Most clinical chart templates are built around the problem.
Symptoms. Frequency. Severity. Functional impairment. It’s the language of diagnosis, and it has its place. But if you practice from a narrative orientation, you’ve probably felt the friction when sitting down to document a session that was rich with meaning, hope, and movement, and finding that none of your fields quite capture what actually happened.
I felt that friction for years. And eventually I stopped trying to fit narrative work into a DSM-shaped container and built something different. Michael White spoke of maps, ways of navigating the territory of therapeutic conversation. A chart template, I've come to think, is its own kind of map. It tells me where I am in the work, what terrain we're moving through, and where I need to look next.My own charting continues to evolve and in this moment this is what my chart template looks like and why each field exists.
The name the person gave the problem:
This is where I start. Not my clinical language. Theirs.
In narrative therapy, the process of externalizing the problem, separating the person from the problem, giving it a name, is foundational. That name they gave to the problem belongs in the chart. It can be one of the most significant things in the session, and it’s almost never captured in standard documentation.
When I can look back across sessions and see how a person’s relationship to the the problem has shifted that’s the arc of the work, right there.
How the problem shows up in their life:
Not a symptom checklist. A description of the problem’s tactics, where it gets traction, how it recruits the person, the ‘solutions’ it promises, what territory it occupies. This field keeps me oriented to the problem as a presence the person is in relationship with, rather than a fixed internal state they need to manage.
It also keeps me alert to the fact that problems rarely announce themselves loudly in moments of change. They move quietly into the threshold, the in-between space where the old way of living is losing its grip and the new one hasn’t arrived yet. That particular territory, the not-yet, the wanting, is where the problem often does its most persuasive work. Knowing this keeps me oriented to where I’m listening most carefully.
Problem story:
The dominant narrative. The story that has been told, by the problem, by others, sometimes by previous professionals, about who this person is. Capturing this explicitly keeps me focused on what we’re working against.
Unique outcomes:
The moments when the problem’s influence was absent, reduced, or resisted, even briefly. These are the entry points into the preferred story, and they’re easy to lose if you’re not actively watching for them. Having a dedicated field means I’m always listening for them. And it shapes how I’m present in the room.
Preferred story / preferred identity:
Who is this person outside of the problem story? What do they know about themselves that the problem would prefer they forget? This is the heart of the work, and it deserves its own space in the chart.
Values, hopes, dreams, belonging, what they’re stepping into.
This is where I get to capture the poetics of what matters to the person. Not treatment goals in the clinical sense, but a living record of what matters to this person, what they’re moving toward, and their preferences regarding what they want their life to look like. Revisiting this across sessions is one of the most powerful things I do. It reminds both of us what we’re oriented toward, and where we are going.
Communities of concern:
Who witnesses this person’s preferred story? Who in their life sees them as they want to be seen? Who would not be surprised by the what they are doing in their life and in therapy? Narrative therapy has always understood that identity is not forged alone. This field keeps the relational and communal dimension of the work visible in the documentation.
Why this matters beyond the paperwork:
Here’s what I’ve noticed since making this shift: the template changed how I listen. It brings an intentionality into the work.
When you know you’re going to document unique outcomes, you listen for them more carefully. When you have a field for the name the person gave the problem, you make sure you ask. The structure of your documentation shapes the structure of your attention.
That’s not a small thing.
If you’re a narrative therapist, or a therapist who’s been drawn to narrative ideas but isn’t sure how to let them fully inhabit your practice, I’d invite you to look at your chart template as a clinical statement. It reflects what you believe about people, problems, and change.
What does yours say?
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***The above ideas reflect my own clinical practice and is shared as a professional resource for informational purposes. It is not a substitute for clinical supervision, and all practitioners are responsible for ensuring their documentation meets the standards of their own regulatory body. If you’re an RCC in BC, please refer to BCACC standards; if you practice elsewhere, consult your relevant governing body.***
