What is Narrative Therapy

‘Narratives’ are something which we all use a lot every day. They are what we use to correctly tell a story or explain a sequence of events to a listener.

Think how many times we ask our children to tell narratives each day e.g. “What did you do at school today?” “What happened at playtime?” “What did you do at after-school club?” “What did you do at football/swimming/dance?” “What things did you do at the weekend?”

Your child has to use lots of different skills to produce the narrative:  they have to remember what actually happened, they have to put the events into the correct order, they have to work out what key pieces of information the listener needs, they have to select the correct words to use to describe the events, they then have to put these words into the right order in sentences and with the correct grammar. Phew – telling a narrative is actually a pretty tricky task!

Sometimes, children can struggle with telling narratives. They can:

  • Use general/non-specific vocabulary e.g. “I went in there and got it”
  • Use short sentences e.g. “Did painting”
  • Confuse the order of events e.g. “got my coat and came home and then went to assembly”
  • Not introduce the topic/people properly so the listener cannot work out the story e.g. “did it yesterday”
  • Only talk about things in the ‘here and now’ and not respond to questions about things they have done earlier e.g. ‘at school/at the weekend.’
  • Not understand the question words e.g. “who?” “where?” and give the wrong type of answer e.g. “Where did you go at the weekend?” “with mummy”
  • Not understand the ‘time’ words e.g. ‘day’ ‘night’ ‘yesterday’ ‘tomorrow’

Narrative Therapy can support children with all of these difficulties. Here is one group that was run last week:

Name: Narrative Therapy

Session: Number 9

Participants: 6 children aged 5 years old who all have difficulties accurately telling narratives.

Activity One: Attention and Listening Rules

At the start of each session, the children remind themselves of the ‘groups listening rules.’ This helps them all to use ‘good looking, sitting, listening and thinking’ so they can take part in the activities and learn.

Activity Two: When concept?

‘when?’ is introduced to the children. A colour-coded visual symbol is used with the ‘when’ Makaton sign. The visual clues and spoken word support all the children to understand and remember the concept.

Each child was then asked different ‘when?’ questions. They got to collect ‘clock’ stickers every time they answered questions like: “When do we eat chocolate eggs?,” “when do we brush our teeth?” “when do we eat cereals?”

Activity Three: Day and Night Stations

A feely bag of toy objects was passed around the group and each child took out and labelled the object e.g. ‘pyjamas’ ‘sun’ ‘lunchbox’ ‘moon.’ They then had to work out if that object would be seen at ‘daytime’ or ‘night time’ and take their object to either the ‘day’ station or the ‘night’ station.

Activity Four: Birthday Spiders!

A big spider diagram was drawn with a birthday cake in the middle. The children then had to think of different things that would be seen or done when it is a birthday and these were drawn at the end of the spider’s legs e.g. birthday card, birthday presents, birthday party. If the struggled and needed some help, there was a box full of birthday objects to help them. The children came up with lots of brilliant ideas – it’s just a shame the therapist’s drawing skills were not quite as brilliant!

Activity Five: ‘Five Minutes Peace’

A lovely story reinforcing the ‘night time’ concept was read to the children. It tells the difficulties of Mr.Bear trying to find 5 minutes peace at night time!

Activity 6: Stickers

This is when the children get to decide which sticker they want: do they want the ‘ears’ for ‘good listening’? ‘the pair of eyes’ for ‘good looking’ or the ‘brain’ for ‘good thinking’?

Narrative Therapy can be completed in a group or individually. Narrative groups run by SpeechRight are especially popular in school settings. Work completed in the groups can be carried over into the classroom supporting the childrens’ understanding of topic stories, their vocabulary, their spoken narratives and their written narratives too. If your school is interested in finding out more about the support SpeechRight offers, see the School Support leaflet.

Meet 33 year old Jack

Each week we will put a spotlight on one of the people the SpeechRight speech and language therapists have been working with. This will give an insight into the types of difficulties we support and what goes on in a speech therapy session.

Name: Jack

Age: 33

Difficulties: Jack has a stammer. His stammer first appeared when he was 4 years old. Jack’s stammer involves repetition of the initial sounds of words, blocks (where his mouth is in position to say a word but no noise comes out) and prolongations (where a sound is made longer). Jack has never received any speech and language therapy support until he came for a detailed initial assessment 2 weeks ago with SpeechRight. This identified that Jack would benefit from therapy which:

  • gives him some direct speech strategies he can use to support his fluency
  • focuses on his general communication skills e.g. volume, eye-contact, talking speed, posture, facial expression
  • considers his thoughts and feelings around his stammer and its impact on his daily life

Hearing: No concerns

Session: Therapy Session Two with Emma

We started the session with a re-cap of how things had gone during the week. Jack reported that he had been able to try some of the activities we had suggested at the last session and he was pleased with how this had gone. Jack said he felt that his stammer had increased this week in his spontaneous conversations but when we discussed this in more detail, we realised that potentially the stammer had not increased but Jack’s awareness of it had. This is important because if Jack is to have strategies to use to support his fluency, he needs to be aware of what his talking and stammer are like now.

We had three key areas we were targeting today:

Abdominal Breathing: Breathing is important to consider when looking at our fluency. The breath coming out of the lungs ‘powers’ our voices. Therefore, if we do not complete regular, relaxed breaths we are going to be unable to maintain a steady, calm flow of talking. Together, Jack and I practised this breathing and began to use it as we slowly increased the length of our utterances from single sounds to short words, longer words, phrases and sentences.

Tallying: Tallying was used to help Jack accurately identify when he stammered. He needs to know this in order to use the direct strategies he will be taught. Jack and I held a conversation about our favourite holiday destinations. As we were talking, every time Jack felt he stammered he held his finger up. In the same way, every time I thought I saw or heard a stammer, I held my finger up. The idea is for Jack to ‘catch’ as many stammers as he could. Following practice last week, Jack achieved a near 100% record in this session. When Jack ‘caught’ his stammer, he was also able to learn more about what happens when he does stammer; he realised that in a stammering moment when he is repeating the initial sound of a word, there is a lot of tension in the top part of his throat.

Talking Speed: Jack uses a fast talking speed and this puts lots of pressure on his language system to: quickly workout what he wants to say, to formulate the utterance he needs to produce and to quickly move his mouth and tongue into all the correct places to make the speech sounds. This can encourage him to stammer. A fast talking speed also puts lots of pressure on the listener to keep up with and follow what Jack is saying. If Jack does stammer, combined with his fast talking rate this can have a negative impact on Jack’s ability to clearly communicate his ideas. We encouraged Jack to use a ‘good talking speed’ by using more pauses in his speech (rather than saying each word more slowly). By pausing, it also gave Jack chance to use his ‘relaxed breathing.’ Jack practised reading aloud a range of different reading passages with a special ‘syllable ball’ that gave him the pace he needed to follow.

Jack was given a number of different activities to practice linked to the exercises we had done today. Jack has a lot of work on at the minute with his business so he felt that he needed a longer time before the next session in order to complete enough practice. Jack felt a session in 3 weeks would be best.

In the Spotlight next week will be a group of six 5 years olds who are completing a Narrative Group at school. Narrative works on developing a child’s attention and listening, understanding, talking and social communication skills.

Meet Emilia, our week two spotlight

Each week we will put a spotlight on one of the people the SpeechRight Speech and Language Therapists have been working with. This will give an insight into the types of difficulties we support and what goes on in a speech therapy session.

Week Two Spotlight

Name: Emilia

Age: 3:2

Difficulties: Language Delay. Emilia communicates using some single, spoken words e.g. “juice” and lots of non-verbal communication e.g. pointing, reaching, looking.

Background: Emilia had an initial assessment. She showed that she understood everything that was said to her but was delayed in her development of spoken words. ‘Delayed’ meant Emilia was showing the ‘typical’ path of spoken language development but it was happening at a much later age for her.

Examples:

  • To request a drink, Emilia will say “juice”
  • If she sees a noisy fire-engine on the road, Emilia will look at her mum and then point to the fire-engine.
  • To request a biscuit, Emilia will gesture ‘eating.’

Hearing: All assessments passed

Session: Therapy 3 with Mum, Dad, Emilia and Emma.

Emilia and her parents are taking part in Parent-Child Video Interaction Therapy. This therapy involves parents being given strategies to use within their interactions with Emilia to support her spoken language development. Parents know they have not caused Emilia’s language difficulties but there are specific strategies they can now use with her to encourage her speaking skills.

Parents both reported how they had got on with the strategies they had been practising in their ‘Special Time’ last week with Emilia. ‘Special Time’ is a specific 5-10 minutes parents identify daily when they play with Emilia and focus on their strategies. Dad said he really liked the way ‘Special Time’ gave him the justification to take time out from work/jobs and simply ‘play’ with Emilia.

We separately video-ed mum and dad playing with Emilia for 5 minutes each. Together we then watched the video back and identified all the positive things Mum and Dad were doing to support Emilia’s language (there were lots!) and looked at how each of them had used their targets.

Video is used, as research shows, this is the most effective tool in helping bring about change in peoples’ behaviours; rather than being told they have/have not done something, the video allows them to actually see it for themselves.

After watching the video, Mum felt that she had not used her strategy enough with Emilia during her interaction. In fact, the video showed her that there were lots of lovely examples where she had used the strategy and, within the video, Emilia actually used one new spoken word which she had not said before. Dad felt that he had used his strategy a lot with Emilia but he changed his mind after watching the video as he realised that there were lots of missed opportunities for the strategy’s use.

We then agreed parents’ new targets for the week ahead before we all finished with a game of ‘animal lotto.’

This lotto gave lots of opportunities for us all to practice the language development strategies together during play. I also demonstrated the key animal Makaton signs to parents so they could now sign, make the symbolic noise and label the animal. All of this will help to support Emilia’s language development; the animal noise will grab her attention so she can listen to the animal label and, if everyone else is using signs, this will encourage Emilia to use signs/gestures herself. Research, and my own experience, shows that using signs helps to support and develop children’s talking skills.

The family left happily with their strategies to practice in Special Time and the animal lotto game to play.  I was left slightly disappointed to have lost yet another game of Lotto this week!

In the Spotlight next week will be Jack. Jack is 33 years old and has referred himself for support with his stammer.