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Psychological research has emphasized the importance of narrative for a person's sense of self. Building a coherent narrative of past events is one objective of psychotherapy. However, in guided self-help therapy the patient has to develop this narrative autonomously. Identifying patients' narrative skills in relation to psychological distress could provide useful information about their suitability for self-help. The aim of this study was to explore whether the syntactic integration of clauses into narrative in texts written by prospective psychotherapy patients was related to mild to moderate psychological distress. Cross-clausal syntax of texts by 97 people who had contacted a primary care mental health service was analyzed. Severity of symptoms associated with mental health difficulties was assessed by a standardized scale (Clinical Outcomes in Routine Evaluation outcome measure). Cross-clausal syntactic integration was negatively correlated with the severity of symptoms. A multiple regression analysis confirmed that the use of "simple sentences", "finite complement clauses", and "coordinated clauses" was associated with symptoms (R[superscript 2] = 0.26). The results suggest that the analysis of cross-clausal syntax can provide information on patients' narrative skills in relation to distressing events and can therefore provide additional information to support treatment decisions.