Practical Narrative Therapy

Jo Viljoen, PhDClearview Clinic

KameeldriftAlcohol and Substance Abuse Recovery

29 August 2011

My thanks to

And all the people who have shared their stories with me

and who have invited me along to journey with them in search of their preferred ways

of being

This conversation rests on the shoulders of Narrative Therapists

all over the worldWith particular mention to

Michael White, David Epston, Jill Freedman, Gene Combs, Peggy Sax, Alice Morgan, Dirk Kotze, Christina

Landman, Anton Fick, and the members of the Reauthoring

Teaching study group

Before Narrative Therapy

Before I often felt stuckWhen I did not have words or answers, I gave advice

AND USED WORDS LIKE

I was the expert, the analyst, the behavioural specialist with the power to tell people the right or the wrong way of living their lives. I gave them advice and they had to follow it. If they did not, it justified my using words like:

UNCO-OPERATIVEMANIPULATIVERESISTANT TO TREATMENTNON COMPLIANT

The patient was the seeker of health and I the health care provider. That gave me a lot of power.

Meeting of Minds

I met Grace and Narrative ways of working almost at the same time

Grace’s Curriculum Vitae of Mental Illness

“The doctors used to tell me to take my medication and live with it. That meant there was nothing they could do for me. I also always felt that they were not giving me all the information, as if they kept some coveted information for themselves.

It felt as if they did not offer me any way to change; they were not prepared to partner with me to change; it felt unsolvable. It felt as if that was who I was and that I had to accept it as such.” (Grace)

Grace’s Curriculum Vitae of Mental Illness

I was very ill before I met Pieter. I overdosed and cut myself repeatedly. He did not realize how ill I was, but I was as mad as a hatter.

When I fell pregnant, the doctors told me that I was too mentally ill and could not bring up a child. They insisted that I have a legal abortion based on my history of mental illness. Pieter and I decided to take responsibility for the baby, refused the termination of pregnancy and got married.

I decided to "pull myself together" and become a wife for Pieter

and a mother for Anne.

It was like putting a lid on a volcano.

“I put myself under pressure to prove that I was not crazy.

I was scared that I would somehow be exposed as a lunatic, as a crazy, evil, sick person.

I even baked my own bread.

I looked around me and saw what other happily married women were doing and I copied them. I managed to be the perfect person for seven years.”

Narrative approaches excited us!

Grace

“I researched all the diagnoses they gave me, because if something was wrong, I wanted to know how to fix it. I felt like a horrible, hysterical, over-the-top hopeless case. Nobody believed me that I wanted to be well.“

Narrative practice: the position of

the therapist• De-centred• NOT KNOWING• Always curious• Wondering • Collaborative

A completely different perspective

Co-creation of new narratives• Together we set out to try and

understand her lived experience as a woman struggling with mental illness for many years

• I tried very hard to maintain a position of not-knowing, curiosity and interest

• I soon found that whenever I felt out of my depth, I became directive

• I learnt to speak a new language in which problems are seen as separate from persons

Summary:The position of the therapist

• Decentred but influential (White 1997)– Not giving advice,

solutions or opinions– Not normative

judgements or evaluations

– Or positions of authority (Morgan 2000)

• Narrative practices hold the person’s ideas and resources at the fore

• And decline invitations to be the expert in people’s lives.

Externalising conversations

• The person is not the problem

• The problem is the problem

ALCOHOL

What can be externalized?

• Feelings• Problems between

people• Cultural and social

practices that assist the problem, e.g. inequality

• Metaphors • More than one problem

at a time

Problems and identity

• A person who uses drugs is called a .....?

• A person who drinks a lot of alcohol is called a...?

• This way of speaking about problems internalises problems and affects identity

Internalized vs. Externalized Problems

Internalized • I am a drunk• I am a junkie• I am a depressive kind of

person• I am a worrier• I am as failure as a person

Externalized• Ask client to name the

problem• Personify the problem• Explore the voice and words

the problems whispers or shouts into the persons ears

• Explore the problems tricks and strategies

What happens when a problem gets externalised?

Shift in language and attitude• It separates the persons

identity from the problem• Speak differently about

problems• Not just a technique or a

tool, its a belief system• Enables the therapist to join

with the client against the problem

Create space• Untangle problem saturated

identities• Creates space where clients

can renegotiate their relationships with the problem

• Provides relief and a course of action to take

• Reduce guilt and blame• Leave room for responsibility

How to Name the problem

• Speak of problem as separate to the person

• Therapists language, choice of words and choice of phrase

• Phrasing of questions• Use clients own words• Use the word THE e.g.

The Worry, The Fear, The Fighting

Bear in mind the social context

• Be aware of the politics involved in naming the problem

• Consult the client about the name of the problem

• Collaborate to come up with a name that is truly representative to the client’s experience.

• Bear contextual factors in mind: recent life changes, losses, moves, social attitudes etc

Issues of abuse• Due to prevalence of abuse we should check out

whether it is part of the social context of a person’s life

• Important to do this to prevent silencing a victim of abuse

• Need to constantly check the broader social context

• Externalising conversations need to be seen in the context of these checking out processes and a constant awareness of the broader context of peoples lives

Narrative Questions• The influence of the

therapist has to do with their skills in consultation and asking questions in particular ways

• This stance invites people to become the primary authors of their own lives

• And put people’s views, preferences, desires, hopes, dreams and purposes at the centre of the conversations

Types of questions

• Landscape of action

• Landscape of identity

• Landscape of experience

What is it about narrative practices that intrigues you?

What changed in my practice?• I became more aware of

practices of power in the relationship between me, the therapist and the person seeking help

• I started taking notes differently

• I started speaking in different ways, externalizing problems in language

More transparency

• I started listening for the absent but the implicit

• Seeking alternatives to the dominant problem saturated stories that bring the clients to therapy

What changed

• I stopped giving advice• I ask questions I

genuinely do not know the answer to

• I listen for times when the problem had less or no influence on the persons life

• I asked more questions• I make fewer

assumptions• I collaborate more• I seek more supervision• I practice, practice,

practice

Ask about the effect of conversations

– What have they found useful, what interested them and why?

– Offer a range of options as to directions that could be followed and then ask the client which direction they would most want to pursue?

– I began to create a different rhythm of conversations in which I would offer scaffolding and options, and the client would make decisions that I would then follow.

Taking it back practices

• Two way nature of therapeutic conversations• Find ways to reflect back to those consulting

me about a difference a particular conversation might have on my future work and other aspects of my life as therapist (White 1997:132)

Positioning myself as a therapist differently opened space for me to more fully appreciate the competencies, abilities and resources available to people

Hope

• A de-centered position of the therapist opened space for me to more fully appreciate the competencies, abilities and resources available to people.

• Focusing on these seem to fill the conversations with hope and to direct them away from problem saturated descriptions and negative identity conclusions.

Room for curiosity

• Therapist responsibility is to be skilled at facilitating conversations that would allow people to resource their own ways forward, in ways that suited them.

• This position opens room for curiosity, a curiosity that has become one of my closest companions in therapeutic conversations (Morgan)

Morgan A. 2000. What is narrative therapy?

Adelaide: Dulwich Centre Publications. Morgan A. 2002.

Beginning to use a narrative approach in therapy. The International Journal of Narrative Therapy and Community Work

Viljoen, HJI. 2002. Deconstructing harmful religious discourses on the lives of Afrikaans women. Pretoria: UNISA

White, M. 1997. Narratives of Therapists’ Lives.

Adelaide: Dulwich Centre Publications.

www.narrativeapproaches.comwww.reauthoringteaching.com

www.dulwichcentre.com.auwww.narrativepractices.com.au