Gardner 2009

Journal of http://jag.sagepub.
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Applied Gerontology
One Story at a Time: Narrative Therapy, Older Adults, and

Addictions
Paula J. Gardner and Jennifer M. Poole
Journal of Applied Gerontology 2009 28: 600 originally published online 23
January 2009
DOI: 10.1177/0733464808330822
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What is This?
Journal of Applied
Article Gerontology
Volume 28 Number 5
October 2009 600-620
One Story at a Time © 2009 The Southern
Gerontological Society
10.1177/0733464808330822
Narrative Therapy, Older Adults, http://jag.sagepub.com
hosted at
and Addictions http://online.sagepub.com
Paula J. Gardner
New York Academy of Medicine
Jennifer M. Poole
Ryerson University, Toronto, Ontario, Canada
Various factors including social isolation and financial worries put older adults
at risk for addictions. Indeed, older adults are the largest consumers of medica-
tion, and alcohol consumption is rising. Yet interventions are limited and prob-
lems often go unreported. Unearthing “problem” stories in people’s lives (i.e.,
“the addiction story”) and retelling them in more empowering ways, narrative
therapy offers a viable therapeutic alternative, and research on narrative therapy
has proven encouraging. However, little is known about narrative therapy with
older adults and with addictions. Seeking to address these gaps, an ethnographic
study was conducted in Toronto, Canada, with a group of older adults receiving
narrative therapy for addictions. Findings suggest that the therapy was “helpful”
and participants were able to reduce or halt their substance misuse. Most impor-
tant, aspects of narrative therapy such as storytelling may be particularly well
suited to older adults, offering powerful possibilities for applied gerontology.
Keywords: narrative therapy; older adults; addictions; qualitative research
A myriad of factors including social isolation, discrimination, physical

illness, and financial worries, place some older adults at risk for addic-
tions to alcohol, gambling, and drugs (National Advisory Council on Aging
[NACA], 2002). Although not unique to this population, the development
Manuscript received: April 26, 2008; final revision received: November 27, 2008;
accepted: December 2, 2008.
Authors’ Note: Thank you to Margaret Flower and Carolynne Cooper for their insights, sug-
gestions, encouragement, and passion for narrative therapy. Thank you also to the two review-
ers for their valuable feedback as well as to Dr. Cutchin for his suggestions on earlier versions
of this article. The research on which this article was based was made possible by a grant from
Manulife Financial.
600
Gardner, Poole / Narrative Therapy, Older Adults, and Addictions 601
and experience of these addictions can be quite different compared with

younger age groups. For example, older people are the largest consumers
of medication, and overprescribing is not uncommon. Medications are
often mixed or taken in larger quantities, and many older adults are likely
to develop both physical and mental dependence on these drugs (NACA,
2002, p. 4). Reflecting another potential substance use problem, alcohol
consumption among seniors is rising, with 6% to 10% of Canadian seniors
reporting an alcohol problem (Centre for Addictions and Mental Health,
2005). In older adults, substance misuse can have serious consequences,
causing or complicating medical conditions, producing unsafe medication
interactions, and increasing falls, confusion, depression, and premature
mortality (Benshoff, Harrowood, & Koch, 2003). Despite the risk and
increasing rates of addictions among older adults, the stigma associated
with these practices means few older people seek help and “the problem”
is more likely to go unreported (NACA, 2002). Recent health reports have
suggested older adults are not sufficiently or effectively served by profes-
sionals (Grimm, 2003) when it comes to these issues. They have suggested
that “practice” with older adults facing addictions is relatively undeveloped
and usually dominated by traditional therapeutic approaches such as absti-
nence and behavior modification.
Narrative therapy may offer a viable therapeutic alternative. A postmod-
ern approach to the practice and theory of therapeutic counseling, narrative
therapy is a collaborative process predicated on the belief that identity is
cocreated in social, cultural, and political contexts and revealed through
stories and narratives. Narrative therapy involves unearthing dominant or
“problem” stories in people’s lives (i.e., “the addiction story”), understand-
ing them, and retelling them in alternative and more empowering ways.
The literature on narrative therapy is expanding, and reported results are
encouraging. However, significant gaps have been identified in both the
research and the practice of narrative therapy. In particular, little is known
about narrative therapy with older adults and with people experiencing
addictions and substance misuse. In addition, empirical research on narra-
tive therapy is limited. In response, the aim of this research study is to
explore narrative therapy with older adults coping with addictions. With
the goal of identifying what practitioners and participants found helpful (or
not) about this therapeutic approach, in this article we discuss how the find-
ings make an important contribution to the literature on narrative therapy
and provide new insights on using this approach with older adults.
602 Journal of Applied Gerontology
What Is Narrative Therapy?
Originally developed by White and Epston (1990), narrative therapy is

described as an “alternative approach to traditional psychotherapy”
(Amundson, 2001; Besley, 2002; Nylund & Nylund, 2003). Informed by the
“poststructural” work of theorist Michel Foucault, narrative therapists sup-
port individuals to critically view their lives and experiences as embedded
within larger social, cultural, and political contexts. From this viewpoint,
people work to separate themselves from their problems (known as “exter-
nalizing the problem”). Opportunities are then created for reauthoring alter-
native stories of preferred lives that can be used to “fight back” against the
problem (White & Epston, 1990). Following Foucault, “things,” including
problems, “can always be otherwise,” and through the reexamination of
words, phrases, and “texts,” difficult subject positions can be “resisted.”
Dorothy Allison, American bestselling novelist and storyteller, proclaims
she is “changing the world, one story at a time” (Public Lecture and Reading,
University of Nebraska-Lincoln, March 3, 2005). Narrative therapy main-
tains similar aspirations, as individuals engaged in a collaborative coauthor-
ing process with therapists are given the space to tell their stories and in
doing so begin to change their world “one story at a time.”
Approaches to narrative therapy are varied; however, several key com-
ponents can be identified. Summarized into three stages (see Table 1),
together these principles form the basis of narrative therapy practice.
Based on White and Epston’s (1990) original conceptualization of nar-
rative therapy, therapists and counselors may conflate these nine compo-
nents and structure their sessions on four central tenets of narrative therapy:
externalizing the problem, developing the “team,” creating the preferred or
alternative story, and thickening the thread.
Key Challenges to Narrative Therapy

Challenges to narrative therapy are primarily focused on what is per-
ceived to be a disconnect between the theory and the practice of narrative
therapy. Narrative therapy embraces the postmodern assumptions of a
multi-verse as opposed to a uni-verse, and, as such, any attempts to identify
itself as “the” way to practice therapy are in direct contradiction of itself
(Doan, 1998). As narrative therapy experiences considerable growth and
increased recognition within therapeutic counseling, some supporters from
within the field express concern that narrative therapy will become that
which it seeks to overcome. That is, despite its explicit rejection of truths
Table 1
Stages and Principles of Narrative Therapy
Stage Principle Description
Stage I: “Position The position of the therapist is as an equal

Deconstructing collaboratively” participant-observer (Carlson, 1997; Kogan
problem- & Gale, 1997), and people are considered
saturated stories experts of their own lives (White, 1995).
“Externalize the Individuals are encouraged to objectify or
problem” personify the problem and talk about it as a
thing (e.g., addiction, depression).
“Excavate unique Hidden assumptions, contradictions, and
outcomes” vinconsistencies in the problem-saturated
stories are located that provide alternative
narratives and open up space for
reauthoring.
Stage 2: “Thicken the new Unique outcomes are incorporated into stories,
Reauthoring plot” and the plot is thickened using “landscape
new stories of action” (to plot events and sequences)
and "landscape of consciousness" (to
develop alternative meanings) questions.
“Link to the past New stories are connected to both the past and
and extend to the the future to facilitate and support
future” alternative ways of being and preferred
ways of living.
Stage 3: Making it “Invite outsider Participatory witness groups composed of
real-Presenting witness groups” therapists, family members, friends, and so
and witnessing on are invited to enhance the narrative
preferred ways process and help move people into the
of living reauthoring process.
“Use re-membering Re-membering practices are based on the
practices and work of Barbara Myerhoff (1982) and
incorporation” signify a special type of recollection that
helps people return to significant
relationships across their lifetime. People
are encouraged to draw on (incorporate)
family and social networks as problem-
solving resources and social supports.
“Use literary Therapeutic documents, such as letters of
means” invitation, certificates, and self-declarations,
may be used in this stage.
“Facilitate bringing- People are provided with the space to share
it-back the positive benefits of therapy with others.
practices”
Source: Adapted from Carr (1998).
or singular accounts, narrative therapy will pursue the historical human

tendency of reification and come to see the practice of narrative therapy as
a kind of “truth” (Amundson, 2001; Carr, 1998; Doan, 1998). The increas-
ing use of narrative therapy and concomitant efforts to defend its position
among traditional psychotherapies have prompted other concerns about
what may be forfeited in this process—“We hope (however) that the rich-
ness of a postmodern perspective will not be lost in a push to manualize and
operationalize these therapies in an effort to legitimize them” (Neimeyer &
Raskin, 2000, p. 9).
Applications of Narrative Therapy

Narrative therapy originated in work with children, and family therapy
continues to dominate the literature. Recently, however, the use of narrative
therapy has expanded to include other populations. For example, narrative
therapy has been used to encourage dialogue about depression and other
illnesses and has shown positive results for promoting resiliency (Focht &
Beardslee, 1996), it has been used with survivors (Wood & Roche, 2001)
and perpetrators (Augusta-Scott & Dankwort, 2002) of violence, and, from
a feminist perspective, it has been used to support women to challenge sex-
ist discourses such as the “beauty myth” (Lee, 1997). Narrative therapy has
also demonstrated its usefulness in cross-cultural and multicultural coun-
seling including Biever, Bobele, and North’s (1998) work with intercultural
couples and Murphy-Shigematsu’s (2000) work with minorities in Japan.
Semmler and Williams (2000, p. 53) suggested that narrative therapy, and
particularly the focus on deconstructing dominant cultural narratives, pro-
vides a gateway to the “heart of internalized racism.” They reported that
narrative therapy provides opportunities to explore culture as a context for
meaning, and consequently it is a particularly effective approach for cul-
tural counseling.
Empirical Research and Narrative Therapy

Within the narrative therapy literature are many examples of observa-
tional accounts, case study examples, theoretical discussions, and critiques.
The availability of reported empirical research, however, is limited. This
paucity of narrative therapy research may reflect the perceived challenges
associated with conducting “rigorous” research that remains “true” to the
philosophical principles of narrative therapy. Indeed, researchers have argued
that outcome research in particular is incompatible with the Foucauldian
foundations of narrative therapy (O’Connor, Meakes, Pickering, & Schuman,

1997) for it brings with it modernist notions of “truth.” However, authors
have also argued that purely descriptive reports are equally problematic
(Steinglass, 1998). Indeed, Steinglass (1998) and others (Etchison & Kleist,
2000; McLeod & Balamoutsou, 1996) have challenged the notion that nar-
rative therapy cannot be “rigorously” researched, advocating for systematic
studies that seek to find the “active ingredients” of narrative therapy.
Although few researchers have taken up this challenge, exceptions
include Besa’s (1994) postpositivist examination of parent–child conflict
and Angus and Hardtke’s (1994, p. 190) combination of two narrative
measures—the Referential Activity Scale and the Experiencing Scale—to
assess the contribution of narrative processing modes to productive psycho-
therapy. In addition, Russell, Van den Broek, Adams, Rosenberger, and
Essig (1993) conceived a model for coding three levels of narrative organi-
zation (structural connectedness, representation of subjectivity, and com-
plexity) called the Narrative Process Coding Scheme. Finally, Luborsky,
Barber, and Diguer (1992) and Luborsky, Popp, Luborsky, and Mark (1994)
engineered the Core Conflictual Relationship Theme—a tool that guides
the extraction of relationship patterns within self–other narratives (Luborsky
et al., 1994, p. 173). In each of these (quantitative) studies, researchers
concluded that narrative therapy has potential as an effective form of psycho-
therapy and is well deserving of further study.
The favored approach to narrative therapy research, however, is qualita-
tive and includes textual and ethnographic methodologies. Delving into this
literature, we located two Canadian ethnographic studies that were particu-
larly relevant to our research. O’Connor and colleagues (1997) focused their
work on understanding the experience of narrative therapy from both the
client and the therapist’s point of view (O’Connor, Davis, Meakes, Pickering,
& Schuman, 2004). The results of these studies demonstrate positive experi-
ences for all participants—therapists report narrative therapy is successful
with clients in reducing problems, and clients describe the experience as
useful and “on the right track” (O’Connor et al., 1997, p. 479).
Other qualitative researchers have preferred a textual approach to narra-
tive therapy research where the text is considered the field of study and
narrative, discourse, and conversational methods are used for analysis.
Kogan and Gale (1997) explained that in discourse analysis research, for
example, “we are less interested in what (this session) ‘really’ means, or
what people ‘really’ experienced, than in how meaning ‘got done’ by the
participants, especially the therapist” (p. 104). Again, findings from such
studies are positive, speaking to remarkable and often emotional examples
of participant transformation through the use of narrative therapy.
Narrative Therapy and Older Adults

Although the narrative therapy literature dedicated to older people is
scarce, three scholarly articles were located (Caldwell, 2005; Kropf &
Tandy, 1998; van der Velden & Koops, 2005). Using a case study approach
with an older woman experiencing depression, Kropf and Tandy (1998)
described how narrative therapy provided the participant with a space to
examine her life from a “survivor” perspective. The therapeutic experience
was described as positive and life affirming and afforded the older woman
new opportunities to regain power within her life. Caldwell (2005) pre-
sented several ways that narrative therapy and arts therapy have been com-
bined to facilitate life reviews with older people. According to the author,
these reviews are therapeutic, and narrative techniques are ideally suited for
this type of therapy (p. 173). Similarly, van der Velden and Koops (2005,
p. 58) described a group therapy program for victims of war that combined
storytelling and art therapy. The older participants were World War II sur-
vivors and attended a group therapy program once a week for 8 months.
During the sessions participants revealed their life story and the therapists
and other participants asked them questions. The therapeutic aim of the
story group was to enable the participants to tell their trauma story within
a safe setting. The authors reported that the group format was very impor-
tant to the success of the therapy as members played the part of the “audi-
ence” and supported the “protagonist” in her or his story.
Gaps in the Literature

Our review of the literature reveals several important gaps. These relate
primarily to the populations served by narrative therapy and to the issues
considered by practitioners and researchers in the field.
Narrative therapy has found a place within family therapy and a focus
on traditional nuclear families—that is, couples (married and heterosexual)
with children (young or adolescents). Family narrative therapy with nontra-
ditional families, however, or with aging or older adults (e.g., grandparents
or parents with adult children) is rare and a common shortcoming of the
family therapy literature in general. Indeed, an extensive content analysis
of the marital and family literature conducted by Van Amburg, Barber, and
Zimmerman (1996) revealed that only 2.3% of articles in family therapy
journals had an explicit aging focus.
Another identified gap in the narrative therapy literature relates to addic-
tions. Although there are a few helpful resources on using narrative therapy
with addictions (see Diamond, 2000; Dulwich Centre, n.d.), no empirical
research was identified on this issue. There are, however, a few informal
reports from practitioners: In an online bulletin, Man-kwong (2004)
described the ways in which he employs narrative therapy in his social
work practice with young people in Hong Kong. Party drugs are a popular
part of youth culture in Hong Kong, and Man-kwong explained how narra-
tive practices helped youth with substance abuse issues externalize their
problem and support their efforts to abstain. In another report, Winslade
and Smith (1997, p. 14) described their narrative approach with young men
as they seek to move beyond alcohol abuse. They argued that alcoholic
lifestyles are entwined in the identity and relationship templates offered to
young men in mainstream culture and that narrative therapy provides
opportunities to support them in finding alternative templates.
In summary, findings from the available literature are very encouraging,
offering support for future research inquiry and possibilities for a much wider
application of narrative therapy practice. However, the narrative therapy lit-
erature and particularly empirically based research is limited, revealing gaps
in our understanding of narrative therapy with older adults and addictions in
particular. Taking up the challenge of “wider application” and seeking to
address these gaps, our research project asked, “What do older adults and
practitioners (working with older adults coping with addictions and mental
health issues) find helpful (or not) about narrative therapy?” The study objec-
tives were (a) to explore the usefulness of narrative therapy for groups of
older adults with addictions and mental health issues, (b) to investigate the
unique aspects of narrative therapy with groups, and (c) to examine how nar-
rative therapy may be particularly well suited to older adults.1
Method
To answer the research questions, investigators used a modified version

of O’Connor et al.’s (1997, 2004) research protocol. This adapted ethno-
graphic design consisted of participant observation, extensive field notes,
and in-depth interviewing methods. The study protocol received Institutional
Review Board approval from the Toronto Academic Health Sciences
Council in 2004, and the study took place from September 2005 to April
2006 at the Centre for Addiction and Mental Health (CAMH) in Toronto,
Ontario. CAMH is a large, multisite health care facility with multiple in and
out patient supports, and this study was situated in the OPUS 55 outpatient
program for older adults. With a philosophy of modified harm reduction
and a critique of abstinence-based models, OPUS 55 program staff use a

language of “substance misuse” instead of addictions, examining mental
health issues concurrently.
The team coordinating the study consisted of two researchers (hired by the
therapists and independent of CAMH) and two therapists (employed at
CAMH and trained in narrative therapy). Together, the researchers and thera-
pists facilitated the recruitment process, organized prestudy information ses-
sions for potential participants, and discussed the therapy and the research in
debriefing meetings following each therapy session. In addition, the thera-
pists organized and ran the weekly therapy sessions (2 hours each session)
and participated in an in-depth interview with one of the researchers after all
the group sessions were completed. The researchers observed and took
extensive field notes at all eight of the group sessions and conducted one-
on-one interviews with all group participants and both therapists. The study
participants attended an information session (where the study was explained
and informed consent was obtained), participated in the 8-week narrative
therapy group, and were individually interviewed (for approximately 1 to 2
hours) after the group therapy sessions were completed.
Study Participants
Consistent with qualitative research, study group participants were
selected using purposeful sampling. The study criteria were (a) willingness
and ability to attend an 8-week narrative therapy group, (b) older than 55,
and (c) seeking assistance for addictions (or substance misuse) and mental
health issues. Participants were recruited through therapist outreach, word
of mouth, and advertising in local free newspapers.
The final group of participants consisted of 12 older adults. The partici-
pants ranged in age from 55 to 70 years of age. Seven were men and five
were women. They reflected the diversity of some of Toronto’s cultural
groups and included immigrants from Africa, Germany, Spain, France, and
Scotland. In keeping with the tenets of narrative therapy and in line with the
OPUS 55 Program focus on harm reduction, participants were not sub-
jected to intake assessments, nor were they asked to detail the “stage” of
their addiction. Through observing the therapy sessions, however, we
learned that many of the participants had experienced a range of therapies
and supports prior to the group including cognitive-behavioral therapy,
12-step groups, and mental health support. Three participants had not
received any formal group therapy prior to the study.
Data Collection
The two primary methods of data collection were participant observa-
tion and semistructured interviews. Each interview was approximately 1
hour and took place after the therapy sessions were completed. The inter-
view questions focused on a self-reported evaluation and discussion of the
process of group narrative therapy with older adults as well as their indi-
vidual experiences (e.g., helpfulness or not, strengths and weaknesses of
the process, and how participants felt about the group process and the age
of the group participants). All of the therapy sessions as well as the indi-
vidual interviews were audiotaped and transcribed professionally. In addi-
tion, both researchers attended and observed all of the therapy sessions and
maintained extensive field notes during the sessions and over the course of
the entire study. Through an inductive process the development of general
themes and preliminary analysis was ongoing throughout the data collec-
tion phase. These themes were discussed and debated among the research
team, and the final list provided the basis of the coding scheme used in the
data analysis.
Data Analysis
Data were analyzed in two stages using a constructivist grounded theory
approach (Charmaz, 2000, 2003, 2005; Charmaz & Mitchell, 2001; Glaser
& Strauss, 1967; Mills, Bonner, & Francis, 2006; Strauss, 1987).
Constructivist grounded theory methods involve simultaneous data collec-
tion and analysis with each informing and focusing the other throughout the
research process. In this study, our early analysis began and continued dur-
ing our (team) discussions and (researcher) reflections after each therapy
session, which we then used to help us focus the data collection at subse-
quent sessions. Using a constructivist grounded theory approach, we devel-
oped increasingly abstract ideas about the research participants’ meanings,
actions, and worlds while simultaneously seeking specific data to fill out,
refine, and check our emerging conceptual categories. These early concep-
tual categories were used as a preliminary broad coding scheme that we
then used during our final (two-stage) analysis process. Stage I, “coding,”
involved (a) immersion into the data and multiple close “readings” (listen-
ing to audio recordings, reading the interview and therapy session tran-
scripts, and examining the field notes) and then (b) integrating this
knowledge back into our preliminary broad coding scheme. During this
stage of analysis, chunks of data, quotes, and keywords that were deemed
important and relevant to the research question were highlighted and

assigned a code. The list of codes was then continuously refined through
ongoing consultation between the two researchers. Stage II, “coding to
interpretation,” began once the data had been coded (organized into various
categories). At this point, the coded data were systematically explored to
generate meaning by looking for patterns, themes, contrasts, contradictions,
paradoxes, similarities, and differences. The final themes were agreed on
by the research team as appropriately reflecting the views and opinions of
the research participants and their experience of group narrative therapy.
Results
Overall, findings from this study suggest that narrative therapy is a help-
ful therapeutic approach for older people with addictions. All of the par-
ticipants described their experiences as positive. A good example is Steve’s
response when asked what he found most helpful or least helpful about
narrative therapy:
Well, I never knew anything about it, and now I am a believer, yeah . . . that
approach is probably the most progressive approach I’ve encountered in my
lifetime. And I think here, I’m creeping up on 70, and I’ve never had anything
that inspired me as much as narrative therapy. And made me want to, you
know, deal with the problem and realize that it’s not as bad and it’s not as
hard as I made it out to be because of the approach, you know . . . these
classes, and just being around people who experienced the same thing, your
age group, I mean to say, wow! . . . And you see the improvement from
week to week, and then this kind of gives you a new look, a new life on the
whole thing, the whole process of trying to overcome the problem, or the
problems. (Steve)
In terms of the “problem” (addiction or substance misuse), the findings

suggest narrative therapy has a positive effect. When asked to report on how
narrative therapy may or may not have had an impact on the “problem,”
eight participants felt narrative therapy had a very beneficial effect on their
substance misuse, and at the time of the interview four participants indi-
cated they were presently abstaining from use.
It’s been very helpful; it’s useful to me right now. I use the tools of it to rein-
force the other, positive story. It brought it into much more relief; much more
obvious . . . it became more conscious. That is very positive especially
when it comes to the issue, the problem. It helps me to understand the chal-
lenge and to put it in terms of the societal level. (Jake)
In addition, four of the participants felt that narrative therapy was “good”
for both addictions and mental health, even though they had “slip-ups” dur-
ing the study, and all participants wanted to continue the group narrative
therapy sessions.
The analyses also provided some important and useful insights into the
strengths and weaknesses of the narrative therapy process. Participants
reported on the helpfulness of the four key tenets around which the therapy
sessions at CAMH were organized—externalizing the problem, developing
the “team,” creating the preferred or alternative story, and thickening the
thread. Three of these tenets were very helpful according to the partici-
pants, and the process of working to externalize the “problem” seemed to
be especially important and empowering.
Externalizing the problem:
By putting the problem somewhere else, whether it’s in the room or in the
balcony or whatever, then you’re separating yourself from the guilt. I’m not
a bad person; I’m just a person with a problem. (Bruno)
And I . . . I really thought about the group throughout the week. But it was
hard [at] first to get rid of the problem, not to talk about the problem. Because
also we enjoy talking about the problem. It’s fun [chuckles]. (Sheila)
Developing the team:
Oh. I can’t tell you how much I’ve learnt and as you said, I’ve starting using the
narrative therapy approach in my life, you know. I remember that one week when
we were talking about, you know, the team, and then I thought who was on my
team and other things that have happened and I felt pretty good. (Gretchen)
Creating the alternative story:
Narrative therapy, then it is a way for a particular person to start to look at

their life in . . . through story and also that . . . we have different sto-
ries and they are positive aspects to draw on, and that we can retell our
story. We live out a story and we can—we live out a story and whether we
know it or not, whether we’re conscious of it or not, and that we are chal-
lenged by narrative therapy to, through awareness, to become aware of the
story we’re telling ourselves and make choices of what short story we want
to tell ourselves, and that there’s more than one story. There can be many
stories. And ahm, in that sense, that’s what’s so powerful about it. (Jake)
The final tenet, “thickening the thread,” was not considered to be helpful
by participants. They reported feeling confused about this concept and that
they could not easily connect to the words used to identify this stage of the
process. Instead, they suggested using “grounding,” “evidence,” or “building
the facts” as different ways of naming and then practicing this final tenet.
Narrative Therapy and Older Adults

In addition to exploring what participants and practitioners found help-
ful (or not) about narrative therapy, we were also interested in how this
therapeutic process may be suited to older adults specifically.
The ways in which age or age-related processes affect the narrative therapy
experience were among the most profound findings of this study. Age was
revealed as a key determinant of both individual as well as group experience.
In the therapy sessions, age was frequently discussed, and participants regu-
larly related their experiences to their stage of life. In the follow-up interviews
individuals described how age served to draw the group together as a “collec-
tive,” that it was very helpful to them that the group consisted of people their
own age and also that one of the therapists was herself an older adult:
It was great to have [older therapist]; she understands where I am in my life

right now, and her examples and jokes I can get. (Gretchen)
Further analysis revealed age played a role in the experience of narrative

therapy for this group in three main ways: time—a sense of urgency, cohort
experience, and wisdom and understanding.
Time—A Sense of Urgency

The notion that time is precious was particularly relevant to the study
participants and their narrative therapy experience. Participants reflected
that their older age presented them with a sense of urgency which they
described as “time is running out” and “the party is over.” This sense of
urgency brought with it the courage to “try something new,” as they
described in their interviews when asked why they volunteered to be part of
this project:
Because I think they, you know, they say you can’t teach an old dog new
tricks. . . . Well, they found that that theory doesn’t work ’cause [an] old
dog is more willing to learn than a young dog because, you know, he’s got
the time to do it, and he’s got the experience, and they’ve proven it already.
The old dog is more willing to learn than a young dog. (Steve)
Connected with this heightened awareness of time was the recognition of

the toll that the years of addiction had taken on their bodies and the need to
make a change or risk increasing health concerns.
I think . . . I think, you know, the old saying, “we’re sick and tired of being
sick and tired,” you know, there comes a point where if you haven’t quit
before or if you’ve quit and come back, there’s a time to stop. Because your
health, your body can’t take it any more anyways. (Bruno)
Participants described a persistent “fatigue” and recognized that their

additions were “catching up to them” and “now is the time to slow down.”
The wish to “slow down” was particularly important to the narrative ther-
apy process, bringing openness to the “other stories” that had been silenced
by “the problem” for so many years and also allowing participants the time
to really listen and reflect on the stories of others.
Cohort Experience
Analysis highlighted many examples of shared cohort experiences that
served to connect individuals with other members of the group. For exam-
ple, growing up in the 1940s and 1950s, participants all maintained memo-
ries of the war or postwar period that they shared openly in the therapy
sessions. In addition, participants discussed what seemed to be commonly
shared beliefs and attitudes such as their work ethic (“independent,”
“strong,” and “hardworking”) and a view of alcoholism or addiction as a
“weakness” of character—“I felt I was the problem, you see where I come
from, a small town in Germany and grew up after the war, you were
expected to solve your own problems” (Gretchen). Participants often
argued that their experience and perception of their addiction were very
different from those of younger people. As older adults who were experi-
encing retirement, had grown children or even grandchildren, and mostly
were living alone, they felt their isolation was more marked, their sense of
purpose in life lacking, and the emotional and physical pain of the addiction
greater. The shared cohort experiences were important to the narrative
therapy sessions, providing a common ground on which to share stories and
a point of humor that everyone could relate to and appreciate.
Wisdom and Understanding

Finally, wisdom and understanding emerged as a significant theme.
Participants reported an increased personal wisdom and understanding of
themselves as a result of their age, which was helpful to their narrative
therapy experience. They described their fierce independence as youth and
their ability now as older adults to “let go” of this, recognizing that overcom-
ing their addiction requires the support and assistance of others. Several
participants described themselves as “smarter” than they were in their youth
and indicated that their accumulated job-related and relationship experience
was extremely helpful for “figuring out life” including their addiction.
Well I think as we get older, I think we get a little more, ahm, hopefully
tolerant so that you can think in terms of trying to change things. (Lorna)
Of course one of the advantages of being older, you don’t expect things, you
know, you’ve been through a lot of stuff and you do have patience and that
sort of thing, I think. (Jake)
Participants also reported that with age and wisdom comes stories, and
they recognized that an abundance of stories is very helpful for a therapeu-
tic technique that relies on storytelling for its success: “The older you are
the more stories you have to tell” (Sheila).
The many and diverse ways in which age and age-related processes
shaped the experience of narrative therapy lead us to suggest that the expe-
rience of addictions is historically constituted and shaped by stages of the
life course.
Discussion: The Promise of Narrative

Therapy for Older Adults
Findings from this study add to the growing body of literature that sup-
ports the use of narrative therapy. In particular, this study provides new
insights into the use of this therapy with older adults and with people with
addictions, and findings suggests that narrative therapy may be particularly
well suited to this age group. We believe that the reasons for the compatibil-
ity may be linked to the themes “time,” “cohort experience,” and “wisdom.”
Examining these themes further, we make two additional suggestions for
interpretation. First, the success may be linked to the idea that narrative
therapy presents itself as a form of resistance for older adults, and, related
to this, the storytelling format utilized in narrative therapy may be one of
its most salient features for older people as it provides a rich opportunity
for showcasing the accumulated life stories of a population (old, experiencing
substance misuse) often silenced by stigma and isolation.
Resistance
A fundamental yet often neglected principle of narrative therapy is a
concern for issues of inequality and social justice. Narrative therapy is seen
to provide important opportunities for resistance for marginalized popula-
tions such as older people. The analysis indicates that this is true for the
study participants in a number of specific ways.
First, narrative therapy fosters an awareness of the ways in which domi-
nant discourses weaken personal agency and undermine appreciation of
one’s authoritativeness. Given that the loss of control and the loss of auton-
omy are significant factors for older people, the foregrounding of partici-
pants’ narratives may be a way to resist disempowering practices in
addictions and mental health such as “traditional” assessment procedures
that label and limit individuals. It may also be a way to shift some thera-
peutic power from therapist to participant.
Second, the process of narrative therapy itself allows for and encourages
expressions of resistance—participants own and express alternative stories
(both in terms of the addiction or mental health issue and also about being
“old”). Narrative therapy provides the space and time for narratives that
surprise, that delight, or that have been long buried and tucked away as
“irrelevant” to the problem. Indeed, for one quiet gentleman in the study, his
“expression of resistance” manifested itself in his dress and outward appear-
ance. When interviewed about why he had begun the sessions in baggy gym
pants but ended Session 8 in a suit and hat, he made it clear that he was
“sending a message” about who he had become through the process.
Similarly, a goal of narrative therapy is to help people who are silenced
for reasons such as poverty or disability to feel “entitled” to take up space
in the world. There are several discourses that serve to oppress older people
(Grimm, 2003, p. 253) and prevent them from taking up space in most
Western spaces including the formal mental health and addictions systems.
Simply by coming to this group older people are taking up space in the
world (and in the psychotherapeutic “system”).
In addition, the authors suggest that for all of the participants (therapists
and clients), narrative therapy provides a form of resistance to hegemonic
practices in psychotherapy. By not making a “meal” of the problem, by

focusing on assets and alternatives, teams and threads, resistance becomes
power (Foucault, 1980), representing an important practice for the “power-
less” in society.
Storytelling
Storytelling is at the root of narrative therapy, and gerontological
research suggests older persons have numerous stories to tell (Osis & Stout,
2001). Many older people, including those from cultures with strong oral
traditions, use storytelling to share wisdom and build intergenerational
relationships. Older people have lived long lives and therefore have many
experiences of triumphs and challenges that become resources to be tapped
for motivating change (Eron & Lund, 2003). The deaths of family mem-
bers, partners, and friends as well as poor health and social factors such as
ageism and poverty mean that older people may have fewer opportunities
than their younger counterparts to tell their stories to a supportive audience.
Although not explicitly narrative therapy, storytelling is a narrative process
that has been shown to improve mental health (McLeod, 2004; Rennie,
1994). Described as a fundamental way in which people make sense of the
world, Rennie (1994) argued that storytelling is more than an aid to the
process of therapy—it is integral to the process itself. In group therapy,
stories are shared and cocreated through a dialogical process. The common
theme in the growing narrative discourse (including narrative research, nar-
rative analysis, and narrative therapy) is that people are social beings and
have a basic need to tell their stories. Telling one’s story promotes a sense
of knowing and being known and leads to social inclusion (McLeod, 1999;
White, 1995).
This research supports claims (Grimm, 2003) that narrative therapy pro-
vides extensive opportunities for the remembering and re-experiencing of
past knowledge’s and relationships and thus represents an effective approach
with older people. Unlike other storytelling therapies, such as reminiscence
therapy (Cappeliez, O’Rourke, & Chaudhury, 2005; Wong & Watt, 1991)
or life review (Davis-Berman & Berman, 1998; Fisher, 1991), narrative
therapy is a very specific and focused kind of storytelling where partici-
pants are guided in their remembering toward their positive life stories,
which are then utilized throughout the therapeutic process to support indi-
vidual change.
Narrative Therapy and Applied Gerontology:

Challenges and Opportunities
As is always the case, our research on narrative therapy unearthed ques-

tions that speak to the limitations and challenges of such an inquiry. We
wonder how we might have improved “intake” in ways that clarified com-
mitment but did not further oppress these older adults and if we should have
more thoroughly differentiated among “substances” (i.e., a narrative therapy
group just for alcohol misuse). And should we have included a quantifiable
element to the research such as a pretest and posttest or a questionnaire for
participants?
Turning to the tenets of narrative therapy, we wonder whether more
attention should have been given to the “literary means” or documents
sometimes offered by participants. What could we have made of the poems,
letters, and “reports” that some participants brought to the groups? Indeed,
might we have extended that eighth tenet of narrative therapy to include
artifacts such as clothing, jewelry, or charms participants deemed symbolic
of change and support? In addition, we believe that the “importance” of an
“older” narrative therapist was an underexplored factor in this research,
warranting further study on who “holds” participants’ stories. Finally, we
regret that there were not more opportunities for Tenet 9, “taking it back
practices,” which create opportunities for participants to share benefits of
narrative therapy not only within the group and their social circles but also
with what Foucault would call the wider “episteme.”
Despite these concerns, this study demonstrates the promise and benefits
of narrative therapy for older adults and for applied gerontology. Although
further study is warranted, findings from this project not only add to the
formal research on narrative therapy but also are the first to speak to the
practice of narrative therapy with older adults with addictions. Listening to
and cocreating these stories in narrative therapy provided important insights
into aging processes and experiences while simultaneously providing a
space for older people with addictions to begin to change their worlds, one
story at a time.
Note
1. The focus of this article is on Study Objectives A (usefulness) and C (suitability for
older adults). We discuss narrative therapy with groups and for mental health issues elsewhere
(Poole & Gardner, submitted).
References
Allison, D. (2005). Unpublished lecture presented at University of Nebraska-Lincoln.
Amundson, J. K. (2001). Why narrative therapy need not fear science and “other” things.
Journal of Family Therapy, 23(2), 175-188.
Angus, L., & Hardtke, K. (1994). Narrative processes in psychotherapy. Canadian Psychology,
35(2), 190-203.
Augusta-Scott, T., & Dankwort, J. (2002). Partner abuse group intervention: Lessons from
education and narrative therapy approaches. Journal of Interpersonal Violence, 17(7), 783-
805.
Benshoff, J., Harrowood, L., & Koch, D. (2003). Substance abuse and the elderly: Unique
issues and concerns. Journal of Rehabilitation, 69(2), 43-49.
Besa, D. (1994). Evaluating narrative family therapy using single-system research designs.
Research on Social Work Practice, 4(3), 309-325.
Besley, A. C. T. (2002). Foucault and the turn to narrative therapy. British Journal of Guidance
& Counselling, 30(2), 125-143.
Biever, J. L., Bobele, M., & North, M.-W. (1998). Therapy with intercultural couples: A post-
modern approach. Counselling Psychology Quarterly, 11(2), 181-188.
Caldwell, R. L. (2005). At the confluence of memory and meaning—Life review with older
adults and families: Using narrative therapy and the expressive arts to re-member and re-
author stories of resilience. Family Journal, 13(2), 172-175.
Cappeliez, P., O’Rourke, N., & Chaudhury, H. (2005). Functions of reminiscence and mental
health in later life. Aging & Mental Health, 9(4), 295-301.
Carlson, T. D. (1997). Using art in narrative therapy: Enhancing therapeutic possibilities.
American Journal of Family Therapy, 25(3), 271-283.
Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4),
485-503.
Centre for Addictions and Mental Health. (2005). Project Seagull. Toronto, Ontario, Canada:
Author.
Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin
& Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 509-535). Thousand
Oaks, CA: Sage.
Charmaz, K. (2003). Grounded theory. In M. S. Lewis-Beck, A. Bryman, & T. F. Liao (Eds.), The
Sage encyclopedia of social science research methods (pp. 440-444). Thousand Oaks, CA:
Sage.
Charmaz, K. (2005). Grounded theory in the 21st century: Applications for advancing social
justice studies. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative
research (3rd ed., pp. 507-535). Thousand Oaks, CA: Sage.
Charmaz, K., & Mitchell, R. (2001). Grounded theory in ethnography. In P. Atkinson,
A. Coffey, S. Delamont, J. Lofland, & L. Lofland (Eds.), Handbook of ethnography
(pp. 160-174). Thousand Oaks, CA: Sage.
Davis-Berman, J., & Berman, D. (1998). Lifestories: Processing experience throughout the
lifespan. Clinical Gerontologist, 19(3), 3-11.
Diamond, J. (2000). Narrative means to sober ends. New York: Guilford.
Doan, R. E. (1998). The king is dead; long live the king: Narrative therapy and practicing what
we preach. Family Process, 37(3), 379-385.
Dulwich Centre. (n.d.). Deconstructing addictions: A Web-based resource. Retrieved April 3,
2007, from http://www.dulwichcentre.com.au/deconstructing_addiction.html
Eron, J., & Lund, T. (2003). The narrative solutions approach: Bringing out the best in people
as they age. In J. Ronch & J. Goldfield (Eds.), Mental wellness in aging: Strengths-based
approaches (pp. 273-298). London: Health Professions Press.
Etchison, M., & Kleist, D. M. (2000). Review of narrative therapy: Research and utility.
Family Journal, 8(1), 61-66.
Fisher, B. J. (1991). The essence of a life—Life histories as a method for generating images
of successful aging. Teaching Sociology, 19(1), 21-27.
Focht, L., & Beardslee, W. R. (1996). “Speech after long silence”: The use of narrative therapy
in a preventive intervention for children of parents with affective disorder. Family Process,
35(4), 407-422.
Foucault, M. (1980). The history of sexuality, Volume I: An introduction. New York: Vintage.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualita-
tive research. Chicago: Aldine.
Grimm, R. (2003). Narrative therapy with older adults. In J. Ronch & J. Goldfield (Eds.),
Mental wellness in aging: Strengths-based approaches (pp. 237-271). London: Health
Professions Press.
Kogan, S. M., & Gale, J. E. (1997). Decentering therapy: Textual analysis of a narrative therapy
session. Family Process, 36(2), 101-126.
Kropf, N. P., & Tandy, C. (1998). Narrative therapy with older clients: The use of a “meaning-
making” approach. Clinical Gerontologist, 18(4), 3-16.
Lee, J. (1997). Women re-authoring their lives through feminist narrative therapy. Women &
Therapy, 20(3), 1-22.
Luborsky, L., Barber, J. P., & Diguer, L. (1992). The meanings of narratives told during psycho-
therapy: The fruits of a new observational unit. Psychotherapy Research, 2(4), 277-290.
Luborsky, L., Popp, C., Luborsky, E., & Mark, D. (1994). The core conflictual relationship
theme. Psychotherapy Research, 4(3-4), 172-183.
Man-kwong, H. (2004). Overcoming craving: The use of narrative practices in breaking drug
habits. International Journal of Narrative Therapy and Community Work, 1, 1-5.
McLeod, J. (1999). A narrative social constructionist approach to therapeutic empathy.
Counselling Psychology Quarterly, 12(4), 377-394.
McLeod, J. (2004). The significance of narrative and storytelling in postpsychological coun-
seling and psychotherapy. In A. Lieblich, D. McAdams, & R. Josselson (Eds.), Healing
plots: The narrative basis of psychotherapy (pp. 11-27). Washington, DC: American
Psychological Association.
McLeod, J., & Balamoutsou, S. (1996). Representing narrative process in therapy: Qualitative
analysis of a single case. Counselling Psychology Quarterly, 9(1), 61-76.
Mills, J., Bonner, A., & Francis, K. (2006). The development of constructivist grounded the-
ory. International Journal of Qualitative Methods, 5(1), 1-9.
Murphy-Shigematsu, S. (2000). Cultural psychiatry and minority identities in Japan: A con-
structivist narrative approach to therapy. Psychiatry: Interpersonal & Biological Processes,
63(4), 371-384.
Myerhoff, B. (1982). Life history among the elderly: Performance, visibility and remember-
ing. In J. Ruby (Ed.), A crack in the mirror: Reflexive perspectives on anthropology
(pp. 20-35). Philadelphia: University of Pennsylvania Press.
National Advisory Council on Aging. (2002). The NACA position on supportive housing for
seniors (No. 22). Ottawa, Ontario, Canada: Author.
Neimeyer, R. A., & Raskin, J. D. (2000). On practicing postmodern therapy in modern times. In
R. A. Neimeyer & J. D. Raskin (Eds.), Constructions of disorder: Meaning-making frame-
works for psychotherapy (pp. 3-14). Washington, DC: American Psychological Association.
Nylund, D., & Nylund, D. A. (2003). Narrative therapy as a counter-hegemonic practice. Men
& Masculinities, 5(4), 386-394.
O’Connor, T. S., Davis, A., Meakes, E., Pickering, R., & Schuman, M. (2004). Narrative
therapy using a reflecting team: An ethnographic study of therapists’ experiences.
Contemporary Family Therapy, 26(1), 23-39.
O’Connor, T. S., Meakes, E., Pickering, M. R., & Schuman, M. (1997). On the right track:
Client experience of narrative therapy. Contemporary Family Therapy, 19(4), 479-495.
Osis, M., & Stout, L. (2001). Using narrative therapy with older adults. In G. Kenyon, P. Clark,
& B. de Vries (Eds.), Narrative gerontology: Theory, research, and practice (pp. 273-290).
New York: Springer.
Poole, J., Gardner, P., Flower, M. and Cooper, C. (Unpublished manuscript submitted for
publication in 2009). Narrative therapy in a group for older adults? Practice, research and
recommendations. Social Work with Groups.
Rennie, D. L. (1994). Storytelling in psychotherapy: The client’s subjective experience.
Psychotherapy: Theory, Research, Practice, Training, 31(2), 234-243.
Russell, R. L., Van den Broek, P., Adams, S., Rosenberger, K., & Essig, T. (1993). Analyzing
narratives in psychotherapy: A formal framework and empirical analyses. Journal of
Narrative & Life History, 3(4), 337-360.
Semmler, P. L., & Williams, C. B. (2000). Narrative therapy: A storied context for multicul-
tural counseling. Journal of Multicultural Counseling and Development, 28(1), 51-62.
Steinglass, P. (1998). Researching narrative therapy. Family Process, 37(1), 1-2.
Strauss, A. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press.
Van Amburg, S. M., Barber, C. E., & Zimmerman, T. S. (1996). Aging and family therapy:
Prevalence of aging issues and later family life concerns in marital and family therapy
literature (1986-1993). Journal of Marital & Family Therapy, 22(2), 195-203.
van der Velden, I., & Koops, M. (2005). Structure in word and image: Combining narrative
therapy and art therapy in groups of survivors of war. Intervention: International Journal of
Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict, 3(1), 57-64.
White, M. (1995). Re-authoring lives. Adelaide, Australia: Dulwich Centre Publications.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.
Winslade, J., & Smith, L. (1997). Countering alcoholic narratives. In G. Monk, J. Winslade,
K. Crocket, & D. Epston (Eds.), Narrative therapy in practice: The archaeology of hope
(pp. 159-192). San Francisco: Jossey-Bass.
Wong, P., & Watt, L. (1991). What types of reminiscence are associated with successful aging.
Psychology and Aging, 6(2), 272-279.
Wood, G., & Roche, S. (2001). Situations and representations: Feminist practice with survi-
vors of male violence. Families in Society, 82(6), 583-590.
Paula J. Gardner is a postdoctoral fellow in the Division of Health Policy at the New York
Academy of Medicine in New York City. She is committed to community-based, interdiscipli-
nary research, and her interests include social inequalities and aging, healthy aging and age-
friendly communities, and healthy public policy.
Jennifer M. Poole is an assistant professor in the School of Social Work at Ryerson University
in Toronto, Ontario, Canada. Her research interests include health and mental health, contem-
porary social theory, pedagogy, and qualitative research. She hails from Montreal.

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One Story at a Time: Narrative Therapy, Older Adults, and

The online version of this article can be found at:

Southern Gerontological Society

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OnlineFirst Version of Record - Jan 23, 2009

Keywords: narrative therapy; older adults; addictions; qualitative research

A myriad of factors including social isolation, discrimination, physical

and experience of these addictions can be quite different compared with

What Is Narrative Therapy?

Originally developed by White and Epston (1990), narrative therapy is

Key Challenges to Narrative Therapy

Stage I: “Position The position of the therapist is as an equal

or singular accounts, narrative therapy will pursue the historical human

Applications of Narrative Therapy

Empirical Research and Narrative Therapy

foundations of narrative therapy (O’Connor, Meakes, Pickering, & Schuman,

Narrative Therapy and Older Adults

Gaps in the Literature

To answer the research questions, investigators used a modified version

and a critique of abstinence-based models, OPUS 55 program staff use a

important and relevant to the research question were highlighted and

In terms of the “problem” (addiction or substance misuse), the findings

Externalizing the problem:

Developing the team:

Creating the alternative story:

Narrative therapy, then it is a way for a particular person to start to look at

Narrative Therapy and Older Adults

It was great to have [older therapist]; she understands where I am in my life

Further analysis revealed age played a role in the experience of narrative

Time—A Sense of Urgency

Connected with this heightened awareness of time was the recognition of

Participants described a persistent “fatigue” and recognized that their

Wisdom and Understanding

Discussion: The Promise of Narrative

practices in psychotherapy. By not making a “meal” of the problem, by

Narrative Therapy and Applied Gerontology:

As is always the case, our research on narrative therapy unearthed ques-

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