Narrative Therapy

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Narrative Therapy

• SOW6425
• Professor Nan Van Den Bergh

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NARRATIVE THEORY

• All people are engaged in an ongoing process of
  constructing a life story, or personal narrative,
  that determines their self-understanding and
  their positions in the world
• It is the words we use, and the stories we learn
  to tell about ourselves and others, that create
  our psychological and social realities
• Our life narratives are co-constructed with the
  narratives of significant other people in the
  family, community, and culture
• The way we speak, and the things we speak about,
  are determined (and limited) by our cultural
  heritage

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NARRATIVE THERAPY

• A journey of co-exploration with a client in
  search of potentials that are hidden by a life
  problem, or subject position, and that can
  contribute to an alternative life narrative
• Problems, or conditions of emotional or material
  suffering, result from personal narratives that
  keep the person in a subjugated position and
  exclude certain possibilities for future action
• Many problems are (at least in part) by-products
  of cultural practices that are oppressive to the
  development of functional life narratives
• The goals of therapy are to awaken clients from
  problematic patterns of living, liberate them
  from externally imposed constraints, and help
  them author new stories of dignity and
  competence.
• This is a therapy of advocacy.

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NARRATIVE THEORY VS. OBJECT RELATIONS THEORY

• In object relations theory, clients are
  encouraged to explore their interpersonal
  patterns (interactions with significant others in
  the past) that may either facilitate or impair
  current functioning.
• Focus is on the interpersonal
• In narrative theory, clients are encouraged to
  explore their interpersonal and inter-cultural
  patterns (the ways and extent to which they have
  adopted arbitrary cultural beliefs and
  practices) that may either facilitate or impair
  current functioning.
• Focus is on the inter-cultural

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KNOWLEDGE

• Knowledge represents socially situated beliefs
  that influence what people understand, see, and
  say
• It is not objective but reflects the values of
  certain people at a certain place in time
• It is embedded in all cultural institutions and
  relationships
• Any generalizations about people serve to
  reinforce positions of power among groups rather
  than represent objective truth
• The prevailing ways in which a society is
  understood gives some groups privilege and
  downgrades the positions of others.

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DISCOURSE

• A set of coherent stories or statements about
  the way the world should be
• conversations about ideas that are based on
  prevailing cultural ideologies
• Discourses include prescriptive functions
• how we should think and behave
• We live in a cultural soup of social contexts
  where many different, potentially conflicting
  discourses operate.
• Some are dominant while others are subjugated,
  depending on who is in power.
• Our social positions are largely determined by
  prevailing discourses
• We create our worlds with the ideas and terms
  available to us

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IDENTITY

• Identity is how we define ourselves at
  particular points in time
• Our standpoint
• Who we are is a matter of constant contradiction,
  change, and ongoing struggle
• Identity is a dynamic process of being rather
  than something essential or continuous
• Subjectivities our identities/positions in
  relationship to others (like a role)
• The subjectivities we live with are not
  necessarily of our own making
• They are products of social interactions and
  power relations

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DECONSTRUCTION

• Uncovering the hidden relationships in claims to
  knowledge
• Uncovering and challenging assumptions about the
  way the world should be, and thereby opening up
  new possibilities
• Exploring previously unstated cultural
  assumptions that contribute to the construction
  of a problem
• Deconstruction questions
• Who has said that?
• Where are they in the power structure?
• Who benefits from this belief?

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Reconstruction

• Formulating a new story based on our actual
  accrued experience

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ACTIVITIES OF THE SOCIAL WORKERIN NARRATIVE
THERAPY

• Do not diagnose, treat, seek solutions
• Assume an investigative, exploratory,
  archaeological position
• Attend closely to the ways clients use language
• Listen for opportunities to promote the emergence
  of a counterplot to the dominating problem
  story,
• give the clients hinted-at competencies the
  acknowledgement they deserve
• Attend equally to the clients past, present, and
  future

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THE SOCIAL WORKER-CLIENT RELATIONSHIP

• Critically analyze the impact of the preferred
  description of yourself as an expert
• What impact does that have on the helping
  relationship and engagement?
• Create a connection
• orient the client to how you work
• ask for his or her opinion (continue this
  practice regularly)
• Maintain a stance of persistent and genuine
  curiosity
• Engage client in share responsibility for the
  shaping of the counseling conversation
• Align against the problem, with the person

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THE SOCIAL WORKER-CLIENT RELATIONSHIP (cont.)

• Validate
• Avoid deficit talk
• Use language of the clients experience (
  Experience-near terminology vs. professional
  terminology)
• Underscore client's willingness and ability to
  take
• Offer your own stories (similar to
  self-disclosure) if appropriate
• Attend to alternative stories of protest,
  resistance and resourcefulness
• Attend to transference
• not a characteristic of the client, but as a
  representation of internalized social positions
• How is client responding to you based on possible
  cultural scripts?

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THERAPEUTIC POSSIBILITIES IN NARRATIVE
CONVERSATIONS

• Separate the person from the problem use
  externalizing conversations
• Move the problem story away from the client
• The person is the person and the problem is the
  problem
• Sorry syndrome
• Map the effects the problem story has had on the
  clients lifestyle and on others
• Assess the damage problem story has had on
  intentions, purposes, values, believes, hopes and
  dreams
• Map the effects of the person on the problem
• Address clients involvement with creation and
  maintenance of the story problem
• Also address strengths and competencies of client

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THERAPEUTIC POSSIBILITES IN NARRATIVE
CONVERSATIONS (cont.)

• Identify unique events that stand apart from the
  problem
• Exceptions
• Explore abilities that have contributed to
  desirable events
• Undertake an archeological excavation of
  historical origins of deeply held beliefs and
  knowledge that provide a context for
  understanding the clients story
• Dig down to the culture of where the story began
• Uncover subjugated knowledge and strengths that
  may have been hidden by the power of the
  problems story

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THERAPEUTIC POSSIBILITIES IN NARRATIVE
CONVERSATIONS (cont.)

• Facilitate outsider witnesses and reflecting
  team practices
• Seek an audience to witness the favored
  developments people who will notice,
  acknowledge, and respond
• Send letters
• Ask Who would be most surprised? Least
  surprised?
• Construct new narratives that reflect alternative
  views of problem and the client
• These are more coherent with values, beliefs and
  practices of engagement with people in clients
  support system

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DOCUMENTING THE CHANGE PROCESS

• Writing letters
• To client
• Client to others
• A good letter five regular sessions!
• Audiotapes, videotapes
• Certificates for children
• Encourage the client to give guidance to others
• Ask the client if you can use his or her story to
  help others

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THE FUNCTIONS OFEXTERNALIZING CONVERSATIONS

• Creates space for a different understanding of
  a personal narrative, personal identity
• Client can see herself as separate from the
  problem story
• Consider the problem story as a kind of false
  self
• Distancing enables to explore the true self
• Externalizing can parody or make fun of
  introjections client has taken in from dominant
  culture, and others

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AUDIENCE

• People who can be recruited to bear witness to
  the emergence of the clients new description of
  him or herself
• This is necessary in order for the client to make
  a departure from the identity offered by the
  problem account
• These may include living and deceased persons
  (who are alive in the clients heart and mind)

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ONE MODEL FOR CLINICAL PRACTICE BASED ON
NARRATIVE THERAPY

• Prior to the first meeting send the client a
  letter of introduction
• try to allay any anxieties about the meeting
• show respect for the clients feelings
• affirm the clients dignity
• give choices about what happens
• At the first meeting If there has been a written
  referral - Read it (or portions of it) to the
  client
• describe any diagnostic terms used
• consider re-naming the problem
• discuss the reason for referral,
• get the clients feedback

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ONE MODEL FOR CLINICAL PRACTICE BASED ON
NARRATIVE THERAPY (cont.)

• The presenting problem - Explore this in depth
  from the clients perspective
• How does the client describe her/his concerns?
• How have they dealt with challenges?
• Personal and family history - This is where the
  narrative conversation begins it is intervention
  as well as assessment
• Inquire about strengths, talents and
  accomplishments
• Previous treatment history - Get the facts but
  more importantly
• assess the clients reactions, meanings, and
  effects of these experiences on the clients
  identity

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ONE MODEL FOR CLINICAL PRACTICE BASED ON
NARRATIVE THERAPY (cont.)

• After the meeting - Promote a reflexive
  alliance by writing an account of the
  conversation after the client leaves
• including new questions that have occurred to you
  since the meeting
• Send this to the client and ask for his or her
  reactions at the next meeting.

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NARRATIVE THERAPY VS OTHER APPROACHES

• A set of simple and accessible ideas, not a set
  of strict procedures
• Metaphoric Comparisons with Other Therapies
• Mechanistic therapies (cognitive, behavioral,
  structural)
• Repairing the faulty machine
• Romantic therapies (ego, object, self, family
  emotional systems)
• Peeling the onion
• Postmodern Hippie therapies (includes solution
  focused)
• The Story Whats your story?
• How people construct truth about themselves
• Problems as located in a problem story line

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Examples of Use of Narrative Therapy
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Considerations When Working With Alcohol-affected
Clients in Narrative Approach

• Avoid using the jargon of the medical model
• Avoid using or reinforcing totalizing
  descriptions (such as, I am an alcoholic)
• Recognize and respect the social prominence of
  alcohol discourses
• Educate the client about the blinding power of
  alcohol discourses (I cant be an alcoholic
  because I can limit my use)
• Personify the alcohol lifestyle (AL)
• Reframe the challenge to Getting a divorce from
  AL
• Help the client reclaim agency (the capacity to
  act) and competence (by recognizing and building
  on strengths, exceptions)
• Build an audience for the new story

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SOME INTERVENTION THEMES FROM THERAPY WITH MALE
SEXUAL ABUSE SURVIVORS

• Deconstruction - Taking apart and looking beyond
  the taken-for-granted meanings and common sense
  explanations in male survivor stories, such as
• The myth of the he-man
• Myths of masculinity
• Fears of homosexuality
• Sexual identity
• Reconstruction of a new story of worth, via
• Recognizing achievements, attributes, and
  capabilities
• Resisting the tendency to be defined by others
  (or by prevailing discourses

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SOME THEMES FROM APPRECIATING INDIGENOUS
KNOWLEDGE IN GROUPS

• Assumption Participants have knowledge and
  skills in their lived experience that can be
  constructively shared for the mutual development
  of new narratives
• The group leaders expertise A curious,
  not-knowing style of communication
• using members own language to understand their
  meanings
• listen for alternative meanings, and help them
  externalize

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SOME THEMES FROM APPRECIATING INDIGENOUS
KNOWLEDGE IN GROUPS

• Skills Training Groups (Assertiveness)
• Leader acknowledges his or her strengths but also
  limitations
• Asks for help from the group
• Let the group set rules
• Ask questions to affirm members existing power
• Brainstorm about what assertiveness means
• Tap into social inequities about having the power
  to be assertive
• Ask for feedback at the end of each session

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SOME THEMES FROM APPRECIATING INDIGENOUS
KNOWLEDGE IN GROUPS (Cont.)

• A Womens Assertiveness Group (more structured)
• The group is an audience for members preferred
  descriptions of themselves
• Let members choose their own preferred
  self-descriptions
• Ask a set of questions each week about member
  experiences during the previous week
• Ask about messages received about how women are
  supposed to behave
• Ask how have they overcome the effects of these
  constraints

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NARRATIVE APPROACHES IN MEDIATION

• Mediation is a process for resolving conflict
• Conflict is the inevitable result of the
  articulation of differences.
• It is emergent and malleable, not fixed.
• Points of view are always related to social
  discourses and ones cultural position
• In mediation, mutual understanding is as
  important as resolution
• A Mediation Process
• Two mediators are preferable, to model
  cooperation and to broaden each others, and the
  clients, understanding
• Pre-mediation discussion is held to plan for
  safety and to consider the effects of
  participants prevailing social discourses in
  this situation

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NARRATIVE APPROACHES IN MEDIATION (Cont.)

• Separate sessions with each client - To develop
  rapport, promote free discussion, suggest new
  understandings, develop an externalizing mode of
  conversation, examine the effects of the person
  on the problem and the problem on the person
• Joint session - The agenda includes a mutual
  establishment of rules, summarizing the process
  of individual sessions, promoting mutual
  understanding (vs. solution), deconstructing the
  dominant problem, promoting a mutual problem
  definition, developing alternative stories of the
  relationship of the participants, developing new
  ways of cooperating
• Develop a written agreement - Show caution about
  the future, ask what if questions

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HEALTH PROMOTING CONVERSATIONS

• The problem of disconnect between health
  professionals and indigenous people
• Relationships between the two can be enhanced by
  listening
• Step 1 Make contact with representatives of the
  indigenous people
• Step 2 The day-long program
• Begin with lots of time for informal
  conversation
• Use the language of the people
• Highlight indigenous wisdom
• Emphasize alternative knowledge about the
  health issue
• Include presentations by health
  professionals
• Preserve the dignity of all participants
  in the process
• Promote various social groups getting
  together after the program

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HEALTH PROMOTING CONVERSATIONS (Cont.)

• Hold follow-up meetings for participants
• With affirmation, the indigenous people can be
  encouraged to take greater responsibility for
  health
• Hold community demonstrations