Post-Modern Models of Family Therapy

1. Post-Modern Modelsof Family Therapy University of Guelph Centre for Open Learning and Educational Support William Corrigan, MTS, RMFT AAMFT Approved Supervisor (519) 265-3599 williamcorrigan@rogers.com

2. Day Three Narrative Therapy

3. Reflections on Day 1 & 2 • What stood out for you? • Have you noticed an influence on your practice? • What would your clients say is different about you? • Questions

4. Final Paper • 10-15 pages • Introduction (≤1pg) • Brief description of the model(s) used (2-3pgs) • Case study/application (~4-7pgs) • Background, genogram, presenting problem, who presents for therapy • Sample questions, excerpts of dialogue, some transcript, homework • Expected or actual changes from session to session • Diversity and contextual issues • Reflections on model, fit with self as therapist (2-3pgs) • Conclusion (≤1pg) • References

5. By the end of today • Narrative Therapy • Externalization • Deconstruction • Reconstruction • Definitional ceremonies • Use of letters in Narrative Therapy • NT with couples • Work on Debate for Day 5

6. Narrative Therapy Assumptions and the Process of Therapy

7. How Stories Shape Us • Looking at the idea of ‘story’ in NT • Exercise: • In pairs, interview each other about a familiar or pleasant story told about you • Use the questions to guide the conversation • Interviewer: be curious and interested in the development of the story

8. How Stories Shape Us • Focus on process, not content • Debrief: • What are your reflections on the idea of ‘story’? • What do you think contributed to this story being visible and available to you? • What do these ideas mean for your work?

9. Post-Modern View of Reality • Realities are socially constructed • Realities are constituted through language • Realities are organized and maintained through narratives (stories) • There are no essential truths (Freedman & Combs, 1996, p.22)

10. The Narrative Therapist • Curious, respectful, solicitous, and persistent • Solidarity with the people who seek help • Having hope for people; “psychotically optimistic” (Bill O’Hanlon, The Third Wave, Networker, Nov/Dec ‘94) • Choose what to attend to – multiple threads • More active at first, then less so as people become more engaged • Co-creator of new realities with individuals/families • A humble collaborator • Transparency

11. Small Pieces of Narrative “The person is never the problem… the problem is the problem” (Michael White, 1991)

12. Use of externalization(White & Epston, 1990, 39-40) • Decreases conflict between persons (eg. blame, shame, guilt, etc.) • Undermines the sense of failure around the problem • Increases cooperation, uniting against the problem • Opens up new possibilities to retrieve their lives and relationships from the problem and its influence • Frees people to take a lighter, more effective, and less stressed approach to “deadly serious” problems • Presents options for dialogue, rather than monologue, about the problem

13. BREAK10:30 – 10:45

14. Process of Narrative Therapy (J. Myers-Avis, 2008) Deconstruction • Engage in externalizing conversation • Externalize the problem • Review the effects of the problem on client’s life & relationships, with particular emphasis on its effect on their view of themselves/relationships • Taking a position • Elicit history of the dominant story using recruitment/training questions • Discover meaning client attributes to past experiences • Inquire about anticipated future impact of the problem • Evaluation of problem in terms of preferred way of being/relating/seeing self

15. Process of Narrative Therapy (J. Myers-Avis, 2008) Reconstruction • Identify a unique outcome • Engagement in a re-authoring process through: • Unique account questions • Unique re-description questions • Unique possibility questions • Unique circulation questions • “Experience of experience” (indirect) questions • Questions that historicize unique outcomes

16. Deconstruction:1. Externalize the problem • Review the effect of the problem on the person’s life and relationships, with emphasis on its effect on their view of themselves and their relationships • The problem is separated from the identity of the person and the underlying dominant narrative is unmasked • “How is the problem affecting you, your life, your relationships, and/or your view of yourself?” – responses reveal the dominant or problem-saturated story

17. Deconstruction:1. Externalize the problem • Don’t rush this step - a broad “mapping” at this stage gives a broad area to explore for unique outcomes in the next stage e.g. How has depression got in the way of your relationship? What does your eating disorder tell you about your family? When frustration is having its way with you, how does it affect your relationship with your children?

18. Finding a name for the problem • Listen for metaphors • Use family’s language • Modify it so problem is objectified or personified • Check it out with the clients to see if it fits • May take some time to find something that accurately describes the problem • May be more than one problem

19. Small Pieces of Narrative • “Our lives are multi-storied. No single story of life can be free of ambiguity or contradiction. No self narrative can handle all the contingencies of life.” (White, 1994)

20. Walking out on the problem Dispelling the problem Going on strike against the problem Setting themselves apart from the problem Defying the problem’s requirements Taming the problem Escaping or freeing their life of the problem Undermining the problem Declining or refusing invitations to cooperate with the problem Reducing the problem’s grip on their lives Resigning from the problem’s service Metaphors used in externalization • usually more than one metaphor used • beware of ‘totalizing’ – defining problems in terms that are totally negative • may invalidate what people give value to and what might be sustaining • do not introduce battle metaphors or initiate totalizing of the problem

21. Externalising Conversations • In groups of three: • Investigative Reporter, Problem, and Problem’s Subject • Choose roles and what the Problem is • Reporter talks to the Problem about it’s successes • Reporter talks to the Problem about it’s failures • Problem’s Subject listens carefully wo/interrupting • Share the experience of these two interviews

22. Externalising Conversations: The Problem’s Successes • Problems tend to be boastful and arrogant, disclosing their secrets • Don’t try to change the Problem • Ask about the Problem’s influence in different parts of life (relationships, impact on feelings, interference in thoughts, effect on how subject sees him/herself) • Strategies, techniques, deceits, and tricks Problem resorts to • Special qualities possessed by Problem used to undermine and disqualify subject’s knowledge and skills • Purposes that guide Problem’s attempts to dominate; dreams and hopes for subject’s life • Who stands with the Problem – allies • How Problem might react to its dominance being threatened

23. Externalising Conversations: The Problem’s Failures • Problems grudgingly begin to admit their failures • Areas of life that the Subject still has some influence despite the Problem’s efforts • The counter-techniques/strategies and tricks developed by the Subject to mess up the Problem’s plans • Special qualities, knowledge, and skills Subject has that the Problem has had difficulty undermining or disqualifying • The purpose and commitment that guides the Subject’s efforts to challenge the attempts by the Problem to dominate • Who stands with the Subject and how have they helped deny the Problem’s wishes • The options available to the Subject for taking advantage of the Problem’s vulnerabilities and for the reclamation of their life

24. Deconstruction:2. Taking a position • Separation from the dominant story leads to the possibility of choice • Recruitment/training questions: • History of dominant story is elicited through questions that explore how client came to hold these beliefs • Training/recruitment questions are powerful in opening space for the person to contextualize their experience; the problem is examined in a larger context such as issues of gender, class, culture, etc. e.g. Do you have any ideas about how you were recruited into this view of yourself as a failure? Do you think that women are more vulnerable to the view that they have failed their children?

25. Deconstruction:2. Taking a position • The meaning the client attributes to these past experiences is elicited • Listen for particular words or phrases • Check your assumptions (e.g. “not-knowing”) • Ideas about success or failure • Ideas about what a good relationship is • Ideas about confidence, insecurity, etc. • Explore the future impact of the problem • What do you imagine will happen if… • Evaluation of whether this is a preferred effect in the client’s life • Client is asked to judge whether the influence of the problem is preferred or not preferred • What assumptions might be keeping the problem in place?

26. Unique Outcomes • “There is always a history of protest, resistance or struggle” - MW • Unique outcomes must be considered significant by the person • “It is never the size of the step that a person takes that counts, but its direction”(White & Epston, 61)

27. Reconstruction:3. Identify a unique outcome • An entry point for the beginning of authoring a new story • Seeks to identify occasions when the person/family/relationship has not been oppressed by the problem (similar to exceptions in SFBT) • Invite people to notice those intentions and actions that contradict, the problem-saturated story i.e. things that could not have been predicted/accounted for from a reading of the dominant story

28. Reconstruction:3. Identify a unique outcome • These can be historical, or can be located in the events which occur in the session: • Given your father’s encouragement of secrecy, were there any times when you were able to rebel against it and tell someone about what was happening to you? • Can you recall a time when you could have let depression come between you but you didn’t? • Have there been some areas of your life that have been untouched by this view of yourself as a failure?

29. Reconstruction:4. Engagement in re-authoring • There is always an alternative story attached to any unique outcome - the process of uncovering it is like unraveling a loose thread a) Unique Account Questions • Invite people to make sense of unique outcomes (i.e. events that don’t fit the dominant story) • “How” questions - utilize a grammar of agency, turning points and change • There is an assumption that unique outcomes always have a history e.g. Despite the hold that fear and secrecy had on you, how do you think you were able to stand up to them and get help to escape? How did you manage to take this step to turn your back on frustration? How did you resist or refuse the tyranny of the problem (habit, story)?

30. Reconstruction:4. Engagement in re-authoring b) Unique Re-description Questions: • Invite people to give significance to the unique outcomes and unique accounts through re-description of themselves, others, and their relationships. • How do they think and feel about these? How do they fit with their preferred way of being? preferred way of relating? preferred way of viewing self? e.g. What does this tell you about yourself? What does this tell your partner (children, parents) about you? What does this tell you about your commitment to yourself? about the kind of person you are? If your best friend was here, what would she/he say that it tells them about you?

31. Reconstruction:4. Engagement in re-authoring c) Unique Possibility Questions • “next step” questions • Invite people to speculate about the personal and relationship futures that are attached to the unique accounts and unique re-descriptions e.g. What does it tell you about your future, knowing that you have been faced with a situation of great fear and intimidation, and that you took strong action to escape it? What do you see for you and Susie in the future if you continue in this direction? What difference will it make to your future if you keep this knowledge of how you dealt with this situation close to your heart? • These can lead back to unique re-description questions: e.g. If you find yourself taking this next step, how will this affect how you feel about yourself?

32. Reconstruction:4. Engagement in re-authoring d) Unique Circulation Questions (related to definitional ceremony/outsider witnesses – MW) • Circulation is critical to the continuation of the alternative story • If there is an audience to a performance of a new story, the story is authenticated e.g. Who is someone you’d like to let know about this new direction that you’re taking? Who has already noticed that you have begun moving in this new direction? Who might be the first to notice? What would they say about you?

33. Reconstruction:5. “Experience of experience” questions • Can be asked in each category and are often most helpful in the development of a new story • These questions invite people to be an audience to their own story e.g. What do you think that I am learning about your relationship as I hear how you were able to avoid being totally overwhelmed by the effects of secrecy? (or conflict or anger?) What do you think this tells me about the nature of your new direction?

34. Reconstruction:5. “Experience of experience” questions Questions Which Historicize Unique Outcomes • These are important questions, which assist people to get in touch with an alternative story e.g. Of all the people who’ve known you over the years, who would be the least surprised that you’ve been able to take this step? Of all the people who knew you as you were growing up, who would have been most likely to predict that....? • Following this, a whole series of questions can be asked about the context: e.g. What would ........ have seen you doing which would have encouraged him/her to predict that you would be able to take this step? What qualities would ....... have noticed about you that would have led him/her to not be surprised that you have been able to.......?

35. Small Pieces of Narrative • The role of therapy … “is to bring these alternate stories out of the shadows and to elevate them so that they play a far more central role in the shaping of people’s lives.” (White, 1994)

37. Definitional CeremoniesMaps of Narrative Practice (2007) M. White • first referred to as ‘reflecting teams’ (T. Andersen, 1987) • rituals that deeply acknowledge people’s lived experience • provide an opportunity to tell the stories of their lives before an audience of carefully chosen outsider witnesses • outsider witness is a ‘witness’ to the conversation, usually between therapist and client(s) • through these retellings people experience their lives as joined around shared themes that reinforce the alternative story • witnesses then discuss: what they were drawn to, the images that were evoked (metaphors), their own personal experiences that resonated with these expressions, and how their lives have been touched by these expressions • “outsider witness registry” – former clients who volunteer to participate as outsider witnesses

38. Definitional CeremoniesMaps of Narrative Practice (2007) M. White • process: • interview with client(s), interview with outsider witnesses (expression, image, resonance, and transport), interview client(s) again • eliciting reflections from witness: • “When people are an audience to important stories, and when they have had the opportunity to respond in the way you have, they often go on a journey in their own lives. I’d be interested in any reflections that you might have about where this has taken you. Maybe to new thoughts about your own life. Maybe to some realizations. Anything.” (p. 174) • in the retelling of the retelling, the same categories of inquiry are used (expression, image, resonance, and transport) except the image is focused on the person’s life and identity rather than on those of the outsider witness

39. Definitional CeremoniesMaps of Narrative Practice (2007) M. White • invite outsider witness to: • play a part in a tradition of acknowledgement that is particularly relevant to rich story development • engage in retellings that are the outcome of close listening and that are composed of particular aspects of the stories that they were drawn to • express these retellings in ways that will not be imposing • respond personally in speaking of their understanding of why they are drawn to what they are drawn to and about how this affected them • step back from many of the common ways that people respond to the stories of other people’s lives, including: giving opinions or advice, making judgments, and theorizing

40. LUNCH (with Michael White) 12:30 – 1:15

41. Narrative Therapy The Use of Letter Writing in Therapy

42. Narrative Letters • Letters from therapists to clients can be powerful tools for re-authoring lives • Help clients remember what happened in session • “bare witness to the work of therapy and immortalize it” (DE) • As a jumping off point for next session • Helps both therapist and clients with recall • Including and privileging the client’s point of view

43. Narrative Letters • Used by many narrative therapists as case notes • Use client’s own words and quotes • Explain use of letters in therapy with clients re. taking notes • Read notes back to clients during the session to check for accuracy • Slows therapy down

44. Narrative Letters • Pay attention to the metaphors people use – often have powerful meaning for them • DE follows the flow of the session in writing letters for more coherence - “follow’s the clients inner logic of their own story” • Able to ask questions in letter you didn’t think of before • Able to salvage a bad session by admitting mistakes and asking questions about it to clients • Reflect confusion back to clients – transparency

45. Narrative Letters • Look for and highlight small changes • Similar to a reflecting team: what are you curious about, what do you wonder, what else would you like to know, what might you predict, etc. • Different types of letters: • letters of invitation – written to invite other members into therapy • letters of redundancy – to help someone give up an old role in their family • documents of identity - written “charters” celebrating the person’s strengths, capacities and current progress • discharge letters or letters of retirement (e.g. Jenni Schaefer)

46. Tips on WritingNarrative Letters (DE) • Start with an introductory paragraph reconnecting the client(s) to the previous therapy session • Highlight some novel aspect of the client’s personhood/relationship • Describe the influence of the problem on the client(s) • Reinforce the externalization of the problem • Ask the clients questions that you thought of after the meeting • Use tentative language (e.g. “I wonder if....”) • Document and highlight unique outcomes or exceptions to the problem • Honour the client’s own solutions rather than imposing your own

47. The “Economics” of Narrative • In a survey by David Nylund on the value of letters to clients: • 40 respondents • 37 said they were “very helpful” • 3 considered them “helpful” • The average worth of a letter was 3.2 face-to-face interviews (range from 10-0.25) • 52.8% of gains made in therapy were attributed to the letters alone • the average length of therapy was 4.5 sessions

48. Narrative Letters • Examples • For supervision in Narrative Therapy: Judith Myers Avis, AAMFT Supervisor, Guelph, (519) 821-2493 • For more on Narrative Therapy, articles, news & events: www.dulwichcentre.com.au

49. Narrative Therapywith Couples:Tips & Techniques

50. Narrative Therapy with Couples (2014) J. Freedman • Try to locate the problem in a larger discourse • e.g. things you try to live up to • Notice what stands outside the problem discourse • Problem may not go away but it doesn’t have as much power • May be quick or it may take time • Did they say anything that doesn’t fit with the problem? • “Tell me something about you that has nothing to do with the reason you are here”