DM: There are now a number of investigators from different perspectives who have been very sensitive and innovative in exploring the nature of the stories that individuals tell about their trauma. Those stories change over the course of time. The meaning that a traumatic event has for individuals is critical. This is not novel. A number of people have highlighted the role of appraisal processes and the role of the stories that people tell over the course of time. I have become particularly interested in how these stories change in my patients. I spend a good deal of time supervising clinicians - psychiatrists, psychologists, social workers- and we have audio taped and videotaped therapy sessions. We have noted that both symptom reduction and behavioral changes covary with the changing nature of the accounts that clients offer over the course of therapy. A sense of personal agency often emerges. Clients, over the course of therapy as they improve, often shift the focus of their accounts. They now move from viewing themselves as victims to becoming survivors if not - thrivers. As they do so they offer interesting accounts of how they can now often have many of the same kind of thoughts, feelings, intrusive ideation, etc. but this doesn't seem to bother them as much. They do not feel "stuck." There is a certain shift in the nature of their narrative. We have become very interested in tracking these changes. The challenge for us, at a research level, is whether these narrative changes are epiphenomena that follow behavioral changes and physiological changes or whether these narrative changes play an instrumental role in facilitating change. There are a number of investigators who have studied victims of natural disasters ( Harvey), rape victims (Foa et al.), AIDS victims (Folkman and Stein), child sexual abuse victims (Janoff-Bulman and Silver), each of whom have highlighted the role of narrative changes. The challenge for the field is that, at this time, we don't know how best to analyze and code these narrative accounts. The constructive narrative approach is a set of clinical observations in search of a methodology and a theory. Let me conclude by saying that when bad things happen to people, the way they tell others, as well as tell themselves "stories" about the trauma, can influence their abilities to cope. Also note, that how people cope can influence the "stories" they tell. But often traumatized individuals struggle to put into words, or into some other form of expression, the impact of the trauma. In their attempt to convey their distress they often employmetaphors. "I am a walking time bomb." "I am a victim of the past." "This event opened up a can of worms." "I am spoiled goods." "I feel like I am on sentry duty all of the time." Thus, in their own way, they become poets. But these metaphors become more than figments of speech. I believe they become ways in which individuals come to construe and construct "reality." One can view therapy as a way to elicit clients' stories and to help them change their narratives. InA Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post-Traumatic StressDisorder(referred to as thePTSD Clinical Handbook), I describe a variety of psychotherapeutic techniques to accomplish these objectives.
JSV:On that note, in 1994 you publishedA Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post-Traumatic Stress Disorder. This compendium of information is magnificent. In fact, the Administrative Board of the Academy has recommended this publication for professionals across disciplines. What motivated you to develop that project and what were some of your most memorable moments as you were compiling it?
DM:Idoappreciateyourevaluationandinfact,Ihavebeenquitepleasedinhowthisvolumehasbeenreceivedandreviewed.IhavebeenaconsultantforanumberofyearsandineachsettingI
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