Article By: Michael Azarani, Ph.D.
Clinical experience reveals much about the artistic and scientific practice of psychology. Integrating these two dimensions often feels like balancing on a tightrope, where I often have to confront the limitations of the clinical literature amidst the reality of complex clinical presentations and experiences. The fine line between art and science becomes more apparent the longer I spend in clinical practice. Any clinician with good instincts who has spent any amount of time in practice comes to appreciate the complexity that individual differences, ideographic learning and developmental histories, cultures, and contexts bring to the clinical endeavor.
One way that I often find the clinical literature lacking is in matters of culture, anti-colonial, and liberatory practice. To be sure, researchers within certain subdisciplines of psychology have sought to address these theoretical and empirical gaps (and their contributions have been immense), but amidst the pressures of academia to “publish-or-perish,” much of the multicultural literature can feel circumscribed to very specific populations and constellations of experience within that population that are difficult to apply to any individual case. Indeed, one of the first valuable lessons I learned as a trainee was that variability within a group is often greater than the variability between groups, a lesson which is reaffirmed with each new client that sits in my chair.
So, how, in the midst of all these barriers, do we work across differences in ways that promote liberation and challenge the oppressive and marginalizing notion that one size of therapy fits all? While there are plenty of scholars who have written rich theoretical takes on how to conceptualize from a culturally-informed lens, I want to focus on one aspect of culturally commensurate (i.e., extending from one’s culture) practice that has been transformative in my development as a therapist and catalyzing in its ability to locate in the client core conflicts, and beliefs born out of culturally-bound experiences unique to one’s identity: Storytelling.
Storytelling has been an integral phenomenon of human experience and expression for thousands of years. From epic poems like the Odyssey to religious texts to oral storytelling traditions of Indigenous people worldwide, storytelling has been used for creative expression, moral teaching, and community building.
Even in the modern era, the impact of storytelling remains relevant and has been integrated throughout disciplines beyond literature, finding homes in fields like psychology, education, and critical philosophy. Indeed, post-modern therapists have often mobilized narrative as a means of helping clients re-story problem-saturated narratives and recenter their experience on resilience and hope while re-locating popular notions of pathology back to the culturally informed and sociopolitical milieu from which such problems tend to arise.
Critical race theorists mobilize counterstory—writing that aims to cast doubt on the validity of taken-for-granted societal assumptions held by the majority population—to challenge oppressive and marginalizing myths of vulnerable people and revisionist histories.
During the start of my clinical practice, I had the honor to be taught by a Native elder who, unlike many professors during my training, utilized culturally-commensurate practices, such as storytelling, to educate me and my peers about the therapeutic endeavor. Through the use of stories, I could examine in myself the various ways that dominant, problem-saturated stories took root in my sense of identity and contributed to how I engaged with myself and others and would, undoubtedly, contribute to how I worked with clients. Through the use of counterstory and traditional Indigenous teachings, my elder helped me re-story the colonial, revisionist history of my Indigenous Mexican heritage and re-center my understanding of identity on the violence and genocide that contributed to my beliefs about myself and my culture.
What storytelling revealed to me was that my and my family’s understanding of our indigeneity was a feature of a White supremacist system designed to eradicate Indigenous identity, not a flaw. It was through storytelling that my elder used to reveal these insights and truths.
Without question, storytelling can be a potent tool for unsettling our taken-for-granted assumptions and beliefs. The clinical observation of many analytically-oriented therapists that internal conflicts can often be summarized in child-like desires for care, connection, understanding, and love positions many people to be touched by narratives that capture the most fundamental human experience. It’s no wonder that story has endured and developed in various mediums and disciplines.
In my clinical practice, I often mobilize storytelling to deepen clients’ internal understanding and as a stimulus for their free associations. A client who struggles to meet the demands of a marginalizing society while maintaining integrity may find insight in Indigenous stories I heard from my elders of tricksters like Cayote. Another client struggling with core conflicts of being competent may benefit from traditional Indigenous stories of self-actualization or other culturally commensurate storytelling.
By now, you may notice that storytelling is an intersubjective endeavor that brings together the subjectivities of clients and therapists to co-create, dialogically, new meaning. As such, storytelling as a clinical tool demands the expert mobilization of therapist subjectivity to support clients in expanding their awareness and understanding of self. Storytelling, therefore, can be a culturally-commensurate tool that disrupts the notion—and often outdated idea—of a stoic, blank-slate, impenetrable therapist.
Clinicians and clients can also mobilize stories via modern mediums such as music, television, or comic books. While working with a queer, Vietnamese-American client navigating the coming out process with their family, I utilized the graphic novel, The Magic Fish by Trung Le Nguyen—a story of a first-generation Vietnamese boy navigating coming out to his mother who struggles to speak English and must use story to communicate her love and acceptance of her son—to help this client begin to process their fears, hurts, and needs. Through this medium, we could elaborate the client’s emotion, understand it more fully, and connect their experience to the social and cultural realities of their context.
My use of the graphic novel was intentional and designed to evoke, provocatively, the experience of repressed pain such that it could be re-storied and reconsolidated for the benefit of the client’s health in a way that captures the cultural nuances so often ignored by traditional approaches to therapy.
Sometimes, recognizing a client’s needs via story can become an avenue for deepening the therapeutic relationship, one of the most critical factors in psychotherapy outcomes. Thus, storytelling is a powerful tool clinicians can mobilize to usurp the dominance of sterile, culturally bankrupt medical therapy models and be mobilized to support and promote abolition, liberation, and survivance (i.e., surviving and thriving).
As a clinician committed to liberation and anti-colonial practice, it is essential to resist the norms of modernity that maintain psychotherapy as the right hand of supremacy and violence against the most marginalized and vulnerable people. Although we may never be able to completely divorce therapy from the colonial context in which it was birthed, integrating culturally-commensurate and creative interventions that center relationship and culture, such as storytelling, maybe one way we can resist the harm in which our field has been historically complicit, and toe the line between art and science.