Describe a therapeutic approach of your choice in terms of key concepts and therapeutic process.
The use of Narrative Therapy
Describe a therapeutic approach of your choice in terms of key concepts and therapeutic process.
Also explain how this approach contributes to your self understanding.
Describe the ethical and multicultural relevant issues.
TABLE OF CONTENTS
TABLE OF CONTENTS 2
INTRODUCTION 4
2 THE CONTEXT OF NARRATIVE THERAPY 4
3 KEY CONCEPTS OF NARRATIVE THERAPY 5
3.1 The narrative metaphor 5
3.2 Social constructionism 5
3.3 Post-modernism 6
3.4 Post-structuralism 7
4 THE THERAPEUTIC PROCESS 7
4.1 A re-authoring therapy 7
4.2 Telling the problem-saturated story 7
4.3 Naming the problem 7
4.4 Externalising discourses 8
4.5 Deconstructing dominant discourses 8
4.6 Constructing Positive Alternatives - Unique Outcomes 8
4.7 Taking a position on the problem 9
4.8 Re-telling the new story 9
4.9 Audiences 9
4.10 Therapeutic documents 10
4.11 Ending therapy 10
5 THERAPEUTIC GOALS 10
5.1.1 Re-authoring of a problem-saturated life story 10
5.1.2 Privileging family members 10
5.1.3 Creating a safe space 10
6 THERAPIST'S FUNCTION AND ROLE 11
7 CLIENT'S EXPERIENCE IN THERAPY 11
8 RELATIONSHIP BETWEEN THERAPIST AND CLIENT 11
9 A CONTRIBUTION TO MY SELF UNDERSTANDING 12
9.1 My thin and problem-saturated story 12
9.2 Externalising the problem 12
9.3 Unique Outcomes 13
9.4 An audience 13
9.5 Retelling my new story 13
0 MULTICULTURAL ISSUES 14
1 ETHICAL ISSUES 15
2 CONCLUSION 15
3 REFERENCE LIST: 16
INTRODUCTION
The therapeutic modality I have chosen is Narrative therapy because I find it to be a useful approach that is not directive and instrumental, but is rather an attitudinal collaborative approach that influences a therapist's way of being. This approach does not lend itself to any specific techniques in the counseling process but makes use of a wide variety of methods of intervention to assist the individual in need.
According the narrative metaphor we all make sense of our lives through stories or self-narratives. At times our self-narratives may be thin or self-limiting and a re-authoring process may help us to remember forgotten parts of our narratives as we re-tell our new thicker self-story.
In this assignment I will explain the narrative metaphor as an approach to counselling and discuss the key concepts underlying it and the therapeutic process of narrative therapy. I will also discuss how the narrative metaphor contributed to my personal growth and self-understanding, the potential use of this approach at Crescent Clinic where I spent time, and the multicultural and ethical issues surrounding this approach.
2 THE CONTEXT OF NARRATIVE THERAPY
In order to explain the process of Narrative therapy it is helpful to briefly place it in the context of a paradigm shift that began in the 1950s. Several writers have contributed to this "new epistemology" which has "a common foundation in the writings of Gregory Bateson" (Searight & Openlander, 1987, p.52).
The movement has progressed through several waves. The first wave was a move away from pathologising the individual to focusing on relational "patterns that connect" (Bateson, 1979) within a system. This was a recursive process where positive and negative feedback loops maintained the stability of the system as it resisted change. Symptoms were perceived as communicating a message (Haley, 1963 Minuchin, 1974, 1981; Watzlawick, Weakland & Fisch, 1963) that a system required a change in structure (Minuchin 1974, 1981) or a change in relational dynamics (Haley, 1963). The therapist intervened in the system in a directive and instrumental way as one proffering expert knowledge and experience. This first order cybernetics (or simple cybernetics / engineering cybernetics) offered much excitement as therapists engaged in a new way of doing therapy that presented striking results with little or no insight necessary on the part of the identified patient.
A recognition that the pathology had been moved from the individual to the family (Hoffman, 1985, 1998) resulted in a second wave where the therapist was perceived as part of the system. Here one cybernetic system was recognised as observing another cybernetic system as well as the fact that the very act of observing changed the observed. This second order cybernetics (or cybernetics of cybernetics / biological cybernetics) was much less directive, to the extent that it was at times criticised as irrelevant. The focus was on how people constructed their realities.
A third wave moved away from the mechanistic model of cybernetics to a more hermeneutic or interpretive model (Anderson, 1997; Anderson & Levin, 1998) considering the metaphors of narrative and social construction (Freedman and Combs, 1996; Anderson & Levin, 1998) in the process of meaning making. It is here that narrative therapy falls. Umpleby (2001) terms this social cybernetics. Where a first order cybernetic model favours realism and suggests that reality can be known out there and a second order cybernetic model considers that reality is socially constructed and that no objective reality can be known, rooting this belief in neurophysiology in line with the radical constructivism camp, social cybernetics adopts interactional constructionism (O'Hanlon, 1993) or social constructionism (Gergen, 1985) which recognises how people create and maintain and change their reality through language and the story telling of for example narrative therapy. Here the paradigm has once again shifted - from system to story (Freedman & Combs, 1996)
Michael White and his colleague David Epston are recognized for exploring the narrative metaphor under the umbrella of narrative therapy albeit they are humble in taking credit for it. This writer is aware of the fact that she will present a narrative within this missive that is her own understanding (and hopefully not too much of a misunderstanding) of the writings of White and Epston (White & Epston, 1990; Epston, White & Murray, 1992; White, 1995; White, 1997)). In addition she will present her understanding of others (Payne, 2000; Freedman & Combs, 1993, 1996; Vorster, 2003; Corey, 2001) that have engaged with White and Epston's writings as well as related their own insights and experiences while engaging with this metaphor.
3 KEY CONCEPTS OF NARRATIVE THERAPY
There are several key concepts that inform narrative therapy. The two most import concepts are the narrative and the social constructionist metaphors. Post-modernism and post-structuralism also merit attention.
3.1 The narrative metaphor
nar·ra·tive n.
. A narrated account; a story.
2. The art, technique, or process of narrating. (www.dictionary.com)
Drawing on the works of the social scientists Jerome Bruner and Clifford Geertz (1983, 1986 cited in Freedman & Combs, 1993), White (1990) used the text analogy and compared it to a life story or "self narrative" (Gergen & Gergen, cited in White, 1990) in the therapeutic discourse. Bateson (1972, 1979) believed that people make meaning of their lives by situating events in stories. White has expanded this belief within the narrative metaphor by contending that people can change the stories of their lives by recognising the dominant discourses that do not fit with one's current story.
In narrative therapy the therapist and person with a thin narrative, known as a client or patient in dominant therapeutic discourses, work collaboratively to thicken 1 or create a richer narrative in the process of re-authoring their history or life narrative.
"Stories are full of gaps which persons must fill in order for the story to be performed. These gaps recruit the lived experience and the imagination of persons. With every performance persons are re-authoring their lives" (White, 1990, p. 13, emphasis mine)
3.2 Social constructionism
So cial con struc tion ism n
in sociology, a school of thought pertaining to the ways social phenomena are created, institutionalized, and made into tradition by humans (www.dictionary.com)
The metaphor of social constructionism (as previously mentioned also known as interactional constructionism) directs us to regard the way that our realities and sense of meaning are constructed in interaction with one another. Social constructionism holds that "knowledge rests heavily on social consensus. Our social experiences and interactions shape what we take to be reality and what we regard as truth" (Hare-Mustin & Marecek, 1997, p.105).
Particular institutions such as language contribute to the creation of meaning in our lives. Humberto Maturana said "we distinguish in language. What we don't distinguish doesn't happen to us." (n.d). Gergen (1985) referrs to "communal interchange" (p.266). Thus, reality is socially constructed and language is used to achieve this (Hare-Mustin & Marecek, 1997; Hoffman, 1992; Vorster, 2003). Language is understood "as the means by which people come to understand their world and in their knowing simultaneously to construct it" (Becvar & Becvar, 2000, p. 88, emphasis mine).
This metaphor is integral to narrative therapy as we use language to tell our problem-saturated story, unique outcomes and our new rich narrative.
The social constructionist therapist:
* Believes in a socially constructed reality.
* Emphasises the reflexive nature of the therapeutic relationship in which client and therapist co-construct meaning in dialogue and conversation.
* Moves away from the hierarchical distinctions toward a more egalitarian offering of ideas and respect for differences.
* Maintains empathy and respect for the client's predicament and a belief in the power of the therapeutic conversation to liberate suppressed, ignored, or previously unacknowledged voices or stories.
* Co-constructs goals and negotiates direction in therapy, placing the client back in the driver's ...
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The social constructionist therapist:
* Believes in a socially constructed reality.
* Emphasises the reflexive nature of the therapeutic relationship in which client and therapist co-construct meaning in dialogue and conversation.
* Moves away from the hierarchical distinctions toward a more egalitarian offering of ideas and respect for differences.
* Maintains empathy and respect for the client's predicament and a belief in the power of the therapeutic conversation to liberate suppressed, ignored, or previously unacknowledged voices or stories.
* Co-constructs goals and negotiates direction in therapy, placing the client back in the driver's seat, as an expert on his or own predicaments and dilemmas.
* Searches for and amplifies client competencies, strengths, and resources and avoids being a detective of pathology and reifying rigid diagnostic distinctions.
* Avoids a vocabulary of deficit and dysfunction, replacing the jargon of pathology (and distance) with the language of the everyday.
* Is oriented toward the future and optimistic about change.
* Is sensitive to the methods and processed used in the therapeutic conversation.
(Hoyt, 1998, p.3)
3.3 Post-modernism
post·modern·ism n.
postmodernism n : genre of art and literature and especially architecture in reaction against principles and practices of established modernism (www.dictionary.com)
Narrative therapy is a post-modern approach, which deconstructs all prior assumed knowledge and points out the inadequacies of any "objective knowledge" such as psychiatric nomenclature or any truths that I may have internalised as a therapist and wish to impart to my clients, whether this is done unwittingly or not.
Within the narrative metaphor one maintains "an awareness of choosing one's ways of knowing" (Griffith et al, 1992, p. 11) and recognises that the modernist assumptions that knowledge is objective and fixed or that universal truths and objective reality exist are not necessarily true. These notions are replaced by the acknowledgment that post-modernism "offers alternatives to many of the long held modernism-based assumptions and enshrined traditions of psychotherapy theory and practice, including problems and symptoms such as dysfunctions, language as representational, the therapist as the knower and curer, the client as an independent object, the notions of a core self and a reflective mind, and the education of therapists" (Anderson, 1995).
3.4 Post-structuralism
post·struc·tur·al·ism n.
Any of various theories or methods of analysis, including deconstruction and some psychoanalytic theories, that deny the validity of structuralism's method of binary opposition and maintain that meanings and intellectual categories are shifting and unstable. (www.dictionary.com)
An unequal balance of power is created by the way we use language if that language is used in a way that excludes, objectifies or marginalizes others (Foucault, 1992). White is particularly careful to use language in a way that is inclusive in the spirit of post-structuralism and engage in terms of description that are not the taken-for-granted terms when it come to the lived experience. For example rather than say that someone "lacks self-esteem" which is a term loaded with meaning from overuse, White talks about a "thin description" and instead of saying that work is "self-fulfilling", White talks of "work that is more richly describing of a person's knowledges and skills of living" (1997, ix).
The writer has adopted White's language in the course of this writ in order to be congruent. I note that White is unhappy with the use of the terms therapy and therapeutic conversation, but offers no alternative for them (1997, x).
4 THE THERAPEUTIC PROCESS
4.1 A re-authoring therapy
In the re-authoring process a new narrative or self-story emerges: one with a past, present and future - that is a complete narrative emerges (Vorster, 2003).
Several narrative practices exist which can be used as part of the therapeutic conversation (a term borrowed from Andersen & Goolishian, 1992), however it is not necessary that each of these practices exist in any one session or that they exist in the following prescribed sequence, or that they contribute to each session at all (Payne, 2000).
4.2 Telling the problem-saturated story
The therapeutic process begins with the telling of the (often) problem-saturated story in a safe, uninterrupted space. The therapist listens to the story and accepts it, but recognises that this is a thin narrative and is unlikely to be the complete or only story. This recognises that the initial story usually excludes some forgotten or unnoticed elements of the lived story.
Once the initial story has been told the therapist asks the person to expand on their story by asking expanding questions. Together they remember an initial version of the story.
4.3 Naming the problem
Whilst encouraging the person to expand on their narrative, the therapist will ask them to name the problem that is experienced as oppressive. If the person is not able to come up with names on them own the therapist may suggest options such as depression, stress or "Sneaky-Poo" (White & Epston, 1990) until a name is provisionally agreed upon. This may change after further clarification provides a more precise description of the problem. Naming the problem will contribute to the process of externalising the problem.
4.4 Externalising discourses
Externalisation is an approach to therapy that objectifies or personifies the named problem. Therapy enables the person to see the problem as something outside of themselves, "as something that can be resisted rather than an essential feature of themselves" (Epston & White, 1995, 342)
The therapist uses language that the problem is "having an effect on" rather than being intrinsic to or existing within the person. By externalising the problem and looking at its effects, the focus moves away from blame and accountability of the individual: "the person is not the problem - the problem is the problem" is a well quoted maxim of narrative therapy.
"Externalising conversations have the effect of deconstructing some of the "truths" that persons have about their lives and about their relationships - those truths that people feel most captured by" (White, 1995, p.42).
Externalising language is not used in the context of abuse. Abuse and violence are named as such: "he abused you for a long time" or if the person themselves is an abuser "you abused her over a long period". Externalising language may be used to describe beliefs and assumptions used to justify the abuse: "You were dominated by a belief that violence is acceptable" (Payne, 2000, p 12).
4.5 Deconstructing dominant discourses
"Dominant discourses constrain and enable the personal construction of meaning in particular, predictable ways, without, however, restricting the individual's choice of what to narrate or how to word the account" (Talbot, Bibace, Bokhour & Bamberg, n.d).
These dominant discourses are powerful and tend to be accepted by people and societies as if there are no alternatives. Dominant discourses in many societies perpetuate patriarchy, marginalise those who are not hetero-sexual, and exclude non-Western religions. Many members of these communities accept these exclusions as part of their personal narratives, without any realisation that these discourses are not helpful. For example women allow themselves to be subjugated without reaching out for alternatives or anorexics buy into the dominant discourses of the post-Twiggy era. These dominant discourses can be explored and deconstructed within the therapeutic process in order to see how they are maintaining the problem-saturated story. Narrative therapists are also asked to remain vigilant against the more subtle manifestations of dominant cultural beliefs.
4.6 Constructing Positive Alternatives - Unique Outcomes
In the process of telling a narrative, the therapist might notice aspects or significant memories which contradict the problem-saturated dominant story. White uses the terms 'unique outcomes' 2 to describe these aspects of the story that seem to deny, refute or challenge the dominant problem-saturated story. The therapist asks expanding questions to focus on how these unique outcomes do not fit with the initial story. This deconstruction paves the way for a wider outlook of the life experience and a new richer story to be cemented in place.
The problematic story has advantage of having been around for a while and dominating a person. The problem has a plot which "has the audacity to inform a person about himself in a summary way: who he is, who he has been in the past, and who he might be" (Freeman, Espston & Lobovits, 1997, p. 95). By thinning this plot and juxtaposing it with the process of thickening the counterplot: a positive alternative to the problem-saturated story emerges. The alternative story's counterplot is discovered by questions and comments that reveal the relative influence of the problem on the life of the person as well as the influence of the person on the life of the problem. This process highlights special abilities that the person has, unique outcomes, times when the problem did not overwhelm them when it could have, times when they were stronger that the problem.
4.7 Taking a position on the problem
Once the person has told their initial problem-saturated story, expanded on it and come to recognise some of the unique outcomes within the process of enriching the narrative, they are in a position to hold on to the problem-saturated story that has dominated their life or they can choose to fully embrace the richer account of their narrative that they have come to tell in the process of therapy or thicker counterplot. There may be many reasons for not challenging the initial problem-saturated story - it may be too strong or it may be too soon and the person may still need to explore the alternatives. Once the person chooses to embrace this new view of themselves and the problem they continue to tell the story.
4.8 Re-telling the new story
The continued therapeutic process is all about telling and re-telling the new narrative until it becomes a viable alternative.
Principals of telling and re-telling in order to allow the enriching of the evolving self-story include:
* Telling them to a variety of people in addition to the therapist
* Hearing their stories reflected back to them in ways which demonstrate others' interest, respect and wish to understand
* Telling them again to other audiences
* Hearing the stories as perceived by this audience
* Continuing to re-tell and re-hear, re-tell and re-hear.
(Payne, 2000, p 163)
4.9 Audiences
According to the narrative metaphor, normal people achieve a sense of legitimacy when they make claims about their lives relating to their self-narrative and more importantly, when these claims are witnessed by themselves or others (White 1993). Thus, when persons hear themselves tell their story they are able to consolidate their narrative identity.
Part of the therapeutic process might include the identifications of others who may be able to "participate in the acknowledgement of the authentication of this (new) version" (White, 1993, p25). When this might be particularly difficult the person might recruit those who are least inaccessible to this new view, as in my case with a long illness resulting in social withdrawal it was easier to recruit new friends to authenticate my new life story. Alternatively, White and Espton (1990) give the example of Freddie, the mischief-maker who has decided to abandon his mischief lifestyle; they wrote a letter on his behalf to members of the community to vouch for his integrity as a non-mischief-maker.
Outsider witnesses Payne p 161
4.10 Therapeutic documents
This writer is particularly enamoured with the idea of therapeutic documents. Various documents can be used in the therapeutic process to represent, even celebrate, the new story.
As mentioned above, therapists wrote to the community as an audience to vouch for Freddie's integrity as a do-gooder. Various formats can be used: letters, certificates, contracts, lists, essays or statements. The therapist may write the document alone or may write it in collaboration with the person in therapy.
"Their use as a device for consolidation is based on recognition that the written word is more permanent than the spoken word and, in Western society, carries more 'authority' - here, the authority of the person" (Payne, 2000, p 15)
4.11 Ending therapy
The therapeutic process ends when the person decides that their self-story is rich enough to sustain their future. Epston and White (1995) consider this to be a rite of passage and not a loss as the dominant psychotherapy model does, but is rather the final session is a happy occasion which may include a ceremony or the presentation of a therapeutic document. It will include the final re-telling of the new viable self-story.
5 THERAPEUTIC GOALS
Narrative therapy is not directive in its attempts to achieve resolve and it is not instrumental in that there is a unique outcome for each individual and each person achieves their own unique life story.
5.1.1 Re-authoring of a problem-saturated life story
The therapeutic goal is to re-author the life story within the narrative metaphor. "There is concerted effort on the part of the therapist to privilege family members as the primary authors of these alternative stories" (White, 1995, p.66).
The goal of narrative therapy is to re-author the whole story. The result is a richer story with a past, a present and a future - it is a complete narrative that emerges (Vorster, 2003).
5.1.2 Privileging family members
The narrative metaphor maintains "an awareness of choosing one's ways of knowing" (Griffith& Griffith, 1992, p. 11). "There is concerted effort on the part of the therapist to privilege family members as the primary authors of these alternative stories" (White, 1995, p. 66).
5.1.3 Creating a safe space
Here the focus is not on specific techniques, but rather the goal is to create "a context for change" rather than the first-order approach of "specifying the change" (Hoffman, 1985, p. 393).
6 THERAPIST'S FUNCTION AND ROLE
The therapist's function is to create a collaborative space where the therapeutic conversation can take place. Here the focus is not on specific techniques, but rather the goal is to create "a context for change" rather than the first-order approach of "specifying the change" (Hoffman, 1985, p. 393).
A Narrative Therapist maintains "an awareness of choosing one's ways of knowing" (Griffith& Griffith, 1992, p.11) The therapist is responsible for creating an atmosphere of curiosity, openness and respect. Griffith & Griffith (1992) talk about the difficulties trainees feel when trying to practice narrative therapy in that it is not a technique that needs to be applied, but an attitude that recognises that "a therapist must choose wisely those ideas supporting the emotional posture that will organise his/her ways of knowing in therapy" (ibid, p 8)
7 CLIENT'S EXPERIENCE IN THERAPY
Once the person has shared their problem-saturated story, they begin to expand on this narrative and in the process of telling and re-telling their story, re-author this story. The therapeutic process focuses on various ways of telling the story - naming the problem, externalising the problem, looking at unique outcomes, constructing alternative possibilities and aligning with the positive alternatives that fit with their new view of themselves.
Therapeutic letters may be used by the therapist as a way to focus on unique outcomes and hopeful elements of the therapeutic process which may continue the course of action between therapeutic sessions. The therapist will, however take time to reflect on these or other therapeutic document written by the therapist or person in therapy, as this is an integral part of the therapeutic process.
There is no focus on history or aetiology of the problem. The focus is on remembering forgotten parts of the narrative or deconstructing the dominant discourses that may have perpetuated a thinning of the narrative.
8 RELATIONSHIP BETWEEN THERAPIST AND CLIENT
The narrative metaphor encourages the therapist to take a collaborative position and move away from some of the key words such as "exclusion, objectification, subjectification, and totalisation" (White, 1998, p. 43) and recognise "how I believe the expression of my personal experience, imagination and intentional states, has shaped my questions, comments, etc" (ibid, p. 69).
There is recognition of the person as being the expert of their own experience (Anderson & Goolishian, 1992).
It is a process where all participants pro-actively engage in "meaning-making" and the therapist makes a concerted effort to position family members as the primary authors of these new stories. (Griffith & Griffith, p. 66).
Narrative therapy recognises a "two-way-account of therapy" (White, 1997, p. 130) which recognises that the therapist too, is shaped by the nature of this work and that the therapist has a responsibility to articulate this effect.
In so doing the therapist undermines the rigidity of the power relation of the therapeutic context, and the potential of this power relation to approach states of domination. In challenging the hierarchy of knowledge, a two-way account of therapy establishes a context in which the potential for persons to experience their lives as the objects of professional knowledge is diminished. In that this two-way construction of the therapeutic process introduces alternative relationship practices, it assists therapists to avoid the reproduction of the 'gaze' (Foucault, 1973, 1979) in our work - the practices of evaluation, the documentation of person's lives, the techniques of remediation and correction. A two-way account of the therapeutic process contributes to the structuring of relations that challenge the marginalisation of the identities of persons who consult therapists, that challenge the construction of 'otherness' (White, 1997, p. 131)
Therapists are trained in expert views and may easily fall into the trap of believing that we possess truths that should be privileged above other knowledge and we may forget that these "truths" actually specify certain norms of how people should live their lives (White, 1998).
The distinction "is that we can pursue these skills and use to learn them effectively, but not perceive ourselves as knowing the truth about how people should be" (White, 1998, p. 73).
9 A CONTRIBUTION TO MY SELF UNDERSTANDING
9.1 My thin and problem-saturated story
In 2001 I stumbled and fell. It hurt. It hurt so much that my employer insisted that I be booked off work. I was put onto disability. I became a disabled person. For three and a half years I internalized my disability along with my Severe Major Depression F33.2 and Chronic Fatigue Syndrome. As a disabled and labelled person life became problematic. I struggled to physically hold it together and my body refused to work, I was depressed and I felt that the end of the world was upon me, and I was suicidal and wanted that world to end.
My life became problem-saturated. My story thinned out. I lost touch with the hyper-competent person that I had been and rather than not being aware of certain parts of my narrative I seemed to disconnect with parts of it as the fatigue, depression and suicidality consumed me.
9.2 Externalising the problem
Albeit not necessarily under the umbrella of a narrative therapist at the time, some narrative ways of being came to pass in the form of externalising the problem.
Without realising the benefits, I found myself referring to "the depression" rather than myself being depressed. I was able to realise that I had been affected by the depression, but I didn't internalise it and I believed that it was the depression that had made me withdrawn, anxious and socially inept. I understood that when the depression lifted I would find myself again.
The Chronic Fatigue Syndrome was also something that I was given the capacity through disability benefits to rest out and I related to this as something that would pass with time.
What was trickier to deal with was the monster of suicidality which often won the battle albeit fortunately never the war. A Mindfulness-based Stress Reduction course taught me to treat these conditioned responses to my desires to escape life's difficulties as a thought - simply a thought - and I developed a relationship with these thoughts where they could be observed and allowed to pass without any need to internalise them or act upon them. Thus unique outcomes came to be.
9.3 Unique Outcomes
Being able to resist the overwhelming thoughts of suicide was something that gave me tremendous strength and contributed to my new story. I recently realised that I have not attempted suicide for over six months and that albeit suicidal thoughts have entered my sphere of ruminations, they have not overwhelmed me or consumed me. In fact they now seem to be notions that occur, but not ones that I would follow through on. These unique outcomes are tremendously empowering and I have written a certificate in lieu of this.
9.4 An audience
I have been involved with my current partner for four months. He has known none of my depressed or suicidal state and although I have disclosed a considerable part of it to him, not knowing it experientially it seems to be quite distant to him. While chatting one evening he described me as stable. I was astonished! However, reflecting on his statement I had to concede that his experience of me has been one of stability, control, humour and one who is all together. It was this external audience of my new story that helped me to integrate my narrative identity.
A second audience was my father's peers. My sister and I organised a surprise 70th birthday party for him at the end of August. I put together an extremely well orchestrated graphic presentation for the invitation as well as on the evening in collaboration with my brother in Canada which impressed the socks off my dad and his friends. My sister and I also presented a polished speech. My date for the evening was impressed and the general feedback received was excellent in terms of the smooth running of the evening. I knew that I would not have been able to pull something like this together a year previously - it would have reduced me to the safety of inpatient status - and my audience added to my identity of competence and witting bravado.
Both my partner, who is new in my life, and my father's peers are persons who know me that might be the least inaccessible to my new view of myself. These humble beginnings can allow for a more successful audience experience. However, my family have also participated in being an audience and my father continues to verbalise this each time he sees me by saying: "You are better now Billy aren't you? You are looking so much better! I think you are better!"
9.5 Retelling my new story
Over the course of the last six months I have had the opportunity to tell my life story in several ways. My application for a Clinical Masters allowed me to tell a story with a past, a present and a future. Whereas in the past my history was thinned by my disability narrative, over this time I was able to re-author my richer story and perceive my illness as fortuitous in that it has set the grounding for the beginnings of a spiritual rebirth and a time of exponential growth which has contributed to my narrative and continues to do so in the present. I have also been able to consider a future and give this a place in my narrative.
My stability has afforded me a place where I have been able to take the risk of going out there to meet new people - including my new partner. This year has presented me with many new friends and just as many new opportunities to tell my story - my new thickened positive construction of my life story - including how grateful I am for the time I had to experience the thinned illness narrative - and where it has brought me.
This essay has been a wonderful opportunity to express some of my narrative, but certainly to think through it all and retell it to myself.
And then I present a therapeutic document which expresses my sentiments and containment currently.
Certificate of Life
This is to certify that
Ellen G
Has chosen life
She has chosen to leave behind the monster of suicidal tendencies and stick with life. No longer will she attempt to escape this life, but will revel in it and attempt to stop and smell the flowers (with pooh bear) at every available moment.
Signed: Ellen G
This 1st day of September 2005
0 MULTICULTURAL ISSUES
White (2004) points out that people seem to relate to narrative practices quite immediately. He believes this has to do with the fact that many of the practices of narrative therapy are closed linked to folk psychology - a centuries-old tradition of understanding life and identity.
All cultures have as one of their most powerful constitutive instruments a folk psychology, a set of more of less connected, more or less normative descriptions about how human beings "tick", what our own and other minds are like, what one can expect situated actions to be like, what are possible modes of life, how one commits oneself to them, and so one...Coined in derision by the new cognitive scientists for its hospitality toward such intentional states as beliefs, desires, and meanings, the expression of "folk psychology" could not be more appropriate. (Bruner, 1990, cited in White, 2004, p 19)
"What White has done in general is to naturalize therapy. If the therapeutic boundary was shaky before, it has now collapsed. White goes directly into the lives of the persons consulting with him, ignoring the caste lines of traditional mental health" (Hoffman, 1998, p 108).
Another essential issue to consider with regard to the practice of therapeutic documents is literacy, particularly within the South African context. It is importance to check that persons have sufficient literacy skills to read and write therapeutic documents. If there is reluctance to participate this may be owing to insufficient literacy skills, the therapist may offer to write the document if the person is not keen, which will result in a therapist-produced document that the person nonetheless owns.
1 ETHICAL ISSUES
By and large, narrative therapy is an ethical approach in that it is sensitive to the prevailing dominant discourses as well as subtle manifestations of dominant cultural beliefs and how these may perpetuate thin narratives.
There has been not an insignificant amount of criticism about the process of externalization. 3 The primary criticism is that the process of externalization is manipulative in that the therapist is using a position of power to brainwash the person (Payne, 2000). However, others (Hoffman) warmly regard this process as "like reweaving the carpet while standing on it instead of calling it ugly and throwing it away" (1998, p 108). The process of externalization is a linguistic one that follows a collaborative practice of naming the problem, which is negotiated and is quite overt and nothing that this writer feels deserves undue criticism.
Other less efficacious arguments have been than narrative therapy is in fact quite directive in that the questioning is leading the person to a particular conclusion and that as co-author the therapist may subtly sell a story that becomes the dominant discourse which marginalized inner voices that do not fit with the new narrative (Vorster, 2003)
2 CONCLUSION
Narrative therapy offers a way to fill in the gaps within a persons thin life story by examining their relationship with the problem and how dominant discourses may have allowed this life story to be perpetuated. Through this process a person is able to highlight unique outcomes and choose to identify with an alternative or richer narrative.
The narrative metaphor has certainly enriched my life personally as I have come to re-author my personal narrative and remember how competent I really am as well as how I am able to look the monster of suicidality in the eyes.
I also believe that the narrative metaphor could be employed within the context of Crescent Clinic in a gainful way as people thicken their personal narrative within the group setting that provides an audience to acknowledge this new thickened reality.
3 REFERENCE LIST:
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Payne (2000) and Freedman and Combs (1993, 1996) claim that White has borrowed these terms from Geertz (1973), however, an examination of the original text shows that Geertz in turn admits to borrowing it from Gilbert Ryle
2 This term is borrowed from Erving Goffman (1961, cited in Payne ,2000) and seems to be the term of choice for aspects of the thinned description that are rebuffed by new remembrances. White is, however, not particularly attached to this term.
3 The writer is unsure whether internet newsgroups (for eg sci.psychology.psychotherapy.moderated) would be a valid source of research. However, she encountered a noteworthy amount of discussion around Narrative Therapy, some of what she considered to be misunderstandings, and the concept of externalisation did receive a considerable amount of bad press. The author did her best to add her voice to this story.
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