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.

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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.

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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Importance of therapeutic relationship to Freud