ARO-HEALING

We have joined a growing community of therapists around the world who are collaborating with children and families in ways that allow all of us (therapists, children, and parents alike) to be lighthearted, humorous, and creative--and yet surprisingly effective in resolving many of the problems that we face today. In our view, the developments collectively known as narrative therapy offer some unique and helpful perspectives to the field of child and family therapy.

The term narrative implies listening to and telling or retelling stories about people and the problems in their lives. In the face of serious and sometimes potentially deadly problems, the idea of hearing or telling stories may seem a trivial pursuit. It is hard to believe that conversations can shape new realities. But they do. The bridges of meaning we build with children help healing developments flourish instead of wither and be forgotten. Language can shape events into narratives of hope.

We humans have evolved as a species to use mental narratives to organize, predict, and understand the complexities of our lived experiences. Our choices are shaped largely by the meanings we attribute to events and to the options we are considering. A problem may have personal, psychological, sociocultural, or biological roots--or, more likely, a complex mix of the above. Moreover, young persons and their families may not have control over whether a certain problem is in their life. But even then, how they live with it is still within their choice. As Aldous Huxley once said, "Experience is not what happens to you. It is what you do with what happens to you."

A PLAYFUL APPROACH

It has continued to astonish us how resourceful, responsible, and effective children can be in facing problems! Externalizing language separates children from their problems and allows a lighthearted approach to what is usually considered serious business. Playfulness enters into a family therapy when we narrate the relationship between a child and a problem.

When adults and children collaborate actively play is a mutual friend. It inspires children to bring their resources to bear on problems and make their own unique contributions to family therapy. Playful approaches in narrative therapy direct the focus away from the child as a problem and onto the child-problem relationship in a way that is meaningful for adults as well as intriguing, not heavy-handed or boring, for children.

EXTERNALIZATION

"The problem is the problem, the person is not the problem" is an oft quoted maxim of narrative therapy. The linguistic practice of externalization, (White, 1988/9; White & Epston, 1990a) which separates persons from problems, is a playful way to motivate children to face and diminish difficulties.

In a family, blame and shame about a problem tend to have a silencing and immobilizing effect. Moreover, when persons think of a problem as an integral part of their character or the nature of their relationships, it is difficult for them to change, as it seems so "close to home." Separating the problem from the person in an externalizing conversation relieves the pressure of blame and defensiveness. No longer defined as inherently being the problem, a young person can have a relationship with the externalized problem. This practice lets a person or group of persons enter into a more reflective and critical position vis-à-vis the problem. With some distance established between self and problem, family members can consider the effects of the problem on their lives and bring their own resources to bear in revising their relationship with it. In the space between person and problem, responsibility, choice, and personal agency tend to expand.

This practice also tends to create a lighter atmosphere wherein children are invited to be inventive in dealing with their problem, instead of being so immobilized by blame, guilt, or shame that their parents are required to carry the full burden of problem-solving. As White (1988/9, p.6) has commented, externalizing conversation "frees persons to take a lighter, more effective and less stressed approach to 'deadly serious' problems."

Soiling was one of the first problems to be externalized by Michael White (1984; 1989). In a straightforward externalization encopresis was renamed "Sneaky Poo." Encopresis is a medical diagnostic term; in itself there is nothing wrong with it. However, the grammar that we use in speaking with and about young people has certain effects. To say that "Tom is encopretic" is to imply something about his identity. To say that "Tom's problem is that he soils his pants" is accurate, but it may be adding shame to an already humiliating situation. To say that "Sneaky Poo has been stinking up Tom's life by sneaking out in his pants" is a more gamesome way to describe Tom's relationship with the problem of soiling. It is more likely to invite Tom's participation in the discussion of his problem. It can also evoke a more sportive stance for Tom vis-à-vis the problem, as we can now talk about how "Tom can outsneak Sneaky Poo and stop it from sneaking out on him." Tom no longer has to be a different kind of person from the one he understands himself to be. In fact, revising his relation with such a problem as "Sneaky Poo" may very well confirm him as being just the right kind of person for the job at hand--"outsneaking Sneaky Poo."

Standing as an alternative to the diagnosis and treatment of pathology, the focus in an externalizing conversation is on expanding choice and possibility in the relationship between persons and problems. Roth and Epston (1996, p. 5) write:

In contrast to the common cultural and professional practice of identifying the person as the problem or the problem as within the person, this work depicts the problem as external to the person. It does so not in the conviction that the problem is objectively separate, but as a linguistic counter-practice that makes more freeing constructions available.

When they enter therapy overwhelmed by a problem, members of the family may expect that the clinician will discover further underlying conflicts in their minds or relationships. Therapists take an active role in shaping the attributions that are used to describe young persons and families and to explain their problematic situations, and when a therapist listens to, accepts, and then furthers the investigation of a pathological description of a child, the child's identity may suffer.

When a problem is externalized, the attitude of young people in therapy usually shifts. When they realize that the problem, instead of them, is going to be put on the spot or under scrutiny they enthusiastically join in the conversation. Relief shows on their faces. Their eyes light up, as if to say, "Yeah, that's it, that's how I look at it. It's not my fault." They are then in a position to acknowledge that the "problem" happens to be making them and others miserable and to discuss matters with, at times, remarkable candor.

Although in one sense it is a serious pursuit, we find this practice to be inherently playful and appealing to children. Maria sent Jenny a valentine card one year, with the caption "Poo Poo to Fear and Temper" and little drawings of each on the front. On the back was written "I like talking with you and I like calling fear and temper names. From Maria." Jenna, a nine-year-old once wrote in relation to a mask she had made of "The Trickster Fear": 'You're no longer nothing . . . being nothing made it hard to know you. Once you're named, you can be known and conquered!"

EXTERNALIZATION AND CHILDREN'S IDENTITY FORMATION

Aside from their understandable opposition to being blamed or shamed, perhaps children are showing common sense in resisting being defined by descriptions that imply that their identities are limited or fixed. Even adults do not find rigid negative descriptions of themselves particularly motivating toward change. Why shouldn't children resist a fixed adult-imposed definition or a normative characterization? After all, identity remains exploratory and relatively fluid well into adolescence.

Viewing the child as facing rather than being a problem is a helpful start to preserving the fluidity of identity formation. Externalization seems a natural fit for many children. It is compatible with the way they typically approach difficulties in the dynamic learning environment of play. In play, along with hats, costumes, and accents, multiple perspectives and roles are tried on during "dressup" and other games. This fluidity allows the child to explore variations of attitude, identity and behavior--to try out the emotional flavor of the moment or day. In fact, when a child's play is repetitive, ritualistic, or confined in its range of roles and behaviors, we may wonder about abuse or other severe interruptions to developing identity.

For the child, externalization is like playing a game of "pretend." Implicitly, or sometimes even explicitly, we are saying to the child, "Let's pretend the problem is outside yourself and we'll play with it from there." As Paley (1990, p. 7) writes, "'Pretend' often confuses the adult but it is the child's real and serious world, the stage upon which any identity is possible and secret thoughts can be safely revealed."

As therapists, we have been especially trained in the use of words. But practicing the language of externalizing conversations is for us, as for many others, not so much about learning a technique as about developing a particular way of seeing things. As Roth and Epston (1996a, p. 149) write:

We do not see externalizing as a technical operation or as a method. It is a language practice that shows, invites, and evokes generative and respectful ways of thinking about and being with people struggling to develop the kinds of relationships they would prefer to have with the problems that discomfort them.

We have noticed some benefits for us personally. Focusing our attention on values, hopes, and preferences, rather than on pathology, we find ourselves less fatigued by the weight of the difficulties we encounter. Since we can now put the problem in the spotlight, we can be more forthright in our questions and comments. As well as allowing us to connect with children "where they live," this practice stimulates our creativity as well.

This approach is distinct from most open, unstructured play therapy, in that we collaborate closely with children in play that is actively focused on facing a problem. Children's sense of effectiveness as agents of change clearly increases when they experiment with possibilities in relationship to an externalized problem. In therapy with families the play is mainly with words, using humor wherever possible! But an externalizing conversation is easily enhanced with other forms of expression favored by children, such as play and expressive arts therapy.

SELECTED READINGS (Emphasis on children)

Epston, D. (1986). Nightwatching: An approach to night fears. Dulwich Centre Review, 28-39.

Epston, D. (1989). Collected papers. Adelaide, Australia: Dulwich Centre Publications.

Epston, D. (Autumn, 1989a) Temper tantrum parties: Saving face, losing face, or going off your face! Dulwich Centre Newsletter, 12-26.

Epston, D. (1993). Internalising discourses versus externalizing discourses. In S. Gilligan & R. Price (Eds.), Therapeutic Conversations (pp. 161-177). New York: Norton.

Epston, D. (1994). Extending the conversation. Family Therapy Networker, 18(6), 31-37, 62-63.

Epston, D., & Betterton, E. (1993). Imaginary Friends: Who are they? Who needs them? Dulwich Centre Newsletter, 2, 38-39.

Epston, D., & Brock, P. (1989). Strategic approach to a feeding problem. In Epston, D. Collected Papers. Adelaide: Dulwich Centre Publications.

Epston, D., Morris, F., & Maisel, R. (1995). A narrative approach to so-called anorexia/bulimia. In Weingarten, K. (Ed.),Cultural Resistance: Challenging beliefs about men, women, and therapy . (pp. 69-96). New York: Haworth.

Epston, D. & White, M. (1992). Experience, contradiction, narrative, and imagination: Selected papers of David Epston & Michael White, 1989-1991. Adelaide, Australia: Dulwich Centre Publications.

Epston, D., & White, M., & "Ben" (1995). Consulting your consultants: A means to the co-construction of alternative knowledges. In S. Friedman, (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 277-313). New York: Guilford.

Epston, D., Lobovits,D., & Freeman, J. (1997). Annals of the "new Dave". Gecko, v.3

Freedman, J., & Combs G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton.

Freeman, J., Epston, D. & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton.

Freeman, J. C., & Lobovits, D. H. (1993). The turtle with wings. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy. (pp. 188-225). New York: Guilford.

Lobovits, D. H., Maisel, R., & Freeman, J. C. (1995). Public practices: An ethic of circulation. In S. Friedman (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 223-256). New York: Guilford.

Lobovits, D., & Prowell, J. (1995). Unexpected journey: Invitations to diversity. Paper from workshop presented at"Narrative Ideas and Therapeutic Practice," Fourth International Conference, Vancouver, BC.

Lobovits, D. & Freeman, J. (1997) Destination Grump Station, Getting Off the Grump Bus. In D. Nylund and C. Smith (Eds.)Narrative Therapy with Children and Adolescents. New York: Guilford Press.

Roth, S. & Epston, D. (1996). Developing externalizing conversations: An exercise. Journal of Systemic Therapies, 15(1), 5-12.

Roth, S. & Epston, D. (1996a). Consulting the problem about the problematic relationship: An exercise for experiencing a relationship with an externalized problem. In M. Hoyt (Ed.) Constructive therapies: Volume 2., (148-162). New York: Guilford.

Seymour, F. W. & Epston, D. (1992). An approach to childhood stealing with evaluation of 45 cases. In M. White & D. Epston (Eds.) Experience, contradiction, narrative, and imagination: Selected papers of David Epston & Michael White, 1989-1991. (pp. 189-206). Adelaide, Australia: Dulwich Centre Publications.

White, M. (1985). Fear busting and monster taming: An approach to the fears of young children. Dulwich Centre Review.

White, M. (1986). Negative explanation, restraint and double description: A template for family therapy. Family Process, 25(2), 169-184.

White, M., (Winter,1988). The process of questioning: A therapy of literary merit? Dulwich Centre Newsletter, 8-14.

White, M. ,(Spring, 1988a). Saying hullo again: The incorporation of the lost relationship and the resolution of grief. Dulwich Centre Newsletter, 7-11.

White, M. (1988/9). The externalizing of the problem and the re-authoring of lives and relationships. In M. White (Ed.),Selected Papers . (pp. 5-28). Adelaide, Australia: Dulwich Centre Publications.

White, M. (1989). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. In Selected Papers.Adelaide Australia: Dulwich Centre Publications. (pp. 115-124). Original work published in 1984, Family Systems Medicine, 2(2).

White, M. (1991). Deconstruction and therapy. Dulwich Centre Newsletter, 3, 21-40.

White, M. (1993). Commentary: The histories of the present. In S, Gilligan & R. Price (Eds.), Therapeutic Conversations (pp. 121-135). New York: Norton.

White, M. (1995). Re-authoring lives: Interviews and essays. Adelaide, Australia: Dulwich Centre Publications.

White, M., & Epston, D. (1990). Consulting your consultants: The documentation of alternative knowledges. Dulwich Centre Newsletter. 4, 25-35.

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

http://www.narrativeapproaches.com/narrative%20papers%20folder/arts_process.htm

Narrative Therapy with Children and their Families May 2000

Expressive Arts Workshop Materials

© Jennifer Freeman M. F. C. C. , R. E. A. T.

 http://www.narrativeapproaches.com/narrative%20papers%20folder/narrative_therapy.htm

MULTI-MODAL NARRATIVE/EXPRESSIVE PLAY

Meditate: Guided relaxation. Be centered, contact inner wisdom/resourcefulness. Find a still/empty space. Allow an externalized problem to present itself.

NB: It is OK if during the process, the problem changes or mutates. Best to just trust the process and find out what you can learn from this.It is optional to share with a partner at points throughout.

Journal: Option I Consider these questions and take a few brief notes:How does this problem oppress you and limit your experience of yourself; relationships; actions and choices? How did the problem, like a weed, take hold in your life? What is the soil it grew in? (E.g. social /cultural--gender, class, race, socio-economic--messages and practices). How would you prefer things to be?

Option 2: Have the problem write/tell a brief description of you, or tell your story from its point of view. E.g.: This is the way I (the problem) see Jack/Jackie. This is what I get him to be and do. This is what I keep her from doing. Here's what I need from him/her to keep me going. My main underpinnings are (social ideas /ideologies and practices; other habits, problems or ways of thinking e.g. perfectionism supported by insecurity). Let me tell you if there are times I am friend to him/her and when I am foe.

Draw: the influence or effects of the problem on your life.

Suggestions:

#Your own inspiration.

#A symbolic drawing.

#A map of the problem's influence.

#A cartoon series showing different areas of effect.

# An intuitive drawing using your non-dominant hand and showing the influence of the problem in shapes and colors.

Movement: Relax and play. Walk around in an everyday way. Now let the problem influence your walking. What happens when the problem is in charge? Notice your posture and breathing. Develop into a movement. What sounds emerge? Develop a transitional movement that loosens the grip of the problem. Explore pathways out of the problem into a preferred state. Expand into a movement of liberation.

Draw: Your preferred relationship with the problem-- relatively free or empowered.

Journal:

1. Jot down some notes Think of a time when you were able to have a better relationship with the problem, when you felt empowered or were free of it. Does the movement remind you of this? What relationship do you prefer to have with the problem that you have experienced before, or would like to experience more of? What becomes possible when you hold this image of yourself?

2. Now describe yourself as a loving friend might from the "alternative knowledge" or empowered point of view (rather than the problem's point of view). Try to incorporate past, present and future into your story.

Relax & visualize: how do you imagine your life as you continue to embrace this direction in a week, or in a few years. What possibilities open up for you?

Receive an eidetic image or symbol of this preferred relationship and healing and thank your inner guidance.

Share with your partner or reflect in journal: What was meaningful to you in this exercise? What possibilities do you sense for yourself in your work?

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