Using a Narrative Metaphor: Implications for Theory and Clinical Practice

The evolution of family therapy from a cybernetic metaphor to a narrative metaphor has led us to think differently about therapy, about clients, and about ourselves as therapists. In this article we pursue how this different way of thinking has informed a theoretical understanding of a narrative therapy approach and consequently has opened space for different ways of working clinically. We begin by tracing the evolution to narrative; we consider the implications of social constructionism and its political effects; and we complete the discussion by focusing on narrative theory. We then show how the clinical work follows logically and is coherent with the theoretical considerations. We describe, and illustrate with clinical examples, an innovative approach to working with couples and families with adolescents. In this work we pay attention to the larger cultural stories, including gender constructions, and to personal stories that persons have created to make meaning out of their experience as they interact with one another in a reciprocal meaning-making process. Interventions focus on externalizing the problem narrative that is influencing the client(s), mapping the effects of the problem pattern and/or the totalizing view persons might have of others, and creating space for client(s) to notice preferred actions and intentions. Finally, we close the loop by asking questions of ourselves and others about the effects of working from a narrative metaphor.     

Utilizing artistry in a therapeutic relationship

Abstract

In many humanistic approaches, therapeutic change involves utilizing the relationship between the client and therapist as a tool for personal growth. Like any relationship, the therapeutic relationship is one that is co‐created between those engaged in it, namely, the client and the therapist. Utilizing this co‐created relationship requires a sense of artistry on the part of the therapist. A therapist must be willing to engage in this meaningful relationship with the client. A therapist must also be aware of the personal values that he or she brings into therapy, and how they influence the therapeutic relationship. Finally, a therapist must acknowledge the power that the therapist and the client possess in the relationship, and understand how that power can be used to validate and invalidate the therapist's and the client's personal meanings. These aspects of therapeutic artistry are discussed and the use of therapeutic artistry in Eron and Lund's (1996) narrative solutions approach is presented.     

Getting the story right: a Reductionist narrative account of personal identity

A popular “Reductionist” account of personal identity unifies person stages into persons in virtue of their psychological continuity with one another. One objection to psychological continuity accounts is that there is more to our personal identity than just mere psychological continuity: there is also an active process of self-interpretation and self-creation. This criticism can be used to motivate a rival account of personal identity that appeals to the notion of a narrative. To the extent that they comment upon the issue, proponents of narrative accounts typically reject Reductionist metaphysics that (ontologically) reduce persons to aggregates of person stages. In contrast to this trend, we seek to develop a narrative account of personal identity from within Reductionist metaphysics: we think person stages are unified into persons in virtue of their narrative continuity with one another. We argue that this Reductionist version of the narrative account avoids some serious problems facing non-Reductionist versions of the narrative account.     

The Relation of Psychotherapy Integration to the Established Systems of Psychotherapy

That individuals (and groups) have vested interests is part of the nature of the human condition and is captured in the cognitive theoretical concept “personal domain” (Beck, 1976, p. 56). Of relevance to psychotherapy integration (and consistent with this concept), there are some apparent philosophical differences between advocates of psychotherapy integration and those of the major systems of psychotherapy. In the same manner that the various schools of integrative and eclectic psychotherapy compete with one another (Lazarus & Messer, 1991, p. 144), so too do they contend with the established systems. In this article, we present several issues about which the systems of psychotherapy and the integration movement may differ, and we respond to criticisms of cognitive therapy that have been the focus of previous articles in this journal. Finally, we give examples of how those who research and apply the contemporary systems of psychotherapy can, within those systems, explore possibilities for psychotherapy integration. We conclude that there is probably much that the integration movement and the established systems of psychotherapy can offer each other.     

Reconstructing An Erection and Elaborating Ejaculation: Personal Construct Theory Perspectives on Sex Therapy

Abstract

Personal construct psychotherapy has rarely been applied to sexual disorders. In this paper a constructivist approach is contrasted with alternative methods of treating such problems on three related dimensions concerning whether it (1) is introspective or extraspective, (2) views the complaint as representing a personal construction or faulty mechanism, or (3) aims toward personal or normative goals. It will be illustrated by reports of the treatment of two men presenting with sexual complaints, and its technical eclecticism will be compared with integrative trends in sex therapy.     

Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy

Despite being a characteristic symptom of schizophrenia, implications for therapy with persons experiencing prominent disorganization have received less attention in the psychotherapy literature than have other aspects of the disorder. As such, formal thought disorder may be viewed largely as a barrier to effective participation in therapy. In contrast, though, a range of writers from varied traditions have stressed that this feature of schizophrenia is meaningful and improved coherence of speech is an important and viable component of treatment and recovery. This paper suggests that an emergent integrative psychotherapy, metacognitive reflection and insight therapy (MERIT), may be well-suited for work with persons experiencing disorganization symptoms. A brief overview of MERIT is provided, followed by a case report of an 18-month course of therapy with a man with severely disorganized speech.     

Theorizing the Narrative Dimension of Psychotherapy and Counseling: A Big and Small Story Approach

In this article, we develop a theoretically substantiated narrative framework for assessing psychotherapy practices, based on a big and small story approach. This approach stretches the narrative scope of these practices by making explicit and advancing small story counseling. We demonstrate how this framework can be a reflection tool by systematically applying six story dimensions to an example from army counseling. Small story dimensions one (multiple storytellers) and three (ways of ordering experience) draw attention to which persons and stories we do not engage with in counseling practices. Small story dimension two (future and on-going temporal orientation) marks a shift towards language of (future) potential, rather than a language of deficit. Small story dimensions four (low tellability) and five (fluent moral stance), reinstate the art of listening to client words, and remind us to resist the inclination to interpret these too easily in terms of a specific counseling theory or moral framework. Finally, small story dimension six (embeddedness) encourages counseling-on-the-move. Finally, we discuss the implications of widening the narrative scope of psychotherapy and counseling, such as the need to develop small story competence and to assess the therapeutic quality of everyday talk.     

Experiential personal construct therapeutic artistry: The therapy relationship and the timing of interventions

Abstract

Experiential personal construct psychotherapy focuses on the intimate, interconnected, and evolving relationship between the therapist and the client as vital to therapeutic growth. Great creativity is demanded of the therapist who aspires to connect with clients in life‐changing psychotherapy. This article first describes the essential nature of the therapy relationship with its implicit and explicit demands for therapist creativity. These principles then are illustrated through a discussion of the critical issue of timing therapeutic interventions.     

Psychotherapy research: an interplay between inner and outer and a succession of meanings

Psychotherapy research is a rapidly developing area of study that aims to explore the integration of inner and outer conditions of an individual’s experience, the interplay between subjective and objective, as well as between individual and collective. Questions regarding a more integrative view and qualitative research in psychotherapy are discussed in the paper. The author introduces some ideas from the studies on psychotherapy effectiveness that were done at Vilnius University by a group of researchers who work in the ‘Centre for research on the psychodynamics of personality’. Clinical psychologists who hold a doctorate degree or who are in doctoral studies in the Department of Psychology at Vilnius University are members of this research group. The subjective understanding about healing episodes and the development of depth premises were the main tasks of these studies. Among other methods, the researchers used the drawing a picture of a healing moment and telling a psychotherapy story recalled by the client to collect data. Two examples of drawing a picture of a healing moment and one example of telling a therapy story are analyzed in the paper. The themes of subjective experience of renewal in psychotherapy as well as the multiplicity of experience and results in psychotherapy are discussed in the paper with case illustrations. This study showed that drawing a picture opens one more dimension of reflection and that it can be an appropriate tool for developing individual narratives as well. Authoring and re‐authoring one’s life narrative is accepted as part of a productive therapy as well as discovering one’s inner authorship. The ability to follow a succession of meanings, as well as a connection to nature and culture could be one of the ways of actualizing an integrative view in psychotherapy research.     

Hope

Summary

The author describes her treatment of her first alcoholic client and observes how the process of providing hope to this client heightened the author's personal capacity to hope. Hope as an aspect of healing is considered and personal reflections on psychotherapeutic work with alcoholics are discussed.     

Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter

BackgroundNarrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change.AimsThis paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement.MethodsA definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described.Results and conclusionsResults from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit.Educational objectives: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.     

Who Dares,Speaks: Critical psychotherapy and the poetics of suffering

It is proposed that a critical psychotherapy could be developed by combining ideas from psychoanalysis with concepts from poetics, as Lacan originally suggested. Taking a narrative and personal style, and using examples of two men silenced by trauma and a clinical vignette, the author combines Laplanche’s psychoanalytic concept of fourvoiement with some examples of the poetics of ambiguity as an example of how such a critical psychotherapy could develop. Studying how words express more than their literal meaning is combined with the idea that we are continually going astray from the original decentring concept of the unconscious that Freud introduced to psychotherapy.     

Supervision in the Psychotherapy of Schizophrenia: Awareness of and Mutual Reflection upon Fragmentation

Historical and newly emerging models of schizophrenia suggest it is a disorder characterized by the fragmentation of the experience of the self and the world, leading to the interruption of how a unique life is unfolding in the world. It has been proposed that psychotherapy might therefore promote recovery by facilitating the development of a greater ability to integrate information about the self and others. In this paper we explore how the supervision of a metacognitively-oriented psychotherapy can assist therapists to experience and conceptualize fragmentation within sessions, join patients in the gradual process of making sense of their psychiatric problems and life challenges, and ultimately envision and achieve recovery. Common challenges and responses within supervision are described and discussed.

     

A Cross-Contextual Construction of Clients' Therapeutic Practice

This study demonstrates how gathering data from a different context can significantly change how an object of study may be viewed. Data from a qualitative diary study of psychotherapeutic practice were used to construct a cross-contextual view of psychotherapy. Data about clients’ everyday lives as well as psychotherapy sessions were analyzed. Examples of how extra-therapeutic factors are significant to client change are presented. Six types of extra-therapeutic information sources that clients use to develop their personal stances while in therapy were identified. The case of one client's abundant use of extra-therapeutic sources of information offers a different construction of how psychotherapy works, emphasizing client activities outside sessions. The implications of the study for psychotherapy research are addressed.     

Story telling and schizophrenia: Using narrative structure in phenomenological research

Abstract

This report demonstrates how narrative findings from phenomenological research can provide insights into the structures of lived experience that generalize beyond the individual cases. Building upon a narrative perspective, the author suggests that the phenomenological study of schizophrenic delusions can disclose the subjective lives of people struggling with this illness. Viewing delusions as stories that people with schizophrenia tell about their lives further suggests that delusions may play a role in the course of the disorder as “regulatory mechanisms” that help people modulate the amount of change to which they will have to adapt in the context of significant life events.     

Constructive Metatheory: II. Implications for Psychotherapy

Abstract

The implications of constructive metatheory for the conceptualization and practice of psychotherapy are briefly outlined. It is argued that the constructivist therapist construes the client as an active and developing process, and that psychological problems are approached not as piecemeal flaws or deficiencies, but as expressions of current discrepancies between an individual's adaptive capacities and the challenges she or he faces. Likewise, the process of psychotherapy is portrayed as one of trial-and-error experimentation with different (novel) ways of “being in the world.” Ideally, the client and therapist create an intimate and emotionally charged alliance in and from which the client can explore and experiment with self and world relationships. These practical features dovetail with many assertions of the major me-tatheories of psychotherapy, and it is argued that constructive metatheory may be uniauely suited to facilitating attempts at conceptual integration