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Narrative Therapy 2012

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Robin Dickey

on 26 March 2013

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Transcript of Narrative Therapy 2012

Narrative Therapy Robin Dickey, MA, LPC-Intern MA, LPC-intern; TW graduate Fort Worth Brief Therapy Center
Arlington Counseling Group
Supervisor: Mat Trammell, MS, LPC-S Narrative
Therapy Client Problem Therapist Unique
Outcomes Theraputic Documentation Be Curious! Problem-Saturated Stories Take a Position Preferred Story Name Externalize Started in '80s
Australia, New Zealand, Canada, USA Michael White David Epston The Dulwich Centre:
“The approach to counselling focuses on the stories of people’s lives and involves finding ways in which people can change their relationships to whatever problem or difficulty they are facing.” http://www.dulwichcentre.com.au/ "The Client is not the problem, the Problem is the problem"
Micheal White Constructivistic
We come to see ourselves by looking in the mirrors that other people hold up for us. In this way, a person’s identity is said to be socially constructed. Client Narrative therapy involves exploring the shaping moments of a person’s life, the turning-points, the key relationships, and those particular memories not dimmed by time. Focus is drawn to the intentions, dreams, and values that have guided a person’s life, despite the set-backs. Oftentimes, the process brings back stories that have been overlooked-surprising stories that speak of forgotten competence and heroism. Narrative therapy focuses on how these important stories can get written and rewritten.
- –Erik Sween, Gecko (1998: 2) Narrative therapy proposes that people use certain stories about themselves like the lens on a camera. These stories have the effect of filtering a person’s experience and thereby selecting what information gets focused in or focused out. Narrative therapy provides a means to refocus the lens on this camera and help reshape a person’s stories and life.
Erik Sween, Gecko (1998: 2)
Problem–saturated stories can become identities.

Ex. “I am depressed.”
"She is schizophrenic" The therapist listens, clarifies the role that the problem plays in the client’s life, and asks questions.
Investigative Reporter
Neither direct nor passive “Active”
Focus on the client’s language and words
Be creative!
Think outside the therapy box What is Narrative Therapy?
How Narrative Therapy works
Examples Life so far Stuck-Seek therapy New story The person can choose to remain dominated by the problem saturated story or decide to take fully into account the richer story. Learn about wants, current strengths, forgotten strengths, interests, things of value

Visualize alternate/preferred stories and possibilities

Provides the opportunity for the client to take control of the problem, understand the role it plays, and change the role it plays in order to obtain a more preferred life. Techniques-ish

Name the problem
-Thing, description, a phrase

Externalize the problem

Find exceptions /unique outcomes

Use outsider witness technique
Saying "hullo again" for grief
Using the Tree of Life with children
Narragrams and white boards

Therapeutic Documentation Robin's Favorite Part! Once the problem has a name, it can become a separate entity from the client; no longer a characteristic of the client.
Enables the person to feel more in control of the problem
If you could give a name or a phrase to what you have just described, what would you call it?
Tell me what depression means to you, what does it look like?
Counselor continues to use the client’s term (and new terms as/if it changes) throughout therapy
*NOTE: Abuse and violence are bluntly named
-Ex. "April" Slimer Externalizing language suggests that the problem is ‘having an effect’ on the person rather than existing within or being intrinsic to them.

Used throughout therapy, there could be many problems that are externalized.

Aim is to help separate the client from the problem (s) How has the shield been helpful for you?
How have you used it positively?
How is it not helping you at this point, with your
current situations?

What is different when you don't use the shield?
When is it safe to put it down?
What about when you have the shield,
but you don't need the spear?
At what point is the spear necessary?

Do you think other people notice? Do you make it obvious? Unique Outcomes-The times when the problem is not such a problem. The times when the client has control. The part of the story that doesn't fit with their problem-saturated story.
The Therapist points out the contradiction between the problem-saturated story and the unique outcomes.
"It sounds like when you are hanging out with your friends, you can leave the shield and spear at home, or at least in the car."
"What would you be doing differently if you didn't have to worry about carrying around that heavy shield?"
"Do you bring it to therapy with you?"
"I did at first, not anymore."
"What makes it safe for us to talk and not have the shield and spear?"
Ask questions to cover thoughts, feelings, and actions.
People gain a wider perspective on their experiences. Relative Influence Questions
Elicits 2 descriptions:
Influence the problem has had and is having on the person/family
Influence the person/family members/family as a unit has had and is having on the problem The therapist asks questions to focus on current and past feelings, thoughts, and actions perceived by them and others. This helps determine what the future might look like without the influence of the problem. Example of Relative Influence Questioning:
Black Out Mode (BOM)
-She feels rejected, disrespected
-He sees her feeling hurt, needing space, nothing he can do or say
-When she is in BOM he needs a safe place
-She allows BOM to happen when she keeps her feelings hidden from him
-He keeps BOM around by not offering affirmation

Look for Unique Outcomes These documents summarize the person’s discoveries and describe the person’s own perceived progress (not a pat on the back).
Physical documentation has more of a permanent impact and sense of control of a situation.
These documents also aid in the client remembering and summarizing what has happened in the course of therapy.
Can be at multiple times throughout therapy Letters, Certificates, Lists,
Etc. Bera, W. (2010) Narragrams: Visualizing narrative therapy. Kenwood Centre Publications, LLC, Minneapolis: MN.
A template of how to conduct and implement Narrative ideas in an organized visual fashion that is beneficial for both client and counselor Narragrams Negativity Negativity Uses language found on the Narragram
Specific goals and limitations
Specifies the amount of time the family has to begin working on the removal of Negativity and what happens if they run into problems (it gets discussed at the next session) Accomplishment Presented in front of Family
Acknowledge her accomplishment
Summarize the progress thus far
Encourage continued progress outside of therapy
Express my understanding of their progress Happy Pills Rx Family Story Drawing Genogram
See the relationship and hear stories about each of them
Great excuse to ask questions
Miracle Question
Sounds SolutionFocusy, doesn’t it?
It’s not the technique, it’s how you apply it in your sessions
Narrative focuses on the influence the problem has on preventing the miracle from happening so that once the problem’s role has changed, the client can see their abilities towards the miracle.
Scaling Questions
Again, SolutionFocusy. The purpose is not to find out what it will take to reach a new level on the scale, but to find out what each level looks like without the problem.
Strategic techniques Other Tools BOOKS
Freeman, J., Epston, D., & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton.
Morgan, A. (2000). What is Narrative Therapy? An easy-to-read introduction. Adelaide, SouthAustralia: Dulwich Centre Publications.
Payne, M. (2003). Narrative therapy: An introduction for counsellors. London: SAGE Publications, Inc.
White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W.W. Norton & Company, Inc.
White, M. (2011). Narrative practice: Continuing the conversations. New York: W.W. Norton & Company, Inc.
Zimmerman, J. L. & Dickerson, V. C. (1996). If problems talked: Narrative therapy in action. New York: The Guilford Press.

The International Journal of Narrative Therapy and Community Work
Morgan, A. (2002). Beginning to use a narrative approach in therapy. The International Journal of Narrative Therapy and Community Work (2), 85-90.

Hedke, L. (2002). Reconstructing the language of death and grief. Illness, Crisis, & Loss, 10(4), 285-293. Suggested Readings Robin Dickey, MA, LPC-Intern
easier one: robind@uta.edu Continuing therapy: Telling and retelling
When therapy continues, it aims to facilitate the building and expanding of the richer story. The client decides when the story is rich enough to sustain their future. Sometimes marked with a ceremony.
Ask the client at the end of each session how the therapy session went, what they got out of it, how it was for them.
8-10 session average Difference with Families and groups... Are you sure this isn't SFT?
Does Externalizing the problem take the responsibility away from the client?
There aren't very many techniques/tools, does this make it difficult to measure progress or goal achievement?
How can you work with multiple people with multiple problems?
What if they don't want to "play along" with the creativity?
How do you think of the questions?? Critiques and Questions People are more comfortable describing their pain and problems with metaphors, cliches, descriptions.
"Problems" look different to everyone, it is important for the therapist to understand what a Problem looks like to their client(s) in order to understand the effects of the Problem and to become a collaborator.

Ex. I don't know what anger looks like, but I can picture your shield
-People use non-verbals to describe a problem as well. Metaphors Write a letter to your present self from you 5 years from now, describing how you are living in a more preferred story.
What advice do you have for present self?
What have you achieved? What goals are you still working on? How did you get there?
Who has noticed that your life is better? How will present self notice things are getting better? What have you learned about yourself and others in the last 5 years?

Group/Family Exercise-Everyone shares their letters, members reflect on what they heard. A discussion is held about what can be done now to ensure the client continues moving toward the preferred outcome.
Individual Exercise-Helps determine what a person's ultimate goals in life might be, how their immediate goals and ambitions will help them get there, who can help, who will notice, what they need to get there. Future Self Letter The name of the Problem-Anger
-Client documented when Anger shows up, where, how, what she and others do to invite anger.
-Client discussed what feelings are associated with Anger. Discussed the physical symptoms, effects on others in the house, and begins to create the identity of Anger.
-Client went home and informed other family members about Anger's presence and her wish to remove it and replace it with Laughter. Being able to laugh and let go was one of her goals. In order to achieve this goal, she needed to let go of Anger.
-Wrote a letter from Future Self about how Laughter has replaced Anger
-Made "Anger" and "Laughter" puppets
This activity invited members of the family to help be a part of her goal achievement, allowed her to see that she does not need to keep Anger inside of her.
-Progress reports from herself and her husband
This activity allowed her to see that the "eggshells" had been removed and her husband felt comfortable talking with her, knowing she wouldn't allow anger to take over.
-Reported examples of successes over Anger "The Perfect Client" White Board Visual representation of discussion in the session Shows up when I am under a lot of pressure
-Last seen November, 2012
I worry when Slimer is around which keeps me from focusing on what I actually have control over
Physically I am shakey and sweaty when Slimer is here
I get cranky, distracted, easily irritable when I am dealing with Slimer Slimer
If I don't give Slimer attention, he tends to go away
If I take deep breaths, and focus on my breathing, it is difficult for Slimer to have an effect on me
If I talk about it, he leaves me alone
If I change "worry" to "excited" in my head, Slimer doesn't have control over my excitement, only the worry Problems stick around because they have been given a purpose "I use my anger as a shield, it keeps people from getting to close or letting them hurt me." What does the shield look like? "It is spikey, bullet proof, metal, heavy...and now that I think about it I would say it also has a 12 foot spear that sticks out of it" Do One Thing Different "I spend 90% of my day in the chair"
"When my wife and son are gone, I just sit and worry about everything" "The next time you want to worry, right down the specific worry that pops into your head. Then, get out of your chair and go sit on the couch instead. How long do you think is enough time to worry about one worry?" "Um, 15 minutes is probably enough..." "Worry about that thing for 15 minutes, then go back to your chair and unworry about that worry until a new one comes along. Then repeat. If the worries show up in that chair, we need to let them know they aren't to be there anymore. You get to take control of the worries!" (Next Session)
"Well, I found it very difficult to worry for 15 minutes straight; felt like a waste of time, I didn't want to worry anymore. So I went back to my chair and avoided more worries for the sake of not being bored on the couch when I could be happy in my chair." Directions:Take one peppermint as needed BEFORE anxiety gets to freak out mode (obsessive thoughts). Purpose: Build a protective barrier against freak out mode.

Side Affects: Likely to cause laughter and distraction from anxiety. If this occurs, good job, you beat the anxiety! Claire ANXIETY OVERLOAD!
This problem could eat Slimer for lunch it is so big
-Power to make her parents divorce and her sisters hate her
-Power to make everyone around her talk about her faults
--Power to turn her boyfriend gay, and force her to call me....
-What if what if what if what if what if what if what if what if

"I wish I had a happy pill that would just make the thoughts go away"
"What would you be doing without your obsessive thoughts? What could you focus on instead? What would you do differently?" Dosage: 5 Set appointment for refill I I love Narrative! Critiques and Misconceptions Problem-focused
Removes responsibility from the client
Won't work well with more than one person; more than one problem Works with... Everything! (I am biased)
-Individuals, families, couples, groups
Communities affected by a trauma *What about your anxiety? * what about your anxiety? Invite the problem(s) to join the session
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