Levels of Narrative - Kirkpatrick • Personal stories • Community narratives • Dominant cultural narratives

16. Levels of Narrative – Kirkpatrick • Personal stories – individual experiences: • reflected through a temporal lens of past, present, and future, • in social interaction that occurs during and shapes the storytelling • which provides the social and environmental context (containing either opportunities or barriers to the individual)

17. Levels of Narrative – Kirkpatrick • Community narratives: These narratives reflect the communal stories of a group of people. • Shaped and reshaped over time (by the community and individuals)

18. Levels of Narrative – Kirkpatrick • Dominant cultural narratives: Master narratives of different groups of people • These are stereotypes which provide a short hand way of characterizing a group (often negative)

19. Storymaking – Mattingly (continued) • Mattingly – narrative can shape action • OT intervention involves a prospective “therapeutic emplotment” • clients and therapists create new narratives

20. Storymaking – Mattingly • Therapists and clients create a collaborative intervention process • Helps understand and enable clients to transform • A new story is enacted in the intervention process when clients engage in desired occupations