Psychotherapy and other stories

It is still considered somewhat unusual for an individual to straddle C.P. Snow's 'two cultures' divide. We live in a society in which art and science are still viewed as being irreconcilable pursuits. Yet, over the past decade, I have been both a clinical psychologist and a novelist. In a few months I will stop seeing patients to concentrate on my writing, and then I will be described as a novelist and former clinical psychologist. However, I don't really see it like that at all, as I have always recognised continuities linking clinical practice and writing novels.  

The practice of psychotherapy has long been associated with 'storytelling'. Anna O., the very first 'psychoanalytic' patient, entered an altered state of consciousness during which she would tell Josef Breuer (Freud's avuncular patron and collaborator) stories that reminded him of those written by Hans Christian Andersen (Guttmann, 2001). These formed an integral part of her treatment and prompted her to describe Breuer's approach as the 'talking cure'.

Yet more extraordinary is Ernest Jones suggestion that Freud's revolutionary technique of 'free association', was inspired by a now little known author called Ludwig Börne, who in 1823 wrote an essay titled 'The Art of Becoming an Original Writer in Three Days' (Jones, 1977). Börne's advice to aspirant authors was to simply write without interruption, 'falsification and hypocrisy, everything that comes into your head' (pp.218–219 in Jones). This of course recollects Freud's famous injunction that patients should ignore all censorship and express every thought – however trivial or unpleasant. Freud had been given the collected works of Börne when he was 14 years old, and they were the only books from his adolescent library that he kept as an adult.     

Since Breuer and Freud's time, all forms of psychotherapy have involved some form of 'storytelling'. Patients tell stories to therapists, and therapists tell stories (in the form of rationales, schemes and myths) back to patients (Frank & Frank, 1993). Moreover, in many contemporary therapies, the 'storytelling' component has acquired particular significance (e.g. reminiscence with the elderly or narrative therapy). It may even be the case that being able to tell a good story about one's self, is a powerful predictor of mental health. Mary Main and colleagues (1985, 1990) have found that a sense of emotional security is closely related to the presence of internally consistent and coherent self-narratives (see Gerhardt, 2004, for a summary). A failure to develop a cohesive and emotionally 'literate' personal narrative might not only have consequences with respect to poor mental health, but lead to antisocial behaviour. For example, David Canter (2006) has suggested that the inner narratives of violent criminals are impoverished, resulting in a breakdown of empathy.

Like all therapists, I have become accustomed to patients telling me their chaotic life stories. At such times, I often find myself offering them a number of narrative schemes to help them make sense of their experiences. These schemes frequently correspond with some of the basic plots we find in literature, for example, 'slaying the monster', 'rags to riches', or 'voyage and return' (Booker, 2004). The line between clinical psychology and creative writing becomes blurred, as the patient and I produce life-story drafts and edit them accordingly. Of course, this doesn't happen with every patient. Where the presenting problem is characterised by specific symptoms and clearly circumscribed, CBT has been quite sufficient; however, when dealing with complex or difficult presentations, helping a patient to put the chapters of their life into a meaningful order has frequently proved extremely productive.

Perhaps it is true that a good therapist will also be a good storyteller, and vice versa. There are several reasons why this should be the case.

Firstly, therapists and novelists must have a well developed theory of mind.  Keith Oatley – also a psychologist/novelist – has recently argued that fiction is a kind of social simulation that runs on the hardware of the human brain (Oatley, 2008). Thus, the more time we spend reading fiction, the more socially skilled we become. More interesting is his suggestion that frequent reading of fiction (i.e. exposure to meaningful narrative) might strengthen selfhood.

Secondly, therapists and novelists must be able to use language well. Unlike psychiatrists, a clinical psychologist does not have an armamentarium of drugs at his or her disposal. To 'change' a brain (which surely must be the ultimate effect of psychotherapy) armed with only the English language and a few models of mental functioning still strikes me as vaguely miraculous. In the same way, suspension of disbelief while reading a novel – achieved with only well-chosen words on a page – is also a kind of miracle.

A further point worth making, concerns the subject matter of psychology. The topics which psychologists study – for example, memory or psychopathology – frequently play a part in tried and tested plot lines (e.g. man wakes up in hotel next to body covered in blood, but can't remember who he is or how he got there).

The parallels between detective fiction and psychotherapy are obvious. Psychotherapists and detectives havea great deal in common. Both scrutinise evidence, look for clues, reconstruct histories, and seek to establish an ultimate cause. It is no coincidence that Freud viewed himself as the Sherlock Holmes of the mind and was a great fan of Conan Doyle.   

I doubt very much that there are many students who embark on a psychology degree thinking that the education they are about to receive might equip them to become novelists. Yet, I firmly believe it can. I have found my background in psychology immensely useful – far more, I think, than the traditional writer's training of a degree in English followed by a career in journalism.

My most successful fiction has been a series of psychoanalytic detective thrillers set in Freud's Vienna.
Without an appreciation of Freudian theory and my experience as a practitioner – I could never have written them. Moreover, when I am no longer seeing patients, I will not see myself as a former or retired clinical psychologist, but rather, as a clinical psychologist practising in a different context.

Frank Tallis's latest Freudian detective thriller is Darkness Rising, published by Century.

References
Booker, C. (2004). The seven basic plots: Why we tell stories. London: Continuum.
Canter, D. (2006). Criminal shadows: Unlocking the minds of serial killers and sexual predators and cracking cases. New York: Dorset Press.
Frank, J.D. & Frank, J.B. (1993). Persuasion and healing: A comparative study of psychotherapy (3rd edn). Baltimore, MD, & London: Johns Hopkins University Press.  
Gerhardt, S. (2004). Why love matters: How affection shapes a baby's brain. Hove: Routledge.
Guttmann, M.G. (2001). The enigma of Anna O: A biography of Bertha Pappenheim. Wickford, RI, & London: Moyer Bell.  
Jones, E. (1977). The life and work of Sigmund Freud. Harmondsworth: Penguin.
Main, M. & Goldwin R. (1985). Adult attachment classification system. Unpublished manuscript. Berkeley: University of California.
Main, M. & Solomon, J. (1990). Procedures for identifying infants as disorganised-disoriented during the strange situation. In M. Greenberg et al. (Eds.) Attachment in the pre-school years: Theory, research and intervention. Chicago: University of Chicago Press.  
Oatley, K. (2008). The mind's flight simulator. The Psychologist, 21, 12, 1030–1032.