Articles

From client to co-author – taking the narrative turn Issue 24, Winter 2005
by Jan Logan, City Lit, London
For some time I have been interested in narrative ideas and practices and have been exploring the extent to which these can be applied to stammering therapy. This has now grown into a passion! Nonetheless, when invited to write about narrative ways of working for signal, I was initially reluctant as I am still getting to grips with this area. Whilst my thinking about therapy has changed significantly, I am only just beginning to incorporate different ways of working into my practice. On reflection, I decided it might be useful to take stock and summarise my thinking thus far. One way of doing this is to tell my own story about my relationship with these ideas and practices and where they have taken me in my journey as a therapist. In doing so, I hope to share my interest and enthusiasm and to open a dialogue with other people who may be interested.

A different ‘take’ on stammering – new beginnings My story began with a conversation with a colleague, Sam Simpson, whose work with adults with aphasia has been influenced by recent developments in disability discourse and narrative practice. This exchange sparked my interest and, keen to apply some of these ideas to adult stammering therapy, Carolyn Cheasman, Sam and I jointly ran a ‘self-advocacy’ group for adults who stammer at City Lit. Since that time, ‘social model’ thinking (which places disability firmly in society rather than within the individual), disability discourse and narrative ideas and practices have increasingly influenced my thinking about stammering therapy. Our experience at City Lit has shown, however, that the notion of disability in relation to stammering remains contentious, as reflected in the mixed response we have had to courses based on these ideas: some people have been extremely interested whilst others are less open to looking at such issues. Eager to develop my knowledge about narrative practices and interested in exploring the transferability of these ideas to stammering therapy, I embarked on a masters project at Bristol University. Having learned more about narrative ways of working, I believe there are strong links between some of these ideas and disability discourse. However, taking the ‘narrative turn’ (Hermans and Hermans-Jansen, 1995) now seems to me to be a less challenging way of incorporating some of these ideas into stammering therapy. Like many other therapists working with adults who stammer, I have never been comfortable with the medical model that places the therapist in an ‘expert’ role, with the client as an individual in need of ‘treatment’. What struck me about the narrative approach was the emphasis placed on social context, rather than the individual. Narrative therapy proposes that the problems people bring to therapy are not located within the person but rather are the result of interaction with the broader culture within which they live. This fitted with my understanding of the social model of disability that is interested in the perspective and experience of the person with the illness/disability. Narrative practice offers a particular way of understanding people’s identities and is based on the idea that we make sense and meaning out of what happens to us through the stories we tell about ourselves. These stories not only shape our sense of self, but also influence our perspective on life. What particularly interested me was the idea that the meanings people take on are not fixed and so open to re-negotiation and change. I imagine these ideas will be familiar to those with experience of personal construct psychology.

Unpacking the dominant story – finding new perspectives, Narrative practitioners are interested in the broader context (social/cultural/political) that affects people’s lives. Dominant cultures that focus on the individual and individual responsibility tend to encourage people who may be experiencing difficulties to see themselves as the problem. And indeed, many people who stammer experience negative feelings about stammering and themselves as people who stammer. Corcoran and Stewart (1998) looked at the subjective experiences of people who stammer and identified ‘suffering’ as a primary theme with the key elements being ‘helplessness’, ‘stigma’, ‘shame’, ‘fear’ and ‘avoidance’. These feelings can sometimes be interpreted as ‘low self-esteem’ by both therapist and client, ie, the problem is located within the individual and the client’s sense of individual responsibility for the problem is reinforced. Horseley & Fitzgibbon (1987) discovered that many people who stammer are subject to stereotyping. In narrative terms, stereotyping is likely to influences the stories people tell about themselves (McKenzie & Monk1997). When applied to stammering, these ideas suggest that the social and political context may be very influential, leading to the internalisation of negative perceptions of stammering and self-limiting beliefs such as: “If I stammer people will think I am stupid” “I don’t believe I can stammer and be a professional” “Boys don’t go out with girls who stammer” “I need to be better than other people to prove I can do my job”

A narrative-based approach to stammering would be interested in making explicit the role that context has played in influencing an individual’s beliefs about him/herself and stammering. Deconstruction conversations, a central component of narrative therapy, offer a way to do this. As Alice Morgan (2000) explains, these kinds of conversations ‘… help people to ‘unpack’ the dominant stories and view them from a different perspective … The dominant story becomes situated culturally and historically. These conversations often enable people to break further from a sense of guilt or blame as they come to see their problem no longer speaks of their identity.’

Neglected stories and plots Narrative ideas and practices are informed by post-structuralist thinking about identity, in particular the notion that people’s lives are multi-storied (Thomas 2002). Narrative therapists believe that whilst people have many different stories about their lives there are likely to be dominant stories which overshadow the others. These dominant stories can sometimes be unhelpful. For example, an individual may have a dominant story about being unattractive, weak-willed or unlikely to have a relationship as a result of stammering. This perception of self comes to be seen as ‘the truth’ – ‘this is how I am’, obscuring other stories of strength and resilience. Rather like the solution-focused brief therapist, who believes there are always exceptions to the problem and encourages the client to notice these exceptions, therapists influenced by narrative ways of working are interested in alternative or neglected storylines contradicting the dominant (problem) story. Through narrative conversations they look for openings to these other storylines. For example, the therapist might ask: “Was there a time when you went ahead and spoke in spite of the fear encouraging you to avoid or hold back? How were you able to do this?” “Can you think of any times when you told someone about your stammer, even though you felt you might be rejected because of it?” “What does this tell you about yourself that you didn’t realise before?” The diagram opposite illustrates the way dominant stories/plots are in sharper focus in the foreground, while, in the background, other events are waiting to be linked up to form an alternative storyline. These alternative accounts are called ‘unique outcomes’ or ‘sparkling moments’ (White & Epston 1989). Once a ‘sparkling moment’ has been identified the therapist then asks questions in order to develop and extend this new storyline. The idea is that not only do people get in touch with alternative or preferred identities, but these new stories can then be used to manage the problem differently or reduce the problem’s influence in people’s lives.

From client to co-author So how do narrative therapists conduct narrative-based conversations? What makes a narrative conversation different?
Narrative conversations are collaborative and the client takes a leading role in determining the direction of therapy. Clients are seen as the experts on their own lives, their personal experience and ‘insider-knowledge’ giving them the ‘unique ability to counter the disordered storyline of their lives’ (DiLollo 2005). The therapist’s role is that of a co-author in the generation of new stories and revised identities. Interestingly, Jane Fry’s article on Cognitive Therapy in signal, issue 21, referred to ‘Socratic questioning’. Socrates’ students were helped to learn by responding to questions rather than instructions. Similarly, a narrative therapist’s expertise lies in the ability to take a position of genuine curiosity and ask useful questions. He/she would be particularly interested in assisting the client to:

• Identify and name the problem story in their own terms
• Externalise the problem
• Explore the way the context (social/cultural/historical) has influenced their beliefs about the problem and themselves
• Explore the effects of the problem
• Find alternative stories and preferred identities (‘unique outcomes’)
• Develop stories of resistance
• ‘Thicken’ alternative stories.

Externalising practices and stammering – a good fit?
The notion of separating the person from the problem (the person is not the problem – the problem is the problem) will be familiar to those readers who have experience of solution-focused brief therapy. Similarly ‘externalising conversations’ are central to a narrative approach. For example, rather than talking about a problem as if it were an inherent part of an individual (“How long have you been depressed?”) a narrative therapist would speak about the problem as being outside of the person (“How long has the depression been influencing you?” “Are there times when the depression is not around or around less?”) These kinds of conversations enable people to separate themselves from the problem affecting their lives and talk instead about the relationship they have with the problem or how that might be revised in order to reduce the problem’s influence.

Whilst this idea interested me, I initially found it difficult to relate to stammering. It seemed to run contrary to my beliefs about the importance of clients owning, and working towards becoming more accepting of their stammer. I was interested to find that Walt Manning (Di Lollo; Neimeyer & Manning, 2002) had similar misgivings. However he goes on to suggest that this seeming incompatibility is not necessarily the case. He states: “Acceptance of and desensitisation to stuttering does not require one to accept him or herself as a ‘stutterer’ as much as accepting that stuttering is a problem and that ‘I am a person who stutters”. What has helped me to link externalising practices to stammering therapy has been to talk and think in terms of people’s relationships with problems and how these might be changed. For example, I now tend to talk about people ‘revising their relationship with stammering’ or ‘reducing the influence of avoidance’. A recent example of someone revising their relationship with stammering was a client who reflected that an important change she had made was ‘making friends’ with stammering. This was a new story for her, illustrating her preferred identity was one which not only included stammering but the relationship she had with it had changed significantly. Interestingly, this new relationship afforded her increased fluency.

The plot thickens, Whilst many people do develop revised relationships with stammering during therapy, I have noticed that once back in the outside world, many lose touch with this new story. Whilst group therapy offers a forum where preferred stories can be witnessed and affirmed, opportunities to ‘thicken’ or elaborate these new stories outside therapy may be limited. ‘Outsider-witness practices’ offer just such an opportunity. These practices are central to narrative ways of working as follows. When people are engaged in changing their relationship with problems and negotiating new identities, the journey can be a challenging and unnerving one. Other people who have ‘insider-knowledge’, that is, experience of dealing with similar problems, can be a valuable resource. One way of drawing on these resources is to set up an outsider-witness group. People with ‘insider-knowledge’ are recruited to act as audience and witness to an individual’s new story and revised identity. This forum provides a particular kind of space where preferred identities are listened to and responded to in particular ways, strengthening new storylines and making it easier for individuals to incorporate these new stories into their sense of self. The process of witnessing can take a number of different forms. Whilst there is not space to discuss them here, I am planning to develop outsider-witness practices in our therapy programme at the City Lit and intend to document this process. My hope is that by inviting people to share their stories and experiences of stammering with others, new stories will be strengthened and insider-knowledge validated. Including clients in the co-authoring process places them and their expertise at the centre of therapy, allowing me, a fluent therapist, to take a more de-centred position. It seems to me that involving clients more is a positive direction for therapy; one, which, I hope, will both enrich people’s stories of their lives and enhance professional knowledge.


J.Logan@citylit.ac.uk

References:

Corcoran, J.A. and Stewart, M. (1998) Stories of Stuttering. A qualitative analysis of interview narratives. Journal of Fluency Disorders, 23, 247-264.

DiLollo, A. and Neimeyer, R. (2004) Narrative Means to Therapeutic Ends: Application to Speech-Language Pathology and Audiology. Presentation given at the American Speech & Hearing Association conference 2004. Session No 315.

DiLollo, A., Neimeyer, R., Manning, W. (2002) A personal construct psychology view of relapse: indications for a narrative therapy component to stuttering treatment. In Journal of Fluency Disorders No27 19-42.

Fry, J. (2004) Cognitive Therapy – worth thinking about. signal No 21, Spring 2004.

Hermans, H. and Hermans-Jansen, E. (1995) Self narratives. Guildford Press, New York, USA.

Horsley, I.A. & Fitzgibbon, C.T. (1987) Stuttering children – investigation of a stereotype. British Journal of Disorders of Communication, 22, 19-35.

McKenzie, W. & Monk, G. (1997) Learning and teaching narrative ideas. In G. Monk, J. Winslade, K. Crocket, & D. Epston (Eds) Narrative therapy in practice: the archaeology of hope. San Francisco: Jossey-Bass Publishers.

Morgan, A. (2000) What is narrative therapy? An easy-to-read introduction. Dulwich Centre Publications.

Thomas, L. (2002) Post-structuralism and therapy – what’s it all about? In The International Journal of Narrative Therapy and Community Work, No 2.

White, M. and Epston, D. (1989) Narrative means to Therapeutic Ends. New York; W.W. Norton.