Narrative Therapies with Children and Their Families

A Practitioner's Guide to Concepts and Approaches

Arlene Vetere, Emilia Dowling

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317417019
• Edition: 2
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Narrative Therapies with Children and their Families introduces and develops the principles of narrative approaches to systemic therapeutic work, and shows how they can provide a powerful framework for engaging troubled children and their families. Written by eminent and leading clinicians, known nationally and internationally for their research and theory development in the field of child and family mental health, the book covers a broad range of difficult and sensitive topics, including trauma, abuse and youth offending. It illustrates the wide application of these principles in the context of the particular issues and challenges presented when working with children and families.

Since publication of the first edition, the importance of narrative therapy has continued to grow, and this new edition provides an updated and revised overview of the field, along with three new chapters to keep apace with developments in child mental health trauma work. This book remains a key text in the field of systemic narrative training and practice.

With clinical examples throughout, this practical book will be welcomed by family and systemic therapists and other professionals in the field of child, adolescent and family mental health.

Part I

Narrative concepts and therapeutic challenges

Chapter 1

Narrative concepts and therapeutic challenges

Emilia Dowling and Arlene Vetere

Putting the family back into narrative work

The family therapy field has recognised it is sometimes not enough to expect children’s problems to change just because the systemic meaning for the family has been addressed, or because the parents have been helped with their problems. ‘Playful’ approaches that directly focus on the child’s problem have been developed within the narrative therapy approaches to balance earlier systemic practices that may have risked ignoring the child’s perspective. Balance, though, is the key word for us. Now that the field has recognised the need for direct work with children, and the potential for working with children’s stories, it is important not to throw out earlier systemic ideas and approaches (Vetere and Dallos 2003). The systemic paradigm enabled us to shift the focus from intra-psychic pathology to interpersonal relationships and their contexts. Conceptualising people’s difficulties in terms of patterns of interaction has been one of the most productive contributions of systemic thinking to the understanding and reconstruction of mental health problems. The recognition that different levels of context can give different meanings to behaviour and relationships helped us think about wider social and cultural influences on people and their relationships, while also considering how relationships themselves can change lived experience and influence more widely held beliefs.

Children’s problems are often not theirs alone! The systemic adage that children’s behaviour is reactive to their social and interpersonal contexts and that problems can be directly related to other stresses in the family is still helpful to us in understanding how problems arise and where solutions might lie. Children can be said to learn ways of managing emotion and anxiety, and coping within family systems, and family members may be involved in creating anxieties – for example, where a child is worried about the well-being of a parent, or where a child is frightened and at risk of direct harm in the family.

Systemically speaking, family groups, households and extended kin members filter wider cultural messages to children, and provide the context in which these cultural influences are understood and given meaning. The systemic tenet of paying attention to the interpersonal context in which the problem behaviour occurs may have been forgotten or at least marginalised within some of the narrative therapy literature. We believe it is important to bring this back and incorporate it into the dominant discourse of therapy. Sal Minuchin in his seminal paper, ‘Where Is the Family in Narrative Family Therapy?’ (1998), raises important questions, arguing that as narrative therapy highlights context and culture, paradoxically the theory seems to have misplaced the family and returned to a focus on the individual. Questioning what the losses are, he asks,

What are they shedding? First, the observation of dialogues among family members and their effects on interpersonal patterns. Second, the spontaneous and induced enactments that transform a session into a live scenario … . Third, a recognition of the therapist’s knowledge as a positive force for healing.

(Minuchin 1998: 403)

When using a narrative approach as the focus of the therapeutic encounter, we must be aware that we might be returning to that individual focus on the story from one person’s perspective, and that decisions about who we see might mean who we listen to and therefore whose voice might remain unheard. A particular danger for therapists might be the temptation to privilege adults’ over children’s voices. For example, George was referred to a child and adolescent mental health service by the school for being ‘aggressive’, after repeated attempts on their part to discuss the situations with the parents. The contact between the school and the family had fallen into a pattern whereby the teachers presented the parents with complaints about George’s aggressive behaviour both in the classroom and in the playground. George’s stepfather would get enraged by the complaints and would arrive home to give George a telling off for misbehaving at school. This had led to paralysis in the teachers, who worried about the consequences for George if they communicated their concern to the parents. Communication between the family and the school had virtually ceased.

A family–school meeting was set up to try to ‘widen’ the narrative about George in the family and school context. When his mother was asked if George was good at anything, she described how artistic he was and how he used to love drawing with his father, who is an architect. Not anymore, though – his parents are separated and George’s contact with him is very erratic. One of the teachers confirmed how she had seen these abilities in George during design and technology lessons and wondered whether it might be possible for George to reconnect with his father. With these new elements to enrich the story about George’s aggression it was possible to begin to make connections between his angry outbursts and the feeling of loss of his father. The teachers showed an interest in engaging George in tasks which could develop his artistic talent, and his mother and stepfather, in the light of new understanding about George’s behaviour, were able to take active steps to promote contact between George and his father on a more regular basis.

The family systems field has helped us focus on family members’ strengths – often success in therapy involves tapping into family resources (social, behavioural and psychological). In our view this process involves integrating feeling, thinking and action within a reflective feedback process that helps us fine-tune our responses towards desired ends. Narrative therapists, for example, work on ‘discovering’ children’s abilities in the face of serious and distressing problems, and in the face of problem-saturated stories. Freeman et al. (1997) give some examples of what we think are excellent facilitating questions to ask about children: ‘If I were shipwrecked on a desert island with your son/daughter, what would I come to respect about him/her? What would I come to depend on him/her for as time went by?’ However, where we think the narrative approaches have parted company with systemic thinking is in the understanding of emotional experience and the emphasis on interpersonal processes. A social constructionist view of emotions is that the emotions that are described in therapy acquire their meanings by being situated within a narrative plot. While we agree with this, and also agree that a task of therapy is to bring a language to experience, we think there is more to it. Emotions, for us, go beyond words and semantic understanding. They are embodied and sensory experiences and can be profoundly interpersonal, such as in attachment relationships and in therapeutic relationships.

Anderson and Levin (1997) talk about multiple coexisting stories where therapists and clients, adults and children are equal contributors in a collaborative therapeutic approach. This does not mean that there are no contradictions or discrepancies: ‘New meaning occurs as thoughts are expressed, clarified and expanded. As each person talks others listen. Outer and inner dialogues occur simultaneously and overlap’ (Anderson and Levin 1997: 266). Refreshingly, they take an interactional perspective of narratives co-evolving in conversation: ‘Any narrative therefore that may be attributed to someone is not that person’s internal property but rather a social, multiple voiced and dynamic product’ (p. 276).

Challenging the dominant discourse of ‘separation’ in adolescence, Weingarten (1997) invites parents and young people together, giving the message that they can benefit from listening to each other’s perspective and be a resource for each other. A basic premise of family therapy revisited.

We understand the social constructionist position on language to be that it constructs the means by which thoughts, feelings and behaviours are produced, and because these are all historically and culturally situated, they are not seen as static truths (Gergen and Kaye 1992). For us, the systemic position is crucial in our thinking and practice – that words and language derive meaning from the relational emotional contexts in which they are used. Systemically speaking, meanings, words and their use in language are iteratively constructed over time, mutually influenced by the richness of non-verbal communications in relationships. We would suggest that social constructionist narrative approaches have helped systemic practitioners stay light on their toes in relation to theory and observation, but that without systemic thinking, the ideas contained within social constructionist narrative approaches lack practical application. Thus, for us, a rapprochement between systemic thinking and practice and the critical perspectives of narrative-based social constructionist approaches offers a solid, ethically accountable base for our practice.

In concluding this section, we have some concern that the recent ‘turn to narrative’, so to speak, runs the risk of losing sight of some of the benefits of a systemic approach to thinking and practice. However, we think the narrative approach to exploring children’s stories in therapy, as espoused by White and Epston (1990), can be made systemic. Vetere and Dallos (2003) and Dallos and Vetere (2009) outline three ways in which this can be achieved: (1) by exploring the connections between the feelings, beliefs and stories about relationships and events from everyone involved in the network of concern; (2) by generating multi-perspectives about these events; and (3) by exploring the fit between older and more current stories or accounts about self, others, events and the connections between them. When moving beyond therapeutic exploration of these stories, we can maintain our systemic focus in the co-construction of new stories by: (1) exploring children’s and family members’ preferred ideas about events, embodied experiences and relationships; (2) sharing our professional knowledge to support these good ideas and to validate felt experiences; (3) encouraging further reflection on the fit between the different ideas generated from different perspectives; (4) addressing the relational, emotional and psychological implications of these preferred ideas; and (5) exploring the implications for action (Fredman 1997).

A hierarchy of discourses?

The stance the narrator takes in relation to the story

When working with children and families, social and health care professionals are called to intervene when someone in the relational system is concerned about one of their members. The concern may come from school if a child is not performing or is exhibiting behavioural difficulties, from a GP or social services if there are concerns about the child’s physical or emotional welfare, or from family members who wish to consult about their own concerns about family functioning. In exploring these concerns, professionals informed by narrative ideas will help their clients to identify a range of stories that will help to widen the narrative, which is often initially presented as a problem-oriented dominant story. The process of widening the narrative involves helping people integrate across thought, feeling and action so that they might reflect on what is happening and what they want. Reflection and integration set the scene for more effective and more satisfying problem solving in relationships.

Altschuler (2002) in her work with families and chronic illness, quoting Zimmerman and Beaudoin (2002), summarises the narrative approach as one where

• The client’s experience is privileged over that of the therapist or referrer in defining the problem;
• Questions are asked to separate the client from the influence of the problem story;
• Emphasis is placed on exception: current and past experiences that contradict the problem story are noticed;
• Subsequent questions explore the meaning of these less noticed experiences, with the goal of helping clients re-author an alternate story so that it becomes more influential than the problem story.

(pp. 12–16)

The key question, however, when working with families is whose story remains the dominant one, and how do we as professionals enable the less powerful members of the family, often the children, to contribute to or even challenge the dominant story as told by the adults. Fredman (2002) describes her narrative approach as participating in the ‘co-creation of preferred stories with people that have a good enough fit with their lived experience and are meaningful and coherent for themselves and those in significant relationship with them’. The question for us in child and family mental health must be, how are we able to incorporate the children’s perspective, enabling their voices to be heard?

Gorell Barnes and Dowling (1997) describe their work with families during and in the aftermath of divorce as the telling and retelling of different stories, allowing different voices to be heard. These stories, maybe initially conflict-laden, often full of resentment and hostility, gradually evolve and thicken to incorporate positive elements and affectionate memories often produced by the children when their voice is helped to emerge. This can result in a rewriting of the story, or the development of a healing narrative, in a way that permits a more balanced and therefore more integrated and coherent account of the lived experience, allowing family members to develop a new and more satisfying story of the family in its current form.

Who are the other participants?

Professionals working with families are often faced with the dilemma about whose voice is privileged over whose. Is it the referrer’s voice who emphasises the ‘index’ patient’s need for ‘treatment’ because of his or her ‘problems’? When making basic decisions about who to invite to a first session, are we implicitly silencing or marginalising those who are not asked to attend? Might an older brother deemed to ‘have left home and therefore not involved’ not have some crucial stories to tell about his relationship with the younger sibling ‘in trouble’? The meaning of the problem behaviour from his perspective might contribute to a much richer understanding of the young person’s difficulties and help find a solution. A decision by a professional to work with a family presenting a child with a school-based problem might leave out a crucial voice, the teacher; even when a teacher is included, what about the head teacher or other members of the school community, such as peers, teaching assistants and so on? The list is endless and it would be totally impractical for mental health professionals to include everyone in their work. But we must be aware of those voices we are not hearing, of those stories that remain untold and therefore are marginalised from the emerging dominant story.

An example of narrative and post-divorce work

In the course of work with families post-separation and post-divorce, Dowling and Gorell Barnes (2000) describe as a therapeutic goal helping the family to co-construct an ongoing, overall post-divorce family narrative. This would allow the acknowledgement of different views of equal validity, without marginalising or privileging any one version. The hope is that children would no longer be required to falsify or distort their own experience in the service of each parent’s reality. They pay particular attention to the child’s voice, knowing from clinical experience how often children are required to privilege other views above their own. The work involves developing richer narratives of the family experiences, including positive as well as negative elements of the relationships, and emphasising the ongoing importance of parent-child relationships even if the marital relationship has come to an end. For the parents it is important to develop a new narrative of a co-parenting relationship in the service of the children.

In the course of the work they identified three main groups of parental relationship narratives:

The first grouping contains ongoing conflict laden relationships, which include narratives that disqualify the child’s experience in favour of a personal slant preferred by one parent. The children have to develop parallel narratives to ‘fit’ with each parent and are left with a loyalty dilemma as to which to believe and therefore whom to please. A higher order organising construct of their experience becomes ‘not to upset the other parent’.

The second group lacks narratives and denies the children in the family a right to a story. The main features of this group are:

1. a) An intransigent silence involving a refusal to talk about areas of the child’s experience that relate to the other parent.
2. b) A refusal to clarify or develop explana...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Author biographies
• Foreword
• Editors’ introduction to the second edition
• Part I Narrative concepts and therapeutic challenges
• Part II Narratives of childhood
• Part III Narratives of working with families
• Part IV Narratives in special contexts
• Index