Who Are We, But for the Stories We Tell: Family Stories and Healing

Functions of Family Storytelling

And sometimes remembering will lead to a story, which makes it forever. That’s
what stories are for. Stories are for joining the past to the future. Stories are for
those late hours in the night when you can’t remember how you got from where you
were to where you are. Stories are for eternity, when memory is erased, when there
is nothing to remember except the story (O’Brien, 1998, p. 38).
With each year of our lives, we add well over half a million minutes to our banks of
experience. However, to be human is not simply to keep a record of the details of that
sensory experience, but rather it is to organize those experiences into a cohesive story that
allows us to integrate selected moments into our sense of who we are. Stories are used to
organize, predict, and understand the complexities of our lived experiences.
Family stories go beyond the lived experience of each individual member. Family
storytelling gives us access to the multiple meanings of family experience while building a
shared theory to explain the meaning of life events to the family as a whole (Boss, Beaulieu,
Wieling, Turner, & LaCruz, 2003; Fiese & Sameroff, 1999). Family stories illuminate the
content (the details of “what happened”), the affect (the “how it felt”), as well as the
meaning (the family’s sense of “why this happened”). Collaborative storytelling allows for
each member to share a perspective of the experience, including the emotions attached,
which then allows the family to develop a shared understanding of events. This chronicling
of experience develops the family’s history into a framework for meaning making. Family
stories as told over time become internalized as family schemas for individual family
members (Bakhtin, 1981; Hermans & Dimaggio, 2004). Further, family stories allow us to
step beyond our immediate experience and to interpret events with an eye toward the future.
The story is like the thread that weaves together a family’s past providing shape and form
together with the anticipated future. Finally, families often use their stories to communicate
beliefs, values, and important life lessons of the family system and of the larger
sociocultural context (Fiese & Wamboldt, 2003).

Family Storytelling Skills
And just as spiders don’t have to think, consciously and deliberately, about how to
spin their webs, and just as beavers … do not consciously and deliberately plan the
structures they build, we do not consciously and deliberately figure out what
narratives to tell and how to tell them. Our tales are spun, but for the most part we
don’t spin them; they spin us. Our human consciousness, and our narrative
selfhood, is their product, not their source (Vollmer, 2005, p. 418).
Telling family stories comes naturally to most families. It is an ordinary part of shared
family meals, family leisure time, and special family events. Through frequent practice,
families develop natural abilities in storytelling. Families skilled at storying demonstrate
both practicing and representing characteristics (Pratt & Fiese, 2004). Practicing
characteristics suggest the act of storytelling, how the family tells the story, who talks, and
who listens. Representing characteristics suggest how the content of the story is understood,
what the story means, and what message the family is trying to communicate. Using
practicing characteristics like a coordinated perspective (Bohanek, Marin, Fivush, & Duke,
2006) and coregulation of affect, as well as representing characteristics like shared meaning
making (Hill, Fonagy, Safier, & Sargent, 2003), families join their voices together to
coconstruct a story. These elements of family storytelling require a degree of
interdependence and are necessary to move from an experience where each family member
recites their independent story to the creation of a shared story.

Coordinated Perspective
The task of constructing a family story is complex, involving the input of multiple members.
A coordinated perspective involves the family’s use of a collaborative style in which each
member contributes to the story. A coordinated perspective involves determining what is
relevant for inclusion in the family story, appreciating multiple points of view, and
managing the storytelling process so that all voices are heard. The results are a final version
of the story that incorporates the perspectives of the whole family rather than one or two
individual members.

For this process to be successful, first, family members must understand that within a story
attention is focused on only a part of lived experience. This means that each story told is an
interpretation of an event. As orator, each family member must decide what part of his or
her experience is relevant and necessary to the family storyline. This ability emerges from a
relational context. Consider the four fundamental components of joint attention and their
significance for storytelling: one, interacting with a social partner; two, to share an
experience; three, through coordinated attention to an object (or event); and four, with
mutual affect (Carpenter, Nagell, Tomasello, Butterworth, & Moore, 1998; Liszkowski,
Carpenter, Henning, Striano, & Tomasello, 2004). The development of joint attention skills
within family relationships provides a foundation for learning that some experiences are to
be ignored while others are worth noticing and reporting in the story. Families must work
together taking into account the emerging capacities of each of their members to tell about
experiences of central importance to the collective. It is in this way that family members
decide what fraction of their lives becomes part of their story, part of how they define their
family. Further, family members must make explicit how the main characters, context, and
sequence of events belong to a typical family story and are pertinent to their family story
(Dimaggio & Semerari, 2001).

Second, having determined the central storyline, reaching a coordinated perspective requires
family members to demonstrate their skills at synoptic and credulous listening and also
reflectivity. The ability to listen for different perspectives, or synoptic listening, allows
family members to appreciate multiple points of view and accept that everyone in the family
perceives events differently, even an event experienced by the whole family at the same time
(Nwoye, 2006). The ability to hear the story without criticizing, judging, or correcting, or
credulous listening, involves both letting the orator tell his or her story without interruption
and with the knowledge that the audience will believe or accept the story as a valid
representation of the orator’s perspective. In a collective process like family storytelling,
reflectivity incorporates not only taking into account how each individual felt themselves,
why they felt or acted the way they did, but also considering how other members of the
family might have felt (Singer & Rexhaj, 2006). “Importantly, this also relates to [family
members’] abilities to form ideas about others’ internal states; for example, to be able to
consider what might have been going on in the mother’s or father’s minds – feelings,
intentions, needs and explanations which may have guided their actions” (Dallos, 2004, p.
48).

Third, a coconstructed story that belongs to the whole family requires use of a set of
collaborative problem-solving skills, including balancing power, influence, control and
negotiation. Families have to understand that, quite naturally, the voice of some members
carries more meaning-making authority than others (Besley, 2002). Families using a
collaborative style do not let this voice be the only one heard and heeded. Their
understanding of this dynamic allows them to structure the family interaction during
storytelling so that all members express a point of view and then negotiate a shared
perspective. Parents/caregivers help younger family members by soliciting their contributions and by integrating all viewpoints into a shared, consistent frame of reference
(Bohanek et al., 2006). When families use a coordinated interaction style,
several perspectives are taken, and most important, parents structure and integrate
these different perspectives for a more complex understanding of one’s own
perspective, the perspective of others, and the integration of the self with others.
Families using a coordinated narrative interaction style teach their children that
they are part of a unified, cohesive family whose members understand and work
through positive and negative experiences together (Bohanek et al., 2006, p. 48).
Co-Regulation of Affect A good story, along with relaying the “what” happened, reveals the feelings that accompanied the experience. Joyful stories can have families laughing uncontrollably while sad stories are often told with tears running down family members’ faces. The process of telling family stories enables each family member to deal with potentially intense emotions within the context of a story and within the safety of the family unit. The act of family storytelling provides collective experiences of affective coregulation much like the responsive, repetitive dyadic interactions used to encourage internalization of emotional regulation within the infant—caregiver relationship (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001). The family’s facility with sharing and regulating intense emotion during storytelling is consistent with findings of attenuated physiological
responsivity within the social context of the family (Seeman & McEwen, 1996). The process
of organizing emotionally complex events into coherent form, a component of family
storytelling, has also been found to influence a child’s emotional and behavioral regulation
(Oppenheim, Nir, Warren, & Emde, 1997).

The nature of storytelling allows family members to relate feelings congruent with the
content and to express feelings at an intensity consistent with the social rules of storytelling
and familial/cultural norms. For this to happen, family members must be able to recognize
and respond congruently to the affect expressed. Such empathic listening gives the
storyteller permission to add affect to the storyline, demonstrates attunement, and supports
emotional coregulation. Empathic listening facilitates the family’s ability to express
emotionally charged materials while they share stories about difficult topics.
Shared Meaning The family’s skills at using a coordinated perspective and co-regulating emotions provide the foundation for their coconstruction of meaning: “Meaning is not a stable entity but an outcome of relational negotiations in a particular context” (Penn, 2001, p. 44). Family stories act both to convey meaning as well as to guide families toward reaching a consensus among all members regarding that meaning.
Stories that become incorporated in the family history and communicate important
information about the family involve a shared frame. This shared frame provides a platform
for families to understand each other’s actions and emotions, jointly appraise situations and
place events within the family’s past, current, and future. Joint frames are similar to
internalized working models or schemas and help families make meaning of their
experiences. They involve “the interpretations and views that have been collectively
constructed by family members as they interact with each other; as they share time, space,
and life experience, and as they talk about these experiences” (Patterson, 2002, p. 355). The
shared frame does not belong to any one family member, rather it is jointly held by all and
“is a characteristic of the `system’ that has established them” (Hill et al., 2003, p. 210).
Arriving at this shared frame is not an easy process. It is a skill that families practice through
the act of storytelling as they build and communicate their shared worldview.

Families use this shared frame to coconstruct coherent stories. Such stories involve a goal
structure that relates how the story fits with the family’s purpose and aspirations. Family
stories recall events that to explain how specific episodes are significant to the family or to a future goal of the family (Dimaggio & Semerari, 2001; Habermas and Bluck, 2000). A
coherent family story has explanatory significance in that it contains information about why
events happened to the family, or how an event is similar/dissimilar to other experiences in
the family’s history, and how the storied event links with other events along the family
timeline. For example, families tell stories that portray family members as heroes or villains
as a way to interpret the historical behavior of their relatives. By making these connections,
the family ties together discrete scenes across the family cycle to explain who they are
(Dimaggio & Semerari, 2001). A coherent family story is also thematically consistent.
Through thematic coherence the family develops a dominant theme that becomes central to
their family storyline. In this way, the story being told holds true to the shared family
paradigm, values, and messages. Thematic coherency in family stories allows storytellers to
consider the past in light of current events and to look toward the future guided by the
shared family identity (Haberman & Bluck, 2000).

Often the family’s shared frame dictates the meaning that families make from their
experiences. Thus, an important skill set in family storytelling is agility. Agility allows
family members to hear or imagine the untold stories, the different possible versions of the
stories being told, the options that are not included as the story unfolds, or the alternative
endings (Hester, 2004). Agility makes explicit the fact that we can story only a small bit of
experience, and in the act of storying that small bit, we imbue it with significance and
meaning. Storytelling agility gives families the opportunity to recognize and imagine
alternatives to their dominant family story, to suppose how else they may have felt or what else they may have done.

Trauma and Family Stories
Everybody, including children, has a story to tell that can break your heart. People
record their life experiences, both pleasant and painful, in story form. People’s
stories are not neutral but partial, told from the angle of vision of the owner of the
story (Nwoye, 2006, p. 19).

Storytelling provides us with a means for chronicling, sharing, and making meaning of
experience. What happens, though, when family members experience overwhelming,
overstimulating, painful, and terrifying events? Traumatic experience, described by
Shengold (1989) as “too much too much-ness” (pp. 1) can derail family storytelling. How
does a family know how to incorporate the “unspeakable” in their story? This is especially
challenging for families who face repeated, chronic, multigenerational patterns of exposure
to violence, traumatic loss, and looming danger.

Trauma impacts family storytelling processes and the stories families tell. It impacts both
practicing and representing characteristics of family storytelling. Traumatic experiences can
make it difficult for families to use a collaborative style and reach a coordinated perspective
by, among other things, negatively affecting each family member’s storytelling abilities and
the ability of caregivers to facilitate family storytelling. Traumatic experiences can also
impact the family’s ability to use their storytelling skills to make meaning of such events and
incorporate them into the family story.

For individual family members, exposure to trauma can lead to impairment in a number of
domains that, in turn, can affect their ability to participate effectively in family storytelling.
Traumatic experiences, especially those involving interpersonal violence, adversely impact
(a) attachment schema and relationships; (b) affect/emotional regulation; (c) cognition (e.g., attention and concentration); (d) language and communication; and (e) self-concept (Cole et
al., 2005; Cook, Blaustein, Spinazzola, & van der Kolk, 2003; Pearlman & Courtois, 2005),
which, among other things, leads to cascading impairments in self-regulation, ability to self-
reflect, joint attention, empathy and expectations about the world (Cook et al., 2003; Ford,
2009). Thus, the empathic listening and synoptic listening skills of individual family
members, crucial to the co-construction of family stories but requiring attunement, empathy,
and perspective taking, can be can be disrupted.

Chronic traumatic circumstances keep family members constantly on edge, hyper-reactive to
potential threats and create difficulty regulating emotions and behaviors, making it difficult
to incorporate affect into family stories without emotional expression being either overly
constricted or so intense that it is overwhelming. Additionally, uncontrollable, potentially
dangerous conditions engender intense feelings that can exceed each family member’s
emotional regulation capabilities. The inability to tolerate intense emotions, a trauma-related
symptom, may bring about reactions, such as rage, avoidance, and dissociation, and in this
way constrict each family member’s ability to participate in any coregulated process,
especially one involving memories of a stressful event (Briere, 2002).

At a dyadic level, trauma can erode parent–child processes that support family storytelling.
We know that when parents are able to be attuned and regulated while they talk to their
children, they can successfully scaffold their child’s discourse. In a study looking at mothers’
conversations with their 8–12-year-old children about acute and chronic stressful events,
Sales and Fivush (2005) found that mothers who utilized explanatory language and language
that referred to emotions had children who did so as well. However, traumatic stress can
impede a parent’s ability to respond effectively to discussions about negative emotions or
events and can interfere with parent–child conversations about the past, which are critical to
construction of stories and autobiographical memories (Green et al., 1991; Haden, 1998;
Laible & Thompson, 2000; Valiente, Fabes, Eisenberg, & Spinrad, 2004). Further, when
parents or primary caregivers have their own history of trauma, the attunement skills needed
for storytelling can be negatively impacted (Cook et al., 2005). One study’s results suggest
that the level of trauma experienced by maternal caregivers adversely affects children’s
performance on a storytelling task (Schechter et al., 2007).

Parents/caregivers with their own unaddressed histories of trauma may have difficulties
accessing an internal, reflective sense of self (Briere & Scott, 2006). This can limit
caregivers’ self-reflection during the storytelling process, as well as impede caregivers’
efforts to scaffold their children’s self-reflective skills. Without such reflectivity during
family storytelling, it is difficult for families to reach a coordinated perspective. Finally,
trauma can also limit parents functioning as coregulators of the family given that they have
difficulty regulating their own affect around stressful topics or around their children’s
intense affect (Kinniburgh, Blaustein, Spinazzola & van der Kolk, 2005).
Family meaning making processes are also impacted by trauma. When a family has dealt
with significant trauma(s), these experiences can create a family identity that becomes a
nucleus around which family stories develop. Pathologizing stories of what happened, fed
by the family’s underlying beliefs, may end up dictating how family members see
themselves, each other, and their future. These stories may end up restricting family
members’ view of the possibilities of how they can behave or take action in their lives
(Dallos, 2004). Trauma becomes the dominant narrative, the glue that binds the family
together and that determines whether future experiences stick to the family’s unfolding
narrative or fall away from the family’s conscious perception. In a family affected by
trauma, “the dominance of a (post) traumatic identity can then be consolidated at personal
and social levels, as it functions as an interpretive framework for integrating subsequent life experiences and relating and enacting them with others” (Neimeyer, Herrero, & Botella,
2006, p. 132).

Finally, trauma interrupts families’ ideas of past, present, and future. If an event is so
overwhelming that family members become too upset to tell the story of what happened and to transform the event into a neutral narrative (van der Kolk, Brown, & van der Hart, 1989;
van der Kolk & van der Hart, 1989), the trauma cannot be synthesized into the family’s
history or placed in context alongside other life experience. Particularly in cases of severe
and/or chronic trauma, a family’s past life has likely been so dominated by trauma that living outside the past is challenging and imagining the future is out of the question. These factors can adversely affect a family’s ability to reminisce as well as construct coherent family’s stories.

Family Trauma Narrative: A Therapeutic Approach
In terms of faith, what brings meaning and integration to one’s experience, the facts
are quite secondary. It’s the story (and not the facts) that grips the imagination,
impregnates the heart, and animates the spirit within … (Diarmuid O’Murchu,
Quantum Theology, as cited in Diane Schoemperlen, Our Lady of the Lost and
Found, p. 304).

Narrative therapy is an accepted component of empirically supported treatment for
individuals with traumatic stress disorders (Silverman et al., 2008; Wethington et al., 2008).
Application of this therapeutic strategy with families holds promise as well. A family trauma
narrative process brings members of a family together to share their trauma story. As a
family weaves their trauma story, they find ways to work through the trauma, develop a
shared sense of meaning, and use problem solving techniques for minimizing additional
stresses. Therapists working with families affected by trauma can scaffold and bolster the
family’s natural abilities in storytelling to support coconstruction of a family trauma
narrative. It is our hope, through this discussion, to give recognition to the complexity of this work and to provide some guideposts for those working with families who must attempt to bring each family member’s experience of the trauma into alignment with the shared family story.

Many Roles of the Therapist
The therapist providing trauma intervention at the family level must attend to developmental
or experiential differences between variously aged individuals in the family system and
scaffold narrative skills from an individual toward a family trauma narrative. The therapist
must also monitor any dissynchrony of family members’ reactions or course of recovery
(Pynoos, Steinberg, & Piacentini, 1999) and focus on emotional regulation, family
communication, and meaning making.

The therapist draws on theory as well as professional experience when working with those
who are creating a narrative about traumatic events. Even within the ranks of those practiced
with narrative interventions, there is some disagreement regarding methods. For example,
reasonable minds differ about whether or not to encourage clients to relive, through
retelling, their overwhelming moments. Because perspective taking and coregulation of
affect (practicing characteristics) are affected by trauma as much as meaning making
(representing characteristics), helping families strengthen their storytelling skills and process
may, in and of itself, be therapeutic. Rather than directly discussing traumatic events,
assisting families with adjusting or building the skills to adaptively create family stories may
serve them well in coping with future stressors (Bohanek et al., 2006). However, if the
family wants to talk about their trauma directly, as they talk about what happened, their shared story helps improve memory for the event by reinstating experience, filling in
missing pieces and correcting misinformation; clarifying interpretations and attributions; and
developing empathy for the pain the story reveals.

It is the therapist’s role to carefully guide the family in a shared decision-making process
about how to proceed with the trauma narrative. We recommend that the therapist, in
concert with the family as expert and full participant (Hester, 2004), begin by identifying
objectives and defining boundaries of the family trauma narrative process. Identifying an
overarching objective, such as “Develop a shared story that lets us understand each family
member’s perspective and points us toward a hopeful future,” reassures each family member
of the value of the effort involved. Then, the therapist facilitates a discussion about the
boundaries of the narrative process, working with the family, to decide: which traumatic
event(s) to incorporate in the narrative; whether to detail specific trauma(s); whether all
family members are aware of the details of the event(s); whether to limit the discussion of
certain specifics; and whether each family member present has the requisite skills and
readiness to participate in constructing the narrative. Once these decisions are made, the
therapist can proceed with a clearer appreciation about when to inquire about details and
when not to, when to promote simultaneous individual work and when to keep the work
within the family system, and when to focus on how the family is storying instead of what
they are storying.

When beginning the family narrative portion of the trauma intervention, a review of stress
inoculation techniques (either recently learned or recently reviewed by the family) serves as
an important precursor or reminder of the shared responsibility (caregiver(s)/therapist) for
titrating experiences so that they are not overwhelming. Both externalizing and internalizing
behaviors are commonly seen during episodes of emotional dysregulation. As part of the
work, the therapist must continually monitor and assist with coregulation of family
members, utilizing either down-regulating (i.e., calming, soothing) or up-regulating (i.e.,
activating, energizing) techniques. Ensuring that family members have reached a state of
affective and behavioral regulation is a key strategy when ending each narrative session:
family members must be prepared to reengage with life outside the therapy space.
Monitoring communication, both explicit and unstated, is a key aspect of the therapist’s role
in family trauma narrative interventions. Adults in the family are typically focused on the
messages communicated through words while children, particularly early elementary and
preschool aged children, often communicate through play or nonverbal behavior. During one
particularly poignant therapeutic conversation, a grandparent suggested that a child did not
care about what had happened “since he never cried or showed any kind of sadness.” The
therapist then pointed out that while the grandparent had been talking, the child had been
quietly playing with puzzle pieces and had constructed a number of figures, all of whom had
sad or crying faces. It was only after that therapist’s intervention that the grandparent and
young child were able to understand the sadness they jointly held. It almost goes without
saying that clinicians attend to the listening skills (e.g., synoptic, credulous, and empathic)
used by the family as they tell their story.

One of the goals of family narrative is that family members will realize that there may be
multiple realities, multiple truths, about what happened. Even when all members of a family
are present during the traumatic event, their individual experiences will be idiosyncratic:
“Our lives are multistoried. There are many stories occurring at the same time and different
stories can be told about the same events. No single story can be free of ambiguity or
contradiction and no single story can encapsulate or handle all the contingencies of life”
(Morgan, 2000, accessed online). The therapist helps to elicit pieces of the story from each
family member and then helps to integrate the pieces into a cohesive whole that includes perspectives from each family member. For example, one child in the family may have been
in the home during the start of a house fire while a second child was not. The first child
needs others to hear and understand the details of the scene so that the others may be able to support him. This is the case even months later when no one has yet been told exactly what he heard and saw. However, the second child may be overwhelmed by hearing the details. Yet, the second child, who has also experienced the traumatic loss, can provide a perspective that will likely be helpful to the healing process. The therapist encourages the family to appreciate that each member of the family is a partial knower, and in the giving-and-taking turns between telling the story and listening to the other’s story, family members grow in appreciation for their multiple viewpoints. The understanding of this concept can help weave the family together, improving cohesion while at the same time allowing space for
individual growth and development. Narratives also allow family members’ verbal mastery over the event as well as the ability to externalize the problems, challenges, or traumas they face (Besley, 2002). The therapist works with the family to place the situation outside the individual or family, as if in a story, allowing family members to observe the challenges from several different angles. The therapist helps the family conceptualize any problem as outside the individual family members, so blame or defensiveness may be averted. The therapist asks each member to notice the transactions and the patterns that create either constraint or freedom (Minuchin, 1998). Because of the story, family members can think about the problem or the trauma; they can mentally walk all around it and construct linguistically new ways of thinking about it.

In addition, some trauma theorists assert that an active therapeutic ingredient of constructing a trauma narrative is reworking the trauma: “Telling the story of the trauma pain allows the other family members to help you continue the story while changing the story line in a way that results in a better ending” (Lantz & Raiz, 2003, p. 169). Through telling the story of the trauma(s), an individual (or family) impacted by trauma can gain a sense of mastery over the traumatic event by talking or playing out alternate endings, what they wished had happened or what they would have liked to have done differently. Pynoos, Steinberg, and Aronson (1997) describe these as “intervention fantasies” that “represent mental efforts to contend with or counter traumatic helplessness and injurious outcome” (p. 279). In an attempt to help one family deal with each member’s sense of guilt surrounding the death of a family member during a domestic dispute, the therapist encouraged them to construct multiple endings to their story. The victim’s mother fantasized aloud that had she known about the domestic violence she would have convinced her daughter to leave the relationship. The victim’s sister altered the story’s tragic ending by imagining that she had decided to come to sister’s home to visit that evening preventing the argument from getting out of hand. Finally, one of the victim’s children wondered whether his sister could have saved their mother by calling 911 when she called for help. Hearing the alternative endings allowed the children to share details about their last night together as a family, details that had not been disclosed previously, and to talk about how scared and helpless they had felt during their parents’ fights. Bringing these details to light also helped all family members realize how much they wished they could have done something to prevent the victim’s death and to support each other in laying down this burden.

Within the context of narrative therapy, the process of forming the trauma narrative is used
as a way to reconstruct the story so that subordinate story lines are drawn out. Narrative
therapists seek to draw out alternative stories that will help people to disentangle themselves from the influence of the traumatic event(s) and its effects (Morgan, 2000), including stories that bring to light acts of redress, and which unearth how traumatized individuals and families survived and endured in the face of adversity (White, 2005). Further, through reconstructing the stories, narrative therapists seek to bring into focus what is most
meaningful to family members, including values, aspirations, hopes, and dreams (Morgan,
2000).

Part of the work of interventions with families who have experienced trauma is problem-
solving and implementing new coping strategies (Lantz & Gyamerah, 2002; Salmon &
Bryant, 2002). Narrative components of trauma treatment are particularly helpful here:
“Story alterations offer potential therapeutic changes because shifts in the story alter the
teller’s experience of the world. Changes in the story provide access to new solutions”
(Angell, Dennis, & Dumain, 1998, p. 623). Often, the therapist who is monitoring for
unexplored areas or open spaces in the narrative can offer questions designed to help the
family reflect on the meanings and beliefs inherent in the story (Freedman & Combs, 1996;
Levy, 2006). Dialoguing with the family about their goals and intentions, heroes who have
influenced the family, turning-points, or cherished recollections may, in turn, point toward
unforeseen possibilities (Sween, 1998).

(this research paper was shared from NIH and is for educational purposes only)