Lecture 8: Introduction to Narrative therapy

Systemic ComparativeKevin Standish

Newham College University Centre

Learning Outcomes

1. Identify the background influences2. Describe the core concepts of Narrative Therapy3. Conceptualisation of problems in Narrative

Therapy4. Therapeutic goals in Narrative Therapy5. Therapist role in Narrative Therapy 6. Narrative Therapy interventions7. Evaluation of Narrative Therapy

IDENTIFY THE BACKGROUND INFLUENCES

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The limits of language ….mean the limits of my world

Ludwig Wittgenstein

What childhood stories are you still clinging on to?

Michael White

David Epston

“Narrative Means to Therapeutic Ends”

Human Nature

People are interpretive beings who make meaning of themselves and their world through the language of stories that have become part of themselves, as well as their understanding of those stories

Narrative Family Therapy1. Based on “liberation philosophy” (postmodern, social

constructionist) which avoids objectification of people/families—belief that problems arise because of culturally-induced subscription to narrow and self-defeating views of self and world

2. No normative pattern to be achieved (meaning, purposefulness, health determined by each family/culture/situation)

3. Focuses on narrative reasoning (versus logico-scientific)—asserts that people live their lives by stories, and these can be re-written (re-authoring in creative ways)

4. Families encouraged to externalize their problems (problem becomes separate entity, avoids blaming traps)

DESCRIBE THE CORE CONCEPTS OF NARRATIVE THERAPY

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PRIMARY THEMES IN NARRATIVE THERAPY

Realities are socially constructed

Realities are constituted through language

Narrative organizes and maintains reality

There are no essential truths

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PRIMARY THEMES IN NARRATIVE THERAPY

Our lives are storied

Identity generated through stories

People are not problems

Problems are to be externalized

Deconstruct problems

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REALITIES ARE SOCIALLY CONSTRUCTED

We become who we are through relationship—through how others perceive us and interact with us and how we make meaning of the social interaction

(Combs and Friedman, 1999)

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REALITIES ARE SOCIALLY CONSTRUCTED

Identity=definition of the author generated in the text of one’s story– Self dwells within the story – Confirmed and modified through interaction

– Basis for identity rests in the group fiction

– Fiction can either heal or cripple the person who possesses it

(Hillman, 1983, cited in Nagel, 1988)

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REALITIES ARE CONSTITUTED THROUGH LANGUAGE

Internal reality differs from external reality

Combination of values, experience and filters

Postmodernists state that words and language create reality

(Combs and Freedman, 1998)

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REALITIES ARE CONSTITUTED THROUGH LANGUAGE

[Three umpires] are sitting around over a beer, and one says, “There’s balls and there’s strikes and I call ‘em the way they are.” Another says, “There’s balls and strikes and I call ‘em the way I see ‘em.” The third says, “There’s balls and there’s strikes, and they ain’t nothin’ until I call ‘em.”

(Combs and Freedman, 1998)

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OUR LIVES ARE “STORIED”

Dominant identity story– Solution or problem oriented?

Life story=sufficient and self-contained fiction

Differs from biography, oral history or life history

Theoretical Concepts

• Problems are manufactured in social, cultural, familial, political and historical contexts rather than being intrinsic to or inherent in the person.

• People’s lives are created and interpreted through their stories… ones they hear, create in their own minds, and ones they tell and retell

• Drawing people’s attention to subtle changes in their lives can foster new insights, promote empowerment and help people develop better ways to resolve difficulties… through this knowledge people can truly become authors of their own lives…

• Client is an expert on his own life and counselor is an expert of narrative therapy

Theoretical Concepts

Theoretical Concepts• Stories give

messages and become road maps of our lives

• Believes stories have cultural and interpersonal basis and meaning are generated in social interaction

• Person isn’t the problem the problem is the problem

CONCEPTUALISATION OF PROBLEMS IN NARRATIVE THERAPY

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IDENTITY GENERATED THROUGH STORIES

Represents the key to meaning and significance (Fisher, 1984)

Stories provide– Significant events and appropriate meanings for

listeners– Identify and affiliation for those who tell them

Healing for both listener and storytellerEmphasis on “listening, accepting, making non-

judgmental, non-confrontational comments.” (Hennings, 1987)

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PROBLEMS ARE TO BE EXTERNALIZED

Hidden problems cannot be changed– “only as sick as your secrets”

Externalization allows re-authoring

May need to externalize solution as well as problem

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DECONSTRUCTING THE PROBLEM

Erase object of text as well as author “I’m not much, but I’m all I think about.”

Can ask multiple forms of same question

Therapist becomes linguistic detective

Intricate and delicate process

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EXAMPLE OF DECONSTRUCTION

“A tear in the hand of a Western manHe’ll tell you about salt, carbon and waterBut a tear to an Oriental manHe’ll tell you about sadness, sorrow, the love of

a man and a woman.”

“Ride the Tiger,” Jefferson Starship (1974) Dragon Fly

THERAPEUTIC GOALS IN NARRATIVE THERAPY

Therapeutic Goals

• Therapists invite clients to describe their experience in new language and facilitate the discovery or creation of new options that are unique to them

THERAPIST ROLE IN NARRATIVE THERAPY

Counselors’ Roles

• Therapeutic Anthropologists

• Supportive, facilitator, encourager… not an expert

• Never Judges

• Active role… suggesting exercised, offering new viewpoints, soliciting feed back

• Create shifts to bring about new meaning to the client’s story

• Does not seek to heal or “fix” people but to learn about client & understand them

Therapist Role• Suggest alternative

viewpoints and elicit stories

•Mirroring- reflect themselves as well as the client

• Emphasis on being respective & encouraging of client’s strengths and resources

• Participatory witness and interpersonal relationship based on collaboration not just reflection (person-centered) but interactive

•Careful listening, empathetic, summarization and paraphrasing to give people ownership

The Therapeutic Process in Narrative Therapy

• Collaborate with the client in identifying (naming) the problem

• Separate the person from his or her problem• Investigate how the problem has been disrupting

or dominating the person• Search for exceptions to the problem • Ask clients to speculate about what kind of future

they could expect from the competent person that is emerging

• Create an audience to support the new story

Narrative Therapist’s function and role• To become active facilitators

• To demonstrate care, interest, respectful curiosity, openness, empathy, contact, and fascination

• To adopt a not-knowing position that allows being guided by the client’s story

• To help clients construct a preferred alternative story

• To separate the problem from the people (instead of person own the problem)

• To create a collaborative relationship --- with the client being the senior partner

Therapeutic Relationship

• Emphasize the quality of therapeutic relationship, in particular therapists’ attitudes

• Client-as-expert, clients are the primary interpreters of their own experiences

• Therapists seek to understand client's lived experience and avoid effort to predict, interpret, and pathologies.

NARRATIVE THERAPY INTERVENTIONS

Therapeutic Techniques• No recipe, no set agenda, and no formula• This approach is grounded in a philosophical

framework• Questions—and more questions: – Questions are used as a way to generate experience

rather than to gather information– Asking questions can lead to separating “person”

from “problem”, identifying preferred directions, and creating alternative stories to support these directions.

Therapeutic Techniques

• Externalization & Deconstruction – Externalization is a process of separating the

person from identifying with the problem– Externalizing conversations can lead clients in

recognizing times when they have dealt successfully with the problem

– Problem-saturated stories are deconstructed (taken apart) before new stories are co-created

Essential reading

Therapeutic Techniques• Search for unique outcomes– Successful stories regarding the problem

• Creating Alternative Stories – The assumption is that people can continually and

actively re-author their lives– Invite clients to author alternative stories through

“unique outcomes” – An appreciative audience helps new stories to take

rootRead

Therapeutic Techniques

• Documenting the evidence– Therapists write and send a letter to clients

between sessions regarding their strengths and accomplishments, alternative story, and unique outcomes or exceptions to the problems.

http://www.youtube.com/watch?v=XMst5HoOS6c

Narrative Treatment Techniques

1. Externalization of problem—the problem is the problem, and is given a name. Family and members not defined by problem

2. Influence of the Problem on each Person3. Influence of the Person on the Problem4. Raising Dilemmas—examine aspects of problem

before need arises5. Predicting Setbacks—they almost inevitable, best

dealt with when anticipated

Narrative Treatment Techniques

6. Using Questions • Exceptions-oriented • Significance of exceptions

7. Letters to client families—a form of case note to family, put in transparent/congruent statements

8. Celebrations/certificates—festive, signify victory/achievement, tailored to circumstances by wording, printed and include logo (For achievements in conquest of “Apathy”)

EVALUATION OF NARRATIVE THERAPY

Summary and Evaluation

• Contributions– Client-as-expert (not knowing position)– View people are competent and able to create

solutions and alternative stories– Do not support the DSM-IV-TR labeling system– A brief approach, is good for managed care. – In general, studies provided preliminary support

for the efficacy

Summary and Evaluation

• Limitations– No set of formulas or recipes to follow– Inexperienced therapist may view narrative as techniques.

However, the attitude of the therapist is critical to the success of outcomes.

– Therapists need to be able to make quick assessments, assist clients in setting up the goals, and effectively use appropriate interventions

READINGS ETC

http://www.theinstituteofnarrativetherapy.com/papersandresources.html

Popular articles about narrative therapy and community work

• http://www.dulwichcentre.com.au/articles-about-narrative-therapy.html

2 free chapters

• http://www.dulwichcentre.com.au/what-is-narrative-therapy.html

http://www.delrayrecoverycenter.com/ebooks/narrative-therapy/download/

Narrative Therapy Exerpt from Dr. Bitterhttp://www.youtube.com/watch?v=gYaDrVp_DyI

• Dallos, R. & Draper, R. (2010) chap 3 • Metcalf, L. (2011) chapter 13 • White, M & Epston, D. (1990) Narrative means to therapeutic ends. New York: W.

W. Norton • Kaslow (2010) Family therapy Narrative• Moreira, et al (2011) CLIENTS’ NARRATIVES IN PSYCHOTHERAPY• Von Sydow (2002) Systemic Attachment theory and therapeutic practice• Wallis et al (2011) What Is Narrative Therapy and What Is It Not• Dallos (2004) Attachment narrative therapy integrating ideas from narrative

attachment theory

• Advanced reading• Chang & Nylund (2013) Narrative and Solution-Focused therapies a 20 year

retrospective• Payne, Martin (2006) Narrative Therapy : An Introduction for Counsellors 2nd

ed. SAGE Publications London. Full Text available as an eBook on EBSCO Host via your Athens login.

• Meier, Scott T (2012) Language and Narratives in Counseling and Psychotherapy Springer Pub. Co New York, N.Y. Full Text available as an eBook on EBSCO Host via your Athens login