'narrative means to theraputic ends' – book summary and review

Quick summary: Below is a book review for ‘Narrative means to therapeutic ends’ written by Michael White and David Epston. I use this opportunity to highlight the major themes of Narrative therapy in general. This is a great book!
For more information about David and Michael you may visit http://www.dulwichcentre.com.au/ (this is a center in Australia which is dedicated to helping people through narrative therapy (Epston and White were co-founders I believe) – the book I am reviewing is a must read for the philosophically inclined – you can get this book at any major online retailer or by clicking the web site above.
Review of White and Epston’s
Narrative means to therapeutic ends
Summary of the basic content of the book
 
            This book starts out very philosophical. White lays out his reasoning for his narrative view and compares that view point against other widely known theories concerning the way we perceive and organize our existence. He explains why he disagrees with certain aspects of the more objective sciences and educates us on some of the current themes in the social sciences. In his philosophical discussions he briefly explains some of his techniques used in narrative therapy. The last two thirds of the book are devoted to helpful examples of how to help clients by offering written narratives. The letters are real and the authors offer their reasoning behind each different type of letter.
What this book is not- this book does not focus on the actual therapy sessions and the way that those sessions could be conducted by a narrative therapist. Instead this book was primarily written to explain the philosophical tenets that led to the narrative therapy model and an in depth explanation on how to use written letters to help your clients.
The Philosophical beginning
 
Power- White fist talks about the two opposing views on the concept of power. One theory being that power is a construct maintained through language and the other theory being that that power actually exists and can be utilized to oppress others. 
Text analogy-The narrative view point is related to the social scientist’s text analogy which suggests that given objectivity doesn’t exist and we cannot actually know a true reality, we then make up stories, which serve as our interpretations of our subjective perceptions.  In this way White extrapolates that change can occur by “re-authoring” or telling a different story about the same perception.
Positivist physical sciences and biological sciences- To understand the text analogy it is nice to compare it to other leading theories on how change occurs. The two theories above believe in a degree of objectivity and therefore look at change in more definite terms. In short, a problem cannot be altered by changing the way we perceive it; instead a problem must be isolated, diagnosed and then removed as if it were tangible. Essentially the problem actually does have an objective existence, which is in contrast to the text analogy which would suggest that a problem is only a problem if one chooses to perceive it that way.
The inherent shortcoming of using narratives as a means of organizing our lived experience– White suggests that we do not in fact offer a story to all aspects of our lived experience; instead we tend to focus on stories that fit nicely into our dominant story and perhaps into that story which is most pervasive in our society at large. White uses this belief as the starting point for many of his narrative techniques. Essentially he suggests that we can offer precedence to un or under-narrated aspects of our lived experience to offer a change in the way we perceive our lives. This flows right into the concept of unique outcomes, which is a technique used to find an exception to the dominant “problem saturated” narrative.
Foucault and his view that power and knowledge are essentially the same thing- White references this man quite often and uses some of his philosophies to explain the many dimensions of the narrative perspective. It is suggested that power is knowledge because when we push an ‘objective truth’ onto a society the individuals in that society will align their own narratives around the dimensions outlined in the ‘truth’. In this way knowledge is power as knowledge can be used to direct the narratives of individuals in the direction of agreed upon truths. This has many Multi-Cultural themes as the dominant cultures have historically suppressed the subjective narratives of individuals in minority groups by forcing them to align with oppressive narratives. In simple terms, when an individual believes a stereotype to be true they might write their own story in a way that ignores authoring their experiences that are contrary to the stereotype.
Brief overview of Narrative techniques (extremely simplified) – White and Epston include these in their theoretical discussions and they use these concepts in their letters to their patients.
            Deconstruction – The therapist asks question to get to the specifics of a stated experience. So instead of saying,” I am sad,” the client would specify that ,” when my child’s incontinence came into our life I have noticed that a heightened sense of irritability towards my spouse came with it.” This is used to show that an event can be interpreted many different ways and the idea that there is solely one meaning to a perception or narrative is what some authors have described as an illusion. This technique has dialectic attributes as the therapist might ask questions such as what is good about that event and what is bad about that event. When a client can see an experience with greater dialectic maturity she/he is more able to re-author that experience in a way which will best serve her/him.
            Externalizations – This is used to help the client to separate the problem they are facing from their identity. Often this simply involves the addition of a preposition such as ‘I am with depression’ in stead of ‘I am depressed’. White and Epston will ask their clients question such as,” and when did this depression enter into your life?”
            Therapeutic questions – Are used to decipher the client’s narrative. They are used to help the therapist to understand the client’s perceived reality. As objectivity does not exist it is important for the therapist to get an idea as to how the client perceives their lived experience and how the client authors what he/she perceives. White enjoys asking question with words that suggest the inevitability of the new narrative coming to fruition. He will say “when this happens” instead of “if this happens”.
            Unique outcomes – The therapist tries to help the client to give examples of instances where the problem was resolved or viewed differently. The therapist tries to get the client to tap into un-authored aspects of their lived experience. The un-authored experiences are unique or different from the dominant story, which the client might be having trouble living within.
            Definitional ceremonies – out-side observers re-tell the new narrative of the client to “thicken“the new narrative.
            Therapeutic letter – (from the therapist) helps in displaying the advancement of new narratives, and to give positive feedback and encouragement. This is the main concept of the book and will be described in great detail below.
            Supportive leagues – this is essentially a gathering of people who have separated a problem from their identity and can work together to co-create narratives to stay successful. If a group was being oppressed by a socially constructed truth, they can band together to author a different interpretation.
Goals of therapy – The goals of therapy are to separate the client form the problem and to re-write self defeating narratives.
Written tradition vs. oral tradition – White gives us the argument in favor of writing letters containing alternative narratives. White supports his idea of writing letter by offering some points on the advantages of the written language. For one, our culture tends to put more emphasis on the sense of sight than any of the other senses. Therefore it is easier for us to accept a new story when we can see it. Second, a written story offers a sense of time which then aids the reader in making meaning from the temporarily relevant narrative. In other words it allows us to see our story in a timely context so that we might make meaning from the linear conglomerate of perceived experiences.
Panopticon- White ends his philosophical discussion with a jab at the current systems in place for oppressing the populace by quantifying existence and allowing it to be constantly evaluated based on the constructed variables of those in dominant positions. The Panopticon was literally an architectural design that would maximize the efficiency of those people working within its boundaries. The inhabitants were all classified and then were measured on set variables. All the inhabitants were made to believe that they were constantly being watched though the architecture was actually designed so as to create the illusion of constant observation. The example was mostly a metaphor used to display how fear can be used to get a populace to adhere to dogma so that they can be controlled. With a freedom from dogma, which is essential if one is to adhere to postmodern principles, our authentic self in free to narrate our perceptions towards our existential growth.
Letters written to clients and people relevant to the clients- White and Epston believe that it is important for people around you to share in your new narrative. Sometimes letters are written to people other than the client so that a new narrative can be shared with significant others; this is especially important given the systemic nature of this theory’s base. Often the process of letter writing is a collaborative effort between the therapist and the client/s.
Types of letter (I will try and be brief) he calls them Narrative Modes
 
           
            Letters of invitation – Given narrative therapy is a systems theory it is desirable to involve multiple members of that system.  There are often times when a member of the system is not present at a therapy session though their presence could be of benefit. These letters are sent to encourage a person or people to attend a session by sharing some of the new narratives of the attending people with the absent person or people.
 
            Redundancy letters – in this case redundancy is related to the jobs or familial roles that people perform within a given system. These letters are often written by the client with the help of the therapist to inform someone that they have been relieved of their job. As the client re-authors his/her life, the resulting independence might lead them to relieving a person from a care giving role. In this example a letter would be written to the caregiver so that the caregiver can accept the new independent narrative of the client.
            Letters of prediction – In these letters the therapist writes a new narrative which encompasses the goals and hopes of the client. The premise is that the client will believe the story and the belief in the new story will result in the prophesy coming true. Essentially the therapist writes what will happen and the client then makes it happen.
            Counter-referral letters – In these letters the new narrative is sent to the person who referred the family to the therapist. This is a way of spreading the new narrative and offering a follow up to a potentially concerned person.
 
            Letters of reference – In certain situation clients are found to believe a troublesome narrative because it has been pushed on them from an important person in the client’s life.  In Epston’s example he was meeting with a couple who were constantly told that they were bad parents by the husband’s parents. The clients ended up believing the narrative which suggested they were bad parents despite the overwhelming amount of evidence to the contrary. In this situation a letter that was filled with lived experiences in support of a new narrative (that they were good parents) was written to the husband’s parents. Again this is an attempt to get more people to participate in an alternative narrative.
            Letters for special occasions – These letters are written to help a client prepare for a potentially stressful occasion by writing down how the client would like the occasion to proceed. All pertinent information that is necessary for the other members of the system to perceive the client accurately during this special occasion is included. These letters are pre-emptive in that the purpose is often to explain how the client perceives the situation so that other members of the system can interact with the client with insight.
            Brief letters – There is a vast array of content that might be included in brief letters, and there seems to be one consistent theme. The theme is to let the client know that you are thinking about them and that you genuinely care. Often times these letter offer a brief summary of the new narratives of the last session. Other times brief letter might be sent to an old isolated client to simply let them know that you are thinking about them. The act of receiving mail tends to make people feel important. Brief letter are very often used to offer a quick reminder that the client can use the above techniques to re-author aspects of their lived experience.
            Letters as Narrative – These letters essentially encompass all the aspects of the narrative theory. They are used to depict the linear nature of the client’s story while showing that that story can progress forward without the detriments of inevitability. The process allows the client to first externalize the troublesome variable and then choose how they intend to author their story. Often a letter will be offered by the therapist in which unique outcomes and other progress will be summarized. The client will then write back a letter including the advancement to their new narrative. Again, seeing your story on paper helps you believe it. This has a lot of over lap with the secret, which is very popular these days. In a sense you can create your own truth as you are the author of your own life.
Self stories – these are letters written by the client once they have successfully authored their story in a way that fits their liking. Once the therapeutic process has been successful and the client feels great within her/his new narrative these letters offer significant others the opportunity to read the new story of the client. This new story can include a re-authoring of the past present and the future to anyone the client so desires. The letters are the client’s authentic autobiography.
Counter Documents – These are awards or diplomas for the successful completion of a goal. They are a visual reminder of success.