In recent years, narrative approaches in clinical and ethical decision-making in psychiatry, psychotherapy, and behavioral health have increased in importance. While the waning of psychoanalytic and psychodynamic teaching in residency programs and the increased effectiveness of psychopharmacologic interventions in clinical practice have decreased the profession’s reliance on interpretive or “talking” psychotherapy, the influence of the medical humanities has increased interest and curiosity about narrative theory and application in the behavioral health fields. Managed care has had a negative impact on health care education and health care practice, and yet it has had a positive impact by fueling new discussion and reflection upon the fundamental ethical aspects that define the patient-professional relationship in health care.
In this chapter, I present the case of J.S., a former patient who was in treatment with me for more than ten years and helped me to explore ways in which narrative can improve clinical and ethical decision-making in psychiatry and psychotherapy. 1 A narrative therapeutic approach evolved in our work together over the last ten years. J.S. has reviewed this manuscript and has given permission for its publication. I have changed several elements to protect her privacy.
J.S. is a forty-five-year-old divorced woman. Her first appointment with me was ten years ago. In those first sessions, she told me that she had seen another psychiatrist, Dr. A., who had diagnosed her with major depression, anxiety disorder, post-traumatic stress disorder, and a mild borderline personality disorder. She was treated with several medications, including an antidepressant, an antianxiety medication, and a medication for occasional sleep disturbance. Over the years, she had tried numerous antidepressants, antianxiety agents, and mood-stabilizing medications. At the time of her first visit with me, she believed that she was on an optimal combination of medications.