宇聯心理健康志業群

by Irene Chiang

[Abstract]
Among several postmodern theories and approaches in the field of marriage and family counseling, narrative approach is one that has gained increasing popularity in family therapy in many countries, and in recent years, it has attracted more and more people in Taiwan as well. The first part of this research paper will begin with a brief history of the development of narrative approach, and aspects such as its leading therapists, theoretical formulations, development of normal family and behavior disorders, therapeutic goals, and its evaluation will also be discussed. Next, this research paper will introduce, in its second part, a personal marriage and family counseling integration approach with Christian faith.

FAMILY COUNSELING BASED ON NARRATIVE APPROACH

Narrative theory is one of the newer therapy approaches applied in family counseling in the 20th century. The key persons for establishing narrative theory are Michael White and David Epston from Australia and New Zealand; they developed narrative therapy in the mid-1980s. However, it was until they published Narrative Means to Therapeutic End in 1990 that the narrative approach began to gradually gain general attention and popularity. Influenced by postmodernism and social constructivism, narrative theory has become one of the latest trends in family therapy (Chou, 2004).

Theoretical Formulations

Narrative theory borrows the concept of literature critique from constructivism to separate and analyze the meaning, and in the aspect of social psychology, narrative theory treats reality as the constructive product of interaction among the individual, others, and social faith. White and Eptson stated that they referred to the ideologies of French philosopher and historian Michel Foucault, Jerome Bruner (White & Epston, 1990), and Gregory Bateson’s systems metaphor through the cybernetic paradigms (Freedman & Combs, 2000). It is said that narrative theory seems to provide a new model of thinking for human change, but it could also be treated as a product evolved from the existing theory and practice (White & Epston, 1990).

Lynn Hoffman, a renowned social worker, indicated that in the early development of family therapy, the focus was shifted from concentrating on individual’s consciousness state to the process of interpersonal relations and behaviors emphasized by systems theory, and such a change has brought the attention back to the emphasis on thoughts, feelings, and beliefs. Hoffman considered the systems approach based on cybernetic theory and mechanistic theory has lost its effectiveness; constructivist therapy establishes its foundation not on the first order cybernetics, but on the second order cybernetics, and the result of observation is up to the observer to decide (Freedman and Combs, 2000). Systems theory, as behavior and cognitive approaches, are all based on modernism – the observation of objectivity, rationality, and understanding. However, postmodernism, in “an attempt to rethink the cultural landscape with theories taken from linguistics, psychiatry, continental philosophy, and left-wing politics” (Poetry Portal, 1995-2003), considers the majority of facts and truth are not given, but constructed by the society.

Knowledge is power, and the enhancement of self-understanding could also increase the power of people. White and Epston (2000) believe that everyone gives meanings to her or his life stories. We are not capable of remembering all details and trivial issues in our lives, so the experience of construction is merely a process of choice. We arrange our life stories and make them consistent, integrated, and meaningful. We remember events that fit into our meaning of life, and forget those not fitting into our predominant stories. In additions, it is possible that we imagine or exaggerate things to achieve congruency between actual events and our stories (Wu, 2004).

As previously mentioned, narrative theory borrows concept of literature critique from constructivism, considering it necessary to deconstruct characters and plots in order to re-evaluate the meaning of time. In most cases, clients bring their predominant stories, in other words, the dominant narrative, and their life experiences permeated by their problems into counseling sessions. These stories limit their views and actions, and it is through the help from their family members, employers, social workers, and other related people that they not only see the reality they construct, but more importantly, they also see more realities in order to have more choices. Therefore, this kind of therapy is creative, reflective, and sophisticated, but not corrective, forceful, or directive (Wu, 1988).

Moreover, social constructivism has tremendous impact on narrative theory’s view on the client, the client’s problems, and treatment. Unlike modernists, postmodernists believe in subjective reality, which means reality changes according to the process of observation utilized by the individual; reality is determined by the use of language, and most of what people say is the function of their background context. Therefore, people’s focus on the world, events, and truth has shifted from objectivity to perspectivity, wholeness to uniqueness, validation to legitimation, and essence to context, and their description on reality has also shifted from concepts to constructs. The emphasis of postmodernism or narrative theory is that people and their problems are separated; their problems are the problems, but they themselves are not the problems. Problems are constructed by the society or culture, oppressions from mainstream consciousness such as ethnicity, nationality, gender, social status, and sexual preference. For example, in many countries, aboriginal people are frequently linked to alcoholism. However, when a population is forced to survive, compete, and numb itself by a set of unfair rules of games regulated by the other population, it is easy for the oppressed population to believe in such principles (Chan, 2004).

In the early development of psychotherapy, the focus was on the individual. However, postmodern thoughts on psychology bring psychotherapy from systems theory to social constructivism. According to Freedman and Combs (2000), the systems metaphor only enable us to see the complementary circulation and how family members work together to generate problems within their own family, but it does not help family members discover cultural values, system, and customs that negatively influence their lives. Furthermore, the systems metaphor does not agglomerate them to rebel against those values, system, and customs. When a narrative therapist meets the family, she or he is not the commander from outside of the family. On the contrary, she or he is there to help family members find resources and solutions as another human being (Chan, 2004).

Leading Figures of Narrative Approach

The leading figures of narrative theory are Michael White and David Epston.

Michael White, the mastermind behind narrative family therapy, was originally a mechanical draftsman. However, he soon realized that he preferred people to machines, and thus he went into social work where he moved toward family therapy. White was initially attracted to Gregory Bateson’s cybernetic thinking, and he later became more interested in the ways people construct meanings in their lives, rather than just with the ways they behaved. White is renowned for his persistence in challenging clients’ negative self-beliefs, and his persistent optimism in assisting people to develop healthier interpretations of their life experiences. Without a doubt, White’s resolutely positive attitude has contributed to his enormous success as a therapist. He now works at Dulwich Centre in Australia (Paratore & Nichols, 1998).

David Epston is the other founder of narrative therapy and the co-director of the Family Therapy Centre in Auckland, New Zealand. He also co-wrote Narrative Means to Therapeutic Ends, the classic publication on narrative therapy with the co-founder of narrative therapy, Michael White. Originally trained in anthropology, Epston has been a major figure in the development of narrative therapy, particularly by recognition of the therapeutic significance of rituals, and his emphasis on how cultural influences affect people’s beliefs and assumptions. When establishing the philosophy and practice of this therapeutic approach, Epston actually suggested the “narrative” metaphor as the therapeutic foundation (Leading Edge Seminars Inc., 2005).

Basic Assumptions

The assumption of narrative therapy is that every story is ideological, and it represents the reality in an ideological way as well. Although the stories are co-authored within the context of a society and the framework of familial and organizational structures, there is much in life that is inconsistent, irrational, incoherent, discrepant, disharmonious, and muddled. According to White and Epston, it is this excluded material that can be restoried after exploration in a deconstructive way. Therefore, deconstruction serves as the tool to untie the grip of a domineering story (Boje, 2005).

In additions, Narrative therapy has increasingly been applied to organizational studies. For instance, Barry (1997) has applied narrative approach of family therapy to organizational consulting. It is possible that his practice from family counseling to organization consulting focuses on how stories are characteristically “problem-saturated” in dysfunctional organizations as in dysfunctional families. In narrative therapy, the assumption is that human lives are keenly affected by their story sensemaking, and poor relations are inlaid in the structure of these stories (Boje, Alvarez & Schooling, 2001/2002).

In narrative theory, the emphasis is on the partnership between the counselor and the client, and the latter is the real expert on her or his own problems. Counselors could use relative influence questioning to separate problems and those who are affected by them. In other words, counselors help their clients ponder on the degree their problems have influenced their lives and themselves. In additions, externalization of problems, the search for unique results, the development of stories with unique results into stories with solutions via circulation questions, letters, and re-authoring are all helpful in terms of assisting clients to deconstruct, expand, and reconstruct their predominant stories (Hsu, 2000).

Development of Normal Family and Behavior Disorders

Nichols and Schwartz (2004) offer their views on normal family development and development of behavior disorders based on narrative theory:
A. Normal Family Development
1. Narrative therapists do not agree on judgments regarding the so-called “normal” behavior because they encourage clients to construct their own meaning about problems.

2. According to narrative principle, there are four basic assumptions about normal families:
(a) People have good intentions – they do not need or want problems
(b) People are profoundly influenced by discourses around them
(c) People are not problems; their problems are
(d) People can develop alternative, empowering stories once separated from their problems and from common wisdom that they have internalized

B. Development of Behavior Disorders
1. Problems are actually the outcome of stories people tell themselves
2. The encouragement of these stories is for people to respond to one another in ways that perpetuate their problems
3. Patterns of tunnel vision are referred to as problem-saturated stories

Goals of Therapy

The goals of therapy using narrative approach are (Department of Counselor Education, University of Wyoming, 2004):
1. Create conversations of change
2. Challenge impoverished interactions
3. Externalize problems and separate problems from the person
4. Generate alternative meanings
5. Discover hidden talents and abilities
6. Re-authoring

In the practice of narrative therapy, the treatment would begin with the understanding of the client’s stories, broaden her or his stories, and then reconstruct them to make the client discover the existence of a fact with more aspects, expand the client’s view, and help the client distinguish and mobilize those facts that were previously ignored, but are currently beneficial for her or his problems.

Therapy Process and Conditions for Behavior Change

Generally speaking, there is no distinction between “diagnosis” and “treatment” in narrative therapy. Narrative therapists consider diagnosis a process of continuous and constant transformation, and each session has its own therapeutic effects. However, White and Epston (1990) believe that there are two aspects within narrative approach – deconstruction and reconstruction.

The therapy process of narrative approach is divided into the following stages (Department of Counselor Education, University of Wyoming, 2004):

1. Deconstruct problem – Externalize the issue
Deconstruction allows the dominant stories to be identified, named, externalized, and their hierarchy effects explored. “Narrative therapy reverses the claims (claiming strengths in face of domination), and the story to be restoried and resituated in preferred stories of being (reclaiming Aboriginal knowledges)” (Boje, 2005).

2. Separate problem from client identity
(a) How have you influenced, stood up to, or protested the problem?
(b) How did you evaluate the effect? Is it positive or negative?
(c) How have couples or families evaluated the problems?
(d) Identify and name the plot or story

3. Deconstruct internalized (past) interpersonal patterns of recruitment
Interactions are familial and cultural in nature (interpersonal), determining of thoughts and behaviors of clients and families (internalized).

4. Reconstruct preferred story of self around unique outcomes
Reconstruction helps clients and families stabilize new self-description and promote enduring self-affirmation.

5. Deconstruct anticipated future recruitment

6. Mobilize support and audience for preferred story

Next, the techniques and strategies of narrative approach are classified into the following three aspects (Department of Counselor Education, University of Wyoming, 2004):
1. Reflecting discussion
2. Utilization of reflective teams
3. Therapeutic letter – therapists use letters as progress notes, reminders, and expanders of therapeutic work

In narrative therapy, the therapist’s “attitude” is more important than “techniques” (Chan, 2004). The way it differs from traditional therapy is that each client, problem, and session is unique. The narrative approach does not depend on preconceived knowledge such as commonalities of problems, nor does it rely on across-the-board skills and techniques. The therapist asks and offers with a tentative attitude, and this has no implication on judgment, blame, or a predetermined hypothesis. The therapist must be as willing to make a difference as she or he expects the client is. In traditional therapy, questions are usually rhetorical or act as pedagogic devices to focus on one aspect of the client’s story for a specific purpose that frequently confirms the therapist’s knowledge. In narrative therapy, however, the therapist is trying to learn about and understand the client, hear stories of the client, as she or he wants to tell it, and be open to new experiences. The therapist is not the only expert, but the co-expert who works with the client, and both sides – the client and the therapist, determine the structure (Gortner, 2001).

Example

Outsider Witness Group, initiated by narrative therapist Michael White in Australia, is a reflective group particularly designed for the aborigines to help them rediscover their own self-respect and ethnical recognition under the oppression of mainstream White culture. White uses several methods to achieve the goal of therapy, and one of them is the attempt to proceed conversation between the therapist and the client, surrounded by the latter’s significant others. After the conversation, the surrounding significant others would one by one talk about their individual opinions and feelings about the conversation, and how these stimulate their new thoughts. They do not criticize or make suggestion. Instead, they express their individual life experiences and feelings stirred by the client’s dialogue with the therapist. The client, through the assistance of Outsider Witness Group, is able to become aware of her or his own stories being listened, and these stories are even capable of touching another person’s life. Therefore, the client would experience the awareness of her or his own value and the existence of her- or himself (Chan, 2004).
Evaluation of Theory and Outcome

According to Nichols and Schwartz (2004), there are two most powerful ingredients in narrative therapy:
1. Narrative metaphor: the belief that people can change their stories
2. Externalization of problems

Next, critiques on narrative approach are:
1. Disregard of three essential characteristics of family therapy:
(a) The impact of family conflict on problems
(b) The focus is on dyads (the married couple) and triads (parents and their child)
(c) Treating family as a unit

2. Rejection of the aforementioned main principles, and thus it overlooks the fact that some families have actual conflicts that do not vanish; change might be temporary.

3. Disregard of these principles and empirical research
Although narrative approach has received considerable attention, the lack of empirical research might result in declination of attention.

4. Potential threat of diminishing application
The medical system increasingly addresses the narrative and existential dimension of psychotherapy, but the technical rationality is still the leading method. Next, the costs of the health care system have reached an ever-increasing level in many countries, and “an economic rationality is applied in which only those treatments are offered that are evidence-based, effective, and efficient” (Bouwer, 2005, p. 2). Given both dominant perspectives and the time-consuming nature of narrative therapy, there might be a threat for this approach to be continuously and widely used in years to come.

INTEGRATION OF FAITH AND FAMILY COUNSELING

Integrating Christianity and Family Counseling

Most of the clergy agree that it is possible to integrate religion and counseling to have a more profound and positive impact, and such possibility should base on certain theoretical foundation. It is true in Christianity that pastors and ministers are counselors in nature because of their advantageous position and role. Due to their unique relationship with the believers, they are able to act as counselors or coordinators for Christian families. When there are issues such as family crisis, illness or death, the clergy are almost always in the presence of these situations, especially in western societies. Therefore, the major responsibility of the clergy is to help people achieve meaningful awakening and real hopes (Crabb Jr., 1986).

Moreover, counseling and consultation, including family counseling, has always been an important part in practical theology, and the subject of Pastoral Counseling, including education counseling, marriage and family counseling, emotion counseling, and grief counseling, is the core requirement for people who are educated and trained to become the clergy. For instance, there has been successful integrations of theology and counseling in Taiwan, such as Wesley Counseling Center and Christian Cosmic Light Holistic Care Organization in Taipei where the practices of group counseling, marriage and family counseling, children and adolescent counseling, and counseling education are well-recognized nationally.

Family Counseling Approach

We are all God’s children, and we have plenty of God-given resources within ourselves to successfully deal with different life events and promote personal growth. Although it is challenging to obtain adequate knowledge about other families, and even more difficult to empathize with families from other cultures, since we were all created in God’s image, we do have things in common regardless our races or nationalities, and Christian family counselors have to rely on God to help them to better understand each family. In God’s eyes, human beings are good and honest in nature, and we have to discover our inner treasure in order to connect with and accomplish our self-esteem. Moreover, The process of human beings is common in many aspects, so it could be adapted into various conditions, cultures, and environments (Satir, Banmen, Gerber & Gomori, 1991).

In the development of a normal family based on narrative theory, family members all have good intentions (Nichols and Schwartz, 2004), and according to Satir, Banmen, Gerber, and Gomori (1991), parents are always doing their best to handle different familial situations as well, but they often repeat the patterns that are familiar to them back during their own process of growth, even if they know these patterns are dysfunctional. It is for counselors to keep in mind that when people seek family counseling, they or their families are not the problems; their issues are. Treat the problems, but not people who bring them to counseling. Furthermore, the ways people deal with family problems, not the problems themselves, are the real focus of family counseling (Satir, Banmen, Gerber & Gomori, 1991), and counselors have to help their clients find out how they could appropriately behave and interact when facing their own problems.

Next, it is always possible to make a difference. Although there are limitations toward extrinsic changes, and things and talks around us have a tremendous impact on us, inner changes are indeed possible. In family counseling, it is crucial for counselors to pay attention to the health of the family and its various possibilities, but not merely pathology. In additions, “hope” is an important element of “change,” and we are able to make various choices to properly react to our situations. Therefore, the main goal of family counseling is to enable family members to make choices for themselves (Satir, Banmen, Gerber & Gomori, 1991). For Christian counselors, the Scripture is always the ultimate inspiration and guiding light for empowerment.

Empowerment in family counseling should happen in a number of ways and at a number of levels. “There should be empowerment for all arenas of life: personal spirituality, ethics and vision; family, marriage, lifestyle, singleness and parenting; work, education and corporate ethics; church life, calling, giftedness, mission, and so on” (Icenogle, 1994). Christian counselors, guided by the Scripture and the spirit of Jesus, are there to provide a setting for families and their members to deal with every aspect of family life “as to be lived in the presence of the empowering Lord” (Icenogle, 1994). Counselors should help family members become aware of the fact that each of them does have the resources and abilities to change, and they are able to cooperate with one another to establish support among them for the empowerment to achieve congruency.

Process of Family Counseling

The following outline describes the procedure of an effective family counseling that can be adapted into counseling sessions on a regular basis for family counselors from a Christian perspective:

1. Introduction and prayer: form a circle with family members, begin with an introduction of yourself and the purpose of the family counseling session, and lead a prayer for the session. For those who are not Christians or do not initiate their interests on Christianity, you may alternatively lead a short meditation session prior to the beginning of the actual counseling session.

2. Listening and observing: ask family members to briefly introduce themselves and how they like themselves to be called. Keep direct eye contact with each of them, and make sure that their bodies are at the same level (Satir, Banmen, Gerber & Gomori, 1991). Keep in mind that the counselor’s behavior serves as the model for effective expression and interaction. Then, invite them to start sharing their individual views upon themselves and other members, as well as personal experiences and feelings toward their family and its many issues. Encourage them to use “I” statement and if necessary, use body language to express their emotions. Pay attention to any non-verbal clues.

3. Assistance: “hope” only is not enough to make a difference; people need plenty of help to bring about change. Be sincere, and establish reliability through confidence, competence, and high self-esteem in order to create a comfortable, uninterrupted, and secured environment with minimum restrictions (Satir, Banmen, Gerber & Gomori, 1991). Response, guide, and encourage family members to ensure their continuous expression and interaction. Ask questions instead of telling them what to say or do.

4. Comfort and encouragement: be supportive and reassure that they are not along in their struggle. Family members would also express support and encouragement among themselves within a secured and supportive context. Help them reduce their defense and concentrate on the here-and-now, but leave rooms for them to process past issues.

5. Awareness and possibilities: help them be aware of their source(s) of pressure, the motive force behind their pressure, their usual patterns of thinking, verbal and physical reaction, and the meanings of all these. Then, use pressure to promote the changing process, provide attention and acceptance, offer positive regard, encourage everyone to use her or his own resources, including the support system, to deal with family issues and make new choices, and help them stay in the process of change (Satir, Banmen, Gerber & Gomori, 1991).

6. Contract: ask family members to write therapeutic letters or post-it notes to record, maintain, and practice their new choices. You could also encourage them to use other means such as prayer, meditation, or cooperative action plan to actually practice their new ways of expression, reaction, and interaction, as well as being responsible for themselves. Contract making is the official act of statement for a whole new beginning, and it help advance congruency among family members.

7. Evangelism: in times of conflicts and difficulties within a family, family members particularly need spiritual insight, support and guidance. It is a perfect time to introduce Christian faith to group members. For those who are not Christians or do not initiate their interests on Christianity, you could integrate Christian thoughts into your statements throughout the entire session without directly mentioning Christianity or the Scripture.

8. Share and closure: encourage family members to share their thoughts and feelings about this session, and they might come up with things to do in the next session. End the session with a prayer, and for those who are not Christians or do not initiate their interests on Christianity, an ending meditation works well for the closure.

[References]

Boje, D. M. (2005). Narrative therapy. Retrieved November 5, 2005 from http://cbae.nmsu.edu/~dboje/narrativetherapy.html

Boje, D. M., Alvarez, R. C. & Schooling, B. (2002). Reclaiming story in organization: Narratologies and action sciences. In Westwood, R. and Linstead, S. A. (Eds.), The language of organization (pp. 132-175). London: SAGE Publications. (Original work published 2001)

Bouwer, J. (June 2005). Life story book methods and care for the elderly: An empirical research project in practical theology. Symposium conducted at the seventh conference of the International Academy of Practical Theology, Brisbane, Australia.

Chan, T. S. (November 2004). A view for human beings from narrative therapy. Taiwan Association of Clinical Psychology Journal, 25(3-6).

Chou, J. J. (March 2004). The story tells: Narrative therapy. Symposium conducted at the Teachers’ Seminar at Yu Dah High School of Commerce and Home Economics, Taipei, Taiwan.

Crabb Jr., L. J. (1986). Effective biblical counseling. Winona Lake, IN: Bmh Books.

Department of Counselor Education, University of Wyoming. (2004). Narrative therapy: A brief therapy model. Lecture notes.

Freedman, J., & Combs, G. (2000). Narrative therapy: The social construction of preferred realities. New York, NY: W. W. Norton & Company.

Gortner, E. M. (2001). Narrative therapy: The collaborative language systems approach. Lecture notes.

Hsu, J. Y. (2000). Comparison on communication and narrative theories. Manuscript submitted for publication.

Icenogle, G. W. (1994). Biblical foundations for small group ministry: An integrational approach. Downers Grove, IL: InterVarsity Press.

Leading Edge Seminars Inc. (2005). Close up on narrative practice: A day with Davie Epston. In Leading Edge Seminars Inc. Website. Retrieved November 6, 2005 from http://leadingedgeseminars.org/epstonf2.htm

Nichols, M. P. & Schwartz, R. C. (2004). Narrative therapy. In Nichols, M. P. & Schwartz, R. C., Family therapy: Concepts and methods (6th ed., pp. 329-346). Boston, MA: Allyn and Bacon.

Poetry Portal. (1995-2003). Post modernism definition. In Poetry-Portal.com. Retrieved November 6, 2005 from http://www.poetry-portal.com/styles5.html

Paratore, J. B. & Nichols, M. (1998). Michael White. In Allyn & Bacon Family Therapy Website. Retrieved November 6, 2005 from http://www.abacon.com/famtherapy/white.html

Satir, V., Banmen, J., Gerber, J., & Gomori, M. (1991). Satir model: Family therapy and beyond. Palo Alto, CA: Science and Behavior Books.

White, M. (1997). Narrative therapy. Retrieved November 5, 2005 from http://www.massey.ac.nz/~alock/virtual/white.htm

White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton & Company.

Wu, J. J. (1988). Family therapy: Theories and practice. Taipei: Da Yang Publications.

Wu, S. J. (December 2004). Enrich your life stories. Symposium conducted at the Narrative Therapy Workshop, Taipei, Taiwan.