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The Use of Narrative Therapy with Families
Sarah M. Gibbs
Abstract. Helping clients and families to understand their life stories is the foundation of narrative therapy. Building on the post-modern tenets of social constructionist philosophy, narrative therapists believe that truth is relative and debatable, and that people can rewrite their personal stories to accommodate life transitions and challenges. Drawing on the recent literature, this article presents a brief review of narrative therapy, highlighting its theoretical underpinnings, basic strategic approaches, strengths and uses. A personal reflection by the author, as well as a brief case study; are also included.
---- Hannah Arendt
Introduction and Review of Narrative Therapy
Family therapists have a fifty-year history of engaging with new and unorthodox ideas, of questioning commonly held views, and developing creative practices. Although the theories may be diverse, the field of family therapy is generally characterized by a number of common themes, such as considering the problems people face in the context of life and life transitions; as well as understanding people's identities and roles as constructed through family relations, history, and culture. Over the past two decades, the use of narrative, which focuses on understanding the central themes in a client's life story, has emerged as a powerful family therapy approach (Anderson and Bagarozzi, 1983; Byng-Hall, 1998; Nichols and Schwartz, 2006; Freeman and Couchonnal, 2006). The metaphor of the narrative derives from a social constructionist orientation, and represents a paradigm shift in the way that therapists view their own role in the therapeutic process (Legg and Stagaki, 2002; Nicholas and Schwartz, 2006). At the center of post-modern philosophy, social construction seeks to understand the processes by which people describe, explain, and ultimately view themselves and the world (Legg and Stagaki, 2002). Consistent with these post-modern origins, narrative theory rejects the notion of a universal truth, in favor of multiple realities and perspectives. Thus, the client is regarded as the expert on his or her story, while the therapist's view is regarded as one of many, rather than the "correct" or privileged one (Legg and Stagaki, 2002; Nicholas and Schwartz, 2006).
Family stories provide a contextual framework and connections to the past, that may be used in therapy to help members better understand their current situations. Yet much of the meaning that people bring to personal and family narratives is based on and maintained by the dominant culture in which they live. In all societies certain values are given a preferred status, whereas others are subjugated. While the culturally approved lifestyles and values often change throughout history, those people whose experiences do not conform to the prevailing current cultural story (such as ethnic minorities, disabled persons, gays and lesbians, or people with non-traditional gender roles), may feel their stories to be less valid (Jones, 2004; Freeman and Couchonnal, 2006). The perception of being at odds with societal norms and expectations may even lead people to ignore or conceal important aspects of their personal narratives. Narrative therapy places a strong emphasis on the role that society and culture play in the development of personal struggles, and thus may prove especially effective in working with ethnically and culturally diverse families (Woodcock, 2001; Allison, 2003; Freeman and Couchonnal, 2006). Even cultural metaphors, such as Greek myths or the universal story of the "evil stepmother" can exert an influence on family dynamics (Anderson and Bagarozzi, 1983; Jones, 2004). Narrative practitioners can help families identify and dismantle any destructive or marginalizing cultural narratives, while cooperating with them to construct more empowering cultural stories.
Many people seek professional help when they perceive their story as empty, stuck, or incongruent with their personal experiences. Thus the primary goal of narrative therapists is to help individuals and families construct more satisfying and authentic stories (Anderson and Bagarozzi, 1983; Coulehan, Friedlander and Heatherington, 1998; Nicholas and Schwartz,2006). This process of transformation starts with therapeutic conversation, employs a collaborative approach, defines and externalizes challenges, deconstructs the story's meaning or significance, emphasizes the utilization of strengths, and ultimately generates construction and anchoring of alternative narratives (Anderson and Bagarozzi, 1983; Byng-Hall, 1998; Androutsopoulou, Thanopoulou, Economou and Bafiti, 2004; Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006). A further exploration of these therapeutic techniques is outlined in the following section.
Narrative Approaches and Techniques
First and foremost, the foundation of any therapeutic approach is establishing trust and rapport with the client or family. In the case of narrative therapy, this often starts with listening to and acknowledging client's stories. Listening actively to client's existing family or cultural narratives often sheds light on how they view themselves, how they define their challenges and solutions, and their attitudes towards change (Woodcock, 2001; Freeman and Couchonnal, 2006). While this type of listening may seem simple enough, it requires the practitioner to be aware of their existing preconceptions. Thus, narrative therapists are encouraged to explore their own personal and cultural stories, as well as past experiences, so as to avoid both imposition of their own stories and inadvertent filtering out of the client's relevant narrative details (Coulehan et al., 1998; Woodcock, 2001; Androutsopoulou et al., 2004).
Another significant aspect of the narrative approach is acknowledging the right of the clients to name their challenges and define their own reality. This requires the therapist to adopt a naïve approach to the narrative and indeed to counseling in general, and to allow the client to be the expert. A partnership is formed, wherein client and therapist work together as coauthors in the mutual exploration of perceived problems (Nicholas and Schwartz, 2006). While this effort is collaborative, the therapist acts as the facilitator of the conversation, creating space for new stories and meanings. Some strategies to help clients define their challenges include suggesting that they give their narratives a title to reflect their view of the challenges and themselves, as well as externalization techniques (Woodcock, 2001; Androutsopoulou et al., 2004; Jones, 2004; Freeman and Couchonnal, 2006). Narrative therapists believe that people are not their problems, and the process of externalization helps clients to see that they are less confined by their stories, and to focus instead on experiences providing exceptions to their problems. In using externalization, practitioners may encourage clients to label, objectify or even personify problems, to allow them to be seen as separate entities (e.g. people are not anxious, but overtaken by anxiety) (Coulehan et al., 1998; Woodcock, 2001; Dallos, 2004; Nicholas and Schwartz, 2006). This technique can serve to decrease helplessness, opening up new avenues for change. A second and related technique is that of "mapping" the problem, which involves posing questions that encourage people to determine the degree to which the problem is affecting their lives (Jones, 2004; Nicholas and Schwartz, 2006). Such questions as "How does anxiety create trouble for you?" can lead to an exploration of how clients can exert their own influence over the problem at hand.
The process of deconstructing stories has origins in literary interpretation, wherein deconstructive readings are used as part of a larger interpretive strategy that aims to destabilize cultural hierarchies (Legg and Stagaki, 2002; Boston, 2005). This practice has been adopted by narrative therapists, as a means towards offering alternatives to problem-saturated personal narratives and destructive dominant societal norms (Boston, 2005). Deconstruction is also a necessary prequel to the process of narrative reconstruction - the ultimate goal of therapy. In listening to client's stories, therapists attempt to identify dichotomies, exclusions, exceptions, and hierarchies of characters or voices, as well as possible alternative plots or meanings buried within the narrative (Androutsopoulou et al., 2004; Boston, 2005; Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006). Practitioners may point out their observations to clients with rhetorical or circular questions, such as "What would have to happen to change this story's ending?" (Legg and Stagaki, 2002) or asking them to speak from the perspective of a subordinate voice (Boston, 20055). In effect, deconstruction serves to "read between the lines" of the given narrative to reveal new meanings and initiate the authoring of a new story (Nicholas and Schwartz, 2006).
A strategy used as a part of many therapeutic approaches, seeking out and utilizing strengths, lies at the core of narrative technique (Eron and Lund, 1998; Allison, Stacey, Dadds, Roeger, Wood, and Martin, 2003; Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006). As client and therapist work together to define challenges and deconstruct the story, previously unrecognized competencies and strengths are often revealed. The therapist can bring these so-called "unique outcomes" to the fore by asking about times when the person or family has overcome a particular problem, or when the problem was less noticeable or stressful (Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006). This search for exceptions to the dominant narrative can be difficult, because often clients want to focus on all that is bad, and do not believe they possess strengths or narratives of competence (Jones, 2004). In this case, it may be easier for clients to begin by relating stories about a mentor or public figure who has overcome similar obstacles, followed by speculation as to how this relates to the client's own exception stories (Freeman and Couchonnal, 2006). By identifying exceptions and strengths, the focus of the therapy begins to shift towards the future and creating a new narrative.
Just as culture, history and context may shape a story; stories also have the power to bring about change. Narrative therapists can help clients to recognize and reaffirm their abilities to author their own lives, and can assist them in this process by helping to develop alternative meanings and interpretations of existing and exception narratives. A new story is built around what strengths and meaning say about the nature of the individual or family unit, that is, determining how the new story reflects not only what the family is, but what it wants to be. The anchoring of this new story can be accomplished by reframing a situation or offering different versions to the client for consideration, which provides clients with new options for problem solving and healing (Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006). Individuals and family members can be encouraged to enact new behaviors within the therapeutic session,
and to reinforce them on their own time through homework such as journaling and developing rituals (Woodcock, 2001; Jones, 2004; Freeman and Couchonnal, 2006; Nicholas and Schwartz, 2006), or by interacting with other people in their lives who can authenticate the new story (Eron and Lund, 1998; Freeman and Couchonal, 2006; Nicholas and Schwartz, 2006). The therapist can also serve to reinforce new stories by providing a summary for the client of what has transpired in the therapy, either verbally or in the form of a letter (Nicholas and Scwhartz, 2006).
The flexibility of narrative therapy is one of its greatest strengths, allowing it to be employed in concert with other therapeutic approaches and with diverse client populations. Narrative approaches have been used in combination with attachment theory (Byng-Hall, 1998; Dallos, 2004), family systems models (Woodcock, 2001; Dallos, 2004), strategic therapy (Anderson and Bagarozzi, 1983) and even solution-focused modalities (Freeman and Couchonnal, 2006). It has been shown to be effective with individuals and families, and is being adapted for use with groups (Jones, 2004). Narrative strategies can be combined with play and art therapies to treat self-esteem issues and improve coping skills in children and adolescents (Wood and Frey, 2003). Certain contraindications for the use of narrative therapy are supported by the literature, for example, in the case of clients with brain damage, mental retardation, or episodic psychosis (Freeman and Couchonnal, 2006).
Perhaps narrative therapy's greatest limitation is the difficulty in assessing its effectiveness: How does one measure the transformation of a personal story? As such there is limited research to support the usefulness of narrative therapy with individuals and families. However, some narrative theorists and clinicians have recently begun exploring the concept of coherence as a criterion by which to evaluate client progress (Byng-Hall, 1998; Androutsopoulou et al., 2004; Dallos, 2004). In this context, coherence refers to the more quantifiable aspects of a narrative, such as linearity, consistency of plot, relevance, and the lack of contradictory statements, all of which have been shown to increase or improve with clients undergoing narrative therapy (Androutsopoulou et al., 2004). Much of the coherence work has evolved from research based in attachment theory, which has provided some reproducible data showing that adults who can tell coherent stories about their childhood experiences with their parents are more likely to raise children who are more securely attached (Androutsopoulou et al., 2004; Dallos, 2004). In addition, the leading narrative theorist John Byng-Hall has used various clinical examples to illustrate the benefits of helping family members to tell more coherent stories (Byng-Hall, 1998). These researchers propose that assessing client's stories using the coherence criteria could help practitioners to detect areas of narrative incoherence that may serve as jumping off points for therapy, as well as allowing both therapists and clients to monitor and
discuss how the narratives are transforming throughout the process.
Although I had never been exposed to the theories and techniques of narrative therapy prior to this summer, I have always been drawn to post-modern and social constructionist philosophies. Science works within popular models and theories, yet it is widely acknowledged that scientific progress is often made by those individuals who reject the popular dogma and think outside the box. Thus as a research scientist, I felt that deconstructing dominant scientific paradigms was an essential part of my job, but I frequently experienced situations where the same data could be interpreted in multiple ways. While debating experimental results lies at the heart of scientific discovery, I often found it frustrating that so many scientists would claim their work to be evidence of an absolute truth. To my mind, scientists build stories as much as any scholar in the humanities; demonstrated most significantly by historical hindsight: few now believe that the sun circles the earth, despite daily observations suggesting it is so! Although almost any scientist would admit as much, there is little tolerance for this type of thinking in the scientific field at large, aside from scientific historians and philosophers. For modern science to progress, the concept of an "absolute truth" must be perpetuated.
Narrative therapy embraces the concept of relative truth, yet also employs the very scientific strategies of exploration, observation, and the gathering of evidence to support or refute the dominant narrative. This approach comes very naturally to me, as does the collaborative nature of the narrative therapeutic interaction. I like the premise of accepting clients as experts on their own stories, as opposed to viewing them as helpless and lost, while still being able to offer them my own expertise in helping them understand how their story has affected their behavior and relationships. And because neutrality and objectivity are not considered useful (or even possible) within a social constructionist paradigm, narrative therapists are given permission to voice their opinions, favoring and giving credence to one version of a client's story over another. When appropriate, narrative therapists are also encouraged to disclose their own stories. As a person who is full of her own stories and opinions, I feel I would be much more comfortable acting in this capacity than in the role of an authoritative or persistently neutral therapist, one whose job is, in the Rogerian tradition, to primarily reflect the statements and feelings of the client. I find it useful and validating when someone tells me a personal story that relates to my own situation, and I would welcome the opportunity to judiciously provide this service to my clients. I also appreciate that narrative therapists seek to highlight their client's strengths and help them to externalize their problems, while still emphasizing the personal responsibility that each person has for authoring and assigning meaning to his or her story.
Finally, I appreciate that narrative therapy makes a deliberate effort to consider the role of society and the dominant culture in how people view themselves and their lives. I have felt the pressure of societal norms at many points in my life, and know firsthand how powerful an influence they can be. The most obvious of these centered on my career in science, a role that society has yet to truly accept for women. Almost every woman scientist I know struggles with pressures from scientific society, which requires absolute and unflinching dedication, and mainstream culture, which demands that women be consummate wives and mothers. Faced with these competing value systems, it can be very difficult for women scientists to recognize their desires and set their own life course. Interestingly, I encountered an unexpected cultural conflict when I chose to leave research science and pursue a career in counseling. While it is common for women to leave science to raise children, it is unusual for them to pursue a different career entirely. In fact, it is unusual for anyone - male or female - to leave a science career at the point I did and embark on a new path. The dominant story in scientific society is "The only people who leave science are the ones who are not successful." Thus my dilemma was compounded by the fact that I was actually good at what I did, and many people in my field of research could not understand how I could walk away from grants and job offers in academia. For a long time, it was hard for me to understand it, too. I had been pursuing an academic science career for 15 years, and had allowed myself to become convinced that it was what I wanted. Even when I became desperately unhappy, I still clung to the story that I would be a scientist, aided by the encouragement of the culture to which I belonged. When I finally left, knowing I had made the right decision, I temporarily lost my identity. One year later, I am still in the process of building a new story for myself, one that can integrate my past career with my new aspirations. I feel that as a narrative therapist, I would have a personal understanding for those clients who are struggling with the influence that cultural and societal norms have played in their lives.
Case Study (hypothetical)
Marie is a 42-year old woman who reports free-floating anxiety, periods of dissociation, and frequent crying spells. She experiences insomnia and often takes long naps during the day. Marie says that while the symptoms have been present for four years, they have recently increased in frequency and duration and are becoming incapacitating. Marie is a widow: her husband and father of her children, John, was a firefighter who was killed in the World Trade Center attacks of September 11, 2001; his body was never recovered. After 9/11, Marie quit her job as an elementary school art teacher to concentrate on raising Alex. The family currently lives on life insurance and compensatory payments from John's fire department. The oldest child, Steve (17), is responsible and shows great concern for his mother; however, he gets into frequent fights at school and with his sister Marybeth (15). Marybeth has few friends, spends much of her free time at home, and frequently takes care of Alex (6) after school and on weekends, while her mother sleeps. Marie has been taking prescription medication for depression since March of 2002. She does not drink, and reports that the family has no history of using drugs or alcohol.
When listening to the family stories, it becomes apparent that they are still struggling with unresolved grief surrounding John's death. Marie says that she had belonged to a 9/11 widow's group, but stopped attending because she "didn't have time" and felt she "didn't belong." Marie channeled much of her energy caring for her children, and took great effort to ensure that they rarely saw her grieving. With the help of Steve, she has put most of the family photos and movies into storage, along with her husband's clothes. She calls Steve and Marybeth the "rocks I hold on to", and praises their courage and commitment to the family following their father's death. However she now finds it increasingly difficult to "keep it together." Marie feels that her symptoms are preventing her from being a good mother to her three children. Steve is somewhat obsessed with 9/11. He has read many books about the tragedy and conspiracy theories surrounding it. He gets very agitated and opinionated whenever the topic of 9/11 is raised; and although this has led to arguments with friends and family members, Steve says that he "owes it to my father" to "spread the truth about what happened." He idolizes his father as a hero, who taught him to "be strong" and "to be a real man". Although only ten when her father was killed, Marybeth recounts vivid memories of her time with him. Shortly after 9/11, she made a small shrine to her father in her room at home. She says she frequently "talks to my dad" and keeps a journal about 9/11 and the memories of her father, but doesn't share them with her brother or mother. Marybeth is frustrated at what she calls the "lack of caring" on the part of her brother and mother concerning John's death; she feels that they have "forgotten him" and that she is the "only one who still cares." She gets angry when people refer to her father as a hero; to her, his death was "a waste" because he was unable to save anyone - this is a source of friction between her and her brother.
The members of this family have used very different ways of dealing with the events of the past five years. There are many layers to their story, and I feel that the personal tragedies of losing a husband and a father have in part been obscured under the more public story of 9/11. The fact that John was a fire fighter adds another layer of cultural mythology to the narrative, and the lack of a body to bury has left part of the story unfinished. My goal with the family is to help them uncover the personal stories of loss that are currently buried by public myth and their individual grief processes. For Marie, the challenge is to help her build a personal narrative of a woman grieving the loss of her life partner, as opposed to the "9/11 widow" with the "hero husband." Steve feels that he is following in his father's footsteps by not expressing his grief, instead channeling it into anger and intellectualism; he would benefit from a new story in which he is a son and a brother, not just a replacement father who must always be strong. While Marybeth has addressed her loss, she should recognize she is not the only one who misses her father, and that she need not continue carrying the family's grief. Finally, John's death should be acknowledged by all, so the family can recognize a shared loss and help one another to grieve.
The public mythology surrounding 9/11, and the heroism of the fire fighters who died at the WTC creates a conflict for those wanting to commemorate a personal loss that is simultaneously becoming an historical event. As the five-year anniversary of 9/11 approaches, the event becomes a primary media target, making it very hard for victim's families and friends to avoid. This may in part explain Marie's increased depression and anxiety in recent months. I would use deconstruction techniques to help this family separate the public tragedy from their personal grief. I want to help the family to write the story of their father and husband, apart from his larger-than-life role as a 9/11 hero. Marie and Steven in particular need to acknowledge their personal losses, which in turn may help Marybeth to feel that she is not alone in her grief. Asking questions to elicit stories about John as a regular human being, father, and husband, as opposed to a firefighter, a hero, or a part of American history, would be one approach that I would take.
Ultimately, my desired outcome in working with this family is to help them author a new family story that personalizes their losses, allowing them to grieve and begin healing. Grieving is complicated when there is no body to bury, as it leaves unanswered questions and no designated grave or memorial. Thus as a way to anchor their nascent story, I would encourage the family to create some sort of ritual to commemorate John's death, allowing every member to have creative and emotional input. They may make a small shrine in the house, or plant a tree in a park, but the point is for them to work together to create a personal memorial that can serve as a sacred place for grief and contemplation. In this way, they not only build a story that honors the memory of their husband and father, but also create something new together as a family unit; this shared experience will hopefully serve to strengthen the emerging family narrative.
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