Essay On Narrative Therapy Limitations

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What are narrative approaches?

Narrative approaches to counselling and community work centre people as the experts in their own lives and views problems as separate from people. Narrative approaches assume that people have many skills, competencies, beliefs, values, commitments, and abilities that will assist them to reduce the influence of problems in their lives. The word ‘narrative’ refers to the emphasis that is placed upon the stories of people’s lives and the differences that can be made through particular tellings and retellings of these stories. Narrative approaches involve ways of understanding the stories of people’s lives, and ways of re-authoring these stories in collaboration between the therapist/community worker and the people whose lives are being discussed. It is a way of working that is interested in history, the broader context that is affecting people’s lives, and the ethics or politics of this work. These are some of the themes which make up what have come to be known as ‘narrative approaches’. Of course, different people engage with these themes in their own ways. Some people choose to refer to ‘narrative practices’ rather than ‘narrative therapy/community work’ as they believe that the phrase ‘narrative therapy/community work’ is somewhat limiting of an endeavour which is constantly changing and being engaged with in many different contexts.

(For an easy-to-read introduction to narrative therapy, see What is narrative therapy?: An easy-to-read introduction by Alice Morgan, Dulwich Centre Publications, 2000.)

How do narrative approaches fit with family therapy traditions?

Family therapy is a diverse endeavour that has a fifty year history of engaging with new and unorthodox ideas, of questioning commonly held views, and developing creative practices. The family therapy field is characterised by a number of themes including considering the problems people face in the wider context of life; considering people’s identities as constructed through family relations and through history and culture; and addressing people’s problems through an interactional or participatory approach – that is to say, by meeting with families and other communities of people.

Within family therapy, there are a number of different approaches, all of which explore these themes differently. The family therapy field has shown a genuine interest in narrative ideas, opening space for narrative therapy discussion, keynote addresses, workshops, and publications. Narrative approaches emerged from the various schools of family therapy, sitting alongside structural family therapy, systemic family therapy, constructivist family therapy, brief therapy, solution-focused therapy, linguistic systems approaches, and various others. Although these schools of thought all share the common themes listed above, there are also many significant differences between them.

Is there only one form of narrative practice?

No, not only is there diversity within the field of family therapy, it seems relevant to note that there is also a considerable variety in the ways in which people have taken up the narrative metaphor in therapy and community work. Some writers have explored the potential for postmodern ideas to influence conversations, while others have explored poststructuralist ideas. Some others are now referring to themselves as discursive practitioners (sharing much in common with critical psychology). Some people work mostly with individuals, couples, and families, while others are engaged with communities and are interested in developing collective ways of working. There is a vibrant diversity of thought and practice.

What are some of the ways of thinking and traditions that narrative approaches are linked to?

There have been, and continue to be, a great range of traditions with which narrative approaches are linked. Various narrative practices are linked to developments within family therapy traditions. Family therapy has provided a context for asking questions about what is not often questioned. This is particularly true in relation to taking into consideration issues of context and social fabric (for example Salvador Minuchin’s work in relation to the lives of families in poverty). The emphasis on curiosity within narrative practices is linked to developments that occurred previously in the Milan family therapy model. The use of reflecting teams within narrative therapy is linked to the groundbreaking work of Tom Andersen (See Andersen, T. (1999). The reversal of light and sound. In Gecko: A Journal of Deconstruction and Narrative Ideas in Therapeutic Practice,  no.2, Dulwich Centre Publications). Many narrative practitioners started out working from systemic or interactional family therapy perspectives.

There have, however, also been many alternative sources that have informed narrative practices – from anthropology, literary theory, poststructuralist philosophy, and feminist writings and explorations. More recently, work in partnership with Indigenous Australian communities has contributed to the development of narrative ways of working in community gatherings.

Many narrative ideas and practices have been developed through conversations with those who have consulted narrative therapists/community workers. It seems important to acknowledge these people’s contributions to many of the ideas, practices, and ways of working that have come to be known as narrative approaches.

Who is engaged with narrative ideas and practices?

People from a wide range of professions and perspectives are engaging with narrative ideas – from family therapists, community workers, teachers and school counsellors, academics, anthropologists, community cultural development workers, and film and video documentary makers. As these engagements occur, they lead to further creative developments in narrative thinking and practices. Many disciplines (anthropology, literary theory, cultural studies, philosophy, the arts) have been engaging for some years with postmodern and poststructuralist ideas. As narrative approaches are also significantly informed by poststructuralist thinking, this is leading to many generative connections and conversations across these fields of thought. As mentioned above, the people and communities with whom narrative therapists/community workers are working are also engaged in narrative ideas in ways that shape their future directions.

Are narrative ideas only able to be used with people choosing to come voluntarily to counselling or community projects? What about involuntary clients?

Many of the ways of working that are referred to as narrative approaches originated from work with people who had no choice but to attend therapy (involuntary clients), who were living in situations in which they had little choice over aspects of their lives (as in locked psychiatric wards), or who initially were unwilling to join a conversation with a worker (people who were not speaking to anyone, who were living reclusive lifestyles). Narrative practices derived from a desire to find ethical and effective ways of working in these situations. Many workers are continually refining ways of working in such contexts.

Can you only use narrative practices with people who are eloquent and articulate?

Narrative therapy/community work always involves conveying meaning and the telling of stories, but the ways in which this occurs differ enormously depending upon the people involved. Much of the work that is now referred to as ‘narrative approaches’ originated in, and continues to involve work with, very young children. Much of the work also had its origins in conversations with people who had great restrictions upon their lives and ways of expressing themselves (for example, those living within institutions). There is a great diversity of ways in which stories can be told and conveyed that do not require what is generally considered to be eloquence or literacy, or for that matter any formal education. People try to make themselves understood in a great variety of ways. It is the practitioner’s role to engage with the experience and meaning of the person who is consulting them in whichever way or shape the expressions of this meaning occurs.

Are narrative practices transferable across cultures?

This question can really only be answered by people from non-dominant cultures. Over many years, therapists and community workers have been consistently challenged to recognise that due to the significant distinctions and differences between cultures, any form of practice cannot be simply transferred from one community to another.

Just as with any way of thinking or working, there will be many aspects of narrative practices that cannot simply be applied from one culture to another. Differences across cultures (such as whether the culture is informed by oral or written traditions, whether or not direct questions are appropriate, variation in ideas about family and community life, etc.) mean that great care needs to be taken so as to ensure that dominant cultural ideas are not enforced upon others. Ideally, workers would be of the same cultural background as the people consulting them. Ways of ensuring that work is accountable to the people, cultures, and communities whose lives are most affected by it is very important.

A diversity of people from many different cultures and communities have engaged and are engaging with narrative practices. This is occurring in different ways in different places. The ways in which these people and communities engage with narrative practices will, in turn, creatively influence the direction of narrative therapy/community work.

Are narrative practitioners anti-medication

Put simply, no. This is a question commonly asked of family therapy, and narrative practitioners in particular. Narrative approaches are associated with a clear questioning and challenge of pathologising practices – these practices are common within all disciplines of the health professions – social work, nursing, psychology, psychiatry, etc. Narrative approaches question pathologising practices, refrain from locating the problem in the person and instead locate the problems in people’s lives in their broader social context. This does not mean, however, that narrative practitioners are opposed to the use of anti-psychotic medication in any general way. In some circumstances, medication can contribute enormously to people’s lives, whereas in other circumstances, it can be used in ways that are primarily for the purposes of social control. In circumstances where medication is involved, narrative practitioners are interested in exploring with people a range of questions to assist in clarifying what is and what is not helpful in relation to the medication.

Sometimes it is said that the writing about narrative therapy/community work is inaccessible and difficult to understand. Is this true?

There is an enormous diversity of written material available about narrative therapy and community work. Much of this material is very easy-to-read and accessible to those with little familiarity with this subject. There are many papers written by a great diversity of authors all of whom are experimenting with and engaging with narrative ideas in their own contexts. Other writings, which articulate the thinking that informs narrative practice, sometimes require more effort to read as these writings grapple with complex issues. These writings deliberately use language in very precise ways in order to clearly articulate the distinctions in thought that inform narrative therapy. To use other language in these situations would perhaps make the passages easier to read, but would mean they would lose their precision. Maintaining a diversity of ways of writing about narrative therapy seems very important.

(If you have queries about writings that are available in relation to narrative therapy, please see the Dulwich Centre Publications page on this website!)

About these questions and answers

We have compiled these answers to commonly-asked questions about narrative therapy in response to regular requests. Ula Horwitz, with assistance from other people working at Dulwich Centre Publications, facilitated a number of interviews (either in person or via email) and compiled the responses from these interviews. The responses to these interviews were then combined and circulated widely for further discussion and refinement. This process worked very well, although obviously the variations in people’s responses are not adequately represented here. If people are interested, we may put together a more detailed publication at a later date. But for now, we hope these are useful and stimulate further thinking. We’d love to hear your feedback!

We’d like to acknowledge the following people who were interviewed or generated draft responses: Jill Freedman, Gene Combs, Maggie Carey, David Denborough, Jeff Zimmerman, Loretta Perry, Yishai Shalif, Bill Lax, Cheryl White, and Stephen Madigan. The following people offered their feedback on an earlier draft: Janie Cohen, Nelia Farmer, Hugh Fox, Michael White, Rikke Helmer, Catherine Johnston, Geir Lundby, Kirby MacLaurin, Robert Mayer, Nancy Merrill, Sallie Motch, Douglas Mowat, Mandy Pentecost, Kari Rosenberg, Jane Speedy, Deb Stewart, and Makiko Ueda.

The final responsibility lies with Dulwich Centre Publications.

A narrative is a story comprised of a collection of events. Every person has a story; for some, it’s essentially positive sprinkled with negative events throughout. But for others, the negative elements or problems are front and center, overshadowing anything positive. Many people go through life defining themselves by their problems. This often makes them feel stuck, hopeless, fearful, or empty.

For example, individuals who’ve struggled with anxiety for many years often describe themselves as “an anxious person.” The more that becomes their “story,” the more they see themselves as fearful and incapable of handling challenges. Similarly, those whose stories center around past mistakes or failures regard themselves as “losers” or “total failures”, while those who struggle with depression define their lives as “hopeless.” Needless to say, these stories exert a powerfully negative impact on the course their lives – unless and until they change the story.

Narrative therapy helps people see themselves as separate from their problems and to use their own inherent strengths and abilities to change their lives. The goal of this therapeutic approach is to help them rewrite the negative story – the problem-saturated narrative – that has been dominating their lives for so long. They learn to regard problems as something they have, not something they are.

In narrative therapy, the therapist isn’t the expert; the client is. This shift in perspective from more traditional forms of therapy can be especially empowering for individuals who seek treatment. It’s not uncommon for therapy clients to regard themselves – at least to some degree – as weak, inferior, or even damaged because of their depression, anxiety, relationship struggles, unresolved grief, or whatever disorder or challenge that caused them to seek professional help in the first place. Narrative therapists work in collaboration with clients to help them achieve their therapeutic goals in a respectful, non-judgmental, and non-blaming manner.

As clients learn to externalize their problems or challenges and deconstruct the problematic story, they can then begin the process of reconstructing it. They use positive alternatives to create a winning story. It’s akin to a writer going back through a novel he’s written – one that was rejected by potential publishers due to flaws in the storyline. Building upon the strengths and most interesting aspects of the original story, he rewrites the novel and turns it into a bestseller.

Narrative Therapy Techniques

Following are some of the techniques often used in narrative therapy:

Externalizing the problem – As mentioned above, in narrative therapy, problems are viewed as something people have, not something they are. In other words, people’s problems don’t define them, nor does their story need to limit or confine them to an undesirable reality. Externalization may involve objectifying, personifying, or labeling the problem – making it a separate or external entity. For example, a person with OCD could personify the intrusive thoughts as an annoying bully.

Mapping the problem – This narrative technique involves the therapist’s use of questions that help people identify how a problem is impacting their life. For example, the therapist might ask someone who’s feeling stuck in unresolved grief, “What sorts of problems does this grief cause in your life?” Such a question can help him consider things he can do – ways to change the grief narrative – to exert control and reduce its impact.

Identifying unique outcomesWhen clients tell their stories, they typically emphasize all the things that support it. For example, the middle-aged man who perceives himself as a failure in life will tell a story that supports his negative story. He’ll inevitably gloss over or omit all the successes he’s had over the years. The therapist, however, will ask him about exceptions to his narrative. The exceptions, or “unique outcomes,” refer to times when the problem wasn’t so bad or noticeable. Unique outcomes reveal clients’ strengths and skills. Clients can then incorporate these into their new, more positive, narrative.

Deconstructing the story/Identifying alternative narrativesAs clients begin to tell their story, the narrative therapist will point out certain things, such as exceptions (mentioned above) to the dominant story, hidden meanings, and potential alternatives to the current storyline. The therapist’s observations help clients deconstruct their story and consider ways it can be changed.

Exploring and considering alternative plots or endings helps clients begin the process of rewriting – or reconstructing the current, problematic narrative. The new story – which is a more positive perspective of the problem – helps the client begin to overcome it. This process helps clients discover solutions they may not have considered before.

A Brief History of Narrative Therapy

Narrative therapy was developed back in the 1980s by two family therapists with backgrounds in psychiatric social work: Michael White, from South Australia, and David Epston, from New Zealand. Rather than adhering to more traditional approaches to psychotherapy that pathologized people’s problems and / or viewed them as buried in the unconscious mind, White and Epston developed a different approach based on the power of language and stories.

They recognized the powerful role that people’s personal stories – their “narratives” – played in their individual lives. People came into therapy with a story that was “problem saturated.” The presenting problem (e.g. depression, anxiety, posttraumatic stress, grief, or being a victim) not only dominated their life; it also often defined them. White and Epston focused on helping their clients make positive changes and improve their lives by having them essentially rewrite their own stories.

What to Expect in Narrative Therapy

Narrative therapy, like most other types of psychotherapy, usually involves weekly sessions with the therapist. Although the therapist will facilitate the process, it is a collaborative effort between client and therapist. Since clients are regarded as the expert in their own lives in narrative therapy, they – and not the therapist – identify their problems. During sessions, narrative therapists guide the conversation in a way that fosters discovery, and allows and encourages new stories – and new meanings – to emerge. They help their clients rewrite the dominant story – the one that led them to seek therapy – and create one that is much more positive, desirable and empowering.

Disorders, Problems, and Conditions That Can Benefit from Narrative Therapy

Narrative therapy can be used to help children, adolescents, adults, and seniors. It can be a very beneficial form of therapy for couples and families. It’s also been used effectively in group settings.

The problems and disorders that may benefit from this particular therapeutic approach include, but aren’t necessarily limited to, the following:

  • Family conflict
  • Marital problems
  • Relationship issues
  • Anxiety
  • Depression
  • Bipolar disorder
  • PTSD
  • Recovery from abuse and other types of trauma
  • Grief and loss
  • OCD
  • ADHD
  • Substance abuse and addiction
  • Anger issues
  • Aggressive behavior
  • Acting out/tantrums
  • Problems at school
  • Specific phobias
  • Social anxiety
  • Lack of confidence
  • Low self-esteem
  • Sexual identity issues
  • Poor coping skills in children and teens
  • Eating disorders
  • Domestic violence issues
  • Chronic illness

Benefits and Advantages of Narrative Therapy

Following are just a few of the many potential benefits and advantages of narrative therapy:

  • It’s a non-pathological, non-blaming, non-judgmental approach to therapy that separates the problem from the person.
  • It regards the client – rather than the therapist – as the expert in his or her own life. This can be very empowering to therapy clients, as many people seek therapy regarding themselves as “broken” or “disordered” and perceiving the therapist as the person who (hopefully) can “fix” them.
  • It focuses on the client’s strengths, skills, and knowledge rather than on his or her weaknesses and past failures.
  • It helps clients look at their problem(s) from a more objective perspective. This objectivity enables them to consider alternative interpretations of their story.
  • It can be used to enhance other types of therapy, such as art therapy, play therapy with children. Or family systems therapy.
  • The process of externalizing problems and viewing them as separate from the client, therapy clients often feel less guarded and defensive. This enables them to engage more openly and proactively in the therapy process.
  • The approach is very optimistic and even playful at times, making it an appealing therapy for anyone who’s been in therapy in the past and left feeling disillusioned or discouraged by the process.

Potential Disadvantages of Narrative Therapy

No approach to psychotherapy is perfect or without limitations. Following are some of the potential disadvantages or limitations to narrative therapy:

  • Compared to more traditional types of psychotherapy, narrative therapy is relatively new. As such, there isn’t a substantial amount of scientific research that supports this as an effective therapeutic approach.
  • Another potential disadvantage of narrative therapy is that some individuals feel uncomfortable being the “expert” and driving the therapy process. This can be especially problematic for therapy clients who aren’t particularly articulate.
  • Narrative therapy also isn’t appropriate for all types of clients, for obvious reasons in many cases. For example, individuals who are psychotic or have limited cognitive, intellectual, or language skills would not be good candidates for this particular type of therapy.

Finding a Qualified Narrative Therapist

Many types of mental health professionals, including psychologists, clinical social workers, and marriage and family therapists, use narrative therapy in their clinical practice. When looking for a qualified therapist, make sure he or she has received appropriate training and certification from an established narrative therapy training program. The Dulwich Centre in Adelaide, Australia, (co-founded by Michael White) currently offers narrative therapy training programs (including online training) all over the world via members of its staff. There are also several independent narrative training programs in the U.S. and other countries. An online search for “narrative therapy [your city]” is one of the quickest ways to find a narrative therapist in your area.

Narrative therapy is a wonderfully optimistic, respectful, and non-judgmental approach to therapy. If you are struggling with mental health issues or other life challenges that are negatively impacting your life, it might be worthwhile to consider narrative therapy. If you’ve been in therapy before and felt it was too one-sided or unhelpful in other ways, narrative therapy can provide a different perspective, as well as an opportunity to work in a collaborative, highly interactive manner with a therapist. By rewriting the “story” that dominates your life, you can begin to create a future that aligns with your desires and goals.

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