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Practical Narrative Therapy
Jo Viljoen, PhD
Clearview Clinic
Kameeldrift
Alcohol 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 world
With 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 stuck
When 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-OPERATIVE
MANIPULATIVE
RESISTANT TO TREATMENT
NON 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
Externalized
• 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
• 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.com
www.reauthoringteaching.com
www.dulwichcentre.com.au
www.narrativepractices.com.au