Narrative therapy - Therapy Essay Example

This research paper will criticall examine narrative therapy and in particular the externalization technique - Narrative therapy introduction. I will briefly cover general issues linked to narrative therapy before finally examining  the therapeutic process and the externalisation technique.

Narrative Therapy

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In order to explain the process of Narrative therapy it is helpful to briefly place it in the context of a paradigm shift that began in the 1950s. Several writers have contributed to this “new epistemology”.The movement has progressed through several waves.

The first wave was a move away from pathologising the individual to focusing on relational “patterns that connect” Bateson, 1979 within a system. This was a recursive process where positive and negative feedback loops maintained the stability of the system as it resisted change. Symptoms were perceived as communicating a message Haley, 1963 Minuchin, 1974, 1981;

Watzlawick, Weakland & Fisch, 1963 that a system required a change in structure  or a change in relational dynamics. The therapist intervened in the system in a directive and instrumental way as one proffering expert knowledge and experience. This first order cybernetics (or simple cybernetics / engineering cybernetics) offered much excitement as therapists engaged in a new way of doing therapy that presented striking results with little or no insight necessary on the part of the identified patient.

A recognition that the pathology had been moved from the individual to the family resulted in a second wave where the therapist was perceived as part of the system. Here one cybernetic system was recognised as observing another cybernetic system as well as the fact that the very act of observing changed the observed. This second order cybernetics (or cybernetics of cybernetics / biological cybernetics) was much less directive, to the extent that it was at times criticised as irrelevant. The focus was on how people constructed their realities.

THE THERAPEUTIC PROCESS

A re-authoring therapy

In the re-authoring process a new narrative or self-story emerges: one with a past, present and future that is a complete narrative emerges

Several narrative practices exist which can be used as part of the therapeutic conversation (a term borrowed from Andersen & Goolishian, 1992, however it is not necessary that each of these practices exist in any one session or that they exist in the following prescribed sequence, or that they contribute to each session at all Payne, 2000

Telling the problem-saturated story

The therapeutic process begins with the telling of the (often) problem-saturated story in a safe, uninterrupted space. The therapist listens to the story and accepts it, but recognises that this is a thin narrative and is unlikely to be the complete or only story. This recognises that the initial story usually excludes some forgotten or unnoticed elements of the lived story.

Once the initial story has been told the therapist asks the person to expand on their story by asking expanding questions.

Together they remember an initial version of the story.

Naming the problem

Whilst encouraging the person to expand on their narrative, the therapist will ask them to name the problem that is experienced as oppressive. If the person is not able to come up with names on them own the therapist may suggest options such as depression, stress or “Sneaky-Poo” White & Epston, 1990 until a name is provisionally agreed upon. This may change after further clarification provides a more precise description of the problem. Naming the problem will contribute to the process of externalising the problem.

Externalising discourses

Externalisation is an approach to therapy that objectifies or personifies the named problem. Therapy enables the person to see the problem as something outside of themselves, “as something that can be resisted rather than an essential feature of themselves” Epston & White, 1995, 342

The therapist uses language that the problem is “having an effect on” rather than being intrinsic to or existing within the person.

By externalising the problem and looking at its effects, the focus moves away from blame and accountability of the individual: “the person is not the problem – the problem is the problem” is a well quoted maxim of narrative therapy. “Externalising conversations have the effect of deconstructing some of the “truths” that persons have about their lives and about their relationships – those truths that people feel most captured by” White, 1995, p.42

Externalising language is not used in the context of abuse. Abuse and violence are named as such: “he abused you for a long time” or if the person themselves is an abuser “you abused her over a long period”. Externalising language may be used to describe beliefs and assumptions used to justify the abuse: “You were dominated by a belief that violence is acceptable”

Payne, 2000, p 12.

Deconstructing dominant discourses

These dominant discourses are powerful and tend to be accepted by people and societies as if there are no alternatives.

Dominant discourses in many societies perpetuate patriarchy, marginalise those who are not hetero-sexual, and exclude non-Western religions. Many members of these communities accept these exclusions as part of their personal narratives, without any realisation that these discourses are not helpful. For example women allow themselves to be subjugated without reaching out for alternatives or anorexics buy into the dominant discourses of the post-Twiggy era. These dominant discourses can be explored and deconstructed within the therapeutic process in order to see how they are maintaining the problem-saturated story. Narrative therapists are also asked to remain vigilant against the more subtle manifestations of dominant cultural beliefs.

Constructing Positive Alternatives – Unique Outcomes

In the process of telling a narrative, the therapist might notice aspects or significant memories which contradict the problem-saturated dominant story. White uses the terms ‘unique outcomes’ to describe these aspects of the story that seem to deny, refute or challenge the dominant problem-saturated story. The therapist asks expanding questions to focus on how these unique outcomes do not fit with the initial story. This deconstruction paves the way for a wider outlook of the life experience and a new richer story to be cemented in place.

The problematic story has advantage of having been around for a while and dominating a person. The problem has a plot which “has the audacity to inform a person about himself in a summary way: who he is, who he has been in the past, and who he might be” Freeman, Espston & Lobovits, 1997, p. 95. By thinning this plot and juxtaposing it with the process of thickening the counterplot: a positive alternative to the problem-saturated story emerges. The alternative story’s counterplot is discovered by questions and comments that reveal the relative influence of the problem on the life of the person as well as the influence of the person on the life of the problem. This process highlights special abilities that the person has, unique outcomes, times when the problem did not overwhelm them when it could have, times when they were stronger that the problem.

Taking a position on the problem

Once the person has told their initial problem-saturated story, expanded on it and come to recognise some of the unique outcomes within the process of enriching the narrative, they are in a position to hold on to the problem-saturated story that has dominated their life or they can choose to fully embrace the richer account of their narrative that they have come to tell in the process of therapy or thicker counterplot. There may be many reasons for not challenging the initial problem-saturated story – it may be too strong or it may be too soon and the person may still need to explore the alternatives. Once the person chooses to embrace this new view of themselves and the problem they continue to tell the story.

Re-telling the new story

The continued therapeutic process is all about telling and re-telling the new narrative until it becomes a viable alternative.

Principals of telling and re-telling in order to allow the enriching of the evolving self-story include:

·         Telling them to a variety of people in addition to the therapist

·         Hearing their stories reflected back to them in ways which demonstrate others’ interest, respect and wish to understand

·         Telling them again to other audiences

·         Hearing the stories as perceived by this audience

·         Continuing to re-tell and re-hear, re-tell and re-hear.

(Payne, 2000, p 163)

Audiences

According to the narrative metaphor, normal people achieve a sense of legitimacy when they make claims about their lives relating to their self-narrative and more importantly, when these claims are witnessed by themselves or others White 1993.

Thus, when persons hear themselves tell their story they are able to consolidate their narrative identity.

Part of the therapeutic process might include the identifications of others who may be able to “participate in the acknowledgement of the authentication of this (new) version” White, 1993, p25. When this might be particularly difficult the person might recruit those who are least inaccessible to this new view, as in my case with a long illness resulting in social withdrawal it was easier to recruit new friends to authenticate my new life story. Alternatively, White and Espton 1990 give the example of Freddie, the mischief-maker who has decided to abandon his mischief lifestyle; they wrote a letter on his behalf to members of the community to vouch for his integrity as a non-mischief-maker.

Outsider witnesses Payne p 161

Therapeutic documents

This writer is particularly enamoured with the idea of therapeutic documents. Various documents can be used in the therapeutic process to represent, even celebrate, the new story.

As mentioned above, therapists wrote to the community as an audience to vouch for Freddie’s integrity as a do-gooder.

Various formats can be used: letters, certificates, contracts, lists, essays or statements. The therapist may write the document alone or may write it in collaboration with the person in therapy.

“Their use as a device for consolidation is based on recognition that the written word is more permanent than the spoken word and, in Western society, carries more ‘authority’ – here, the authority of the person” Payne, 2000, p 15

Ending therapy

The therapeutic process ends when the person decides that their self-story is rich enough to sustain their future. Epston and

White (1995) consider this to be a rite of passage and not a loss as the dominant psychotherapy model does, but is rather the final session is a happy occasion which may include a ceremony or the presentation of a therapeutic document. It will include the final re-telling of the new viable self-story.

THERAPEUTIC GOALS

Narrative therapy is not directive in its attempts to achieve resolve and it is not instrumental in that there is a unique outcome for each individual and each person achieves their own unique life story.

Privileging family members

The narrative metaphor maintains “an awareness of choosing one’s ways of knowing” Griffith& Griffith, 1992, p. 11. “There is concerted effort on the part of the therapist to privilege family members as the primary authors of these alternative stories”

White, 1995, p. 66.

Creating a safe space

Here the focus is not on specific techniques, but rather the goal is to create “a context for change” rather than the first-order approach of “specifying the change” Hoffman, 1985, p. 393.

THERAPIST’S FUNCTION AND ROLE

The therapist’s function is to create a collaborative space where the therapeutic conversation can take place. Here the focus is not on specific techniques, but rather the goal is to create “a context for change” rather than the first-order approach of

“specifying the change” Hoffman, 1985, p. 393.

A Narrative Therapist maintains “an awareness of choosing one’s ways of knowing” Griffith& Griffith, 1992, p.11 The therapist is responsible for creating an atmosphere of curiosity, openness and respect. Griffith & Griffith 1992 talk about the difficulties trainees feel when trying to practice narrative therapy in that it is not a technique that needs to be applied, but an attitude that recognises that “a therapist must choose wisely those ideas supporting the emotional posture that will organise his/her ways of knowing in therapy” (ibid, p 8)

The Externalization Technique

“The problem is the problem, the person is not the problem” .White & Epston, 1990. The externalization element of narrative therapy diffrentiates people from problems, in a seemingly playful method in trying to heighten the spirits of children in an attempt to make them face and get rid of difficulties. This method allows the therapist to participate.

In certains famillies shame and blame in regards to problems are susceptable to having a silencing and paralysing effect. When people think of a problem as a pivotol part of their character it become harder for them to convert as the perception “close to home.” homes in on the person.s mind. Creating a division between problem and the person in an externalizing conversation results in relief of pressure of blame. Since it would be no longer regarded as being the problem, a young person divulge in a relationship with the externalized problem.

This method allows a person or group of people to enter into a more pivotol and immense position vis-à-vis the problem. With some clear daylight being found between self and problem, members of the family can consider the effects of the problem on their own lives use their own methods in revising their relationship. Once this has occured the elements of responsibility and choice are likely to expand.

The method of externalization also create a better atmosphere when considering children as they are persuaded to be inventive in dealing with their issues, instead of being paralysed by blame and shame  their parents step in and take full responsibility of problem-solving.

The main element in an externalizing conversation is on creating more choice and possibility in the relationship between persons and problems.

When a person has a problem, family members may think that the therapist will find further concealed issues in their minds or relationships. Therapists take a very active stance in shaping the attributions that are employed to describe youngsters and families and to evaluate their problems and when a therapist pays attention to, accepts, and then engages in deeper investigation of a pathological description of a child, the child’s identity as a result may suffer.

Whenever a problem is externalized, the attitude of youngsters in therapy normally moves. When realization sets in that the problem is going to be put on the spot rather than themselves they readily participate in the conversation. Signs of relief show on their faces.

Externalization seems a good match for many children perfectly. Great compatability is demonstrated with the way they approach difficulties in a learning environment. Since the environment is rather dynamic this allows the child to explore different types of attitudes and identities.

For any child it seems, externalization is similar to playing a game of pretence.

Practicing externalizing conversations is not in actual fact to do with learning a technique but rather is more linked to developing a particular mthod of seeing the world

We don’t define externalization as a technical method. Rather it’s a language practice that results in imaginative ways of thinking about and being with people who tend to struggle in developing the kinds of relationships they would much rather prefer to have with the problems that cause tension.

The approach of externalization is different from unstructured narrative therapy, in that we work together with children in play that is predominantly focused on facing to a problem. Externalizing conversation is very enhancing with other wats of expression favored by children.

REFERENCE LIST:

Epston, D., White, M & Murray, K. (1992). A Proposal to a re-authoring therapy: Roses Revisioning of her life and a commentary. In McNamee, S. & Gergen, K. (Eds.) Therapy as social construction, pp 96-105. London: Sage

Epston, D & White, M. (1995). Termination as a Rite of Passage: Questioning Strategies for a Therapy of Inclusion. In Neimeyer, R. A., & Mahaney, M. J. (Eds.) Constructivism in Psychotherapy. pp 339-354. Washington: ASA

Freeman,J., Epston, D. & Lobovits, D. (1997) Playful Approaches to Serious Problems. New York: WW Norton

Griffith, J.L., Griffith, M.E. & Slovik, I.S. (1992). Owning one’s epistemological stance in therapy. Dulwich Centre Newsletter, 1, 5-11

Hare-Mustin, R. & Maracek, J. (1997). Abnormal and Clinical Psychology: The Politics of Madness. In Fox, D. & Prilleltensky, I. (Eds.) Critical Psychology: an Introduction. pp 104-120. London: Sage

Payne, M. (2000). Narrative Therapy. An Introduction for Counsellors. Sage Publications: London.

White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. USA: Norton

White, M. (2004). Folk Psychology and Narrative Practices. In Angus, L. E. & McLeod, J. (Eds.) The Handbook of Narrative and Psychotherapy. Practice, Theory and Research. p. 15-51. Sage: Thousand Oaks

Roth, S. & Epston, D. (1996). Developing externalizing conversations: An exercise. Journal of Systemic Therapies, 15(1), 5-12.

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