Presentation on theme: "Overview of Narrative Theories. They are survivors. If you don’t have respect for their strength, you can’t be of any help. It’s a privilege that they."— Presentation transcript:
They are survivors. If you don’t have respect for their strength, you can’t be of any help. It’s a privilege that they let you in—there’s no reason they should trust you—none. You can’t know the terror—it’s your worst nightmare come true—a nightmare from which you never awaken. It’s unrelenting. There has been no safety; no one, no time, no place, no thing. All was tainted. Hope was obliterated, time and time again. That they are sharing their stories with you is in itself a supreme act of valor. (Adapted from banner hanging at River Oaks Hospital, New Orleans, Louisiana by Lon B. Johnston, April 2, 2003.)
Overview of Narrative Theories Challenge the hierarchy of power and knowledge that empowers professionals to marginalize clients' descriptions by imposing their allegedly objective knowledge. Attempt to flatten the hierarchy by positioning themselves more as co- travelers, who are willing to learn from others.
Overview of Narrative Theories Therapy from a narrative perspective emphasizes an elaboration of constraining monologues to liberating dialogues and/or the deconstruction or rewriting of problem saturated stories to stories of courage, strength, and competence.
Collaborative Language Systems Therapy CLS is the process of creating a safe space in which people can participate in a conversation that continually loosens up, rather than constricts and closes down. This is facilitated by a therapist posture that emphasizes collaboration, openness, and curiosity (not knowing). CLS therapists are not intentionally trying to rewrite stories or externalize problems. They value elaborating dialogues from stuck monologues to more liberating dialogues.
Narrative Deconstruction Therapy Narrative deconstruction emphasizes deconstruction and power in therapy. Practices include: questions that invite clients to consider how certain narratives shape their lives questions that invite clients to examine times when they were able to refuse living by problem-saturated narratives separating the problem from the person (externalizing).
Narrative Deconstruction Therapy Externalizing is a countercultural practice that protests Modernism and is a way to invite clients to deconstruct and reauthor problem-saturated stories into stories of competence and courage.
Central Theoretical Constructs Freedman and Combs (1996) distill the essential ideas of narrative theory down to 4 constructs: realities are socially constructed realities are constituted through language realities are organized and maintained through narrative there are no essential truths.
Reality is Socially Constructed We develop our self-image and our view of others through the particular context of our relationships. If ideas, perceptions, and beliefs that support problems are constructed, that means they are malleable. We cannot change the events of history, but we can change the interpretation.
Language Constructed Reality Creatively using language, discourse, or conversation is the art of both branches of narrative therapy. In the narrative deconstruction approach, emphasis is placed on deconstructing problematic or oppressive meanings so that new, more empowering stories can emerge.
Language Constructed Reality In the conversational elaboration approach, the basic premise is that human systems are language-generating and meaning-generating systems. Communication is seen to define rather than being a product of sociocultural systems. Because the problem is socially created in language, it is also resolved in language. "The therapeutic system is a problem-organizing, problem-dissolving system" (Anderson & Goolishian, 1988, p. 372).
Realities are Organized and Maintained Through Narrative We are born into cultural, contextual stories, and we take on personal stories through our lived experience. Therefore, new, preferred stories of self must extend beyond the therapy hour by being lived and circulated within the client's community. White (1995) says, "If stories that we have about lives are negotiated and distributed within communities of persons, then it makes a great deal of sense to engage communities of persons in the renegotiation of identity" (p. 26).
Realities are Organized and Maintained Through Narrative "The hard-won meanings should be said, painted, danced, dramatized, put into circulation" (Turner, 1986, p. 37). Client victories can be reinforced by literally including family, friends, and colleagues in the conversation.
There are No Essential Truths Being born at a certain time as male/female; within a particular region, family, and socioeconomic level; and learning a particular language, religion, cultural values, and so on, shapes one's meanings and stories. Consequently, meanings and stories are not neutral.
There are No Essential Truths What is valued and privileged are culture, gender, and class specific. Whatever is privileged in the dominant culture, whatever sexism, classism, racism, and heterosexism exists in the culture, shapes our language. Because therapists, like fish, live in the waters of their culture, they are often inducted into therapeutic practices that inadvertently collude with oppressive cultural practices.
PHASES OF HELPING Many therapies that have been influenced by modernism are often described in terms of having a beginning, middle, and end of the therapeutic process. From a post-modern perspective, however, narrative therapists are more interested in an ongoing collaborative conversational process of learning about clients‘ stories than interpreting, intervening, or imposing therapists' views or theories on them.
PHASES OF HELPING Engagement The initial phone call The initial meeting Multiple helpers Data Collection and Assessment Planning/Contracting and Intervention
Engagement: The Initial Phone Call Therapy begins before the client enters the therapist's office. How the client decided to seek counseling, who (if anyone) influenced the decision, and generally what the client's concerns are important questions to consider during the first call.
Engagement: The Initial Meeting In the initial meeting, central themes are established and discussed. These themes are woven throughout the therapy, so the entire process should feel connected. Some useful questions to help establish central themes and focus are What is the concern that brings you here? How is it affecting you and others? What has been helpful with this situation? What has not been helpful? How long has it been a concern? What are your ideas about how the difficulties began? How do you hope the situation changes?
Multiple Helpers: Getting Others on the Treatment Team Narrative therapists are curious about: what others believe the problem is their ideas about what may be making the situation better or worse what solutions have been attempted and by whom how useful the solutions were who is most concerned where and when the situation improves.
Data Collection and Assessment: Ongoing Conversations As therapists, we are in the position of being learners about the lives of our clients. They teach us about themselves—their concerns and hopes. Together the teacher and learner define the problem to be addressed. We learn about our clients and their concerns through a process of recursive or divergent assessment, where our questions are designed to generate new leaning, open space, and highlight change.
Planning/Contracting and Intervention: An Overview Narrative therapy is about conversation, dialogue, and mutually rewritten stories. It is not about intervening. Interventions and strategies are terms that imply power and private knowledge held by the therapist, to be imposed on the client. Therapy is not done to the client but with the client.
Planning/Contracting and Intervention: An Overview Some questions toward co-creating a therapeutic focus might be: What do you hope to accomplish by coming to therapy? How would you know if you got what you came here for? What would that accomplishment look like in your life, to you, and to others? If the process were successful, how would I know or what might I see?
Clients are viewed as having the necessary strengths and capacities to solver their own problems. The task of the social worker is to identify strengths and amplify them so that clients can apply these “solutions.” In general, the past is deemphasized other than times when exceptions to problems occurred. The model orients instead toward the future when the problem will no longer be a problem.
Overview of Solution-Focused Therapy When clients view themselves as resourceful and capable, they are empowered toward future positive behavior. Behavioral, as well as perceptual, change is implicated because the approach is focused on concrete, specific behaviors that are achievable within a brief time period. The view is that change in specific areas can “snowball” into bigger changes due to the systems orientation assumed to be present.
Historical Developments Although some of the key figures associated with solution-focused therapy are social workers (e.g., Insoo Kim Berg and Michelle Weiner-Davis), the model has arisen out of the field of family therapy, with Mental Research Institute (MRI) brief therapy as a specific influence. An essential family therapy concept involves a systemic notion of causality, that a change in one part of a routine sequence will result in further change for the system. MRI brief therapy focuses on problems, whereas solution-focused therapy emphasizes solutions to problems.
Historical Developments Another major influence on solution-focused therapy is the work of the psychiatrist Milton Erickson. Erickson believed that individuals have the strengths and resources to solve their own problems and that the therapist's job is to uncover these resources and activate them for the client. A further theoretical influence on solution-focused therapy is social constructivism, the view that knowledge about reality is constructed from social interactions. In other words, reality is relative to the social context. Thus, the solution-focused practitioner uses language and questioning to influence the way clients view their problems, the potential for solutions, and the expectancy for change
Phases of Helping Given the difficulty in trying to outline the phases of solution-focused treatment in generalist- eclectic terms, this section will be outlined in the following way: joining (engagement), assessment (assessing the client relationship, assessing pretreatment change), goal setting (the miracle question, scaling questions), the exception-finding intervention, and termination.
Phases of Helping: Joining The social worker gains cooperation of the client in finding solutions by "joining" with the client as the initial phase of engagement. "Joining" is the social worker’s task of establishing a positive, mutually cooperative relationship. Every problem behavior contains within it an inherent strength (i.e. reframing). Normalizing is used to depathologize people’s concerns so that problems are made more manageable when they were previously viewed as insurmountable.
Phases of Helping: Assessment There are three main client relationships in the solution-focused model: the customer the complainant "This sounds very hard. How do you manage? How do you have the strength to go on?" the visitor “Whose idea was it that you come to therapy?" and "What would they say you need to do so you don't need to come here anymore?"
Phases of Helping: Goal Setting In the solution-focused model, emphasis is on well-formulated goals that are achievable within a brief time frame. Discussion of goal formulation as starting as soon as the client comes in contact with the practitioner: What will be different about your life when you don't need to come here anymore?
Phases of Helping: The Miracle Question In the miracle question, clients are asked to conjure up a detailed view of a future without the problem. A typical miracle question involves the following: "Let's say that while you’re sleeping, a miracle occurs, and the problem you came here with is solved. What will let you know the next morning that a miracle happened?" Sometimes asking clients to envision a brighter future may help them be clearer on what they want or to see a path to problem solving.
Phases of Helping: Scaling Questions The social worker helps the client develop concrete, behaviorally specific goals that can be achieved in a brief time frame. For example, rather than "not feeling depressed," goals might involve “getting to work on time," "calling friends," and "doing volunteer work. As this example illustrates, goals should involve the presence of positive behaviors rather than the absence of negatives.
Phases of Helping: Scaling Questions Scaling questions involve asking clients to rank themselves on a scale from 1 to 10, with 1 representing "the problem'' and 10 representing “when the problem is no longer a problem." The practitioner then develops with the client specific behavioral indicators of the 10 position.
Phases of Helping: Scaling Questions Scales offer a number of advantages: A ranking will enable clients to realize they have already made some progress toward their goals ('You're already at a five? You're halfway! What have you done to get to that point? Scales can also be used to guide task setting ("What will you need to do to move up to a 6?"). Clients identify specific behaviors that will help them move up one rank order on the scale. Finally, scales can be used to track progress over time. Scales can further be used as a basis for the exploration of relationship questions. Relationship questions help clients understand the context of situations and the part they themselves play in interactions.
Phases of Helping: Finding Exceptions to Problems The central concern of solution-focused practice is identifying exceptions, times when the problem is not a problem or when the client solved similar problems in the past. Exceptions provide a blueprint for individuals to solve their problems in their own way. Another way to seek exceptions is for the worker to help clients identify strengths they display in other areas, such as their employment or hobbies. A further wav to find and build on exceptions involves an intervention borrowed from narrative therapy, called "externalizing the problem.” A final way to help clients discover exceptions is to prescribe the "first formula task" for homework alter the first session. “This week notice all the things that are happening that you want to have continue to happen." The purpose of the task is to have clients focus on what is already working for them.
Phases of Helping: Termination Because change is oriented toward a brief time period in the solution focused model, work is oriented toward termination at the beginning of treatment. Questions include "What needs to happen so you don't need to come back to see me?" and "What will be different when therapy has been successful?" Termination is geared toward helping clients identify strategies so that change will be maintained and the momentum developed will further change to occur.
Phases of Helping: Termination "What would be the first thing you'd notice if you started to find things slipping back?" "What would you do to prevent things from getting any further?" and "If you have the urge to drink again, what could you do to make sure you didn't use?" might be typical inquiries to elicit strategies to use if there is a return to old behavior. With all of the changes you are making, what will I see if I were a fly on your wall 6 months from now?