Narrative Therapy - Coursework Example

NARRATIVE THERAPY Name Institution Professor Course Date Introduction Narrative therapy is a broadly acknowledged approach in the areas of social work, counselling psychology and family therapy. NT is founded on the concept that individuals establish and tell tales to construct meanings and make sense of their lives, relationships and experiences. The major role of narrative therapy is to explore tales in a non-judgemental manner. Based on an extensive literature review, this paper draws attention to narrative therapy, describes the intervention and its theoretical foundations and critically analyses the application of NT in mental health practice. The paper also identifies and discusses cultural, religious, racial and gender sensitivity required by therapists, identifies and explains ethical issues required to be put into consideration within therapist-client relations besides discussing the implications for narrative therapy in the future mental health practice. Narrative Therapy and Its Aims Narrative therapy entail a non-pathologising and collaborative approach to community work and counselling which considers people as the experts of their lives. A narrative perspective considers problems as separate from individuals and assumes individuals as holding a lot of competencies, beliefs, commitments, values, abilities and skills that help them to modify their relationships with the issues that influence their lives. NT uses the power of individuals’ personal tales to ascertain the life intention of the narrator. It is founded on the idea that people make meaning in their lives via the stories they live. Instead of changing the person, NT focuses on changing the impacts of the problem (Morrow, M. & Weisser 2012, p.28). The aim of narrative therapy is to attain some space from the problem thereby making it possible to understand how a given concern is serving an individual instead of destroying her/him. For instance, posttraumatic stress might assist in protecting an individual from the hard emotions linked with a given event, even though it leads to a host of novel troubling symptoms. The procedure of externalisation can assist an individual to establish increased self-compassion that subsequently help the individual to feel more competent of change (Baumgartner & Williams 2014, p.7) . In addition, NT assist client take their issues within the context of cultural, political and social storylines that affect the way people view themselves and their personal tales. Narrative therapy centres on the manner in which personal experience is organised into stories. (Stacey & Stickley 2010, p.71).The tales reveal how persons assign meaning to their lives. The goal of narrative therapy is not to disclose historical truth but to produce narrative in an intelligent manner. The therapy seeks to externalize issues, viewing them not as individual issues, or event situated within the family structure, but as a major factor of the dominant social structure. Narrative therapy is devoted to overcome and analyze the different axes of oppression that stratify the social world (McLaren 2009, p.161). The political perspective of NT inspires people to view their problems in relation to the leading discourses of political, cultural and social temperament. Theoretical Foundations Narrative therapy is founded on the postmodern narrative approach of viewing human relationships from a moral and storied universe. Some of the people associated with the development of narrative therapy include Michael White, David Epston, Victoria Dickerson, Jeffery Zimmerman and Kate Kawalski ( Payne 2006, p.2). The founders of the narrative theory were profoundly influenced by Foucault’s work. From the genealogical work of Foucault, Michael White gleaned that overriding discourses dehumanise, marginalise and objectify people and social groups via Foucault dividing practices that entails separation of abnormal and normal ( McLaren 2009, p.161). As a result, the main objective of the narrative therapy is to deconstruct the oppressive overriding discourse. Narrative therapists see problems via a political lens and look at the effects of toxic social narratives such as racism and class bias. Payne (2006, p.2) asserts that NT does not include other therapies not specifically referred to as narrative. However, narrative concepts appear in therapies that are not narrative. Some of the ideas informing the narrative therapy include ideas from Paul Ricoeur, a French philosopher who wrote ‘Time and Narrative’ in 1980s a time when Epston and White were creating their notions on therapy. Capitalising on St Augustine and Heidegger’s ideas, Paul Ricoeur positioned narrative at the centre of human responsiveness. He asserts that narrative is a mental structuring procedure through which people define their existential relationships to the movements of the planets, stars earth and galaxies to their linear perspective of time categorised by the invention of calendars, world events as well as to the sense of moving from past to future through anticipation and retrospection. Stories present messages and eventually become direction of people’s lives. More so, stories hold interpersonal and cultural foundation and meaning is formulated in social interaction (Centeno 2014, p.53). The stories do not only consist of a neutral linguistic memory representation, but are also influential. The tales come to establish the matrix of beliefs and concepts through which people understand their lives and the world. Strengths and Limitations Narrative therapy is a non-threatening, strength-based and playful in its approach to handling mental health problems affecting people. Narrative conversations alleviate the pressure of defensiveness and blame which make this approach effective to people who may be cautious of seeing a therapist. Given it is open nature and involvement of numerous individuals in the conversation, narrative therapy is perfect for working with children and families. Externalisation of the problem leads to the effectiveness. In addition, NT helps patients to re-construct their own tales in a manner that lowers the incidence of the issue to eradicate negative upshots and strengthen personal achievement and development. In NT, the attention is not on therapists solving a client’s problems, but is in patients discovering themselves via conversations. The approach is transparent and collaborative. The approach aims to view issues as separate entities to individuals, postulating that people’s set of skills, mindset and experience would help them lower the effect of the problems. This approach places people in author and protagonist roles while the problem becomes an antagonist. Similar to solution-oriented therapy, NT stresses the strengths of the patient particular when handling challenging problems. Notwithstanding the extensive use of NT, this approach holds some limitations or boundaries. In several occasions, different patients may anticipate the therapist to operate as the specialist rather than having to control the conversations. In this regard, NT can be challenging if the client is not eloquent. Lack of intellectual capacity and confidence among other issues could undermine the client’s expression via a narrative. More importantly, NY lacks formula, agenda or recipe. Although the approach is established on a philosophical blueprint, sometimes it can be subjective or an extensively interpretative process. The Use of Narrative Therapy in Mental Health Based on its strengths, NT is applicable to people struggling with anxiety and depression. Through NT, mental health professionals understand and manage the mental health issues affecting their clients. Narrative therapists help clients to externalise their issues via complicated tales that they narrate about themselves. According to Hall and Powell (2011, p.2), mental health practitioners require to understand their clients at depth and understand their social contexts in efforts of providing holistic care. Understanding people through their narrative offers person-revealing and contextual characteristics that make them. The narrative therapy in mental health practice allows therapists to understand and holistically manage the problems of their clients. Hall and Powell (2011, p.3) asserts that the narrative therapy helps patients to integrate and relate past occurrences such a prior neglect or interpersonal trauma that are usually intertwined with present symptoms. A study carried out by Hijazi and associates indicated that NT is effective managing patient with posttraumatic stress ( Hijazi et al 2014, p.319). Participants in the study demonstrated satisfaction with the narrative therapy. The results indicated that NT augmented posttraumatic growth and wellbeing two and four months later among the symptomatic and traumatised Iraqi refugees in the United States. The therapy also lowered posttraumatic stress and depression two months after the therapy. The findings that narrative therapy enhances posttraumatic growth are a clear indication of the effectiveness of narrative therapy in the mental health practice. Apparently, narrative therapy changes people with painful emotional memories from terrified avoidance to courageous confrontation ( Palic Elklit 2011, p.10). Narrative therapy is effective in mental health practice because it allows clients to share burden of trauma and have another individual bear witness to the suffering. However, in patients who are not articulate or lack intellectual capacity and confidence strategies that would ensure effective communication can be implemented. The client should be empowered because the most essential aspect of NT is to empower clients. Narrative therapy in the mental health practice enhances wellbeing; establish a positive mood, engagement and vitality. Similarly, a study carried out by Ikonomopoulos, Smith and Schmidt (2014) indicated that narrative therapy is effective in addressing behavioural problems, anxiety and depression (460). The results from the study indicated that NT help youth to overcome mental health issues. According to Ikonomopoulos, Smith and Schmidt (2014, p.469), integrating narrative therapy within rehabilitative programs for incarnated people is an efficacious practice. Narrative therapy lowers hostility, depression, obsessive-compulsion and interpersonal sensitivity among incarcerated people. Phobic anxiety and paranoid ideation also lowers following narrative therapy. This is because, NT allows people explore novel meanings, develop identities and establish a preferred life direction while promoting mental health. Results from a study carried out by Roe and associates demonstrated that narrative therapy is effective in addressing stigma (Roe et al.2014, p.310). Narrative therapy demonstrated great reductions in self-stigma and augmented self-reported quality of life among self-esteem people with serious mental illnesses such as bipolar (Suto 2012, p.90). Racial, Cultural, Religious and Gender Sensitivity Needed by Counsellor/Therapist Attaining efficiency of therapeutic involvement across a diversity of client is a foremost concern for therapists. Understanding racial, cultural, religious and gender sensitivity issues is key to maintaining an effective therapeutic relationship between the patient and therapist. It is important that a therapist establish a powerful rapport with his/her patient and develop a strong therapist-patient alliance to understand the emotional symptoms of the clients. As the populace looking for psychological and counselling services grow considerably diverse, it is important that therapist employ cultural competency during the therapeutic interventions. As regard, cultural issues, a therapist must focus on language use. Apparently, language is burdened with potential ambiguity, unthinking symptoms and misinterpretation. Narrative therapists stress that people interpret the experiences they bring to therapy principally via seeing them through social and cultural lenses instead of through inherited psychological or biological factors (Sagan 2012, p.239) . These socio-cultural aspects are regularly invisible as they are often ignored. Language, a product of culture is essential in NT. Language and its ability to oversimplify distort and clarify plays an influencing and mediating role in the interpretative processes of NT (Roe et al. 2014, p.305). It is through language that people organise and define their feelings and thoughts. Given that language is a cultural product, it influences people’s interpretations of what takes place through providing canonical tales and ready-made meanings. The canonical narratives are regularly a source of loss of identity and distress when people’s lives fail to match them. According to Payne (2006, p.8), language by its very temperament is saturated with culturally and historically derived meaning which may distort or influence what the client and the therapist characterise and the manner in which they communicate. Language is constitutive of individual’s lives. Language brings fort realities and is evocative. In this perspective, therapist must pay careful attention to the language use from the start and throughout out the therapeutic process (Guilfoyle 2015, p.39). It is important that therapist uphold an ethnic and gender-neutral vocabulary. As regard, gender sensitivity, therapist must maintain therapeutic neutrality during the therapeutic process. Femininity and masculinity are good examples of gender sensitive issues that therapist must consider during the therapeutic process. Femininity and masculinity are likely to instigate rooted associative overtone of decisive, tough and active compared with passive, vulnerable and soft tones that suggest an absolute gender distinction. Given that the narrative therapy comprises of conversations carried forward by the therapist’s questions, the questions asked should be gender sensitivity (Robjant & Fazel 2010 p.1038). Therapist must uphold therapeutic neutrality when dealing with power differences in couples. As regard racial issues, desensitising one-self to fears regarding racial issues discussion is an essential step toward greater effectiveness with multiracial clients. Skill in working with multiracial clients requires the credibility of the counsellor with respect to issues of identity and race. Therapists must maintain race neutrality and provide services that are race sensitive. They must be able to connect with the client based on shared racial status. Therapists working with multiracial clients should recognise the contradictions inherent in a cultural atmosphere that has sought to assign racial membership depending on physical characteristics (Lenz, Speciale & Aguilar 2012, p.26). Therapists must examine their own beliefs about race and the degree to which they have subscribed to racial stereotypes and myths. Differences in religion are central to narrative therapy. Sensitivity to religion manifests in the central position that religion take in therapeutic conversations. Therapists must maintain an attitude of effective or professional neutrality in which he/she must remain neutral in respect to religious values as well social and ethical values. They must not direct the treatment according to some religious ideologies. Ethical Issues The moral and ethical foundation of professional practice demonstrates an area of debate and inquiry in social and health care. In counselling, practitioners hold confidential data about their patients and hold the power to make recommendations or decision that can basically change an individual’s life. At the same time, service user groups, insurance firms or legal profession can be unrelenting and vigorous in pursuing the information from the service providers. Such occurrences instigate ethical issues relating to right to privacy and confidentiality. Confidentiality is a basic ethical principle. Dilemmas relating to confidentiality and privacy surface when the confidentiality principle is in conflict with other moral standards such as avoidance of harm to others and patients and legal matters. However, ethical issues of confidentiality and privacy can be tabled to counselling board in consideration of hospital policies or individual cases. Ethical issues relating to right to privacy, boundary issues and right to access of patients information should be addressed based on Code of Ethics such as Australia Counselling Associations. The ACA Code of Ethics and Standards of Practice offer guidelines for ethical practice and helps therapists to make ethical decision efficiently. Paternalistic interventions such as involuntary treatment or forced treatment should be given only to patients who lack decisional capacity or when acting in the best interest of the patient with reference to the Code of Ethics (Reynolds & Polanco 2012, p.19). Therapists must maintain boundaries during the therapeutic process and avoid exploitation of patients to prevent ethical issues relating to boundaries. The intensity of the therapeutic relationship can activate fantasies and needs of both the therapist and patient. Boundary crossing exploit the power differential in the therapeutic relationship and weakens the autonomy of the patient. In the event of boundary crossing issues, therapists must use the ethical code to augment their capacity to address ethical issues in a manner that facilitates capacity to take ethical action. Implications of Narrative Therapy in Future Mental Health Practice A tension amid the complex narrative brought by a patient into the consulting room and a doctor’s comprehension of what is actually taking place based on pathology idea and formulated diagnosis exists. In most situations, one does not know what to believe between the doctor’s account, patient’s accounts or account of reality. To understand a client mental health situation, mental health professionals are resorting to the ‘talking cure’. The achievement of the talking cure relies on the ability of the therapists to provide coherence to the patient’s experience of mental or physical heath illness and to allow the establishment of narrative of coping or healing. The NT perspective to mental health is concerned with the question how clinicians and patients working together can establish a tale that makes sense. Clinicians from diverse therapeutic schools are abandoning the search for normative description of a client’s problems and are embracing the search for suitable novel story for every patient. The change holds its origins in postmodern and modern intellectual movements. For instance, Goolishian and Anderson, influential American therapists contend for the call to abandon definitive models that test the experience of patients against some programmed outlook of normality (Launer1 999, p.118). The therapists recommends applying an approach that recognises the patient as an expert besides an approach the holds the potential to aid any probable reality account as long as it make sense in the eyes of the client. However, the conversation amid a client and clinician cannot be viewed as a tool for pursuing hidden truth but instead as a way of establishing beforehand unformulated truths. The role of subjective patients’ narratives in mental health care practice demonstrates a therapeutic and clinical tool resourceful in harmonising objective, scientific information. Mental health practitioners have realised the effectiveness of narrative therapy. They consider narrative therapy as a therapeutic tool to direct the clinical practice. Given that the role of narratives has drawn the attention of mental health providers and scholars, training programs and workshops about narrative therapy have been established. The effectiveness of narrative therapy in mental health issues such as suicidal thoughts, anxiety and depression most mental health therapists will adopt this approach. Literature has demonstrated effectiveness of narrative therapy in mental issues such as PTSD, depression, anxiety, stress, behavioural problems among other mental health issues. Narrative therapy will become a perfect expression of the postmodern revolution in the mental health practice. The approach will eventually become mainstream in social work, family therapy and training centres around the world. However, in some mental health issues, it may be difficult to reframe them as stories. As a result, the tale telling perspective may collide with objectivist and positivist viewpoints. However, to address this problem, a social constructionism can be adopted because this approach views stories as an agreed version of reality. Conclusion Narrative therapy is a way of functioning that puts into consideration the wider context of individuals’ lives in diverse dimensions of ability, sexual orientation, race, gender and class. Narrative separates people from their issues and inspires them to depend on their skills to lower the problems that they face in their lives. In life, personal experiences are changes into personal tales that give meaning and assist people to shape their identities. NT is therapy is founded on the postmodern narrative approach of viewing human relationships from a moral and storied universe. It is applicable to people struggling with PTSD, depression, bipolar disorder, stigma, anxiety and other mental health issues. However, therapists must maintain neutrality in matters relating to religion, culture, race and gender to ensure effectiveness of NT. Besides, several ethical considerations such as respects of persons, justice and beneficence must be maintained. Given the effectiveness of NT, it is evident this approach will become mainstream in mental health practice. References Baumgartner, B & Williams, B 2014, ‘Becoming an insider: Narrative therapy groups alongside people overcoming homelessness’, Journal of Systemic Therapies, vol.33, no.4, pp.1-14 Centeno, R 2014, ‘ Introduction to critical family therapy’, Journal of Systemic Therapies, vol.33, no.3, pp.50-68. Guilfoyle, M 2015, ‘ Listening in narrative therapy: Double listening and empathic positioning’, South African Journal of Psychology, vol.45, no.1, pp.36-49. Hall, J & Poweell, J 2011, ‘ Understanding the person through narrative’, Nursing Research and Practice, vol. 2011, p1-10. Hijazi, A et al 2014 ‘ Brief narrative exposure therapy for posttraumatic stress in Iraqi refuges: A preliminary randomised clinical trial’, Journal of Traumatic Stress, vol.27, pp.314-322. Ikonomopoulos, J, Smith, R & Schmidt, C 2015, ‘ Integrating narrative therapy within rehabilitative programming for incarcerated adolescents’, Journal of Counselling & Development, vol.93, pp.460-470. Launer, J 1999, ‘ A narrative approach to mental health in general practice’, BMJ, vol.318, pp.117-119. Lenz, A. S, Speciale, M & Aguilar, J. V 2012, ‘Relational-cultural therapy intervention with incarcerated adolescents: A single-case effectiveness design’, Counselling Outcome Research and Evaluation, vol.3, pp.17–29. McLaren, M 2009, Feminism, Foucault, and embodied subjectivity, USA, SUNY Press. Morrow, M. & Weisser, J 2012, ‘Towards a social justice framework of mental health recovery’, Studies in Social Justice, vol. 6 no.1, pp. 27–43. Palic, S & Elklit, A 2011, ‘Psychosocial treatment of posttraumatic stress disorder in adult refugees: A systematic review of prospective treatment outcome studies and a critique’, Journal of Affective Disorders, vol.131, pp. 8–23. Payne, M 2006, Narrative therapy, UK, SAGE. Reynolds, V & Polanco, M 2012, ‘An ethical stance for justice-doing in community work and therapy’, Journal of Systemic Therapies, vol. 3, no.4, pp.18–33. Robjant, K & Fazel, M 2010, ‘The emerging evidence for narrative exposure therapy: A Review’, Clinical Psychology Review, vol.30, pp.1030–1039. Roe et al. 2014, ‘Narrative enhancement and cognitive therapy (NECT) effectiveness: A quasi-experimental study’, Journal of Clinical Psychology, vol. 70, no.4, pp.303-312 Sagan, O 2012, ‘ Connection and reparation: Narratives of art practice in the lives of mental health service users’, Counselling Psychology Quarterly, vol.25, no.3, pp.239-249. Stacey, G & Stickley, T.2010, ‘The meaning of art to people who use mental health services’, Perspectives in Public Health, vol.130, pp. 70–77. Suto, M. 2012, ‘ Stigma shrinks my bubble: A qualitative study of understandings and experiences of stigma and bipolar disorder’, Stigma Research & Action, vol. 2 ,no.2, pp. 85–92. Read More

Narrative therapy is devoted to overcome and analyze the different axes of oppression that stratify the social world (McLaren 2009, p.161). The political perspective of NT inspires people to view their problems in relation to the leading discourses of political, cultural and social temperament. Theoretical Foundations Narrative therapy is founded on the postmodern narrative approach of viewing human relationships from a moral and storied universe. Some of the people associated with the development of narrative therapy include Michael White, David Epston, Victoria Dickerson, Jeffery Zimmerman and Kate Kawalski ( Payne 2006, p.2). The founders of the narrative theory were profoundly influenced by Foucault’s work.

From the genealogical work of Foucault, Michael White gleaned that overriding discourses dehumanise, marginalise and objectify people and social groups via Foucault dividing practices that entails separation of abnormal and normal ( McLaren 2009, p.161). As a result, the main objective of the narrative therapy is to deconstruct the oppressive overriding discourse. Narrative therapists see problems via a political lens and look at the effects of toxic social narratives such as racism and class bias.

Payne (2006, p.2) asserts that NT does not include other therapies not specifically referred to as narrative. However, narrative concepts appear in therapies that are not narrative. Some of the ideas informing the narrative therapy include ideas from Paul Ricoeur, a French philosopher who wrote ‘Time and Narrative’ in 1980s a time when Epston and White were creating their notions on therapy. Capitalising on St Augustine and Heidegger’s ideas, Paul Ricoeur positioned narrative at the centre of human responsiveness.

He asserts that narrative is a mental structuring procedure through which people define their existential relationships to the movements of the planets, stars earth and galaxies to their linear perspective of time categorised by the invention of calendars, world events as well as to the sense of moving from past to future through anticipation and retrospection. Stories present messages and eventually become direction of people’s lives. More so, stories hold interpersonal and cultural foundation and meaning is formulated in social interaction (Centeno 2014, p.53). The stories do not only consist of a neutral linguistic memory representation, but are also influential.

The tales come to establish the matrix of beliefs and concepts through which people understand their lives and the world. Strengths and Limitations Narrative therapy is a non-threatening, strength-based and playful in its approach to handling mental health problems affecting people. Narrative conversations alleviate the pressure of defensiveness and blame which make this approach effective to people who may be cautious of seeing a therapist. Given it is open nature and involvement of numerous individuals in the conversation, narrative therapy is perfect for working with children and families.

Externalisation of the problem leads to the effectiveness. In addition, NT helps patients to re-construct their own tales in a manner that lowers the incidence of the issue to eradicate negative upshots and strengthen personal achievement and development. In NT, the attention is not on therapists solving a client’s problems, but is in patients discovering themselves via conversations. The approach is transparent and collaborative. The approach aims to view issues as separate entities to individuals, postulating that people’s set of skills, mindset and experience would help them lower the effect of the problems.

This approach places people in author and protagonist roles while the problem becomes an antagonist. Similar to solution-oriented therapy, NT stresses the strengths of the patient particular when handling challenging problems. Notwithstanding the extensive use of NT, this approach holds some limitations or boundaries. In several occasions, different patients may anticipate the therapist to operate as the specialist rather than having to control the conversations.

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