Are narrative story-stem methods valid in the ‘non-Western’ context? A systematic review.

Narrative story stem techniques (NSSTs) offer insight into attachment and other representational aspects of preschool to young school aged children’s inner lives. While the method moved into the academic and clinical mainstream some 35 years ago, their applicability to “non-Western” contexts remains little understood. This synthesis comprises 31 NSST studies of samples from parts of Africa, East Asia, Latin America, and the Middle East, and from US and UK ethnocultural minoritized backgrounds. In the reviewed studies, three specific NSSTs dominated, story stems were used most to evaluate attachment, and some were clinically focused. However, there was also a strong cultural focus and over half of samples were socioeconomically disadvantaged. Studies revealed both universal and culturally specific features of NSSTs. Attachment distributions were as expected, given the high clinical risk in pooled samples (49% secure, 19% avoidant, 12% ambivalent, 20% disorganized), including by clinical and socioeconomic risk status. Gender differences were similar to “Western” findings. However, the growing evidence for convergent validity across cultural groups is tempered by low reporting of psychometrics. Narratives may sometimes reflect children’s unintended interpretations of the task and therefore not activate internal representations, or may reflect reality but lack equivalent meaning in coding schemes. We discuss how researchers and clinicians can enhance the validity of NSSTs by considering the role of culture in the sense-making process. Pending further validation work, NSSTs have the added potential to give a voice to young children from underrepresented backgrounds.