Psychotherapy’s Third Wave?
The promise of narrative

delicate means by which it is achieved. It is through the therapist's careful use of language in the therapeutic conversation that the person's healing initiatives are achieved."

One brief therapist I know unsuccessfully tried using externalization after reading White and Epston's book, Narrative Means to Therapeutic Ends. "I would externalise and it would fall kind of flat," he told me. "My clients would look at me blankly. 'So, I'm under the influence of Depression. So what,' they would say. I knew I was missing something, but I wasn't sure where to go with it or what I was missing."

What many therapists fail to understand is that, as Karl Tomm explains, "What is new about the narrative approach is that it provides a purposeful sequence of questions that consistently produce a freeing effect for people." Following the therapeutic sequence is a bit like building an arch, brick by brick. If you try to do the last step without having patiently spent time doing the first ones, your arch isn't going to hold up. Here is my understanding of the fundamental structure of the narrative approach:

1. The collaboration with the person or the family begins with coming up with a mutually acceptable name for the problem:

One might ask a child who has been having temper tantrums, "So, Anger has been convincing you to throw yourself on the floor and kick your feet, huh?" To a person who has been having paranoid hallucinations you could ask, "When Paranoia whispers in your ear do you always listen?" At first, the person and his or her family may persist in attributing the problem to the person, but the narrative therapist will gently persist in the other direction, linguistically severing the person from the problem label, and clients themselves soon begin to take on the externalized view of the problem.

2. Personifying the problem and attributing oppressive intentions and tactics to it:

Next, the therapist starts talking to the person or family as if the problem were another person with an identity, with tactics and intentions that are designed to oppress or dominate the person or the family. Often, the therapist will use metaphors or images that help bring the process to life for them and the clients. For example, "How long has Anorexia been lying to you?" or "How does the Alcoholism bully push your family around?"

3. Investigating how the problem has been disrupting, dominating or discouraging the person and the family:

Before the therapist tries to change the situation, he or she finds out how the person has felt dominated or forced by the problem to do or experience things he or she didn't like. The therapist might ask anyone in the room about the effects of the problem on the person and on them. This both acknowledges the person's suffering and the extent to which his or her life and relationships have been limited by the problem and provides further opportunities to create the externalization by asking more questions. The language highlights people's choices and creates an assumption of accountability, rather than blame or determinism. If the person is not the problem, but has a certain relationship to the problem, then the relationship can change. If the problem invites rather than forces, one can turn down the invitation. If the problem is trying to recruit you, you can refuse to join.

This step also increases motivation. The family and the person come together with the therapist in their common goal of overthrowing the dominance of the problem in the person's and family's lives.

4. Discovering moments when clients haven't been dominated or discouraged by the problem or their lives have not been disrupted by the problem:

This is akin to the solution focused method of searching for exceptions to the problem, only instead of asking, as solution oriented therapists might, "What was the longest time you have gone without drugs?", a narrative therapist would ask, "So what's the longest time you have stood up to Cravings?"

5. Finding historical evidence to bolster a new view of the person as competent enough to have stood up to, defeated or escaped from the dominance or oppression of the problem:

This is where the method really gets interesting. Here, the person's identity and life story begin to get rewritten. This is the narrative part. To keep this from being merely a glib reframing of the person's life, the narrative therapist asks for stories and evidence from the past to show that the person was actually competent, strong, spirited, but didn't always realise it or put a lot of emphasis on that aspect of him or herself. The therapist gets the client and the family to support and flesh out this view.

Solution oriented therapists would quickly move on to the future once a past exception is discovered, content to use that exception to solve the problem. Instead, the narrative therapist wants to root this new sense of self in a past and future so bright the person will have to wear shades. Typical questions might be: "What can you tell me about your past that would help me understand how you've been able to take these steps to stand up to Anorexia so well?" and "Who knew you as a child who wouldn't be surprised that you've been able to reject Violence as the dominant force in your relationship?"

6. Evoking speculation from the person and the family about what kind of future is to be expected from the strong, competent person that has emerged from the interview so far:

Next, the narrative therapist helps the person or the family to speculate on what future developments will result now that the person is seen as competent and strong, and what changes will result if the person keeps resisting the problem. For example, "As you continue to stand up to Anorexia, what do you think will be different about your future than the future Anorexia had planned for you?" or "As Jan continues to disbelieve the lies that Delusions are telling her, how do you think that will affect her relationship to her friends?" This step is designed to further crystallise the new view of the person and his or her life.

7. Finding or creating an audience for perceiving the new identity and new story:

Since the person developed the problem in a social context, it is important to make arrangements for the social environment to be involved in supporting the new story or identity that has emerged in the conversation with the therapist. Narrative therapists use letters, asking for advice for other people suffering from the same or similar problems, and arranging for meetings with family members and friends, to accomplish this social validation. Some questions might be: "Who could you tell about your development as a member of the Anti-Diet League that could help celebrate your freedom from Unreal Body Images?" and "Are there people who have known you when you were not under the influence of Depression who could remind you of your accomplishments and that your life is worth living?"

Not just a technique

Having just given you this formula, I have to give you a warning: if externalisation is approached purely as a technique, it will probably not produce profound effects. My biggest concern about narrative therapy is that many therapists will use it merely as a clever device. "There is nothing so dangerous as an idea," wrote Emile Chartier, "when it is the only one you have."

Because the technique is relatively easy to learn, therapists might just go around externalising problems, like earlier family therapists went around creating paradoxes or reframing people and expecting miracles. But if you don't believe, to the bottom of your soul, that people are not their problems and that their difficulties are social and personal constructions, then you won't be seeing these transformations. When Epston or White are in action, you can tell they are absolutely convinced that people are not their problems. Their voices, their postures, their whole beings radiate possibility and hope.

They are definitely under the influence of Optimism.

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© Human Givens Publishing Limited and Bill O'Hanlon (1995)

This article first appeared in Volume 2, No, 4 (1995) of the Human Givens journal.

BILL O'HANLON, MS., is the author of several books including: In search of solutions, Solution orientated Hypnosis: An Ericksonian Approach, A Brief Guide to Brief Therapy. He teaches workshops internationally and has a private practice.

> More information on the human givens approach can be found in the following book by Joe Griffin and Ivan Tyrrell

Human Givens: A new approach to emotional health and clear thinking

>Find out more about the issues raised in this article at the following MindFields College events

Brief Psychotherapy
strategies Seminar

How to lift depression: effective brief therapyWorkshop

Return to top

> More information on the human givens approach can be found in the following book by Joe Griffin and Ivan Tyrrell

Human Givens: A new approach to emotional health and clear thinking

>Find out more about the issues raised in this article at the following MindFields College events

Brief Psychotherapy strategies Seminar

How to lift depression: effective brief therapy Workshop

Return to top