Narrative Therapy

Narrative Family Therapy

John Stafford

Brandman University

Abstract

Narrative therapy emerged from the post-modern therapy movement as a powerful therapeutic technique that encompasses numerous methods specifically designed to help an individual or family identify their problems as being separate from the person. While other approaches to therapy may promote this concept, narrative treatment does so in the unique way of helping the patient[s] turn a problem situation or history into a story that both themselves and others can view from outside the problem. As this paper will demonstrate, the benefits of narrative therapy reach far beyond simple approaches and directive therapies designed to help clients overcome obstacles.

Keywords:  postmodern therapy, narrative therapy, family therapy, individual therapy, therapeutic approaches

Narrative Family Therapy

Mental health therapy has taken many forms over the decades, from the early days of Freud to new and modern methods that seek to find new and innovative ways of treating clients and the plethora of conditions that arise. Postmodern approaches apply new and sometimes unorthodox modalities to work with individuals, couples, and families seeking help. One such postmodern approach is narrative therapy. Although some of the process’ in narrative therapy may appear familiar, or at least hold some resemblance to other theories, the underlying perspective is that people and their problems are separate, and that each person has his or her interpretation of events, or what is commonly referred to in narrative therapy as “their story.” Narrative therapy strives to help the client tell their story and feel more profound empowerment to make changes in thoughts and behaviors to re-write their life story for a more positive future that encompasses a purpose, a person, and capabilities wholly separated from their problems.

Because of narrative therapy’s approach to helping people who define themselves by their problems learn to externalize and reauthor the issue[s], narrative therapy shows excellent benefit to individuals, couples, and families alike. Of primary focus is encouraging the client[s] to become the active author of their life by giving verbal accounts of their experiences and how they affect their perceptions (Bardin, 2018). The oral reports viewed as stories that build over time. Based on events that occur in the indiviudal[s] life with varied levels of significance, these stories often stemming from negative life experiences or events play a crucial role in shaping the indiviudal[s] identity. The therapist role in narrative therapy is to regard the client stories as a life rich with undiscovered possibilities. A significant aspect of the therapist role is to direct the conversation. He or she will ask the client what they want to discuss to get the conversation started. The questioning and conversational stage usually reveals the presenting problem and the client is encouraged to continue their story.

Another emphasis of narrative therapy is a cultural perspective. The theoretical assumptions emphasize a comprehensive understanding and importance of how culture plays a role in the development of an individual’s identity (Morris, 2006). To state that narrative therapy simple views people like stories to be re-authored is a short-sale at best. A more in-depth look, narrative therapy is rooted in solid assumptions. One assumption is that truth becomes overridden by different interpretations of reality and that meaning is an individual's construction of cultural, political, and social contexts. Further assumptions assert that an individual’s life gets modified by the stories told by others and by the individual and that multiple selves make the individual. Lastly, narrative therapy makes a cultural statement by asserting that culture in itself is a collection of stories combined to be the most influential aspect of a person’s life (Morris, 2006).

The art of narrative therapy is not just telling stories, externalizing problems, and approaching the client with cultural competency. If this were the case, the theory itself would not effectively help a client resolve presenting issues. There is a human aspect in the method that requires the therapist to view the client[s] as a unique individual lacking in deficiency and defectiveness. The client should never feel that he or she is the blame of the presenting problem[s], nor should they blame anyone else, and that the client is the ultimate expert on his or her life in the therapeutic relationship, and that words people use have a significant impact (Bardin, 2018; Positive Psychology Program, 2018). These human aspects are vital to working with any client. When working with couples or families, the human component has more profound implications because the therapist is now working with multiple personalities and stories to help the family or couple recognize the influence the problem has on the family, and the influence the family has on the problem (Bardin, 2018). As the couple or family begins to tell the individual stories associated with the perceived problem, the therapist could start to help them deconstruct the problem-saturated story. Deconstructing the problem story reveals both or multiple sides of the story that adds to the overall frustration the couple or family is experiencing. It helps them recognize that negative thoughts become a self-fulfilling prophecy (Bardin, 2018). The positive aspects of the process reveal hope, individual abilities, courage, determination, and self-efficacy and esteem, all leading toward the ability to re-author the story to a new, positive version (Bardin, 2018).

Although the tenents of narrative therapy appear appealing and innovative at a certain level, some issues need careful review. Postmodern therapies could serve as a third-wave of therapeutic approaches that aim to modernize many aspects of psychotherapy. However, proving the efficacy of any form of treatment takes time and research. Narrative therapy is relatively new in comparison to traditional therapeutic methods. There is a shortage of scientific research supporting the overall effectiveness of this approach. Additionally, certain types of clients would not qualify as good candidates for narrative approaches, in particular, clients with psychotic issues, or who have limited intellectual, language, or cognitive skills. Finally, clients with difficulties in articulating their problems could exhibit discomfort being placed in the role of “expert” as it pertains to their own lives in the narrative therapy process (Addiction.com, n.d.).

Working with children introduces additional complications to therapy that vary depending on the age of the child. Younger children are still developing communication skills and gaining an understanding of the world they live. Older children, while more developed, are still learning social skills and mental and emotional maturity. These issues complicate the therapeutic process because the therapy sessions require tailoring to meet the comprehension and communication levels of the young client. Contrary to common belief, children are not as resilient as once thought. Failure to address childhood traumas like abuse or neglect resulting in potential affective, behavioral, and cognitive dysfunction is a paramount concern (May, 2005; Ramey, Young, & Tarulli, 2010).

Regarding narrative therapy, a child who experiences maltreatment from parental figures most likely constructs a chaotic and incoherent story; in many cases, this story includes scenarios of death and violence that have no comforting resolution (May, 2005). When a child is removed from their birth-home and placed in foster care or with relatives, another concern arises. The child, accustomed to an abusive relationship with his or her birth parent[s] likely views any attempt of caring and compassion from others as suspect, or the forefront to further abuse. He or she is unlikely to trust the motives of others and resist any forms of positive connections (May, 2005). One narrative intervention that figures prominently with children is externalization. At the core of this intervention, the child can name, objectify, and sometimes personify the problem, which allows them to put the problem issues in a separate space and view them as not being an internalized issue (Ramey, Tarulli, Frijters, & Fisher, 2009). Another form of externalizing showing positive results with children is the scaffolding conversations map that involves the creation of several steps of mapping out the problem or initiative with the child in various levels of importance. This process allows the child and therapist to create a visual map of the child’s story that enables him or her to establish more control in the shaping of their life (Ramey, Tarulli, Frijters, & Fisher, 2009).

Case Conceptualization

Ivan has endured a tremendous amount of trauma that started with the physical, emotional, and verbal abuse he was exposed to by his birth parents. He most likely has severe issues with abandonment and an inability to trust authority figures. Additionally, his life experiences being as they were, Ivan was not able to learn how to respond to compassion or love from adults in a positive and trusting manner. All Ivan has learned in his young life is violence and emotional neglect. His mental development is such that these issues have formed his story destructively. Ivan’s story, defined by depression and trauma appears hopeless to him and affects his sense of self-worth. His foster mother’s stated desire to care for Ivan and his unwillingness to let her or other family members into his life reflects a story of frustration that internalizes feelings of rejection.

Neither Ivan or his foster mother discuss any situations where previous attempts to correct the issues have worked. Ivan’s repeated foster care placements also indicate that his feelings of abandonment have become more of an expectation and that his acting out serves as a self-fulfilling prophecy. It is unclear from the vignette if his foster family includes other children, which could add additional complications for Ivan because his behavior could result in further isolation and frustration as the other children react negatively. The family talks about the situation with a deep sense of failure and internalization of the issues. The foster mother talks about Ivan’s behaviors as his problems instead of problems affecting him and the family. Ivan is made central to the entire situation. Ivan also views himself as a fundamental problem. He considers himself as worthless and undeserving of a loving family environment.

The task of the therapist in this situation appears an undaunting task. However, understanding the traumatic experiences Ivan has endured, and the willingness of his foster parents to provide Ivan with a caring home is a solid launching point. Mapping the influence the problem has, and on the family and the impact the family has on the problem, the family begins to externalize and deconstruct the issues. They will start shifting away from Ivan being the disruptive force in the family and view the problems as being the destructive force. By doing this, the family can remove focus from Ivan and feelings of failure or rejection. They can start re-authoring the story with a focus on the problems that negatively affect Ivan and the family, and he can begin re-authoring his story with a stronger sense of self-worth and acceptance of compassionate relationships.

The Goals

            The ultimate goal for this case is to alleviate Ivan’s trauma, depression, and feelings of unworthiness. Doing this will enhance Ivan’s ability to re-author his life story in a positive manner that will enable him to see himself as worthy of a loving family structure. Furthermore, the family will be able to re-author the negative experiences in a positive way that will provide Ivan with supporting and understanding infrastructure. It may sound easy, but changing problem-stories involves dedication and participation from the entire family. The three goals are overcoming trauma and depression, removing self-blame, and integration into the family unit. Reauthoring the family narrative which is being held back by the current stories for Ivan and the foster mother prohibit the family from moving forward because Ivan focuses on his internalization of the abuse and feelings of worthlessness, and his adoptive mother focuses on Ivan being the problem and her failure to reach him.

The Therapist

The therapist conducts the sessions in a respectful and non-blaming manner that emphasizes the client[s] as being the expert in their life story. He or she initiates the meetings by asking questions designed to map the influence the problems have on the family, and the impact the family has on the issues. This process of mapping provides a diagram of sorts and creates a sense of empathy between the client[s] and therapist that invokes a healthy and empowering experience for the family and the therapist alike (Nichols, & Davis, 2016).

Telling the Story

            Telling an individual’s story can take several forms. Because of Ivan’s age, it may be easier for him to express his story by starting with drawing or playing with objects that have a significant representation of his life. Doing these exercises allows the child to experience the problem issues by acting them out or visualizing them in drawings that help him or her start imagining a separation between the experiences and themselves. The current narrative is one of despair and internalization of problems viewed as Ivan’s fault. This narrative prohibits the family from recognizing the issues as external influences on the family that maintain the chaotic atmosphere, which in turn, continues the problems.

Deconstructing and Externalizing

            Deconstructing the problems is a crucial aspect for this scenario. Ivan and the family are overwhelmed by the number of issues, which maintain the problem-saturated story[s]. By deconstructing the narratives, we can look at each problem in a smaller context and remove any overgeneralizations associated with them. The process of deconstruction also allows the client[s] to explore the issue more and begin to understand how those problems block his or her ability to gain what they want their story to be. Once the matters become deconstructed, the next goal is to externalize and depersonalize them. Doing this removes the person[s] from being the root cause and emphasizes that the problems are not the person. Additionally, separating the person from the problem removes stigma, whether internally or externally imposed, and provides a higher degree of control over the issues.

Look for Unique Outcomes

            As Ivan and the family progress in the previous goals, unique outcomes should begin to surface. These unique outcomes provide moments where the family experiences positive results and interactions. Focusing on the individual strengths and accomplishments that lead to these sparkling moments aids all members of the family to begin re-authoring their story based on positive aspects of their life and maintain an emphasis on the benefits of preserving externalization of the problems that contributed to the dysfunction in the family. The process encourages family members to strive for higher goals as they progress.

Conclusion

Narrative therapy is a postmodern theory showing potential for the treatment of numerous scenarios. Although the approach lacks much empirical study data, there is enough research to assert that certain individuals, couples, and families benefit from the processes involved in the narrative therapy process. In the case of Ivan and his foster family, narrative therapy provides ample opportunity to the child and foster family to identify the main problems by telling their individual and combined stories, deconstructing those stories into manageable chunks and externalizing the issues, so the indiviudal[s] are no longer viewed as the problem. The narrative therapy approach, in this case, allows the therapist to work with the family members on different levels, which benefits the child and the adult by employing various techniques designed to provide comfort and empowerment at the same time, ultimately enhancing the overall therapeutic process.

 References

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Bardin, G. (2018). Narrative Therapy. Lecture presented at PSYU 556 in Brandman University, Palm Desert.

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Morris, C. C. (2006). Narrative theory: A culturally sensitive counseling and research framework. Retrieved from https://www.counseling.org/resources/library/Selected Topics/Multiculturalism/Narrative_Theory.htm

Nichols, M. P., & Davis, S. D. (2016). Family therapy: Concepts and methods. Upper Saddle River: Pearson.

Positive Psychology Program. (2018, August 10). 19 Narrative Therapy Techniques, Interventions Worksheets [PDF]. Retrieved from https://positivepsychologyprogram.com/narrative-therapy/

Ramey, H. L., Tarulli, D., Frijters, J. C., & Fisher, L. (2009). A Sequential Analysis of Externalizing in Narrative Therapy with Children. Contemporary Family Therapy,31(4), 262-279. doi:10.1007/s10591-009-9095-5

Ramey, H. L., Young, K., & Tarulli, D. (2010). Scaffolding and Concept Formation in Narrative Therapy: A Qualitative Research Report. Journal of Systemic Therapies,29(4), 74-91. doi:10.1521/jsyt.2010.29.4.74