- Some goals for today would be that
you leave with a beginning understanding
of some key ideas for narrative therapy.
You'll learn about how to apply this theory
in a range of ways with young people, that I'll try to
provide a range of examples, of how I've used these ideas
in group, with people of different ages,
with home based work, with school based work,
with a range of settings.
And also, I hope that you'll ask questions if there's things
that as you listen, they feel like it's a good fit for
the people that you work with, that are wondering about,
in particular, some other people you're working with.
I'd love to have those questions throughout the day,
and we'll have consultation time at the end today.
And so then you'll leave, ultimately, with a beginning
understanding of how to apply these ideas to your work.
To go ahead and get started, you have a copy
of today's schedule, and as I talked about, there're a range
of different kind of activities.
So, in terms of this morning, what we'll talk about,
in terms of slides, I'll talk a little bit about
the definition of narrative therapy, for those who might
not be familiar with it.
The context, the historical context of how it entered
through theoretical frameworks within social work.
Some of the underlying assumptions.
So I try to do that without talking about what's similar,
or different from other theories, that people might not,
you know, know about.
There can be a lot of ways that people can use
pieces of narrative therapy, or other kinds of ideas.
I think most people practice eclectically today,
and so, my hope would be is that, you have a sense of this
theory as a stand alone theory as you leave today,
but also maybe some ideas about pieces that you might
use in your work, with your existing frameworks.
A little bit about, you know,
this is a theory that relies heavily on some postmodern
ideas about how language creates meaning.
A little bit about how people come to understand themselves
in the world, and their either experience
with problems, et cetera.
A big concept that I would like you to leave today,
is the idea of externalizing problems,
that we'll talk about this morning, and that's probably
the singular idea, that is most
known about narrative therapy.
But we'll spend a lot of time on that this morning,
as well as having you practice with each other
around that idea.
I'll also do a live interview, and we'll look
at transcripts, so that idea might be clear.
So, a definition.
And every now and then, I'll have a slide that has
way too much information on it, for which I apologize.
But this is the definition that comes up, a website of
Dulwich Center in Australia, which is where a lot of narrative
ideas came to fruition.
And so it's, "Narrative therapy isan approach to
"counseling and community work.
"It centers people as the experts in their own lives,
"and views problems as separate from people."
We'll spend a lot of time on that idea this morning because
these sentences are long, but have a lot of different ideas
that we'll explore over the day.
It assumes that people have many skills, competencies,
beliefs, values and commitments and abilities that will
assist them to reduce the influence
of the problems in their lives.
The word narrative is referred to as the emphasis
that is placed upon the stories of people's lives,
and the differences that can be made, to the particularly
tellings and re-tellings of these stories.
One of the things that I think about, is after beginning
to study narrative therapy--
And I actually realize, I should introduce myself
and tell you a little bit about how I
learned about narrative therapy.
kind of attention, different level of attention to
the role of language, in conversations with people.
And how it is significant, if someone comes to us
who's experiencing a tremendous amount of depression.
To have a conversation where I am asking, to try to
understand the ways--
I mean, it's really important in any kind of collaborative
or strength-based, or any kind of work,
that we do have a good sense of the effects of a problem
in people's lives.
But I have often--
I've worked in in-patient psychiatry for a long time,
and so a lot of initial questions I used to have,
went into something like depression.
I would be looking for all the different areas
of functional impairment, so I would be asking questions
exploring, and looking for different kinds of ways that
symptoms appeared in people's lives,
such as, "How is your appetite?"
But really sort of, trying to get a full picture
by exploring what I knew to be known deficits,
that might come up in people's lives
in response to depression.
How it can be a very different kind of question and
conversation, to start a conversation.
You know, if I know that someone has had a
history of depression.
If I know that someone had a history of depression in
their lives, to ask a question like, "How is it that you
"have responded to the depression before?"
Or, "How have you overcome this depression in the past?"
Already, from that initial question, I probably will get
a sense of, you know--
At the end of the day, I get a lot of the same information,
but from the get-go, if I'm asking for people for their
knowledge of what they're doing, in response to some of
the ways of depression in their life, it's just,
from the get-go, a different kind of conversation.
So that's what they mean, a little bit about,
the differences that can be made in the particular
telling and re-tellings of a story.
Narrative therapy, what the work looks like,
it involves ways of understanding stories,
and re-telling them in--
Over the course of therapy.
We'll spend a lot of time on that today.
And it's a way of working, that's interested in the history
of broader context, on what's impacting people's lives
and the politics of therapy.
So, one of the things that we'll speak to in
a minute is, I was originally very drawn to these ideas,
because it does--
There's no sense that therapy, or the therapeutic room
is a neutral environment.
It very much understands links between problems
in people's lives, and the, you know, social problems
and different kinds of experiences.
And so, the way that someone is experiencing,
for example, anorexia nervosa, in their lives,
is also going to be very much, probably, linked to their
understanding of maleness or femaleness in their lives,
and the certain kinds of expectations around
gender roles or identity.
For example.
In terms of a historical context,
about when did these ideas really emerge?
I think there was a book published in 1990, that really
became an international, like--
Mood narrative therapy from an idea that was popular
in Australia and New Zealand, which is where the two primary
authors live, or lived.
So it really then hit the larger family therapy circuit.
At any rate, these ideas, coming within the field of
family therapy, where connected to a lot of emerging
ideas at the time.
This was right around the time where solution focused
therapy was popular within the United States.
Also, ideas of social constructivism.
Or ways of really thinking about how different kinds of
ideas that we thought of as, sort of,
intrinsic or biological in people, where ideas like race
and racism were beginning to be seen
as a social construction.
It was not so much the genetic differences between people,
but rather how we, in our society, had constructed
or understood race and racism.
These ideas were really emerging, and really entering
the therapy room in different ways.
It was through the 1980s, for example, in the US that gender
and feminism, really entered into family therapy.
Also, in the world, particularly in Scandanavia,
reflecting things were beginning to be introduced
in family therapy.
This is something that is taught now within most
graduate schools of social work, in terms of--
And also schools of marriage and family therapy,
other counseling approaches.
It's really hit a point of mainstream popularity.
Although it originally came through the family theory
and family therapy, that realm, it's done equally
as much with individuals, as it is with families
in other context.
I got my Masters here in Smith, and so, was trained with
psycho-dynamic approaches.
I really was thinking a lot about expl--
And particularly in a medical setting
of working of inpatient psychiatry.
As I look to define what depression was in people's lives,
I had a pre-determined set of questions, or ways of thinking
or conceptualizing what depression would be, that I
would ask, really, about different kinds of symptom sets.
We know what markers are for depression, and its impact
in terms of--
So I would be asking about anhedonia, I would be asking
about appetite, sleeping.
And by putting these limitations on my conversations,
I was really, not only perhaps limiting my understanding
of the effects of depression on someone's life,
but I was also coming to define how that person might
experience depression in their life, and particularly
by going through DSM criteria.
So, how the conversations might be a little bit different--
And I hope that going through and seeing some of
the sample questions, or other things.
Where I've strayed from that, is really--
Because those kinds of questions, they're not wrong,
but it's really privileging my ways of thinking,
and my training, in a certain body of knowledge
with the DSM, in terms of--
It's privileging my expertise, my professional expertise
around the idea of depression.
Instead, these different kinds of conversations aren't
going to stray much away from that, from the very beginning,
to get a very personalized account of depression
in someone's life.
And so that, yes, that might involve things like
differences with appetite, or sleep, or other
kinds of things, but I may hear much more about, what's more
painful about the experience that someone's going through
right now, is...
Their very particularly account of loneliness, for example,
might be what is most painful to them.
Really trying to step away from my knowledge,
but much more into their experience of something,
which is just a little bit of a shift,
of really giving someone the lead.
As we'll talk about, throughout the day, just from the
very beginning, in even assessment conversations,
has so much...
Even quick interactions that I might have had with someone
initially on a psychiatric unit, you have--
And I could think about treatment, follow up,
or other kinds of things, even if I wasn't going to be
continuing with that person.
We're so different.
If a person is able to conceptualize their own experience
with depression and really hone in on,
"What's so overwhelming for me, is the intensity of
"the loneliness that I feel."
As opposed to me talking about how they're eating
and sleeping, and other kinds of things.
It just also helps them think about the steps
that they might take in their own life or--
You know, part of the--
And we'll get into this more today.
As people are talking about their own experience of
what's painful, part of what I listen for,
is the other side of the story.
Is the flip version of the coin.
If someone is talking about an experience of
acute loneliness, what they're not talking about is
the knowledge that they have of connection, or a value that
they have of connection.
That idea that, somewhere in their life exp--
Part of what makes the loneliness so acute in this moment,
is the knowledge and history of feeling a different kind of
way of being, in relation to the world.
Or a desire, or a wish, to have something that,
perhaps, has never been accessible to them.
And so, when we medicalize--
I mean, there's nothing necessarily wrong about
medicalizing a diagnosis, but if we put the depression
inside someone in defining a problem in relation
to symptoms, treatment is a lot--
What a person can do in relation to treatment,
other than taking a medication,
is rendered largely invisible.
If a person has a clear sense from their own way or
articulating and forming a problem, it really--
What it is about this depression that's most overwhelming,
is how profoundly lonely I feel in the world right now.
And our conversations, not only will be about medications,
will be about other things that might be helpful,
but are also really focused on the specificity of a person's
hopes or desires, in relation to connection with others.
The history of that, what knowledge they have,
have they ever built community before, what friendships
are they missing?
You know, other kinds of things.
It makes a lot more visible steps that they might
take in their own life, to take a stand against
the depression in some way, by highlighting what their
preferences or hopes are.
They have a different kind of vision of a road forward
of steps that they might take, that's a little bit different
from having the effects conversation, about other ways
that they feel downtrodden,
by the experience of depression.
Too many of those kind of conversations, turning up
the volume on those kinds of conversations,
makes it difficult for people to have energy or strength,
to step forward in relation to that particular
kind of experience.
But also, how can agency practice shift?
Because there's not going to be--
You know, there still are ways that we need to come up with
a medical diagnosis, in order to be reimbursed for services.
It's really thinking increasing about what are
both (mumbling) ways.
What are ways that I write treatment goals, for example,
that both can be paid for, but that maybe are also
reflective of some--
that are very individualized in some ways, strengths-based.
What's really interesting is I do feel like--
You know, although it's difficult,
narrative therapy is difficult to research in a way that--
To get good evidence based outcomes.
Increasingly, there's so many trends, for example,
with wrap around in children and adolescent services,
with different kinds of initiatives with the recovery model,
that is really becoming more prevalent in mental health
nationally, and also with
National Institute of Health grants, there just have been
different initiatives, within the National Organization
of Psychiatry, for example.
Social work values, through NASW are very much connected
to a lot of these ideas of strength based
empowerment and collaboration.
But there's a real trending, I think nationally, to this.
I know I am consulting right now with a psychiatric
hospital in the area, and they're looking at everything from
forms to the training, so everyone on the unit is trying
to think about and talk about problems in these ways.
The child welfare.
So DCF within Massachusetts has a great
consultant with Bill Madsen, who's really working to
train folks to work on family vision.
Like family plans for well being, and visions of
well being, and identifying protective and risk factors.
So there's just a real shift in the way things
are talking about, that it may take some time,
but I hope in this really difficult practice culture
that we're in--
You know, (mumbling) right now, that there is some
trending there, there is--
There a lot of cracks in the pavement, with little flowers
and weeds growing through in this way, so I feel
quite hopeful about it.
I think that we're getting at some of these things in
the conversation, which why I always like conversation
and extended examples during PowerPoint.
But some underlying assumptions.
We'll talk about these.
They're a little abstract, as I end this slide
and the next slide.
I think we will really them more during the day.
There's some packets over there.
Is a postmodern understanding, or a construction of
the self, is really this idea that, although our biology
is important in shaping in many ways, really understand
the self as something in relation to other people.
That all learning is social relational.
If I were to ask you to think of one adjective,
to describe yourself, like if you just almost
have one in your head.
Can people shout them out so I know there's not just
a pause where you're being like ...
So like, smart, kind, good listener.
What other kinds of things might people be thinking?
Verbal, okay?
Empathic.
Gentle, okay.
So-- What?
Honest, okay.
So each of these understandings...
If you think about it a little bit with the history,
and it's hard to do without mainly more of
a conversation, is that, you might be able to
think of a time in the last week.
You know, why, for example, did you think of gentle,
or verbal, or empathic.
Right now as opposed to another time.
So there might be a time, just even in the last
three days, where someone you're having a
conversation with may have re-enforced that idea about
that was the type of person that you were.
Over time, that would be connected to other kinds
of stories and experiences.
But how we come to understand any one thing about ourself,
is through the linked sequence of events.
I'm going to go ahead and go to the blackboard example
of this, because this also really talks about many of the
other things on this slide, so you'll get the X's
on future slides, and we'll just skip through them.
But I do feel like this is really important,
in the understanding of narrative therapy.
So it's really thinking about how we come to any
understanding of ourselves, so any of the adjectives that
you just listed, are because of individual events
that are linked together over time.
So, a training example that I, Otu Asmorgan,
who was a teacher of mine in Australia,
is the good driver story.
It's just a nice neutral one.
So, the details of this are actually true,
in terms of my own understanding of myself
as a good driver, but I feel like it's a good neutral
example, of a part of of my identity that I am not
terribly invested in, so I can share the things that
are inside and outside of this story.
So true story is that, on the day that I got my
driver's license, back when I was 16.5 years old,
the person who was working for the state of Illinois
as the driving instructor, to take me on a road test,
so I was the best new driver of the day.
So that was the first feedback.
Also, my mother had been a lot more nervous when my
sister learned to drive, than when I did.
So, I had a sense that I might be a good driver,
but having this person from the state of Illinois
certify me as a good driver was really meaningful.
Then a little bit from then, very early on,
I started qualifying for a good driver's discount,
which my parents were quite appreciative of.
As I got older and went to college, we'd go on road trips
and other things with friends.
Friends had no problem, ever, with me borrowing their
car or driving.
Among trips, I'd noticed with pride that people would
feel comfortable sleeping in the car, if I was taking
a late night shift.
As I got older, that very same trend continued,
as my friends started to have young children, and I thought,
"Hey, someone's going to let me drive with
"their infant in the car?
"I must be a good driver."
And, for many, many years, I continued to qualify for
good driver discounts.
So, overall, because of a bunch of individual things that
have happened, I really came to understand myself as
a good driver.
But why this is important is with any story,
or understanding about ourselves, there are things that
we are discarding, or not including in the story.
And so, not to pick on any of the people who shared examples,
but there have probably been times that you have
not been emphatic (laughs).
Or not been gentle, or been quiet, or other things in
response to some of the examples that you read.
And just like you can look at the bored--
And actually, there's a lot of non-good driver
things than good driver.
So for example, this guy never would have thought I was the
best driver of the day if he had asked me to parallel park.
But thankfully, even though that was a requirement
for your license, he didn't ask me, so (exhales).
And that's relevant, because I'm blind in one eye,
so my depth perception, even though I can test and
I'm visually okay, there are things that I don't
do particularly well.
I mean, I've compensated.
Now no one's ever going to lend me their car in this room.
But I have lived in the same house for 10 years,
and I have a long very straight driveway, and I just think
I'm constant entertainment for the neighbors,
because when I reverse, I'm like (reversing noises).
I zig-zag, and have to pull forward and back for something
that's really 30 feet.
So, they do not think I'm a very good driver.
In fact, they probably call their children in
the minute they see my garage door open.
I also haven't qualified for the good driver discount
for many years, because I've had a speeding ticket
and a fender bender, in the last five years.
So overall, there's as much evidence that I'm not a
good driver, as I am a good driver.
But, I'm going to continue to believe that
I'm a good driver.
What's relevant is--
So what we hold on to, has a lot to do with
some of our values, how important something is in
our life, or anything else.
But this idea of life being composed of stories,
and that there's always the existence of the
outside stories, as well as the dominant story of the time.
And to being really one of the most fundamentally
underpinning ideas in narrative therapy.
So when you were asking me about the conversation of
depression on a psychiatric setting, you know,
I just happened to land on loneliness.
But that's not ...
If we slow down a conversation, it wouldn't be unusual
for maybe someone to talk about their loneliness as being
really what they experience as most painful for depression.
And so that is then--
What I bring to it is, there may be lots of many stories
about loneliness recently, but for someone to know
that loneliness, whether it be an advantage or disadvantage
of such a dualistic way of thinking, is to say that,
what someone's dominant experience is, is there's also
probably when they're really talking about it with pain,
there must be experiences or connection in their history.
They're just not as well connected in this moment,
or they're not as experienced in that moment.
This may not be so different from other kinds of ways
of working, but ever people are--
I have young people often coming to me with
a range of problems, like anger problems, for example.
But there's also--
I always love the conversations with teenagers.
I worked in residential for a long time, and someone gets
in trouble for something, and then they get me as their
therapist, and they're like, "Beth, you have no idea.
"It's true, I yelled at the staff and I said these things.
"What I wanted to do was throw the chair, and I really had
"much worse things that I was thinking of."
Well, it's so good to know that you had a filter.
It's so often people are making choices, even if their
choices are still not at a level that we want.
But I also feel like, beginning to highlight.
So in that moment, not to let someone off the hook for
what they did, but to say, "Okay.
"Six months ago, you probably would've thrown the chair
"and said the absolute worst things that you thought of.
"How did you discern that doing what you decided to do,
"would be a better option?"
So really helping people focus in those moments,
about some of the decisions or knowledges that were at play,
as well as other kinds of times, where they stayed
in great behavioral control.
And as you begin to highlight what it was that they knew,
or did, or consequences they were able to think of,
or other kinds of things in that moment, one can begin to,
once it's very well detailed, begin to connect this other
themes and gradually over time, come up with this
competing story, and people's sense of this.
Because if we--
Okay, I'm going to give another example, from actually
the inpatient unit, where I'm doing some consulting.
There is a young boy who's on the unit right now,
about five years old, who spent the first two years of
his life in a very abusive--
Just, a house that was characterized--
I'm sure there were loving exchanges,
and things that happened.
But a lot of abuse and neglect, to the point where the state
intervened, terminated parental rights, and placed this
child in foster care.
The first foster home, the child ended up
experiencing some abuse.
Was put in a second foster home, that ended up looking to be
a permanency placement, where there was a very
strong and lovely connection with the mother and the child.
However, circumstances emerged in that foster parent's life,
where they had to terminate their plans to
go ahead with the adoption.
And so he ended up in care.
At this current time, he's been in different levels
of institutional care, largely locked psychiatric units,
for about two years.
And so one can begin to think, if we think about
just what we know about attachment, or connections, or
the significance of early relationships, that this young
child's behavior has really--
He's really lost a sense of trust in others, he has a lot
of volatile, violent, impulsive behaviors.
It's very hard for him to trust, struggles with structure,
struggles with certain--
I think that he has experienced his life, if you think about
it from his perspective, as being so horribly unpredictable.
And it's terrifying to try to make any attachments
with adults, because even as his time in inpatient settings,
the minute he might become close, or begin to rely
on staff members, boom, without any clear way that
he would understand it, things have shifted,
and he's suddenly in a new environment, with new adults.
And so, we can project and think about all the different
kinds of impacts, or ways of learning and knowing the world,
that this could have without some kind of intervention,
in a long term way.
It's so important that we apply all that we know, and that
we think about, how can we help him with symptom management?
What kind of way of thinking about him diagnostically,
would be important.
Really also, social workers thinking about what kind of
placement plan would make sense.
But what I've also begun to work with staff in the hospital,
is also, you know--
As I ask staff stories, his behavior is pretty frustrating,
and lots of time, he might be on a one to one.
And I could get lots of different stories from them about
the challenges in working with this young man.
Oh, he's not a young man, he's a boy.
The challenges of working with this boy.
But also, then I heard some stories
that were very different.
Like one day, I was doing a training.
The over night nurse said that, that very morning,
he had woken up ear--
He wakes up very, very early in the morning.
But he had decided--
Like she was taking his vitals and he said,
"Okay, now I'm going to take your blood."
And he said, "Give me your arm."
He was doing the clean up.
He's had his blood levels taken early in the morning,
because I think he's on maybe some Lithium at this time.
And so, he cleaned her arm, he said, "Okay," he had a pen.
He said, "This isn't going to hurt a bit."
And like, I guess she made some kind of face, he said,
"No, no, please don't worry.
"I'm really not going to hurt you."
And he took her blood very carefully with a pen.
And I thought, here's something, this kid,
the stories, what he--
If we can imagine, how does he understand himself right now.
He probably has some very negative self-esteem,
or self-understandings, from all the ways the rug has
possibly has been pulled out of him, and out of his control.
And how could he not understand the world in any other
kind of way, than it was his fault, or that he might take
it personally with the abuse, with other kinds of things.
The ways that he has been individually targeted in the past.
I thought, "If every single time."
What I would want this nurse to do in the future, be like,
"How did you know that I was scared?
"What did you see in my face?
"How did you know that squeezing my hand, and telling me
"something gentle would be affirming?"
When we began to talk about what kind of knowledge
or skills, or what kind of way would he--
What kind of impact would it have, for him to verbalize
his knowledge in that way?
One time not so much, but if every single staff member
who interacted with him during the day, began to listen for
things that really helped to highlight his
knowledge in relationships, the ways that he was good at
responding to people, how responsive
and attentive he could be.
First of all, as we began to ask him how he knew to do
these things, or how appreciated that was, the chances are--
It's sort of, you take a behavioral model, and it's like,
you're kind of beginning to shape behavior, right?
But you're also beginning to shape his identity, because if
he's beginning to understand himself more as someone who's
good at relationships, someone who people like to be around,
someone who's nurturing.
All of those things are just the very things, that I want to
turn up the volume on in an intervention with a young
child who is going forward and hopefully can make
a connection in a foster care type of setting.
This is a child where because of the paucity of relationships
and sort of attachment issues in his life, if we can really
highlight those skills, abilities and strengths,
that's going to have a lot more--
You know, really talking about that he has that ability
to do things, because I get alarmed, in having worked
inpatient settings for a long time, how quickly kids can
attribute behavior change, or strengths or skills,
or abilities, to medication.
"Oh, it's the Lithium that did that."
I'm pretty sure that the Lithium didn't help him--
It may have helped with some up and down impulsivity,
but it wasn't the Lithium that had him noticing that the
nurse's face was a little scared, to have this--
You know, this kid is often violent with a pen,
getting ready to take your blood with the pen, it's like,
"Am I really going to have my blood taken with the pen?"
The fact that he noticed her distress in that moment,
offered soothing words, that's not a result of--
A medication isn't doing that, that speaks to some kind of
knowledge or experiences of life.
So if you think, within a milieu environment, if you
people could be attuned to really listening for particular
kinds of things, and responding to different kinds
of things, that that does really have great impact
on a person's behavior.
So this gets back to these ideas about, life is composed
of multiple stories, the good driver stories
and the bad driver stories.
As a therapist, or in a milieu treatment setting,
we're really going to try to connect and create a
dominant story, or at least an equivalent story,
that would be preferred as identified as the client,
or really, people in this unit, I don't think that this
young boy could identify that, "Yes, I like to be
"thought of as a more nurturing, or emphatic,
"or relational person."
But really to know that this is something where there's
probably great deficit in his understanding of himself,
and how helpful that could be, to strengthen
that understanding, before he goes to a next placement.
Because if he really can learn more about how he knows
about trust, how he knows about relationships, that's going
to serve him well, in whatever setting he's in.
I'm going to just, being aware of time, talk a little bit--
Just skip ahead through some of these slides,
but I'm happy to talk more about them at the break,
or at other times.
This is an idea that there's different kinds of positions
or ways that we can be, in response to people.
I've talked a little bit about expertise.
Who has the expertise in the relationship.
So, an idealized narrative therapy relationship would be
this de-centered--
And I feel like a weather person on the stories.
So this de-centered and influential position.
The reality is for any of us, that I often would be flowing in
many of these categories within any single therapy session
or conversation with people.
But ideally, I want to try to be
de-centered and influential.
So de-centered means, specifically, that I want to privilege
the client or family's knowledges and experiences of life,
over my own.
I want to be influential, in that all the knowledge
I have, so going back to that depression interview,
all the knowledge I have about how many people
experience depression, both in a medical way, and all the
conversations that I've talked with.
I am always going to be generating hypotheses.
But I think that, that de-centered idea is that any kind of
hypothesis that I generate, or interpretation that I'm
thinking about, I'm going to propose in a way that,
it is more tentative, it is more exploratory,
and that truly, if a person says no, that, that's not a good
fit for them, I'm going to take them at their word,
and not assume that my professional training or experience
gives me more knowledge and experience at life,
to their life.
So they're the experts on their life.
So, I want to stay influential, and that I'm
generating hypotheses, that I'm using all the knowledge
and experience and training that I have in my
thought process, but I really think of myself more as a
consultant or a facilitator, in the work,
than I do as an expert.
I think of the person and people that I am working
with more as experts.
The centered and influential, is, I think, how we're
often training within this field, to take a position.
And it's like, "Well gosh, I paid all the money for
"the degree and for the training, licensing,
"for my continuing education, that it all needs to
"come up for something."
And I think a lot of people do come to us,
desperate for our expertise.
Most people, when they come in, walk through the door,
they're looking to us to have the answers to the questions
that they may have.
So it's not--
It's more that I don't want to de-value that position.
And I think that many people feel comfortable and do
incredibly, amazing work practicing from that position.
But I also feel like, my experience from practicing
in that position is that for me personally,
it's led to a lot more burn out.
When I become an expert in a person's life, I come to have
ideas and things, like I'm working harder
than this person is on their treatment, and particularly
around risk behaviors.
I remember there was someone who, I really struggled,
and couldn't get into a de-centered position with through--
But they had very high risk suicidal behaviors,
and were very dependant on me.
And I felt like it was this incredible burden, that I
somehow ended up taking up, in relation to the work
that was so exhausting, that somehow I felt that if they
took action against their life, it would be really my fault,
because I didn't have the right answer,
or I didn't do something the right way.
And this was when I first moved from in-patient
to out-patient work, and I just felt so overwhelmed
and unknown in that work, and so responsible
for how the shoe would be.
It's the same thing with residential.
It's like, if the kids are doing well,
you're a great therapist.
If the kids are struggling, it's your fault.
I think that there are ways that there can be
tremendous joys in practicing from a centered position,
particularly if the people that you are working with
are doing well, and you feel like you get
some of the credit for that.
But I think the downside, and maybe I'm just the
worst therapist, but the downside is that when people
are struggling or not doing so well, it's like,
oh you have to take a certain
amount of responsibility for that as well.
So I feel like the more de-centered but influential I've
been able to stay, you know, really helping people to see
how their choices, their decisions, their knowledge and
skills has more impact than anything else on their behavior.
How actively I work, also to de-center my expertise by
connecting people to communities of support, as opposed to
allowing myself to become that cherished source of support
for someone, has been so helpful.
Centered and non-influential, whoo.
I work a lot with adolescents, and I can just tell you,
it's so easy to get in this position, like how you
know you're in that position
when you feel a lecture coming.
Or particularly around a risk (mumbling) or a behavior
you're worried about.
There's use of self that can be effective, and then
there's use of self where you're just like,
"Man, I am just being another ineffective lecturing adult
"with this young person."
When they have tuned out so beautifully in my presence,
I know that I've gotten into a centered
and non-influential place.
And similarly, I think that it's equally easy to get into
a de-centered and non-influential place of--
And then it's like, that might be the worst overall
feeling in the work that I've ever had.
It's sort of, like, where you're in a swamp with
other people, and everyone's like, "Where's the guide?"
It's just, where you feel really lost, and there's not
a sense of direction.
And there's moments where I think of, "Will a real
"therapist please come into the room right now?"
Like, "What would a real therapist do in this situation?"
It's when I've gone to a de-centered
and non-influential point.
I've talked about this, in terms of,
different kinds of stories.
I do feel like, what's helpful is you're beginning to
try out new kinds of ideas, is that, for example,
with that young boy on the in-patient unit that I
talked about, although he's five years old,
that dominant story of a lack of self worth
or not being good at things, being a failure,
or however he would verbalize those kinds of understanding
about himself, that is going to be a very strong,
well-established storyline in his life.
And so, it really will take effort and some time,
of turning up the volume on other things, and through lots
of different people, to create something that can compete
with that automatic identity conclusion
or negative way of thinking about himself.
So I think about it so often when I read things in
the literature, any theoretical approach,
because I really do--
I teach first year practice and other kinds of survey
courses, where you talk about a lot of different kinds of
theoretical approaches.
But what I really noticed is, when you read about an
approach in the literature, no matter what it is,
it seems like it's easy and successful.
And really work is much messier, and protracted,
and harder to gain inroads, but I think it's helpful to
have the knowledge, that as you are trying to help someone
arrive in a different way of understanding themselves
or a situation, no matter what you approach,
it just does take time, and you really need to build up
something that can contest with that
dominant story or understanding.
All right.
So one of the things that I have liked about
narrative therapy is that it does connect to larger social
discourses, or that's another way of saying, just the
kind of different ways that societal influences impose
different kinds of rules or behavioral expectations
on us in some way.
And so, one of the things that I think can be a downside
around something like pathologizing, or coming internal or
more medical-based understandings, is the different kinds
of ways, for example, I talked a little bit about how it's
harder to know how to go forward.
If someone is saying, "I am depressed," and we're really
taking about it in a medical way, that keeps that problem
located inside of them, it's much harder for people to know
the steps that they might take about the problem.
If they're talking more in a very experience near way,
no matter what our approach is, you know, if you're
talking more about their acute loneliness, and their hopes,
and their dreams, or how life used to be different
and what they're longing for, there's much clearer
way forward, in terms of what they might do.
Similarly, I think the world is not a level
playing field for people, and as we talk about problems
in a way that doesn't link it to larger systemic
issues of oppression, it becomes harder to see or understand
what those influences are.
I think it's harder to have a conversation about how racism,
or sexism, or homophobia, or ableism, or ageism
might be impacting someone's experience
of loneliness, or a sense of what they might do to go
forward into the world, to have it be
aligned with their hopes.
But when you talk about it in an external way, or when you
ask particular questions about the influence
of such factors, and help people make those connections,
I think it can be really useful.
I know that there were a couple different op-ed pieces
in the New York Times, just in the last week, that I thought
did a really nice job of taking an individualized incident.
One was about the Trayvon Martin case, and it was a
op-ed piece by Charles Blow, about how the system
failed Trayvon Martin.
And another was about a Supreme Court of Iowa decision about
a dental hygienist who was fired, because of her
physical attractiveness, and how the Supreme Court
of Iowa upheld the decision, that her attractiveness--
The dentist who fired her was saying that her presence
in his office was putting marriage at risk, because he was
tempted to have an affair.
And so, the Supreme Court upheld that decision, so this is
a really interesting article about "lookism."
Or, just the effects of, are we really focusing our
energy on the wrong place?
We're focusing on a physical characteristic of
attractiveness, as opposed to really critiquing this idea
of how others' perceptions of beauty.
In this case particularly, linking it to gender and
patriarchy and the male gaze.
You know, why is that--
The fact that they didn't overturn that.
It's an interesting op-ed piece.
I thought, what was nice about both of those editorials
was that it was a great example of taking something from
an individualized way, and putting it within a
larger systemic context.
For the Trayvon Martin op-ed piece, it was on racism.
For the other piece, it was on sexism.
I think that they are interesting reads, just help--
Remember to make those links.
I feel like in that way, narrative therapy is very
connected to these ideas, and those politics do
come into the therapy room.
And in that way, I also feel like--
That's one of the reasons I have always been proud to
be a social worker, in terms of, it's not that we have
a perfect history by any shape of the imagination, but how
social justice is an important part of NASW,
as we think about what our role is in the world.
Okay, so I know there were some people who had some
understanding about what external--
You know, about narrative therapy before coming in.
And I'm guessing that maybe you had heard
about externalizing before.
I think one of the things that he might have said is,
"The problem is the problem, the person is not the problem."
So often I hear persons being talked about as problems
within agency context where I work.
But also, how oftentimes people come in talking
about themselves and the problem too, it's like, how do
people describe a problem.
Generally it's, "I am depressed, I am anxious."
So take away from the influence or the effects that a
diagnosis has had on someone's life, but I think that so
often, these people come to us, problems have
come to define them.
I think a lot about family work with young kids.
It's like, so often, sometimes it can be overwhelming
to have initial family sessions, where it's like "that child
"is the problem," and is the reason for all the problems
in the family, and it's just like, "How can I shift
"the conversation some way, where we can try to understand
"this in a different kind of context?"
And it's the same thing with individuals who--
Because if you lose yourself behind a--
If a diagnosis, or something, or any kind of problem has
taken over, it doesn't need to be a diagnosis.
It's very then hard for that person to find themselves,
to figure out what might be important to them,
or what they might want different in their life,
because it becomes quite easy to be a passive--
Well, to be a passenger to whatever the problem is,
and the problem ends up guiding all of the ways
forward in your life.
So, overall, externalizing tends to--
They seek to separate the person from the problem.
Also recognize that the people,
the stories that people tell about their lives
are shaping of their identity.
And so it sounds like the person that you are working with,
the way they would describe their life right now
probably would be dominated by this bipolar story,
and less about who they are.
It's funny, if you attend to the language in those moments,
people will be telling stories about the problem,
almost instead of saying, "I," it's just interesting
as people get into this position.
So, "Externalizing conversations employ a range
"of techniques," there can be different kinds of
sequencings of questions, it can be very subtle.
I mean, lots of times, people will ask me,
"What if a person isn't interested in the idea?"
It's not something I say, "Okay, we're going to have
"an externalizing conversation now."
No, but lots of times, I might just be doing--
Like, I've shifted my language to the point where I
would be talking about the bipolar.
So it can be a very small shift of language.
Like, "When the influence of the bipolar--
"When influence of bipolar is around, what do you find
"yourself doing or thinking, that might be different?"
To really just try to do things--
"What does this problem have you thinking about
"yourself right now?"
So anyway, influence of "range of questions and techniques,
"that seek a comprehensive account of the role of the
"problem in a person's life, as well as a fuller description
"of a person's life as separate from the problem.
"In sum, the process of externalizing seeks to reify that,
"'the person is not the problem,
"'the problem is the problem.'"
One of the things in externalizing conversations too,
is that it--
Sometimes you might start out with a conversation about a
particular problem or issue, and I think particularly
lower level problems, when you guys will do an
externalizing conversation, where I ask you to pick
education size problem to externalize.
And so, I know that, for example as I worked with students
or if I think about things that I have externalized in exercises,
There have been things that have surprised me.
One of the steps in it--
We'll talk about the steps right now, is...
To arrive at a statement of position.
So sometimes, people will start to talk about a problem
and its effects in their life, and they may end up coming
to the conclusion that the problem has actually been more
helpful than they originally think.
It may come to a re-naming or a certain kind of thing.
But, I have had students, for example, who have started
with an idea of procrastination.
But really, as they really began to sort out what it
was that they were talking about, it really,
maybe became connected to some ideas that they had
about value, or quality, or different kinds of ways
that they wanted to engage with their work, that they
really appreciated about themselves.
So it wasn't the procrastination was all bad all of
a sudden, it really had some values embedded in it,
that they really felt were important.
And that helped them understand why it was very
difficult for them to think about changing that behavior,
or some of their habits around paper writing
and other kinds of things.
At the end of the day, that client is really the expert.
So I know, when I have taught before, people may
think about something like AA.
To describe oneself as an alcoholic, that's a really
totalizing account, but actually, for folks who
may use that as a way of describing themselves, it can be
an incredibly helpful account.
Part of it is getting the detail and the descriptors,
and it sounds like that person that you're working with,
the way that it's changed over time, is a story that has
changed incredibly with meaning.
And I think that AA is a really interesting popular example,
because often, the ways that that story shifts,
or the ways that that identity is understood.
It isn't a thinly described, "I am an alcoholic."
It is actually a process of telling stories
with an audience witness your story, and your
evolving story, where that identity gets constructed.
And so there's a way in which, even though, sometimes the
language doesn't necessarily fit with what I'm talking about
in sort of a totalizing, pejorative account of someone.
I think that actually, if we ask someone who's immersed
in the experience, where they have found AA to be
very supportive, and have come to the conclusion of
using these kinds of labels, to really ask them at
different times, more about what that meaning is,
and how that has been helpful or not helpful,
as a way to understand themselves in the world.
I think you can get a really rich
account of that understanding.
So in some ways that does fit.
One of the things that I think are often--
When you think about what to externalize,
there's lots of questions that come up, so I think that
one of the things--
With the transcript example that I looked at, I particularly
chose an example with anger problems, in particular,
because I think sometimes, as people think about separating
a person from a problem, there's a worry, and I think it's
a good worry, to think about I don't want to--
If there's any kind of behavior that's causing harm
to anyone else, I don't want to separate a person from
a problem in a way, that they are not being accountable
for their actions, against that might be harmful
towards other people.
And so, that's when you ask, "Well, how do I know
"what to externalize?"
And really thinking about, "And what are the effects
"of externalizing?
"And how am I to engage in the process of separation?"
If someone's doing anything that's harmful for others
in a way that holds them accountable.
One of the things that I think is helpful to
think about, about externalizing problems,
is this understanding of, what are the differences between
internal state understandings of problems, and external
state understandings of problems.
And so, internal state understandings about a problem,
their negative identity, conclusion or strengths,
can be more richly described than other kinds of things.
So, describing things that have been internalized.
So people are-- like the bipolar for example,
and your example.
When people have come to understand themselves as
a problem, or it's obscuring in some way, I think can be--
Those are really nice things to target,
as a way of externalizing.
Effects can be the actions that people have taken,
beliefs or values, as I've talked about, social oppression
and its role becomes more visible.
And this fits with other narrative practices, in that
it can be a launching point for c--
It can be that initial externalizing, and where one ends up
might be this initial story, and the creation of a new story
or there can be other ways, or pieces.
It can also just provide a new understanding of
how to go forward.
I think of--
I use the example of, I don't know if other people
are looking, particularly families with younger children.
I think particularly, anyone who's ever used play
therapy techniques, I think that this process of
externalizing can dovetail really nice;y with what
people are probably already doing, because it can really--
Whereas a lot of the questions that I'll have in
our exercise we'll do together, are really much more
geared towards adolescence and adult ways of thinking.
There's beautiful and playful ways you can do this
with young children.
So I think of some in-home family work that I did,
where I was with a child who drew a picture--
It's not uncommon for people to draw a picture
of their problems, so kids can do that really lovely.
And we did a one--
A Wild West or FBI, but you want to do Wild West when
working with kids because you don't want to introduce
the FBI most wanted posters for kids.
We did a Wild West wanted poster on this angry monster,
that she began to externalize.
At first the mom was like, "Really?
"Are we going to be doing this?"
But to really, this kid could--
Once the angry monster was out there, a very colorful
picture of a warm fuzzy, but multicolored.
And it wasn't such a warm, fuzzy, this angry monster.
She could really identify the times when the angry
monster was most likely to come around, and this was
important information for the wanted poster bulletin.
She and her mom could notice that transition times
were particularly hard, so bed time, after school.
There were a lot of different kinds of conditions or
circumstances, when that angry monster was much more
likely to show themselves.
When it became, not that the child had such angry issues,
but there was an angry monster at loose around the house,
the mom was also able to acknowledge that her stress level
could contribute to the presence of the angry monster,
when she was wasn't able to listen as well, or lost
some of her patience, the angry monster was much more
likely to rear its ugly head, and really begin to
be tantruming, or other things around the house.
So once we first drew a picture, and then describe what
that angry monster would do that was problematic.
It wasn't what the angry monster would do, it would be
what the angry monster was convincing that young girl to do.
It was the girl's behaviors.
Angry monster wasn't tantruming, the girl was, but it was
also a different conversation when its externalized,
of, "Have you ever been boss of the angry monster,
"or is the angry monster always the boss of you?"
And she could say, "Well, maybe my monster is often
"the boss of me.
"I haven't been the boss very often.
"Like one time, I did this.
"And another time, I did this."
It's, again, when she's not the one with all the
anger issues, she could think about the times when she
was able to take a stand against the anger in her life.
Bless this mother, because she initially was like,
"Who is this in-home therapist arriving with their crayons?
"And how is this possibly going to be helpful?"
But, I just had talked to her a little bit about what
we might do ahead of time, ask her if she would be
willing to try this out for a week or two.
So we made some wanted posters, and posted them up in
different places around the house, where that angry monster
was most likely to come around.
And it just gave them both, again, a different kind
of language, to talk about the problem about like,
"Honey, could you--
"I would really appreciate it if you could stand up
"to the angry monster right now.
"I think the angry monster's beginning to be
"the boss of you."
It was like a way--
Just like we often talk to parents about--
You talk about the behavior, and it's like,
"It's not you, honey, it's your behavior."
All these kinds of ways, it just is another way.
She also could have some ideas of things that they could do,
that were useful, in terms of steps that they could take
together against the angry monster's influence.
And then that angry monster, after about a month
and a half, did move out of the home.
I think it got to be so ineffective, it went to go
find another child to bother (laughs).
But it was really helpful, because we also could talk about
what were the conditions that were present, that the
angry monster was not a problem at school, for this child.
It was really particularly some things that were
happening at home, so it was also way of beginning to
talk about those environments, in a way that
I think the mother felt that she wasn't being judged.
It can be hard, depending on how you're referred to treat--
I think it can be relieving, that this kind of way
of working can also really actively shift away
from ideas of mother blame, or other kinds of ways
that people might be--
It's such a different way of talking about a problem,
that I think that people aren't feeling
judged in the process.
This internal versus intentional state,
problems or understanding.
Internal state understandings of problems really thinks
about things in more biological drives, or things are
motivated by certain needs that might be met or unmet.
Different kinds of deficits, traits or attributes.
Intentional state understandings is what we might work
towards as we create a different kind of story, but they're
reflections of personal agency, and so purposes, hopes,
commitments, dreams, values, beliefs.
Those are the types of things, when I think about that
I may be de-centered and that I'm really trying to pull
forth people's expertise.
But I am influential in that all of us ask questions,
and are listening and responding to certain things.
Like, I am always listening or responding.
I have tremendous biases that I bring into the room,
where I'm really listening for
reflections of personal agency.
So, out of all the things that I could repond to about
the angry monster's presence,
I really want to hear them both talk about what they
know about it, when its around.
What knowledge or skills they've had, in relation to
reducing its influence.
I am going to be listening for very particular kinds
of things, and all of the things that I'm most
listening for, are going to be reflective
of personal agency states.
Does that make sense?
Personal agency states I think are
intentional state understandings.
I am not going to be thinking about problems
or conceptualizing them, in a way--
About unmet needs of, an automatic or out of
an awareness understanding.
I want to really focus on people's awareness by asking
questions about knowledge or skills, it really is about
bringing something into people's awareness. which is really
how unconsciousness is really thought of.
It's really about healing happens as the
unconscious becomes conscious.
This is not that different, in that I', really wanting
people to have more awareness about--
If I'm asking about, what are the conditions that the
angry monster is more likely to have influence?
What they are is identifying quite actively
situations or moments that are more likely to have
things come into play.
It's the same data set, one way of understanding
of looking at this snap shot of a moment, might be
that due to fatigue at the end of the day, a parental
figure has less patience, and is really trying to
move forward with structure and bed time,
because with the knowledge that, that is what's best
for the child in that moment.
But the child is feeling like they just need
attention on one issue.
It could be an unmet--
You can look at it, and really clear;u understand it's
an unmet need for attention, or patience, or a something
in that moment, that then causes this behavior of a
wild tantrum to come into play.
But another way of understanding it is if they can verbalize
and describe things, and children can do this in language
that is accessible to them, it's just another way of
applying some words to things that may already be
familiar with people,
but I just think are helpful to understand about,
to just really--
I'm pulling for awareness and knowledge, and talking about
what's important to them in their life.
And I think that...
It's perfectly okay to have less patience
at different moments of the day.
I also feel like, really understanding the value
of patience, or how, if one could just extend, just a little
bit more in that moment, sometimes that can be enough
to transition, or to avoid a temper tantrum, even if that--
Things shift, as different kinds of understanding come to
people's awareness about needs and other things.
It's just a different way of conceptualizing.
I don't think I'm being too clear.
I can move on, but does anyone have a particular question
that I might help clarify that further?
On this slide, I have things that talk about internal
state understandings, and intentional state understandings.
And I feel like, thank you, because I know I'm flying
through a lot of these slides.
For me, I really think about this slide, as fitting
into my own internal process of thinking, and listening,
and formulation.
So, in many ways, this gets back to the earlier type of
question about, if I have a certain kind of way
of conceptualizing something, that is more with an internal
state understanding.
So, if we go back to thinking about traditional ways
that I had talked about depression, for example,
which would be much more about
internal state understandings.
I don't want to remove something that might be a very real
biological component, but I feel like there's a lot of
other ways that I might have understood it, in terms of
deficit, so really, this might be an expression of something
that had happened in the past, that might be out of
people's awareness.
So more an unconscious state, or--
And it's not that I'm not exploring for things that are
out of people's awareness.
Like again, it's not necessarily so different, but I'm
not exploring people's relational history, to look at
patterns of deficit or--
I'm not necessarily looking for something in that way.
And again, the tricky part about this, is I do feel like
at all times, people have the same set of experiences.
It's like the data set is the same, but just
how I'm then constructing the conversation.
I'm not going to have them describe their experience,
in terms of a history of disappointments, or losses,
or other kinds of things, because I feel like if
I am turning up the volume, or if I am exclusively
listening to solely those types of accounts,
that ends of being shaping of people's experiences.
If they're talking about what they haven't gotten
repeatedly over time, even if that is something that's true.
Or if I come to understand it as something like--
The sequence of disappointments is this idea about
repetition compulsion, like they sort of being driven
to do something that's not fully in their awareness.
It's not that, that is necessarily a wrong idea.
I think that, that can be a very helpful way,
in conceptualizing our understanding of things
to a certain degree.
But I also feel like, in my conversations with people,
I'm really thinking about, what are the effects of
describing experience in ways that
are very deficit oriented.
Like if, you know you just feel like--
We'll talk a lot also in the afternoon about, I've come
to understand, for example, in responding to trauma.
I really am having less effects conversation.
I'm spending lot less time.
I want to move pretty quickly, often, from normalizing
conversations, I feel like there can be something that
is actually very helpful, and powerful,
and acknowledging of people in some ways, to do something
like a conversation about diagnosis.
Or if people are talking about distress
they're experiencing in relation to flashbacks
or something like that.
To hear that other people also have intrusive thoughts
about past and painful experiences is helpful,
because people are feeling very not normal.
Part of what they want is that assurance, or community
of others, who are having these kinds of experiences.
But I don't want to linger in conversations that are
promoting the normalcy of people's passive
experiences or responses.
I don't know, I just going to follow this to the end.
With the trauma conversation, I would really then want to
get much more about what was distressing to the person
about having those intrusive thoughts or memories.
Was there a particularly--
Again, particular value, dream, sense of, if I think about
people talking about experiences of being abused
as a child, not only what were the effects of what
they experienced, but what was it, what kind of values
or ideals, or hopes, or beliefs that were
foundationally important, were transgressed?
Because I also think that when it becomes also a
conversation about those beliefs, other kinds of
commitments that they've made, in response to that
kind of experience of trauma that they have experienced.
There becomes more of a sense of purpose about--
The fact that you have chosen a career in child advocacy.
The fact that you're now working in DCF, would that be--
Would that commitment that you've made in your professional
life, be a reflection of--
In some ways, it can--
The value of yours that was transgressed, when you were
abused as a child, what are some of the ways that,
that value continues to be expressed in your present life?
It's been expressed in your choice of work, and your
advocacy, and your valuing of children's safety and lives.
I just think that there can be a way that's very different,
than to look solely at effects of what was done to,
or ways that--
But again, it highlights the activity or response.
Is that helpful?
So whether it be with the depression about the value
of connection, the value of certain kinds of relationships,
and the--
Which is really what's fueling the pain of loneliness.
I would really want to--
It's a different kind of thing, to talk about
people's dreams and knowledge and experiences,
and hopes for connections, as opposed to purely on--
And yet, you can't move to these more happy thoughts.
I feel like there's a great article on solution focused
therapy, that I have used in teaching, that I just feel
is really helpful for any kind of strengths-based
and collaborative theory.
You can't move--
It calls it, solution force therapy.
I really feel like the people who sit with us, if we move
too quickly to any kind of fix, no matter what our approach
or solution, before we fully understand the problem,
it's not going to work.
Like, if we start asking questions real quickly, like,
"How will you know if you woke up and the problem
"was all gone?"
People are like, "You don't even know what the problem
"is to begin with.
"How can we be wishing it away, at this point?"
I think that it is important, so it might be,
even initially, that I'm tracking potential hopes
to explore later.
I do really want to hear the effects, but I don't want
to linger and have too many questions solely about
effects, or having types of conversations that locate
people's responses, or take things for granted.
Oh, it's by Nylund and Corsiglia.
and it's Becoming Solution Forced.
It's focus is crossed out and forced in therapy.
That should be enough key words to get you there.
You can email me, and I could potentially
send it to you as well.
There is often a sequencing of questions in externalizing
that, one doesn't necessarily need to go in order,
but it can be helpful to do a flow in order,
because it just makes more sense,
as one who's answering the questions.
So, characterizing the problem, and the negotiation of
a personalized and specific definition of a problem
or concern.
So that one, when I talked about the name,
The Angry Monster, that was something as I had them
describe the effects of what was initially anger problems,
or tempter tantrum, it became to be described initally
as The Angry Monster.
Another example that came up during the break,
was using a rational recovery model, talking about
substance abuse as The Beast.
And thinking about the beast gives a little bit of space
about the beast's influence in one's thinking or actions.
The next part is about naming the effects or influence
of the problem.
This might be the ways that, when the problem is around,
how is that influencing people's beliefs about themselves,
actions that they're taking, other kinds of things.
I've used other kinds of therapies, or like, cognitive
behavioral therapy, for example, when I talked about
something like thought distortions,
or the effects of things.
Sometimes I've talked with teenagers about, to help them
think about the ways that depression
impacts their thinking or cognitions.
I've talked about...
Imagine walking to the cafeteria in high school,
and as you walk in, there's a table of your friends,
and they all burst out into laughter, when you arrive.
On some days, you know someone's told a good story
or joke, you walk over and you hear what
they're talking about.
And other days, you're equally 100% sure that they are
laughing about you, and you might
have some thoughts to that.
Like, "Oh, I have a bad outfit on."
And really, to help them then think about what triggers
might be, what was the sensitivity that
has them equally sure.
And it's helpful to then have them begin to think about
both ways of thinking.
In this way, I think that you can talk about,
when the depression is around, what does that have you
convinced about yourself, in a different kind of way?
But with anything, before I would externalize anything,
part of these first part of the questions, as you're
naming the effects or the influence, is to--
I don't know if I would start with externalizing
sexual offending, for example.
It might be a different kind of--
My preliminary conversations with someone would be a little
bit about their relationship to that label.
Like, are there ways that it served them well?
Are there ways that it hasn't?
Are there ways that it fits with values that they have?
This is any label or diagnosis.
Like a certain sort of controversial to use for example
in this moment, but ways that it fits maybe, or maybe not.
Fits with this value, or ways that it doesn't.
You know, who--
As they come to think about that, that is who they are,
what has been--
How have they experienced that as problematic?
How does it not fit with who they are?
How does it fit, also, with a part of their history,
or behaviors that they've had.
I think, particularly, as people are transitioning,
or other kinds of things, I think that I actually like
to use the example of sexual (mumbling), because I think it
speaks to the range of complexities that fit with that,
because no one is holding any one label.
And certainly the folks that you're working with,
are not solely sexual perpetrators.
It can be very easy to see why the external world has
really tried to collapse that, and have that become
their total identity.
And so I do feel like it would be a series of many
conversations over time, to highlight who they understand
themselves to be, outside of that identity, or organization.
What it is that they value, or other kinds of things.
I don't want to take--
We're not talking about any kind of perpetrating,
you know, behavior that's harmful of others.
I also feel like it's really--
So part of that, is to really expand their identity
away from that label, to help them stand in a different
place, other than that identity, because that will allow
a different kind of community way of being in engagement.
Of course there's always--
When people have done things that are harmful
to other people, it's like, I don't want to just only
have my conversations outside of the problem, as if
it's a cotton candy world, and everything's going to be
okay if we only talk about the best of
all of ourselves, and sort of ignore the worst.
I think that as we talk about issues of risk, and risk that
involves any kind of harm towards people in any way,
whether that be sexual perpetration, or child abuse,
any kind of physical or emotional violence of different kinds,
I think that there's ways of exploring the violence.
Also, just very carefully, where you're looking at
people's actions, decision making, experiences,
that might contribute.
This is where the broader social ideas
also, really come into play, what are the ideas about
the way that masculinity, or femininity, are in the world,
that might create conditions, or invitations for people to
express themselves in certain ways, or other ways.
There are a couple books that I think about.
There's a book by Alan Jenkins,
called Invitations To Responsibility, that talks
specifically about working with men who've perpetrated
sexual violence against women in narrative ways.
There's also another person who I would keep an eye out for,
who lives in Eastern Canada, and does some of the most
creative and amazing work I've seen with male perpetrators
of abuse, and I've been hoping to help publish more
and more for years.
His name is Art Fischer.
I think that there are a lot of interesting writers.
That almost is a day in itself, about ways of, how do I
hold people accountable--
Both expand the identity outside of this negative thing,
which is true for any potential diagnosis, but also
particularly around issues of risk.
Working with ways that are empowering to them, but also
acknowledging of the risky behavior.
But really, it is similar in that you are really pulling out
values, looking at social interest, social influences,
but also continuing to hold people accountable
for harm that they've done towards others,
and thinking about--
There's really, also, a lot of interesting--
We're not even talking about some of the community
work aspects.
There's been some really fascinating...
There's some strong connections between narrative therapy
and restorative justice movements.
And so, really thinking a lot about, what are ways
of reparations, in terms of thinking about harm
and reintegration of people in community.
So, really thinking about if people are coming out
of any kind of prison, or institution,
or other kinds of ways, where they've been
separated from their behaviors.
What are the ways that we, in the outside community
and helping community, can also really work at
partnering with the community,
with folks who are re-entering it.
How can they return--
Because we know that--
I know as a social worker, and I would imagine that
other people might share, the sense that it's really about
people are less--
Like, if you are not marginalized, but really given full
membership back in society as you come back in the world,
you would be more likely to be able
to fully participate in some ways.
I think that a lot of restorative justice movement think
a lot about reparation conversations, and really re-entry
back into the world.
How's this going, so far, if I may just do a check?
I'm always so aware.
I can lose focus sometimes when I teach, if I get too
too new to the clock in what I originally planned.
I feel like by the end of the day, I can really make sure
that we get to material, but is this going okay
for all of you so far?
Would anyone be courageous enough to say, "No, it wasn't!"
Okay, all right.
No, but these are great questions, thank you.
But in the externalizing, as I said the characterization
of a problem, and looking at the effects and influences
of the problem, revealing its tricks and tactics,
I think what's so helpful to always remember
and keep in mind too, is that for so many folks,
before something became a problem in their life,
it was really, it had its purpose.
Or worked well enough, or it was a friend.
So we're talking about this idea of the beast, if you think
about this within rational recovery, if you think about
the beast as maybe being a representation of a way of
describing a history of substance abuse.
You know, there will be a time, when using or drinking
might have been really helpful around
some social anxiety issues.
Like, it might have promoted connection, or been
connected with values.
Most problems, if you trace the history, there can be some
ambivalence, or change hasn't happened easily,
because there's a mixed history of things that were maybe,
at one point, positive, and then had become more negative.
So think about issues, look at the naming, effects,
or influence of the problem, and its tricks and tactics.
It can be exploring a complicated history.
It's sort of like, that friend who you're like,
kind of have a mixed really--
Who hasn't always been so, you know like--
It's a conflict, most problems have pretty
complicated histories in their relationships with people.
What becomes important, and I think is really critical
for change, is that evaluating the effects, influences
the person, this again, where you're centering the person
as the expert, where they have to evaluate the effects,
and end up making a statement in relation to the problem.
So, going back to the years that I worked
on inpatient units, it would really be absolutely
not uncommon, for an adolescent to be hospitalized
for self harming behaviors.
Self injurious behaviors of some kind.
Often times, family, school, everyone would really
define the problem as these self injurious behaviors,
and they were very worrisome.
And I agree, they were very worrisome behaviors.
But often, I would be sitting with a young person,
and they would have a very different idea of what
the problem was.
They would say, "Well, these self injurious behaviors
"are not such a big deal to me.
"In fact, they're the most useful way that I have
"come up with to date, to manage my emotions, or feelings.
"There is a physiological effect that I experience."
They wouldn't necessarily say it in these words,
but their experience of cutting, releasing endorphins,
or other kinds of experience that really were biolog--
Or really had some kind of biological feedback in them,
that was helpful, and that, "I'm not willing to
"change these behaviors at this time."
Or anyone who's ever worked in mandated treatment,
which is a lot of treatment with adolescents,
but certainly on a unit.
People can be really smart.
If a kid gets in an the patient unit, and knows that in
order to leave, they need to say, "Yes, yes, yes, yes."
Or, "No, I won't cut," "No," this.
"Yes my coping skills are reading, writing in my journal
"and listening to music."
Like whatever the common things that we tell
work with teenagers.
They can say the right things to get out,
but if you're really thinking about changing behavior,
it's important that as we work with this system,
that we have a shared understanding of what the
problem is in the first place.
And so, I do--
When we talk about a characterization of the problem,
it has to be something that would fit with
all parties involved.
I want to honor the school and parent's opinion,
but I also know that if I define the problem solely
in that way, that young person is not going to
be motivated to take any steps towards changing that
relationship to the self harm that they have in their life.
But you know what, lots of times, young people
find it problematic, the adults meddling.
The lack of privacy might be a result.
The fact that they've been hospitalized against their will,
and that they don't have privacy in a hospital setting.
So it hasn't been uncommon, for me to take, then,
the issue that is related to the self harming behavior
about the loss of privacy and independence,
that might come for some young people.
It wouldn't be uncommon, during the times that I've
worked at the hospital, that upon discharge,
a young person might need to visit their primary
care provider once a week, to have a body check.
We might remove it from the tension between the parent
regularly checking the child wasn't cutting in places
that were under clothes, because that really was causing
a lot of problems in a parent-child relationship.
But the fact that they would have to go to the doctor
and be looked at, would be considered problematic.
Or the fact that they weren't allowed to have their
bedroom door closed at home anymore.
They might be willing, or, you know--
Or that their parents might be searching the room
a couple times a week for sharps.
And different kinds of safety plans were put in place.
Young people might be very motivated, to try to get their--
Well maybe it would be worthwhile to try to find
some other ways of managing intense emotions, if they
could then earn the capacity to close their door,
or other kinds of things.
So part of it sometimes, in the naming effects
particularly, and working with systems where there's
very different understandings of the problem, you can
get to a way of describing, or coming up with a way,
a conceptualization of a problem, that really fits with
everybody's goals and needs,
and then treatment really will become a lot more successful.
Okay, so there are some examples and you have these
in some of your work sheets, but because you can get
into pairs, I think it'll be helpful.
But, "The first part of externalizing a conversation,
"seeks to have a person consulting us
"name the problem as they understand it."
Lots of times, I feel like the best way to get at this,
is to start with a story.
"Can you describe a time when this problem was around,
"so I might have a better understanding of your experience?"
You know, "What name might you give this belief?"
And again, this goes back to your question, Tuva,
about like--
From the beginning, that internal states versus
intentional states, a lot of these things from
the beginning, I have my bias and my conceptualization
as I'm answering intentional state understandings of things.
So, what name might you give this belief.
That's very different from asking a question that
might be reflective more of an internal state understanding.
That's the danger, if you ask a question,
I'll keep coming back to it, over the course of the day.
"Is there a particular time or place, where this
"blank," or whatever they're naming it, "has more or less
"of an influence in your life?
"Can you give me an example?"
For some people, maybe younger people, and sometimes
other people, I think that so often, we can listen to
the way that people put language to things.
I think so many of us automatically do minor shifts
towards the ways that people talk--
The different kinds of metaphors that people use.
I know I can always--
I'm not a real visual person, so I often wouldn't come
up with a lot of visual metaphors, but if people are very--
You discuss things in sort of image, or that kind of thing,
I'm much more likely to work in that way with people,
or other kinds of metaphors.
I think we all do that.
But, just for some people, this idea of
externalizing this problem were a person,
what kind of person would do this sort of thing?
What would it look like, sound like?
The next part of exploring the effects and influence
in "multiple domains in a person's life, where the problem
"might have influence, as well as its tricks and tactics."
Things like a lot of you will be trying this
in the next half hour.
If we ask a question that people start to answer,
"I don't know," I've asked too big of a question.
And so, one thing that I might do
and this sort of fits with the learning model.
Learning model by Lev Fakosky, for people who know
developmental theory, is something that underpins.
There would be an idea between, sometimes to get people
to a naming, it helps to do a mis-naming.
I actually feel like, when I work with young people
who I tend to think of, just as a group,
or less abstract, and more concrete.
See if I wanted to try this question, and they said,
"I don't know."
It would be like, if I knew that they liked,
I don't know, a particular Disney movie or something.
Whatever I knew to be within the realm of characters of life,
I might do something like,
"Would it be this type of character?"
Anything I could name.
I would try to offer a variety of examples, like three
or four examples, and then always add something else.
Because I think that so often, this idea of mis-naming
versus naming, it's just like offering a little scaffolding.
If I give any of the rest, however I'm trying to find
a word in conversation, and we're struggling for word
finding with an attentive listener, so I'm trying to
remember something and the other person knows, for example,
it seems to be some kind of fruit that I'm trying
to think about, they might say,
"Banana, apple, orange."
Trying to offer that to me, it's like,
"Oh no, it was kiwi."
And so often, how we come to a particular knowing,
is when people offer us examples that are, maybe,
close or far way.
And so, I think about that a lot, not only in trying
narrative questions in therapy, but it's not always--
I don't know if we can get--
Sometimes, it's very much about a particular stance
that someone's taking in relation to therapy.
First place, again, that I'm influenced by my
work with adolescents.
Sometimes, I might get an, "I don't know," just because
of a really good stance of, "Look, I'm really not interested
"in doing this kind of work."
And other times, it's really a genuine I don't know,
like I've asked a question that is too abstract or out of
the realm that people can imagine, so what I want to do
is ask--
I want to make my question smaller in some way,
so I might offer different kinds of choices,
but always with an "or something else."
Or I might offer--
There are other ways that I might try to make
my questions smaller.
So I would think of that as an example, and if it still
feels like, "Oh, this isn't a good fit."
I feel like the joy about learning many different
theoretical approaches or the joy of practicing in
an eclectic way and drawing off of many different kinds
of ideas to create our own voice,
is that we try something else.
But I do feel like, especially as I'm trying out
something new, its helpful to not--
So we can give up too easily on ideas too, and so one
thing to do is really to make it a little bit smaller
in the moment.
Or even to get into specifically,
what kind of voice do they have?
Do they have like a dark voice?
Do they speak a certain way?
I used to have a kid, when I first started to work,
who he engaged in what I would call Accent Therapy.
I could tell about how he was viewing a problem
or an issue, because he watched a lot of inappropriate
movies at home, so he would talk like a mobster
in some incidences.
This was many years ago, and he talked with a Minnesota
accent for the most scary or evil character.
I was like, "Well, where did that come from?"
And I was a little sensitive, because I had just been
living in Minnesota, and I didn't think it was in
my language, but it turns out,
he had watched the movie, Fargo.
It's like an elementary school student learning the
wood chipper, and all the other images from that movie
really made the Minnesota accent be the most scary
thing that he could imagine.
So it was sort of helpful.
So there's just different ways of working with
different people that can be helpful.
I love those ways of really making it, because it's--
Whether we call that externalizing, or something else,
it really had that same intention or effect of a way that
a child could put language to an experience,
and name it as something that's different than themselves.
And it is the power of the naming.
I think that, that's the power that--
I guess that also goes back to that quadrant
of centered or de-centered, that we're more centered,
we're the ones that really owns that power
in doing the naming,
But with something like externalizing, or reaching for these
intentional state understandings, we're really sharing
that power of the naming, or giving that power of
the naming to the people who are in the room.
And so, in your example, when you're having folks use
different colors, or use different locations, or talk about,
"How can I bleed this color in more?"
It's really about, they're getting to do what the
naming is, that their problem is experiencing, as well as
what the naming is, about ways around it.
And so I think it's just a beautiful example,
and thanks for sharing your work.
Yeah.
So these are different kinds of questions.
It's a little bit of a different kind of way
to think about a problem of, you know,
"Does the Angry Monster--"
I don't think I would ask that particular seven
year old, but, you know, "What does the Angry Monster do
"to enforce a set of rules, or code of conduct?
"What does it have you doing at different times of the day?
"What do you think that says, about what the
"Angry Monster's intentions are for your life?
"Do you have the same hopes as the problem?
"Does the problem have the same hopes for you?"
So I feel like these kinds of questions
can be really useful.
Also, you have more effects and influence.
Another thing that we'll go into, in the afternoon,
is that as you're re-structuring a new story, we'll talk
a lot about how there's meaning questions
and action questions, and you can begin to look
back at some of these externalizing questions, sometimes in
the narrative literature, for those who had
experience, or reading these might be called,
landscape of identity, meaning questions,
or landscape of action.
But again, as you're exploring the effects of
the problem, I always ask questions that explore people's
beliefs, or understandings of themself.
Like that young boy on the inpatient unit who
experiences himself as a failure.
Part of what we're externalizing or amplifying is
different kinds of ways of understanding
himself relationally, but also focusing a lot on
what he's doing.
Like, the actions, about, "How did you know?
"Did you see something in my face?
"How did you know to squeeze my hand?"
Those kinds of things, to really do a balance,
of both the doing and the thinking.
I know that for me, I love living up here in the world
of beliefs, thinking, and actions.
I just love that realm, and I've been really--
And this has been helpful in my work, to think also,
more about lots of people, and more do-ers,
and thinkers and experiencers of life.
And to really balance my questions, and not always
go, sort of, what my trends or tendencies might be.
So then where you get to, is to have people take
a statement of position.
And so, by the time you've looked at effects,
sometimes people are a bit ambivalent.
Sometimes, people are really--
It seems really like they've come--
They're really clear that it's a negative something.
And so then I might say something like, "Well it may
"seem obvious, but I want to check in with you,
"to see if the Angry Monster has been something that
"has been helpful, unhelpful,
"or a bit of both in your life."
Or, like the self harm.
This is a great one for that self harm example,
with the adolescent.
The parents, the school, are going to identify self harm
as being very problematic.
But the first time around with that adolescent,
if I know that I can actually--
They'll have described in these conversations, the ways that
the self harm has been very helpful to them.
When they get the idea, they can really do a lot of
identifying about what kinds of circumstances, or events,
or things, or emotional state, they might be in,
when they turn to, for example, cutting themselves.
But, they might not be wanting to change.
I think about couple people that I've mentioned, who've had
problems with substance abuse.
Think about motivational interviewing, for example,
as someone might see there's a lot of overlapping values
and similarities and ideas in narrative therapy.
And motivational interviewing, for folks who are
familiar with it, is something where you really are
listening for, and targeting the ambivalence,
in people's statements.
And as you explore that ambivalence,
you're really thinking--
You're getting underlying values and hopes, and then
helping people move along the stages of change.
And I do feel like, there can be a similar (mumbling)
in looking at their statement of position.
It's sort of a way of exploring that.
And then, asking them to justify it, because that's always--
I don't know, I think this is important for everyone,
but also, working in that context of a lot of mandated
treatment and inpatient, it's like, asking that second
level of question, of not--
Just that I need to make sure you're not just saying
what you think you want to hear.
Can you really support your statement of position,
by helping me explain it in a way that like, you know--
And why you value this particular way,
or that particular way?