Outline of Narrative Therapy

Some chaplains, pastoral counsellors and spiritual care psychotherapists integrate narrative therapy into their spiritual care of clients. Students being trained in pastoral counselling and spiritual care psychotherapy work under a qualified supervisor from the Canadian Association for Spiritual Care (CASC). Following is a description of the background, assumptions and ideas of narrative therapy.

Background

The narrative therapy that we describe has been developed by an Australian social worker named Michael White (d. 2008). He ran the Dulwich Centre for therapy in Adelaide, Australia. He worked for a few years as a social worker in a psychiatric hospital and then moved into the Dulwich Centre. He has written numerous articles and three books on a narrative approach to therapy. Narrative therapy has many manifestations not just the ones developed by White.

How we understand narrative therapy in viewing the  client/patient: Assumptions and Ideas.

1. People relate their experiences through stories about themselves, their families, life. People live storied lives and are story tellers. These stories are part of a fabric of interpretation. Stories and experiences have many interpretations – there is not just one interpretation. In fact there are dominant stories and alternative stories. Around a problem, clients often have a dominant story that sometimes shows itself as a story of defeat. The alternate story can be one of success around the problem. Usually alternative narratives are based on the client’s strengths. White believed that if you can find two exceptions (unique occurrences) in the client’s experience to the client’s story of defeat, you have the beginnings of an alternate story.
2. A narrative has a purpose. People seek to follow their positive intentions.
3. The client is the expert on their experience. The narrative therapist is the expert on narrative.
4. The stories we tell about ourselves and the world are closely related to our identity.
5. The problem with which the client is struggling is separated from the client. The client is not the problem. The problem, the negative behaviour and attitude, etc is the problem. This separation leads to an externalizing conversation.
6. All of us can change our narratives. They are not fixed even though they are powerful and shape and interpret future experiences. We can believe and live the alternative narrative.
7. Narrative therapy views clients/patients as part of a community. Community can be family, friends, church, co-workers, teachers, etc. Community needs to be part of the client’s change.

What we do as spiritual care providers who utilize narrative therapy:

1. Listen to client’s stories
2. Help people uncover their alternative stories and strengths
3. Make a narrative assessment
4. Use a variety of questions to help the client draw out the wisdom and strength from within themselves
5. Develop externalizing conversations about the problem
6. Scaling questions
7. Therapeutic letter
8. Use and work with colleagues on reflecting teams
9. Facilitating person centered therapy by connecting supporting, and confirming the patients strengths
10. Ask client to identify unique occurrences
11. Help them to reframe through the use of new perspectives of understanding
12. Build an audience for change because clients are part of a  community
13. Recognizing that change is a social collaborative effort. The treatment team is important in that collaboration. Use the developmental theory of Vygotsky.
14. Support structures to reflect back to the client the changes they observe
15. Co-constructing/collaborating with the client for change; we help draw out from the client their own solutions or goals without judgement. Through questions and feedback develop a scaffold for the client to achieve what is possible.
16. Drawing on client’s own story of success and allowing these stories to emerge
17. Meaning making – helping clients find meaning and purpose in their lives/narrative. Many pastoral counsellors and spiritual care psychotherapists view meaning making as a spiritual process – even if there is no mention of the Divine or sacred.

As providers of spiritual care, we seek to integrate this narrative approach into spiritual care. We are open to the diversity of faith experiences and endorse a multi-faith approach. If a client is not interested in spirituality or the Divine, we respect that belief. We can still listen to their story especially around their illness or problem without any reverence to the Divine. However, many Canadians do believe in God and their spirituality can be a resource for healing. Psychotherapy means cure (therapy) of the soul (psyche). As spiritual care psychotherapists and pastoral counsellors, we see ourselves as curing or caring for the soul of the client. Often clients have many narratives around their beliefs and experiences of the sacred. Narrative therapy is used by many professionals in various health care disciplines: nursing, social work, psychiatry, spiritual care and there is some research that shows its effectiveness.

Resources: White, Michael, Maps of Narrative Practice (New York: W.W Norton, 2007); O’Connor, Thomas St. James, Elizabeth Meakes, Ruth Pickering and Martha Schuman “On the Right Track: Clients’ Experience of Narrative Therapy” Contemporary Family Therapy 19(4)December 1997, 479-495; O’Connor, Thomas  “Climbing Mount Purgatory: Dante’s Cure of Souls and Narrative family Therapy” Pastoral Psychology  47(6) Summer 1999, 445-457; White, Michael and Epston David, Narrative Means to Therapeutic Ends, WWNorton: New York, 1980

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Alida van Dijk, MA, Susan Howard, BA, Ibrahim Long, MA, Christine Hossack, MDiv, Tracey Hand-Breckenridge, MDiv, Stephen Graham, MDiv, Danielle Wiebe, MTS, Thomas St. James O’Connor, ThD