Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 8 Narratives as a Key to Understanding

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins “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)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Listening for Meaning In listening to patients’ stories, health care practitioners bear witness to: – suffering, personal strengths and triumphs

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins While client narratives are individual representations of the client’s experience and current perspective – they are shaped by dominant narratives in the culture. Listening for Meaning (Continued)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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) Listening for Meaning (Continued)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Frank’s Typology of Illness narratives Restitution narrative Chaos narrative Quest narrative

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Frank’s Typology of Illness narratives

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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…”) Frank’s Typology of Illness narratives

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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) Frank’s Typology of Illness narratives

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Master Narratives - Kirkpatrick Master narratives represent the values of a culture –May reflect the power of dominant members of society and their prejudices

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Master Narratives - Kirkpatrick

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Narrative - Kirkpatrick Personal stories Community narratives Dominant cultural narratives

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Narrative – Kirkpatrick Personal stories – individual experiences: 1.reflected through a temporal lens of past, present, and future, 2.in social interaction that occurs during and shapes the storytelling 3.which provides the social and environmental context (containing either opportunities or barriers to the individual)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Community narratives: These narratives reflect the communal stories of a group of people. –Shaped and reshaped over time (by the community and individuals) Levels of Narrative – Kirkpatrick

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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) Levels of Narrative – Kirkpatrick

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Storymaking – Mattingly (continued) Mattingly – narrative can shape action OT intervention involves a prospective “therapeutic emplotment” –clients and therapists create new narratives

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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