Constructivist Narrative Treatment

From Chapter 7, from the constructivist narrative perspective, traumatic events challenge or damage our personally constructed narrative representation of reality and the goal of treatment is thus constructing a new narrative and assumptive world that assimilates the traumatic experience is crucial to recovery. As Donald Meichenbaum (2000) states, "People are story-tellers. . . . They offer accounts that are designed to make sense out of the world and their places in it. . . . Now, consider what happens to people's stories when really bad things (traumatic events) are experienced" (p. 55).

Characteristics of individuals with ongoing PTSD symptomology include an inability to integrate their trauma stories, continued searching for an explanation and failures to find satisfactory answers to the why questions, constant engagement in counterfactual and what if thinking, and continual comparisons between life as it is and life as is could have been. Meichenbaum characterizes this narrative process as consisting of metaphors and language of damage, hopelessness, and fear.

Therapy from the constructivist narrative perspective is characterized as a "collaborative co-constructive approach" (Meichenbaum, 2000, p. 58). The patient sets out to rewrite his or her trauma narrative through engaging in a set of 10 core therapeutic tasks outlined as follows:

1. Establish a therapeutic alliance with empathy and support.

2. Provide education about PTSD through dialogue and discovery, not lecturing.

3. Increase patient's coping skills and enhance self-care activities.

4. Nurture hope by focusing on what the patient has accomplished and signs of resilience.

5. Help the patient do "memory work of trauma resolution and reintegration" (p. 59).

6. Help the patient find meaning with emphasis on mastery, control, competence, and self-acceptance.

7. Encourage and ensure social connections.

8. Encourage the patient to take credit for any change.

9. Help develop skills to avoid revictimization.

10. Address relapse prevention.

Meichenbaum (2000) reminds us that the construction of narratives comes from actually living our lives. He states that "the construction of a new narrative emerges out of the actions that patients take to refashion their lives" (p. 59). In essence, in practicing and living differently, we tell a different story.

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