Gail Noppe-Brandon, LCSW, MPA, MA
author bio at end of article.
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I know that readers of this site approach work from many different experiential angles. What I hope to offer in this article about Coherent Narrative Therapy (CNT), is a portal into beginning any kind of work, and a lens through which to listen as you do your ongoing work. The goal of CNT, for the practitioner, is greater access to discovery work that will yield either the client’s transformation, or a radical acceptance of their own self, as they are. The goal for your clients, is authorization: authoring their own story and becoming autonomously and securely attached to their own emotional truth; that kind of being, that kind of solitude, is the opposite of aloneness...it is at-one-ness.
CNT is an amalgam of two approaches: Coherence Therapy (CT) and Narratology.
The organizing principle of CT is the belief that symptoms are actually very coherent solutions, which were formed in response to early problems and learnings. These solutions – problematic though they may have become – are actually preferable to the remembered or feared alternative, and they will only fall away when their original purposes are brought into awareness, and when it then becomes clear that these solutions are no longer needed to survive, or to be safe. This coherent therapeutic process is accomplished through many techniques, some of which are actually quite narratological, such as: the co-writing of emotional truth statements with clients, in order to frame stuck places; the use of sentence completions to elicit client knowings; and the spinning of projected narratives that are deprived of their symptoms!
Narratology, as broader than the clinical modality of Narrative Therapy, (conceived in the 1980’s by Epston and White), has as its organizing principle that in order to work well with someone, (whether you’re a therapist, a teacher, a doctor, a lawyer, a parent, etc.), you need to know their story. But, as with classic Narrative Therapy, it is also holds with the core belief that we are not what happened to us, and that people need to be separated from the negative stories of who they are, through forensic investigation of their actual lives. They also need to be freed from the pathologizing diagnoses that may have locked these stories in place…which is, in and of itself, a look at the coherence of their symptoms! And, as with all humanistic and constructivist approaches, it privileges transparency and equality in the healing dyad: client and clinician are collaborators, not helper and helpee.
The two approaches – Narratology and Coherence Therapy – share the belief that what happened to us has shaped our behaviors, in ways that are completely explicable, and that when we discover the connections between what we once learned – through experience or modeling – and how we currently behave, we can either radically, (and unproblematically), accept the resulting choices we’ve made, or we can transform them. Interestingly, there’s a third lens that can be neatly laid on top of both the Coherent and Narratological approaches, and that is Mindfulness. The poet, Grace Shulman, said: ‘We see things only once — in childhood —the rest is all a memory’. I was reminded of this construction recently, while reading a book about the science of meditation, written by a Tibetan Buddhist who’s been collaborating with American neuroscientists to study the effects of Mindfulness on the brain. The scientists had explained to the monk that ‘perception begins with stimulus’. An example of what they meant is this: The optic nerve sees a banana. It takes in something yellow, that’s brown at each end. Once the visual stimulus is sorted in the Thalamus, it’s sent for processing in the limbic region of the brain, where the nature of the experience is registered as pleasant or unpleasant, and a judgement is then made as to whether this yellow thing is a good thing, or no. It’s then kicked up to the neocortex for pattern storage as banana...both what it tastes like, and whether we like it or not. This is very loosely the map of perception; and once we have stored a perception this way, we’re no longer actually seeing the banana, (or anything else), but an image we’ve constructed, and one that now also carries past experiences, and all of its associated biases...including the environment and expectations in which we first encountered it. In order to overstep this sort of non-seeing, in the act of being mindful we strive for a state that yogis identify as beginner’s mind, in which we attempt to actually experience the thing we’re encountering itself, and not the idea we’ve constructed about it, replete with all the possible prejudices and mis-learnings therein, and where the neuronal patterns stored in the amygdala can be triggered easily by events that bear even a slight resemblance to an earlier incident, and can distort our perception of present-moment events. Anyone whose taken an MBSR, (Mindfulness Based Stress Reduction), training, knows that this is what slowly eating a single raisin is all about. When we can slow into full presence, this act of re-knowing is actually a kind of memory reconsolidation, such as we aim for in Coherence Therapy, Narrative Therapy, EMDR, AEDP, IFS, Hypnosis, Somatic Experiencing, and many other transformational approaches.
In this manner, when I speak about a client’s narrative, I’m speaking about the perceptions they have come to have about the world, and of themselves, and of their lives; the hope is that in really looking at what they’ve lived, they will have the opportunity to actually parse what have become deeply embedded constructions, and not necessarily the truth of what they’ve actually lived, or can live – which is mutable – and therefore the opposite of frozen trauma. Nothing in our experience – our thoughts, feelings, or sensations – is as fixed and unchangeable as it appears. When you think of the past, you’re merely recalling an experience that’s already happened…it’s only a memory, a thought passing through the mind. The past is nothing more than an idea…the future, too, is just an idea. What you’re left with, as an actual experience, is the present. But the moment you identify an instant as now, that moment has already passed. As a laboratory science, memory reconsolidation is about revising old learnings by presenting repeated prediction errors in the present: that is, cheese used to come when the bell was rung, now it comes when the lever is pushed; the rodents’ expectation is changed, their new habit follows. It’s both similar, and far more complex, with the humans we work with.
In a clinical human context, unlike the lab, it’s important to remember that the process of learning something new, doesn’t erase autobiography…it simply changes the way the expectations have generalized. In other words, if our perceptions really are mental constructs, conditioned by past experiences and present expectations, then what we focus on, and how we focus, become important factors in determining our experience. The more deeply we believe something is true, the more likely it will become true in terms of our experience. So, if we believe we’re weak, stupid, or incompetent, then no matter what our real qualities are, no matter how differently our friends and associates say they see us, we’ll experience ourselves as weak, stupid, or incompetent...until we can see, explicitly, where, how and why this false narrative took hold…and what it would now cost us to revise it. If our parent had low self-esteem, and felt threatened by any of our accomplishments that might exceed them, and criticized us harshly to keep us in our places, or cut us off if we left our place, we’ve been taught – as surely as we once learned whether or not we liked bananas – not to expect, or even wish, to be seen differently. We’ve learned that competence and self-worth will be punished…and this is what we refer to as a schema…a rule we’ve learned about the world; and our narratives about ourselves play out in accordance with these well-learned rules. Simply identifying these schemas is how we begin to understand the coherence of our struggles…but that’s just the beginning; then the narrative must then be revised!
There’s currently still a fissure between the spiritual worlds of embodied mindfulness, and the storied world of our narratives; you often hear the instruction to let go of the story, and just follow your breath. I, and other clinicians who practice the Buddhist science of mind, (like psychologists Jack Kornfield and Mark Epstein), believe that this is a false bifurcation, much like the one that once caused a separation of body and mind between the two fields of psychiatry and psychology. I’m hoping to help close that gap a little in this writing. The universe in which we live, and the universe in our minds, form an integrated whole. There’s a widely held and, I believe, misguided notion that a settled mind is one that has no story, and that healing lies in the relinquishing of the story. The fallacy here, is that you can’t let go of that which you don’t hold. Discovery of the story is central to the understanding of the coherence of problematic or symptomatic behavior, and only that which is explicitly understood can be ultimately surmounted and healed. Interestingly, just as the results of a scientific experiment are conditioned by the very nature of the experiment, simply by studying the narrative it’s already changed…with the addition of deep dramaturgical inquiry, it’s changed even more.
A Narratological approach takes the whole story that a person holds about themselves, studies it, fills it out, notices patterns and ruptures, inconsistencies, distortions and contradictions, and therein alchemizes this unsorted data via a healing, sense-making, into a coherent and.integrated whole. It also features a distinguishing approach to client material: in CNT an outline of the whole story, rather than only the problematic timeframe, or the symptom-generating event – out of context from the rest of the client’s life – is gathered in the first sessions, in an exercise called, The Story of You. This global telling focuses, illuminates, and changes the client’s experience of their own story, even before further work is done. In a talk he recently gave, Jack Kornfield said:
“When we feel something fully, it gets softer”. With a holistic telling, and attuned questioning, clients can feel the entirety of their experience this way, with greater clarity and self-compassion. This global telling also changes the experience for the clinician, who is not simply getting a brief bio/psycho/social, or genogram, but a sense of how the client holds the story of themselves, which can then inform everything else that is ever shared in subsequent sessions. How can we respond appropriately if our vision is limited, if we don’t have the big picture?
In closely noticing themes and ruptures, as in Mindfulness, attentiveness guides us very gradually to let go of habitual assumptions, and to experiment with different questions and different points of view. Many clinicians now begin their assessment work with the Adult Attachment Interview, (AAI), a wonderful tool for mapping both relational deprivation, and relational capacity. Unlike the AAI, the dramaturgical questions asked in the Story of You sessions, are not limited to just human relationships, or even primarily those with the client’s parents. The first sessions are a kind of attachment interview, in that many of the questions that are asked address key relationships, but it differs in two very significant ways. First, relationships with people are just one strand of what’s shared and asked about, clients can also have usefully secure attachments to animals, homes, hobbies, toys, God, self, memories, etc. CNT practitioners are not limiting their exploration. Also, we’re combing through their entire experience, not just ten memories that are primarily about caretakers. And while pure Coherence Therapy interventions often do come down to an attachment issue, we’re casting a broader net, including the gathering of positive experiences, which will all inform the work.
Before we even begin to listen to their chronological story, we ask clients to share the earliest thing that most defined them, that is, that had the most impact. This is similar to the AAI question about 'early experiences that may have affected adult personality', but requires less cognition and insight about connections that may not be remotely in awareness yet. The desired response to our question is a gut instinct, regarding one thing about their early life that stands out above all the rest – ten times out of ten this defining thing is directly connected to their current stuckness, also known as their presenting problem. Clients don’t typically have any trouble answering this question, though they often surprise themselves with what they say.
It is probably becoming apparent that the whole key to Coherent Narrative Therapy, is full context...we want to know, and want the client to re-know, all that they’ve lived; not just how they attached and separated. My work didn’t grow out of the study of Attachment Theory, but the study of Dramaturgy…which is the art of culling, shaping, and understanding story. Another suitable name for the approach might be Contextual Therapy, because it allows the clinician to have the full context of everything their client might subsequently bring. I’ve been astonished when therapists I train go back and get this full story from clients they’ve worked with for many years, only to learn for the first time that, for example, the client had been sexually molested as a teen, or had an unwanted pregnancy, which turns out to be highly relevant to many other crises or aversions that have come up in the work.
This approach also focuses on the client’s actual text, the words they speak spontaneously, and in response to the clinician’s questions. It is therapy with text: con-text. And much of this text is recorded during session in a notebook, which is not an archival document – we rarely need to look back at these books later, because radical listening, and noting, allows us tremendous recall – the way in which typing up notes for an exam might! However, we do look back at them throughout the session, to read aloud things that clients have said, for the purpose of meta cognition; or to share patterns we’re noticing; or to align conflicting reports: we call this mapping. If you were to read the transcriptions that are typically derived from most sessions, replete with highlighting of schemas; circles around heightened language or prompts for them to write about later; and arrows connecting dots of coherence, you could probably follow the trajectory of how healing might have occurred that day.
Additional client text is then generated from those prompts that were circled, which are assigned for between-session free-writing in order to deepen meaning, and access blocked memories. These prompts are chosen on the basis of their connection to the presenting problem, or as a possible portal to memories that are still out of awareness. As the research of psychologist James Pennebaker has shown, writing uses a different part of the brain than talking does, one closer to where memories are stored, and because the story-telling drive is in the other hemisphere, when writing from memory there’s a right/left brain tacking akin to hypnosis and EMDR. This invites material to float up into awareness, and without being traumatically triggered. EMDR practitioners are actually wonderful narratologists, as they’re listening for key phrases and events, and opening associative channels that help to unlock that which is, as yet, only implicit…I would suggest that if their initial assessment also included a complete story session, there would be even more understanding of the potential targets to draw upon and potential treatment blockages to unblock; like having the whole elephant rather than just the ear to study. The between-session writing also has many other benefits: it keeps the client connected to their own self-discovery process, even while out of session…which inculcates agency and a secure self-attachment. It’s a meditative practice that settles their minds. And it begins to define their voices and senses of self (author-ity).
Returning to the idea of the memorized banana versus the actual banana, as clients write about and contemplate the enormous variety of factors that came together to produce their specific sense of self, attachment to this I they thought they were, begins to loosen. They become more willing to let go of the desire to control or block their thoughts, emotions, sensations, and so on, and begin to experience them with less pain or guilt, absorbing their passage simply as manifestations of a universe of infinite possibilities. In so doing, they can also begin to regain the innocent perspective most of them knew as children. They can move and bend the idea of the banana, or they can eat an actual banana and see how they really like it now. Their story become less fixed, less frozen; less traumatic.
When I train experienced therapists to apply the Coherent Narrative Therapy model, the four things I most emphasize are these:
Get the whole context upfront. (If most conflicts between people stem from a misunderstanding of one another’s stories, most inner conflicts stem from misunderstanding our own.)
Never lose sight of the presenting problem, and how it connects to what comes up in that first and every subsequent session. (This requires mindful tracking).
Never lose sight of how the presenting problem connects to the earliest most urgent learnings
And don’t let the words your clients are speaking just go by…question everything; and re-cycle their own usages for in-session discovery work, and/or out-of-session writing.
Once we know the basic outline of the story, and the connection between the presenting problem and the deepest early learnings, we are mindfully listening to everything, at each session, through the lens of this global knowing. Over the months, or years – depending on the depth of the trauma – we often return to parts of the story, and listen again…noticing how further context, and healing has changed their meanings, and noting how perspectives have shifted. This meta awareness is, in and of itself, juxtapositional, and helps to reconsolidate memories toward a more fully integrated narrative, and transformation.
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Gail Noppe-Brandon, LCSW, MPA, MA is a clinician in New York City who also works internationally online as a Narrative Coach. She practices Coherent Narrative Therapy, which marries a narratological approach to a coherence-based one and utilizes her skills as a Certified Advanced Practitioner of Coherence Therapy and her training in writing, Focusing, EMDR, and mindfulness. Gail also teaches Coherent Narrative Therapy to clinicians as a certified CEU provider in New York State. Formerly an NYU dean and professor of writing, Gail is a three-time Carnegie Foundation award winner for excellence in teaching, has assisted Bruce Ecker in training psychotherapists in NYC, and regularly gives talks on Creating Coherent Narratives at institutes, conferences, and in her courses for the National Association of Social Workers. Her publications include several books; articles in The Neuropsychotherapist; a book chapter co-authored with Robin Ticic that introduced Coherence Therapy to German-speaking clinicians using one of her cases; and an article on Coherent Parenting on the CPI website. Gail is deeply committed to encouraging clinicians to contextualize presenting problems into the whole story of their clients, and to bringing writing easily into regular use in talk therapy, for its effectiveness with memory retrieval and trauma reduction.