Narrative Therapy as an intervention technique: A qualitative study from the geriatric social work field in the Chinese Mainland

Abstract

The world population is ageing, and China is no exception. The Chinese government attaches great importance to older adults’ mental health in the increasingly ageing society. This study adopts a qualitative research approach to investigate how Narrative Therapy is applied from three dimensions in geriatric social work in the Chinese Mainland. There follows a discussion of the relationship between the three dimensions. It concludes with a recommendation on how to improve indigenization and specialization and build an evaluation tool combining qualitative and quantitative modes to promote better application in geriatric social work.

Keywords

Ageing geriatric social work intervention technique Narrative Therapy older adult qualitative study

Introduction

At the biological level, ageing results from the impacted accumulation of various molecular and cellular damage over time, which is induced by the accumulation of damage in response to various stressors (Guo et al., 2022). The world population is inevitably ageing, virtually every country in the world is experiencing growth in the number and proportion of older persons in their population (UN, 2022). In China’s seventh census, there were 264.02 million persons aged 60 and above, accounting for 18.70 per cent of the Chinese population. Precisely, there were 190.64 million persons aged 65 and above, accounting for 13.50 per cent of the Chinese population (National Bureau of Statistics, 2021). China’s ageing situation has attracted the government’s attention, not only in the physical aspects but also in the aspect of mental health, which implies that scholars should find a suitable way to focus on older adults’ mental health and life status.

In China, being a new way in the geriatric social work field, Narrative Therapy is getting more and more attention. It is gradually being used for older adults in social work fields. Narrative Therapy has enormous potential contributions to the development of social work practices, in Mainland China. The recognition of the basic concept of Narrative Therapy is relatively high, yet, its application rate in the field of social work practice is meagre (Li, 2014). There is little international research on how Narrative Therapy can be used in Chinese Mainland social work practice, let alone the geriatric social work field. This study explores how Narrative Therapy, as an intervention technique for geriatric social work, is applied in the geriatric social work practice of the Chinese Mainland and discusses the relationships between different dimensions. Then, this study raises recommendations to promote better use of Narrative Therapy in geriatric social work in the Chinese Mainland.

China’s geriatric social work and Narrative Therapy

As a respectful approach to counselling and community work, Narrative Therapy firmly believes that the person who came to consult the therapist is the expert in his or her life, not the therapist. Narrative Therapy deeply embraces the idea that people construct their living realities through the narratives or stories they share with themselves. These stories are situated within a larger cultural and political context, and therefore socially constructed. Each person distils the meaning of his or her life from these stories (Hugo and Deon, 2006). The Narrative Therapy approach and counselling assume that the challenges stem from repressive stories that dominate people’s lives, including personal lives, relationships, abilities, actions, interests, achievements, and losses. Each story is formed by the processes inherent in successive events. ‘Meaning’ is abstract thinking associated with a story, that repeatedly gives meaning to our experiences (Morgan, 2020).

Narrative Therapy, which borrows ideas and propositions from social construction theory, is widely used in social sciences as a postmodernist approach to therapy (He, 2006). It emphasizes personal experiences and elaboration of meaning and has gained considerable momentum in psychotherapy (Danner et al., 2007). During the 1970s and 1980s, social workers Michael White and David Epston developed Narrative Therapy as a family therapy and the use of Narrative Therapy was taken up in the family therapy field in Australia and New Zealand (Chamberlain, 2012). Narrative Therapy spread in Australia and New Zealand in the late 1980s and in North America in the 1990s (Kelley, 2013). Hong Kong and Taiwan introduced the theory and practice of Narrative Therapy earlier. In Hong Kong, it is mainly represented by the Baptist University, but in Taiwan, it is mainly represented by the National Changhua University of Education (Li, 2013). Narrative Therapy in Hong Kong presents multidisciplinary collaborations and diverse practice models, after experiencing the past 20 years of development (Chan, 2023). The Social Workers Federation, the Christian Church and other social organizations undertaking psychological counselling tasks attach great importance to developing narrative psychotherapy concepts. In the region of Taiwan, narrative psychotherapy has become an essential part of the professional study of psychological counselling (Li and Sun, 2003).

Michael White describes six significant skills of narrative practice: Externalizing conversations, Re-authoring conversations, Re-membering conversations, Definitional ceremonies, Conversations that highlight unique outcomes and Scaffolding conversations (Shaw, 2010). There is a significant and ever-increasing body of evidence for the effectiveness of Narrative Therapy practices. Most studies used quantitative measures, including some evidence-based studies (Beaudoin et al., 2016; Lopes et al., 2014) and randomized controlled trials (Karibwende et al., 2022; Zhou et al., 2023). The geriatric social work field is no exception; for example, in the geriatric medical field, Narrative Therapy has been shown to have a significant effect in promoting older adults’ wisdom of life (Powers et al., 2019), alleviating older adults’ cognitive death anxiety (Nozari et al., 2019), increasing older dementia sufferers’ cognition (Bartolucci and Batini, 2019), and improving female older adults’ depression, loneliness (Chiang et al., 2010) and positive emotions (Yousefi et al., 2015). Research revealed Narrative Therapy can also enhance the quality of cerebral apoplexy patients’ lives, relieve the feeling of cancer pain and be used to intervene in depression, loneliness and anxiety, proving effective. Some doctors also confirmed that Narrative Therapy positively influences retirement syndrome (Ding et al., 2012).

Narrative Therapy in the Chinese Mainland has come a long way in recent decades and experienced three development stages. In recent years, Chinese Mainland Narrative Therapy has been widely used in clinical practice, and some localized Narrative Therapy methods and techniques have gradually developed (Li, 2013). Narrative Therapy is gradually extended to family therapy, society, groups, businesses, schools, mental health centres and so on (Qu et al., 2017). In the Chinese Mainland, Narrative Therapy mainly concentrates on education and medicine. Family mental health care and community work are less involved, due to the limitations brought about by the lack of localization work and influential research in the Chinese Mainland (Gao and Chen, 2021). Although less involved in social work, this study still finds practical research in which Narrative Therapy is used to intervene in matters concerning older adults or conditions in their community (Chow and Fung, 2021). Geriatric social workers focus on the health of older patients and those who are most vulnerable. In the geriatric social work field, research revealed that the therapeutic approach is to help older adults achieve integrity in Erikson’s last stage (Goodcase and Love, 2017). In China’s social work, Narrative Therapy intervenes with older adults and can fit in with both individual cases and groups (Chow and Fung, 2021). In the group intervention, research revealed Narrative Therapy group counselling was influential in reducing depression and loneliness (Dastbaaz et al., 2014). In the individual case, some Chinese scholars have used Narrative Therapy with older adults who live alone to reconstruct a positive self-role to improve their quality of life (Li et al., 2021).

Methodology and ethics

The study will adopt qualitative research methods to understand the topic better. The researchers chose 16 respondents from Nanjing, Jiangsu Province and Nanning, Guangxi Province, China, to investigate the research, including 10 older adults between ages 60 and 85 who received Narrative Therapy and six social workers who have experience in intervening with older adults, using Narrative Therapy. The sociodemographic background of respondents is shown in Table 1.

Table 1.

The sociodemographic background of respondents.

Older adult
Sociodemographic aspects	Number of respondents	%
Gender
Male	2	20
Female	8	80
Age
60–69	3	30
70–79	4	40
80–85	3	30
Marital status
Married	2	20
Divorced	1	10
Widowed	7	70
Occupation before retirement
Housewife	1	10
Worker	5	50
Teacher	1	10
Clerical	3	30
Monthly income (RMB)
1000–2999	2	20
3000–4999	5	50
5000–7999	3	30
Social worker
Gender
Male	1	16.7
Female	5	83.3
Level
Senior	2	33.3
Supervisor	4	66.7
Work experience
5–10	2	33.3
10+	4	66.7
Educational level
College	1	16.7
Bachelor	3	50.0
Master	1	16.7
PhD	1	16.7

Context of data collection: Gathering sociodemographic information from interviewees before the interview.

Summarizing the results: This table shows the respondents’ sociodemographic information. This table shows the rate in different indicators. Among the older adult respondents, the sex ratio is 2:8, a roughly similar age ratio, 70% widowed and mostly workers before retirement, and their income range is mostly 3000–4999 RMB. In social work respondents, the sex ratio is 1:5, at least senior level with above 5 years of experience, and their educational level is mostly bachelor degree.

This study used purposive sampling to select respondents. Purposive sampling is widely used in qualitative research to identify and select information-rich cases related to the phenomenon of interest (Palinkas et al., 2015). The researcher asked some questions based on different roles. For example, the researcher asked older adult respondents: ‘Did you know of Narrative Therapy before?’ ‘Can you tell us about the process of the event?’ ‘Have you felt some changes since you attended events?’ and ‘What do you think needs to be improved during the intervention?’ The researcher asked social worker respondents: ‘Why do you choose Narrative Therapy to intervene with an older adult?’ ‘How do you use Narrative Therapy in social work?’ ‘How effective is the intervention and how do you identify its effect?’ ‘Have you discovered any difficulties or deficiencies in the process of intervention?’ ‘What factors do you think could help make Narrative Therapy better used in geriatric social work?’ and ‘Is there anything that needs to be improved using Narrative Therapy?’ These questions aim to explore the current situation of Narrative Therapy in the geriatric social work of the Chinese Mainland, how specifically it is used, what factors can help it be used better and what needs to be improved during the intervention. The sample size is considered saturated when the researcher finds that the new data overlaps the existing data during collection.

Data analysis involves interpreting the structure and meaning gained through inductive reasoning (Zainuddin et al., 2020). This study adopted thematic analysis theory research to analyse data. Thematic analysis is a method for systematically identifying, organizing and offering insight into patterns of themes across a dataset. It is a way of identifying what is familiar with how a topic is talked or written about and of making sense of those commonalities (Braun and Clarke, 2012). An inductive approach involves allowing the data to determine the themes. So, after the interviews, the researcher transcribed them verbatim and, verified by at least two research members, read the notes to get familiar with the collected data. Then, the researcher applied codes to the data using NVivo 12 to identify patterns and develop themes. Next, the researcher compared and verified notes and analysed them independently. Finally, the researcher wrote up the analysis of the data.

These respondents must agree voluntarily to participate in the studies. The researcher got approval from the author’s University Ethics Committee. Respondents’ consent to participate was sought and confidentiality of information assured. All respondents had the right to choose to stop taking part in it at any time.

Application in geriatric social work in the Chinese Mainland

The narrative technique aligns well with the values of social work, being committed to social justice and diversity (Baldwin and Estey-Burtt, 2012). Furthermore, it is essential to examine how Narrative Therapy in geriatric social work intervenes and its effectiveness. Based on interviewing 16 respondents, this study analysed and collected findings on values, intervention and effectiveness dimensions.

Values

Values are fundamental beliefs that guide or motivate attitudes or actions and help us to determine what is important to us (Steven, 2018). To some extent, values are like the compass people hold and use to direct their lives, and this is also the case in Narrative Therapy (Russo et al., 2022). Narrative Therapy holds the fundamental principles of respect, and non-blame, and views the service recipient as the expert (Jodi, 2023). The National Association of Social Workers’ (NASW) Core Values in Social Work are service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence (Maura, 2020).

Narrative Therapy is a non-judgmental approach recognizing that individuals are not defined by their problems or diagnoses but by their unique experiences and perspectives. It is a culturally sensitive approach that recognizes the importance of cultural contexts and beliefs in shaping an individual’s story (DeKruyf, 2008).

When responding to the question: ‘Why do you choose Narrative Therapy in older adult interventions?’ all the social worker respondents replied that Narrative Therapy could be aligned well with social work and fit the older adult group. Social workers can empower older adults to take control of their lives by encouraging them to tell their own stories and construct a new narrative reflecting their values, strengths and goals. One of the social worker respondents said,

I believe that Narrative Therapy is a value first and a technology second. Narrative Therapy has multiple perspectives: it believes that everyone is an expert in their own life, has their abilities, and is valuable, which is consistent with the social work advocacy of ‘helping others to help themselves’. (Respondent 15, Social work supervisor)

Two-thirds of the social worker respondents claimed that the specific techniques of Narrative Therapy can be considered appropriate for older adults. For example, externalizing conversations can separate people from their problems, thinking that people are different from their problems. One of the social workers stated,

Narrative Therapy is very suitable for older adults, whether in a group or an individual case. Narrative Therapy techniques can free older adults living alone from the label of ‘powerlessnes’, and provide a chance for them to talk about their own philosophical and intelligent stories. (Respondent 14, Social work supervisor)

Intervention

Intervention can also be called operation. This section aims to explore the implementation status of Narrative Therapy in geriatric social work and its operability based on the following three key concepts: ‘combination in practice’, ‘key to promoting intervention’ and ‘areas for improvement’.

Combination in practice

In practice, it is essential to combine Narrative Therapy and social work practice, for instance, the use of Narrative Therapy in individual cases, groups and the generalist intervention model of social work.¹

In the selection between individual case work and group work, social workers proactively assess the needs of service recipients and make a preliminary assessment of their current circumstances. The choice between individual case work or group-based intervention methods is determined based on the situation. Typically, the intervention comprises 6–10 sessions, occurring once every 1–2 weeks. The entire intervention process was conducted according to Narrative Therapy techniques. One older adult individual describes the process:

During a certain period, I was going through a low point in my life, experiencing both betrayals from friends and difficulties in life. The social worker became aware of my situation and visited my home weekly to converse with me, totaling approximately ten sessions. They made me realize my inherent worth and that having an illness is not my fault. Everything I’ve been through has shown how resilient I am, and I could beat the demons that hinder my path to a happy life. (Respondent 1, Female, 66)

Another older adult who participated in a Narrative Therapy group for older adults living alone shared the following experience:

We attended the activities every week and eight sessions. In the initial sessions, we got to know each other and discussed the challenges and feelings of living alone. In the subsequent sessions, we shared our experiences from our younger years, which made me realize that I had overlooked many valuable experiences in my life. I have been through so much, and as I grow older, I should treat myself kindly. I shouldn’t be constrained by external perceptions of ‘age’. (Respondent 8, Female, 70)

One seasoned social worker described the considerations in the selection and implementation of individual and group modes as follows:

Regardless of the intervention method, whether individual or group-based, it is imperative to consider the service recipients, i.e., the older adults, and their intrinsic values. Their values should be showcased and harnessed within both individual and group contexts. In group work, special attention should be directed towards presenting group members’ experiences, as these luminous moments in life can empower the service recipients, facilitating their reconstruction through storytelling. Moreover, group work can facilitate the enhanced utilization of ‘Definitional ceremony’ techniques, as group members serve as ‘mutual witnesses’, promoting more effective implementation of Narrative Therapy. (Respondent 15, Social worker supervisor)

When discussing how Narrative Therapy is used in the generalist intervention model, one social work supervisor said,

During the initial intake phase, it is essential to gain a comprehensive understanding and assessment of the older adults, which includes their background and current circumstances. This information forms the basis for effective planning and goal setting. The intervention stage [indicates] Narrative Therapy is conducted, where activities are typically designed according to the specific conditions of the older adult group. This phase often involves 6-8 sessions, conducted every 1-2 weeks. (Respondent 12, Social work supervisor)

In addition, one social worker also mentioned ‘infusing the value and principles of Narrative Therapy into the social work programme’, as follows:

Once Narrative Therapy is chosen as the intervention method, the entire intervention process, from start to finish, will be infused with the values and principles of Narrative Therapy. (Respondent 15, Social work supervisor)

Key to promoting intervention

In social work practice, some key factors make a more effective combination of Narrative Therapy and social work intervention. If social workers pay more attention to these factors, the intervention will be conducted more effectively and produce more positive results. Therefore, this study set out to examine the critical factors that influence the effectiveness of Narrative Therapy in geriatric social work.

Based on the interview responses, this study divides into two parts crucial factors that social workers should pay more attention to in their interventions: Professionalism and Locality.

Professionalism

The application of Narrative Therapy in geriatric social work relies heavily on social workers’ professional knowledge and intervention skills. In other words, the professionalism social workers possess is paramount, reflected in their proficiency in both the concepts and techniques of Narrative Therapy and social work, which aligned with all the social worker respondents’ answers. One social worker stated,

The primary requirement for integrating Narrative Therapy and social work is that social workers need to be well-versed in the procedural aspects of social work operations and the techniques of Narrative Therapy interventions. (Respondent 12, Social work supervisor)

For example, when recounting one’s own story, especially when the older adult has experienced trauma, it is likely that the lack of experience and specialization of the social worker will cause the older adult to lose control of their emotions or develop feelings of conflict or resistance, resulting in the inability to carry out the intervention and causing the older adult to experience secondary trauma. One of the social workers said,

Social workers’ specialization and mastery of Narrative Therapy are vital, particularly in intervening in some trauma older adults. Inexperienced societies cannot control crises that suddenly arise, and they may even inflict secondary trauma on the older adult. (Respondent 16, Senior social worker)

In addition, social workers have proficiency in both the concepts and techniques of Narrative Therapy and social work. In the social workers’ interviews, five social workers mentioned the selection of Narrative Therapy techniques; two referred to the alignment of social work and Narrative Therapy at different stages; three alluded to how these skills facilitate more effective engagement by service recipients during the implementation process; and one respondent noted her reflection on operational methods. The skills required to enhance service recipients’ engagement involve connecting with service recipients, building trust with them and facilitating techniques to encourage dialogue. One social worker said,

It is essential to consider the educational limitations of older adults and select a proper language they can comprehend and effectively communicate with. (Respondent 11, Social work supervisor)

Locality

Narrative Therapy is widely used in Western countries but may be resisted in Chinese culture because people tend to deal with problems privately instead of sharing them publicly. Narrative Therapy strongly respects indigenous or local culture and believes in the values and beliefs embedded in each person’s cultural background. Therefore, we must focus on indigenous culture and embed indigenous or local culture into Narrative Therapy techniques. Culture here refers not only to localization or eastern cultures but also to indigenous or local cultures, based on the service recipients’ background. Social workers must learn more about indigenous or local cultures to communicate with older adult service recipients. Locality is a significant factor, including local culture and dialect. Only with a complete understanding of the cultural background of the older adult can the meaning of their story be understood and help them in each Narrative Therapy session. Similarly, an identical cultural background can help the Narrative Therapy team members communicate well and promote empathy, facilitating goal achievement. One social worker stated,

The ordinary group activities we usually hold do not attract the active participation of older adults. Therefore, we use careful observation to discover the local older adults’ lifestyles and habits and integrate their cultural habits into the project to establish a relationship with them. The practice has proved that this method can better attract them to participate positively in activities. (Respondent 11, Social work supervisor)

In addition, one out of three social workers talked about how knowing the local dialect is essential due to the limited educational level of many older adults and their insufficient mastery of Mandarin Chinese. One said,

Some older adults do not speak Mandarin, and we must use the local dialect to communicate with them. (Respondent 13, Senior social worker)

Areas for improvement

There are still some deficiencies in implementing Narrative Therapy in the social work intervention process. These deficiencies may be due to the limitations of the professional skills of social workers, or they may be due to the limitations of Narrative Therapy itself.

Based on 16 respondents’ answers, Narrative Therapy, when applied in social work, requires some improvements in individual case work, group work and social work intervention processes.

For individual case work, social workers must transfer their roles. Narrative Therapy believes that everyone is equal and there should be mutual respect, and even regards therapy as co-research between the therapist and the service recipient. It upholds the view that service recipients are the real experts and do not have the authority of so-called experts (Motoyama, 2023). One of the social workers quoted this situation:

In individual case work, the incremental elicitation of older adult individuals’ thoughts and expressions is paramount, which necessitates collaboration between social workers and older adults rather than older adults simply complying with the directives of social workers. The role played by social workers and the relationships established with older adults are critical. Since many of our projects are approached from a ‘problem’, perspective, aimed at assisting individuals in problem-solving, social workers sometimes become dominant in the relationship. This shift in roles is not always easy for social workers. (Respondent 12, Social work supervisor)

Second, group work is a dynamic process consisting of different stages. In group work, social workers should pay attention to the different characteristics of group members at different stages so that Narrative Therapy can be better carried out. Seven out of 16 respondents spoke about this situation, with one older adult respondent saying the following:

Some older adults exit halfway, and some do not cooperate or even engage in antagonism. (Respondent 5, Female, 80)

One social worker described another inadequate feature encountered in group work:

In geriatric social work groups, we often have no prior contact with many of the participants. Many of them are notified and encouraged to attend by the community committee. We can only introduce Narrative Therapy during the intervention process. (Respondent 15, Social work supervisor)

Moreover, Narrative Therapy has its limitations. To some extent, it is merely a technique that involves mental health and is rarely effective in certain material aspects that support daily life. Two older adult respondents noted this:

This activity cannot solve many of the practical problems we face in our lives. For example, economic difficulties, safety risks, lack of care, etc. (Respondent 9, Female, 63)

Effectiveness

The particularity of mental health in older adults combines mental health problems with age-related changes affecting cognitive, social, physical and economic fields (Tournier et al., 2019). Older adults are usually suffering from chronic diseases as they age. They will always be facing some problem or other with regard to their physical and mental health and daily life, such as neurological disorders, anxiety, depression, substance abuse, neglect, lack of care, isolation and loneliness. During the interview, two respondents said that older adults might suffer from chronic illnesses, security risks, lack of care and support, and negative emotions, particularly during the pandemic.

However, this study found that quantitative evaluation tools are rarely used to measure the effectiveness of Narrative Therapy in the practice of Chinese Mainland geriatric social work. The evaluation of effectiveness relies more on social workers’ subjective assessment and former experience.

Older adult respondents and social workers said there are positive changes after Narrative Therapy intervention is used in older adult service recipients. All older adult respondents expressed that although they did not know what Narrative Therapy was, they became more optimistic, happier and more confident. An older adult excitedly described her changes:

I think this event has had a significant impact on my life. It taught me to express my feelings and thoughts better, and it also allowed me to empathize better with others. These events helped me better deal with past emotional issues and made me more optimistic about future challenges. Now, I feel like my life is more fulfilling and meaningful. (Respondent 7, Female, 74)

Six older adult respondents said the event changed their attitudes, habits and personalities. They became brave, stronger and reconciled with their past trauma:

Before participating in the event, I was on the verge of collapse, and I didn’t know who to share my troubles with, so I often cried secretly. Now, I am willing to take the initiative to communicate with people. After the event, my friends and I kept in touch. Now, I have become optimistic and cheerful. (Respondent 1, Female, 66)

Social workers expressed their views based on their experiences and observations in the intervention process. They all agreed that Narrative Therapy can bring happiness to and relieve anxiety and depressed emotions among older adults:

Older adults living alone often feel lonely and need someone to listen to and communicate with them, but they often cannot find the right person. Therefore, they usually close their hearts. In such cases, it is crucial to establish a Narrative Therapy group in which members share their experiences and tell their stories. (Respondent 11, Social work supervisor)

Narrative Therapy can produce several positive effects, particularly against the background of the pandemic (Mendes, 2022). However, all social worker respondents neglected to evaluate the intervention quantitatively. They evaluated it only based on their experience and observation. One social worker said,

Because we did not utilize specific evaluation scales, we could not quantify the extent of their specific changes. But it can be seen that the mood and behaviour of older adults are changing in a positive direction. Furthermore, due to pandemic restrictions, we did not follow up with participants after the project’s conclusion. (Respondent 13, Senior social worker)

As an intervention technique in geriatric social work

This study described how Narrative Therapy, as a technique, is applied in geriatric social work in the Chinese Mainland. Based on the findings, this study explored values, intervention and effectiveness. In the Values part, this study discussed how the values of Narrative Therapy fit social work. In the Intervention part, this study found that social workers intervene using Narrative Therapy within the social work framework, including using social work’s method of individual case work and group work. Professionality and locality are the vital factors that can help Narrative Therapy be applied effectively within the social work framework. In addition, nevertheless, the lack of professional competence of social workers and the inherent limitations of Narrative Therapy may make the intervention insufficient. In the Effectiveness part, this study revealed that quantitative evaluation tools are rarely used to measure the effectiveness of Narrative Therapy, and social workers rely more on their subjective evaluation and former experience in the practice.

As seen earlier, Narrative Therapy and social work are compatible, which has been proven by earlier studies (Dunn, 2014; Ginter and Brownlee, 1995). Usually, values guide behaviours (Mark, 2015) and behaviours also influence values (Theintactone, 2019). Values and behaviours go hand in hand (Kim, 2018). Social workers embed Narrative Therapy in the social work framework in their intervention. The narrative approach’s primary benefit applied in social work is helping the service recipient gain distance and objectivity regarding the problem. The narrative approach can also guide service recipients in discerning the causality that led to the problem, which can help inform their future behaviour (Swhelper, 2023). Suitable interventions increase effectiveness. Evaluation allows social workers to determine what works where problems arise, highlight good practices, indicate unintended effects or unforeseen results, and determine the effectiveness of expenses incurred (Kaczmarek and Romaniuk, 2020). Thus, the evaluation helps the social worker reflect on whether the intervention process is reasonable, and the interventions also further influence or reinforce the formation of values.

This study believes that the dimensions of values, intervention and effectiveness respectively correspond to ideation, feasibility and effectiveness in geriatric social work. The alignment of values plays a supportive role in interventions, while effective interventions also facilitate the manifestation of results. Scientifically and effectively achieved outcomes can refine intervention techniques, fostering a better integration of Narrative Therapy and social work. A fitting intervention process also reinforces values. As shown in Figure 1.

Figure 1.

Narrative therapy in geriatric social work in Mainland China.

Based on this, this study proposes some suggestions to enhance the combination of Narrative Therapy and geriatric social work in the Chinese Mainland, leading to improved application of the therapy.

Indigenization and specialization

When confronted with different topics and cultures, social workers must make changes depending on the individual case’s situation. Social workers should distinguish and respect the different traditional cultures and habits of clients. When intervening using Narrative Therapy, social workers can fully consider clients’ cultural backgrounds, values, habits and life experiences to avoid service recipients becoming retraumatized.

In terms of enhancing specialization, the government should give financial support, set up educational directions, develop more Narrative Therapy-related positions, organize regular training for social workers, promote certification qualifications, and link certificates and promotions to salary and benefits.

Evaluation combining qualitative and quantitative modes

To evaluate the effectiveness of Narrative Therapy, full consideration should be given to the evaluation methods, such as process evaluations and outcome evaluations. It is necessary to introduce quantitative evaluation tools to present the changes in older adults before and after Narrative Therapy interventions in the form of data instead of relying solely on social workers’ observation and experience. Qualitative outcomes can reflect the appropriateness of the intervention process and help it be upgraded. Quantitative outcomes can be used to verify whether interventions were reasonable and effective.

Conclusion

This study explores how Narrative Therapy can be applied in geriatric social work as an intervention technique and explores the current situation of Narrative Therapy based on three dimensions. Subsequently, this study discussed the relationship between the three dimensions and made several suggestions as to how Narrative Therapy can be promoted and used to even better effect. Future studies can focus on developing an evaluation mode combining qualitative and quantitative methods to validate interventions and thereby improve services. Moreover, future studies could also cultivate the development of professional persons who master both social work and Narrative Therapy to facilitate its better use in the geriatric social work of the Chinese Mainland.

Limitations

This study has inevitable limitations: firstly, the research locations, as the study selected two cities in China to conduct the research. The two cities are located in different geographical positions, but in view of the numerous cities in China, it is a very tiny sample. Second, Narrative Therapy may vary depending on the social individual worker’s skill level and the case’s circumstances. The authors could only select 10 participants to survey qualitatively since Narrative Therapy is not widely used in social work in the Chinese Mainland.

Supplemental Material

sj-pdf-1-isw-10.1177_00208728231209477 – Supplemental material for Narrative Therapy as an intervention technique: A qualitative study from the geriatric social work field in the Chinese Mainland

Supplemental material, sj-pdf-1-isw-10.1177_00208728231209477 for Narrative Therapy as an intervention technique: A qualitative study from the geriatric social work field in the Chinese Mainland by Zhao Yang, Mashitah Hamidi and Haris Abd Wahab in International Social Work

Footnotes

Acknowledgements

The authors would like to thank all the respondents for supporting the topic and the article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Zhao Yang

Supplemental material

Supplemental material for this article is available online.

Notes

Author biographies

Zhao Yang is a Master’s student at the Department of Social Administration and Justice, Faculty of Arts and Social Science, University of Malaya. Her research areas are geriatric social work and palliative care.

Mashitah Hamidi is an Associate Professor at the Department of Social Administration and Justice, University of Malaya. Her research is devoted to social services for marginalized groups focusing on labour and gendered migration, stateless people and refugees.

Haris Abd Wahab is a Professor at the Department of Social Administration and Justice, University of Malaya. His core area of expertise is community development. Over the last 20 years, he has been involved in developing and promoting teaching, learning and research opportunities in community development and social work.

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