A typology of narrative impoverishment in schizophrenia: Implications for understanding the processes of establishing and sustaining dialogue in individual psychotherapy

Following from dialogical theories that conceptualize the self as an ongoing series of conversations within and between persons, the authors hypothesize that diminishments in sense of self in schizophrenia could be the result of disruption in the flow of such conversations. In particular, it is asserted that such a disruption could result in at least three forms of disordered selves and resulting impoverished personal narratives: the barren, monological and cacophonous narrative. These phenomena are discussed and subsequently illustrated with case examples that highlight the ways in which each form of narrative impoverishment differently imperils the establishment of a therapeutic relationship. For each of these situations, alternative therapist responses that may lead to better therapeutic outcomes are also offered.