Reflections on "Staring at the Sun"

I've just read Irvin Yalom's latest book on the topic of overcoming the terror of death. It connected very well with two other books that I read just before this: "Heideigger and a Hippo Walk Through Those Pearly Gates", and "Plato and a Platypus Walk into a Bar". Common to these three books is the background on the journey of philosophers who have sought answers to the big questions about life.

Having experienced bouts of death anxiety before, the book did make sense to me in some of its recommendations in overcoming such anxiety. What  stood out for me though was Yalom's definition of ultimate concerns, he wrote "in my view, four ultimate concerns are germane to the practice of therapy: death, isolation, meaning in life, and freedom."  As I think about the approach of Narrative Therapy which I have adopted for my work, there is indeed great similarity with Yalom's existential psychotherapy. Narrative therapy being social constructionist in nature does place social connection  as being significant in therapy, thus the concern of isolation is addressed by efforts to reconnect clients to their community. Helping clients re-discover their personal agency in life basically tackles the issue of finding meaning in life and liberates them to take action.  The key difference is perhaps Yalom's belief that death is at the core of client's problems.

Postmodernism is a return to simpler ideas

While reading about structural family therapy I came across this passage describing the unbalancing phase in its practice:

"It is for their emphasis on the unbalancing phase of treatment that structural family therapists take the most heat from postmodernists and the narrative school of therapy. Joining is common to all forms of therapy and elicits no criticism. Enactments are central to structural family therapy because of the focus on the couple relating in "the here and now" as opposed to reporting on their behaviour outside of the treatment. Enactments in general are not provocative to postmodernists, since in enactments a therapist is simply asking a couple to speak to each other rather than to the therapist. However, the unbalancing phase of treatment is most controversial (Anderson & Goolishan, 1988). Challenging and unbalancing a couple's preferred style of interpersonal behaviour is often labeled by postmodernists as "disrespectful," "bullying," "culturally insensitive," "hierarchical," and/or "patriarchal." We agree that all of these accusations can be true. Some therapists are guilty of imposing their own values, insensitively confronting families, and being ignorant of the cultural differences motivating others. Any therapeutic technique can be misused or abused, and all therapies share in common the injunction that a therapist always remain respectful of her clients. Respect for clients is a necessary condition that must be present in all treatments if there is to be a therapeutic alliance and any meaningful change in behaviour.

But we believe that a therapist has expertise and leverage that can be used to benefit a couple. To deny that a therapist has advanced training and expertise in the dynamics of relational systems would be pointless. Choosing how to use the power of knowledge creatively requires the therapist to be both self-aware and ethical. The therapist intervenes based upon what is observed in the session. The therapist creates intensity by labeling and confronting the family's dynamic. The unbalancing phase of treatment is based upon a belief that people change their behaviour when they reach a critical state of discomfort that becomes intolerable for both the individual and the system. Members of the family at this stage have the opportunity to take responsibility for the consequences of their behaviour." -- Couple Therapy with Gay Men by David E. Greenan & Gil Tunnell.

What I find interesting are the similarities and differences between structural and narrative approaches. In narrative therapy a key concept is that life is multi-storied, thus the therapist finds entry points to unearth some of these other stories that may describe more about client's preferred identity and personal agency.  In a way this can be viewed as a type of "unbalancing" where alternative stories become more visible and known while the problem saturated story loses its grip. Perhaps the problem is not with "unbalancing" but with the approach used in achieving this. 

It does take significant effort on a structural therapist's part to influence a change through modifying existing structure/patterns of interpersonal behaviour.  Looking at a narrative therapist's approach, there is less focus on the therapist's ability to modify or facilitate modification but more on meaning making through dialogue. And how such meaning making can spur clients to seek solutions on their own. This roundabout path does not tackle the problem/structure/pattern/scripts directly which then allows it to be more respectful of clients.

Anderson, H., & Goolishan, H.A. (1988). Human systems as linguistic systems. Family Process, 27, 371-393.

Finding

终日寻春不见春，

芒鞋踏破岭头云；

归来偶把梅花嗅，

春在枝头已十分。

--唐·无尽藏

Is it better to be constantly searching or to have found? In my search for more meaningful connection with people I will be changing my work place. Each change is an opportunity for growth rather than a destination to be desired.

A friend congratulated me and asked if I will be happier at the new place. I said I'm rather happy at the old place, and the new place may in fact give me more stress.

Perhaps my search for ___ (fill in the blanks) has no ultimate end. Just participate fully and savour each moment of the here and now.

Thinking behind practice – post-structuralism, culture, and individualism

I am doing a series of reflections as part of a post graduate course on Narrative Therapy. Overall there will be about ten reflection papers on various concepts and practices that currently form and shape Narrative Therapy.

I chose this set of readings for reflection because post-structuralism has been a significant influence towards my approach to counselling and other aspects of life.  In the counselling arena it has been liberating for me and my clients.  I have a client, X, who was referred to me by school personnel for anger and defiance issues.  Problems happened over the past year and the school counsellor described him as being “resistant” and unwilling to speak.

In my first meeting with the 15 year old boy at his home, he stood by the door and softly apologised for getting home late before going to his room to change out of his school uniform.  I imagined if I had taken up the image of a “resistant” angry boy as a fixed identity then I might not have noticed such subtle expressions of an alternative identity (Thomas, 2002).

Post-structuralism for me invites a sense of inquisitiveness that leaves no stone unturned, where I become an investigative journalist writing an expose (this was how Michael White described a therapist’s role during a 2007 workshop). The brief referral report on X seemed totalizing of his identity and I chose to open an inquiry into the report, allowing X to read the report and respond to all the statements.  There have been other occasions where I invited clients to expose the labels that structuralist ideas may impose on them and this endeavour has often proven fruitful in uncovering their skills, knowledge, and values in response to problems faced.

In later dialogues with X, many other stories unfolded around his school life that contradicted the problem saturated story.  This included his experience of the injustice inflicted on him by certain teachers who did not listen to his explanations, the experience of humiliation when unusual punishments were enforced on him, and the skill of walking away as a means to prevent anger from blowing up.

In his telling over two sessions, the label of an angry defiant youth was not a problem isolated to his “self” or an identity that pervaded in all contexts. I was delighted when X told me he felt more relaxed after the second session.

In working with youths, I have become more aware of their culture and how the culture encompasses their preferred response to life’s problems.  In reading about psychological colonisation (Arulampalam, Perera, Mel, White, & Denborough, 2006)  it reminds me that as adults we often impose our adult ways of problem solving as the sole acceptable or “normal” way.  I have learned to be sensitive to and to be appreciative of youth culture because privileging their ways invites personal agency and relieves the effort of introducing an alien culture to them.  For each client that I meet, I envision a meeting of cultures and therefore an exciting opportunity to learn more about my client’s life.

References

Arulampalam, S., Perera, L., Mel, S. d., White, C., & Denborough, D. (2006). Chap 3: Avoiding psychological colonisation: Stories from Sri Lanka. In Trauma: Narrative responses to traumatic experience. Adelaide: Dulwich Centre Publications.

Thomas, L. (2002). Poststructuralism and therapy - what's it all about. The International Journal of Narrative Therapy and Community Work(2), pp 91-99.

Working with children

I am doing a series of reflections as part of a post graduate course on Narrative Therapy. Overall there will be about ten reflection papers on various concepts and practices that currently form and shape Narrative Therapy.

What I found valuable in readings about working with trauma and children is the care taken to facilitate the building of “territories of identity” (Ncube & Denborough, 2008; White, 2006) which has helped children speak about trauma in a way that does not re-traumatize them.

I used this approach in a recent first time interview with a 17 year old gay teen whose mum described him as having been traumatized by an encounter with an adult male.  No other details were provided. Our conversations explored various parts of his life such as his love for children, his uncertainty over loving a best friend, and his own knowledge about his sexual orientation since age eleven.  I was wondering how to ask about the details of the trauma but after twenty minutes the details gushed out as he described how a man had tried to have unsafe sex with him without his knowledge.  The tellings about other aspects of his life had somehow equipped him to speak freely on this trauma event.  I am thinking my respectful and curious response as an audience to his tellings also contributed to his feeling safe enough to say more.

Michael White further wrote about avenues for therapeutic enquiry into children’s responses to trauma.  In the same interview, which I transcribed for a clinical consultation with Chris Dolman, I attempted to identify such a response and discovered that I had missed something subtle.  The boy spoke about an “uneasy feeling” and “didn’t want to do it”. After discussing with Chris, it dawned on me that somehow I held notions about the word “response” that were limited to action based responses.  I have now expanded my meanings of “response” to include expressions of feeling and intent that could indicate an entry into conversations about the absent but implicit.

Reading about the experiences of using the Tree of Life metaphor has also sparked off my interest in using it to invite conversations about difficult times in the coming out process of gay men (Ncube & Denborough, 2008).  My main consideration is how to invite meaningful conversations in a short span of time and being careful about re-traumatization. I am excited about the next two months when I facilitate a brief support group programme for gay men.

References

Ncube, N., & Denborough, D. (2008). Chap 4: The Tree of Life: responding to  vulnerable children In Collective Narrative Practice: Responding to individuals, groups and communities who have experienced trauma. Adelaide: Dulwich Centre Publications.

White, M. (2006). Chap 7: Children, trauma and subordinate storyline development. In Trauma: Narrative responses to traumatic experience. Adelaide: Dulwich Centre Publications.

Working with couples

I am doing a series of reflections as part of a post graduate course on Narrative Therapy. Overall there will be about ten reflection papers on various concepts and practices that currently form and shape Narrative Therapy.

I have always wondered since coming into contact with narrative ideas how might couples counselling be practiced.  Jill Freedman and Gene Combs’ writing (Freedman & Combs, 2002) provided me a comprehensive picture of how it could be done.  This helped validate that I was on the right track but somehow it did not address my doubts on the idea of “repositioning” in the definitional ceremony for couple work. It seemed daunting to begin on such a task especially with couples in “high and long standing conflict”.

After reading Michael’s paper on conflict dissolution (White, 2004), it became clearer to me that there was much to be considered and managed by the therapist.  It was a relief to read that it can be “extraordinarily difficult” to reproduce the tradition of outsider-witness responses between a couple.  So far my attempts have been getting into a re-authoring conversation with one partner while the other remains an audience, followed by a re-telling with the other.  This works when emotions are not so intense between them.  I also found the linguagram to be helpful in inspiring me to work with couples through externalizing their values, skills, and knowledges by placing them onto diagrams that can then invite further reflections to thicken the alternative stories (Løge, 2007).  I believe having words in print increases the effect of externalizing the words from the speaker, and thus enables couples to speak and notice the unheard stories about each other without escalating emotions.

I have always valued the strong emotions that are present between couples and amongst family members, and often wonder about how emotions can be part of the re-authoring process.  I noticed my practice had gradually shifted away from a “here and now” stance towards one that emphasized “journalistic enquiry”.  Perhaps this was influenced by what Michael White had mentioned during one workshop about his preference of not dwelling on emotions even though he may be touched by a client’s story.  Perhaps I had misunderstood what he said.  It was only recently that I found a fit for using the “here and now” practices after seeing how another narrative practitioner demonstrated her work.  I feel reconnected with what I value and this brings about greater possibilities for how I wish to work with couples and families.

References

Freedman, J., & Combs, G. (2002). Narrative couple therapy. In Narrative therapy with couples ... and a whole lot more! a collection of papers, essays, and exercises. Adelaide: Dulwich Centre Publications.

Løge, A. K. (2007). Conversations with divorced parents: Disarming the conflict and developing skills of collaboration. The International Journal of Narrative Therapy and Community Work, 1, pp 3-14.

White, M. (2004). Chap 1: Narrative practice, couple therapy and conflict dissolution. In Narrative Practice and Exotic Lives: Resurrecting diversity in everyday life (pp. 1-41). Adelaide: Dulwich Centre Publications.

Responding to trauma and abuse

I am doing a series of reflections as part of a post graduate course on Narrative Therapy. Overall there will be about ten reflection papers on various concepts and practices that currently form and shape Narrative Therapy.

It was rather timely that I had read Angel Yuen’s article (Yuen, 2007) and the interview with Michael White (McLean, 1995) about working with clients who experienced trauma and abuse.  It reaffirmed my own principle of how I wished to work with clients, and helped clarify for myself how I wished to practice. This was most relevant in a recent meeting with a gay teenage boy who had a traumatic sexual experience with an older man.

Before being introduced to narrative ideas, I value and still do value creating the space for clients to speak about their difficult experiences.  I am influenced by other schools of thought, especially around emotions.  In my earlier work in counselling clients for HIV testing, the effect of telling another person provides catharsis which clears the way for clients to think differently or act differently for their future.  When I first heard Michael White in 2007 speaking in objection to the Western ways of revisiting traumatic experiences, it struck me as something important in knowing there was more than one way to work with difficult experiences.  These were ways that were culturally relevant and powerfully acknowledging of client’s own resources.

I found this phrase to be significant for me: “Distress yes, re-traumatisation no” (McLean, 1995), because it is an encouragement that I can be influential in asking  questions about the trauma, and more specifically the response to it.  In the process of enquiry with the teenager, we uncovered the skills and knowledge that he already had in terms of negotiating with men on what he preferred, and an acknowledgement that this incident came about because of the unfair power difference exerted by the older man in withholding to send him home. His feedback that the session was “like having a wind to clear the haze” signified to me that he was gradually redefining his view about the traumatic experience.

The levels of enquiry described by Angel Yuen made my work easier as it pulled together questions that centred on client’s expertise, connection and contribution from significant persons, and identification of personal agency.  I recognized the scaffolding nature of this enquiry and in my limited practice have come to appreciate how it helps clients to reach a rich meaningful conclusion about the trauma that is not totalizing of their identity.

References

McLean, C. (1995). 'Naming abuse and breaking from its effects' an interview with Michael White. In Re-Authoring Lives: Interviews & Essays. Adelaide: Dulwich Centre Publications.

Yuen, A. (2007). Discovering children's responses to trauma: a response based narrative practice. The International Journal of Narrative Therapy and Community Work(4), pp 3-18.