Disorganized narratives: problems in treatment and therapist intervention hierarchy

The way in which patients tell therapists their stories has an impact on treatment. They try to put their emotions and the events generating them, their goals and the behavior they adopt to achieve them, and so on, together in a coherent discourse. But some patients fail in organizing their narratives. They might describe a diffuse arousal without letting the reasons for their discomfort be known, switch from one subject to another without any apparent connection, or pile up one topic after another, thus overwhelming a listener, who is unable to see which is the main one. We call such narratives disorganized. They do not help a patient to make sense of experience or achieve consistency in behavior. A therapist listening has difficulty in planning treatment and often reacts negatively to such patients. Here we propose a series of interventions aimed at improving narrative coherence, creating a sound therapeutic relationship and making treatment effective. We will describe the therapy with a seriously dissociated patient in which this intervention has proven useful