- Okay, well thank you, and welcome back
and so what this afternoon will look like
is a have a bit more slides to really talk about
sort of re-authoring conversations,
which has really had a structure and build,
like that alternative story, like in that first example.
Well, I mean, it could be building the bad-driver story.
It could be building with that young boy
on the inpatient unit, just his ways
of knowing and caring and being
in relationship to others.
So that's what we'll talk about
sort of with the slides.
We will look at a transcripted conversation
with a mother and teenage boy that will
start with a bit of externalizing and then move
to a reauthoring idea, and I am determined
to make sure that there's time for you guys
to practice a little bit, and you can choose
whether you want to externalize.
At least I'm not making you do an active role-play
in front of the room, unless you're reading from a script.
The new semester started at Smith this past week,
and in my narrative therapy class,
I have an assignment that's a group assignment
about doing a role play, and that's the four words,
that incite fear in social work students
are role play and group project. (chuckling)
That's assignment, woo!
Anyway, but I also wanted to make sure that we use time
at the end to talk about consultation,
and I've really had the pleasure of already
getting to talk too people individually
and hearing about different kinds of practices
people are already doing in their work
or have done with these ideas, and so, you know,
I think part of the challenge in hearing
about a lot of collaborative strengths-based therapies
is trying to figure out how does this fit
in the environment that I'm working in,
when we think about what practice environment
is often like.
You know, I realized that somehow, I got away
without really introducing myself ahead of time,
so I just will say something.
You've all been very patient to sit with a stranger
for the last three hours, but I guess I should
just say to context a little bit about
how I learned about narrative therapy was
As a student here at Smith in Master's Program,
I was initially introduced to the ideas in
a couple of my classes, and I actually had
the opportunity to take a narrative and feminist
family therapy class during my final summer here,
and after I graduated, I decided that
out of everything that I learned,
this is really some of the ideas
that were most exciting to me, and so,
you know, already being in such deep debt,
I decided to go further.
I studied in Australia with Michael White,
who's one of the primary theorists
of narrative therapy.
They do an international certification course,
and so that was a really powerful experience
and a true joy to work with other social workers
from around the world, and we have stayed close as a group.
They actually now are just starting a Masters Program
in narrative therapy, which is also
really an exciting initiative on their part.
And I teach.
Currently, I'm a doctoral student,
and I also am teaching both here and at
Simmons College School for Social Work.
Here at Smith, I teach a sort of 10-week
feminist ideologic and narrative family therapy class,
and a narrative therapy electives, as well as,
this here, Intro to Family Therapy.
For years, I've been teaching first-year practice here.
And I also teach similar types of courses,
first-year practice family therapy
or group therapy usually at Simmons.
Oh, and an Intro to Stats class,
which is just a fun little different type of thing.
I also am a a field advisor for Smith,
and so I know there's a lot of supervisors
and field advisors here this weekend,
and so that's also a way
that I stay connected to the school.
And then I also see clients.
I do narrative supervision,
and I consult with agencies in this area.
So, okay, enough about me.
Let's talk a little bit about re-authoring conversations,
and really, how these are sort of cultivating
stories of strength and meaning.
So sometimes they're call preferred stories.
It just would be really, how do I create
another kind of automatic way of thinking
or another way of understanding or being
in the world in relation to a problem or a value?
One of the things we'll also work with
a little bit this afternoon is there's a range
of visual tools.
I think, you know, like narrative therapy,
although I find it to be really a very creative
an artistic approach, is actually a very structured
approach, and I'm not was always someone who can think
a lot of visual tools, or that's not always something that
can be so helpful for me, personally,
but we're going to do exercise in mapping
this afternoon as we talk about re-authoring,
and actually, for me and my learning,
it was actually really helpful.
I wouldn’t have though of this.
So we'll play with it a little bit.
I do have to say, one of my favorite narrative books,
we talked about narrative means
to therapeutic ends this morning,
but one of my favorites is on the short reference list,
and I think I put up a chapter of it on mine,
which is the mapping narrative practice by Michael White.
I have cards here.
If anyone wants my e-mail or anything,
I can help you if there's particular areas
of interest or focus in your work
that you'd like to have, maybe, more information
or a resource list, I am happy, if you would e-mail me,
I can give you resources, and if I have them scanned,
I'll give you copies of the articles.
So just as we were just talking about,
our identities are based on the stories
that we tell about ourselves.
I've heard it said that stories
aren't just about ourselves.
It's of who we are, and so a lot of them
are linked to things that we value or hold dear,
So in this story that we, you know,
had heard about, you know, both compassion and connection
and that became the compassion monster
that so much of that story as we so deeply heard
is how grounded that is in values
and things in people's lives, so, you know,
one of the things about thinking
about the intentional state understanding list
is that we're really thinking about
is that we're really connected to those
values, dreams, commitments, and hopes.
That says narrative psychiatry.
Sorry, that was from another training,
but re-authoring stories, or narrative psychiatry
or narrative training, there is actually,
for the psychiatrist in your life,
there is a local psychiatrist here,
who's in my peer group, and who I've been
doing some training with lately
named Dr. Sue Ellen Hamkins.
She's a former psychiatrist here
at Smith College, and now she is the
the Assistant Associate Medical Director
with the College Counseling Center
at UMass Amhurst, and she has written
a wonderful book called The Art of Narrative Psychiatry,
which will be coming out in the fall
from Oxford University Press, and what I love
about it is it's, you know, a lot of books
about narrative therapy, a couple that I put
on the list, the William Madsen book,
which there's also a chapter that
I posted to Moodle and the Michael White book.
I just find that I really like to teach
with materials that have a lot of transcripts,
that have a lot of clinical examples in it,
because it really makes the reading come alive,
and Sue Ellen's book is very much like that,
as with those other sources.
- [Woman] (inaudible question).
- Her last name is H-A-M-K-I-N-S.
So in the process of re-authoring stories,
narrative therapy seeks to deconstruct stories
that are harmful and reveal the broader cultural influences
of harmful and negative stories,
as we talked about.
It tends to try to identify alternative strength
stories that highlight strengths,
meanings and actions taken that stand
in contrast to the person's problem experience,
and to connect these alternative stories
and events over time, to create new stories
of strength and meaning, so it's just like connecting
the Xes in a good driver story.
That's what we would seek to do.
In deconstructing of harmful narratives,
narrative therapy utilizes a range of tools,
and it's really, you know, the collaborative
attuned therapeutic relationship.
And this theory would be the same as with any other.
All research shows that it's less about
one's theoretic approach than the relationship qualities
and how important it is to always practice
in an attuned, connected way.
Strength space, externalizing, linking
to broader socio-cultural discourses,
and then creating these new stories.
So the problem stories are often well known
to those who come to consult with us,
and they're established over time
in connection to other people, and they tend
to be really very detailed in the minds
of the people who come to talk to us.
And so to create a new story, narrative therapy
would utilize questions which elicit the details
of action, and so if you've read things
in narrative therapy literature, it's often called
landscape of action questions and meaning,
which is sometimes called the landscape
of identity questions.
So I'm going to actually, before I get to the next slide,
I really want to give a detailed
clinical example, because I do feel like it's helpful.
We've had a few over the course of the day,
but even though this is entitled
narrative work with children and adolescents,
through conversations and a lot of folks in here,
I understand that a lot of people in here
are working, also, with adults.
That's right, okay.
So I thought maybe I could use
an example of an adult with this,
if that might fit for people,
and I really also wanna talk about trauma
in my example, because I think that that's something
that all of us are really doing a lot of work with,
and that's yet another area where I think that
a lot of the ways that we're taught to engage
in people's experiences with trauma
are a lot about effects conversations,
as opposed to response conversations,
and I think that response conversations
are ones that really pull out those intentional
state of understandings, as opposed
to internal kinds of understanding
and really pull out active experience
as opposed to positioning a person
as passive recipients to their experience.
I think what so many people experience
as profoundly traumatizing in a range
of traumatic experiences that they are
in that moment, they feel that their capacity
to respond and to engage in things
that they might like to do, like,
feels very limited, and in fact,
it often feels invisible to people,
and I worry that sometimes the ways
that we talk about things, people's responses
in that situation, people are very good
at minimizing the ways that they responded
if a genetic event happened.
They didn’t do enough.
If they had done more, it wouldn't have happened.
But I think that it's very easy for the ways
that people did respond and continue to respond
to trauma and pain end up inadvertently getting put
beside in a lot of our conversations.
You know, I think it's more typical,
and I think about a lot of ways of practice
where I've practiced, historically,
to talk about how, for example, something
like a flashback can be interrupting,
as opposed to what's upsetting about the meaning.
What values were transgressed in some ways
in the traumatic experience to talk about
in the first place?
So my example that I'm going to talk about
is with an adult woman in her 40s,
and this is from some years ago
when I was working in the Boston area,
and I had had the context of working with her
for some time, and when she first came
into therapy, and this is not unusual,
she talked about her desire to work on some trauma
that had happened very early in her life
that she saw as being very influential in a lot
of the ways that her life had gone on,
you know, proceeding from that moment.
She was a woman who had just a history
of juggling many problems throughout the course of her life.
I mean, just a lot of struggles, and in fact,
for a long time, our therapy felt like
we were sort of in a batting cage,
and each week, because of the balls
that she had in the air at all times,
each week we were responding to whatever pitch
had come at her, you know, or several.
You know, more than working on other things,
and it's not that that's not very valuable
work, it just sort of felt like
when she talked about what she hoped for
in therapy, it didn't always feel like what we were doing
in a week-to-week basis fit with her
initial hopes were, and some of the things
that she had going on is that she was
a single parent of three special-needs children.
I mean, that alone has lots of pitches coming at you.
She had been in a series of relationships
characterized by domestic violence and abuse,
and had minimal contact with two people
but each of her children's fathers
had been abusive towards their children
and had been abusive towards her,
and there were, you know, two men in those relationships.
As she continued to date, although she didn’t
continue to have children, often times, relationships
would move into a realm of sort of
how she might describe as domestic violence,
or I also would describe it in that way,
interpersonal violence.
She had a very long-term struggle,
decades, with eating disorders or eating issues,
but primarily through withholding of food,
and really struggled to engage in any kind
of practices of self-care, would often put
others in her life before herself.
And I've talked to her about sharing this story,
her story with others, which (inaudible)
felt she was okay with.
So I just want to say that also for the record.
So we had been working for some time together
and, you know, periodically, usually around the time
that treatment eval was,
I would often ask her how treatment was going,
but, particularly, it would be reconnecting
to her original desire to talk more about trauma.
Particularly, as quarterly treatment plans
or other things were done, and one time,
she decided that she didn't want to talk about,
and it came at a time that I was in the practice of --
There's an article that I love,
and I actually really should post it.
I'll to try to remember to do that.
It's a chapter by Michael White called
The Absent but Implicit, and it's an idea
that I was talking about earlier.
If what's painful about the depression
is the experience of loneliness.
What's not being spoken of but is known
and sort of hidden in that experience
is that there is some knowledge of connection,
and there's likely some history of connection.
You know, some people do have a relation of life
where there hasn't been a history of connection,
but there may very well be dreams of connection
because of things that they've read
or other ways that they've experienced the world,
and so, you know, lots of times,
it's remarkable to engage in conversations
where you're doing re-authoring,
and if you can get people to describe
their vision or their hopes or, you know,
something that connects you in the present
or what they might want for their selves.
That knowledge, going back to how
all of learning is social relationships,
and we know ourselves through our relationships with others.
So often, there was a teacher.
There was a therapist.
There was a neighbor
There was somebody in their life who saw
or understood them in that way.
That's why I love that question of
who would appreciate this desire for connection?
Who would know that that was important to you,
or that was something that you cherish?
Is there someone who you have felt connected to
or you felt saw you in some way?
So, at any rate, it's this absent
but implicit idea is that so often
whatever we're getting, like, the flip side
of that might be that intentional state
of understanding, that value, that hope,
that dream may be right behind what we're getting,
and so if you're doing a crisis evaluation
in the emergency room because someone's expressing
a tremendous amount of hopelessness
and suicidal ideation, you know, so often,
that absent implicit idea, ultimately,
sort of, in what have you been able
to hope for in this time, and even if a person's
expressing tremendous hopelessness,
but they got themselves to the ER
for an evaluation, like, might there be some hope
that life could be different still inside them
that's helping them have this conversation?
Or, you know, whatever did get that person
to the emergency room for the evaluation,
even if they were dragged there by a loved one.
You know, what does that loved one know
about the history of their life
or what hopes might they have, or what does
it say about the connection that they have
to that person that they would be willing
to still try maybe one more time
to continue in their life, and so
it is often, sometimes, it can be
just a shadow or a glimmer, but there could be something
underneath what's presented that can speak
to a value or internal state of understanding.
Does that make sense?
Okay, so, this article has a lot
of beautiful examples and talks a lot
about this way of double listening with people,
and I had just, I don’t know why I had never
done this before or since, but at the time,
that this work changed with this particular client,
I had decided that I love this article,
and every time I read it, I noticed
that I took something different away from it,
and so I decided that every Sunday night
for eight weeks, I was going to read the same article
to see what happened.
And what's so interesting to me,
and any time I tell this story,
I'm like, okay, I need to do that again
because what happened is not only in my work
with this person, but in my work with several other people,
there were some really significant shifts
that happened at that time, and I just think
that there was something about my listening
that really must've changed, and so this
is probably somewhere between week three or five
in my eight-week commitment of reading
the same thing over and over,
that she came in and decided
she wanted to tell me the story about
"the original trauma" in her life,
and she had started to talk about something
I'd heard for years about the ways
her family of origin could be disappointing
to her, how she felt let down or neglected by them,
and she said, "You know, I just..."
I must've asked some questions.
She's like, "You know, I never have told you
"what originally happened, in terms
"of why I feel this way, and it's important
"that you know, because I think
it explains a lot about me."
And so the story that she told was that
when she was an infant, her parents had divorced,
or not divorced, they had separated.
I don't think they were ever married,
but had separated during her mother's pregnancy with her,
and she was primarily cared for by her mother
during that time, although her father
had some custody, and her paternal grandmother
would look after her, as well.
And during her infancy, there was one period
of time, her father and paternal grandmother
suspected that her mother was abusing drugs,
and they had some concerns, but they were really
trying to keep an eye on it from
the distance that they had, but there was
a several day period where her mother
had had some warning signs, and then, like,
what is answering the phone or wasn’t responding,
and after four days of no contact or response,
the grandmother, in particular, got quite worried,
and decided to by and check out the house.
As they ended up breaking into the house,
they found that the children had been left there
for several days.
Both needed to be in the intensive care unit
for a while, but it was my client, who was an infant,
and her a young, toddler sister,
and as she told the story,
it was as if all air had left the room
in terms of the pain that she spoke about the story with,
but there were a couple of things,
as I was listening I found remarkable,
and one was that an infant could live
for several days without any attention.
I mean, there was a rotten bottle in the crib.
Her diapers were just soaked.
Her sister had fared a bit better medically
because she was a little more mobile
and was able to, I don’t know if she ate garbage,
or what she did, but she was able to
consume something and have some fluids over the time.
But to think of the vulnerability of an infant,
and that she was alive,
I was just thinking about what a miracle.
And one of the things also about her story,
she said that her grandmother always said
that what stood out for her was as the door opened,
and they called out, she cried out,
and that would be a very easy thing
to just miss in this story, but this is
where was really grateful, and I think
that the impact of this article,
because the article was really reinforcing
to me about how skills and knowledge about life
are present in us in the very beginning,
and I didn't want to think that it was
an automatic response that infant might have,
to cry out, because I actually would think
that if I thought about the situation,
I'm sorry, I got very connected to my client,
but, you know, that infant, my client,
probably cried out many times over the previous days,
because that's what infants do.
If I think about infants, that's what infants do.
If infants have a need, they cry out.
We hope that they're responded to.
That this is such a primary part
of we understand attachment and wiring.
What was it that allowed her after days to cry out?
She probably heard the noise, but it just...
I just asked my client when we were talking
if we could just pause and talk about that cry
and what it might be emblematic of, and what
she thought it might say about
the type of person that she was.
She said, "I just cried out."
And I'm, like, "Well, no."
You know, I can imagine a lot of infants
might've given up at that point.
In fact, I would imagine that
a lot of infants would be dead.
You know, she was a parent of three children.
She knew that a lot of infants could be dead in that moment,
so what was it about you in particular,
that you were both alive, and that you cried out,
that you had the energy or desire to connect
in some way that you cried out?
What was that cry about?
What would you call that cry?
And she thought and said, "I think
"I still must've had hope that somebody would come back
"or that somebody would take care of me."
And in that statement,
you know, there were a million possibilities
that ended up coming out of that statement.
Within that statement,
well, I can tell you some of the directions
that we went to, so we spent a lot of time
thinking about that cry.
What it might say in terms of that infant
and what and she as an infant might've
hoped for for her life.
What it said about who she was
as a person at that young age,
and she really, for the first time,
could identify some different kinds
of meanings about that.
You see, when had really struck me
in my work with this women, for the years
that I'd worked with her, is how she often,
I mean, one of the reasons why sometimes
I would get frustrated, even though it seemed
very much how she could imagine that I could be
helpful to her, but as we were responding
each week to those balls in the batting cage,
the way that she was describing her life
was that of a passive recipient to her life.
That things were being done to her.
Things were happening to her.
She could describe her responses to things,
but so very rarely was she talking about
her personal agency in moving through life.
And a lot of that had to do with other kinds
of socio-cultural identity and location.
She was was struggling financially.
She was a single parent with three kids.
Her economic opportunities had been somewhat limited
in some ways, so she was a very, very intelligent person.
She just had not had the opportunity to pursue
post-secondary education or finish high school.
When she was beginning to talk about herself
as a infant, who might've had some hopes for connection,
this was actually the very first time
in our conversation where she could begin
to detail what those hopes for her life might be
in a different kind of way, and when she could
talk about how the taking action of crying,
when she thought about it and began
to talk about it like it was taking action,
it was a choice to cry out, because
it was a choice to cry out.
It really had different possibilities.
I'm sorry to sort of linger here,
but then it took us to so many places
and so quickly when this began to shift.
And so, like, one of the conclusions
that she came to, within the next couple of sessions,
was that perhaps she had maintained hope,
and perhaps she had physically survived
because of, actually, the potential presence.
This is something we'll never ever know
of other experiences of being left
for extended periods of time.
This was not something that she would want for herself,
but she felt that maybe, if her mother
was actively using substances at that time,
it was not infeasible that her mother had left her
for other previous periods of time,
and that maybe she maintained hope,
because her mother had returned in the past.
She also felt that the fact she maintained hope,
might say something about her mother's
capacity for parenting.
Although how she has felt about her mother
post-incident and for much of her life
was really around this massive, massive failure.
She thought if she had had hope,
if she continued to cry out, that also
must speak to times where she had previously
cried out and had been responded to,
but it wasn’t an all-bad or all-good experience.
it had been a mixed experience of some kind
to that to date, and it was very heartening for her,
because it also fit with the ways
that she had tried to be a parent for her lifetime,
and some of the things she valued and was important,
and it was helpful for our just think of
that although she had always felt that some,
and, you know, as we began to think about
what her values were as a parent,
also what her mother's values were,
they came clarified, and she could begin
to talk about the ways that she had worked
so hard to never fail her kids.
The way she works so hard to always be there for them,
but after this story was told in a certain way,
you know, she said, "You know, I've always kind of known
"that I've had this commitment because of what happened."
But it was framed differently, and she could really see
the intentionality in some of her parenting choices,
or understand her responses or why she got so frustrated
over things, or why things were so important to her
in a different kind of way.
She also really began to think differently
about the experiences of not being attended to
and in the ways that her family had attended to needs
in a really different kind of way.
And she said, "You know, it's so funny."
When we had talked about her history of relationships
or dating relationships that she would have
that really would get to be kind of
interpersonally sometimes quite scary
over the time that we had seen each other,
she had said, "You know, therapists always tell me
"that I keep getting relationships like this,
"but I've never seen that connection."
And it was very hard, because, you know,
from I knew from the professional literature
or other kinds of things, that this goes back
to that quadrant of true centered,
you centered, and influential,
if I propose this as a kind of idea
or concept to her, it really was letting
it go at an earlier time.
If she said, no, that's not a good fit
for me, like, it doesn't help to think about it
this way or have conversations about it
in this way, even if I felt like, oh, but it is helpful,
like, I had to let it go.
What was so interesting is she led us
right back there after she started
talking about things in a different way,
because she began to talk about what she was noticing,
as she thought about not being attended to
and being attended to, about what felt good
sometimes in relationships, and it was so
powerful to witness her articulation
of these very same concepts but in a way of,
you know, I think that because of what happened,
when people are very attentive to me
and want to know where I am, in particular,
you know, for a long time, that feels very, very
good to me, and then it gets to a point
where it doesn't feel so good anymore.
As soon as she could articulate it from,
like, when she generated the idea,
as opposed to any kind of therapist,
it was a very helpful idea, and, oh, my God,
I can't tell you how quickly it switched,
because the woman who was, you know,
had an online dating thing,
and, like, it went from just me hearing about
bad dates to her determining 15 minutes
into a coffee date, like, uh-uh-uh.
Like, this feels kind of good.
It's a warning.
It was just a shift in her empowerment
because part of that was her belief
that she had discerning, and skills, and knowledge,
and that she could see this,
and she could make that determination.
It was such a shift from a passive experience
of life to an active experience in life,
that suddenly, she was taking action so quickly
in so many areas of life.
Like, it's really hard to describe.
In terms of how she had always thought
about withholding food, you know, she
began to think.
Like, she had made some kind of connection
to earlier in her life about, you know,
not loving yourself, not feeling worthy
of love, but she said, "It's interesting
"that it's about food in particular
"when I was so hungry for that period of time,
"and when I was a kid, after that happened,
"I know I was eating all the time,
"and I got really fat, and people teased me."
Then she sort of went to the other, you know, degree.
Those were her words, her ways of thinking about it,
and she just really thought about,
you know, if I survived that experience,
like, I had different hopes for myself,
and I want to live by those hopes.
Like she really began to think
about the life she wanted for herself.
The idea of being a survivor wasn’t a
thinly describes idea.
It really had a different kind of meeting,
that she could really talk about the ways
that she had survived a great deal,
including some sort of engagement with the system
around some of the care for her children
that was disempowering, and she began to just
speak out on their behalf in advocacy
in a different kind of way.
Her moving from passive to where
so many things were being done to her
and decisions made without, she just really shifted
where she was in her life.
Like, getting into a driver's seat of life
in a really different kind of way.
So some of the things that, you know,
one person that she talked a lot about
who would appreciate her survivorness
was her paternal grandmother,
who had passed away several years earlier,
and a lot of how we began to create a new story,
it was almost like her paternal grandmother's
presence in the room became such
an important part of the work,
and I heard so many more stories about
their relationship or about her childhood,
and and different kinds of ways that
her grandmother appreciated her and knew her
and saw this way that she was a survivor,
and it was really the combination of
a lot of early stories and then more recent things
in thinking about her advocacy for her kids in other ways.
At one point, her eldest son, someone who
would engage in bullying her, not infrequently,
came in, and we thought about who would be
a good family member to come in and sort of,
who in her current family constellation,
would know about her and how she was a survivor.
She identified her oldest son,
and he came in, and it was amazing.
She talked to him about what she
had been learning about herself,
these new appreciations that she had come to,
in terms of being a survivor and a fighter,
which those ideas were really linked,
because she felt she was a fighter
to survive as an infant,
and he added so many stories about
how he had experienced her in life.
About how being raised by her
or even during times that were scary,
like, when his father had been violent,
or when he had been in residential care
or other kinds of things, how she'd always
been the greatest fighter that he had known.
How he felt so protected and cared for by her
over the years, and all of these things
then further added to her experience
as a personal agency.
Does that make sense, or do you have
particular questions about that example?
I mean, I just wanted to sort of...
I mean, that took a lot of time and more sessions,
but it was amazing, because from that initial session,
we focused less and less about the curveballs
and the fastballs of life, and more and more
about this reshaping of identity,
and as the identity was shaped,
the circumstances of her life, the stresses of life,
were not changing.
She continued to have three special-needs boys,
but it was amazing how not only did she make
some shifts in her dating life, but suddenly,
had a really different kind of position
and way of holding her ground.
If her son engage in any kind of verbal bullying,
just so many things shifted where it just
was, like, something awakened in her,
and so she had a different kind of wherewithal.
That's not really the right use of word
in that moment, but different kind of
way of responding to the world, as she
understood herself differently.
That goes back to the idea about
how so much of our reality is shaped
through the tellings, and the way that we experience things.
I don’t know if we think about key stories
that we might tell about ourselves,
and how those might shift to the audience
that is hearing them or to other kinds of experiences.
There was something that she experienced as transformative
in this work, and I also just found it
to be very powerful to witness this huge
trajectory that she had in her life,
and increasingly, like, by bringing her son in,
by having her make other connections,
reaching out to family other kinds of things
in different ways, part of what I wanted
to do from the very beginning when I saw
this sort of transformation happening
is I didn't want to be the only person
who was holding onto this emerging identity.
Right away I wanted to share it with others
and the critical others in her immediate life.
That's another way of me staying decentered as a therapist.
You know, I think any of us might be able
to think of, you know, folks who were
close to us, maybe, in hard times in our life.
Sometimes it can be hard to maintain
relationships because of what they know
or see or about who we were at that time.
Other times, it's just the opposite
because they know us in our fullness.
For me, you know, I felt that
I didn’t want it to be an isolated experience
of this new and emerging self that she was having,
and by really helping, as she gained more energy,
connecting her to the natural supports
and other people in her life was really powerful.
There were just shifts in her language
which made me really feel like that
she was in a really different place,
and I just wanted, there's something
with the narrative therapy called
outsider witnessing practice,
and it's just a way of, you know, just our conversations
overall are turning up the volume in a new understanding.
It started to be present in the room without being there.
Her paternal grandmother had been with us
for such a long time, but it was, like,
who else, is there another person in your family
that would really know these things about you?
And had a strong suspicion that her eldest son would,
and so, I said, if he were here with us,
what might he tell us?
- [Woman] (inaudible comment)
- Yeah, yeah, and then, like, at the session
after that, she said, "You know, I sat down with him,
"and I talked to him about this,
"and, you know, he had some ideas."
And I said, "Would you be open to the idea
"of him and coming into therapy
"and having a structured way
"where he could respond to these things?"
And she was really interested,
and I talk to him on the phone,
and he was interested, you know, which is, like,
how great to have, like, a 16-1/2...
You know, he was, like, 16 or 17 at the time.
He was, like, "Okay, yeah, like I wanna
"come into my mom's therapy."
It was just really beautiful to see that
in their relationship.
Not that it would perfectly go forward from there.
What parent and child relationship does?
But I think it was a very special moment for them.
I was in an outpatient context at the time,
and so I really, more or less, held to
that sort of 50-minute hour type of idea.
I think at the time her son came,
we met for an hour and 15 minutes,
which I sort of planned ahead of time
and thought that that might be the amount
of time that would be needed.
But still not so much extra time.
But if I had a context, like, when I worked,
for example, in the is inpatient unit,
if I had other people come in, I would play with time
in a really different way.
You know, if time is billed by day,
as opposed to by hour, also those of us
working within a milieu context have other kinds
of flexibility with our allotment and how we play with time.
So I can think of times in the inpatient unit
where I would have others come in to witness
an emerging identity or type of idea,
and I might do a really, much longer meeting
at that time, and sometimes even
have multiple layers of responders.
So a lot of that is context,
but in this particular clinical example,
because I was in an outpatient clinic,
I really held to those same times.
During that time, and one thing that I don’t know
how much I'll talk about is this idea of
therapeutic documents, and so that's something
that's written about often in the literature,
and so after that initial session,
knowing what I knew about outsiders witness responses,
I wrote her a letter about what I had witnessed,
and sort of using a particular kind of format
of outsider witnessing, which is to start
with particular words and meanings,
and to connect it to, you know,
my knowledge, and it could be my
personal knowledge of life or clinical.
You know, I sort of did it
in the context of what I knew about her life,
and what I had known about our work together,
to go back to sort of what words had moved me
in our time together and what I could speculate
about her life, and this is sort of...
and sort of ends about, sort of, my hopes
for our future work together.
So I did spend the time to write her a letter
which took a lot more time than my typical note,
but I used it as the note.
And so different people do different kinds
of therapeutic documentation, but for me,
I used periodic letters throughout that process
to help to sustain, underline, and amplify
certain aspects of the process.
Okay, so going back to one of the articles, too,
that I posted online is by Angel Ewan,
and she talks a lot about focusing
on responses to problems and effects to problems,
and she really talks about an article
specifically related to trauma,
and so this gets back to, it's almost like
a similar side-to-side of internal state
of understandings versus intentional
state of understandings, and so, when we're
having effects conversations, we're asking things,
like, how did you feel?
How were you affected, versus how did you respond
and what did you do?
And so, it's a different kind of conversation
to hear things, like, I felt scared versus
I hid under the bed when I was scared,
or I protected my little sisters
from having to hear our mom being hurt,
as opposed to I blame myself.
Or I'm always anxious and depressed.
There was nothing that I could do to stop the abuse.
For a child who's talking about
interpersonal violence between their two parents,
there's nothing that they could do
to stop that abusive relationship.
I feel like these are not conversations that
are not trying to shift reality,
but it's trying to focus on actions that people took.
So by protecting your little sisters
from having our being hurt.
Like, I used to sing songs.
Like, I take them outside.
What is the hidden or underlying value
in that action or decision?
What was it about
that there's a not that she, as a child,
could do to protect her mother, which was painful,
but was it about protecting others in her family?
How did she know that she might take that step
or what difference it might make for her sisters
to not have to hear their mother being hurt at that moment.
So these are just other kinds of examples.
So in terms of creating a new story,
I'm going to move over here and read off the thing.
So the first thing that you need to do
is to elicit a unique outcome.
So something that stands in contrast
to the dominant problem story.
And for it to really have any significance,
we also need to get a lot of details
about that unique moment, because that detail
will really help us understand the meaning
that's ascribed to that experience or the significance,
because, for the example that I just used,
it was the crying out or that cry
was something that really became a focus,
and now that's my suspicion, and, you know,
I have to say, like, I hypothesized and I secretly
wanted it to be an expression of hope
or not giving up.
I mean, really, like, there were things
that I was rooting for, that it might have meaning to,
but just like,
you know, and I might've been able to offer
that in the context, as I suggested to you,
of, like, I could offer maybe, was that hope?
Or was that something, you know?
I could maybe have generated three or four things
that it could be or something else, to let her name it,
but I really feel like where I have often messed up
and gone right into a centered and non-influential position
with narrative therapy, is when I have gotten too clever.
When I have decided that I understand the meaning
of things and the people that are talking to me,
like, when I know what the meaning is.
You know, like, if I think that I know
what it is too much, or I start putting my words
to their experience, that is when I have, like,
taken a right turn away into ineffectiveness,
and so,
so the first thing that one does
is do a unique outcome.
I'm going to use this as a visual thing,
and you have some of these in your packets,
so I'm just going to take a quick pause
and explain what this is.
You know how I did the map before
of the good driver story, with the various incidents?
How a visual that can be helpful in thinking
about a re-authoring story, is to sort of
think about it in the same way.
Now, for this example, you know, we'll do other ones.
Lots of times, you know, the good-driver story,
I told a very linear story, looking back in time.
This is actually a clinical example that I just did
starting with the cry.
Unfortunately, we're also starting
in the most distant past, but if you think about
earlier when I was having you think about
the gentleness or verbal or, you know,
the empathy, the other kinds of qualities
that you describe, I had you focus, first of all, like,
why that quality out of all the other qualities
that you could have thought about out of yourself,
I had you focus in the last 72, you know, 48 hours
when that might've been reinforced in some way.
Most people, when you're doing a re-authoring story,
start off usually in action in the present
or recent past.
Sometimes an idea.
But it's usually relatively recent.
How I think about a re-authoring story,
if I'm using this visual tool,
is this is just a way of mapping your questions
or the way that the conversation is going,
meaning questions, and there's no right or wrong way
of doing any given story.
Because I'm going to ask you to map the transcript
and story in a little bit.
Meaning questions, beliefs, values, ideas,
those tend to be things that would be
on the top part in terms of an X.
A bottom part might be actions, steps,
things that people took.
So, for example, in my conversation with her,
the very first unique outcome, or exceptional experience,
in the creation of really what it meant for her
to be a fighter and a survivor, was that cry.
So that cry was sort of a physical action
that she began to detail out.
As she began to detail out, and I asked her what
it might say about the type of person
that she was or what it might have meant,
she linked it to an idea, which was, like, hope,
and so those two became connected.
You know, she spent some more time
back in that historical period about
how she might have known that.
Previous times her mother had left her.
Like the sense that she had been responded to previously.
She then began to think, well, actually,
the fact that I'm a fighter and survivor,
like, that's when the curveballs
or the fastballs for the week came up.
Actually, just this week something happened,
and, you know, when I heard back from this program
my son's in, I did this thing.
So that came up here.
And I knew to take that step
because I knew that it had been effective before,
and the person that the program had told me
they appreciated it when I called,
and they appreciated the degree
of which I'm involved as a parent.
So, you know, like, you can sort of see, like,
over time it's created, and so there's no
right or wrong.
Actually, I think that thinking too much
about how you're sequencing any set of questions
means you're not attuned and engaged into that moment
of the conversation.
You might have other hypotheses or thinking
about other conversations or things
that you know about that person,
but what I say is that all that matters
at the end of the day, or how I use this
as a visual tool, is that what I essentially
want to build out is a spider web.
But if I'm thinking about how can I,
it's called thickening the story.
If I think about how stories are created with meaning,
is if you're sequencing of events over time,
and then that's sort of how meanings,
so the good-driver story was, like,
a lot of individual incidents that happened
over time, and some of those things
were things that I did, and other things
were things that I believed about myself
or other people believed about me
in terms of my driving, so you want to have
a good mix of beliefs and actions,
and you want to connect those over time,
and then you have a counter story to being
a passive victim, to being a fighting surviver
that can possibly hold the same amount of ground.
You know, if her automatic thought
for so many years had gone to being
sort of a passive recipient in her life
or a victim in her life, it's really almost
like building a brand-new, automatic
way of thinking, or if you think about neurobiology
as a metaphor, you want to really kind of
construct different incidents into
creating sort of new, automatic neural network of response.
So you want to have something that's really strong,
and so to do that, it was the linking actions
and beliefs over time,
and so at the end of the day,
at the back of your packet,
you'll see, like, an open, blank map
that I have actually brought into...
It looks like that.
So I have actually brought this as a tool
into the room when I'm meeting with people
and just sort of randomly...
If they're, like, "What?"
You know, like, "Excuse me, what are you doing?"
You know, I'm sort of drawing random lines.
You know, and I say, I'm trying to
as I come to understand this,
how I know about how stories are created
in an effective way is if time is an element,
as well as actions and belief,
and that's just sort of tracking
the questions that I'm asking
or the way that the conversation is going.
So when we do the transcript and conversation
in just a couple of minutes,
when we get to the re-authoring part,
I'll have you just play with this.
For some people, it's, like, "Oh, this the helpful,
"little tool that pulls it all together."
Other people start linking two things,
and they're, like, "Ugh, I can't listen,
"and this is absolutely not for me."
I just offer it as an option.
- [Woman] Do you share the master plan?
- Oh, yeah, just like I would share my, like,
you know, from the beginning, if I say that, like,
I'm writing things down...
You know, when I worked on the adolescent inpatient unit,
what was really a fun practice I got into
is we would go right in co-sign our notes sometimes,
which is a really fun thing to do
in a medical record in a hospital setting.
You know, just as a real, like, thinking about power.
It's, like, well, how would you describe this today.
So you could do a typical DAP or SOAP note,
but just to have the power of the person
being able to name their own experience.
There's a lot to talk about, collaborative practices
in all kinds of documentation,
but I feel if I'm going to be sitting there
with a clipboard and the fact that, you know,
I wear glasses and everything else.
I'm often nerdy enough to have a little pen
in my pocket, you know, like, I just feel
like I don’t want this to be some kind
of machination of therapy or I don’t ever want
to be the Wizard of Oz behind the curtain.
That I'm taking notes about something,
people know they're always welcome to a copy
of anything that I do.
That guy that I mentioned, Art Fischer, who does
a lot of work with men who perpetrate violence,
and one of the things I've loved about his work
is he does such amazing things with transparency.
He has a big whiteboard in his office,
and so for things like, whether it be externalizing
or mapping a new conversation or way of thinking
about things, then he has, like, lots of
multicolored dry-erase markers,
and what, I think, he often does is at the end
of the time, he'll, like, use the big white board,
like as big as one of these blackboards,
and he'll just take a digital photo of
the work that they've done on the board,
and that not only becomes, like, the primary part
of the note for the session, but the person also,
he can e-mail it to his client or print it out,
and so he's talked about people have had
things on their refrigerator, that when they have felt
tempted to engage in a certain way with a partner
where they have a history of violence with,
they have gone back to the map of what it is
that they value or what their intentions are
and remember different statements that were
written about their previous conversation,
and it's been helpful to them.
So there's a beautiful story.
Some of Michael White's work,
where a person was really trying to actively
take a stand against...
They were experiencing voices that were
telling them harmful messages about themselves,
as well as, you know, wanting to harm themselves or others,
and you gave the example, and that example
with the beast of, like, someone writing
a letter to the beast, and so, basically,
like having a breakup letter.
This was also sort of a letter of what this person knew
about themselves, and how that was separate
from what the voices were telling them about themselves,
and so there was a moment in a department store elevator,
where the voices were really powerful,
and they just had this document of knowledge
in their pocket at all times, and they just took
it out and started reading it out loud,
and what was powerful about that experience
is some people, I think, rushed off the elevator,
but other people stayed and listened
to this reading of the stands that the person
was taking against the voices in their life
and responded in a really humane and engaging way,
to appreciate that person's persistence
about this problem in their life.
You know, the thing about some reading in narrative therapy
is, like, I read book chapters,
and some that I've read, like, a million times
for teaching, and I just get all teary,
because I find the work is really moving when it's connected
to a lot of deep values.
In the same way, going back to that slide
of responses versus effects conversations,
when I've worked in situations where
the folks that I'm sitting with have a lot of acuity
in traumatic experience,
it's very easy to feel very worn out
at the end of the day.
I work a lot with students and working
with people who are new to the field is
such a reminder of some of my early experiences
in the field where suddenly, when I was only talking
to people about painful things in their life,
the first few months of working,
I felt, like, oh, the world is so broken.
Everyone has been so hurt by people in their lives.
It was just heartbreaking to me
when I first entered the field.
And I think that that's also because
I was having a lot of effects conversations.
I was having people tell me a lot
about the things that had happened to them,
as opposed to hearing a lot of stories
about how they responded to the things that had happened.
And so, there's a beautiful Helen Keller quote
that I can only paraphrase, but she talks about
there's a lot of suffering in the world,
but there's also a lot of responses to suffering.
And I got it wrong, but if you do
Helen Keller and suffering on Google,
there's a very beautiful quote that will come up,
but I think that I have found when I hear
people's responses to suffering,
I leave work in a place where I've often been inspired.
Like, I hold the pain of the knowledge of others' suffering
within inspiration of all the ways
that they've made life commitments or changes
or the actions that people could take against
all the odds when they didn't have a chance,
it's just a very different way of hearing about experience
that is so powerful, and I just feel like it's
such a gift, and it's amazing how that slight shift
from effects to responses, I think,
has allowed, like, me to work in this field
for 40, 50 more years than I might have been able to
if I stayed in effects conversations,
because practicing with an open heart
can be very exhausting, but hearing about other
people's responses from their hearts
is really sustaining in many ways.
Because it's through the rich details and a new way
of creating meaning in describing meaning
that suddenly other links and other life experiences
and other stories will emerge, so if people begin
to think of a fighter and a survivor in her life
in the beginning was really quite a stretch or a reach,
but as the details came forward,
she could think of other things pretty quickly,
and once her grandmother's voice or perspective
came in, whoa, lots of things were added.
I've had that same experience where when I have
described things, like, one time I had the privilege
of having Michael White interview me
for a re-authoring conversation,
and I learned at that moment, and I'm such an
experiential learner, which is why I got my MSW
at Smith in the first place, but I was describing something
and when I was attributing new meaning
to a very recent experience that I had had,
suddenly, he asked some questions about
if this had happened in my past,
and there were stories they came up from elementary school.
It was like they were little air bubbles
that came up from my toes.
This had not been in my awareness in decades.
You know, I wouldn't have even known that I remembered
such an experience, but it really came from
that detail and that particular meaning
that I talked about in that first experience.
It was the most amazing thing.
I was, like, okay, if I learn nothing else
from this conversation, I leanrned an awful lot
about myself, but if I learned nothing else,
it's really to focus on getting that detail
and slowing down at the beginning,
and then to trust that more things will come,
more things that the person in front of me can't
imagine will come, that I can't imagine will come
as the therapist, those other stories
will come out in droves, if I slow down
enough in the beginning, get detail,
and trust that they're there.
So it's a cool thing.
I hope you guys get to experience it.
All right, so on your slides, and you'll maybe
hear some of these, too, because we'll go into
the transcript in just a moment.
But the examples of action questions.
Tell me more about that.
What happened?
Where were you?
Who was there?
So again, some of that secondary detail.
Was this the first time that you had done this,
or we're there other times?
How did you know to do that?
Did you plan to do this?
Had you thought about taking this step before?
Who helped you?
What would you call this action or step?
Who in your life would be the least
surprised that you did this.
Meaning questions, and that last one's
sort of traversed both things.
What is it like to consider that you are able to do that?
What do you think that taking this step
might say about what it is that's important to you?
Do actions like this fit with your hopes for your life?
If I were to ask you what kind of kid
can do this sort of thing, what would you say?
Or adult?
Is this important to you?
Why or why not?
Who in your life knows about these hopes of yours?
So I talked already about mapping.
It's a way that can be useful to track questions
or a way of keeping notes.
And I demonstrated, so here is the map.
I feel like Xs are useful because I've used them
as I describe myself being a good driver,
but actually, if I were sitting with people,
I might put a word or two in and so that way,
because also, as people tell these stories
and go in different directions,
sometimes the time really stretches out,
because we're going in unexpected things,
and as people are making new links or connections
together I can follow it really easily.
Just to look at a map like this with just a word or two
in various locations, I can almost remember verbatim
the entire conversation, looking back later.
It really shifted Rhonda's understanding,
for example, when the anger was matched
with the self-hate into really see those connections,
but it was really, I think, I wanted to take
a lot of care as would the school,
if they were present in the room or as would
Rhonda about, like, the whole reason she
was getting into therapy at a relatively early period
in terms of angry, acting out behaviors,
and before, there have been tremendous escalation.
Like that math class incident was about as bad
as it had gotten, but this still was so
outside of the norm for this kid,
and I do feel like what was really helpful to see,
where some of these changes were linked to,
as soon as he started to verbalize that
part of the a protective way was he wanted
to sort of push people away before he got rejected by them,
and we talked about how effective
was the anger in doing that?
Or what were some of the things that
the anger had him doing?
So, like, when we first started talking
about actions effects for the actions,
that's the way he began to verbalize things.
It didn’t quite fit with his, you know,
pure release of anger response picture,
and really, this quickly sort of became
a self-hate thing, so initially, I think,
before the self-hate was even involved,
at right around that point, I felt like, gosh,
I know if I asked him at this point
if the anger is working for him or not working for him,
it probably is going to be a no,
because there is a sadness and a disconnection
that he was verbalizing, and so we,
you know, I think that I would be surprised
if we didn't go back and address it more explicitly,
but it was really almost, like, in talking about it
in thinking about it in this way,
and also thinking about his history
of relationships, like, I think he really
was missing more of his friends that he realized.
It was the sort of, like, and angry hurt
about being rejected by his girlfriend
that was having him acting in angry
and pretty stupid ways.
And that's, he might describe it as stupid.
I think he did but not so effective ways
is kind of what I would say.
If any continuing behavior would have happened
after we talked about that, I would definitely
go back to that and keep looking
at the effects and the consequences,
and how that fit or didn't fit
for him in terms of his hopes or his values for his life.
You know, I feel like, what's helpful when I'm engaging
with other systems that are providing
some kind of consequence or censure,
both in this case with his mom and the school,
you know, I felt like my position was then
to really help him reflect and evaluate
on those effects, and whether or not
it was really working for him.
And the minute he started talking about
how the anger and self-hate had different
kinds of hopes for his life than his hopes,
I felt like that's easy language to continue
to go back to and revisit, if anger
should continue to be any kind of
ongoing issue or problem.
I mean, like, the monosyllabic teenagers
or the less flexible family narratives
are ones that you're not going to see in, like,
a training context as often, because
it would just be a lot more reading,
and there's quiet for 10 minutes. (laughing)
Long silence.
And they don’t make as good training examples,
but I do have to say, you know, one of the joys
of having Michael White as a teacher for a long time,
is, like, he would use a lot of video,
and it was really helpful to see him do work
with very young kids with some pretty significant
cognitive and verbal delays, and it's just
to me that, and I also seen him do work with
people who were actively experiencing psychotic symptoms.
It's a different kind of framework to assume
that there's a meaning-making process
that is embedded within delusional
or other kinds of content.
Again, it's not that you are agreeing with delusions,
like, aligning with the delusions, but it's
really a different kind of way in
engaging with understanding that experience,
and that there can be questions about meaning
that were answered well.
It's just, again, it's sort of, like, with a question
with a concrete thing, it's, like, "What are the ways
"that I can make this question smaller?"
Because people can really begin to get some
momentum and roll with with abstraction,
but there's a equal amount of times
where there's, "I don’t know."
And so I think that making it smaller,
offering choices, rephrasing, these are all things
we do no matter what theoretical perspective we're doing.
You know, another thing that I was talking about
at the break, too, is that I think that I have
gone transparent quite regularly too.
It's like, you know, I am trying to talk
about this in a particular way.
I'm doing that because.
You know, in my experience in doing it
this way has been, would you be willing
to try to explore this?
And in that way, I can make sometimes slight
shifts or corrections or kind of...
Could we say it like, the such and such?
You know, and, like, it's...
So there are lots of different kinds of choices
in terms of helping it be clear to people
about what my intentions or hopes are.
You know, and sometimes I'll really ask a dud question,
and people will sort of look at me,
and I'm, like, oh, well, like, I think, you know.
And then it's kind of fun to be, like,
well, that was kind of a dud question.
You what I was hoping for and my intention behind
that question was such and such.
Or I was kind of --
- [Woman] Did you say dud or dumb?
- Dud, dud.
Like a question that's like, what?
So if just know that I don’t even really know
how to make the smaller.
I think I just sort of missed it altogether,
and it's been really helpful with some people,
and even some monosyllabic teenagers.
It's not like I'm just looking for the articulate,
insightful adult can do this.
You know, this is what I was kind of hoping for
when I asked that question.
Can you think of a better way to ask it?
Isn't that fun?
You know, the kids would come back and be, like,
"Oh, yeah, like, this is what you should have said."
And I'm like, okay, and then I'll, like, say that,
and they're, like, okay, and (laughing)...
I mean, one of the favorite times that I really
got stuck on something, I was, like, wow, like,
I once said to a client, "Like, wow, if you were me,
"what would you ask next?"
And they had a question right there.
And I was, like, oh, great. (laughing)
And I think that idea of, I mean,
I wouldn't do that every session, thankfully.
You know, but there was an old article that I loved.
It was many years ago.
I think it was published in the early 90s or something,
but it was a therapist in California
who actually was sitting with a client
and had just come back from a narrative therapy
conference and had gotten really stuck,
and so they were sitting, she and her client
were sitting in their office, and they just decided...
They described their stuckedness,
and they such a fax off to New Zealand.
And it just was a really odd time of night there,
but David Epstein, who was one of the
primary theorists and narrative therapy
just happened to be sitting by the fax machine,
and so, like, faxed back, and so within the session,
there were like all these faxes going back and forth
to New Zealand that I think,
oh, the phone bill, you know? (laughing)
But at the same time, it is this idea,
like this liberatory thing of if I step
out from being the expert, I just feel
the expansive space in the room
to breathe, and, like, how fun is it
to be able to periodically, if you need to,
ask the person who's consulting you,
"What would you ask next?"
And part of my willing to do this, I think,
has a lot to do with working with young kids.
I remember a very memorable session
I had the young persons where they walked into my office
first and, like, that in my chair and said,
"Okay, I'm gonna be me and you be..."
Yeah, I'm gonna be you and you be me.
And that was a really fun session.
We did it for the whole session,
but it ended up being, like, very externalizing.
And it was fun, because I could be her,
and I could go, "Did I get that right."
And she's, like, "No-no, like this is what
"you should have said."
And then I was, "God, you have really
"much better questions today."
And she's, like, I know. (laughing)
You should be me more often.
So I think that there can be a way of playfulness.
Like I was just saying, Lily had asked
about, you are thinking about a client
that was struggling with some eating disorder issues
right now, and there's a wonderful website
specifically about using narrative
approaches with an eating disorders.
It's one of the huge ways that
it's been a very popular theory.
There's also a great book with the name of
"Biting The Hand That Starves You."
And there's some great titles
in the narrative therapy literature.
Another one is Playful Approaches to Serious Problems.
This is a great one for working with kids,
as well as, I really like
Narrative Therapy with Children and Adolescents.
And there's several books by that title,
and they're both good.
Biting The Hand That Starves You.
On that subject of eating disorders,
I was at a narrative conference,
and there's another really good but very different book
by a public health researcher named Helen Gremillion,
and she's done some writing in their community,
but she's a public health researcher
who actually found,
and this goes back to how we can be very good
about when we diagnose someone with something,
it's sort of a way of locating the problem within someone.
She did this sort of global research
and found, and there's a whole book on it,
and I'm just trying to remember what it's...
I think that Biting The Hand That Starves You
is by Epston-Maisel and Ali Bordon.
But she had another good title as well,
but what she discovered in her research
and her book is really interesting is that there's
there's an actual price point in a gross national product,
as countries are in certain developing economies,
there actually can be a point where the average citizen
gets a certain percentage of income
or where the gross national product is at a certain point.
I can't fully explain how this number is figured out,
but I can tell you basically once household median income
is sort of at a certain place or in certain percentage,
suddenly, anorexia nervosa starts to appear
in females in that population.
You know, later I think, like now, we really see
a lot of anorexia nervosa with young males, as well.
I think it continues to be gendered,
but there are just different kinds of gender expressions
of that in the U.S., I but I found that that
is so interesting to think about that
is linked to both class and sort of gender discourse
about, you know, what is it about that particular moment
in a developing country that that would happen?
I think it probably has a lot to do with media,
disposable income, how things of advertising
and other things start to saturating images.
Billboards, TVs, different kinds of ways that
people are exposed to different kinds of ideas
about how to regulate and sort of discipline one's body,
particularly as a female, and so it's really interesting
to think about that for something that we think
about often as being very biological
or we might locate it within a family system also
is another way of thinking about it.
But it's really a much larger or bigger type of idea.
And so, that's why it wouldn't be uncommon
with any kind of problem to talk about
how do ideas or beliefs or values that are part
of your, you know, culture or any part of identity
fit and do they support this problem?
Do they not support this problem?
I think that those things can be really helpful
ways of identifying and thinking about
how do various parts of who we are and how
we fit into the world have fit in both
providing risk factors, as well as protective factors
for any kind of problem.
You know, I think it so often happens, and, you know,
lots of times when I go into various agencies
or consult with people, like, a lot of it might
around a particular agency culture or different things,
but I've found even at things like,
clinical case presentations, like, there have been times,
you know, starting my career in an inpatient setting,
as we get frustrated, as we get tired,
the ways in which we start to speak about people
behind their backs, like, are not always
really preferred ways of thinking or connecting
with our values, and there's, like,
there's more expressions of frustration.
However, it's, like, how can we possibly imagine
that those very same expressions then don’t become
shaping of those same individuals' experiences
with our agency or with ourselves at some level,
and so even doing simple things like
at a clinical case presentation,
you know, you can do it on a day to you're presenting.
I think that's an easier time to start it
than when someone else is presenting, and say
I'd like to try something new today.
And I wonder, you know, Bobby, if you would listen
as the mother in this family and really, like,
with everything I say, I'm going to ask
for your feedback afterwards about your
responses about about how I represented you or otherwise.
You know, will you sit in as, like, you know,
the oldest son, who's my client.
Will you sit in and just to really help people
at the table shift in their listening and to think
about the ways that people are talked about
our impactful, and to really, like, and it's good,
you know, always with an agency,
even if one is certain one has allies,
and so just pick on your allies at the table,
to particularly be listening from the position
of people who might be most talked about
in ways that would be diminishing of who they are
in some ways or not fully representative
of their experience and so at the end
you could say, "Now, Bobby, what was it like
"to hear everyone talk about..."
You know, like, not only have me speak about
how I've been thinking about this work
but also to hear other people's responses
to your role in the family?
You know, I think that so often we get
into automatic ways or as we feel
worn down or ineffective, I think part
of this distancing and power up and the power down
is also a way to protect ourselves.
You know, it's much easier to talk
about a client's resistance in not coming
than to really do an intensive self-interrogation
about what am I not doing?
To blame externally, that's exactly
what we see and sometimes drives us nutty
about the people who come and talk to us,
but there's a way in which we can, like,
kind of put it in professional discourse
to protect ourselves in some way,
and again, it all goes back to sort of the
power of the naming, and, like, the more expertise
I take, the more I can name what other people
are doing or thinking, which may or may not fit.
You know, I think that lots of times,
it can go a long way to first of all
understand that I understand the behavior of,
you know, it's like, who doesn't want...
I mean, when I think even about the problems
that I might have in my life, I mean, who doesn't
want to, like, find someone with a magic wand
who can make it all better, and if it's, like,
a child in your life, it's, like, okay, great, like,
I'm gonna drop him off, and when I pick them up
I wanted to be all better.
So sometimes, I'm like, whoa.
You know, I might be, like, "Gosh, I wish I had
that kind of magic wand."
And then when I see that, I really, I can talk
with a parent with great empathy about like I can see
how, you know, one could come to the end of your rope.
Or I can see, like, you know, I'd love to hear
more about what is particularly frustrating.
But as I think about helping, you know, working
with your child to develop those skills,
I think it is possible, like, and the empathy
and rejection that I have a magic wand,
isn't a rejection of the idea that, like...
My experience with creating magical solutions
to problems is that it's sort of an all-in
type of experience that there aren't any kind of
generic skills that I can just impart
or give to your child in some way.
That the skills that will be most effective
are going to be building on your child's strengths
and capacities and your family's strengths and capacities,
so I really need your expertise in the room.
And my sense of how lasting change can happen
in the situation or, you know, like, a real shift
in experience is really, you know, through
active participation, and it's not that I don’t understand
that an hour off would mean the entire world to you,
but I also think that with some work,
it won't take too, too long, before you can really
have a bit more of a restful experience in various
pockets or times during the day.
There was a question before about is this a more
extended therapy or a brief therapy?
It can be a really brief therapy,
and it can be one that one can do
in a range of context.
I mean, working in an inpatient setting,
which I did for years and years, so often
you might just have someone for three or four days,
and so I think about it is, depending on one's
context or the time that you have.
You know, with anything, know matter what
your theoretical approach, I think it's really
beginning to conceptualize and formulate something
and think about what is the right-sized piece of work
that I might be capable of doing in this particular moment,
and how powerful it can be even, you know,
so I came to think of, like, when I worked in inpatient,
it was, okay, I want to do a really good
assessment and handoff, you know, back to providers,
but that doesn't mean that's all I need to do.
I can also really find out from that child and family,
the one critical place to do a big push while they're here.
You know, I still have three days.
So I can find my one place, and that one, tiny thing
that's doable and that could be difference making,
if we really put a good effort in that one place,
but to try to spread myself too thinly,
with a short period of time, or limits,
or someone only has six sessions a year outpatient,
it's, like, okay, therapy's not going to feel
effective unless I sort of right-size the problem
and really figure out a focus,
but that shifting language around the problem
can be very impactful in terms of shifting the experience.
And I think that the trick about it is
if you know that you have a really limited amount
of time, is to not feel too rushed at the beginning.
It's not, like, okay, I have six sessions
so I want to externalize by the end of the first session.
And then if I'm gonna move to this other idea...
You know, maybe I just need to allow myself
a deep breath and slow down and maybe if in
the six sessions, I'm just gonna get a deep sense
of the effects of the problem and have someone
take a position on it, and maybe I don't get any farther
than that in six hours.
Well, then that's where I need to pause,
but hopefully, that position will help people
think about the steps that they take against the problem
the next time they come back.
Like, they can do the next piece of work,
and if they've made a good connection with me,
maybe they'll come back with me.
So I do feel like with anything,
you know, I think it is sort of putting forth
a realistic a realistic thing, going back to your parent
and the desire for the magic wand and, like, the skills.
And I think skills is great currency,
but I also feel like this is a therapy
that can really highlight those skills, and steps,
and actions that people are taking
and connecting with beliefs, and that's where I
sort of joke about the adolescent coping skills plan
of listening to music, journaling, and because
it just feels like so much of what, as we talk about skills,
it's, like, a really thin description of something.
It's like, okay, here's a menu of five items.
And I feel like even as were going to
electronic medical records and other things in the field,
like, I hate those drop-down boxes.
And I feel like I actually write narrative therapy
goals, but they're specific enough
and individualized enough.
Like, I sometimes ask for crazy amount of
sessions, and I generally get them,
or if I end up with a phone call
with a reviewer, I think that people are really delighted
to hear about the particularities of treatment
and to see expressions of really attentive,
individualized, treatment on treatment plans.
I think that that stands apart from drop-down box
treatment, so I just sort of feel like, even though I
think there's so much trending, in terms of
heightening productivity, speeding ahead,
fewer sessions, you know, I'm and arguing for
hold steady, don't go too fast.
Actually, the best of work will kind of happen
if you play with time and slow it down a little bit
and help people to understand
that there's no magic pill, and that there's no magic wand,
and that there's no magic skill as something
that's thinly described that can really change something.
I mean, it's just been a pleasure.
Thank you all very much.
[Applause]