Background
I use âtherapeutic storytellingâ as a term to describe telling a range of stories that are used to help listeners explore metaphors that enable them to experience a change in perception about themselves and their situation. These metaphors are a way of describing something as if it is something else. So, for example, if someone were very shy, a metaphor for shyness could be a hedgehog that has lost its mirror and is looking for it. The story of looking for it, finding help along the way and eventually finding it would be a metaphor for dealing with and overcoming shyness. The telling is purposeful, targeted and intended to support and develop the listener regardless of their level of cognitive functioning. The content is important, but so too are the ways in which the story is told and the multisensory elements that are brought into the storytelling. All have an impact on the listener at a conscious and unconscious level. A narrative is a retelling of a sequence of events as a statement and history of those events. A story explores the emotional and sensory components and relationships of those events.
Theories and principles
Storytelling as a therapeutic process is well documented (Dent-Brown & Wang, 2006; Gersie & King, 1989; Gersie, 1992; Lawley & Tompkins, 2000). Lahad (1992) suggested that using metaphor and storytelling with people with post-traumatic stress, for example, enables them to address the emotional content of their experience without having to relive the actual traumatic moment.
Attachment theory is an important foundation of the process. This emphasises the need in early childhood for relationships that provide security and comfort on the one hand and the scope for excitement and exploration on the other (Bowlby, 2011). Telling and listening to stories is one way that listeners can be in comfortable and secure settings whilst exploring and experiencing excitement through their imaginations in short, time-limited, self-contained settings. Stories allow the exploration of frightening things â to experience the fear and elation, the tension and the release, the joy and the sadness (Bettelheim, 1976). Stories also allow the learning of social norms and the development of emotional literacy (Killick & Thomas, 2007; Killick 2018, Killick & Okwedy 2020), and bring the promise of hope â that this too shall pass, something will happen to put right the bad things that have happened, but also that if at first you donât succeed, try, try, try again.
Other research that has contributed to the development of therapeutic storytelling comes from neuroscience. Sunderland (2001, 2003) discusses how âfear kills play and can block the ability to learn and the wish to explore the worldâ and relates this to the brainâs emotional memory system. If a fearful incident has happened in the past, a similar occurrence in the present can trigger the same intensity of emotional response. Emotional memories can be laid down by sensory events that occur even before the child can create a memory they can consciously recall.
The brain works through metaphor, storing information and memory as stories describing the relationship between things. From that relationship the brain can develop and build tension, release and calm that can become building blocks of learning experience and feeling safe. The easiest way to access the memory is through emotion, and stories (when well told) create an emotional response. By listening to and exploring the emotional content of stories the listener is accessing their own experiences, even when those emotional issues are too difficult to consciously express. As the character in the story grows, explores options and matures, the listener unconsciously learns about their own emotions, experiences and feelings to help them make sense of what has happened to them, and decide how they want things to be in the future.
Structuring the story
There are various traditional story formats. I use a basic version of the mythic structure loosely derived from Campbell (2008) and which I find fits most (but not all) situations.
Stories begin with the initial situation, in which we are introduced to the main characters and the setting. Then something happens â the problem or change â which calls the hero to respond: typically, something dark to overcome or a partner to be wooed and won. The hero will then prepare for the quest â be given advice, meet helpers, find magical objects, learn skills â or do nothing at all. Then arise the challenges, obstacles or hazards that have to be overcome to achieve transformation, where the challenge is resolved. This leads to a celebration of success. The cycle then begins again.
The challenges generally occur in threes and allow recognition of the pattern of events â the try, try, try again, relating to how the brain deals with information. Most folk tales have it â Goldilocks and the Three Bears and The Three Little Pigs. The first time an event happens, it is registered: âAha! something happenedâ. The next time it occurs it is recognised: âOh, that happened beforeâ. And the third time it is remembered: âOh yes, I have been here beforeâ. And as it is remembered the listener starts to anticipate the next part of the story: âI know whatâs happening nextâ. With anticipation comes learning and thus the possibility of change (Dowling, 2009, 2010).
Work in practice
The focus of this chapter is on the work at the Childrenâs Trust in Tadworth, Surrey between 2004 and 2007 with children who have acquired brain injury from traumatic events such as road traffic accidents, near drowning or strokes. However, it has application to all children (and indeed adults) who are in need of support to deal with the challenges they face in life and I have applied the same principles in my bereavement work with children and adults for the past 15 years.
Before the session, information was gathered about the child â such as hearing, vision, preferred position, preferred movement. I started (and finished) a session with a short song. This âpunctuatedâ the time and using the song voice differentiated from the talking/telling voice. Then I offered my hand and introduced myself, before moving into the storytelling.
I used fictional, traditional and personal stories, plus helped the children to make up a story about themselves. This was particularly relevant for children recovering from traumatic brain injury, where part of the process was enabling them to create a vocabulary and emotional literacy to describe what had happened to them and how they felt about it. Just being able to name the feelings was very important and to recognise that they were not the only ones experiencing them. The trauma of injury may well leave children in a mental and emotional state where they have no words to describe or convey how they are feeling. Listening to and taking part in a made-up story about familiar characters allows them to name and explore the emotions and then relate them to themselves.
I used the visual, aural and kinaesthetic modalities at as many points as appropriate â providing more opportunities for the child to participate and process information. Using tone of voice and sensory objects with different textures (e.g. rough scouring pads, smooth and silky material, knotted string, red stretchy material) I provided metaphors for the emotions that they might be feeling, and then introduced the words to describe these feelings.
Parents and carers were asked about favourite stories from the past. Sometimes it was fairy tales (Little Red Riding Hood seemed to be popular). Sometimes it was a book (Harry Potter), or sometimes a TV show (e.g. SpongeBob SquarePants or Tracy Beaker). By basing the work on familiar stories we donât have to establish an emotional connection with a character, as that is already in place. The focus is then on putting the characters into new situations where they might feel as the child feels. This enables the child to access their current new experiences and develop their emotional vocabulary. The experiences and memories of the past are used to help them find a place in the present. Sometimes I made up a story that was a metaphor for the childâs experience, incorporating elements of their family story; but not quite their family. There has to be enough distance from reality for a story to be a metaphor rather than a retelling of personal history. Most important is for the intention to be clear in telling a particular story. For example, was I telling Jack and the Beanstalk as a story to address bereavement, self-esteem, anxiety, displacement or transition? My intention affected how I told the story, what words I used and, in turn, what the child experienced. However, everyone is different, and my intention for the story might not always match the childâs response. The child would experience the story at a level they could deal with at the time, and that would determine the course of the post-story work.
Harry Potter has much potential for exploring traumatic injury. He falls from his broom in the Quidditch match and lies in the sick wing. His bones grow back but very slowly â there is no sudden magic response. Harry Potter and the Prisoner of Azkaban was particularly relevant as the background story for enacting and telling new stories that addressed metaphors for physical and mental trauma. The dementors suck all the good experiences out, leaving the person with just the negatives emotions â depression. It is also in this book that through his relationship with the Weasleys, Harry finally understands what a good, functional, loving family has to offer, and really starts to grieve for the loving family he never had. In particular, the Patronus spell that Harry has to learn to use for his own protection could be seen as basic cognitive behavioural therapy. A key part of the work involved enabling the child to find their own positive metaphor â their âPatronusââ to hold back their own demons and deal with depression and bereavement.
Outcomes and evidence: what I look for
Outcomes are related to the childâs behaviour and responses, and feedback from the therapy team and other staff familiar with the child.
For verbal children, I look to see whether they are actively involved in the session, and their recall from previous sessions. Sometimes a child will refer to a story that had been told some weeks earlier, wanting it to be retold, or to share a retelling of it, perhaps incorporating changes in it. This indicates that they have internalised the story and indirectly related it to their own situation.
For children unable to communicate directly, and with varying levels of cognitive functioning, their participation is a positive outcome, as is the way they physically present themselves. For example, actively reaching for objects, responding to different physical textures of materials, and vocalising. I watch for eye movements; changes in breathing; small gestures with the head, hand or arm, or even a startle response; and changes in muscle tone from tense to relaxed. For some children the outcome is a change in behaviour â a child who is restless outside the sessions may be more settled, whereas a child who is normally passive outside may become more active inside the sessions. Feedback from staff was used to discover any differences observed as a result of the sessions; for example, being more settled and less distressed, and in their sessions with other therapists, such as b...