Psychotherapy - The Stories of our Lives
by Susan Varughese
Katie is 16 years old and a victim of 'anorexia nervosa'. She is at the Child and Adolescent Mental Health Clinic in Norway for consultation with Geir Lundby.
Geir begins the conversation by asking her, "What is anorexia trying to make you believe about yourself? What are the tricks it uses on you?" Encouraged by these unusual questions, Katie confides to Geir that she has been hearing voices in her head that make her stay away from food. She went on to identify these voices as Satan's Voice, calling it a death voice. What about her own voice? "Jesus's voice," standing for the life force. Geir asks what is important or precious to her. Katie talks of her love for her family - her nephews and nieces, her belief in Jesus, the church congregation, her friends and her desire to get back to her friends. Katie also talks of her walks in the woods.
Sensing Katie's desire to live and its redeeming possibility, Geir asks her for exceptions or occasions when she has taken any initiative to out-trick Satan's Voice. Katie talks of eating a hot dog for lunch. "What kind of initiative is it?" "A little miracle," says Katie.
Narrative therapy is a uniquely empowering and holistic approach to healing. Its therapeutic process guides one on an introspective journey through skillful questioning of one's life for simple truths as well as for answers to deeper questions of one's existential meaning.
I attended three narrative therapy workshops between December 2005 and August 2006. All these workshops were organised by Mumbai-based psychiatrist, Dr.Dayal Mirchandani, and his artist-wife, Anjali Mirchandani, in collaboration with Dulwich Center, Adelaide, Australia. The first workshop in December was conducted by Mr.John Stillman of Kenwood Therapy Center, USA, the second in February by Mr.Geir Lundby from The Center for Child and Adolescent Mental Health, Norway, and the third, also the most recent, by MS.Maggie Carey of Australia.
Narrative therapy was developed by Michael White of Australia and David Epston of New Zealand. Narrative ideas have come from literary sources, from the work of French philosopher Michel Foucault, Jerome Bruner and Russian learning theorist Votosky. Story is intrinsic to narrative practice - stories of people's lives, their experiences. White says people are interpretive beings and that they interpret their experiences all the time. Stories convey the meaning of our lives, experiences that shape truths we come to believe, our belief systems and our identity. We are multi-storied. There are many stories in people's lives and many stories that happen simultaneously.
The therapeutic inquiry begins with naming the problem, its history and context, followed by its effects and consequences on a person's life and his relationships. This is followed by questions to the client for evaluation of his actions and its justification.
The first concept we were introduced to is called Externalizing conversation. To understand this, we needed to familiarize ourselves with its premise - a problem is separate from the person or, as NT practitioners, would say, "the person is not the problem, the problem is the problem."
It is common practice for people with problems to make them a part of their identity. For instance, a person suffering from depression will often refer to himself as a 'depressed person'. As Alice Morgan explains, "Externalizing practice in contrast to internalizing practice locates problems not within individuals, but as products of culture and history. Problems are understood to be socially constructed and created over time." Externalizing conversation creates space or distance between the problem and the person, liberating him from blame, guilt and shame. According to Geir, it raises hope and new strength and patients are more cooperative and articulate. His conversation with Katie, shown above, is an example of an externalizing conversation. It is completely free from blame - an NT virtue. There is no advice from Geir, either. The therapist is not the expert here. Therapists are influential in the way they get the client to think about his problem and in the language they use.
With children, personifying a problem works very well. Their imaginary world is very real for problem-solving. Geir Lundby shared this example of a four-year-old who came in with the problem of soiling her pants. Geir externalized the problem through creating an imaginary friend, Winnie the Pooh, who is responsible for having put ideas in the child's head that resulted in her soiling herself. Pooh in the toilet is not trustworthy. She is sneaky and so what did such a friend deserve? She deserved to be tricked back. And it worked.
As part of group exercise in all the three workshops, we worked in triads or pairs, practicing externalizing conversation. It seemed odd at first to use problems as nouns or to personify them. But soon, we discovered how much easier it was to open up. It was also less inhibiting, and insightful to list the strategies and tricks our specific problem played on us. And as we shifted gear to explore the exception or how we may have out-tricked the problem, we were witness to our capacity to transcend what seemed all-too-overpowering. I remember I relaxed for the first time and smiled - a new optimism was born. My problem was no longer etched in stone for posterity.
What makes up a story?
o Over time
o Theme or plot that weaves or connects.
The first part of a therapeutic inquiry will focus on the problem story. It does not end here. NT believes that the problem story is not the only story. There are other stories of significance, stories of value and self-worth. NT leverages alternative stories or preferred story to work its empowering magic on the healing process. Narrative therapists call this rich story development, or re-authoring conversations.
Geir shared this story from Michael White's practice. Peter, a young boy in his teens, is brought for consultation for his aggressive behavior. Peter's mother is a battered wife, a victim of her husband's violent abuse. In the course of one such violent episode, Peter threw a brick across the window, shattering it. Peter throwing the brick is the action. What is its meaning? Peter's mother's interpretation of the event was that Peter showed courage in throwing the brick. He loved her and risked his own safety to help his mother. Michael White invited her to share more stories. His mother shared the story of Peter sharing his lunch with three other kids at school, an act of compassion and kindness. Another story followed of Peter being trustworthy, as he carefully safeguarded his cousin's secret of having been sexually abused. All this was a complete surprise to Peter, who was conscious only of being a bad boy. His mother's stories helped him to recognize the good side of himself.
Problem stories inhibit and limit a person's capacities and blocks initiative. Alternative stories empower and uplift one's spirit. According to Alice Morgan, "As clients live out and inhabit alternative stories, results go beyond problem-solving. People live out new possibilities, new self-images and new futures."
For rich story development, another narrative practice is the exploration of intentions, purposes, values, beliefs, hopes, dreams, commitments and vision. Our intentions make our identity. The preferred story is the intentional part of us, what is important in our lives. With intentions at the center of his life, the client is at once placed as the one who is most knowledgeable about himself.
In all the three workshops, we again worked in triads to practice the intentional state. Here again, we worked on real problems. This was tough. I realized how much practice is needed to take this conceptual understanding to skilled inquiry and rich story development.
I have come to respect and greatly admire narrative therapy. The approach of using concepts, clinical examples, followed by practice sessions, made for very good learning in all the three workshops. I sat mesmerized throughout, as I listened to their language and cases, (especially Geir Lundby whose eloquent and lyrical words had the flourish of a poet). Their dramatic stories inspire me to practice narrative therapy.
Subject: 16 years unknown sick - 22 September 2011
Some say depression,anxiety disorder, panic disorder and nervous disorder.I get bore with doctors and medicine do nothing, pls help me. no smoke, no drink, no meat eating. only vege.
Subject: Dermatoglyphics Multiple Intelligence Analysis - 15 September 2011
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by: Manoj Ranadive
Subject: is there any more article or link - 21 December 2009
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Subject: narrative psychotherapy. - 14 October 2008
Read your article on narrative psychotherapy. Very much interested in knowing the technique and learning it. I work in an NGO and feel that it would be very effective in treating aggression and depression in youth. would like to know more about this.
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