A couple of blogs ago, I talked about the five options our clients (and we) have when confronted with a problem. We can:
- Solve the problem in whole or part
- Change the way we think and feel about it
- Radically accept it
- Make ourselves miserable
- Make the situation worse
This blog applies this framework to the storytelling we humans do to make sense of our life experiences. While all humans tell stories, our clients sometimes tell themselves stories that result in significant secondary pain and misery. Healing, then, involves changing the stories and their interpretations.
Storytelling Is Human Nature
Neurologist Oliver Sacks wrote in the New York Times Review of Books that our memories of past events come from “narrative truth,” rather than “historical truth.” We remember the stories we tell ourselves about what happened, not what actually happened.
Two people see the same event. Each one remembers the event differently. One person can see the absurdity in it; another, the pain. At the scene of an accident, one person may remember the suffering of the injured while another may remember that everyone is alive and will recover. It isn’t that one is fabricating what happened, or worse lying. It’s that each one interprets the event in the form of a story, focusing on how the event made them feel more than the facts of what happened.
Sometimes, it’s hard to know whether we remember what happened or what we were told happened. Sometimes we remember what happened to someone else as though it happened to us. Whatever actually happened, the stories we tell ourselves and how we interpret them affect our view of ourselves, others and the world around us.
The stories we tell ourselves give shape to the barrage of details that give us fleeting impressions of everyday life. They bring the past and future into the present, infusing them with meaning. They give us a sense of identity. If our stories are mostly negative, they sap us of optimism and hope.
Stories as Cognitive Distortions
Our stories can give us joy or pain, most often somewhere in between. When our stories consistently make us miserable or cause unnecessary conflict in our work, social and family relationships, we call them cognitive distortions. If our clients don’t know how to draw positive meaning from what happens in their lives, the neural pathways never fire up to identify “what is” and to interpret reality without judgment, much less to inspire optimism and hope.
I had a client several years ago who invariably told herself painful, upsetting stories. As she was going to sleep at night, stories of her childhood trauma ran through her head over and over and over. When she was feeling bad, she watched television shows that made her feel worse. If her kids were going for a hike, she obsessed they would fall off a cliff. She believed she was worthless and unable to do anything “right.” Her stories focused on what she’d done “wrong” instead of her many accomplishments. When she noticed something good, she would tell herself it couldn’t last because nothing ever had. She told herself stories about malevolent motivations and intentions of people with whom she interacted. Her stories haunted her present. She had never developed the neural pathways to identify what was good in her life. She was miserable and her negativity strained her relationships.
When our clients only have stories that lead to negative neural pathways, they often identify themselves as victims instead of survivors, helpless rather than empowered, worthless and not good enough. Instead of seeing a life worth living, they self-harm or think about suicide to protect themselves from life. They define the world as dangerous rather than mostly safe and people as bad and untrustworthy instead of mostly benign. These negative interpretations make them miserable and their relationships conflicted, which reinforces the negative stories they tell themselves and strengthens negative neural pathways even more.
Changing the Stories Using DBT Skills
It’s not easy to change well-worn stories. Willpower by itself is not enough. Dialectical Behavioral Therapy provides a means. The blue circles in the diagram below illustrate how DBT leads to increased adaptive behavior – distress tolerance, emotion regulation and strengthened interpersonal relationships – which leads to more positive neural pathways amd more positive stories.
Negative stories typically arise out of a history of trauma or invalidation. When a client is spiraling down (green circles) — each maladaptive behavior reinforces the negative story and vice versa. To break the downward spiral, our first task as therapists is to help the client notice the pattern without judgment (purple circle). Clients cannot change what they aren’t aware of nor can they change what they can’t accept “as is” – without judgment. Judgments only fuel the negative stories.
When there is a history of trauma or invalidation, we help our clients radically accept its reality. Radical acceptance involves acknowledging the trauma happened; it was horrific and it affects me today. There is neither judgment nor resignation, just acceptance. This is where dialectics come in handy. DBT teaches that someone else may have caused a client’s problems but she is the only one who can solve it. Clients must accept themselves and their stories “as is” before they can change. These two dialectics form the core of DBT.
Stuff happens in life that we can’t control and it is distressing. DBT teaches clients to solve the problems that can be solved and radically accept or change the way they think and feel about the rest. At its core, this involves radically accepting life is uncertain and tolerating vulnerability. Many of the stories we tell ourselves serve to help us avoid the fact that life is uncertain and we are vulnerable.
Other DBT skills confront the stories more directly, helping change the way clients think or feel about themselves, others and the world. We teach them to recognize judgments and strategies to reframe judgments into factual statements. We encourage our clients to ask, “What’s the evidence?” or “How do I know this is true?” We help them differentiate between facts and interpretations and to accept “what is” without judgment.
When the emotions clients’ stories elicit make them miserable, we help them practice acting opposite to their emotions, doing something that makes them happy when they feel sad or doing the thing they fear. We teach clients to approach their thoughts and emotions with curiosity instead of judgment. We challenge them to surf the waves of emotion, noticing and accepting emotions then letting them disappear into the sand instead of crashing into the rocks and going back out to sea only to return again.
We encourage clients to do things that develop a sense of mastery, that make them feel empowered. In session, we do chain analysis to identify the connections between their stories and the behaviors, thoughts and emotions that result in their here-and-now problems. We look for patterns that keep them stuck in their old, negative stories, things like catastrophizing or interpreting other people’s motivations and intentions.
These and other skills help reframe and reshape the stories our clients tell themselves so that over time, their stories begin to shift from pessimistic to hopeful. They get unstuck from the stories that hold them back and start laying down more positive neural pathways. With hard work and practice, our clients can move from a life of pain to a life worth living.
Sandra Miller, MSW, LCSW and sometimes blogger, is one of five therapists who see clients at St. Louis DBT, LLC. Learn more about St. Louis DBT.