Exploring how narrative therapy may facilitate psychosocial adjustment following stroke

Section A is a review of the literature on psychological adjustment following stroke. Empirical research is critically reviewed with reference to two research questions: (1) What do we understand about adjustment following survival of stroke? (2) What psychosocial interventions have been used to support adjustment post-stroke and what are the outcomes? Theoretical models for adjustment to stroke are drawn upon to illuminate the findings. Gaps within the literature are discussed and future directions for research are suggested.
Section B describes a study using mixed methods. The purpose of the study was to evaluate whether narrative group therapy could facilitate psychosocial adjustment in survivors of stroke, and to explore the impact of stroke on survivors’’ lives through their shared narratives.
Methods: Ten participants took part in a six-week narrative group therapy intervention for stroke survivors. Quality of life, use of coping strategies and illness representations were measured pre- and post-intervention, and thematic analysis was conducted on the content of the intervention sessions.
Results: There was no statistically significant change on the outcome measures post-intervention. However the inductive thematic analysis resulted in the identification of four master themes: ‘using the group’, ‘negative talk’, ‘positive talk’ and ‘relationships’. These themes, respectively, revealed that the social aspects of the group allowed comparing experiences and exchanging information; participants were able to discuss the perceived negative aspects of surviving a stroke; with support, participants could identify the adaptations and achievements made since the stroke; and how the stroke impacted on relationships between the survivor and the systems around them.
Conclusion: The findings indicate that narrative therapy requires further evaluation in terms of facilitation of adjustment. However, the thematic analysis supports the utility of group discussions and the provision of information to stroke survivors and their carers, thus indicating potential development of psychoeducation group programmes, provisionally as part of a stepped care model.