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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Narrative Therapy

We all have “narratives” or stories that we construct about our lives. The events around us are not quite as objective as we often like to imagine. We take information, feelings, reactions, instincts and we filter events, creating our own stories of what has happened. This active construction of “reality” is understood, analysed and utilised in Narrative Therapy.

Unlike in some therapeutic approaches where the therapist is an “expert”, the Narrative therapist realises that the client is the expert in his or her own life. By working through the narratives of a client’s life – most specifically those that are problematic for current functioning – the client and therapist are able to develop “richer” narratives, which aid the individual with conflict resolution and creating a perspective of self and the world which assist in sounder mental health. In this context, the therapist is a collaborator with the client, helping construct revised meaning.

There are a number of techniques employed in Narrative Therapy, including:

  • Helping the client to “separate” from problems, seeing that they are not the same as their problems. (This externalisation process also includes “strengths” and other more positive aspects of self, so that the client can author a more preferred narrative of self.)
  • Encouraging the client to consider life events which are not dominant in current narratives (e.g. looking for exceptions).

Narrative Therapy developed in the family therapy practices of Australian Michael White and New Zealander David Epston and is still used in relationship counselling. For some practitioners, including Epston, it is common to use not only verbal narratives, but also things such as letters, documents and other supporting objects.