A Narrative Perspective on Externalising “The Problem”

iCAP Services logoThe problem brought into the session by the client can be so entangled in the person’s life that unravelling “it” from the person can prove a tough challenge for the therapist. Narrative Therapy offers a way in which the therapist can create some breathing space between the client and their problem. A client who comes in and says “I am depressed” has in fact identified wholly with the problem with no separation or boundaries. The therapist when making first attempts to externalise the problem may turn the client’s statement around and ask them “How does The Depression affect your life?” That is, the therapist is beginning the process of helping the client understand that they are not the problem; instead, the problem is the problem. The therapist begins to sow the first seeds of separation.

Michael White, one of the founders of Narrative Therapy, identifies that when externalising conversations with clients, the therapist engages in “four categories of inquiry” (White, 2007, p.38). These four categories are:

1. Defining the Problem.
Using different methods (talk, drawing, painting, re-enactment) the purpose is to gain an understanding of the immediate experience of the client.

2. What are the Effects of the Problem?
Next is determining the effects of the problem and in what areas of life the problem occurs (home, school, work, sport etc.)

3. Evaluating the Effects.
The third stage is evaluating the effects of the problem’s activities. How is it affecting the lives of the people experiencing the problem’s influence and what plans does the problem have for them.

4. Are the Future Plans OK?

Finally, in fleshing out an externalising conversation, the therapist will question the client if what the problem has in store for them and their future is OK; or maybe it isn’t OK (White, 2007, pp.38-48).

Depending on the client’s own awareness, it may take time for the client to be able to identify answers to each of the categories. It may not be a linear process either. The client may firstly describe their current situation and their fears for the future before they understand the full effects of the problem on their and their family members’ lives.

To illustrate these categories further, I draw on a few sessions with a client who exhibited aspects of depression which they identified as “The Hole” during our time together.

Therapist: So can you describe what’s going on for you?
Client: I feel like I am in a deep hole and can’t get out.
T: I have my own idea of what a deep hole looks like. Can you help me to understand what yours looks and feels like?
C: Well… it’s dark and deep… like midnight, every day; all day. I can’t see anything; it’s cold and lonely in the hole. I can’t climb up or see a way out; even though there are jagged rocks all the way up. There’s no way out. I’m frustrated that I can’t do anything about it and no one knows where I am.

Here the client has described feeling isolated, seemingly surrounded by darkness and frustrated that they can’t help themselves to get out of the situation. The client’s near-experience definition describes the day-to-day, in the moment experience of their problem. The client also drew a chart to illustrate the spiralling lows of its effects.

The following commentary described the effect on his behaviour.

T: So how does that affect you; sitting in this dark hole?
C: I can’t stand it… I end up drinking till I write myself off every weekend just to escape. I don’t want to be alone so I go out with mates and get trashed to numb up and not think about it.
T: If you do this regularly, every weekend, does this helps you to cope with “The Hole”?
C: Yeah, it does. It makes me forget…until I wake up the next morning with a hangover and realise nothing’s changed. I don’t want to talk to anyone. I just want to get trashed again and forget its there.

When the client began to evaluate the effects “The Hole” had on their life, the client reported that it served to alienate them from their partner and children so that “The Hole” couldn’t be found out, confronted or questioned. Even though the heavy drinking was initially confined to the weekends, it began to creep into the week, affecting their performance at work.

Finally, if it was OK for “The Hole” to influence his relationships; either within his family circle, his network of friends or work connections; the following question could be asked.

T: So, is it OK with you to be separated from your family and friends while you try to hide “The Hole”?
C: No. it’s not. I hate that I can’t talk to them and tell them what’s going on. I can see what it’s doing to us. I’m not sure how they will take it. I’m always on top of things, sorting stuff out for everyone but I can’t do that anymore.

The client went on to describe their preferred way of life which they described as “Sunshine”. Sunshine was all about family, communication and real connection. This was something that “The Hole” did not like as it would mean the possible end of its existence.

Externalising conversations is only the beginning of the journey to solving the client’s problem. It allows the space needed to examine and evaluate. Once the client is no longer entrenched and identified with the problem, they can step back to examine and evaluate the effects of the problem and begin to identify alternatives for their life (White, 2007, p.61).

References: White, M. (2007) Maps of Narrative Practice. New York, NY: W. W. Norton & Company Inc.

This article was first published on Ezine Articles in 2009.

Tina Pitsiavas is a Counsellor and Psychotherapist in private practice in Wollongong and Sydney.

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