Sometimes during a first session, clients will say things like, "I am depressed." What they are trying to describe is how depression has taken over their lives and is taking away their will to get out of bed, go to work, and clean the kitchen. I try to pay attention to how "depression" does not give an adequate description of who they are and explore who they are apart from the problem.
One of the key tenets of Narrative Therapy is that “the problem is the problem." (Bjorøy et al., 2015). Michael White and David Epston, the founders of this approach, observed that people undergoing psychological treatment, including psychotherapy and counselling, were experiencing their bodies, minds, and relationships as problematic. This experience was backed up with psychological knowledge and language that legitimized expert conclusions about how clients’ bodies and minds had failed them.
Drawing on their experience in the clinic and their reading of philosophy and anthropology, White and Epston challenged the practice of psychotherapy and how it created and reinforced problem identities rather than helping people distance themselves from the problem itself. Hence, the person is not the problem, the problem is the problem.
While it’s one thing to repeat the mantra, it’s another to help people imagine and experience this distance. White and Epston realized that if they were going to help the people they were working with create some distance from problems they would have to counter the way that psychological approaches often internalized the problem and encouraged clients to identify themselves with expert knowledge labels.
the person is not the problem, the problem is the problem.
Descriptions of Anorexia, Oppositional Defiance Disorder, and Bipolar Personality Disorder, can be categorized, scaled, and measured to provide a greater understanding for helping professionals and clients. The descriptions themselves help to define what is and isn’t considered “normal” by the psychological community. These distinctions and descriptions, most commonly found in the DSM-5 (Diagnostic and Statistical Manual), serve as a double-edged sword. On one hand, they provide a framework for understanding and diagnosing mental health issues, offering a common language for clinicians and a sense of structure for the people they are trying to help. On the other hand, these labels can become self-fulfilling prophecies, contributing to the internalization of the problem and reinforcing a sense of identity tied to the disorder.
White and Epston's approach sought to address this by encouraging people to view their issues from a different perspective. They advocated for separating the person from the problem through a process called "externalization." By externalizing the problem, clients could see it as a separate entity that affects their lives rather than as a core part of who they are. This shift allows people to reclaim their identity apart from the problem’s influence on them.
For example, rather than labelling a person as "anorexic," Narrative Therapists would focus on the problem of anorexia as something that impacts their life but is not a defining feature of their identity. People are invited to explore how Anorexia operates in their lives, how it affects their relationships, and how it might be challenged or redefined. As a Narrative Therapist, I would also be interested in times when Anorexia didn’t get the upper hand and the person was able to distance themself from its life-destroying aims.
Stephen Madigan (2011) points out that these problems do not just come out of nowhere, they have a cultural and social history that gets ignored when we locate the problem solely in the individual. He writes, "...narrative therapy would not perceive the use of the word describing the problem of anorexia as inherent to the person suffering... Rather, the person suffering would be viewed within a complex discursive relationship with anorexia—a relationship defined by all those contributing aspects of our culture viewed as supporting of the performance of anorexia."
When we externalize these problems—rather than internalizing them and seeing them as core parts of our identity, or intractable biological certainties—we can recognize times when the problem hasn’t been a part of our lives or certain contexts where it wasn’t present. These exceptions challenge the idea that these problems are internal psychological givens as opposed to more contextual/relational ways of understanding the problem.
"...the person suffering would be viewed within a complex discursive relationship with anorexia—a relationship defined by all those contributing aspects of our culture viewed as supporting of the performance of anorexia." - Stephen Madigan
This kind of narrative reframing can help people view their experiences through a lens of resilience and capability rather than deficiency and failure. Narrative approaches highlight the importance of context in understanding problems. They emphasize that problems are not isolated but are deeply intertwined with social, cultural, and relational factors. By acknowledging these contexts, people can better understand the role these factors play in their lives and how they might influence the problem.
When we hold problems up and outside of ourselves we can ask different kinds of questions that help us recognize how these problems are not aligned with our aims for our life. Externalizing problems can help us reclaim preferred stories about our lives and help us separate our identities from the challenges we face. This approach redefines the therapeutic process and helps us reimagine our relationship to our problems.
Calvin Black is an Arbour Therapist who often uses externalization and narrative approaches to help his clients distance themselves from the problems they are facing. He works with individuals, youth, and couples.
Read more about Calvin here.
References:
Bjorøy, A., Madigan, S.P., & Nylund, D. (2015). The practice of therapeutic letter writing in narrative therapy.
Madigan, S.P. (2011). Narrative Therapy.
White, M.J., & Epston, D. (1990). Narrative Means to Therapeutic Ends.
Comments