Narrative in psychiatry and psychotherapy: the evidence?

Psychiatry is perhaps the most “narrative ” of all medical specialties, but here as elsewhere clinical skills are in danger of being lost as evidence-based medicine becomes the dominant paradigm in medical culture. Psychotherapy is a quintessentially narrative discipline. Starting from an “attachment ” perspective, the uses of narrative in psychotherapy are outlined. These include the importance of metaphor, story-telling, the search for event-scripts, and the role of “narrative competence ” as a mark of psychological health. Life history research, the “adult attachment interview ” and other research approaches to narrative in psychiatry and psychotherapy are described. The paper calls for an integration of narrative and evidence-based medicine. (J Med Ethics:Medical Humanities 2000;26:92–96