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Post-Modern Models of Family Therapy


Title: Narrative & CBT: Some Similarities & Differences Author: wp342 Last modified by: Carlton Brown Created Date: 9/4/2001 1:20:32 PM Document presentation format – PowerPoint PPT presentation

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Title: Post-Modern Models of Family Therapy

Post-Modern Modelsof Family Therapy
  • University of Guelph
  • Centre for Open Learning
  • and Educational Support
  • William Corrigan, MTS, RMFT Carlton
    Brown, MSc., MDiv, RMFT
  • AAMFT Approved Supervisor AAMFT Approved
  • (519) 265-3599 (905) 388-8728

Day Three
  • Narrative Therapy

By the end of today
  • Reflections on day 2
  • Narrative Therapy
  • Use of letters in Narrative Therapy
  • Work on Debate for Day 5

Day 2 Reflections (900 930)
  • Reflecting and dialogue can create new meanings
  • What was Day 2 like for you?
  • What did you like/enjoy that you want to see/do
    more of?
  • What are you most curious about?
  • On a scale from 0 10, where 0 is not at all
    and 10
  • is 100, how would you rate your integration
  • information from Day 2 into your practice?
  • What would make that an X 1?

Narrative Therapy
  • Assumptions and the Process of Therapy

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

Small Pieces of Narrative
The person is never the problem the problem
is the problem (Michael White, 1991)
The Narrative Therapist
  • Curious, respectful, solicitous, and persistent
  • Solidarity with the people who seek help
  • Having hope for people psychotically
    optimistic (Bill OHanlon, The Third Wave,
    Networker, Nov/Dec 94)
  • Choose what to attend to multiple threads
  • More active at first, then less so as people
    become more engaged
  • Co-creator of new realities with
  • A humble collaborator
  • Transparency

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

Externalising Conversations
  • In groups of three
  • Investigative Reporter, Problem, and Problems
  • Choose roles and what the Problem is
  • Reporter talks to the Problem about its successes
  • Reporter talks to the Problem about its failures
  • Problems Subject listens carefully
  • Share the experience of these two interviews

Externalising Conversations 1. Problems
  • Problems tend to be boastful and arrogant,
    disclosing their secrets
  • Dont try to change the Problem
  • Ask about the Problems influence in different
    parts of life (relationships, impact on feelings,
    interference in thoughts, effect on how subject
    sees him/herself)
  • Strategies, techniques, deceits, and tricks
    Problem resorts to
  • Special qualities possessed by Problem used to
    undermine and disqualify subjects knowledge and
  • Purposes that guide Problems attempts to
    dominate dreams and hopes for subjects life
  • Who stands with the Problem allies
  • How Problem might react to its dominance being

Externalising Conversations 2. Problems Failures
  • Problems grudgingly begin to admit their failures
  • Areas of life that the Subject still has some
    influence despite the Problems efforts
  • The counter-techniques/strategies and tricks
    developed by the Subject to mess up the Problems
  • Special qualities, knowledge, and skills Subject
    has that the Problem has had difficulty
    undermining or disqualifying
  • The purpose and commitment that guides the
    Subjects efforts to challenge the attempts by
    the Problem to dominate
  • Who stands with the Subject and how have they
    helped deny the Problems wishes
  • The options available to the Subject for taking
    advantage of the Problems vulnerabilities and
    for the reclamation of their life

BREAK1030 1045
Process of Narrative Therapy
(J. Myers-Avis, 2008)
  • Deconstruction
  • Engage in externalizing conversation
  • Externalize the problem
  • Review the effects of the problem on clients
    life relationships, with particular emphasis on
    its effect on their view of themselves/relationshi
  • Taking a position
  • Elicit history of the dominant story using
    recruitment/training questions
  • Discover meaning client attributes to past
  • Inquire about anticipated future impact of the
  • Evaluation of problem in terms of preferred way
    of being/relating/seeing self

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

Deconstruction1. Externalize the problem
  • Review the effect of the problem on the persons
    life and relationships, with emphasis on its
    effect on their view of themselves and their
  • The problem is separated from the identity of the
    person and the underlying dominant narrative is
  • How is the problem affecting you, your life,
    your relationships, and/or your view of
    yourself? responses reveal the dominant or
    problem-saturated story

Deconstruction1. Externalize the problem
  • Dont rush this step - a broad mapping at this
    stage gives a broad area to explore for unique
    outcomes in the next stage
  • e.g. How has depression affected the way you see
  • yourself and possibilities for your life?
  • What does anorexia get you to believe about
  • yourself?
  • When frustration is having its way with
    you, how
  • does it affect your relationship with your

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

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

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

Deconstruction2. Taking a position
  • Separation from the dominant story leads to the
    possibility of choice
  • Recruitment/training questions
  • History of dominant story is elicited through
    questions that explore how client came to hold
    these beliefs
  • Training/recruitment questions are powerful in
    opening space for the person to contextualize
    their experience the problem is examined in a
    larger context such as issues of gender, class,
    culture, etc.
  • e.g. Do you have any ideas about how you were
  • recruited into this view of yourself as a
  • Do you think that women are more vulnerable to
  • the view that they have failed their

Deconstruction2. Taking a position
  • The meaning the client attributes to these past
    experiences is elicited
  • Listen for particular words or phrases
  • Check your assumptions (e.g. not-knowing)
  • Ideas about success or failure
  • Ideas about what a good relationship is
  • Ideas about confidence, insecurity, etc.
  • Explore the future impact of the problem
  • What do you imagine will happen if
  • Evaluation of whether this is a preferred effect
    in the clients life
  • Client is asked to judge whether the influence of
    the problem is preferred or not preferred
  • What assumptions might be keeping the problem in

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

Reconstruction3. Identify a unique outcome
  • An entry point for the beginning of authoring a
    new story
  • Seeks to identify occasions when the
    person/family/relationship has not been oppressed
    by the problem (similar to exceptions in SFBT)
  • Invite people to notice those intentions and
    actions that contradict, the problem-saturated
    story i.e. unique outcomes that could not have
    been predicted/accounted for from a reading of
    the dominant story

Reconstruction3. Identify a unique outcome
  • These can be historical, or can be located in the
    events which occur in the session
  • Given your fathers encouragement of secrecy,
    were there any times when you were able to rebel
    against it and tell someone about what was
    happening to you?
  • Can you recall any occasion when you could have
    been pushed around by frustration but werent?
  • Have there been some areas of your life that have
    been untouched by this view of yourself as a

Reconstruction4. Engagement in re-authoring
  • There is always an alternative story attached to
    any unique outcome - the process of uncovering it
    is like unraveling a loose thread
  • a) Unique Account Questions
  • Invite people to make sense of unique outcomes
    (i.e. events that dont fit the dominant story)
  • How questions - utilize a grammar of agency,
    turning points and change
  • There is an assumption that unique outcomes
    always have a history
  • e.g. Despite the hold that fear and secrecy
    had on you, how do
  • you think you were able to stand up to them
    and get help to
  • escape?
  • How did you manage to take this step to
    turn your back on
  • frustration?
  • How did you resist or refuse the tyranny
    of the problem (habit,
  • story)?

Reconstruction4. Engagement in re-authoring
  • b) Unique Re-description Questions
  • Invite people to give significance to the unique
    outcomes and unique accounts through
    re-description of themselves, others, and their
  • How do they think and feel about these? How do
    they fit with their preferred way of being?
    preferred way of relating? preferred way of
    viewing self?
  • e.g. What does this tell you about yourself?
  • What does this tell your partner (friend,
    daughter) about you?
  • What does this tell you about your
    commitment to yourself?
  • about the kind of person you are?
  • If your best friend was here, what would
    she/he say that it
  • tells them about you?

Reconstruction4. Engagement in re-authoring
  • c) Unique Possibility Questions
  • next step questions
  • Invite people to speculate about the personal and
    relationship futures that are attached to the
    unique accounts and unique re-descriptions
  • e.g. What does it tell you about your future,
    knowing that you have been
  • faced with a situation of great fear and
    intimidation, and that you
  • took strong action to escape it?
  • What do you see for you and Susie in the
    future if you continue in this
  • direction?
  • What difference will it make to your
    future if you keep this knowledge
  • of how you dealt with this situation close to
    your heart?
  • These can lead back to unique re-description
  • e.g. If you find yourself taking this next
    step, how will this affect how you
  • feel about yourself?

Reconstruction4. Engagement in re-authoring
  • d) Unique Circulation Questions (related to
    definitional ceremony/outsider witnesses MW)
  • Circulation is critical to the continuation of
    the alternative story
  • If there is an audience to a performance of a new
    story, the story is authenticated
  • e.g. Who is someone youd like to let know
    about this
  • new direction that youre taking?
  • Who has already noticed that you have
  • moving in this new direction?
  • Who might be the first to notice? What
    would they
  • say about you?

Reconstruction5. Experience of experience
  • Can be asked in each category and are often most
    helpful in the development of a new story
  • These questions invite people to be an audience
    to their own story
  • e.g. What do you think that I am learning about
  • relationship as I hear how you were able to
    avoid being
  • totally overwhelmed by the effects of
  • (or conflict or anger?)
  • What do you think this tells me about the
    nature of your
  • new direction?

Reconstruction5. Experience of experience
  • Questions Which Historicize Unique Outcomes
  • These are important questions, which assist
    people to get in touch with an alternative story
  • e.g. Of all the people whove known you over
    the years, who would be least surprised that
    youve been able to take this
  • step?
  • Of all the people who knew you as you
    were growing up, who
  • would have been most likely to predict
  • Following this, a whole series of questions can
    be asked about the context
  • e.g. What would ........ have seen you doing
    which would have
  • encouraged him/her to predict that you would be
    able to take
  • this step?
  • What qualities would ....... have noticed
    about you that would
  • have led him/her to not be surprised that you
    have been able
  • to.......?

Small Pieces of Narrative
  • The role of therapy
  • is to bring these alternate stories out of the
    shadows and to elevate them so that they play a
    far more central role in the shaping of peoples
  • (White, 1994)

(No Transcript)
Definitional CeremoniesMaps of Narrative
Practice (2007) M. White
  • first referred to as reflecting teams (T.
    Andersen, 1987)
  • rituals that deeply acknowledge peoples lived
  • provide an opportunity to tell the stories of
    their lives before an audience of carefully
    chosen outsider witnesses
  • through these retellings people experience their
    lives as joined around shared themes that thicken
    the counterplot
  • witnesses discuss what they were drawn to, the
    images that were evoked (metaphors), their own
    personal experiences that resonated with these
    expressions, and how their lives have been
    touched by these expressions
  • outsider witness is a witness to the
  • outsider witness registry former clients who
    volunteer to participate as outsider witnesses

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

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

  • 1220 105

Narrative Therapy
  • The Use of
  • Letter Writing
  • in Therapy

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

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

Narrative Letters
  • Pay attention to the metaphors people use often
    have powerful meaning for them
  • DE follows the flow of the session in writing
    letters for more coherence - follows the
    client's inner logic of their own story
  • Able to ask questions in letter you didnt think
    of before
  • Able to salvage a bad session by admitting
    mistakes and asking questions about it to client
  • Reflect confusion back to client transparency

Narrative Letters
  • Look for and highlight small changes
  • Using letter as a reflecting team what are you
    curious about, what do you wonder, what else
    would you like to know, what might you predict,
  • Different types of letters
  • letters of invitation written to invite other
    members into therapy
  • letters of redundancy to help someone give up
    an old role in a family
  • documents of identity - written charters
    celebrating the persons strengths, capacities
    and current progress
  • discharge letters or letters of retirement

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

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

Narrative Letters
  • Examples
  • For supervision in Narrative Therapy Judith
    Myers Avis, AAMFT Supervisor, Guelph, (519)
  • For more on Narrative Therapy, articles, news

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

Narrative Therapy with Couples (2014) J. Freedman
  • Keeping notes
  • Problem story Alternate Story
  • Dont talk most of Sometimes talk
  • time
  • Listen to problem stories and what is meaningful
    to them enough to get there
  • What do these ideas have you doing?

Narrative Therapy with Couples (2014) J. Freedman
  • Start the next session by reading the notes from
    the last session
  • Continuity, focus
  • Helps to avoid getting bogged down in the
    problem of the week
  • Catch me up on how this has continued?
  • Give them a copy of your notes if they want them
    between sessions transparency
  • Would it be ok if we limit what we talk about
    today to ____?
  • Get permission, collaboration

Narrative Therapy with Couples (2014) J. Freedman
  • Four questions to end the session
  • Was this useful?
  • How was this useful?
  • Would you like to come back?
  • When would you like to come back?

Narrative Therapy with Couples (2014) J. Freedman
  • Think of it all as story or construction
  • Looking through your partners eyes, how would
    you describe yourself?
  • And what is it like thinking of yourself
    described this way?
  • A story is a sequence of events organized over
  • Describe it to me like I was watching it happen
    gets them back into the experience

Narrative Therapy with Couples (2014) J. Freedman
  • Having it witnessed and supported is important
  • Witnessing
  • A position from which someone can listen to
    anothers story
  • A position from which to offer reflections
  • If youre in the room, are you focused on
    correcting another or proving your point to the
    therapist? youre not really listening
  • Interview one person and ask the other to just
    listen, talk to one person at a time
  • Im aware that there are two different stories
  • Choosing questions for the listener that keep the
    conversation moving in the right direction how
    is the information being received?
  • MW spent more time with one before turning to the
  • Turn to the other when something significant
    comes up

Narrative Therapy with Couples (2014) J. Freedman
  • Positioning (MW)
  • Team by your side - Who might be here with you,
    to help/remind you
  • Different context like youre at work
  • Self in touch with whats important rather than
    being right, what do you really value, try to
    hold onto it
  • Vantage point of the relationship think about
    your children, what you want for them if you
    were listening as the relationship vs. as your
  • An anti-anger position give examples imagine
    your childs face, a value you connect to,
    exceptions to anger
  • One way mirror pretend theres a mirror or a
    pane of glass in between
  • Using video tape session and give them a copy
    to watch

Narrative Therapy with Couples (2014) J. Freedman
  • Absent but implicit
  • In order to make a distinction, you have to
    compare it to something else
  • Double-listening (MW)
  • Not always a contrast like mistrust to trust
  • Questions to elicit ABI
  • What does this say about what you treasure?
  • If this problem is a protest against something,
    what would you say that something is?

Narrative Therapy with Couples (2014) J. Freedman
  • Questions to elicit ABI
  • Has something important been violated? Can you
    put what has been violated into words?
  • Could we say that your naming this as problematic
    means that you dont go along with it? In not
    going along with it, are you standing for
    something else?

Narrative Therapy with Couples (2014) J. Freedman
  • Questions to elicit ABI
  • Im getting the impression as you speak of this
    that there is something you miss. Is that right?
    Can you put that into words?
  • In saying no to this, what are you saying yes
  • Why is it important that you speak of this in
    front of your partner?

BREAK205 220
Narrative Therapy with Couples (2014) J. Freedman
  • Relational identity
  • In Western society, much more individualistic
  • In other cultures/societies much more of a
    relational concept
  • The checklist doesnt necessarily have anything
    to do with who you are in a relationship
    (multiple selves?)
  • Socio-cultural discourses that we measure
    ourselves against

Narrative Therapy with Couples (2014) J. Freedman
  • Relational identity questions
  • A description of the partners contribution to
  • A description of the partners appreciation of
  • A description of the effects of the partners
    contribution and appreciation
  • (and the effect of these effects)
  • Who are you vs. who are you becoming (other than
    who youve already been)

Narrative Therapy with Couples (2014) J. Freedman
  • Relational Identity Exercise
  • In pairs, follow instructions and questions on
    handout as guide

  • White Epston (1990) Narrative Means to
    Therapeutic Ends
  • Jenkins (1990) Invitations to Responsibility
  • Epston White (1992) Experience, Contradiction,
    Narrative Imagination
  • White (1995) Re-Authoring Lives Interviews
  • Freedman Coombs (1996) Narrative Therapy The
  • Construction of Preferred Realities
  • Freeman, Epston Lobovits (1997) Playful
    Approaches to Serious
  • Problems
  • Smith Nylund (1997) Narrative Therapies with
    Children and Adolescents
  • Diamond (2000) Narrative Means to Sober Ends
  • White (2007) Maps of Narrative Practice

Work on Debate for Day 5
  • Three groups
  • Collaborative, Narrative, Solution-focussed
  • Need to describe
  • Strengths, advantages, benefits of your approach
  • Weaknesses, disadvantages, drawbacks of the other
    two approaches
  • Be able to defend your approach against
    criticisms from others
  • Present opening/closing arguments

Wrap Up
  • Evaluation of the day
  • Questions
  • See you tomorrow!