Storytelling as a Psychotherapeutic Technique

October 8, 2009

Many psychotherapists adhere to psychotherapy protocols such as cognitive-behavioral therapy, interpersonal therapy, dialectic behavioral therapy, or psychoanalytically oriented psychotherapy. Nonetheless, what actually goes on between therapist and patient is often variable and sometimes unique.

Many psychotherapists adhere to psychotherapy protocols such as cognitive-behavioral therapy, interpersonal therapy, dialectic behavioral therapy, or psychoanalytically oriented psychotherapy. Nonetheless, what actually goes on between therapist and patient is often variable and sometimes unique. One method I use involves storytelling, usually with the hope of producing insight, correcting a cognitive distortion, or providing context for an unusual feeling or happening.

All of my stories are offered as a reaction to what patients are telling me. As I listen to patients, I wonder why they are telling me these vignettes of all the many subjects that they could talk about-past, present, future, imagined or real, sad or joyful. While listening, I always have inward musings, images, and stories. It seems that I engage in constant “free association,” which Freud recommended for patients in psychoanalysis but which I seem to have adapted as a therapeutic tool. More often than not, I will share some of these thoughts with my patients, usually in the form of a story.

Over the years, I have developed almost blind trust in these associations, and they may account for what clinical success I have had in both individual and group psychotherapy. When patients come back to see me, often years later for a different issue or a recurrence of an old symptom or problem, most of what they remember are my stories, sometimes with a new therapeutic slant-one I had not consciously intended!

One story I have told multiple times, especially when confronted with patients who are especially gullible or who never question authority figures, is the orange juice story. It is a true account of my own gradual renunciation of unquestioning belief in what others believe and want me to believe.

The story goes like this. When I was growing up, until age 6 or so, I lived with my parents. My mother was into health foods and listened faithfully to Carlton Fredericks, who was a nutritionist advocating wheat germ and other health foods. Whether related to Fredericks’ radio program or not, my mother was also a firm believer in orange juice. It was necessary for me to drink it 7 days per week, always hand-squeezed by her and carefully strained for pits and pulp. Nothing could stand in the way of this daily ritual and I, too, began to believe that orange juice prepared that way was necessary for my continued health and survival.

Then my mother got sick, even though she also drank hand-squeezed orange juice daily. She became weak and depressed, gained weight, and ended up in the hospital for months at a time. She went to a psychiatrist who administered electroshock treatments, but that helped only transiently. She went from doctor to doctor and hospital to hospital. I spent most of that year and the next in my father’s sister’s house. I slept in the same bedroom with my 3 older cousins (I was in the second grade, and the others were either in high school or college).

Many things were different there. One particular thing was the orange juice or, rather, the lack of it. Orange juice was available only on Sundays when my uncle, a big bear of a man who owned a small trucking company, squeezed the orange juice, and we all drank it-pits and pulp together. I was quite afraid of the pits in particular, but when I swallowed one, my cousins all assured me that it would come out-and eventually it did!

Then my mother returned from the hospital for a while, still without a diagnosis, but with her belief in orange juice seemingly intact. So back I went to drinking orange juice daily, relieved that I no longer had to contend with pits and pulp. However, some months later, she had a recurrence of symptoms, and I was sent to live with my maternal grandparents. They seemed to know nothing of orange juice, but drank prune juice, which my disorganized grandmother could never seem to supply in sufficient quantity for my constipated grandfather. I was something of an afterthought for them as they quarreled about her housekeeping and food preparation. So there was no orange juice, and I (miraculously) seemed to stay well, although with some diarrhea.

My mother made an appearance after 6 months, and I changed schools for the third time in a couple of years and went back to the orange juice routine. However, she again needed to be hospitalized, and it was then my mother’s younger brother’s turn to look after me. His wife was not a believer in orange juice, nor (thankfully) prune juice, but she did offer a mixture of pineapple and grapefruit juice from a can. After a summer with them, my mother reappeared, at first unrecognizably thin (in fact, I was even doubtful that it was her) after an operation to take out a nonmalignant adrenal adenoma. It turned out that all of her symptoms were caused by an overabundance of adrenal corticosteroids, what we now term “Cushing syndrome.”

My now-recovered mother once again instituted the strained orange juice belief system, but I was no longer gullible. I had lived through pits and pulp, prune juice, grapefruit and pineapple juice, even no juice at times, so I no longer cared one way or the other. These were all good people who loved me and wished to do right by me, but they differed about important belief systems, and I was no longer much of a believer. From that point on, I was somewhat skeptical of whatever people told me. Also, I lost desire for any type of juice for break- fast, something that continues today, more than a half century later!

Obviously, not every patient of mine has to endure this story-only those who seem to have ongoing difficulty in believing in their own experience in contrast to what others tell them. Gullibility can get people into trouble and usually does. Somehow the orange juice story seems to get to that issue better than any other kind of discussion. Perhaps, it is a built-in trait of humans to love and to learn best from stories, not only therapeutic ones but those from children’s books and even the novels, biographies, and memoirs that many of us continue to read