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Narrative Therapy

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Savannah Hodge

on 14 July 2014

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Transcript of Narrative Therapy

Questions for Meeting the Person
-What do you do for fun?
-Do you have hobbies?
-What do you like about living here?
-What don’t you like?
-Can you tell me about your fiends and family.
-What is important to you in life?
-What is a typical weekday like? Weekend?
Therapeutic Relationship
Process of narrative therapy:
Techniques:
Case Conceptualization & Assessment
Problem-Saturated Stories – In these stories, the problem is the focus of the story, while the client plays a secondary role.
The therapist intervenes by addressing how the problem affects the client at:

1.
An individual level

Health
Emotions
Thoughts
Beliefs
Identity
Spirituality
Relative Influence Questioning
The first detailed method used for externalizing. It is both an assessment and intervention.

It includes two sections:
a. Mapping the influence of the problem
b. Mapping the influence of the persons
a. Mapping influence of problem
inquiry as to how the problem has/is affecting the lives of the client and others. This often broadens the scope of the problem and if done alone, can be defeating as one begins to see the extent to which the problem has had affect. Thus, it is encouraged to use this with the influence of persons section. Questions to help Map the Influence of the Problem are as follows:
Narrative Therapy Interventions
1.) Externalizing the Problem
This is the defining technique of narrative therapy.
- It is a conceptual and linguistic separation of the person from the problem.

The therapist must believe problems and people are separate.
- This process of separating people from their problems is an organic, ever evolving process throughout therapy.

Therapist’s goal is to shift the view from the client feeling as if they have a problem, to viewing the problem as separate from one’s self.
- Therapists externalize problems by changing adjectives to nouns
* (I.E. I am depressed changed to I have a relationship with depression).
- Another way of externalizing would be to talk about a problem as a side of themselves
*(I.E. The angry side of our relationship).

Externalization cannot be pushed. Rather, it needs to build up from the process of therapy and dialogue as a possibility for the client as to how to think about the problem.
Narrative Therapy
Draw your problem
Unique Outcomes and Sparkling Events
These are stories or aspects of a story in which the problem-saturated story ends in a way that differs from typical outcomes.
Because these particular stories do not end in a dramatic way, they tend to go unnoticed by the client.

Unique outcomes are used to help clients create lives they prefer and develop a more full and accurate perspective of their own identity.
Overview:
We story and create the meaning of life events using available dominant discourses (broad societal stories, sociocultural practices, assumptions, and expectations as to how one should live).









Narrative therapy exists to help in separating the person, from the problem and deeply engaging examining assumptions that inform the client. People don’t have problems is the narrative assumption, rather problems are imposed on people by unhelpful, or harmful societal norms.
...Discourses continued
Local Discourses – Foucault differentiated these discourses from dominant. These local discourses occur in our heads, our close relationships, and marginalized communities, not mainstream.
Treatment Phases
1. Meeting the Person – Getting to know the client as separate from their problems
...Contributors Continued
Dominant Cultural and Gender Discourses
Dominant discourses are a set of social rules and values that make it possible for a group of people to meaningfully interact.

Therapists listen for dominant cultural and gender discourses that have influenced the way clients perceive the presenting problem.

These are essentially messages of how life “should” be that may affect the client’s perception of a problem.

Local or alternative discourses may be counter to dominant discourses.
Goal Setting
- The overall goal of narrative therapy is to help clients enact their preferred realities and identities.
increasing clients sense of agency..aka the sense that they influence the direction of their lives

- Therapists work with clients to develop thoughtfully reflected goals that consider local knowledge


Notice the Language
-Language is not used to connect you to the problem by using language like “What’s your problem?” or “What is wrong with you?"
-Rather, "How long has the problem been in your life?"

-Rather, the focus is on “the problem” and externalizing it from the beginning.
*This is critical not only for the client, but for the therapist. *Therapists need to meet the client apart from the problem, and then meet the problem separately. These two identities must remain separate so the problem is never inherently the problem.

-Narrative therapists view problems from two major perspectives:
1.Adversarial – outwit, outsmart, or evict it 2.Compassionate – understand it, the message it brings, and concerns
Middle-Phase
-target immediate symptoms and the presenting problem
The motto of narrative therapy. Reminds us that the person is not the problem…the problem is. Once the therapist has come to know the client (apart from the problem), they begin to “meet” the problem in the same way, keeping their identities separate.
Thickening Descriptions:
Narrative Therapy
(Umbrella under Postmodern)
Contributors:

Michael White -pioneered narrative therapy and the first to write about externalizing problems. He provided training, writes books and newsletters on narrative therapy. He, along with David Epston wrote the first book ever on narrative therapy entitled Narrative Means to Therapeutic Ends in 1990.
Questions for Meeting the Problem
-When did the problem first enter your life?
-What was going on with you then?
-What were your first impressions of the problem?
-How have they changed?
-How was your relationship with the problem evolved over time?
-Who else has been affect by the problem?
Local and Alternative Discourses
Some values are contrary and non-conforming to dominant cultural discourses.
These are held by individuals with a different idea of what is “good” or how life “should” go.

Local and alternative discourses do not have to be in conflict with dominant discourses.
Instead, local discourses may be a resource for creating new ways of viewing the self and for talking and interacting with others away from the problem.
Late-Phase Goals
- target personal identity, relational identity, and the expanded community:
By: Dave Jaeger, Ellen Singleton,
Christine Gilbert, & Savannah Hodge

“… I think that whatever ‘good’ therapy is, it will concern itself with establishing structures that will expose the real and potential abuses of power in the practices of the good therapy itself. (White, 1995d, p.49)” – Michael White

David Epston – worked closely with Michael White in creating the foundations for narrative therapy. His work was centered around creating unique sources of support for clients such as writing letters to clients to solidify emerging narratives – He lived in New Zealand, and Michael White in Australia.
Jill Freedman and Gene Combs – Wife and husband began work in the mid-nineties, about 5 years after David and Michael’s first book on narrative therapy. They were responsible for developing the narrative approach and the emphasis of social construction of realities. They also further developed the narrative metaphor for conceptualizing therapeutic intervention. They work out of IL.
We experience “problems” when our personal life does not fit with the dominant society discourses and expectations.
Therapists in the narrative world use some of these techniques and have some of these beliefs…


-Listening posture is maintained
-What a client has to say, is worth hearing
-Active listening, interacting, and responding
-Asking questions, making comments, extending ideas, wondering, and sharing private thoughts aloud.
-Optimistically focus on client strengths and ability
-Well defined sets of questions, and strategies to help clients enact narratives
-Social Justice issues and politics regularly involved in conversation
Involves separating the person from the problem. Through this process the clients identify alternative ways to view, act, and interact in daily life.

Dominant Discourses – Philosopher Michael Foucault was a philosopher who coined the term. He believed that problems do not exist separate from their sociocultural context.
- Dominant discourses are culturally generated stories about how life should go, and they are used to coordinate social behavior.
-Examples of dominant discourses might be ideas of success, gender roles, relationship expectations, clothing expectations…

The theory that narrative therapists have is that these discourses are so deep within each of us, often we are unconscious as to where they originated, not the impact on our lives.
Narrative therapists need to pay attention to the fluid interaction of local and dominant discourses and how the discourses of what is good or valued, collide in our local and dominant worlds.
The collision is where problems are created, and the therapists' work is to help clients gain awareness about how these discourses are impacting their lives.
-Assume that all people are resourceful and have strengths
-Do not see people as having problems
-See problems as being imposed upon people by unhelpful or harmful cultural practices
-Deep abiding optimism and hope for their clients
-Quickly connect with what is best with the client
-Role of therapist = co-author and co-editor
*the therapist is not there to offer a “better” story. Rather, they are there to come alongside the client as they attempt to generate a more useful narrative, construct meaning, and assign value.
-Joint process of constructing meaning, a more useful narrative
-Therapist relationship to the problem can be seen as a investigative reporter.
* Inquisitive stance to explore the origins of problems.
2. Listening – listening for the effects of dominant discourses
3. Separating persons from the problems – externalizing the problems and creating space for new stories.
4. Enacting preferred narratives – Identifying new ways to relate to the problem
5. Solidifying – strengthening preferred stories by having them witnessed by significant others in the client’s life.
The process of narrative therapy is one that is thickening and enriching of a person’s identity. Instead of replacing a problem story with a problem-free one, narrative therapist adds new strands of identity to the problem story.
Creating Balance:
Narrative therapy believes that often when a person begins to experience problems, there is a tendency to only notice when those problems exist or are confirmed.

Often other events that do not fit the problem are easily overlooked or go un-noticed. A narrative therapist would seek to create more balance, appreciating a holistic view of our lives rather than a hyper vigilance to our problems.

-Problems and people are separate.

-Narrative therapists believe they have a deep understanding on the origination and formation of problems and deep confidence that through their approach can make a positive impact.

-They also know the client separately from the problem, and are able to instil a sense of optimism and hope by seeing the client in a positive light apart from the problem.
Optimism and Hope
Investigating Reporting
-White said in 2007 “The primary goal of investigative reporting is to develop an expose on the corruption associated with the abuse of power and privilege.

-Although investigative reporters are not politically neutral, the activities of their inquiry do not take them into the domains of problem solving, of enacting reform, or of engaging indirect power struggles…
their actions usually reflect a relatively “cool” engagement.”

-Therapist thus take a calm and inquisitive stance, helping clients gain a healthier understanding of their problems.
2.
A relational level

Significant other
Parents
Friends
Coworkers
Teachers
http://www.ted.com/talks/andrew_solomon_how_the_worst_moments_in_our_lives_make_us_who_we_are#t-333730


-Clients at a physical, emotional, and psychological level
-Clients’ identity stories and what they tell themselves about their worth and who they are?
-Clients’ closest relationships: partner, children, parents?

-Other relationships in the clients’ lives: friendships, social groups, work or school colleagues…
-The health, identity, emotions, and other relationships of significant people in the clients’ lives?
How has the problem affected:
More defined beginning of the externalizing process. This set of questions is specifically designed to follow the questions that map the problem. They are designed to identify how the person has affected the life of the problem. It uses a reverse logic from the initial set of questions. Here are some of the questions used to Map the influence of persons
b. Mapping the Influence of People


-Kept the problem from affecting their mood of how they value themselves as people?

-Kept the problem from allowing themselves to enjoy special and/or casual relationships in their lives?

-Kept the problem from interrupting their work or school lives?

-Been able to keep the problem from taking over when it was starting?
When have the persons involved:
-Decreases unproductive conflict and blame between family members

-Undermines sense of failure in relation to problem by highlighting times the client has had influence over it

-Invites people into a united front against problem and reduces influence

-Identifies new opportunities for reducing the influence of the problem

-Encourages a lighter, less stressful approach to the problem

-Increases interactive dialogue, rather than a repetitive monologue about the problem
White and Epston reported these benefits associated with externalizing:
2. Statement of Positions Map
Four categories of questions developed by White in 2007 that are often used many times in a session. They are designed to create a shift in the clients’ relationship with the problem and open up new possibilities.
1. Negotiating an Experience – Near Definition: Use the clients language to define the problem (i.e. feeling yucky is preferred over depression, and clients language is preferred over the clinical terminology)
2. Mapping the Effects: Involves identifying the effects of the problem on the many areas of the clients’ life like home, work, school, relationships, self-worth, etc.
3. Evaluating the Effects: Asking questions like: Are the above answers/effects okay with you? How do you feel about these developments? Where do you stand on these outcomes?
4. Justifying the Evaluation: This section seeks to understand how and why clients have evaluated things the way they have. Examples might be:
-Why is this okay for you?
-Why do you feel this way?
-Why are you taking this stand on this development?
White would often use metaphors to externalize the problem such as:

Lets walk on the problem
Educate the problem
Reclaiming territory from the problem
Undermining the problem
Resigning from the problems service
Refusing invitations from the problem


White also avoided using any form of totalizing or dualistic thinking. No problem is all bad, nothing happens every time, these thoughts and beliefs may promote dualistic either/or thinking.
3. Problem Deconstruction
This intervention is designed to help clients’ trace dominant discourses and their effects. Here, the therapist listens trying to identify “gaps” in the clients understanding and they ask the client to fill in the details. This helps clients do more unpacking of their stories and begins to tug at the foundations of their dominant and local discourses. They target problematic beliefs, practices, feelings and attitudes by exploring:
History – When the client first encounter the problem and its history?

Context – When is the problem most likely to present?

Effects – What effects has the problem had on you and your relationships/life?

Interrelationships – Are there other problems that feed this problem?

Strategies – How does the problem go about influencing you?
4. Mapping Landscapes of Action and Identity or Consciousness
This is a specific technique for push towards desired outcomes and promote change and typically has four steps:
1. Identify a Unique Outcome – Therapist is charged with listening to and identifying times when the problem could have presented, but did not. Those moments are unique outcomes.
2. Ensure that the Unique Outcome is Preferred – Ask client if the outcomes addressed are preferred: Is this something you want to do, or have happen more often?
3. Map in Landscape of Action – Therapists gathers a map if interactions and events and what happened in what order. Therapist asks critical questions about events, circumstances, sequence, timing, and overall plotting of events.
4. Map in the Landscape of Identity/Consciousness – Once a clear picture of how the unique outcome unfolded, that therapist maps in the landscape of identity. This is designed to thicken the connection between the preferred outcome, and the client’s identity. Questions used for this part might include:
What do you believe this says about you as a person?
What were your intentions behind those actions? What do you value most about the actions you displayed?
What did you learn from this?
Did this change your view of God, yourself, your purpose, goals?
5. Scaffolding Conversations
This is a process of taking clients on a journey from that which is normal and familiar to that which is new and novel. This journey to what is new and novel is something to be done in a relational way in collaboration with others. White developed five increments of movement:
1. Low-level Distancing Tasks – very close to what is familiar to the client. Clients are encouraged in this stage to ascribe meanings to events that previously have gone un-noticed.

2. Medium-level Distancing Tasks – Introduce higher level of newness and encouraging comparison and contrasts to other unique outcomes. How was last night’s effective problem solving conversation different or similar from last weeks? This might be an example question for this level.

3.Medium-High-level Distancing Tasks – Reflection on a chain of associations. Reflection, learning and evaluation from prior tasks and experiences. An example question here might be: Looking back over our problem solving experiences and conversations what stands out as useful in preventing things in the future?
4. High-level Distancing Tasks – abstract learning and realizations. These create a high level of distance between self and experience. They begin to connect the dots of what these prior experiences and conversations say about themselves and their relationships

5. Very-High-level Distancing Questions – Essentially, action plans. How will clients translate their experience and learning into action for the future?
These are used in narrative therapy to break the stereotype that any question is fair game for a therapist in session. These permission questions change the power dynamic in session and allow clients the opportunity to express if they are comfortable with the topics being discussed. These questions are also useful to help guide the therapist as to what the client sees as valuable and worthwhile areas to proceed with. Examples of these questions might be:
Permission Questions
- Would it be alright if I ask some questions about your trauma experience?
- I have been thinking it would be important to talk through some of your abandonment issues today, is that something you feel comfortable addressing?
These are used by therapists to avoid trumping the clients’ thoughts, or not conveying superiority in comments, or taking a position of power. A narrative therapist will avoid phrases like:
Situating Comments
I suggest you…

My studies lead me to think…
Rather, narrative therapists may opt for comments like:
I once read a therapist said…is that something that resonates with you?

Since I have also experienced growing up on a farm, my attention is drawn to…
Other Interventions
Leagues – Narrative therapists have created leagues or memberships that signify and accomplishment or progress towards a new identity (i.e. The Anxiety Whisperers Club).


Definition Ceremonies – Used towards the completion of therapy. A tool to again help solidify new narratives and emerging identity with significant others in the client’s life taking part in a telling of their life story, retelling, and retellings of the retelling.


Letters and Certificates – Therapists write client a letter encouraging the solidification of new preferred narratives and their emerging story, sometimes in lieu of case notes. They tackle four functions: emphasis on clients’ agency, taking observer position, highlight temporality, and encourage polysemy (multiple meanings).
This is a tool that White often used to help clients’ make more sense of their lives. Clients are lead through a process of making associations from their lives. Each association of life includes a “membership” of people and identities. These associations include the past, present, and go as far as the expected future. Then, memberships are upgraded, downgraded, or canceled due to their influence on the client. The process has four components:
Remembering Conversations
1. Identifying others contributions to the client’s life

2. Articulation of how the other person may have
viewed the client’s identity

3. Considering how the client may have affected the other person’s life

4. Specifying the implications for the client’s identity
People are the experts in their own lives



People have the abilities to change their relationships with the problems in their lives





Forge meaning....
Build identity
examples:
"Increase sense of agency in problem-resolution conversations with spouse"

"Increase opportunities to interact with friends using confident, social, self"

"Reduce number of times mother and father allow Anger to take over in response to child's defense"

"Increase instances of defiance in response to anorexia's directions to not eat"
Personal Identity:
"Solidify a sense of personal identity that derives self-worth from meaningful activities, relationship, and values rather than body size"

Relational Identity:
"Develop a family identity narrative that allows for greater expression of differences while maintaining family's sense of closeness and loyalty"

Expanded Community
: "Expand preferred 'outgoing' identity to social relationships and contexts"
- Move from "make this problem go away" to "I want to create something beautiful/meaningful with my life"
Role Play
When have you:
How has the problem affected:
-Your physical, emotional, and psychological level

-Your identity stories and what they tell themselves about their worth and who they are?

-Your closest relationships: partner, children, parents?

- Your friendships, social groups, work or school colleagues (other secondary relationships)
- Kept the problem from affecting your mood of how you value yourself as a person?

-Kept the problem from allowing yourself to enjoy special and/or casual relationships in your life?

-Kept the problem from interrupting your work or school life?

-Been able to keep the problem from taking over when it was starting?
References
Gehart, D. R. (2010). Mastering competencies in family therapy: A practical approach to theories and clinical case documentation. Belmont, CA: Brooks/Cole.
Extra Resources
http://www.poppitscupboard.com/2011/07/story-stones-bag.html?m=1
http://www.pinterest.com/sarahzcase/narrative-therapy/
Full transcript