Externalizing Conversations in Narrative Therapy

Externalizing Conversations: A Comprehensive Guide to Therapeutic Practice

Core Principles of Externalizing Conversations

• Separation of Problem from Person: The primary aim is to distinguish the problem from the individual experiencing it, creating psychological distance. This allows for a space to emerge around the person.

• Developing a New Relationship with the Problem: The newly created space enables the person to develop alternative ways of relating to and interacting with the problem, as exemplified by the "Black Dog" story (a metaphor for depression).

• Fostering Self-Realization: This distance helps the person realize they are more than the problem itself, rather than being entirely engulfed or defined by it.

• Understanding Problem Mechanisms: Externalizing conversations offer an opportunity to explore how the issue affects the person's life and the specific mechanisms or tactics the problem uses to dominate them.

Intersections with Solution-Focused Therapy

• Seeking Exceptions: The rich exploration of the problem's control naturally leads to identifying instances where the problem's influence is less potent. These are "exceptional times or circumstances."

• Points of Entry: These exceptions serve as points of entry to expand the person's narrative, highlighting times when they had more power or agency.

• Thickening Moments: The goal is to "thicken" these exceptional moments and circumstances to create more such spaces and opportunities in the person's life.

Goals and Transformative Potential

• Changing Perceptions: These conversations aim to alter how problems are perceived, understood, and experienced by the client.

• Expanding Client's Options: They also seek to change the client's views regarding their available options for living a different life and engaging in new actions.

• Not a One-Time Technique: Externalizing conversations are not a superficial, one-off intervention. Genuine belief in separating the person from the problem is crucial for the therapist.

• Impact of Therapist's Beliefs: If a therapist harbors presuppositions about a person being "depressed" or "bipolar" (i.e., equating the person with the diagnosis), their efforts to externalize will appear superficial and counterproductive.

• Reducing Internalization: The core task is to genuinely believe that a diagnosis doesn't define the person. The aim is to reduce the degree to which a diagnosis has been internalized by the client, thereby reducing the problem's influence.

• Consistency in Language: Once an appropriate name for the problem is chosen collaboratively with the client, the therapist must consistently use that name and avoid reverting to socially imposed or internalized ways of speaking about the problem.

Achieved Outcomes through Externalizing Conversations

• Objectification and Disempowerment: The problem becomes objectified, which in a societal context, often moves it towards disempowerment. This creates a sense of separation and reduces its perceived power.

• Reduced Guilt, Shame, and Blame: By positioning the problem as the "troublemaker," the person's experience of guilt, shame, or self-blame is decreased.

• Opening Pathways for Action: Externalizing ways of speaking about the problem illuminate previously invisible pathways for new actions and solutions.

• Fostering Cooperative Efforts: These efforts extend beyond the client-therapist relationship to include significant others (partners, parents, friends, family members) who can also join in confronting the externalized problem.

Recommended Reading

• A paper by Mega Carey is suggested as a valuable resource, accessible from the library. It provides examples of utilizing externalizing conversations, primarily, but not exclusively, with children.

The Four Steps: First Statement of Position Map

Note: This mini-lecture outlines the "First Statement of Position Map." A "Second Statement of Position Map" exists but is beyond the scope of this particular course, typically used after initial steps covering multiple sessions.

Step 1: Characterizing the Problem

• Finding a Name: The initial task involves collaborating with the client to find a suitable name for the problem.

• Adding Rich Details (Experience-Near Way): This involves gathering specific details from the client's perspective to characterize the problem.

• Empty Chair Analogy: Imagine asking the problem to sit in an empty chair. The therapist and client then collaboratively observe and explore its tactics, operations, and methods of creating trouble in the person's life.

• Giving the Problem a "Persona": The aim is to attribute human-like characteristics or a distinct identity to the problem.

  • Using Client Metaphors: Clients may spontaneously use metaphors when describing their problems (e.g., "the black dog"), which can be directly incorporated into naming and characterizing the problem.

  • Therapist's Probing Questions: If metaphors are not readily offered, the therapist can ask questions such as:

    • "Is it dark or is it large?"

    • "Is it always around or only sometimes?"

    • "How is its presence? Is it like a control freak, or someone who suddenly appears out of nowhere?"

    • "Is it loud or is it whispering?"

    • "What type of problem is it?" (e.g., for "ADHD," asking "Is it like a black ADHD or a white ADHD? Is it a light one or a heavy one? Is it wandering around heavily and bulky?")

• Value of Characterization: All forms of characterization are considered valuable and helpful in this phase.

Step 2: Mapping the Effects of the Problem

• Exploration of Life Domains: This step involves systematically exploring various aspects of the client's life where complications or disruptions caused by the problem are identified.

  • Examples of Domains: Home, workplace, school, peer contexts, familial relationships, relationship with oneself, friendships, purposes, hopes, desires, aspirations, plans, and future possibilities.

• Acknowledging and Situating the Problem: The goal is to fully acknowledge the problem's effects across these different domains and to situate the problem in time, within various relationships, and within the broader context of the client's life.

• Key Areas of Impact: Exploration includes how the problem impacts:

  • Relationships with significant others.

  • The client's feelings.

  • The kind of story the client can tell about themselves.

  • How the client treats their own life.

• Crucial Linguistic Rule: It is imperative to consistently use the agreed-upon name for the problem (from Step 1) in all questions, instead of the generic phrase "the problem."

Step 3: Evaluating the Effects of the Problem

• Developing a Position: The purpose of this step is to help the client develop a clear position on the effects or influence the problem has had in their life.

• Challenging Assumptions: Therapists should actively ask if these effects are acceptable to the client, even if it seems obvious that they wouldn't be. This approach can genuinely surprise clients.

• Therapist's "Position of Not Knowing": By asking such questions with genuine curiosity, the therapist adopts a "position of not knowing," which highlights the client's expertise regarding their own life. This contrasts with common societal messages that might tell clients how "bad" the problem's effects are.

• Client Empowerment: This process empowers clients to articulate their intentions and values, helping them to stand against the problem's effects.

• Example Scenario: If a client states that the problem prevents them from going out with friends:

  • The therapist asks: "Is this not being able to go out with friends okay with you?"

  • This seemingly simple question can be surprising because many assume the client's negative position is understood. However, therapists should remain curious about the client's explicit stance.

• Opening Pathways for Values: This curiosity creates opportunities for clients to discuss their preferences, hopes, desires, and values.

• Example Questions for Evaluation: "Is this okay with you?" "Where do you stand on this?" "What is your position on this?" "Is this a positive or negative development? Or both? Or neither? Or in between?" Further exploration of their meanings follows.

Step 4: Justifying the Evaluations of the Effects (Why Questions)

• Exceptional Use of "Why" Questions: This is one of the rare instances in therapy where "why" questions are specifically invited. Unlike initial sessions where "why" questions might be avoided, here they serve a focused purpose.

• Purpose of "Why" Questions: These questions are designed to invite the client to justify their stated position on the problem's effects.

• Uncovering Values and Hopes: Asking "Why don't you like/prefer these effects in your life?" prompts the client to articulate their values, desires, hopes, commitments, and plans.

• Stories of Personal Values: Clients begin to tell stories centered on their personal values, contrasting them with what the problem has imposed.

• Example from Step 3: If the client states they don't like not being able to go out with friends, and elaborates, "Of course, I don't like this. This is really not something that I wanted or imagined would ever happen in my life. This whole thing is very strange as it was completely fine for me to go out with people."

  • The therapist would then ask: "Why isn't this okay for you? Why is it that you don't like this?" (Again, client surprise is expected and intentional).

• Deepening the Narrative: The clients then provide narratives of hope, possibility, values, commitments, and plans.

• Thickening Storytelling: Therapists encourage clients to expand on these values, helping them understand what the problem is blocking or making challenging in relation to their aspirations.

Beyond the First Statement of Position Map (Brief Overview)

• Building on Foundations: Externalizing conversations lay the groundwork for subsequent narrative therapy work, which requires significant creativity.

• Second Statement of Position Map: Follows the initial four steps, focusing on highlighting "unique outcomes" or "exceptional circumstances" (instances where the problem did not dominate as expected).

• Developing Alternative Stories: Practices are then introduced to develop new, alternative stories that can replace the problem-saturated narrative, leading to an expansion of possibility and new forms of action in the client's life.

• Further Learning: A free online course on narrative therapy practices is suggested for those interested in deeper engagement with the subject.