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Four stories in one therapy

Therapy can be seen as weaving in and out of four stories that need holding open and apart from each other. These four stories are:

  • the present story (what is happening that helps or troubles me in my life now)

  • the past story (the patterns of relating from early life shaping present responses)

  • the formulation story (how to bring past and present together in a helpful picture)

  • the healing story (establishing a healing relationship together, knowingly, that can be internalised and maintained beyond the therapy)

These four stories can easily be merged or hijacked one by the other reducing their diversity of contribution to one.

On the vertical line

As indicated in the diagram, the separation between past and present stories is on the vertical axis. At the top are the present stories. These are stories of the client’s immediate experience in their own voice. The stories of me and my life, the stuff that's going on for me, the trouble I'm in, the breakthroughs I'm making, the battles I'm fighting. But listen in and follow the flow of sharing and recollection and the client’s voice iThey are the calls for help with alleviating symptoms, problem-solving and understanding. But the stories in the present may be echoed by others from the past. We can call these the ghost stories that haunt us. Whenever we tell stories of the present, we touch abring up the past. Or more than that we give voice to the past. Very often stories in the present are on a kind of vertical line back to stories from the past as the therapy session progresses. In the middle of a present story, the tense changes, the tone of voice changes and a pattern of relating in the present story is mimicking or channeling a pattern of relating from the past. The roles and relationships between people from the past get entangled in the patterns in the present stories. Past and present are threaded together by patterns of relating and narratives of feeling and meaning that hold and shape our individual sense of self and our place in society. In one form or another this dynamic between stories from the past and the present has been at the heart of therapy for well over a century going back to the days of Freud in 19th Century Vienna. Stories from the past tend to plant their relational character and compulsions in stories of the present in the hope of finding a clear narrative.

For example, I may be telling you how I got hurt then angry, then anxious and stifled my anger last week because of what happened at work and realise it’s just how my dad (in one-storied memory or another) used to be hurt in his job and show then stifle his anger and become emotionally cut off. The queen of consciousness element is the narrative in me and my dad’s dominant narrative of himself in the world of emotional unavailability to self and others. In CAT we bring curiosity to the repetitions and resonances between stories from the past and the present and we use our word mapping to tease them out.

Care should be taken not to make simple links between past and present or let the patterns from the past stories become the given formulation for trouble in the present. There is a zone of open and therapeutic dialogue in the middle where the stories of the past and the present meet and are reconsolidated by being repeatedly retold with compassion.

On the horizontal line

Now in the grid above look at the horizontal line between the reformulation story and the healing story. By reformulation story, we mean the stories and narrative that enables understanding of specific problems and needs in relation to the client as a person in the world. The story is put together by mapping and writing side by side with the client, so the reformulation or rethinking is jointly made and owned. Simply understanding is not enough, however. There also needs to do some work in the room and between sessions by session, week by week for healing, change, recovery or growth to take place. In other words, there's a healing story between the therapist and the client where a process of assimilation and change takes place. Whilst the healing story grows from the reformulation story which frames and focuses on the work of recovery and change, it also needs to stand apart and have qualities of its own. Think of it as a new story with moments of new points of view and new ways of feeling familiar emotions and a sense of being jointly responsible for a new, sometimes spontaneous and uncharted relationship. If seen as linked but separate the healing story will bring moments of new discoveries and new depth to the reformulation story. The way we talk about our present life stories by working back and forth between the past and the present, hovering and shimmering between present story and past, is one of the key relational dimensions at the heart of any connection between reformulation narratives and healing narratives.

Now look at the grid

It may help to draw out this two-dimensional grid as an aid to self-reflection on your work. Our challenge is not to have the therapy hijacked by one of the four stories but to hold them sensitively and creatively open and apart from each other. They all play a part.

  • In the top right-hand corner is a combination of the present story and the healing story, this could be something like “What does it mean for me and my world?” questions that are aiming to find and test new solutions and new directions. We're trying to solve problems, make progress, deal with feelings differently.

  • In the bottom right-hand corner, the healing story and past stories, we're reworking something within the deeper structures of the self. What are we co-creatively doing in new ways together? Reliving, reworking, retelling, consolidating new stories and the memories that swim around them.

  • In the bottom left corner, the reformulation story and past stories are digging into making sense of who was involved in shaping those early experiences and the deep and habit-forming self-structures that came from them. It is gently asking who shaped me, who controlled the storytelling, who held the truths, who imposed what or who failed to allow or develop what. These are the past and deeper patterns under present stories and the reformulation story. They need to proceed within the Zone of Manageable Awareness (for more on this idea check out the blog post)

  • The top left-hand corner, it's almost like saying, What's up just now? What do I want to change? What stopping me? What's my goal or aim in therapy and what's standing in the way? What ghosts, or secret and suppressed things are behind there?

Triangulation (bringing together)

The reflective power of visualising these four different stories that come up in a therapeutic session can be that it helps us to not reduce therapy to one story. For reasons that are touched upon in the Blog post on Holding the Story Open, (see also Therapy with a Map) good therapy can't just be about analysing the past and looking into the ghosts and patterns of interaction from childhood. It shouldn't be just figuring out what's wrong and giving a diagnosis or reformulation. Yet neither can it just be about solutions and dealing with the present and trying out new things and attempting to simply change behaviour. Nor can it be just about having an intense therapeutic encounter to the healing story that reworks the past.

The suggested recipe for a good therapeutic encounter is about shimmering and hovering between all four of these stories, a pinch of this and dash of that. Much like in a lot of the most creative cooking the recipe book is used as inspiration rather than instruction and the exact mix of measures can only be felt out in the moment, collaboratively between client and therapist.

In summary the four stories in therapy are linked but they are distinct. They need their own voices, their own say in what is going on, and they must be kept open to but apart from each other for a therapeutic conversation to fully develop and be sustained.

As in Cognitive Analytic Therapy and related integrative and relational therapies, careful mapping and tracking of the stories now and then behind current difficulties can produce a good, shared reformulation. It shapes but does not make the treatment. It is the focus of the beginning of therapy, but reformulation and shared understanding is not enough. The diagram above points to a question about the processes of change in therapy. The fourth story: the healing story has an important component in and of itself which is interpersonal and uncharted. It is full of surprise turns and immediacy of meeting at a personal level. It may take on its own life and direction as something new and unexpected emerges. Though anchored by the reformulation, it is a continuous process of reformulating and restorying.

Steve Potter (2023) Therapy with a Map

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