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211 Cards in this Set
- Front
- Back
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Narrative therapy relies on people to do what? |
The client to take a stand |
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Who founded Narrative Therapy? |
Stephen Madigan |
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APA has come around to Narrative Therapy in the past ___ years |
5 |
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Coins are a metaphor for |
Things people give you, about themselves, that hold value in their life. |
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Narrative Therapy says we are |
Multi-storied, but one story is typically a problem in therapy. |
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No ____________ exists, according to Narrative Therapy |
Universal Truth |
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Influences of Narrative Therapy |
Postmodernism, poststructuralism, feminism, anthropology, French philosophy |
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Postmodernism belief |
No absolute truth exists; Everyone's reality is different, and reality is socially constructed. |
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Postructuralism is |
similar to Postmodernism, but adds that we "speak ourselves into meaning". We construct meaning through language. |
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Poststructuralists believe |
one's identity is in a constant state of flux and influenced by broader cultural and historical contexts that have real effects of people. i.e. Slavery, patriotism, racial identity |
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According to poststructuralism, _______ is crucial |
membership (acceptance within a community) |
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French philosopher wrote many essays critiquing various aspects of society, including medicine, psychiatry, human sexuality, and empiricist science. |
Michel Foucault |
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Our lives are shaped by _________ according to Foucalt |
Dominant discourse |
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According to Foucault, who establishes dominant discourses? |
People with power (white, patriarchal, heterosexual, etc) |
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Dominant discourse is often _______ |
covert; not obvious at first glance |
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Dominant discourse three parts |
What can be said? Who can say it? And with what authority?
Example: In class, we can talk about Psychology, Dr. Heath can say it because he has a PhD, meaning he has authority. |
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what is narrative therapy big on |
asking questions:
I.e.how did you come to this description? what is your history helped you arrive at this description? what social institutions helped influence your description? Do you believe your description is universal and applies to everyone? Is there space for your description to be revised? |
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Dominant discourse in the media |
Spring break; alcohol commercials; standards of attractiveness; romantic relationships scripts |
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What is Narrative Therapy |
Seeks to help people re-author their lives; Acknowledges that we are multi-storied; Thickening client's "thin"description; How client has become problematic and who created that talk? |
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Goal of Narrative Therapy |
to align client with their preferred identity
Listen to marginalized parts and bring them to the surface
"Naming rights"are giving to the client, ie. what would they call "depression" instead of DSM language |
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Narrative therapy in practice |
Avoids a prescriptive/manualized model of teaching;
Few general patterns of progression (8 core processes) |
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Eight core Narrative Processes |
Use of externalizing language; Deconstruction of the problem story; Points of resistance; Unique outcomes; Re-Authoring; Re-membering; Circulation of the new story; Preparing for setbacks |
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What is externalization |
The person isn't the problem, the PROBLEM is the problem. i.e. How long has depression interrupted your life?, how often is anxiety an unwanted guest in your home. |
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Deconstruction of the problem story |
Unpack the story, referred to as "mapping" the influences of the problem. |
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Narrative therapy, there is no... |
I |
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Deconstruction of Problem story |
-Comprehensive understanding of the problem story -Unpack the story.. mapping th influence -Client names the problem -Observe societal discourses -Notice the power of negative stories (one problem dominates)
(split page.. Story of the Person and Story of the Problem) |
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What makes a good NT question? |
Timing One that leads to a client epiphany "why"question |
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Points of Resistance |
Client's resistance of a problem story.
A willingness to stand up and fight a problem.
i.e. a person that says they sleep all day and never go out of the house shows up to therapy |
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Good Points of Resistance questions |
How would standing against "trouble"be beneficial to your life?
Why is anxiety no longer a welcome guest
Why do you believe your life would be more fulfilling if you were able to kick trouble to the curb |
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Unique Outcomes are called... |
Sparkling Moments |
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Unique Outcomes occur |
when you notice the slightest loosening of the problem story. Loosening can be info that is contradictory to the problem. |
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Double listening is when |
the therapist listens for the problem and listen for the loosening of the problem |
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Questions for "tough"clients for unique outcomes |
Tell me about a time when trouble wasn't present?
What parts of yourself does trouble sometimes make you forget?
If you were able to reclaim yourself from depression, how would your life be different? |
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Points of resistance vs. Unique outcomes |
General vs. specific |
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Unique outcome question for couples or families |
What do you see in Jenny that she is sometimes blind to because of troubles presence |
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Re-Authoring |
After many rich and descriptive unique outcomes have been identified, therapist helps client string these together in an effort to create an alternative story to stand alongside to the problem story. New story helps to "thicken the plot"of the client's life story and aligns with more preferred identity. Gives clients opportunity to re-write themselves. |
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Writing a story is a part of |
Reauthoring (either written by the therapist or the client)- crucial that the client's own words are used regardless |
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Re-membering |
reconnect people with communities with clients fighting similar problems
have client write a letter to new clients with same issues |
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Circulation of New Story |
People in client's life become aware of and get on board with this new story by reading the new story |
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Be careful about the stories you tell yourself and others that tell about you? |
Narrative therapy quote |
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What if clients don't have anyone to share the story with? |
Invite therapeutic community to witness client's new story and honor through interaction and conversation. A reflecting team. |
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Preparing for setbacks |
Concrete plan for the client to carry with them for encountering the problem again |
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Solution focused brief therapy
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Believe people are healthy and competent
Past downplayed Looking for what works Therapist help clients find exceptions to issue Shift from problem to solution focus Construction of solution vs solving problems |
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SBFT
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Client creates on solution
Small change leads to large changes Client is expert Best therapy is collaborative Therapist makes no assumptions |
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SFBT questions
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Are important because they help clients:
Use resources How changes imply Chang is useful Focus on solutions Get clients to rememeber when times were better.... |
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What have you done since you made the appt that has made a difference in your probem?
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Insinuates that client has been DOING. Something
Pre therapy change question |
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Exception questions
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Directs clients to better times
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Miracle question
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If a miracle happened, and problems solved while you were aspleep, what would be differnt in your life
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Scaling question
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On scale from one to ten, where are you in reference to issues
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Enlightenment empahsized
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Rationality/reason
Science In.... |
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Romanticism emphasized
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Intuition
Mysticism Emotion Instincts Experience Expression Nationalism Nature |
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Jean-Jacques Rousseau
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1712-88
Father of Romanticism Challenged assumption that humans needed to be governed. Emphasized feelings/instinct vs. reason Humans are basically good We wish to live in harmony with other humans General will is best Education enhances instinct |
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Arthur Schopenhauer
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1788-1860
The world is "will"-blind, aimless, irrational, unending cycle of human needs-hedonic treadmill; or "representation- internal experience of an object |
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Who are the fathers of existentialism?
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Kierkegaard and Nietzche (Sartre is an important dude too)
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Existentialism
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Individuality
Choice Free Will |
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Kierkegaard
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1813-55
First existentialist Very religious, wanted to redefine Christendom as deeper Saw science as too mechanistic Can't know God objectively, must have "leap" of faith |
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Three lifes according to Kierkegaard
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Aesthetic Life
Ethical Life The Religious Life |
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The aesthetic life
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Hedonism
No thoughtful ethical consideration |
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The Ethical Life
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Driven by society
Prescribed through dogma and social norms Obeyed to avoid ostracism Structured and actionable Logical access to ethical knowledge |
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The Religious Life
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Anxiety filled
Paradoxical Teleological (goal) Suspension of the Ethical -Non rational -Absolute obedience to God's command regardless of ethics -A feeling of right doing -Truth of command is experienced not understood |
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Nietzsche
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1844-1900
"Birth of Tragedy" Apollonian aspect-rational, ordered, tranquil Dionysian aspect-Irrational, chaotic, dynamic Two forces in opposition Tragedy is the best expression Embracing this tension is highest form of life |
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Nietzsche three main concepts
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God is dead
Will to power Ubermensch |
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God is dead
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Life guided by doctrine, religion, reason is over No higher source of rule-makingNew goal for humanity was necessary |
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Will to power
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Survival comes desire to exert will
Happiness isn't aim, its byproduct Overcoming makes life affirmation possible Urged fusion Apollonian/Dionysian aspects |
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Ubermensche
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Superman once we embraced Nietszche ideas
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Sartre
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Conciousness-loneliness
Loneliness-Other's disrupt us Self as other- exacerbates lonliness Freedom-Choice available to us |
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Contemporary Existentialism
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Free will
Personal choice Responsibility Facing feelings People are alone and crave connection |
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Frankl
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1905-1997 You can generate hope in any situation "What is to give light must endure burning" Logotherapy |
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Logotherapy
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Life has meaning under all circumstances
Main motivation is will to find meaning Have freedom to find meaning in what we do, or at least take a stand when faced with a situation of unchangeable suffering |
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Frankl says we can understand meaning in these 3 ways
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Doing work or deeds
Experiencing something or someone By the attitude we take toward unavoidable suffering- no one can take our attitude |
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Yalom
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1931-
Therapy is relationship driven Synergy of ideas + relationship |
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Yalom's four givens of human existence
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Death, freedom, isolation, meaninglessness. Know comprehensively
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Contemporary existentialism identifies problems by
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Id ways of coping(denial, ignorance)
Looking for self deception Chronic denial Noticing when clients avoid subjects Focus on client's internal experience |
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CE Therapists
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Help clients:
Confront mortatlity Overcome terror associated with death Understand scope of own power Accept free will Encourage actions that emphasize realness Make own choices |
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Yalom’s 11 factors he identified
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Universality, Altruism, Hope, Guidance, Impart info, Develop social skills, Interpersonal learning, Cohesion, Catharsis,
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Core processes of Narrative Therapy
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Use of externalizing language, Deconstruction of the problem story, Points of resistance, Unique outcomes, Re~authoring, Re~membering, Circulation of the new story, Preparing for setbacks
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Existential factors, Imitative behavior, Corrective recapitulation of original family issue
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Don't know why I wrote this one.. look it up |
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Universality
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feeling of having problems similar to others, not alone (powerful in homogeneous groups)
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Altruism
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helping and supporting others
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Instillation of hope
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encouragement that recovery is possible
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Guidance
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nurturing support & assistance
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Imparting information
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teaching about problem and recovery
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Developing social skills
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learning new ways to talk about feelings, observations and concerns
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Interpersonal learning
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personal issues show up in group; development of group relationships transfers to outside relationships
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Group Cohesion
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feeling of belonging to the group, valuing the group~trust, acceptance, belonging
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Catharsis
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release of emotional tension
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Existential factors
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life & death are realities
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Imitative behavior
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modeling another’s manners & recovery skills
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Corrective recapitulation of family of origin issues
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identifying & changing the dysfunctional patterns or roles one played in primary family
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Yalom’s Developmental Stages of Therapy Groups (Three stages of process)
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1. Cautious & concerned about acceptance, 2. Jockey for pecking order 3. Cohesiveness emerges
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Socializing clients
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(loyalty, sex, exclusion)
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Yalom’s 4 givens
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Death, Freedom, Isolation and Meaninglessness
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Death
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It is coming and there is nothing you can do about it
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Freedom
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All choices are available to you
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Isolation
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You are utterly and completely alone
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Meaninglessness
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Nothing in the universe has any meaning in and of itself
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Leader in interpersonal approach to group therapy
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Yalom
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Content vs. process group
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homogeneous vs. heterogeneous
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Process group focus on
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interpersonal issues
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Having sex with another group member is bad because
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it forms a different entity
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Have an understanding of the concept of the group as a social microcosm
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Clients unknowingly enact their own relationship pathology in the group, focus on here and now.
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Group memberships
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5 to 10, open (deal with loss) or closed (good for cohesive) enrollment
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Not good candidates for group therapy
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acute crisis, psychosis, frequent absence
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Preparing for group therapy
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correct misconceptions, give realistic and encouraging data re: outcome, encourage helpful participation, est. ground rules.
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Confidentiality
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Cant guarantee in group; important to encourage group members
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Outcome in group therapy
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beneficial (about equal to individual)
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Be familiar with some of the core techniques and philosophies of family therapy as discussed in your book and in class
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Came into prominence in 1950s, focus on family communication and functionalism of symptoms that may be adaptive, revolutionary, systemic
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Example of adaptive strategy
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Mom’s an alc-y, kid starts to get stomach ache when mom gets hammered, kid gets comforted.
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If individual exhibits systems
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problem is in entire system (family)
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Families regulate by creating
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homeostasis
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A family member my sense discomfort and
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take action to return to homeostasis
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Assessing families
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interviews, genograms
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Family life cycle
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Leave home, join thru marriage, family w/ young children, family with teens, launching kids and moving on, later life (can be adapted culturally, experientially)
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triangulation
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When someone speaks through someone else when two are in conflict (i.e. go ask your mother)
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Triangulation is particularly a problem when
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triangulated person is a child
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Goal is to make triangle
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a line
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genograms
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family tree that tells relationships between members; can be beneficial
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circular causality
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events influence each other reciprocally
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Who’s going to kill it on this MF’er?
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YOU BABY!
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linear causality
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one individual has their own issues
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“the IP,”
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identified patient (person carrying system for entire family)
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Family needs to be enlightened that
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IP isn’t the problem, problem is part of the system
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Family structure
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unwritten family rules, when flawed problems result, improved by focusing on subsystems/boundaries
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Differentiation of Self
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appropriate degree of self-determination; don’t let it happen and it’ll cause problems. If not dealt with emotional fusion or undifferentiated ego mass
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Rousseau
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Father of Romanticism, “Man is born free and yet we see him everywhere in chains.”, Challenged that humans need to be governed, emphasized feelings over reason, all humans are good and social
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Goethe
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Humans are torn by life’s stresses,Life is opposing forces, love and hate, life and death, good and evil with goal to embrace these forces, meaningful psychological over meaningless sensation, was phenomenologist, evolution proponent, behavior therapy
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Schopenhauer
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life is suffering, suffering is from attachment to desires, ceases from detachment to desires, 8 fold path to relief. Intelligent people suffer most. Gregarious=stupid, solitary=smart
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Cultural Competence
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Therapists should consider ethnicity, religion, etc
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Confidentiality in Family Practice
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difficult when one member tells therapist something private
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DSM disorders apply to
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individuals, not families
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Outcome in family therapy
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difficult to measure, different reports by members
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Outcome research on Family therapy
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it works
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Started first clinic
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Lightner Witmer
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First clinic was designed for
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children
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Disorders of childhood
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ADHD, conduct disorder, oppositional defiant disorder, PTSD
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Two types of Childhood disorders
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internalizing and externalizing
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Developmental perspective
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appropriate stages of child development; expectations vary across cultures
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Comprehensive child assessment must consider
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presenting problem, development, parents/family, environment from multiple sources
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Child assessment methods
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assessment methods, behavioral observations, behavior rating scales, self-report scales, prejected/expressive techniques, intellectual tests
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Projective/expressive techniques
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Rorschach, TAT, sentence completion (for kids: CAT, drawing techniques)
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Intellectual tests
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IQ and academic achievement (good for learning disabilities)
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Therapy for kids
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play therapy (humanistic, psychodynamic)
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Founded self instructional training
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Donald Meichenbaum (a form of CBT)
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Self instructional training
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hear instructions aloud, say aloud, then think them to themselves
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Sh!t that Travis doesn’t do
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Self-instructional training
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Parent training
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formal classes, functional analysis, contingency management
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Outcomes of psychotherapy for kids
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effective (behavior can be slightly more effective)
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General skills for the Clinical Interviewer
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quieting yourself, self awareness, develop positive working relationships
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What is a genogram, and what are the benefits of using this technique in family therapy
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?
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Irvin Yalom
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leader in interpersonal approach to group therapy, the term interpersonal has been used as a label for his approach to group therapy, and his writings have infuenced many group therapists According to Yalom (2005), although it may be possible to conduct group therapy as a series of one-on-one interactions between therapist and clients, such an approach fails to“reap the full therapeutic harvest” that group therapy can offer. Instead, he encourages group therapists to recognize the unique opportunity that group therapy presents: the display of clients’ problematic interpersonal tendencies in the group itself.
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Be familiar with Yalom’s interpersonal approach to group therapy
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PRIMARY FOCUS IS TO STRENGTHEN INTERPERSONAL SKILLS; Yalom (2005) views these problematic interpersonal tendencies as central to clients’ presenting problems, whether or not clients initially recognize it. He argues that all psychological problems stem from flawed interpersonal relationships, as exemplified by his comments about depression: “Therapists cannot, for example, treat depression per se . . . it is necessary first to translate the depression into interpersonal terms and then to treat the underlying interpersonal pathology” This definition of depression differs considerably from traditional medical-model definitions that emphasize intrapersonal or biological roots of disorders. Instead, according to Yalom, an individual’s disorder is a byproduct of his or her disturb way of getting along with other people
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Know Wakefield’s harmful dysfunction theory of mental disorders
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proposes that in our efforts to determine what is abnormal, we consider both scientific(e.g., evolutionary) data and the social values in the context of which the behavior takes place.
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DSM
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Diagnostic and Statistical Manual of Mental Disorders; Published by the American PSYCHIATRIC Association, made by task force of mostly psychiatrists
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DSM-5, mental disorder is defined as a
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clinically signifcant disturbance in cognition, emotion regulation, or behavior that indicates a dysfunction in mental functioning
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In the DSM, mental disorder does not include
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expectable reactions to common stressors
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the DSM refects a medical model of
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psychopathology in which each disorder is an entity defined categorically and features a list of specific symptoms.
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1st edition of the DSM
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published in 1952, was created by foremost mental health experts of the time, who were almost exclusively white, male, trained in psychiatry, at least middle age, and at least middle class.
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With the most recent revisions of the DSM, deliberate efforts have been made to
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include more diversity among the contributors.
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The designers of the DSM-III and DSM-III-R (and to a lesser extent the fourth edition and the text revision) were still
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predominantly senior White male psychiatrists who embedded the document with their biases” (Malik & Beutler, 2002, pp. 5–6)
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Proposed criteria set
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in the “Emerging Measures and Models section DSM-5; diagnosis for which further research is encouraged
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Positive Psychology Definition
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scientific study of optimal human functioning
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PP Concerned with understanding
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Happiness and well-being, Positive traits, Engagement in absorbing activitie, Development of meaningful positive relationships, social systems and institutions
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Martin Seligman
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“Father” of Positive Psychology Unhappy with direction of psycholog as focused too much on pathology and how to “fix” people.
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Seligman’s three dimensions that can be cultivated
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the Pleasant Life, the Good Life, and the Meaningful Life.
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The Pleasant Life is realised if we
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learn to savour and appreciate such basic pleasures as companionship, the natural environment and our bodily needs. We can remain pleasantly stuck at this stage or we can go on to experience the Good Life,
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Good Life is achieved through
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discovering our unique virtues and strengths, and employing them creatively to enhance our lives. According to modern theories of self-esteem life is only genuinely satisfying if we discover value within ourselves. Yet one of the best ways of discovering this value is by nourishing our unique strengths in contributing to the happiness of our fellow humans.
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final stage is the Meaningful Life, in which we
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find a deep sense of fulfilment by employing our unique strengths for a purpose greater than ourselves.
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Positive Affect Definition
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the extent to which an individual habitually experiences positive moods like joy and interest, Tested through questionnaire called Positive and Negative Affect Schedule (PANAS); Proven to be moderately heritable
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Those scoring high in positive affectivity are more likely to
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Be happily married, Like their job, Describe themselves as religious or spiritual
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Mihalyi Csikszentmihalyi
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Father of Flow
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Flow Definition
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psychological state that accompanies highly engaging activities
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What happens during flow
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Time passes quickly for engaged individua, Attention focused on activity itsel, Loss of sense of self as social actor, Often described as the experience of working at full capacity
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Flow is Most likely to occur when there is an optimal balance between
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skill and challenge
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Positive Psychotherapy (PPT)
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Pioneered by Tayyab Rashid and Martin Seligman
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PPT Focuses on
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enhancing well-being through positive psychological interventions seeking to cultivate:Positive emotions, Building strength, Enhancing meaningful relationships
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PPT is a ___ session program
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14
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Character Strengths are Measured by
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Values in Action (VIA) Classification of Character Strengths and Virtues
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Character Strengths work in therapy?
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Structuring life to utilize these strengths instead of focusing and dwelling on weaknesses, Encouragement not only to identify signature strengths, but to use them in a new way every day, important to recognize the strengths of others as well
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Gratitude
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Being aware of and thankful for the good things that happen and taking time to express thanks
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Gratitude work in therapy
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Letter of Gratitude—write a letter to someone that you never thanked but always wanted to and deliver it; Three Good Things/Three Blessings—every day for at least a week, write down three good things that happened to you and why you are thankful for them (For the 14-session program, this journal is maintained indefinitely)
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Forgiveness is a
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Powerful tool that can transform feelings of anger or bitterness into neutrality (and sometimes even positive emotions)
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Forgiveness work in therapy?
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Discuss roles of good and bad memories in maintaining depression, Holding on to anger and bitterness maintains depression and undermines well-being, Write forgiveness letter describing transgression and related emotions and pledge to forgive the transgressor, Letter not delivered
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Savoring
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Awareness of pleasure and deliberate attempts to make it last, The tendency to adapt or habituate to pleasant activities (called the hedonic treadmill) makes this process challenging
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Savoring work in therapy?
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Invite client to take the time, once a day, to enjoy something that they usually hurry through, Write down this experience, how it was done differently, and how it felt compared to when they rushed through it
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Techniques to promote savoring
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Sharing with others, Memory-building (souvenir), Self-congratulation (pride), Sharpening perceptions (focus), Absorption (immersion)
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Efficacy of PPT
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Study conducted by Seligman, Steen, Park, and Peterson (2005) showed Three Good Things exercise and using signature strengths in a new way increased happiness and decreased depression for 6 month; Gratitude letter showed significant positive changes for up to 1 month
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Efficacy of PPT
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Rashid and Seligman (2011) tested positive psychotherapy by randomly assigning individuals with severe depression to either PPT or treatment as usual. Another nonrandomized group received treatment as usual plus an antidepressant medication.Results indicated PPT relieved depressive symptoms on all outcome measures better than treatment as usual and better than drugs, 55% of PPT patients, 20% of treatment as usual patients, and only 8% in treatment as usual plus drugs achieved remission
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Specific therapeutic behaviors
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Listening is primary, eye contact, body language, vocal qualities, verbal tracking a train of thought, positive and connected rapport, technique, directive (interview) vs. non-directive (client-driven) styles
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Postmodernism, poststructuralism, feminism, anthropology, and French philosophy all influenced the formation of
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narrative therapy.
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Postmodernism replaced
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modernism and holds the philosophical belief that no absolute truth exists. Everyone’s reality is different, and reality is socially constructed.
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Poststructuralist thought shares many of the beliefs of
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postmodernism but advances that our unique reality is shaped specifically by our use of language. In other words, we quite literally speak ourselves into meaning.
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Poststructuralists also contend that one’s identity is
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in a constant state of flux and is influenced by broader cultural and historical contexts that have real effects on people.
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Poststructuralists believe reality is
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socially constructed and interactions with others are crucial. As humans, we strive to connect and associate with other humans and also seek membership and acceptance within a community.
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What is narrative therapy?
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Narrative therapy seeks to help people re-author their lives., Acknowledges that we are all multi-storied., People who come to see us are often totalized by problem stories. These stories are thin descriptions of who people really are. The goal is to assist the client in thickening the plot of their life. As therapists, we look at how people have come to see themselves as problematic and who in their lives is a part of this talk.
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Externalization
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The person and the problem are seen as separate. This is not a technique, but rather, a specific language that is used throughout therapy. Some examples of externalizing statements or questions; How long has “depression” been interrupting your life? How often is “anxiety” an unwanted guest in your home? It seems like “trouble” is more likely to follow you when you are around certain friends at school.
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Deconstruction of Problem Story
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While the goal of narrative therapy is to help provide the client space to re-author her or his life, this cannot be done without a comprehensive understanding of the problem story that brought the client into therapy in the first placem the problem story must be deconstructed or “unpacked.” “mapping the influences of the problem”. Having the client name the problem is encouraged (including names that may be a departure from traditional diagnosis) and can help add context. Remember, the goal of narrative therapy is not to deny the presence of the problem story. This is a real story in the client’s life. Instead, the goal is to unearth additional narratives that may have been forgotten or taken for granted as a result of the power of the problem story. Being on the lookout for dominant societal discourses that may be allowing the problem story to remain in a place of power in the person’s life can be helpful.
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Points of Resistance
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Foucault noted that whenever a dominant knowledge is present, there always exist points of resistance. This is true of clients and the problem stories they bring with them to therapy, too. As the problem story is being deconstructed, be on the lookout for ways in which the client may already be standing against the problem story or ways in which they might be willing to stand up and fight against it. When a point of resistance is identified, it can be helpful to follow up with respectful and curious questions. These often come in the form of why questions. This is important because it helps the client identify and expand on reasons why they want to fight back against the problem story.Examples How would standing against “trouble” be beneficial to your life?Why is “anxiety” no longer a welcome guest?Why do you believe your life would be more fulfilling if you were able to kick “trouble” to the curb?
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Unique outcomes (sometimes called sparkling moments) occur when
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you notice even a slight loosening of the problem story. This could also involve information that is contradictory to the problem story. Often times unique outcomes emerge as the problem story in being deconstructed. It’s important to listen closely for these as you are simultaneously unpacking the problem story. For some clients, it might require a bit more work to unearth unique outcomes. This is where the creativity and question asking ability of the therapist is crucial. Examples of questions:Tell me about a time when “trouble” wasn’t present?If you were able to reclaim yourself from the grip of “depression” how specifically would your life be different?What parts of yourself does “trouble” sometimes make you forget?
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Unique Outcomes when working with couples or families it can sometimes be helpful
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to ask questions of others.For example: What do you see in Jenny that she is sometimes blind to because of “trouble’s” presence?
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Re-Authoring
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After many rich and descriptive unique outcomes have been identified, the therapist then helps the client string these together in an effort to create an alternative story to stand alongside the problem story. This new story helps to “thicken the plot” of the client’s life story and aligns with their more preferred identity. In essence, it really gives clients the opportunity to re-write themselves.It is usually most helpful to write down this new story. It helps to make the story more real. Some narrative therapists will write down the story in the form of a letter and give it to the client. Others will hand the pen to the client and encourage them to craft the story. No matter what method is used, what’s crucial is that the client’s own words are used. I’ve witnessed many clients become emotional and somewhat in awe of hearing their own words used. It can be a very powerful experience for any of us to read our own words or have our own words read back to us by someone else.
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Re-Membering
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Problems tend to isolate people. One of the goals of narrative therapy is to reconnect people with others. This can be done by connecting clients with other clients who are fighting against similar problems. This connection can sometimes be face-to-face and involve clients sharing their new identities. Another way this can be done is by having clients write a letter to future clients who might be struggling with a similar problem describing strategies they found effective in their battle.
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Circulation of New Story
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One of the final steps of narrative therapy (one that also helps with re-membering) is to circulate the new story. Once the client has completed the re-authoring process and articulated their new, more preferred identity in writing, it is important that other people in the client’s life become aware of and get on board with this new story. Letters are often sent to family members, friends, teachers, and in some cases even judges or other community members. The goal is to share and celebrate this new, more preferred story.
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What if clients really don’t have anyone to share the story with?
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Use the therapeutic community around you. Other therapists can witness the client’s more preferred story and honor that story through interaction and further conversation. This is often referred to as a “reflecting team.”
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Preparing for Setbacks in NT
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Often, problem stories will resurface and again try to rise to prominence at a later point in the client’s life. It can be helpful for the therapist to point out that this process is likely and to help the client articulate and reinforce ways in which the client will combat the problem story again when it does. The fact they already have a new, more preferred identity in writing can serve as a concrete template they can carry with them as a reminder of how they combated the problem in the past.
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Narrative therapy has been shown to be effective with a variety of problems including but not limited to
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anxiety, depression, disordered eating, family/couples conflict, self-injurious behavior, and childhood/adolescent conduct problems.
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Solution-Focused Brief Therapy (SFBT)
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Therapy grounded on a positive orientation that people are healthy and competent, Past is downplayed, while present and future are highlighted, Therapy is concerned with looking for what is working, Therapists assist clients in finding exceptions to their problems, There is a shift from “problem-orientation” to “solution-focus”, Emphasis is on constructing solutions rather than problem solving
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Solution-Focused Brief Therapy (SFBT) Basic assumptions
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People can create their own solutions, Small changes lead to large changes, The client is the expert on his or her own life, The best therapy involves a collaborative partnership, A therapist’s not knowing afford the client an opportunity to construct a solution
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Solution-Focused Brief Therapy (SFBT) Importance of Questions
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Skillful questions allow people to utilize their resources, Asking “how questions” that imply change can be useful, Effective questions focus attention on solutions, Questions can get clients to notice when things were better, Useful questions assist people in paying attention to what they are doing Questions can open up possibilities for clients to do something different
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Solution-Focused Brief Therapy (SFBT) Techniques Used
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Pre-therapy change (What have you done since you made the appointment that has made a difference in your problem?) Exception questions (Direct clients to times in their lives when the problem did not exist) Miracle question (If a miracle happened and the problem you have was solved while you were asleep, what would be different in your life?) Scaling questions (On a scale of zero to 10, where zero is the worst you have been and 10 represents the problem being solved, where are you with respect to __________?)
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Miracle Question
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Imagine that you go to bed tonight and when you wake up the next morning a miracle had occurred in your sleep. When you awake, you notice that the problem that brought you here to see me has been solved. As you begin to move around your world, what are some of the things you notice around you that let you know your life had suddenly gotten better?
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Common criticisms of postmodern approaches
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Rely too heavily on the resources of the client.Criticize the brief nature of therapy and whether the changes made are enduring.Narrative therapy specifically, is a complex practice that doesn’t have techniques that can necessarily be taught.
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