Mental Health and Speech-Language Therapists Working Together using Story Emotion Social Therapy: here’s how to use this new interdisciplinary model to help individuals share their stories, communicating thoughts and emotions, in therapy.
By: Gary Dick, PhD LISW
Over my 40 years as a clinical social worker, I treat individuals using various treatment modalities, including the most recent use of Story Emotion Social Therapy (SEST), an interdisciplinary storytelling therapeutic approach to help individual’s heal from emotional suffering by increasing their social and emotional narrative communication. I co-founded SEST with Rochel Lieberman, Ph.D., a Speech-Language Pathologist (SLPs) to bridge narrative and behavioral therapy with narrative communication guided by specific roles for mental health providers and SLPs. In my clinical experience, SEST is beneficial across a range of individual problems, with different populations, and in various practice settings. In addition, because SEST directs individuals to their thoughts and emotions related to their story, it can be a helpful approach for providers compartmentalized across the mental health field. Here is my take on the application of SEST.
At the start of a typical session, individuals often begin sharing a story about something that has happened to them recently, or in some cases, a report from long ago. At other times, they start talking about the most pressing issue on their mind or an emotionally charged story. In these situations, the story is presented first, and my role is to listen and emerge myself into their account. In another scenario, individuals with other conditions, such as depression, overwhelming anxiety, speech and language difficulties, or social communication disorder, may sit quietly or talk verbosely without relaying their story and wait for me to begin the session. Consequently, they may be unable to verbalize what is on their mind, using words to express their thoughts or emotions around their problem. At this point in the individual’s storytelling, regardless of the described client profile’s communication skills, I transition into mental health’s role in SEST.
In the first scenario, the individual begins telling their story as soon as they sit down, but I want to know the emotions behind the story. In this case, I will always start with where the individual is by listening to their account. Then, I interject and ask them to take a quiet moment, sit in silence to reflect on the story they just shared, and be present and mindful of their emotions and feelings, the initiation of SEST’s Spin Practices. In some ways, it may initially feel that I am cutting the individual’s story short, but by using SEST, I am taking them deeper into the emotional life of their story. I think we are moving from the external world: the context, thoughts, and perceptions of their story to their inner world: their emotional life, feelings associated with their account. We are social beings, and all accounts have a social and emotional component.
In the second scenario, the individual may be waiting on me to structure the session, which I find extremely valuable using SEST. In contrast to my approach with the first individual, who is extremely verbal, I begin by asking the second individual (one who is quieter or has difficulty expressing themselves) to sit silently. Next, I guide them to gently become aware of any thoughts and feelings they are experiencing at that moment. When they are ready, I ask them to tell me a story that crossed their mind. Suppose the individual still cannot express their story. In that case, I use Dr. Lieberman’s SEST speech-language supports, catchy story pneumonic prompts to guide individuals through storytelling or story retelling derived from the well-established research on the use of story grammar elements, combined with mindful hand gestures representing story grammar and cognitive behavior elements. In both situations, with and without speech-language prompts, I acknowledge that this story, which can be any that crossed their minds, is the individual’s shared story. I want them to sit with it and experience all aspects of their story.
Regardless of the initiated or prompted communicative profiles described in both scenarios, I want the individual to be curious and make meaning out of the story they just shared. I want to know their perceptions and feelings. However, at this point, a challenge often arises: it may become evident to the therapist that cognitive distortions may drive individual’s interpretation of the reality of their lived experiences, and its associated emotions may be derived out of social interactions and interpersonal relationships that are problematic, such as bullying, rejection, hostility, or scapegoating. Using SEST’s guided approach, I then ask the individual to explore another interpretation of their story and ask how it may feel when looking at their story from a different point of view.
At this point in the SEST model, after I heard their original story and the individual provided the second interpretation of their story, SEST guides the practitioner to ask the individual which story makes the most sense to them. The individual is offered a choice to accept a different spin on their story. As mental health professionals, it is essential to remember that our aim is not to try and fix or force them to accept any version of the story. Our goal is to create a space for them to sit and think about their story’s thoughts and feelings.
Case Example:
Sarah is a 14-year-old female who has a troubled home life. She lives with her father and stepmother, who are constantly in conflict, and she gets caught up in the conflict. In addition, her father and biological mother have shared custody and live in separate cities about 100 miles apart. Sarah spent the summer alternating staying two weeks with her mother and then two weeks with her father.
Sarah has experienced panic attacks and chronic anxiety, which increased in intensity at the pandemic’s onset. This emotional difficulty resulted in her being placed in remote learning for emotional problems at the onset of the pandemic. Sarah’s anxiety and fears increased after the January 6th storming of the Capitol Building. With the current return to school, Sarah has fears and concerns about not being accepted by her peers at school since she has been out of the classroom since March 2020 while her classmates continued with in-class instruction. She has not had social contact with any peers her age since March of 2020, only a few phone conversations.
Sarah is a great storyteller, much like the communication type of the first individual I described. She is extremely intelligent, both emotionally and intellectually. I structure our session using SEST’s Spin Practices I explained above. Using the foundational first SEST step of mindful emotional labeling, I ask her to sit in silence and be mindful of how she feels. I remind her to permit herself to feel any feelings that she is feeling, not to try to judge or fix them. She reports feeling alone and alienated. SEST guides the individual to take a quiet moment, sit and experience the feelings.
While she is encouraged to allow her mind to be open and let feelings and thoughts come and go, using the second SEST step, initiating story, she is encouraged to share any story on her mind. She tells how she spends much of her time drawing women in fashionable dresses and hairstyles as she is highly artistic. SEST guides Sarah to think about the pictures or feelings that arise from the story. We sit in silence to leave space to experience the story. When Sarah wants to share her drawings with me, I ask her to show me or tell me a story about the women she draws. In one sketch, Sarah began her story about the power and influence of this woman. She was rich and glamorous and lived an exciting life, seeming to have it all. However, the story did not have a social context, not mentioning any friends. There was nothing about her community or the historical era. She was just one strong woman. We sit in silence to leave space to sit with that story.
Using the third step in the SEST model, interpretation story, I asked Sarah to sit quietly, allow her mind to be curious, and reflect on how she felt about this drawing. Sarah happily reflects on her drawing, and says she is proud of her work. When it came time for her to share her feelings, she spoke about how the woman made her feel powerful and hopeful. After sitting in some silence, she said that it also made her feel sad, which led to a story about her going to the store with her mother. She never asks her to buy her a candy bar because her mother is very poor and cannot afford it. There is a drastic difference in the socioeconomic status between her parents, which is difficult for Sarah to process.
Using the fourth step in the SEST model, the second interpretation story, I ask her to allow her mind to flow with curiosity and kindness and see if there is another story or thought that she might have to interpret some of the evens, outcome, or any part of the first story that she shared. After sitting in silence and reflecting on the drawing and thinking of another interpretation, she said the woman had strength and courage, which she shared was also a part of who she is herself. This answer led to a conversation about her fears of both the pandemic and the January 6th attack. One of the deeper emotions that surfaced was feeling sad because she relayed that her mother was evicted from her apartment and had lost her job. She expressed her concern because her mother found recent employment and is renting an apartment with her sister. She also said that both her and her mother would make it through these difficult times. Even though her safety was threatened by her mother’s situation, the pandemic, loss of social relationships, and political upheaval, Sarah chose to tell the story about the strong woman in her sketch, one without all of the crisis. I ask Sarah to take a quiet moment to leave space to sit and experience her second interpretation story that she bravely shared.
Using the final step in SEST, choice story, I ask Sarah to choose a story she wants to tell in this very moment in time and space. I offer her a choice to spin her ‘shared story’ and select the second interpretation story to make sense of the story. I also offer her an option not to spin the story, maybe stay with the original ‘shared story,’ at least for today, or not change it at all. I remind Sarah that each story that came up for her has value and to think about what motivates her choices to spin or not spin the story. Often, the way individuals view things is as part of our anguish as what happened. Frequently, there are benefits in interpreting stories in another way. Despite this awareness, I ask Sarah not to force any choice; that is something we may explore later in our work. After sitting in silence with this choice, Sarah begins talking. She says that the woman in the drawing symbolized someone Sarah wanted to identify and model her behavior. The chaos in her mother’s life, the conflict between her father and stepmother, the fears resulting from the pandemic, and the political state of the country all emerged to intensify her anxiety leading to panic attacks. So, as she returns to school, she needed a robust role model. Sarah was like the lonely yet strong woman she sketched. Although she has been lonely, she knows that she is strong and resilient, very similar to her mother.
SEST guides Sarah to welcome her choice with a gentle straightforwardness, to smile to yourself as you would to your very dear friend. Take a breath in and think about how you are doing your best and take a breath out and think about letting go of any judgment, overthinking, or negative self-talk surrounding your choice. The SEST practice ends by welcoming kindness, love, and total acceptance of oneself, at this very moment. This practice can end the session or can allow the individual’s mind to shift to our subsequent discussion or today’s exercise without the weight of an untold story.
To read more about SEST, visit wholestoryspeech.com
Gary Dick, PhD LISW, co-founder of Story Emotion Social Therapy, is a professor in the School of Social Work at the University of Cincinnati and has done psychosocial therapy for over 40 years. He believes the stories told in therapy provide understanding into one’s inner cognitive and emotional world.
Rochel Lieberman, PhD CCC-SLP, co-founder of Story Emotion Social Therapy, is a researcher investigating social communication and has been a speech-language pathologist for 20 years. She believes that understanding storytelling is the secret to children’s language development, and early narrative expansion gives children a head start to becoming higher-functioning adults.
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