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Therapeutic Communication with Children : The Mutual Story telling Technique .
Book R eviews
749
could be reduced and understood without re sorting to m edication, with su fficie nt personnel and a goo d th erapeutic alliance. This volume represents a noteworthy effort with an interesting research de sign that takes place in a particular setting with a relativel y homogeneous group . D espite the limitations, it introduces a number of questions for further inquiry and stim u lates thought for future research.
Therapeutic Communication with Children : The Mutual Storytelling Technique . By Richard A. Gardner. New York: Science House, Inc. , 1971 ,970 pp., $25.00.
Reviewed by Saul I. Harrison , M.D. In this volume of close to 1,000 pages Gardner gives us a readable, highly pe rsonalized account of hi s considerable experience with en cou ragin g the ch ild to communicate h is Ian tas ies-s-in particular, th e ch ild of latency age who is in psychotherapy mainl y because of neuroti c or cha ract ero logical problems. This h e does by acting as master of cere m on ies on a " M a ke-U p-A-Story T elevi sion Program" and then indu cin g the ch ild to tell him a story that ha s a beginning, a middle, an end , a nd a moral. After Gardner sen ses the psychodynami c significance of th e chi ld's sto ry, based on principles derived from ad u lt dream analysis, he tell s a story back to th e child using th e ch ild's own cast of characters. But in hi s own story lie healthier adaptations and alternative solu tions that lead to re solution o f conflict. Th e book is organized into three sections, with a foreword b y David M . Levy and a brief introdu ction by th e author. The first sectio n details the basic technique of the mutual story tell ing , whil e th e second section ind ica tes how to apply the technique to selected clinical issue s. Chapters in thi s section deal with oedipal problems; anger in hi bi tio n problems; self-esteem problems; super ego deficiencies; th e psych ogen ic problems secondary to minimal brain d ysfunction; and situational reactions including divorce, parental d eath , and traumatic surgery. In th e third section are four clinical examples of full courses of treatment. Throughout all three sections, 39 different patients appear and reappea r. Nine of these 39 are presented in full-length case studies, and the author very thoughtfully supplies the reader with a "patient index" that en abl es him to follow a given patient sequentially from beginning to end. Gardner solved the problem of whether to give us complete sequential reports of his cases or to try to illustrate particular issu es with clinical vignettes by thoughtfully using both approaches
Dr. Harrison is Professor of Psych iat ry at th e Children 's Psychiatric Hospital, Universit y of Michigan Medical Center, Ann Arbor, Michigan ,
750
Book Reviews
The reader is thus free to choose his own path through the book, which should also make the index invaluable in educational settings. In Gardner's opinion, his stories give him more chance to be heard by the child because stories speak the child's own language, a point of view that will be shared by most, if not all, psychotherapists of children. But many readers may have some reservations about the author's assumption that the interpretations in the therapist's story almost "bypass the conscious and are received directly by the unconscious" (p. 18). In fact, Gardner's creative stories generally contain an obvious message that, he acknowledges wisely, imposes some values of his own on the child (p. 102). The author asserts that he does this overtly, unlike many therapists who do it in more subtle fashion. Indeed, his agreement with Jerome Frank's (1961) thesis in Persuasion and Healing is here carried to an extreme in which all forms of psychotherapy are termed "brainwashing" (p. 901). The advantages of Gardner's laudable awareness that his own values are very much in evidence must nevertheless be weighed against the potential disadvantages to be found in some of the obvious morality woven into the therapist's message. For example, on page '1 5 ~ , Gardner states his wish to avoid the word "aggression" because of its dual potential for both a "complimentary" and "pejorative" sense. But to avoid it is to risk avoiding with it an issue that is central for many patients in psychotherapy, namely, that "aggression" is not inherently "pejorative." And for sociocultural groups who do not share Gardner's values, the disadvantages may be even greater. In short, Gardner, in responding to those who criticize the mutual storytelling technique as being too "manipulative and coercive," may be overlooking that coerciveness may inhere not in the technique per se, but in how and by whom it is used. Recently, a resident in child psychiatry was reporting clinical material to this reviewer in which a great deal of communication took place between the therapist and his young patient through a mutual telling of stories. Although the therapist had initiated this form of communication, it was not structured in the manner described by Gardner, nor was there anything about his stories to suggest "coercion," "manipulation," or "brainwashing." As a matter of fact, the therapist's purpose at the outset seemed to be chiefly exploratory, and his stories contained no confrontations or interpretations until after some time. The foregoing experience occurred shortly after I had read Levy's Foreword to the present volume, in which he described Gardner's technique as an "important psychotherapeutic innovation." When I asked the resident where he got the idea of communicating via mutual storytelling, he seemed puzzled by my inquiry as he had assumed that therapists had always done that sort of thing with children, or for as long as they had accepted child's playas a form of communication. He wondered if the therapist's playing with children is not comparable to telling them a story in nonverbal form. Gardner, toward the close of the book, wonders whether the technique is indeed original, and concludes that what may be original is his having systematized and recorded the process in detail. Of
Book Reviews
751
greater importance, he appropriately underscores that the mutual storytelling technique is not psychotherapy per se, but rather one available technique in the therapist's armamentarium. For those who wonder why the book is so long, the answer may make explicit one of the book's major values for potential readers-the bulk of this volume is devoted to verbatim clinical examples transcribed by an experienced clinician who adds highly personalized commentary. True, Gardner's commentary adds in part to the impression, so common in writings on the techniques and concepts of psychotherapy, that the art in his book exceeds its science. I refer, for example, to the unsupported statement on page 32 that the child's dream recall is usually poorer than the adult's, or the homily on page 451 that all patients, regardless of pathology or duration and outcome of treatment, "still never give up completely the attempt to get one more drop of milk out of an empty breast." Another factor that could be misleading is the incompleteness of some of Gardner's otherwise pragmatically thoughtful suggestions, for example, the description on page 709 of how he deals with clowning in children who suffer from minimal brain dysfunction. To this I would add the several discussions of theory and psychopathology that seem to be founded on varying assumptions about the reader's sophistication. They differ in length and thoroughness, lending a somewhat uneven, discursive quality to the volume, though they do provide breaks in the copious verbatim reports. But all of these are minor disadvantages. They are far outweighed by the value of the book, particularly to less experienced therapists who will cherish the many verbatim examples of therapeutic interaction closely annotated by the therapist's own pragmatic thinking. I trust also that readers will join me in applauding Gardner for not editing out clinical vignettes that do not invariably show him in the most positive light. As in all detailed reports on clinical material, many readers will be provoked toward alternative interpretations and thence to different formulations and interventions. This, too, is by the author's design since he refrains from editing his many explicit examples, nor does he frame them in such a way as to direct the reader's thinking toward a given channel. Rather, Gardner's vividness provokes thought and provides a rich focus for discussion in the educational setting.
749
could be reduced and understood without re sorting to m edication, with su fficie nt personnel and a goo d th erapeutic alliance. This volume represents a noteworthy effort with an interesting research de sign that takes place in a particular setting with a relativel y homogeneous group . D espite the limitations, it introduces a number of questions for further inquiry and stim u lates thought for future research.
Therapeutic Communication with Children : The Mutual Storytelling Technique . By Richard A. Gardner. New York: Science House, Inc. , 1971 ,970 pp., $25.00.
Reviewed by Saul I. Harrison , M.D. In this volume of close to 1,000 pages Gardner gives us a readable, highly pe rsonalized account of hi s considerable experience with en cou ragin g the ch ild to communicate h is Ian tas ies-s-in particular, th e ch ild of latency age who is in psychotherapy mainl y because of neuroti c or cha ract ero logical problems. This h e does by acting as master of cere m on ies on a " M a ke-U p-A-Story T elevi sion Program" and then indu cin g the ch ild to tell him a story that ha s a beginning, a middle, an end , a nd a moral. After Gardner sen ses the psychodynami c significance of th e chi ld's sto ry, based on principles derived from ad u lt dream analysis, he tell s a story back to th e child using th e ch ild's own cast of characters. But in hi s own story lie healthier adaptations and alternative solu tions that lead to re solution o f conflict. Th e book is organized into three sections, with a foreword b y David M . Levy and a brief introdu ction by th e author. The first sectio n details the basic technique of the mutual story tell ing , whil e th e second section ind ica tes how to apply the technique to selected clinical issue s. Chapters in thi s section deal with oedipal problems; anger in hi bi tio n problems; self-esteem problems; super ego deficiencies; th e psych ogen ic problems secondary to minimal brain d ysfunction; and situational reactions including divorce, parental d eath , and traumatic surgery. In th e third section are four clinical examples of full courses of treatment. Throughout all three sections, 39 different patients appear and reappea r. Nine of these 39 are presented in full-length case studies, and the author very thoughtfully supplies the reader with a "patient index" that en abl es him to follow a given patient sequentially from beginning to end. Gardner solved the problem of whether to give us complete sequential reports of his cases or to try to illustrate particular issu es with clinical vignettes by thoughtfully using both approaches
Dr. Harrison is Professor of Psych iat ry at th e Children 's Psychiatric Hospital, Universit y of Michigan Medical Center, Ann Arbor, Michigan ,
750
Book Reviews
The reader is thus free to choose his own path through the book, which should also make the index invaluable in educational settings. In Gardner's opinion, his stories give him more chance to be heard by the child because stories speak the child's own language, a point of view that will be shared by most, if not all, psychotherapists of children. But many readers may have some reservations about the author's assumption that the interpretations in the therapist's story almost "bypass the conscious and are received directly by the unconscious" (p. 18). In fact, Gardner's creative stories generally contain an obvious message that, he acknowledges wisely, imposes some values of his own on the child (p. 102). The author asserts that he does this overtly, unlike many therapists who do it in more subtle fashion. Indeed, his agreement with Jerome Frank's (1961) thesis in Persuasion and Healing is here carried to an extreme in which all forms of psychotherapy are termed "brainwashing" (p. 901). The advantages of Gardner's laudable awareness that his own values are very much in evidence must nevertheless be weighed against the potential disadvantages to be found in some of the obvious morality woven into the therapist's message. For example, on page '1 5 ~ , Gardner states his wish to avoid the word "aggression" because of its dual potential for both a "complimentary" and "pejorative" sense. But to avoid it is to risk avoiding with it an issue that is central for many patients in psychotherapy, namely, that "aggression" is not inherently "pejorative." And for sociocultural groups who do not share Gardner's values, the disadvantages may be even greater. In short, Gardner, in responding to those who criticize the mutual storytelling technique as being too "manipulative and coercive," may be overlooking that coerciveness may inhere not in the technique per se, but in how and by whom it is used. Recently, a resident in child psychiatry was reporting clinical material to this reviewer in which a great deal of communication took place between the therapist and his young patient through a mutual telling of stories. Although the therapist had initiated this form of communication, it was not structured in the manner described by Gardner, nor was there anything about his stories to suggest "coercion," "manipulation," or "brainwashing." As a matter of fact, the therapist's purpose at the outset seemed to be chiefly exploratory, and his stories contained no confrontations or interpretations until after some time. The foregoing experience occurred shortly after I had read Levy's Foreword to the present volume, in which he described Gardner's technique as an "important psychotherapeutic innovation." When I asked the resident where he got the idea of communicating via mutual storytelling, he seemed puzzled by my inquiry as he had assumed that therapists had always done that sort of thing with children, or for as long as they had accepted child's playas a form of communication. He wondered if the therapist's playing with children is not comparable to telling them a story in nonverbal form. Gardner, toward the close of the book, wonders whether the technique is indeed original, and concludes that what may be original is his having systematized and recorded the process in detail. Of
Book Reviews
751
greater importance, he appropriately underscores that the mutual storytelling technique is not psychotherapy per se, but rather one available technique in the therapist's armamentarium. For those who wonder why the book is so long, the answer may make explicit one of the book's major values for potential readers-the bulk of this volume is devoted to verbatim clinical examples transcribed by an experienced clinician who adds highly personalized commentary. True, Gardner's commentary adds in part to the impression, so common in writings on the techniques and concepts of psychotherapy, that the art in his book exceeds its science. I refer, for example, to the unsupported statement on page 32 that the child's dream recall is usually poorer than the adult's, or the homily on page 451 that all patients, regardless of pathology or duration and outcome of treatment, "still never give up completely the attempt to get one more drop of milk out of an empty breast." Another factor that could be misleading is the incompleteness of some of Gardner's otherwise pragmatically thoughtful suggestions, for example, the description on page 709 of how he deals with clowning in children who suffer from minimal brain dysfunction. To this I would add the several discussions of theory and psychopathology that seem to be founded on varying assumptions about the reader's sophistication. They differ in length and thoroughness, lending a somewhat uneven, discursive quality to the volume, though they do provide breaks in the copious verbatim reports. But all of these are minor disadvantages. They are far outweighed by the value of the book, particularly to less experienced therapists who will cherish the many verbatim examples of therapeutic interaction closely annotated by the therapist's own pragmatic thinking. I trust also that readers will join me in applauding Gardner for not editing out clinical vignettes that do not invariably show him in the most positive light. As in all detailed reports on clinical material, many readers will be provoked toward alternative interpretations and thence to different formulations and interventions. This, too, is by the author's design since he refrains from editing his many explicit examples, nor does he frame them in such a way as to direct the reader's thinking toward a given channel. Rather, Gardner's vividness provokes thought and provides a rich focus for discussion in the educational setting.