Because of the ignorance and stigma which still sadly surrounds HIV, children born with the human immunodeficiency virus (HIV) experience additional psychosocial stressors beyond those commonly associated with other childhood illnesses. They often live with real and perceived rejection from others, accompanied by the burden of secrecy and a sense of shame. Thus, when Camp High Five — a camp for children ages six to sixteen living with HIV — was given a grant by the H.E.R.O. for Children Foundation (www.heroforchildren.org ) to enhance HIV-infected children's emotional competence during their week-long summer camp experience, the primary aim was to create an intervention that would target the burden of living with a shameful secret. Given our psychological training, we decided to implement a modified form of narrative therapy tailored toward the camp environment, the cultural background and mixed literacy skills of the campers, and the therapeutic goal of giving voice to the unspeakable. To our delight, the intervention worked better than expected, and the youth created poignant stories. As we discovered, modified narrative therapy is a viable, worthwhile endeavor to include in a camp aimed, at least in part, toward enhancing the emotional life of children and teenagers. In this article, we provide a rationale and how-to guide for using narrative techniques in a summer camp for youth living with HIV, with the hopes that other camps and campers may similarly benefit.
Why Tell Stories
In order to fulfill our therapeutic goals and also work within the camp parameters for time and space, we decided to use a modified form of narrative therapy. Narrative therapists believe that stories (i.e., narratives) shape individuals' identities. In particular, the way in which people tell stories about their lives reflects their inner world and conveys what they think about themselves and their experiences. For example, one's story may reflect a sense of hope and resilience in the face of stress. In contrast, one's story may reflect inaccurate beliefs, a tendency to view situations from a negative vantage point, and themes such as "everyone I care for betrays me." Narrative therapy is also helpful for increasing self-esteem and self-worth by asking an individual to voice the complex and intricate series of events that comprise his or her life and to focus on how problems are viewed, dealt with, and resolved.
Our modified version of narrative therapy involved creating a third-person narrative, a story not about our campers' lives directly, but rather about someone "like you, someone who could be in this cabin." We believed that creating a story about a character like them would allow access to the personal experiences and inner worlds of our campers more so than direct questioning of their own lives. Although traditional narrative therapy would ask for non-fictional stories from an individual person, we decided for two reasons to use the group process so that each cabin would generate one fictional story. First, we wanted to take advantage of the camp dynamics and the bonding of cabin mates to work together toward a common goal of storytelling. Furthermore, the time constraints of camp would not permit us to adequately listen to, analyze, give feedback on, and reconstruct each camper's narrative. Second, we believed that some campers might be reluctant to share personal information about themselves or their experiences in a direct format and that they might be more willing to disclose meaningful information if they could do so under the guise of a character.
We generated excitement among the campers with the notion that they would be authors of their stories, which would be "published" in book form. We encouraged them to illustrate their stories as well. We planned to use our grant funding to print and bind the stories such that each camper would have his or her own cabin's book. As authors, we hoped that the campers would feel that their voices deserved to be heard, that their stories were worth telling, and that they would be free to share their stories with other people in their lives as they chose. We hoped that the stories would reflect some of the problems they experience in their own lives and that the book would be a tangible product to represent their connection to each other, to camp, and to their accomplishments. In addition, we believed that knowing they would be getting their own book might be rewarding in itself to help them engage in the narrative story-telling process.
We met with each group of campers in their own cabins to create a safe place for them to disclose personal information and ideas. We had two facilitators — a psychologist and a clinical psychology graduate student — at each session. We brought a laptop computer with us in order to type in verbatim the campers' words and ideas. After working with several cabins, we found that the process was best facilitated when one of us led the group discussion and one of us took notes on the discussion on the laptop. We introduced the idea that each cabin would author its own book and that each camper would have a copy of their own book to take home; we stipulated that sharing the book after camp was each campers' individual choice, and that deciding to not share the book was perfectly acceptable. We then explained that the main character of the book should be a person similar to the campers in each cabin. So, in a cabin of fifteen- and sixteen-year-old girls, the main character should be a fifteen- or sixteenyear- old girl.
Next, we asked each group to describe the character using questions such as: What is her name? Where does she live, and who does she live with? What does she do for fun? What is she good at? What is hard for her? Who are her friends? How does she do at school? What kind of music does she listen to? Typically, the campers used aspects of themselves when describing their character. For example, one camper who wore an Atlanta Braves T-shirt contributed that his cabin's character liked to watch baseball. By using aspects of themselves to create the character, the campers were both identifying with the fictional character and blending themselves into one person, which strengthened their cabin's group. Almost all of the campers enjoyed this aspect of the narrative process; they seemed proud and happy to share information that defined their character to create something with their group. In addition, this aspect of the narrative process allowed campers to learn more about their peers — when one camper contributed that her character likes to eat Chinese food, another camper said "Ew! You really like to eat that?" By the end of the ten or so minutes it took to describe the character, most of the campers were eager to continue the narrative process.
Developing the Story Once the campers had established many of their character's attributes, we told each group that although they had the ability to create any kind of story that they wanted, their story must include one component — that their character has a secret. We told the campers that they had to decide, as authors, if they would like the book to explicitly state what the secret was or if they would rather not share the specifics of the secret. We then asked the campers to describe what happens when people keep secrets, including both the good and bad things about keeping secrets. Campers typically gave responses that secrets were good because they ensured privacy and security but that secrets were bad because they were a burden and may make you feel like you are lying to someone if you do not tell them the absolute truth. We asked the campers to think about how the character felt keeping his or her secret, how people in general feel when a secret is kept. What does it feel like to keep a secret? Is it uncomfortable? Can it make you angry or frustrated? Are people hurt?
Once we had established that there are many different facets to keeping secrets, we told the campers that every story has a plotline and that they needed to generate one for their story. If a group had difficulties in creating a plotline, we asked them to talk about what their character was like before the secret, what did he or she enjoy, and what was his or her life like overall. As we talked about the secret and the evolving plotline, we continued to ask questions about how the character manages her secret: How does the character think about the secret? What might the character's family think about the secret? What might the character's friends think about the secret? Does the character change his personality, behaviors, or opinions because of the secret? Is it alright to change in response to a secret, and what might the consequences of those changes be? Discussing the many implications of keeping a secret was a way to talk to the campers about managing emotions. Through the cover of their character, many of the campers talked about how difficult it is to keep secrets but that it is sometimes a necessary part of life. Such a conversation enhanced the campers' thinking about emotions, ability to discuss emotions, and capacity to identify emotions correctly.
As the campers generated a plotline and a manner for their character to manage his or her secret, we asked the campers if there were other ways to cope with the secret and what the positives and negatives of these options were. Generating several different alternatives for the character to pursue was a form of problem-solving in which both the campers and the character in the story engaged. Through our discussions with the groups, we were able to problemsolve by weighing the pros, cons, and likely outcomes of each scenario for the character to manage her secret. The purpose of problem-solving was to role-model critical thinking and analysis skills to the campers, in addition to helping them see that there may be numerous ways to confront problems. Although many groups were able to generate interesting plotlines on their own, if they had difficulty, we asked, "What happens to the character over time? What happens to the secret?"
We were surprised by the depth and content of the campers' stories. Having never done narrative work at our camp before, we were not sure what to expect and whether the campers would be able to take the book-writing project seriously. Some of the secrets generated by the cabins included teenage pregnancy, childhood cancer and HIV, and living without HIV in a family of HIV-positive parents and siblings. Perhaps the most moving story was created by a cabin of eleven- to twelve-year-old boys who wrote a story about a family's mother passing away from AIDS and a young son needing to "man up" and become the provider for the family. All the stories were powerful because we could see various aspects of the campers' experiences in the narratives. Aside from the secrets chosen, themes interwoven throughout the narratives also included loss, poverty, violence, social isolation, and resilience.
At the end of our first meeting, each cabin had generated the majority of their story. We then left paper, markers, and colored pencils with each cabin so that the campers could create illustrations for their books. Younger children tended to create many drawings for their books, while the older campers selected not to create any illustrations. Before leaving, we asked each cabin about how their experience with writing a story had been so far, and whether there were any difficulties. Campers tended to give feedback that was very positive, indicating that they enjoyed the experience and were excited to see their books.
We returned to each cabin for a second onehour period to generate a conclusion for the story (if not already completed), collect the illustrations, re-read the story back to the campers, and discuss what they thought of their book-writing activity. Again, we brought a laptop to allow us to take notes on what the campers wanted to put in their story. To help generate conclusions for the stories, we asked the campers, "Does the character handle the secret differently in the future? Why or why not? Did the character learn anything about keeping secrets?" We also asked the campers to think about what would happen to the character's secret and if the character's view of the secret changed over time. In many cases, the campers decided that their character should resolve problems associated with the secret by disclosing the secret to a trusted friend, family member, or therapist. When campers chose to have their character disclose the secret to someone else, we talked extensively about how to approach someone if an issue was bothering you, how you might ask for help, and what words you could use to convey a problem and the distress it has caused.
Once each cabin had finished creating their story, we read our notes for the story back to the campers out loud. This reading became an editing process, in that some cabins decided to change parts of their story, use different words to change the meaning of certain sections, and extend dialogue or descriptions. When the entire cabin agreed that the story was complete, we talked about what illustrations the campers would like their books to have and when we could collect the illustrations. We also verified how each camper wanted his or her name to appear on the book as an author (e.g., first and last name, first initial and last name, etc.). We concluded the book-writing process by talking to the campers about what it was like to be authors, especially about topics with which many of them had had experience. We asked questions about how their view of secrets changed, if they would do anything differently in the future to handle a secret, and what they liked best about the narrative experience. Overall, we received positive feedback from the campers with whom we worked; they both enjoyed the creative process of writing the story and were eager to see their books. After we met with each cabin twice, we converted the notes we took using the laptop computer into stories, used a scanner to add the campers' illustrations to the stories, and formatted the books accordingly. The editing process took longer than planned, and then the books were printed and bound. We distributed the majority of the books to the campers at camp the following summer.
A Powerful Process
As our first attempt, this story-writing experience at a camp for HIV-infected and affected youth went beyond our expectations. We were pleasantly surprised to learn that the narrative therapy process was enjoyable for them. What was most amazing was the campers' contributions to the group creative process; many cabins thoroughly discussed issues related to sexual activity, drug use, violence, values, pregnancy, friendships, family, and life choices. Such topics are often difficult to bring up and openly discuss with the campers with whom we interact in other settings (e.g., the medical clinic). We feel that creating a fictional character and story about that character was a useful way to improve problem-solving, emotion identification and regulation, and social skills in our campers. In addition, because each camper eventually received a copy of his or her book, it is our hope that some of the campers might refer to the story or recall the narrative-writing experience in times of trouble or distress to think about ways to solve problems and make themselves feel better. Overall, we believe that the narrativewriting experience was a powerful process that adequately allowed us to achieve the goals that we wanted to reach.
For those who would like to replicate this process, we encourage the use of some structure (i.e., giving campers a theme on which to base their story) to balance the freedom of the writing process. Key components of our success included having return campers who had a history of feeling safe and supported at Camp High Five, choosing a theme that targeted our audience (i.e., keeping secrets), and using an oral narrative-writing experience rather than a written one (e.g., many of our campers with HIV have learning disabilities). We were impressed by the campers' generally serious approach to this project; most wanted to produce a book of which they could be proud. As a result, we felt that the experience was not only enjoyable but also therapeutic. It is our hope that as our campers continue to grow, they will be able to use some of the techniques they learned through story-writing to help them manage future difficult times in their lives.
Beginning the Narrative Story
Recapping the Narrative Story-Telling Process
Meredith Jones, M.A., is a clinical psychology graduate student at Emory University who served as a resource counselor for Camp High Five in the summer of 2007.
Michelle Broth, Ph.D., is an assistant professor at Emory University in the School of Medicine, Department of Psychiatry & Behavioral Sciences, and the director of Mental Health and Substance Abuse Services for the Family Clinic at Ponce. She is a licensed psychologist who provides clinical services to infants, children, youth, and families living with HIV and/or AIDS. Broth is on the Board of Directors of Camp High Five.
Originally published in the 2009 March/April issue of Camping Magazine.