Narrative Therapy: Description and Case Conceptualization

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Narrative therapy is a postmodern therapeutic approach that focuses on the stories or narratives that people form and develop to explain meaning in their lives (White & Epstein, 1990). Narratives are affected by social constructions and subjective interpretations of events in people's lives. The therapist attempts to help the client by working together to modify narratives that are ineffective or detrimental to the client's functioning (White & Epstein, 1990). The narrative therapy approach was developed in the 1970s by Michael White and David Epstein (White & Epstein, 1990) and gained acceptance in counseling and psychotherapy circles following a series of books written by them. Catrina Brown is a well-known therapist and author specializing in applying narrative therapy to women's issues. Narrative therapists appear to concentrate on family and couples therapy; however, they can also be found in single client therapy, education, and community psychology programs (Brown, 2007; Winslade & Monk, 2000).

In the initial meeting the therapist will typically ask the client to explain their situation (narrative) and listen attentively to everything that the client relates to them. By using active listening techniques the therapist/counselor can implicitly communicate to the client that they are engaged in the client's subjective experience and begin to form a bond with the client (White & Epstein, 1990). Narrative therapists reject the traditional notion that the therapist is either an all-knowing expert or that the therapist knows absolutely nothing and must learn from the client (Brown, 2007; White & Epstein, 1990). Michael White avoids using terms like therapy, counseling, therapist, patient, etc. And instead sees the processes as a collaboration between the client and the counselor (White, 2007). Narrative therapists take the position that both the client and the therapist have specific areas of understanding and are "partial knowers" which allows them to work together in a collaborative relationship to cover the narratives of the client and develop narratives that are more functional (Brown, 2007). Thus, both parties are seen as equal and by necessity need to work together in order to understand the perspective of the client and develop alternative narratives that are more functional and free from the influence of social constructions.

Change occurs as a process of by seeking to understand the client's experiences through listening, understanding, and working with the client to alter the client's narratives. Therapists avoid traditional interpretations, pathologizing, and predicting but instead collaborate with the client(s) to assist them to experience a heightened sense of agency (being able to effectively function in society; Wells, 2011). The therapists/counselors seek to help to develop satisfying, narratives for their clients by deconstructing stories that are problem-saturated and then helping to re-author these narratives in a way that support more preferred outcomes (West & Bubenzer, 2002).

Case Example

Joanne is a 64-year-old woman who lost her long-time partner, Anne, to an unexpected heart attack one year ago. Having been together for 31 years, Joanne reported that she was having significant difficulty "moving on, and taking care of basic things." She has not returned to her part-time position at the local library, and generally avoids contact with friends and family even her two adult sons from an earlier marriage saying that she does not want to "burden" them with her problems. She has avoided dealing with much of the legal issues and paperwork resulting from her partner's death and ruminates about her relationship with Anne, focusing on feelings about not having appreciated her enough during their time together. She feels "lost" and is unable to find purpose or meaning in her life. She has strong feelings of worthlessness, and spends hours thinking about how she "should" have lived her life. Once an avid hiker and golfer, Joanne has not participated in either since Anne's death. Joanne reports that she now wakes up late, "putters around the house" and takes a nap in the afternoon. She is eating poorly, relying on take-out food and sweets for meals.

Case Conceptualization

Joanne lost her partner and has been displaying these behaviors much longer than is typically considered to be a period of normal grief. It is important for the therapist/counselor to listen carefully to Joanne in order to understand how she interprets the world and how her behavior reflects her interpretation of what defines meaning in her life and to ask questions for clarification so as to understand how the client interprets meaning (White & Epstein, 1990).

Joanne appears to foster the dominant narrative that somehow she is responsible for the events that occur within her span of experience, even events over which she has no control.

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This dominant narrative can be seen in her reaction to loss of her partner. Joanne believes that if she would have treated her partner better or if she would have lived a better life somehow this would result in her partner still being alive. Her ruminations regarding how she should have lived her life, her good times with her partner, and her implicit connection between her loss and her own perceived shortcomings indicates that she feels responsible for her partner's death, even though it is apparent that she is not. The dominant narrative is also apparent in her reluctance to open up to her own children because if she does so she will be "burdening" them. Joanne feels that any expression of her pain and grief to others, even her own family, is a burden to them. In order for her to be useful she must be perfect. This is an important notion that needs to be investigated further (her notion of what "perfect" is). Joanne feels guilt, loneliness, and even shame as if the death of her partner is her fault. These feelings have resulted in depressive symptoms and a near complete withdrawal from her former activities.

It is likely that Joanne has many experiences that reinforce this dominant theme for her. For example:

1. Joanne may have been judged negatively by her parents (or perceived that she been judged negatively) when she did not live up to their expectations.

2. Joanne may have perceived that she was being judged negatively by her teachers at school when she did not meet her or their expectations.

3. Joanne may have perceived that she was negatively judged by her own peers when she did not live up to her or their expectations.

4. Joanne may have judged herself negatively which did not live up to her own standards.

The above hypotheses as well as others would be investigated as well as other potential hypotheses/events that contributed to the notion that she is responsible and accountable for everything that occurs within her sphere of perception. As Joanne's dominant theme continues and subjectively reinforced over the course of her life it becomes less and less likely that she would be able to recognize evidence that discount this dominant narrative (White & Epstein, 1990). Life incidents that do not support her dominant narrative are probably ignored or even discounted, whereas instances support her dominant narrative will be remembered and selected to remind her that her dominant narrative is for her, reality.

Treatment

A narrative approach examines the stories people have constructed to define themselves: their lives and their identities (Brown, 2007; White & Epstein, 1990). Using narrative techniques, the counselor/therapist assists the client to modifying these narratives (stories) that are unhelpful or ineffective (Brown, 2007; White & Epstein, 1990).

In the beginning stages of the therapy the therapist/counselor listens attentively to the client as she relates her experiences. The therapist identifies the dominant narratives in her life and any alternative narratives in addition to asking the client what she wants from life and trying to understand the dominant theme regarding how she wants her life to improve. An important process in the early stages of therapy involves mapping -- the -- influence questions which is a series of questions the therapist asks the client about issues that they have internalized (White, 2007). This assists the therapist to understand the relationship between the client and the problem.

As the therapy continues the counselor and the client work together to clarify issues and redefine explanations/perceptions. Goals include:

1. Searching for alternative explanations and incidents where her dominant narrative was reinforced. In narrative therapy this is known as a developing an alternative story. An alternative story develops during the course of the therapy is in contradiction to the dominant narrative where the clients issues with adjustment or behavior lie (White & Epstein, 1990)

2. Search for outcomes that were inconsistent with her dominant narrative and try to understand them in a different context (unique outcomes; Payne, 2006; White, 2007). Again, this contributes to the development of an alternative narrative that is more realistic and also helps to guide the client on a path to realize her own goals.

3. As the therapy progresses the therapist uses deconstruction, which is a means of breaking down the assumptions that she takes for granted (Payne, 2006; White, 2007). This also involves an identifying and understanding social constructions of.....

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