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Evidence Based Practice
Postmodern Therapy in Practice
Table of Contents
I. Distinguishing Ideas
III. Theory Conceptualization
A. Problem Formation
B. Problem Maintenance
C. Problem Resolution
IV. Therapeutic Process
A.** **Therapist Roles
D. Treatment Planning
VI. External Links
file:Social Constructionism and Narrative Practice.pdf
Narrative Approaches Website
According to Michael White, one of the pioneers of narrative therapy, "The term narrative implies listening to and telling or retelling stories about people and the problems in their lives. In the face of serious and sometimes potentially deadly problems, the idea of hearing or telling stories may seem a trivial pursuit. It is hard to believe that conversations can shape new realities. But they do. The bridges of meaning we build with others help healing developments flourish instead of wither and be forgotten. Language can shape events into narratives of hope
Clients organize and give meaning to their experience through the storying of experience. In performing their stories, clients are expressing selected aspects of their lived experience; and by doing so, further shapi ng their lives and relationships (White & Epston, 1990).
Individuals tell stories about their lives in order to place themselves within a meaningful context. When they talk about their lives, individuals demark who the audience is and in what role they play and by doing so, social roles and norms are maintained. Therefore, the stories that people tell about their experirences allows a society, culture, family, or couple, maintain their roles and significance within that group (S. Kvale, 1995). In Postmodern Psychology: A Contradiction in Terms? (p. 34).
Effective therapy engages people in the re-authoring of life's compelling plights in ways that arouse curiousity about human possibility and invoke the play of imagination. It opens space for varying perspectives while assisting people to participate fuller and with a stronger voice of authorship in constructing the stories of their lives (White, 2007).
The objectification of one's body and personal identity is inherent to the beliefs and practices of western culture. This belief has fostered an assumption that the problems people encounter in life represent the truth about their identity and has lead to the labeling of people as disordered or dysfunctional. Externalizing conversations (described below) are used to counter those practices that objectify a person's identity (White, 2007).
Families come to therapy to work on problems or discomforts they have been unable to find solutions for. The solutions that have been attempted only served to perpetuate the problems they had been intended to solve. The family's habitual attempts at solving their porblems have been determined by certain restraints (e.g., presuppositions, premises, and expectations); meanwhile, alternative solutions have not been made available for family members to explore (White, 1986).
*The essence of narrative therapy is the reconstruction of identity. It is through talking and the language about our own lives and the lives of others that we develop our identity.
- Have you ever told an account of an event to one friend and then you talk about it with another friend and, while talking to the second friend, you remember some detail that you did not tell the first friend? The story that you told to your second friend, then, is going to provide you with a different understanding of the event from what you initially thought about it when you told your first friend.
- When clients come to therapy, they have probably talked about their problem with others and reached some conclusion about themselves and their identity. So, the job of the therapist is to flesh out how the client has told their story, how they believe things to be and why, and then imagine how the client wants things to be and, in turn, explore other aspects of the client’s life when they have successfully done that. Then, the client develops a new understanding about their identity (White, 2007).
Jill Freedman and Gene Combs
, David Epston, Freedman and Combs, Steve Madigan
Problems are formed when a problematic discourse or dominant narrative keeps the client from living out his/her preferred (comfortable) narrative or when the client is actively participating in a story that they do not find helpful or satisfying. OR
Problems develop when the individual internalizes a conversation or story that restrains them to a narrow description of self.
Problems develop when an individual becomes so focused on a problem, they neglect to see other valued aspects of their personhood.
Rules have been imposed on the client and the client believes s/he has to conform to those rules even though they are not fitting with the client's life (M. White workshop notes, TAMFT, 2008).
Problems are maintained when clients internalize the problematic discourse, or dominant narrative, believing that it speaks the truth of their identities. Clients are stuck in a story that is not their preferred narrative and they believe that they have no other options for solving the problem.
The client believes that their problems reflect certain "truths" about their nature or character, or the nature and character of others or their relationships. They believe their problems are internal to them or the selves of others, and that they / others / their relationships are the problem. By maintaining this belief, the client sinks further into the very problems they are attempting to resolve (White, 2007)
As the person continues to focus on only the problematic view of themselves, they maintain this problematic view as the only description available.
Problems are resolved when a subordinate story, or preferred narrative, is created through the transformation of previously held beliefs. This can be done by creating a new story, re-authoring the story, or writing a new chapter in the client’s life.
The client is able to be true to their own reality. They are no longer a passive recipient of life's experience and are more empowered to question things that have been imposed on them (M. White workshop notes, TAMFT, 2008).
IV. Therapeutic Process
-The therapist attempts to understand the problem as it is perceived by the client, using the client's language.
-The therapist works with the client to bring forth various experiences of self and to distinguish which of those selves they prefer in which contexts. The therapist then works to assist the client in living out narratives that support the growth and development of these 'preferred selves.
-The therapist employs the client's known, or recognized, skills, knowledges, and resources in determining how to address the problem that brought the client to therapy. These skills, knowledges, and resources are then extended to hypothesize how they can help the client in the future (a subordinate storyline is developed) (M. White workshop notes, TAMFT, 2008).
1.) Externalizing Conversation (externalize the problem)
- used to objectify the problem and help the client move away from their internalized understandings of the problem. By naming the problem and referring to the problem as a separate entity complete with its own lifestyle (White, 1986), clients begin to see their identity as something separate from the problem: "The problem becomes the problem (White, 2007, p.9)." Through externalizing conversations, clients are able to separate themselves from problem-saturated descriptions of their lives and relationships (White & Epston, 1990).
Monk (1997) explains that externalizing conversations help the client to locate the problem within the beliefs of the culture from which the problem emerged.
e.g., "The client has a problem with smoking." - externalizing language
versus "The client is a smoker." - internalizing language
"I have problems staying focused on a task." - externalizing language
versus "I'm A.D.D." - internalizing language
*Externalize by asking:
-What is problematic here?
-What is the nature of this problem?
-How does the problem show itself?
-What does it feel like for this person to have this problem in her life?
-What is influencing the person so she feels, thinks, and acts in this way?
-What is keeping the client from having more positive experiences she’d like?
*“Name the plot” helps find out the tactics & means of operating the problem uses
2.) Deconstructive Listening
- used to reveal meaning or significance that may not have been evident during the client's initial telling of their story (Payne, 2006).
*Listen for Gaps in understandings and Ambiguities in meanings to get better understanding of their situation and problem-saturated narrative
*Summarize often to make sure you understand the client’s meaning
3.) Deconstruction Questions
- used to help client's understand their problems from different perspectives. Deconstructive questions encourage clients to situate their narratives within larger systems and through time. Deconstructive questions are used to reveal the history, context, and effect's of the client's narrative (Freedman & Combs, 1996, p. 120).
-when a story is deconstructed, the client is separated from the storyand by doing this, the client is asked to think about the unique outcomes when the problem is not influencing them in a problematic manner
*Invite clients to see:
-Problems from different perspectives
-How problems are constructed
-That problems are constructed (if did not realize before)
-The limits of problems
-Other possible narratives exist
4.) Relative Influence Questions
- used to help clients separate their lives and relationships from the presenting problem. Relative Influence Questions come in two types: the first involves having the client "map the influence of the problem" in their lives and relationships; the second involves having the client "map their own influence in the life of the problem." Relative Influence Questions enable clients to identify what areas in one's life the problem has influenced (White & Epson, 1990, p. 42).
*Map the influence of the problem by asking:
-What is the influence of the problem on the relationships of clients?
-What is the influence of the clients on the problem?
i.e. How does the problem affect you? those around you?
i.e. When it (the problem) is having its way with you, what happens to your goals and dreams for the future?
i.e. Are you satisfied with the way that (the problem) is (causing problems in your relationship)?
- broadening the scope of the problem allows for more time to let the client tell their story and feel heard, and opens opportunities for unique outcomes
- through this process clients can gain a sense of agency by authoring their preferred story
5.) Contextual Influence Questions
- dominant culture; F.O.O culture; race; culture; gender; SES; “where did you learn to do X?”; “what models showed you about X?”
6.) Opening Space Questions
- used to construct unique outcomes. Unique outcomes are those experiences that would not have been predicted by the plot of a problem-saturated narrative; they are the exceptions to the problem (Freedman & Combs, 1996, p. 67).
7.) Preference Questions
- used to check-in with client that the direction or meaning of an experience is preferred over a problematic story (Freedman & Combs, 1996, p. 129). Preference Questions can be asked throughout the entire interview; these questions allow the client to evaluate their responses to the other questioning.
-Is that your preference?
-Is that the way you would prefer for it to happen?
-Do you see that as a good or bad thing for you?
-Do you consider that to your advantage and to the disadvantage of the problem or vice versa?
8.) Story Development Questions
- used in story construction, or re-authoring, story development questions invite clients to describe the process and details of an experience and connect it to a timeframe, context, or other person. By expanding the experience through space and time and adding people to it, the experience is becomes a story. Stories can be constructed through either actual or hypothetical events (Freedman & Combs, 1996, p. 131).
- reframe relapses as opportunities for the client to develop a better understanding of how to challenge the constraining, unpreferred story
- reframe "issues" as something we attribute great value to something, versus something problematic (e.g., trust issues, or being distrustful, can then be seen as the client taking necessary action to protect trust by being selective in who they give their trust to) (M. White workshop notes, TAMFT, 2008).
9.) Meaning Questions
- also used in story construction, meaning questions invite clients to reflect on different aspects of their stories, themselves, and their various relationships. Meaning questions encourage clients to consider and experience the implications of unique outcomes, preferred directions, and newly storied experiences. New stories are constructed when clients articulate the meaning of their experiences (Freedman & Combs, 1996, p. 136).
"What does that say about you as a person?"
"What does that mean that you were able to push (anger, depression, etc.) out of your life?"
Meaning questions assist clients in further developing a Landscape of Identity (or Consciousness). Every expression of meaning has multiple possible layers that require the therapist to always be listening with intent (M. White workshop notes, TAMFT, 2008).
10.) Unique Outcome Questions
- use instances when the client's goal or preferred way is occurring at some point in the present by asking:
How were you able to defy (the problem) when you did not let it affect you?
Was it easier than you thought, standing up to (the problem)?
Could your presence here today be a unique outcome and, thus, a step towards you overcoming (the problem)?
- these questions invite clients to make sense of exceptions that they might have not considered as significant
- gives clients a sense of self-agency
- provides client with some hope for future, preferred story
- ask client to consider what personal qualities led them to accomplish this instance of exception to the problem, and how they can use these qualitites in the present and future to live out their subordinate story, or preferred narrative.
The therapist is persistent in looking for expressions of contradiction to the dominate story and/or points of entry to the subordinate story. Determining which points of entry will be most meaningful for the client is a process of trial and error, and yet the process itself highlights for the client subtle differences from the dominant story (M. White workshop notes, TAMFT, 2008).
11.) Scaffolding Conversations
- involves moving from what is known and familiar to what is possible for one to know. Derived from Vgotsky's work on learning theory and the zone of proximal development, it is based on the premise that learning occurs in incremental stages that require chains of associations. Scaffolding conversations contribute to concept development and one's beliefs about human agency. These types of conversations are most helpful when clients are stuck or non-compliant (White, 2007; M. White workshop notes TAMFT, 2008).
12.) Outside Witnesses and Definitional Ceremonies
- sometimes clients are able share their stories with carefully chosen outsider witnesses. Somewhat similar to reflecting team practices, outsider witnesses engage one another in conversations about the client's telling of their story. They share what they were drawn to in the telling, or expression, of the client's story, what images these expressions evoked for them, what personal experiences resonated with these expressions, and their sense of how their lives have been touched by these expressions. Definitional ceremonies provide a context for rich story development (White, 2007, M. White workshop notes, TAMFT, 2008).
Concepts derived from M. White's earlier work on Narrative Therapy (White, 1986):
12.) Collapsing Time
13.) Raising Dilemmas
14.) Prediction of Hangover
16.) Responding to Responses
17.) Predicting Relapses
Diagnostic labels are viewed as just one of many ways to describe the client's problem. They are used with caution as to avoid conjuring unhelpful understandings for the client (Biever, Gardner & Bobele, 1998) .
D. Treatment Planning
Structure of Therapy (White, 2007):
1. Externalization of the problem – the focus of this step is to “objectify” the problem by giving it a label and characterizing it.
- The larger society tends to objectify people with labels and associates individuals with certain groups of people who employ certain behaviors (homogenizing people). Larger cultural understandings define people by their identity and so believe that problems are a reflection of a person’s identity, which is more difficult to change, if at all. Therefore, an individual’s attempted solutions often make the problem worse because they are trying to change their personality, not just their behaviors and thoughts.
- If the person is indeed the problem, like cultural understandings would like us to believe, then the solution would be self-destruct and, therefore, a reason why some people self-hate, cut, and induce anorexia and bulimia.
- But when the problem is externalized into its own being, a range of possibilities emerges.
- So, Michael White believes that through externalization of the problem, the problem is the problem and now the person is interacting with the problem, rather than the person
the problem. This interactional relationship now makes it easier for the person to act upon the problem and change things.
- Thus, objectifying the problem contradicts cultural ways of objectifying people (which becomes the dominant discourse clients internalize about themselves and their experiences).
- At this time in the therapy session, therapists should not attempt to change the problem, resolve it, or engage in fighting it.
Four levels of inquiry in order to successfully externalize the problem:
Develop a particular, experience-near definition of the problem
– replace professional and cultural jargon, such as “dysfunctional,” “psychopath,” or medical terms for diseases, with what is known to the client, using
(metaphors) for the problem. You want to know what type of problem it is, what are its tactics, how it behaves, how it thinks, when it misbehaves, who is around, for how long, etc.
-- therapists can use the rationale for this description is because in order to trick the problem and change things, we all need to know how it works (characterizing the problem)
-- you do not want to assume that this problem is just like your other client’s problem or how the book says it is.
-- by exploring the problem’s activities and tactics of misbehavior, the power it once held is now reduced, which gives the client more power to overcome it
Mapping the Effects of the Problem
– discuss the influences and consequences of the problem in all areas of the client’s life, including home, school, work, familial relationships, peer relationships, relationship with oneself, identity formation, and future possibilities.
-- “Now that we know how (the problem) works and misbehaves, let us discuss how it has impacted your life (relationships, work, school, belief about yourself).”
----- now, summarize what was discussed from steps A and B. -----
Evaluating the Effects of the Problem
– you want to find out what the client thinks about what the problem has been doing by asking questions like “Are these consequences okay with you?” “Is this preferable?” For many individuals, this is a novel experience because most of the time this question is answered by others in their life, like schoolteachers, parents, spouses who tell the client, “You’re drinking is a problem” or “You’re spending is a problem.” So, exploring how the client evaluates the impact of the problem allows the client to give voice to how they would rather like their life to be (without the problem).
-- do not assume that all consequences of a problem are going to be negative to the client; some clients may favor some of the consequences, so ask and be curious.
Justify the Evaluation
– this is where you want to explore the “why” of the client’s evaluations (from part C). “Why isn’t this okay for you?” If the client is having a difficult time answering this question, ask the client to tell you a story that would help you understand why the client took this position on the problem, why they evaluated it this way. If it’s a child, the parents and siblings in the session can play a guessing game about why they think the child evaluated the problem like they did and then ask the child which of these guesses fits with how they feel. Another option to undertake if the client cannot answer the why question is for the therapist to summarize what was discussed in substeps A, B, and C. The externalization process is important to perform because it leads to the 2nd process in the therapy session and relays how the client would prefer their life to be, what they
to be like.
- When clients begin to narrate and talk about how they wants things to be (their preferred story), they have begun to initiate a new posture towards pursuing what is important to them, not what society or culture dictates.
2. Re-Authoring Conversations – the focus of this step in the therapy session is to inquire about how the client would like things to be by including aspects about themselves that they have not yet discussed because it doesn’t fit with the current problem-saturated story.
- These neglected aspects of the person’s story are termed “unique outcomes” or “exceptions.” Exceptions to the problem story provide access to the person’s preferred story.
- The “unique outcomes” or “exceptions” are part of what M. White calls the “subordinate storyline” – this is the story that has been pushed under by the dominant, problem-saturated, storyline.
- the therapist wants to invite the client to discuss and even imagine how they would like their life to be
- Michael White borrows an idea from Jerome Bruner about relating literary texts to the lives of clients: Just as in a novel, the author does not tell the reader every little detail; the author purposely leaves out some details so the reader can place the events together on their own and, thus, develop their own meanings about what is happening. Thus, one person who reads novel X will have a different understanding about what happened from another person who read the same novel X. …. Thus, a client has left out other parts of their lives (story) because it doesn’t fit with the current problem-saturated story and, so, it is worth the while to ask about these neglected aspects of their life. Through asking about the actions and instances when the problem was not a problem, the therapist can now ask the client about the meaning they have attributed to that time when the problem was nonexistent.
- landscape of action defined: includes events, actions, time, plot, circumstances of the problem
- landscape of identity (formerly known as landscape of consciousness defined: the meanings the client attributes to the events, what they give value to, and their intentions.
-- includes intentional understandings, which are what the client is
, how they are intending to be perceived, etc.
-- also includes internal state understandings, which are described as the instincts, desires, dispositions of the person (their personality style, per se)
-- the intentional understandings should be valued most in developing an alternative story for the client because they give rise to a sense of “personal agency” and this self-agency is the essence of developing a new identity
-- in contrast, internal state understandings restrict self-agency because it is “just who they are” and, thus, difficult to change; also, this type of understanding isolates the person and then discourages diversity because this person is labeled as “one of those” or as “atypical” since they do not fit the cultural norms of behaving & thinking
- When therapists ask about the landscape of identity, they help the client develop a thicker description of the subordinate storyline and bring it out of the past and into the future.
Steps in re-authoring -- Alternate between:
A. Exploring the present situation of the problem with fine detail (the landscape of action)
B. Exploring what this meant to the client, why they did the actions above, etc. and what this says about them (landscape of identity)
3. Re-Membering Conversations: the focus of this process is for clients to actively engage themselves in a process of renewing relationships they have lost, ridding themselves of relationships they no longer want (in their preferred story), and, thus, give meaning to the aspects of their lives that they want now in their preferred story.
- M. White believed that identity consists of associating our “self” with other people and aspects of the world. Identity cannot be formed in isolation of everything around us.
- As individuals, we are encouraged to identify the contributions that people have made to our lives and how we have contributed to others’ lives. This connection to others builds the association of our self, our identity, to those around us. It is almost as if M. White encourages everyone to be collectivistic, instead of individualistic whereby we see ourselves as alone and to do everything on our own.
- White borrowed from B. Myerhoff’s ideas about the “ordering of life” by explaining that it is through the re-membering process that we give form and shape to our life from borrowing from the past and then taking that into the future of possibilities.
Biever, J. L., Gardner, G. T., Bobele, M. (1998). Social construction and narrative family practice. In C. Franklin & C. Jordan (Eds.) Family practice: Brief systems methods for social work. Garden Grove, CA: Brooks/Cole.
Freedman, J. & Combs, G. (1996). Narrative therapy: The social construction of preferred realities. New York: W. W. Norton & Co.
Lemmens, G., Eisler, I., Migerode, L., Heireman, M., & Demyttenaere, K. (2007). Family discussion group therapy for major depression: a brief systemic multi-family group intervention for hospitalized patients and their family members.
Journal of Family Therapy, 29,
Monk, G. (1997). How narrative therapy works. In G. Monk et al. (Eds.) Narrative therapy in practice: The archaeology of hope. San Francisco: Jossey-Bass.
Payne, M. (2006). Narrative therapy (2nd ed.). London: Sage.
White, M. (2007). MAPS of narrative practice. New York: W. W. Norton & Co.
White, M. (1987). Negative explanation, restraint, and double description: A template for family therapy.
Family Process, 25
White, M. & Epson, D. (1990). Narrative means to therapeutic ends. New York: W. W. Norton & Co.
VI. External Links
Social Constructionism and Narrative Practice.pdf
**Narrative Approaches Website**
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