Grief and Narrative Therapy

In conceptualising and dealing with grief in the Western world, we have bought into concepts that are neither helpful, nor terribly well backed by experience. The book, The Other Side of Sadness, notes that our views of grief are distorted by input like Freud’s discussion of “grief work” (not researched, but something Sigmund considered reasonable in relation to a topic he only briefly considered) and the Kübler-Ross model, also known as the five stages of grief (posited by someone who had worked with terminally ill patients, NOT those who were left behind to grieve). These concepts have become cornerstones of working with those grieving.

What is wrong with having poorly considered concepts as the basis of working with people at their most vulnerable? Many people defer to those they consider “professionals” and when in distress, the views of the therapist can have considerable impact on the client’s ability to survive and thrive (I won’t digress into a discussion of the therapeutic power relationship here). In The Other Side of Sadness, Bonanno argues for renewed consideration of the resiliency of those in grief and in their abilities to come out the other side – often showing little compliance with the stages of grief. I have been reading this book and then I began to read about grief work in Narrative Therapy, as I prepare for my course at the Dulwich Centre in Adelaide this month.

In Chapter 8, “Saying Hello Again When We Have Lost Someone We Love” from the book Retelling the stories of our lives: Everyday narrative therapy to draw inspiration and transform experience (accessed 02 November 2019 at https://dulwichcentre.com.au/wp-content/uploads/2018/06/Saying-hullo-chapter-from-the-book-Retelling-the-Stories-of-our-Lives-by-David-Denborough-2.pdf), David Denborough discusses an approach to grief that does not center on “moving on” or working through stages of grief:

Narrative Therapy and grief counselling
Narrative Therapy and grief counselling

Rather than the Western norm of adjusting to life without the loved one, there are other options for dealing with the pain of separation and loss. In some cultures, our ancestors remain with us in some way. Many Western therapists would argue that moving on is “healthy” and that a person can get “stuck” in grief if the loved one is not assigned a place in the past. The Narrative approach to grief therapy promoted by Denborough (quoting Narrative Therapy founder Michael White) looks for ways to remember the relationship in a positive way, allowing yourself to imagine the love the other person had for you. Pushing your loved one and memories of them into the “past” can mean for some a dismissal of who they were.

There is not only one way to grieve and dominant Western approaches fuelled by armchair discussions of Freud and tidy stages do not fit either the progress or needs of many who have struggled with the loss of a loved one. If you are struggling with the loss of someone close to you, sometimes it helps to remember the joys you shared, their feelings for you and other positive experiences. Not only can these make your loss more bearable, but on a physiological level, these positive emotions can stimulate areas of your brain that are part of your compassionate mind (see The Compassionate Mind, by Paul Gilbert, for discussions of stimulating the compassion centres of the brain).

Here’s to finding more compassionate and loving ways to progress through grief!

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Documentation in Narrative Therapy

There are a number of things that distinguish Narrative Therapy from other modalities of therapeutic work. Some are theoretical and some, like documentation, can be very practical.

Imagine that you have just finished working with a client. You have a fairly standard report that you complete? Why do you complete it? To remember what has happened and (with traditional therapy) to cover yourself legally? The focus of this documentation is not something you usually provide to the client to help him or her on their journey. The client will rarely see any of this sort of documentation.

This focus on audience is a huge distinction. Rather that writing something in a stylised format for a specific industry, rather than writing something in industry specific jargon, rather than writing for colleagues/judges/insurers, in Narrative Therapy you are writing for the person who has come to you for help. You are writing using language the client can understand. You are writing something to help the client along his or her journey.

The founders of Narrative Therapy, Michael White and David Epston note, in Narrative Means to Therapeutic Ends, that:

The life of the file [reports generated for a client from therapy] proceeds through the process of ‘retranscription” and in this process the patient’s experience is appropriated and transferred into the domain of expert knowledge. The language of the patient is transcribed into “official language,” everyday descriptions of problems into correct diagnoses – from “feeling miserable” to “displays low affect.” Eventually the patient’s experience is not recognizable within the terms of it original presentation.

* * *

In addition to the role of the modern document in the redescription and presentation of the self of its subject, it has another role that is perhaps more primary in many circumstances. This is the presentation of the self of its author. Documents are shaped by a rhetoric, and this rhetoric serves to establish, in the reader, “a certain impression of the character and the moral qualities of the . . . writer in a given situation” (Haare, 1985). Thus, documents are a vehicle for the presentation and display of the author’s worth according to moral criteria that have been established in a particular discipline. And in so doing, such documents shape the author’s life, as they do the subject’s. (p 189)

Arguably, these post-consultation documents do not emphasise the client, but the therapist, colleagues, the profession, legal and financial considerations.

This was one of the things that strongly attracted me to Narrative Therapy – sitting down at the end of a session and writing a summary of the session that was primary for the client. Writing something that would potentially help the client in therapy – something that would emphasise my experience of the session for the client, which would allow the client to see “progress over time”, something that would become part of the client’s evolving narratives.

Are you, as a therapist, writing primarily for your client, or are you writing primarily for yourself?

The Role of the Therapist in Narrative Therapy

When I started my counselling degree, I immediately noticed in other students a fairly strong current of those who were dismissive of a “medical model” in therapy. As I thought further on this, I realised that this is why – as much as I loved the topic – I decided not to study psychology as an undergraduate. The idea of people being “well” or “ill” didn’t seem to fit with experience. I had never met anyone I thought was well – we are all on a continuum in a variety of areas related to mental processes. Also, the idea of a therapist being an expert and uninterested observer or helper seemed absurd. Add to this considerations of therapy being used to promote dominant cultural themes (e.g. what was the sexual “norm”, with homosexually being treated as an illness back in the 20th Century) and there was no way I could buy into the dominant views of psychology generally and counselling and therapeutic interventions, specifically.

Along came Narrative Therapy. I was studying my counselling degree and trying to figure out where my views and desire to serve others fit into therapeutic models. I had little interest in brief therapy (for example), where people were patched up just enough to go back onto the assembly line to keep the capitalist machine running. There were so many forms of this, where “efficacy” was monitored to get funding from insurance and government. All of this seemed little different from the medical model I had avoided as an undergraduate.

In Narrative Therapy, the role of the therapist is understood as not being separate from power structures and rather than the therapist being an expert, the client is the expert in his or her own life. The therapist does not deceive him or herself into imagining that power does not exist in the relationship. Solutions are as individual as the persons presenting for therapy. One of the images for this relationship in Narrative Means to Therapeutic Ends (written by Narrative Therapy founders, Michael White and David Epston) is of the therapist as walking behind the client, allowing the client to dictate direction and not blocking the client’s view of the road ahead.

The therapist has power – power which comes from knowledge, power which comes from social position, power which is given by the client. The therapist models good behaviour and part of this modelling is to show the client that he or she is the author of their own narratives. The therapist helps the client to create stories that create the person going forward.

Narrative Means to Therapeutic Ends

I bought this text several years ago. I had first encountered Narrative Therapy in my Master of Counselling degree and I realised immediately that in a post-modern world, this therapeutic approach could be a valuable way to work with clients. I also realised that it could have considerable value when working with indigenous peoples who were seeking to maintain (or reclaim) their own identity within systems of dominant colonial narratives.

I am working through this text again, in anticipation of my studies in November. Exciting stuff!

Master of Narrative Therapy and Community Work Course

I have been looking at this program from the Dulwich Centre and the University of Melbourne for a number of years (maybe 5?) and I have finally signed up for the prerequisite week long training at the Dulwich Centre in Adelaide. Training from the Centre is required to get into the Masters degree and I received admittance into the Masters on Wednesday (subject to completing the week of training), so I had booked into the November training by Friday. Adelaide, here I come!

While I already have a Master of Counselling, I am very interesting in integrating more Narrative Therapy into my work and this program seemed the ideal way to do that. So, in addition to the other topics I discuss on this site, you will be seeing a number of posts on Narrative Therapy.

Looking to create new stories . . .

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What Really Matters at the end of Life

“My purpose today is to reach out across disciplines and invite design thinking into this big conversation. That is, to bring intention and creativity to the experience of dying. We have a monumental opportunity in front of us, before one of the few universal issues as individuals as well as a civil society: to rethink and redesign how it is we die.”

Grief and Bereavement Therapy

I have been thinking of focusing my therapy research lately. While depression and anxiety support have long been interests of mine, I have found myself considering offering more specific grief and bereavement counselling services.

Why? My own depression and anxiety were the result of a sudden loss. Within minutes, I went from a stable world, to dealing with the most traumatic experience of my life. I suffering loss of a sort I had never known and found myself fluctuating between intense grief and rage. As I moved back and forth between these very highly emotionally charged states, the exhaustion and suffering were almost beyond what I could bear. After about a decade, I began to recover.

So, why grief and bereavement? My depression was inspired by loss. I didn’t have negative self-talk or extensive automatic thoughts which drove my suffering. Quite simply, I had lost my wife. The rage, anguish and other traumatic feelings were a result of this event. I was grieving, but didn’t know to identify it as such. While grief and bereavement seems to focus primarily on loss due to death, I would like to research – at least initially – loss of another sort, that is loss of a life partner who is still alive.

Just getting a few ideas down tonight for further consideration.

Kia kaha from the Land of the Long White Cloud!

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A Confession

Sometimes you are aiming for the best person you can be. You spend months in meditation, in living by principles of kindness. You then find yourself in an environment that is not conducive for kindness and tranquility. I have been lucky in my life, as while there have been periods of hostility, I have mostly been surrounded by decent people. There are, however, hostile environments where bullies are able deflect from their incompetence by attacking others. They are, of course, cowards. Bullies always are. They are afraid they will be discovered for the frauds that they are, so they engage in tactics which – if reached the light of day – would bring them scorn, contempt and pity. This is made worse when bullies have power.

How does this relate to Tolstoy and his “A Confession”? Tolstoy was part of the “in” crowd. He was a famous writer who rubbed shoulders with the highest levels of society. He was also, by his own admission, a person who brought suffering to others for his own pleasure. He later felt great shame to look back on these actions. I am reading his “A Confession” and I am not yet to the point where Tolstoy reforms – but I already know that he does. He goes from a life of selfish actions, to giving away his goods to the needy and living by the highest standards.

When I deal with petty, insecure, narcissistic and sadistic people, I try to imagine that they could be better. I pity them, but also realise that there were times when I did things of which I am now ashamed. I ate the flesh of other beings. I was part of enslaving females for what their bodies produced for their children.

Pity the bully, but know they could be better.

Authenticity Inside and Outside of Therapy

I have been thinking a great deal about authenticity lately. My mind is always full of ideas and over the holidays, I found my meditation fruitful, but with what seemed like “random” considerations of authenticity.

Of course, authenticity has a place in our everyday lives, but I was thinking of authenticity as a therapist, both in and out of therapy sessions. Great therapists – perhaps most notably Carl Rogers – have emphasised the importance of authenticity within the therapeutic relationship. For Rogers there were three things required for therapeutic change:

  • Congruence (authenticity and genuineness)
  • Accurate empathy
  • Unconditional positive regard

While I meditated, these first two requirements kept pushing themselves into my thoughts. Why? My personal congruence and empathy have improved dramatically since I became a vegan in early December of last year. I found myself wondering what effects this increased congruence and empathy could have on providing therapeutic assistance to others.

I became a vegetarian almost five years ago. I made this shift because I didn’t want to be responsible for the suffering of other beings. Months into this journey, I began to realise that some of the greatest suffering takes place for the beings which are not killed immediately, but who are forcibly impregnated (raped), have their offspring stolen from them, are tied to milking machines and then – when they are no longer productive – are made into meat for consumption. I began to ask questions like, “How could I consider myself a feminist, if I didn’t equally care for the suffering of these females?” While these questions formed in my mind, I decided to put off my transition to vegan until my son went off to university in 2022.

In late November of last year, I watched a video on Twitter of cows being allowed out of a dairy for the first time. One only had three usable legs and others were barely able to keep themselves off the ground, as they were forced to cross a road. This scene broke my heart and I couldn’t get the image out of my head. I decided over the next 24 hours that I would become a vegan straight away.

Something interesting happened. I didn’t want dairy anymore. I found a level of peace that I hadn’t imagine possible. Suddenly, the inner conflict was gone. I had immediately become authentic. There was integrity (consistency in my actions and mind). The empathy that I already felt for animals was allowed to grow, too. It was as if another me – a better me – had been waiting and was now released. As Carl Rogers would have noted, the distinction between my ideal self and my real self disappeared. This incongruity was gone, as my “I should” disappeared, leaving only the “I am”.

As I experienced these changes, I began to ask myself what effects these changes might have on me as a therapist and what positive changes might be possible in therapy clients from these insights?

I imagine that the application of these insights to the therapeutic relationship could take up many pages/posts, but on a surface level, it is easy to imagine that my greater congruency throughout my life would help to ensure that I am more congruent within the therapeutic relationship. Also, living my life with greater empathy for all beings would have to help me develop empathy for my clients. Congruency and empathy are not something we turn on and off. Arguably, congruence requires consistency.

The question is, “Does my shift to a vegan lifestyle help me to be a better therapist?” If so, is this something specific to me, or are there possible wider applications? I seem to remember that later in his life Carl Rogers began to think that his therapeutic approach had wider life application than just within the formal counselling session. Perhaps the characteristics of the therapist are more about a lifestyle than a role that is assumed for an hour.

Wishing you the best of mental health!

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