Narrative medicine

Domain VIII · Creative & expressive arts therapies · Rita Charon · 2001 · New York

What it is

Narrative medicine is a framework and a training discipline, not a psychotherapy. Rita Charon, an internist with a PhD in English literature, built it at Columbia University in New York, where it is taught in the medical school, in clinician seminars and in a Master of Science programme. It is…

Format

• Narrative medicine has no manualised phases, no fixed session count and no criteria for moving between phases. What the sources describe is a set of recurring formats and an order within each one. Treat the "phases" below as the order of a single encounter or workshop, not stages of a therapy.
• Close reading of a short literary or visual text in a group, using a structured set of reading questions.

Who practises it, and how they are trained or regulated

• B. Within one training session or workshop (Columbia pedagogy)
• Formal training: Columbia lists a Master of Science in Narrative Medicine and an online Certification of Professional Achievement. Their content and length are not drawn on here.
• Professional frame. Narrative medicine is not a regulated profession. There is no registration, licence or protected title, and no professional body that credentials practitioners in the way HCPC, AATA or BAPT do for the arts therapies. Its methods are used inside your existing professional registration and ethical code. Columbia's MS and online certificate are the institutional training routes; workshop…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the seminar becoming a lecture. Working sign: participants bring formal observations back into case discussions.
• the client correcting your assumption, which counts as success. In supervision, a quick check is to ask whose feelings your notes describe.
• writing pulling your eyes away from the client. Some clients find it alienating, especially those with surveillance or trauma histories. In that case write afterwards instead. Working sign: the…
• the group drifting into a complaints meeting or a case conference. Bring it back to the writing. Keep line managers out of the group, or think hard before including them, because their presence…
• prompts that pull too deep for the group's current safety (see 5.3). Use indirect, imaginative or third-person prompts with new groups and distressed participants. Working signs: everyone writes…

Problems the guide addresses

• Stuck or blank participants
• Resistance and scepticism ("I'm not a writer" or "this is soft")
• Overwhelm, flooding and retraumatisation
• Closing safely
• Privacy breaches in patient material
• Non-adherence (parallel charts not written, groups not attended)
• Ruptures
• Modality-specific difficulties

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.