Narrative therapy is a client-focused, strengths-based practice that works from the fundamental position that the client is not the problem: ‘the problem is the problem’ (White & Epston, 1990, in Hoole & Morgan, 2008, p. 105). It is an approach commonly used at WWILD in working with people with intellectual disability.
Narrative therapy is based on the idea that people create a personal narrative or dominant story to understand and give meaning to their lives and to themselves (Lambie & Milsom, 2010, p. 196). These stories are often negative or ‘problem saturated’ (Matthews & Matthews, 2005). Narrative therapy engages in a process of deconstructing the person’s dominant narrative to understand how that narrative influences their thoughts, feelings, behaviours and communication. It then explores whether this narrative is the story the person wants for their life (Betchley & Falconer, 2002, p. 4), and works to develop and actualise new, preferred stories for their life (Matthews & Matthews, 2005).
Introduction to Narative Therapy
Narative Therapy Role Play
Narative Therapy discussion with Jill Olver
Intellectual disability and narrative therapy
Communication challenges are common for many people with intellectual disability and, while counselling practitioners need a solid theoretical basis to their work, they also need to ensure their practice is flexible enough to respond effectively to the needs of this broad client group. Although narrative therapy is traditionally a linguistic approach, it can be successful with people who have communication difficulties. By allowing the necessary time and having a variety of communication and creative techniques available, narrative therapeutic approaches should assist the client to become the ‘primary voice’ in their own story – even if that story is told non-verbally, and/or with the assistance of others (Betchley & Falconer, 2002). (For more information, see the section: ‘Barriers to communication for people with intellectual disability in the counselling context’.)
It is important to carefully consider the involvement of families and other support people in the narrative therapeutic process. Because people with intellectual disability often rely on the support of other people to communicate, these other people play a significant role in developing and maintaining a certain narrative in the person’s life. This may mean that therapy requires collaborating with significant people in clients’ lives, in addition to collaborating with clients themselves. (For more information, see the section: ‘Working well with carers and supporters’.)
Techniques of narrative therapy
Deconstructing the dominant narrative
An important element of using narrative therapy is ensuring that the client has an opportunity to tell their story, in their own words. Part of the practitioner’s role is to listen out for the meaning behind the words and discern how these messages and stories fit into the wider context of the client’s life. Genuine inquiry and understanding allows accurate identification of ‘the problem’ and its causes.
Deconstructing the dominant narrative involves working to understand how the dominant narrative came to be. Questions that can help in this process include:
- Who constructed the dominant narrative?
- Does the dominant narrative support or put limits on the way the client sees themselves?
- How does the dominant narrative support or put limits on how the client behaves?
- How does the dominant narrative serve the client?
- How has the dominant narrative helped or hindered the client? Or helped or hindered those around them? (Matthews & Matthews, 2005).
People with intellectual disability, particularly those who exhibit challenging behaviours, often have negative labels assigned to them – by themselves, by significant others and by society at large. These negative, ‘problem saturated’ narratives are often supported, told and retold by the significant others in the client’s life. Both clients and the support people in their lives may need help to engage in new forms of communication with each other that develop and maintain new narratives (Betchley & Falconer, 2002).
One of the main tasks involved in deconstructing the narrative is identifying and naming the problem. Externalising is a common technique for achieving this. It is a process of naming the problem in a way that helps clients to separate themselves from the problem and the problematic narratives dominating their lives.
As part of externalising, the problem is given a name and the client and supporters work together to ‘defeat’ it (Hoole & Morgan, 2008, p. 109). By naming The Problem, clients can take ownership of it and their relationship with it. The therapist’s role is to listen to what the client is saying and use the client’s words where possible. Whatever label is applied to The Problem, the label must either come from the client or be readily adopted by them once it has been suggested (Matthews & Matthews, 2005).
Externalising starts with language – that is, referring to The Problem with its own identity. Some examples of naming The Problem include:
- ‘The Trouble’ to describe anti-social behaviour
- ‘The Anger’ to describe violent outbursts
- ‘The Beast’ to describe problematic gambling
- ‘The Sadness’ to describe depression and/or anxiety
- ‘The Grog’ to describe problematic drinking.
This process is seen as critical in narrative therapy. Naming the problem is a shift in language that gives the problem its own identity. Ideally, it involves the name being used by the therapist and the client, and also by significant others in the client’s life (Matthews & Matthews, 2005). This allows the practitioner, the client, their family and significant others to be critical of The Problem, without being critical of the person (Matthews & Matthews, 2005).
Examples of externalising dialogue:
|I heard you became angry today||How did The Anger trick you today?|
|How does your partner feel about your gambling?||How does your partner feel about The Beast?|
The process of externalising can be taken a step further by building a more concrete identity for The Problem. This is particularly important for clients with intellectual disability. Building concrete, visual representations of The Problem, using symbols or illustrations that give it a physical form, helps to transform The Problem into something that everyone can see and relate too. This process of making abstract concepts ‘concrete’ is especially important in work with people with intellectual disability.
‘Unique exceptions’ to the dominant narrative
Finding ‘unique exceptions’ to the dominant narrative involves supporting the client and significant others to think about times when things have been different – times when they weren’t experiencing the problem or were able to control the problem. This is an important part of supporting the client to create a new narrative for their life.
To support the client in identifying unique exceptions, the therapist asks the client to think about what life is like when the problem is not around, and listens out for things in the client’s story that contradict the dominant themes in their narrative (Betchley & Falconer, 2002, p. 9). Even in the most problem-saturated stories, there will be a moment when the problem is not as strong as it usually is. These moments are the ‘unique exceptions’ (Betchley & Falconer, 2002, p. 9) or ‘sparkling moments’ (Matthews & Matthews, 2005).
Significant others in the client’s life can support this process by observing and taking notice when the client behaves in a way that is unique or doesn’t fit in with the dominant story. People with intellectual disability may particularly require the support of others to identify instances in their life that challenge the dominant narrative. Family members and support workers can play a big part in helping with this process outside of counselling sessions. Some examples of unique exceptions include:
- A young man who often experiences violent outbursts when teased by his peers at school manages to walk away
- A woman who experiences addiction to poker machines and feels that ‘once she starts she can’t stop’ leaves the premises after half an hour
- A young person who self harms every day never self harms in public.
In narrative therapy, the therapist’s role is to support the client and significant others to create the new or ‘preferred’ story (Betchley & Falconer, 2008, p. 4). This involves a process of supporting the client to imagine a new story for their life, and how they want their life to be different.
The client has an intimate knowledge and lived experience of the problem that needs to be understood by the therapist and then used to help to address the problem. A vital part of this process is discovering and enhancing the existing skills and knowledge the client already has in dealing with the problem. These existing skills are often overlooked in a problem-saturated narrative. In addition, existing skills, gifts and abilities are often overlooked in the lives of people with intellectual disability.
Clients with an intellectual disability may require help from significant others who have been involved in helping to create the new narrative to help in telling and retelling the new story to others. This can be a difficult process, particularly as the client encounters voices that tend to reinforce the old, unhelpful narrative (Betchley & Falconer, 2002, p. 7).
Significant others may play a vital role – by creating opportunities for the new narrative to play out, supporting opportunities for success, and learning new ways to understand and interact with the client to promote the new narrative.