Your Story Matters: Integrating Narrative into Psychological Assessment

Can we understand a person’s psychological world without listening to their story? Unfortunately, it is not possible. Through the stories people tell, it is possible to understand the contextual details that make them individuals and the characteristics that reveal their reality. Narratives are a way of communicating everyday experiences, and almost all cultures have a place for storytelling (Hall & Powell, 2011). Thus, narrative is a culturally congruent way of identifying and understanding experiences. Moreover, narratives show the social context of events and indirectly provide answers to questions of emotion and meaning. It is precisely for these powerful reasons that narratives are utilized as an assessment tool in the therapeutic setting. In order to provide holistic care to the client, listening to their story in all its aspects is of considerable importance in the therapeutic context. In contrast to traditional assessments, narrative approaches promote a meaning-centered, strengths-based, and culturally inclusive understanding of the client (White & Epston, 1990). This is particularly valuable when working with individuals who feel they are not fully seen by traditional diagnostic frameworks, such as those from marginalized communities, trauma survivors, or clients with complex identities (Sue, et. al., 2009; Herman, 1992). On the other hand, narrative-based assessments encourage client collaboration and shared understanding, which strengthens the therapeutic alliance, a key determinant of successful outcomes across treatment modalities (Norcross & Wampold, 2011). Rather than positioning the clinician as an expert interpreting symptoms from a distance, the narrative approach involves a co-constructed, dialogic process in which clients become active participants in defining their problems and envisioning change (Angus & Greenberg, 2011).

In short, in the therapeutic setting, integrating narrative into assessment processes bridges the gap between objective data and subjective experience. By enriching clinical understanding, supporting client empowerment, and aligning assessment with the broader humanistic values of psychotherapy, narratives are a unique tool for providing holistic care to the client. Given the importance of bringing the story into the assessment process in the therapy setting, the current therapy sketch will examine how narratives are handled in the therapy room, explore different types of narratives, and provide a comprehensive overview of narratives.

What is Narrative-Based Assessment?

Humans are organisms that, by nature, prefer to tell stories (Bruner, 1991). These stories allow us to grasp not only what happened but also what it means, a particularly important distinction in a therapeutic context. Integrating narrative into the assessment process allows clinicians to uncover how individuals organize their experiences over time, how they interpret emotional pain, and how they shape their identities in response to adversity (McAdams, 1996; Adler et al., 2016). But what exactly does narrative-based assessment mean? In a basic definition, narrative-based assessment is a clinical approach that focuses on the client’s story as the primary source of psychological information. This method seeks to explore not only an individual’s symptoms, diagnoses, or test scores, but also how individuals make sense of their experiences, interpret past events, and how these interpretations influence their current identities, relationships, and coping patterns (Neimeyer, 2006; White & Epston, 1990). According to this approach, people make sense of the world by telling stories, and these stories are shaped by culture, context, memory, and emotions (Bruner, 1991).

In essence, narrative-based assessment views individuals not as passive recipients of life events but as participants who transform their experiences into evolving life narratives. These narratives are performative in the sense that they not only reflect events but also build a sense of self over time (McAdams, 1996). As a simple example, it is quite possible for two people with similar traumatic experiences to tell completely different stories, with one emphasizing resilience and growth and the other focusing on themes of betrayal or loss. These different narratives, based on the uniqueness of each individual, have profound implications for mental health and therapeutic orientation.

Narrative assessment is often dialogic and collaborative. Clients are not asked closed-ended or pathology-oriented questions, but questions that invite them to describe their experiences in their own words. Clinicians aim to explore themes such as identity, agency, turning points, values, and hopes for the future through the questions they pose to clients (Angus & McLeod, 2004). Tools often used in the context of narrative-based assessment include:

• Open-ended interviews that focus on lived experience and subjective interpretation.
• Life story narratives such as ‘’chapters’’, ‘’high/low points’’, and ‘’core values’’ (McAdams, 1996).
• Narrative timelines allow organizing past events within a coherent framework.
• Written or visual storytelling methods such as journaling, drawing, or creative expression.

As demonstrated, there are various types of narratives, and the way in which narrative is integrated into the assessment is client-specific. While narrative-based assessment can bring significant benefits to the therapeutic process for all clients, it is particularly critical when working with clients whose stories have been fragmented, silenced, or pathologized, such as trauma survivors, marginalized individuals, or those coping with complex identities. In addition, narrative-based assessment has been recognized as a highly appropriate approach in the context of culturally responsive practices, as it allows space for different worldviews, metaphors, and modes of expression (Lieblich et al., 1998; Sue et al., 2009). This is an important point that emphasizes the universality of narrative-based assessment.

As a result, narrative-based assessment complements traditional approaches by adding depth, personalization, and context. It not only helps clinicians understand ‘’what’’ a client is experiencing, but also ‘’how’’ and ‘’why’’ it is important to them. For this very reason, narrative-based assessment is seen as a powerful tool for both meaningful case formulation and therapeutic collaboration.

What are the Forms of Narrative Used in Assessment?

Narratives in clinical settings are not uniform; they emerge in a variety of forms shaped by the client’s developmental stage, cultural background, personal meaning-making process, and psychosocial context. Recognizing the type of narrative a client uses to describe their experience is an important part of psychological assessment. This is because it shows not only how the person understands the world but also which therapeutic stance may be most appropriate for them (Angus & McLeod, 2004; McAdams, 2001).

According to Angus et al. (2004 & 2011), narrative analysis in the therapeutic setting involves focusing on three interrelated layers:

1. Thematic content (what is being told)
2. Structural coherence (how it is told)
3. Emotional tone (what emotional meanings are conveyed)

The narrative forms that are mostly structured in these three contexts and commonly used in psychotherapeutic settings are as follows:

Restitution Narratives: These narratives revolve around the desire to return to former health or normality. The underlying logic is as follows: ‘’I was unwell, but now I’m getting better.’’ This form is particularly common in medical and acute care settings where recovery is expected or desired (Frank, 1995). While often adaptable, reliance on this format can limit clients’ ability to integrate their long-term illness or trauma, which are not easy to process, into their life stories.

Chaos Narratives: Chaos narratives are characterized by fragmentation, non-linearity, and lack of control or meaning. The client may feel hopeless, emotionally distressed, or confused. These narratives are often difficult to listen to because they lack order and coherence (Frank, 1995). Chaos narratives may indicate the presence of unprocessed trauma, dissociation, or depression.

Problem-Saturated Narratives: Originating from the narrative therapy approach (White & Epson, 1990), these narratives are dominated by a sense of failure, pathology, or deficiency. Clients in this narrative framework often externalize blame or self-criticism and think that their problems define them. These stories may be rooted in family scripts, cultural stigmatization, or invalidation of the past.

Redemption and Contamination Narratives: Personal narratives may also include redemption (bad-to-good trajectory) and contamination (good-to-bad trajectory) sequences. Redemption sequences are associated with higher life satisfaction and meaning, while contamination stories are associated with lower well-being and unresolved traumas.

Although narrative types can take multiple forms, there are some key aspects common to all narrative types:

• The structure of a narrative (e.g., fragmented or coherent, active or passive) reveals how clients process and regulate their emotions (Pennebaker & Segeal, 1999).
• The emotional tone of the narrative, whether hopeful, bitter, or thoughtful, carries critical clues about attachment style and unresolved conflicts (Angus & Greenberg, 2011).
• While the dominance of a single narrative type may indicate rigidity or overidentification, narrative flexibility is often an indicator of psychological resilience.

While recognizing that narratives that include different genres offer essential insights into how clients construct meaning, organize their emotions, and express their identities, it is equally important to realize that not all clients may come to the therapy room ready to tell their stories. Contrary to popular belief, the lack of narrative, difficulties in expression, or silences that fill the therapeutic space can hold many meanings. Therefore, in addition to identifying the type of narrative, it is valuable to recognize the barriers to narrative formation, explore how they emerge, and be able to support narrative development in compassionate, flexible, and culturally sensitive ways. In the next section, we will discuss avenues to follow in the context of clients who experience difficulties in presenting narratives.

Eliciting Narratives in a Therapy Setting

Not all clients may be inclined to tell stories voluntarily. Some may have difficulty with verbal expressions, while others may not feel comfortable in the therapeutic setting, or may lack the emotional vocabulary needed to construct a coherent story. This hesitation may also be related to the fact that the client may have a protective mechanism that has been shaped by previous experiences of being silenced, shamed, or not being believed (Herman, 1992). As can be understood, there may be many different factors behind the client’s avoidance of narrative sharing in the therapeutic environment.

But is it also possible to make sense of the client’s silence? Absolutely yes! Although silence in the therapeutic setting is often interpreted as avoidance or resistance, from a narrative perspective, silence can represent (Neimeyer, 2001):

Narrative Gaps: It may include parts of the client’s life that are too painful or confusing to articulate.

Cultural or Interpersonal Norms: In some cultures, silence may express respect or emotional regulation.

Intellectual Space: The client may need to organize their thoughts, feelings, or memories before they begin to talk.

Clinicians respond to the client’s silence with respect, curiosity, and sincerity, seeking answers to the following questions: 

1. ‘’What might this silence be protecting ?’’ 
2. ‘’What meanings might this silence hold ?’’

Beyond exploring the answers to these questions, the following is what can be done in the face of client silence (Rogers, 1957; Angus, 2004; Geller & Greenberg, 2012):

Providing scaffolding: The clinician can use some opening sentences (e.g., ‘’Tell me about a time when you were …..’’) to encourage the client to engage in conversation.

Being patient: The clinician is patient, allowing narratives to emerge over time as a trusting therapeutic relationship with the client develops.

Changing modalities: The clinician may incorporate drawing, writing, or timelines into sessions to stimulate memories or expressions. By asking the client, ‘’Would it feel easier to write about this or draw it ?’’, the clinician can encourage the client to tell their story in their own way.



Normalizing Silence: By normalizing the client’s silence, the clinician acknowledges the importance of not rushing and recognizes that some aspects of the story may be more challenging to address.

Approach with Empathy: By showing an empathetic attitude towards the client, the clinician can indicate that they understand their silence and stand by them.

Holding Space: At times, the most appropriate intervention for the client is for the clinician to sit in silence and offer their presence and trust to the client.

As clinicians draw attention to both the presence and absence of narrative in the therapeutic process, they begin to uncover deeper psychological and relational processes such as trust, regulation, identity formation, and trauma response. Understanding the fundamental role narratives play in shaping human experience, memory, and meaning allows us to recognize assessment as a relational process that affirms identity, rather than simply collecting data. The following section will examine the critical functions of narratives in psychological assessment.

Why Narrative Matters in Psychological Assessment?

Narratives play a crucial role in the psychological assessment process. There are several advantages of using narratives in psychological assessment processes:

1. Enhances Therapeutic Alliance:  Narratives build trust and understanding between the therapist and the client. Norcross and Wampold (2011) said that the helping alliances are strengthened through narrative procedures, a key predictor of outcome. When clients believe that their stories are taken seriously and they are not judged, they become more committed and engaged in the therapy process.

2. Facilitates Meaning-Making and Identity Reconstruction: Narrative helps in understanding meaning and changing identity. In other words, it makes a chaotic experience into a story or narrative (Neimeyer, 2001). It helps with coping with trauma, loss, or transition. Clinicians can help clients identify their dysfunctions and offer alternative meanings or reconstruction (White & Epston, 1990) when they know how clients’ narratives and member accounts shape identity construction.

3. Supports Culturally Responsive Assessment: The narrative method is in agreement with a culturally competent practice that supports culturally responsive assessment. It does so because it respects people’s subjective viewpoint shaped by their values, language, and identity. When assessment procedures are culturally sensitive, they decrease diagnostic bias and increase treatment effectiveness with various groups (Sue et. al., 2009).

4. Encourages Client Empowerment and Collaboration: An assessment where one expert takes an authoritative role generally creates a hierarchical dynamic.  Unlike this type of assessment, narrative ones diffuse power and position the client as the expert of their experiences. This helps the client feel empowered and supports clients and therapists in creating interventions (Angus & McLeod, 2004).

Takeaways:

• The narratives that clients tell are an indispensable tool for understanding their emotional worlds, identities, and cultural contexts.
• Unlike traditional assessment tools, narrative-based assessment offers a client-centered, meaning-focused, and inclusive approach.
• Narrative-based assessment strengthens the therapeutic alliance and brings collaboration to the process, especially when working with individuals who have experienced trauma, have complex identities, or are marginalized.
• The client’s silence is not a lack of narrative, but often as valuable a message as a narrative. 
• Sentence completion techniques, alternative ways of expression (drawing, writing, timeline), and client waiting combined with an empathic attitude allow the narrative to emerge over time.

References

1. Hall, J. M., & Powell, J. (2011). Understanding the person through narrative. Nursing Research and Practice, https://doi.org/10.1155/2011/293837
2. Neimeyer, R. A. (2006). Complicated Grief and the Reconstruction of Meaning: Conceptual and Empirical Contributions to a Cognitive-Constructivist Model. Clinical Psychology: Science and Practice, 13(2), 141–145. https://doi.org/10.1111/j.1468-2850.2006.00016.x
3. Neimeyer, R. A. (Ed.). (2001). Meaning reconstruction & the experience of loss. American Psychological Association. https://doi.org/10.1037/10397-000
4. White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. New York: Norton. https://josefaruiztagle.cl/wp-content/uploads/2020/09/Michael-White-David-Epston-Narrative-Means-to-Therapeutic-Ends-W.-W.-Norton-Company-1990-1.pdf
5. Angus, L., & McLeod, J. (2004). The Handbook of Narrative and Psychotherapy: Practice, Theory and Research. Thousand Oaks: Sage Publications.
6. Sue S, Zane N, Nagayama Hall GC, Berger LK. (2009). The case for cultural competency in psychotherapeutic interventions. Annu Rev Psychol. 2009;60:525-48. doi: 10.1146/annurev.psych.60.110707.163651. PMID: 18729724; PMCID: PMC2793275. https://pmc.ncbi.nlm.nih.gov/articles/PMC2793275/ 
7. Herman, J. L. (1992). Trauma and recovery. Basic Books/Hachette Book Group. https://psycnet.apa.org/record/1992-97643-000
8. Angus, L. E., & Greenberg, L. S. (2011). Working with narrative in emotion-focused therapy: Changing stories, healing lives. American Psychological Association. https://doi.org/10.1037/12325-000
9. Norcross, J. C., & Wampold, B. E. (2011). Evidence-Based Therapy Relationships: Research Conclusions and Clinical Practices. Psychotherapy, 48(1), 98–102. https://doi.org/10.1037/a0022161  
10. Bruner, J. (1991). The Narrative Construction of Reality. Critical Inquiry, 18(1), 1–21. http://www.jstor.org/stable/1343711 
11. McAdams, D. P. (1996). The Stories We Live By: Personal Myths and the Making of the Self. New York: Guilford Press.
12. Adler, J. M., Lodi-Smith, J., Philippe, F. L., & Houle, I. (2015). The Incremental Validity of Narrative Identity in Predicting Well-Being: A Review of the Field and Recommendations for the Future. Personality and Social Psychology Review, 20(2), 142-175. https://doi.org/10.1177/1088868315585068 
13. Lieblich, A., Tuval-Mashiach, R., & Zilber, T. (1998). Narrative Research: Reading, Analysis, and Interpretation. Sage.
14. McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5(2), 100–122. https://doi.org/10.1037/1089-2680.5.2.100 
15. Frank, A. W. (1995). The Wounded Storyteller: Body, Illness, and Ethics. University of Chicago Press.
16. Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243–1254. https://doi.org/10.1002/(SICI)1097-4679(199910)55:10<1243::AID-JCLP6>3.0.CO;2-N 
17. Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/h0045357 
18. Geller, S. M., & Greenberg, L. S. (2012). Therapeutic presence: A mindful approach to effective therapy. American Psychological Association. https://doi.org/10.1037/13485-000 

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