Narrative therapy

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Narrative therapy
MeSH D062525
Michael White (pictured) helped develop narrative therapy Michael White photo.jpg
Michael White (pictured) helped develop narrative therapy

Narrative therapy (or narrative practice) [1] is a form of psychotherapy that seeks to help patients identify their values and the skills associated with them. It provides the patient with knowledge of their ability to live these values so they can effectively confront current and future problems. The therapist seeks to help the patient co-author a new narrative about themselves by investigating the history of those values. Narrative therapy is a social justice approach to therapeutic conversations, seeking to challenge dominant discourses that shape people's lives in destructive ways. While narrative work is typically located within the field of family therapy, many authors and practitioners report using these ideas and practices in community work, schools and higher education. [2] [3] Narrative therapy has come to be associated with collaborative as well as person-centered therapy. [4] [ page needed ] [5] [6] [7] [8]

Contents

History

Narrative therapy was developed during the 1970s and 1980s, largely by Australian social worker Michael White and David Epston of New Zealand, [9] [10] and it was influenced by different philosophers, psychologists, and sociologists such as Michel Foucault, [9] [11] Jerome Bruner, [12] Lev Semyonovich Vygotsky [13] etc.

Conversation maps

Re-authoring identity

The narrative therapist focuses upon assisting people to create stories about themselves, about their identities, that are helpful to them. [14] This work of "re-authoring identity" helps people identify their values and identify the skills and knowledge to live out these values by way of the therapist's skilled use of listening and questioning. [15] Through the process of identifying the history of values in people's lives, the therapist and client are able to co-author a new story about the person. [16] :24

The story people tell about themselves and that is told about them is important in this approach, which asserts that the story of a person's identity may determine what they think is possible for themselves. The narrative process allows people to identify what values are important to them and how they might use their own skills and knowledge to live these values. [16] :36

Narrative therapy focuses on "unique outcomes" (a term of Erving Goffman), or moments that contradict a client's personal "problem-saturated" narrative. Unique outcomes work by revealing a person's strengths, agency, and emotional vitality that are hidden behind a person's personal problem-focused narratives. Unique outcomes can help to reveal entryways to more positive alternative narratives that clients are encouraged to adapt. [17]

Externalizing conversations

The concept of identity is important in narrative therapy. The approach aims not to conflate people's identities with the problems they may face or the mistakes they have made. Rather, the approach seeks to avoid modernist, essentialist notions of the self that lead people to believe there is a biologically determined "true self" or "true nature". Instead, identity, seen as primarily social, can be changed according to the choices people make. [18] [ page needed ]

To separate people's identities from the problems they face, narrative therapy employs externalizing conversations. The process of externalization allows people to consider their relationships with problems. [9] Narrative therapy allows people to become separated from their "internalized" understandings or ideas of a problem by looking at the problem from a social context, engaging in the construction and performance of preferred identities, and externalizing a person's strengths or positive attributes. [19]

An externalizing emphasis involves naming a problem so that a person can assess the problem's effects in their life, can analyze how the problem operates or works in their life, and in the end can choose their relationship to the problem. [18]

"Statement of Position Map"

In a narrative approach, the therapist aims to adopt a collaborative therapeutic posture rather than imposing ideas on people by giving them advice. Michael White developed a conversation map called a "Statement of Position Map" designed to elicit the client's own evaluation of the problems and developments in their lives. Both the therapist and the client are seen as having valuable information relevant to the process and the content of the therapeutic conversation. By adopting a posture of curiosity and collaboration, the therapist aims to give the implicit message to people that they already have knowledge and skills to solve the problems they face. When people develop solutions to their own problems on the basis of their own values, they may become much more committed to implementing these solutions. [20]

Re-membering practice

Narrative therapy identifies that identities are social achievements and the practice of re-membering draws closer those who support a person's preferred story about themselves and dis-engages those that do not support the person.[ clarification needed ][ citation needed ]

Absent but implicit

The concept of "absent but implicit" refers to the discernment people must make between their expressed experiences and other experiences that they had in the past and already assigned meaning to. The concept of "absent but implicit" is used to discover stories of oneself that lies underneath the problem narrative being provided. [21] Inspired by the work of Jacques Derrida, Michael White became curious about the values implicit in people's pain, their sense of failure, and actions.[ citation needed ] Often, people only feel pain or failure in when their values are abridged, or when their relationships and lives are not as they should be. Furthermore, there are often stalled initiatives that people take in life that are also guided by implicit values.

Outsider witnesses map

In this particular narrative practice, people will meet, listen, and respond to the preferred accounts of other's lives. This is referred to as "outsider witness practice" in narrative therapy. [22] Often they are friends of the consulting person or past clients of the therapist who have their own knowledge and experience of the problem at hand. During the first interview, between therapist and consulting person, the outsider listens without comment.

Then the therapist interviews them with the instructions not to critique or evaluate or make a proclamation about what they have just heard, but instead to simply say what phrase or image stood out for them, followed by any resonances between their life struggles and those just witnessed. Lastly, the outsider is asked in what ways they may feel a shift in how they experience themselves from when they first entered the room. [23]

Next, in similar fashion, the therapist turns to the consulting person, who has been listening all the while, and interviews them about what images or phrases stood out in the conversation just heard and what resonances have struck a chord within them.

In the end, an outsider witness conversation is often rewarding for witnesses. But for the consulting person the outcomes are remarkable: they learn they are not the only one with this problem, and they acquire new images and knowledge about it and their chosen alternate direction in life. The main aim of narrative therapy is to help clients to create new, positive stories that they can use to re-author their lives. [24] Narrative therapy helps to separate and externalize people's problems so they can become empowered and retake control of their lives in a positive, meaningful ways.

Therapeutic documents

Narrative therapy embodies a strong appreciation for the creation and use of documents, as when a person and a counsellor co-author "A Graduation from the Blues Certificate", for example. [25] In some instances, case notes are created collaboratively with clients to provide documentation as well as markers of progress.

Social-political therapeutic approach

A strong awareness of the impact of power relations in therapeutic conversations, with a commitment to checking back with the client about the effects of therapeutic styles in order to mitigate the possible negative effect of invisible assumptions or preferences held by the therapist. [26] There is also an awareness of how social narratives such as femininity and masculinity can be corrupted and negatively influence peoples identities. [16] :23–38

Eating disorders

Narrative therapy has made numerous contributions to the field of eating disorders. David Epston, Stephen Madigan and Catrina Brown have made the most significant contribution to bringing a depathologizing approach to this issue. [16] [ page needed ]

Men and domestic violence

Narrative therapy has also been applied to work with men who abuse their female partners. Alan Jenkins and Tod Augusta-Scott have been the most prolific in this field. They integrated a social-political analysis of the violence, while at the same time engaging men in a respectful, collaborative manner. [16] [ page needed ] [27] [ page needed ]

Community work

Narrative therapy has also been used in a variety of community settings. In particular, an exercise called "Tree of Life" has been used to mobilize communities to act according to their own values. [28]

Criticisms

There have been several formal criticisms of narrative therapy over what are viewed as its theoretical and methodological inconsistencies, among various other concerns. [29] [30] [31]

See also

Theoretical foundations

Related types of therapy

Other related concepts

Related Research Articles

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

<span class="mw-page-title-main">Occupational therapy</span> Healthcare profession

Occupational therapy (OT) is a healthcare profession that involves the use of assessment, intervention, consultation, and coaching to develop, recover, or maintain meaningful occupations of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to support mental health and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in activities that occupy an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). OTs and OTAs have different roles, with OTs licensed to complete comprehensive occupational therapy evaluations. Both professionals work with people who want to improve their ability to participate in meaningful occupations.

Rational emotive behavior therapy (REBT), previously called rational therapy and rational emotive therapy, is an active-directive, philosophically and empirically based psychotherapy, the aim of which is to resolve emotional and behavioral problems and disturbances and to help people to lead happier and more fulfilling lives.

Person-centered therapy (PCT), also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy, is a form of psychotherapy developed by psychologist Carl Rogers and colleagues beginning in the 1940s and extending into the 1980s. Person-centered therapy seeks to facilitate a client's actualizing tendency, "an inbuilt proclivity toward growth and fulfillment", via acceptance, therapist congruence (genuineness), and empathic understanding.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

Solution-focused (brief) therapy (SFBT) is a goal-directed collaborative approach to psychotherapeutic change that is conducted through direct observation of clients' responses to a series of precisely constructed questions. Based upon social constructivist thinking and Wittgensteinian philosophy, SFBT focuses on addressing what clients want to achieve without exploring the history and provenance of problem(s). SF therapy sessions typically focus on the present and future, focusing on the past only to the degree necessary for communicating empathy and accurate understanding of the client's concerns.

The Internal Family Systems Model (IFS) is an integrative approach to individual psychotherapy developed by Richard C. Schwartz in the 1980s. It combines systems thinking with the view that the mind is made up of relatively discrete subpersonalities, each with its own unique viewpoint and qualities. IFS uses systems psychology, particularly as developed for family therapy, to understand how these collections of subpersonalities are organized.

Self-disclosure is a process of communication by which one person reveals information about themselves to another. The information can be descriptive or evaluative, and can include thoughts, feelings, aspirations, goals, failures, successes, fears, and dreams, as well as one's likes, dislikes, and favorites.

<span class="mw-page-title-main">Michael White (psychotherapist)</span>

Michael White was an Australian social worker and family therapist. He is known as the founder of narrative therapy, and for his significant contribution to psychotherapy and family therapy, which have been a source of techniques adopted by other approaches.

Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.

Leslie Samuel Greenberg is a Canadian psychologist born in Johannesburg, South Africa, and is one of the originators and primary developers of Emotion-Focused Therapy for individuals and couples. He is a professor emeritus of psychology at York University in Toronto, and also director of the Emotion-Focused Therapy Clinic in Toronto. His research has addressed questions regarding empathy, psychotherapy process, the therapeutic alliance, and emotion in human functioning.

Emotionally focused therapy and emotion-focused therapy (EFT) are related humanistic approaches to psychotherapy that aim to resolve emotional and relationship issues with individuals, couples, and families. These therapies combine experiential therapy techniques, including person-centered and Gestalt therapies, with systemic therapy and attachment theory. The central premise is that emotions influence cognition, motivate behavior, and are strongly linked to needs. The goals of treatment include transforming maladaptive behaviors, such as emotional avoidance, and developing awareness, acceptance, expression, and regulation of emotion and understanding of relationships. EFT is usually a short-term treatment.

Collaborative therapy is a therapy developed by Harlene Anderson, along with Harold A. Goolishian (1924–1991), in the US. It is intended for clients who are well educated in any field, or for those that have distrust of psychotherapists due to past negative experiences with one or more.

Status Dynamic Psychotherapy (SDT) is an approach to psychotherapy that focuses on changing a client's "statuses", whether they be career related, personal or social in nature. SDT is characterized by its lack of focus on factors traditionally targeted by psychotherapy such as the client's behaviors and cognitions, and how unconscious factors come into play. SDT was created by Peter G. Ossorio at the University of Colorado in the late 1960s as part of a larger system known as "descriptive psychology".

Common factors theory, a theory guiding some research in clinical psychology and counseling psychology, proposes that different approaches and evidence-based practices in psychotherapy and counseling share common factors that account for much of the effectiveness of a psychological treatment. This is in contrast to the view that the effectiveness of psychotherapy and counseling is best explained by specific or unique factors that are suited to treatment of particular problems.

Family therapy is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of interaction between family members.

The Houston Galveston Institute is a non-profit organization that offers collaborative counselling and postmodern therapy to individuals, families and communities. The institute is strongly associated with collaborative language systems, a type of postmodern therapy that works with clients via a cooperative partnership to access their own natural resources and develop solutions to their problems. The Houston Galveston Institute is a sponsor of the International Journal of Collaborative Practices.

<i>A Stranger in the Family</i> 1997 book by Vincenzo Di Nicola

A Stranger in The Family: Culture, Families, and Therapy is a text written by Canadian cultural psychiatrist and family therapist Vincenzo Di Nicola integrating family therapy and cultural psychiatry to create a model of cultural family therapy.

Collaborative language systems is a therapeutic approach largely based in contemporary hermeneutics, the study of interpretation as a way to produce understanding, while considering both context and cognition, as well as social constructionism. This approach involves a reciprocal relationship between both the therapist and client, through which the client works through his or her clinical problems using dialogical conversation with the therapist. The therapist and client work together, utilizing their own, individual knowledge and understanding of the issues, to conceptualize and illuminate the client’s problems and provide new context, meaning and comprehension to those problems based on the collaboration.

Cultural humility is the “ability to maintain an interpersonal stance that is other-oriented in relation to aspects of cultural identity that are most important to the [person].” Cultural humility is different from other culturally-based training ideals because it focuses on self-humility rather than being an other-directed "they/them" way of achieving a state of knowledge or awareness. It is helpful to see as others see; what they themselves have determined is their personal expression of their heritage and their “personal culture”. Cultural humility was formed in the physical healthcare field and adapted for therapists, social workers, and medical librarians, to learn more about experiences and cultural identities of others and increase the quality of their interactions with clients and community members.

References

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