Post Modern Approaches (Narrative, Solution, Focused)

Post Modern Approaches to Therapy

Narrative and Solution-Focused Therapy

Constructivism

  • Definition: A philosophical stance asserting that reality is constructed by individuals through subjective understanding and interaction rather than an objective reality.

    • Emphasizes that each person's reality is shaped by unique experiences.

    • Perspectives are influenced by factors such as:

    • Language

    • Culture

    • Values

    • Personal history

    • Subjectivity:

    • Reality varies based on individual perspectives and is constructed through narrative and dialogue.

Constructivism in Counseling

  • Key Aspects:

    • Shift away from traditional diagnosis or fixing problems.

    • Emphasizes collaborative meaning-making and the co-creation of meaning between counselor and client.

    • Recognizes client agency and positions the client as the expert of their own life.

    • Focus on individual strengths rather than weaknesses.

    • Involves language as a central element in shaping individual realities.

    • Acknowledges multiple realities and personal narratives, opposing the idea of a single, objective truth.

Narrative Therapy

  • Activity:

    • Work Format: In pairs.

    • Direction: Each participant tells their story about beginning this program.

    • Time Limit: 3 minutes per person (total 6 minutes).

Case Example: Cassandra

  • Client Information:

    • Name: Cassandra

    • Age: 21

    • Gender: Female

    • Ethnicity/Cultural Background: Vietnamese American

    • Sexual Orientation: Heterosexual

    • Education: Undergraduate student, Political Science major.

    • Occupation: Part-time campus job (student work-study).

    • Referral Source: Self-referred.

Cassandra's Presenting Problem

  • Primary Issues:

    • Persistent feelings of anxiety and self-doubt regarding her future as a counselor.

    • Guilt and grief following family abuse reporting, leading to estrangement.

    • Internal conflict between cultural values (loyalty, honor) and personal ethics.

    • Self-perception issues within romantic relationships, feeling “too much” or “too emotional.”

    • Experiences of internalized racism and cultural shame regarding her family's behavior.

    • Challenges integrating past personal experiences with her professional identity.

Cassandra's Goals for Therapy

  • Objectives of Therapy:

    • Process guilt related to her past involvement with Child Protective Services (CPS) and family conflict.

    • Explore and redefine her family role as the “black sheep.”

    • Establish healthy boundaries with her parents while respecting her cultural background.

    • Strengthen self-compassion and forgiveness towards self and parents.

    • Explore strategies to balance her independence with family connections.

Cassandra's Background and History

Early Life

  • Middle child of five siblings in a Vietnamese immigrant family.

  • Childhood characterized by:

    • Physical discipline.

    • Emotional criticism.

  • Felt protective of her youngest sibling, facing a conflict between loyalty to family and concerns for safety.

  • Made a CPS report in high school about parental abuse, resulting in family conflict and guilt despite the investigation being unfounded.

Current Life

  • Recently relocated for college, experiencing newfound independence yet feelings of disconnection.

  • Pursuing a degree in Political Science, aspiring to a career in advocacy or public service.

  • Describes herself as independent yet occasionally isolated, struggling to trust peers with her emotional challenges.

  • Maintains contact with her family but avoids sharing deeper vulnerabilities out of fear of being judged.

Cassandra's Therapeutic Presentation

  • Presents as:

    • Thoughtful, articulate, and emotionally insightful, yet often minimizes her distress.

    • Frequent apologies following vulnerable disclosures.

    • Self-critical, often deferring to the therapist's perspective.

    • Displays high cultural and emotional intelligence alongside struggles with internalized self-blame and feeling unworthy.

    • Reports somatic symptoms linked to anxiety (e.g., stomach tension, racing heart, insomnia), particularly regarding academic performance and family issues.

Clinical Impressions of Cassandra

  • Mood/Affect:

    • Anxious and self-effacing; tearful during family discussions but attempts to contain emotions.

  • Insight:

    • High; able to engage in complex self-reflection and meaning-making.

  • Interpersonal Style:

    • Compliant, self-effacing, and emotionally giving; struggles with assertiveness and boundary setting.

  • Defense Mechanisms:

    • Intellectualization, self-criticism, emotional suppression, and minimization.

  • Core Themes:

    • Moral injury.

    • Family estrangement.

    • Protector identity.

    • Cultural identity conflict.

    • Internalized oppression.

    • Fear of emotional unworthiness.

Narrative - Way of Being

  • Key Approaches:

    • Curious Stance: Understanding the lived experiences without imposing interpretations.

    • Collaborative Nature: Working alongside clients rather than viewing them as projects or subjects of work.

    • Decentered Perspective: Centering clients' voices and acknowledging them as experts in their narratives.

    • Social Awareness: Recognizing how clients' identities and experiences are shaped by power dynamics, cultural contexts, and language.

    • Strengths-Oriented: Emphasizing clients’ strengths rather than deficits.

    • Dialogical Relationship: Meaning is co-constructed between the counselor and client.

    • Counselor Role: Acts as a co-author or editor in the narrative process.

Ear of the Story

  • Intentions of Listening:

    • Go beyond the surface to grasp underlying values, hopes, and identities.

    • Implement a 'Double Listening' approach:

    • Ear of the Problem: Identifying challenges the client faces.

    • Ear of Possibility: Focusing on strengths and survival rather than solely suffering.

    • Observations to Note:

    • Signs of resistance.

    • Values.

    • Hopes.

    • Identity.

Example Statements:

  • “I know calling CPS made everyone hate me, but I couldn’t just stand by and do nothing.”

  • “Sometimes I wish I could just be the kind of daughter they wanted, quiet and obedient.”

  • “Sometimes I think I’m just too sensitive — other people would have just dealt with it.”

  • “When I help other students with their problems, I feel more like myself again.”

Narrative - Way of Understanding

  • Conceptual Framework:

    • Suffering is not an internal disorder but emerges from narratives people adopt about themselves.

  • Problem-Saturated Stories:

    • Dominated by problems.

    • Rigid and encompassing, allowing little room for other identities or experiences.

  • Contextual Considerations:

    • Suffering is socially constructed, partially stemming from oppressive systems and dominant societal discourses.

    • Internalization of societal messages results in restrictive narratives.

Narrative - Way of Intervening

  • Main Goals:

    • Re-author life narratives, moving away from problem-saturated stories.

    • Focus on preferred, more empowering narratives.

    • Deconstruct dominant discourses, inviting critical reflection on cultural and systemic norms.

Interventions in Narrative Therapy

Externalizing the Problem

  • Core Principle:

    • Shift perception to differentiate the person from the problem (e.g., say “my anxiety is visiting me” instead of “I am anxious”).

  • Purpose:

    • Reduces shame and allows for a clearer understanding of how problems operate.

  • Approach:

    • Rename the problem (e.g., call anxiety “Horace the Frog”).

    • Develop a nuanced list of questions for the client.

Identifying Unique Outcomes

  • Objective:

    • Find contradictions to prevailing narratives (times of resistance, value-based actions).

  • Purpose:

    • Acts as entry points for alternative narratives.

  • Approach:

    • Create a list of questions prompting clients to reflect on unique experiences and strengths.

Landscapes in Narrative Therapy

Landscape of Action

  • Focus:

    • Observable actions within the client's narrative.

  • Purpose:

    • Identify unique outcomes and alternatives to problem narratives.

  • Meaningful Questions:

    • Who, what, when, where, why, how?

Landscape of Consciousness

  • Focus:

    • The meanings, intentions, beliefs, values, and feelings behind actions.

  • Purpose:

    • Deepens understanding of preferred stories connected to identity and values.

  • Meaningful Questions:

    • Explore reflections on their inner experiences.

Interventions - Re-Authoring Conversations

  • Focus:

    • Exploration of clients' values, hopes, and intentions to co-create preferred identities.

  • Objective:

    • Facilitate the construction of coherent narratives around unique outcomes and preferred self that bridge isolated moments into a sustained identity narrative.

  • Experience:

    • Engage in storytelling around clients’ values, identities, and meanings.

    • Develop a structured set of questions to facilitate this discovery.

Thickening the Preferred Story

  • Focus:

    • Adding depth, detail, and relational context to the preferred narrative.

  • Purpose:

    • Solidifies new stories and connects sustainable identities to relationships, values, and histories.

  • Approach:

    • Create a focused list of questions to guide this deepening process.

Documentation in Narrative Therapy

  • Techniques:

    • Writing letters.

    • Naming values.

    • Certificates of progress.

  • Purpose:

    • Solidifying new narratives and providing tangible evidence of growth.

    • Create keepsakes that reflect the journey.

Outsider Witness Practice

  • Concept:

    • Another person listens to a client’s new narrative and shares feedback on its impact.

  • Purpose:

    • Fosters community and validation, creating ‘audiences of identity.’

    • Involves thoughtful selection of who engages with this re-authoring process.

Metaphors and Narrative Practices

Tree of Life

  • Approach:

    • Clients draw or build a tree representing the different aspects of their life stories.

  • Purpose:

    • Provides a safe way to explore identity, focusing on strengths and resilience.

    • Allows for reconnection with culture and re-authoring in the aftermath of trauma.

  • Components of the Tree:

    • Roots: Family, culture, traditions, place of origin.

    • Ground: Daily life (activities, work, school).

    • Trunk: Strengths, values, and skills.

    • Branches: Hopes, dreams, and aspirations.

    • Leaves: Important people in their life (living or deceased).

    • Fruits: Gifts received from others (kindness, lessons, love).

    • Optional Storms: Challenges and hardships externalized.

Team of Life Concept

  • Approach:

    • Utilizes sports metaphor to articulate identity, support systems, life goals, and resilience.

  • Purpose:

    • Engaging and accessible means to heal.

    • Highlights the importance of social support, values, and skills.

  • Components:

    • Team Members: Important supportive figures (family, friends, mentors).

    • Coach: Influential roles (role models or inner wisdom).

    • Position Played: Various life roles (e.g., helper, protector, leader).

    • Training/Skills: Strengths and life lessons accrued over time.

    • Goals: Aspirations for the future.

    • Obstacles/Defenders: Challenges faced, externalized.

    • Victories: Achievements and acts of resistance or survival.

Suggested Activity: Tree of Life/Team of Life

  • Format: Initially individual reflection.

  • Directions:

    • Choose either the Tree of Life or Team of Life metaphor to explore your counselor identity.

    • Sketch the chosen metaphor and label its sections.

    • Re-group into small groups of 3-4 to discuss:

    • Experiences reflecting on identity in this format.

    • Connections to the narrative concept of being “multi-storied.”

    • Influence of various voices on personal and professional identity.

  • Time Allotment:

    • 20 minutes for creation.

    • 15 minutes for reflection discussion.

Solution-Focused Brief Therapy (SFBT)

  • Founders: Steve de Shazer and Insoo Kim Berg.

  • Core Focus:

    • Solutions instead of problems; brief, goal-oriented, and client-centered.

  • Key Features:

    • Emphasizes strengths and resources towards a preferred future.

    • Questions such as “What works?” rather than “Why did this happen?”

    • Facilitates immediate engagement with client resilience.

Core Principle

  • “You don't need to know why the house is on fire to start putting water on it.”

SFBT – Way of Being

  • Counselor Attributes:

    • Warm, respectful, and collaborative.

    • Maintains a “not knowing” stance.

    • Focuses on hope, capacity for change, and client agency.

    • Intentional language use; highlights possibilities.

    • Concerns problems as temporary and solvable.

    • Identifies and amplifies unique outcomes (exceptions) in the client’s narrative.

    • Relies on intentional and specific questions to guide interactions.

SFBT – Way of Knowing

  • Key Understanding:

    • Avoids diagnosing or pathologizing clients.

    • De-centers the problem; many clients fixate on problem-focused thinking, which limits their vision of self-efficacy.

  • Challenges:

    • Clients may lose sight of their strengths and potential solutions.

    • They can feel powerless and hopeless if overly focused on past failures.

    • Recognizes that clients often have already taken steps towards change without realizing it.

SFBT – Way of Intervening

Key Interventions

  • Miracle Question:

    • A thought exercise enabling clients to envision a life free of their problem.

  • Scaling Questions:

    • Help measure progress and set realistic goals.

  • Exception Questions:

    • Foster awareness of moments when the problem was not affecting the client.

  • Coping Questions:

    • Highlight strengths and resilience, often unnoticed by the client.

  • Compliments:

    • Provide intentional affirmations about their efforts, strengths, and values.

  • Small Steps:

    • Encourage the client by creating manageable, achievable tasks.

Practical Exercise for Cassandra's Case

  • Objective: Develop a series of questions or statements relevant to her therapy and goals based on SFBT principles.

Activity Insights

SFBT Activity

  • Task: Self-reflect on a time when a challenge was overcome.

  • Focus: Assess what strengths, actions, and resources contributed to overcoming this challenge.

  • Group Activity:

    • Discuss in pairs or small groups how those resources can be leveraged in the pursuit of becoming a preferred future counselor.

Evidence Base

Narrative Therapy

  • Research Level: Limited; primarily qualitative studies and community-based outcome research.

  • Notable Applications:

    • Tree of Life: Studies involving children and youth impacted by HIV/AIDS, refugee trauma, and gender-based violence.

    • Team of Life: Applications with former child soldiers, Aboriginal groups, and at-risk youth globally.

Solution-Focused Brief Therapy (SFBT)

  • Research Level: Growing evidence base demonstrated through randomized controlled trials (RCTs) and meta-analyses.

  • Key Settings: Proven effectiveness across diverse contexts including brief therapy settings, schools, substance use, depression, couples/family therapy.

  • Value: Cost-effective, often requiring fewer sessions while maintaining flexibility and a non-pathologizing approach driven by client needs and goals.