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Narrative Practice

What`s Your Story?
by

Nebriah Acton

on 2 November 2014

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Transcript of Narrative Practice

Historical Development
What are Narratives?
Key Concepts
Description of Change
8. The Practitioner Encourages the Client to take a Position on the Problem.
Taking a position on the problem in narrative therapy means asking the client to move from a position of problem saturation, where the problem has dominated many aspects of their lives, to a position where the client reflects on how they have influenced " the life of the problem" (Payne, 2006, p. 74).
Within narrative therapy, change is seen within the clients stories (Davies, Bronwyn, Linnell, & Sheridan, 2010). Initially the client comes into narrative therapy with a problem-saturated story, and through subtle therapist interventions, the client is able to draw positive solutions from their newly written narrative (Davies, Bronwyn, Linnell, & Sheridan, 2010).
The client goes from interpreting the problem as apart of them self, engrossed within their identity, to viewing the problem as a separate entity, not apart of their identity, but effects their lives (Davies, Bronwyn, Linnell, & Sheridan, 2010).
If narrative therapy is successful, the therapist and client will see a change within the clients self-account, becoming one that is "coherent, meaningful and adaptive" (Dwivedi, 1997, p. 26).
In group narrative therapy, the clients will move from a perspective that is saturated within their own narratives, to a position that hears and understands the perspectives and narratives of the other members involved (Dwivedi, 1997).
Change is mainly seen within microsystem level being narrative therapy is done with individuals and small groups. However, change could be seen in macrosystem levels. For example, narrative therapy with a client may influence the social services used by the client, such as having child welfare withdraw their services due to success in therapy.
"Central to the change process in narrative therapy is clients' ability to engage in re-authoring conversations that allow for “rich descriptions” of ways of being and living" (

Consistency with Social Work Ethics and Values
Narrative therapy proves to be consistent with Social Work Values and Ethics, which will be explained using the core social work values and principles.
Role Expectations for Practitioners
The main role of the practitioner is to facilitate the client showing them respect, acceptance and support for their stories (Payne, 2006).
Narrative Practice

What's your Story?
Narrative practice was constructed by
White, M.
and
Epston, D.
in
1989
/
1990
(Payne, 2014). Payne explains that "Narrative Practice permits a fuller exploration of clients experiences and the development of alternative perspectives, identifying the ambiguities in life experiences"; to
encourage clients to share their stories, and rewrite alternative stories that provided a new perspective for future scenarios and situations in their lives
(p. 245). The purpose of constructing narrative practice, Payne explains, was to empower people to
get involved in their own therapy.

Abels and Abels (2001) say narratives are a
"landscape of the person's life"
as they reflect the meaning of people's existence (p. 1).
Narrative reflects
culture, how people think, feel and behave
which continues to develop throughout their lives (Abels & Abels, 2001).
Clients can use narrative therapy as a way to r
evisit existing stories
in their lives, and work with the therapist to
re-write the outcomes
to a more preferred ending (Abels & Abels, 2001).
An important aspect of narrative practice is to encourage the clients to re-examine their stories, and
have a desire to change
the outcomes (Abels & Abels, 2001).

Abels and Abels (2001) say that narrative practice is an approach that
empowers
the client to self-direct change in their lives.
Narrative practice is an approach that seeks to
minimize authority
used by the practitioner (Abels & Abels, 2001).
The practitioner must understand that the stories the client share are true to them, and they must
respect, non-judgementally
, the differing social realities they might have (Abels & Abels, 2001).
The practitioner must understand that this approach is
client-related
; there is little the practitioner can do other than support the efforts of the clients, openness to developing new knowledge and accepting that each clients experiences will be different (Abels & Abels, 2001).
Abels and Abels (2001) also suggest that the practitioner must use
skills that enhance the re-authoring process
and not those skills that develop a power differential.
Externalizing the problem:
Specific Interventions
Deconstruction:
Role Expectations of the Client
Key Concepts Continued
Externalizing the problem "encourages [clients] to objectify, and, at times, to personify the problems that they experience as oppressive", therefore the problem becomes separate from the client thus the client does not view themselves as the problem(White & Epston, 1990/2005, p.88).
An example of externalizing the problem from White and Epston's Work (1990/2005) called: "Sneaky Poo"
"Nick was a six year old with encopresis, where he had an inability to control his bowel movements. This had become a problem for both Nick and his family members, and had directly effected each of their lives. During his therapy, the family was encouraged to call Nick's problem sneaky poo. The therapist suggested that this would help the family to externalize the problem from Nick allowing them talk about it freely without pointing blame or suggesting the Nick himself was the problem. In therapy Nick's parents, Sue and Ron were able to identify alternatives their negative behaviors by reflecting on how Sneaky Poo had the ability to change their lives. Nick was able to control the urge to play with his feces by thinking of sneaky poo as separate from himself. With time, sneaky poo went away and the family had created a new narrative ending for their lives" (White & Epston, 1990/2005).
deconstruction starts by "understanding a situation [then] taking it apart to see its elements more clearly" (Payne, 2014, p. 255).
Deconstruction implies that each communication has a message pertinent to a situation, how and where that message is carried out and why that communication is taking place in that setting (Payne, 2014).
By understanding each message comes with an analysis of the above, one is understanding the different aspects of social relationships and the power differential within them (Payne, 2014).
Even further, Payne (2014) explains this understanding can expose peoples use of language when communicating.
Additional Interventions for Narrative Therapy
Payne explains discourse as "Culturally derived assumptions which encourage persons to attribute their problems to identity, personality, psychological deficits, or inescapable conditioning, which need the interpretation of wise experts" (p. 47).
Payne goes on to say discourses are "the habitual ways of thinking which are common currency within a particular social grouping, expressed in language characteristics which embody these shared beliefs and values" (p. 48).
Discourses can have a negative effect on clients lives; take into consideration the harmful and limiting effects discourses could have on the identity of the client (Payne, 2006).
It is important for the practitioner to help the client be aware of discourses, which can be done by simple questioning such"how did you come to that idea?" (p. 50).
Rather than: providing the client with practitioner's "expert knowledge" that comes from practitioners own biases and perspectives, with an analysis of what the practitioner believes the clients needs are (Payne, 2006).
It's the practitioners role to keep the practitioner-client relationship egalitarian (Payne, 2006).
Narrative therapies "aim [is] to encourage knowledge, skills and capacities for living to become consciously recognized, and
transformative
. [Narrative] therapies aim to create a context of respect and acceptance where these elements, not initially very much part of the person’s self-perception, may be recognized, spoken, reinforced and drawn upon for positive change" (Payne, 2006, p. 5).
Payne (2006) states that in order to keep a power balance within the client-therapist relationship, the therapist should not use terms such as client or patient in therapy but rather use "person" when addressing the client. For the purpose of this assignment, the author will use the word client to not confuse the roles of the client or therapist.
About narrative therapy with counsellor Jill Oliver (WWild Sexual Violence Prevention Association Inc, 2012).
Rather than: holding power over the client and imposing the practitioner's agenda for change on the client.
It's the practitioner's role to be conscious of the language they use in therapy, keeping in mind the language should be evocative; using imagery within the words. The language must also be gender and ethically neutral (Payne, 2006).
"Narrative therapists encourage a focus on the untypical – untypical, that is, as perceived by the person. They encourage the untypical to be considered in great detail because it is through the untypical that people can escape from the dominant stories that influence their perceptions and therefore their lives" (Payne, 2006, p. 7).
Rather than: using language that the client cannot understand, comprehend or relate to; the practitioner must not use language that creates a power difference between the client and practitioner (Payne, 2006).
Role Expectations for the Practitioner Continued
Narrative Session Overview & Interventions
1. Allow client to tell their story, uninterrupted.
2. Once the client is finished, the practitioner should "ask clarifying and extending questions" to receive more detail from the client.
3. The practitioner should encourage the client to name the problem, in a word or phrase; such as "divorce" or "stress within the marriage".
4. The practitioner should use externalizing language so that the client can separate the problem from their identity, but instead see the problem as an external barrier affecting the client.
5. Addressing the societal and political aspects of the problem that affect the client.
6. Next the practitioner will use relative influencing questioning.
7. The practitioner will use deconstruction to address outcomes that are unique to the problem.
8. The practitioner encourages the client to take a position on the problem.
9.Therapist and client create therapeutic documents.
10. Practitioner encourages the client to remember important experiences and people in the clients life.
11. Encourage the client to share their stories with other people or supports other than the therapist.
12. The client is welcome to tell and re-tell their story to the therapist if needed.
13. Closing narrative therapy when the client determines their narrative is finished.
(Payne, 2006)
1. Allow the Client to Tell their Story, Uninterrupted
Payne (2006) states that the therapist is to encourage the client to tell the narrative that has brought them in to see the therapist today. Payne says that often times the client will tell a problem-saturated narrative. The therapist must respect the clients story, allowing them to tell their story uninterrupted and free of practitioner perspective Payne explained.
2. Once the client is finished, the practitioner should "ask clarifying and extending questions" to receive more detail from the client.
Payne (2006) states that after the client appears to be finished telling their account of the problem, it is the therapists job to get the client to go into more detail. Payne says that this is done by asking clarifying and extending questions which demonstrates the therapists interest in the clients story.
3. The practitioner should encourage the client to name the problem, in a word or phrase; such as "divorce" or "stress within the marriage".
Naming the problem can give client back a sense of control in their lives (Payne, 2006). Payne suggests that naming the problem also normalizes the problem for the client, and they can then see themselves as separate the problem.
4. The practitioner should use externalizing language so that the client can separate the problem from their identity
5. Addressing Societal and Political Aspects of the Problem that Affect the Client
Externalizing Internalizing Discourses:
Externalizing Internalizing Discourses Example
A woman grew up with a fascist father who did not believe in independence for his daughters, and exerted extreme dominance over the women in his household. His daughters were not allowed to have any social life, or relationships. They were pressured to finish school as soon as possible and not pursue higher education. Their main roles as daughters to a fascist man was to serve their father. After going on a brief vacation to visit relatives, one of the daughters fell in love with a man and ran away with him. She later married and had children. Now that her daughter is becoming a teenager, she is having a difficult time distinguishing between extreme or reasonable rule- enforcement.
As the therapist in this situation, it is your job to help the client distinguish between their personal beliefs or discourses that have been internalized. In this case, the therapist would ask questions such as "Do you hear your father's voice (metaphorical) when creating guidelines for your daughter?" . By externalizing the problem, the client may be able to reject previous family oriented conceptions. This will help the client to identify their own conceptions and perspectives, and in this case her own parenting expectations (Payne, 2006).
Payne, M. (2006). Narrative Therapy. London, GBR: SAGE Publications Inc. (US). Retrieved from http://www.ebrary.com
6. Next the practitioner will use relative influencing questioning.
Deconstruction Continued:
7. The practitioner will use deconstruction to address outcomes that are unique to the problem.
While the client is telling their stories, the therapist should look for areas in their stories that are contradictory, possibly suggesting that there is an alternative perspective present within the client (Payne, 2006). These areas of contradiction can be clues to unique outcomes, however the therapist must check with the client without assuming that this contradiction will be a unique outcome (Payne, 2006).
If the client believes this contradiction is significant to them, it becomes a unique outcome (Payne, 2006). A unique outcome is defined by Payne as a narrative that runs alongside the main narrative, offering a differing perspective, which in turn can provide further exploration for the client creating deeper meaning for him/her.
Furthering this definition, Payne (2006) explains unique outcomes as " those thoughts and behaviours which are unique to themselves as individuals, as persons with unique histories and unique experience"(p. 66).
By taking a perspective on the problem, this helps the client to look at the problem from a different perspective (Payne, 2006). Now that the client has externalized the problem, the therapist can now help the client decide where they would like to go now in their narratives (Payne, 2006).
9.Therapist and Client Create Therapeutic Documents
Additional Interventions of
Narrative Therapy
Scaffolding:
Using the analogy of scaffolding, Payne (2006) suggests that the stories of a client have many different levels, in order for these stories to become a complete metaphorical building, each level must be built one at a time. Payne suggests that when a building is being built, scaffolding is used to allow the workers to move from level to level. Payne suggests that the client starts from the bottom, which is the main problem that brought them in, to an up and down sequence that allows for further exploration of the clients life or narrative.
Payne (2006) states the up-down sequence (scaffolding) is done through distancing questions which begin with questions of the main problem, and extend to questions of clues and unique outcomes.

In order to prevent the client from forgetting about agreed upon tasks, the therapist may use therapeutic documents created by both the therapist and client (Payne, 2006). Therapeutic documents can be used as summaries, reminders, affirmations and records for the client to remember the new narratives they have created (Payne, 2006).
Therapeutic documents can be both formal and informal, ranging from sources such as letters, statements, certificates, creative writing, emails, video and sound tapes, drawings, and photographs" (Payne, 2006, p. 101)
10. Practitioner Encourages the Client to Remember Important Experiences and People in the Clients Life.
"Narrative therapy embodies an assumption that cultural, social and political factors are enmeshed with the problems people bring to therapy, and in particular that power-based relations in Western society are endemic both interpersonally and more widely" (Payne, 2006, p.13).
Because clients are often put in vulnerable positions that pin-point their powerlessness to their authority, they often attribute societal shortcomings as personal failures (Payne, 2006).
The therapist should help the client address these aspects, and assist the client in freeing themselves from feeling blame due to social power (Payne, 2006).
Relative influencing questioning gets the client to address times in the clients life that they have had control over the problem, and felt they had power over the problem (Payne, 2006).
A relative influencing question looks like this: " Can you remember a time when you had the upper hand over this problem?" (Payne, 2006, p. 13).
Relative influencing questioning often leads to entry points and unique outcomes that the practitioner can use to explore the clients perspectives more deeply (Payne, 2006).
Addressing these important people in narrative practice can help the client to invite people back into his/her life that have had a positive influence, and help the client to disengage from those who have caused negativity(Payne, 2006).
11. Encourage the Client to Share their Stories with other People or Supports other than the Therapist
The therapist will suggest the client invite relatives, friends or peers at a specific stage of the therapy, to create an audience for the client(Payne, 2006). "Members of the outsider witness team may touch on one or more of their own related experiences, not to diminish or take from the person’s account but to reinforce it by resonances from their own lives" (Payne, 2006, p. 16).
12. The Client is Welcome to Tell and Re-Tell their Story to the Therapist if Needed.
If more sessions are need, the therapist will assist client in fulfilling the richness of their stories, until they feel that they have made a significant enough ending to their narrative.
13. Closing Narrative Therapy when the Client Determines their Narrative is Finished.
The end of therapy is marked when the person feels that their story is finished (Payne, 2006). Payne suggests that the final session should be made positive for the client, inviting friends, relatives and peer to make it a celebration. Payne also suggests that client should be given a certificate or a presentation to conclude their therapy.
The therapist should use subtle intervention and questioning methods that come from a place of "curiosity, unknowingness and are subjunctive in mood" (Davies, Bronwyn, Linnell, & Sheridan, 2010).
Rather than: questioning and intervention methods that elicit a power differential (Davies, Bronwyn, Linnell, & Sheridan, 2006).
Strengths of Narrative Practice
Weaknesses of Narrative Practices
1. The success of the narrative therapy can depend on the practitioners worldview (Abels & Abels, 2001). Abels and Abels say that it can be difficult for the therapist to abandon their own worldveiw, as it is the only perspective they know; however this can be detrimental of the success of the therapy.
2. "It calls for the worker to accept that there is new knowledge, often unique to the individual and/or group, that needs to be learned in order for narrative practice to be a helpful process for the client" (Abels & Abels, 2001). Abels and Abels say that it is because of the above reason that therapist may not be able to provide adequate help to the client being that each client needs a different knowledge base from the client.
Weaknesses of Narrative Practice Con't
3. The relationship and rapport building is the most important aspect of narrative therapy, meaning if the therapist isn't able to build rapport with the client the therapy will not be effective (Abels & Abels, 2001). Abels and Abels explain that if the rapport fails, therapist cannot rely on technique to guide the therapy.
1. Narrative therapy is a diverse practice that can be used with many different populations; it is not geographically dependent, gender-based or culturally biased practice (Payne, 2006).

2. Narrative therapy does not rely on intrusive labeling instruments, such as the DSM, which gives the client the opportunity to free themselves of the internalization of these labels that have the ability to effect the clients self-perception (Rodewald, 2012).

3. Narrative therapy is a different approach to therapy that focuses on "activities such as encouraging a full description of the problem and exploring the person’s history" that have different aims and meanings than other therapies, although they are similar elements (Payne, 2006, p. 158).

4. Payne (2006) shares that narrative therapy has changed the ways in which he practices other therapies, as narrative therapy has exposed him to self-reflect on the practices he had taken for granted, re-creating his practice towards a more warm and optimistic approach.
"The unity of a human life is the unity of a narrative quest"
(as cited in Dwivedi, 1997, p. 21).
MacIntyre uses the quote ...
The client must present the therapist with a story, or a problem that they would like to share (Payne, 2006). It does not matter in which context the story be presented, whether it be problem-saturated or optimistic, but the client must be open to sharing with the therapist (Payne, 2006).
Once the client has told their account of the story, they must be willing to change their perspective from being problem-saturated towards viewing themselves as a separate entity to the problem (Payne, 2006).
The client must be open to viewing their stories from an alternate perspective, in which they must reflect on unique outcomes within their narratives (Payne , 2006).
Mainly, the client must be willing to take the reins in their progress towards change; as narrative therapy reflects the 'client as the source of change' perspective (Payne, 2006).
When client is taking part in narrative therapy as part of a group, the clients must respect each others narratives (Freedman, 2014). This is done by taking a witnessing position, where the hear out and understand the other member's story (Freedman, 2014).
Effectiveness as a Practice
Students Evaluation of Narrative Therapy
After thoroughly researching narrative therapy, I have developed a strong understanding of how narrative therapy can be a useful tool in creating change within the clients stories, perspectives and overall well-being. Narrative therapy uses a strength-based model to address problems within the clients life. Firstly, clients are given the opportunity to view their problems as separate entities of themselves, and in my professional opinion I can understand how this can change the clients idea of themselves drastically. By viewing the problem separately from their identity, the client is able reflect on their perceived self-esteem, and how it has been influenced by the discourse presented in their lives. In doing so, clients are able to increase their self-awareness and in turn, possibly increase their self-esteems by not viewing themselves as a problem, but rather that they have a problem. I believe that this is an important aspect of how clients can discover change more effectively, without feeling like they have to change themselves completely. I believe narrative therapy can have long standing effects on the clients ability to resolve problems they are faced with in the future, by providing them with self-taught skills. Because many other approaches being used in social work practice are considered problem-saturated, narrative therapy provides an alternative optimistic approach to finding solutions. It also appears to me that narrative therapy uses a system based on mutual respect and relationship to create change, rather than a more intrusive labeling paradigm that does not allow the client to direct or guide their process of change. The interventions used in narrative therapy, with intensive study and practice, can not only be useful in narrative practice, but also used in how we view and deconstruct problems in other approaches. Overall, I have a positive view of narrative therapy.
In a study viewing six families experiencing parent-child conflict, Besa (1994) reported that five of six families showed improvements using narrative therapy, with a decrease of parent-child conflict by eighty-eight to ninety-eight percent. Etchinson and Kleist (2000) state that there were no improvements observed in parent-child conflict within these families when narrative therapy was not being implemented. Etchinson and Kleist (2000) conclude that it appears narrative therapy is effective in reducing parent-child conflicts.
In a study viewing eight families having issues with children, St. James-O'Connor, Meakes, Pickering and Schuman (1997) concluded that narrative therapy is an empowering modality for families (as cited in Etchison & Kleist, 2000). The authors also concluded that success in therapy (the reduction of problems with children) as reduced more significantly for families that were involved in narrative for longer periods of time as compared to those involved for shorter periods of time (Etchison & Kleist, 2000).
Two more studies, ones conducted by Coulehan, Friedlander and Heatherington (1998) and Weston, Boxer and Heatherington (1993) suggest that narrative therapy appears to be a successful approach to use with families.
Etchinson and Kleist (2000) imply that narrative therapy is a "useful application when working with a variety of family therapy issues" (p. 65).
In a study using adults with major depressive symptoms,Vromansa and Schweitzera (2011) discovered "nearly 75% of clients reported reliable improvement in depressive symptoms, with 61% moving into the functional population and more than 50% achieving clinically significant gains" concluding that narrative therapy appears to be a successful approach to treating major depressive orders.
Example of Externalization
Animated Narrative Therapy
Before wrapping up the interventions of narrative therapy, here is a final video to explain the different narratives that can be presented in narrative therapy.
Value 1: Respect for the inherent dignity and worth of a person (Miller, 2007, p. 200).
Narrative therapy is committed to providing individuals with respect to be just that, individuals (Miller, 2007). Narrative therapy is client-centered and gives the client full reins to their own progress, while the therapist takes the backseat and offers guidance (Payne, 2006).
Value 2: Pursuit of Social Justice (Miller, 2007, p. 201).
Miller (2007) uses the CASW code of ethics, which states that social workers, or in this case Narrative therapists, mus "oppose prejudice and discrimination" (p. 202). As explained earlier in this presentation, Payne (2006) describes narrative therapy as a gender-neutral, culturally diverse and discrimination-free practice that can be used with all different sorts of people.
Value 3: Service to Humanity (Miller, 2007, p. 202).
In regards to 'integrity in professional practice', the CASW states that "social workers strive for an impartiality in their professional practice, and refrain from imposing personal values, views and preferences on the clients " (Miller, 2007, p. 202). Payne (2006) suggested that within narrative therapy, the therapist must let go of their personal world-view or perspective and understand that the clients worldview must be viewed for the betterment of their success.
Value 4: Integrity in Professional Practice (Miller, 2007, p. 202)
Within Miller (2007) book, CASW states that " social workers promote individual development and pursuit of individual goals" and that social workers must use the power vested in them responsibly (p. 202). Payne (2006) explains that power in narrative therapy is to be seen egalitarian to the client, and the client is to see themselves as the expert in their own lives, and thus change. It appears in narrative therapy that the client is invited thouroughly to participate in their own goals, as therapuetic documents call for the client's participation.
Consistency with Social Work Ethics and Values Con't
Value 5: Confidentiality in Professional Practice (Miller, 2007, p. 203)
The CASW explains the importance of confidentiality when working with the sensitive matters of the client (Miller, 2007). Payne (2006) explains that confidentiality is upheld within the practice, and if documents in regards to clients are being shared, the ethics and guidelines are followed.
Value 6: Competence in Professional Practice (Miller, 2007, p.204)
The CASW states that the development of the practice must be on going to increase the knowledge and skills available to the client (Miller, 2007, p. 204). As will be seen in the next slide, extensive research has been done, and is being done to this relatively new practice.
4. Payne (2006), finds that in his own narrative practice, he can find it frustrating that he believes to have a full understanding of narrative therapy, however comes to the realization that he has interpreted these meanings using his own perceptions. Payne says that he knows he is not alone in this frustration and goes onto use another therapist, Daphne Hewson, as an example.
Strengths of Narrative Therapy
5. Lastly, narrative therapy does not come from a place of dominating assumtions, as many psychologically based practices do, but rather is client-centered, focusing on how clients can be the root of their own change (Payne, 2006). Payne says that narrative therapists do not hold power over their clients, but rather work alongside them.
(WWild Sexual Violence Prevention Association Inc, 2012)
(NarrativeTherapySF, 2010)
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