Ilana Simons

Ilana Simons Ph.D.

The Literary Mind

A Therapist Should be a Good Storyteller

How a Novelist and a Therapist are Alike

Posted Jul 21, 2010

Sliced carrots slapped against the nurse's chest and a lunch tray clattered to the floor. The tall African American 22-year-old who I'm seeing in therapy, who I'll call Anthony here, was raging. "You ain't seen my hell. They hated Tupac. They hated Malcolm X. You ain't know f**k about me."

Anthony has lived in the psychiatric hospital where I work for the past five months. Unlike the majority of patients here, Anthony isn't psychotic-he doesn't hear voices or have bizarre delusions-but he's spent most of his life in mental hospitals because he hasn't been able to control his anger. He often talks about his horrible childhood as a touchstone: He lost both parents to drugs when he was 10, moved in with an aunt who sexually abused him, went homeless at 16, and saw all of his cousins either die from drugs or enter jail. "I was crazy mad even as a kid. I'm an abused dog," he says. During intake to this hospital, he spat at the chief of psychiatry; last week he broke a nurse's nose.

Doctors have diagnosed his personality with the pathology of Borderline Personality Disorder, but Anthony justifies his anger as a rational answer to reality. "This is what abused dogs do." He's right, in a way, that his anger often seems sane or justifiable. But the problem is that this story Anthony tells himself-that he's a "dog with a right to anger"- has kept him in hospitals throughout his adolescence.

Working with Anthony has been interesting for me for a few obvious reasons. For one, he's taught me about social injustice. He can also be fun and charismatic. Another reason I've liked the work is that it's helped me see how closely related storytelling is to therapy-or how connected my two fields, of literature and psychology, are.

I did graduate work in literature before I started with psychology, and the two have always been related for me, because I think in both fields, we try to organize the mess of human emotion and motivation into a narrative, telling a story with a believable beginning, middle, and end driven by a character's intention. Writers and therapists need to be good storytellers, because they have to build stories that organize emotion.

Anthony is a terrific storyteller, but the story he's told himself has been so strong and dominant in his life that it's driven him down one road without an exit strategy. It's a story that probably needs rewriting if he wants to change his behaviors. When we work together, I feel as if we're collaborators trying to cut up a narrative that isn't working, to find an equally believable new one.

In a recent session, he gave me his usual speech about Malcolm X and Tupac and the black man's right to rage. He spun a great argument: Why would any sane person who's been abused so brutally trust anyone? When I spoke, I felt the storyteller in me rising to a challenge. My face was tight with anger that matched his. "You mother died. Your dad died. Your aunt abused you. You were homeless. If none of this had happened, you might have been a huge yellow smiley face of an Anthony, going off to college and earning six figures by the time you were 30. But all of this did happen. From all of that crap, there was formed this being, this living, breathing animal." I cupped my hands in the air between us, as if I were holding a small world. "This animal is you. You can forget how it got here. Now it's here, in this room, telling a story. It can choose now to do anything it wants. It can fight. It can drop the fight. It can fly."

The author in me was excited. I was trying to defocus him on his past, galvanize energy for making choices, offer an image that could be a new metaphor for self. And I was thinking that this is what therapy often is-organizing information into a narrative that makes growth possible. Then came our back and forth. He told me about Tupac. I told him about a yogi. He told me about angry dogs. I spoke about walking in Central Park. We were collaborators on a script, finding what images might stick.

Whatever changes stick come slowly. There was one good moment last week in which he was talking about being a dog, and I asked what happens when the dog is fed, and he said that the dog sometimes rolls over, exposes his belly, kicks his leg, and asks to be rubbed. That was a wonderful bridging of narratives on Anthony's part: He was telling me that, yes, the dog can learn to trust. It just takes carefully written and believable changes in the dominant narrative.

So-this week I'm thinking about the relationship between books and the stories of self or identity. I'm working on the metaphors I use in therapy and letting my storytelling self out to play at times in my work.

I do think that authors are like therapists insofar as they build new images that might replace staid old images, offering us new lenses for seeing life. Below are some books that have been important for me, and I'd like to know if any books have given you new images or narratives to live by.

-Harumi Murakami has given me a way of simplifying emotions. His books are like wide open spaces that suggest I can walk through events with a "simple mind," with lightness and unknowing.

-Virginia Woolf has given me a way to organize my feminist impulses. Her books have constructed language and ideology for how to stake my position as a strong woman.

-In the world of psychology, I've been inspired by the way Acceptance and Commitment Therapy uses metaphors for changing lives. Steven Hayes is often credited as the founder of ACT. He argues that a useful metaphor can often be the best way to get a patient to think in new ways about old problems.

What books have been useful in forming the way you see the world?

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