Narrative Practice with individuals who suffer from Mental Health Disorders

Australia’s mental health disorder rate is increasing, raising the demand for more effective treatments. Often counselling sessions are generic, merely discussing the sole issue rather than exploring the clients surrounding life narrative. This article will be reviewing narrative practice theory developed by Michael White, this practice is a potential solution as an applicable treatment for mental health disorders. Narrative practice is an incomplete area of study, nevertheless, this allows a wide spectrum of areas to be built on. This article will review narrative therapy regarding mental health, specifically depression/ anxiety and bi polar disorder, it will be analysing the effectiveness of this practice on the individual and whether it results in positive or negative outcomes.

Firstly narrative practice as a term should be discussed and defined. Narrative practice was developed by Michael White, though this research was never completed due to his sudden death.  Morgan (2000) defines narrative therapy as a; ‘respectful, non-blaming approach which views problems separately from people’.  Whilst Ikonomopoulos, Smith and Schmidt (2015 p.460-461) define narrative therapy to be based on peoples experiences and the situations constructed through cultural and social interactions. This definition has not separated this therapy from the individuals, rather it takes the view that societal views have a significant impact on a person’s individual self-worth. This is the definition that will be implied through-out the rest of this analysis whilst focusing on mental health disorders and specifically Ferguson’s (2014) idea of stigma stalker, which will be discussed later.  Mental health disorders have become a pandemic in Australia, as of 2007 forty five percent of Australians between 16-85 years of age at some point in their life experience a mental disorder (Australian Bureau Statistics 2010) and it can be assumed that this number is slowly increasing. Therefore, it should be studied whether narrative practice is an alternative therapy for individuals with mental health disorders. Unlike traditional counselling sessions it is believed that narrative practice will see clients opening up through-out the process providing greater in-depth answers about what shapes the individual (Dulwich Centre 2002). The concern about narrative practice being undertaken with individuals that are suffering from mental health disorders, is the sensitive nature of their condition and it is unclear how they will interpret their results. Morgan (2000) notes that some narrative therapy scenarios can result in an individual becoming dis-empowered, thus it is important that the session is handled with care.

Stigma stalker is defined by Ferguson (2014 p.4) as the judgement and shame that consistently follows individuals with mental health disorders. This stigma is either felt from the individual’s personal beliefs or they believe it is radiating from their colleagues or family and friends. Stigma is a significant barrier for individuals with mental health problems, this is why it is important to not separate the practice from the individual; as often this stigma in society is the main issue. The crux of narrative practice in this instant is to address the damaging effects that society has created for these individuals (Burgin, Gibbons 2016 p.53) and to ultimately allow them to see there is a story beyond their mental health struggle (Ikonomopoulos, Smith and Schmidy 2015 p. 461). An excellent example is Anderson and Hiersteiner (2008 in Ikonomopoulos, Smith and Schmidy 2015 p. 461) whom worked with incarcerated youth, majority of whom were repeat offenders and suffered from a mental health disorder. It is clear that Anderson and Hiersteiner (2008) employed the absent but implicit in this research, the absent but implicit is a technique that encourages double listening. Ultimately the listener will be hearing the problem but will also be contrasting it with what the client is leaving out of the narrative (Carey, Walther and Russel 2009 p.321). Carey, Walther and Russel (2009 p.321) states that we can describe meaning by contrasting it with something else, and this is what Anderson and Hiersteiner (2008) are attempting to do within their work. The majority of the youths described their narrative around their abuse and recovery. Whilst through implementing the absent but implicit Anderson and Hiersteiner (2008) were able to help these youths create a life story beyond their abuse and recovery by re-authoring their life narrative. Resulting in these clients being able to consider future possibilities (Ikonomopoulos, Smith and Schmidy 2015 p. 461).

Similar narrative therapy has been undertaken with adults that suffer from bi-polar disorder. Bi-polar is a significant mental health disorder that results in the individuals mood fluctuating between extremes, thus this is a very sensitive area to address. Burgin and Gibbons (2016) studied the outcomes of adults with bi-polar who have received narrative practice as a treatment and detailed their outcomes. Their findings were significant and once again they found that society has created an oppressive and dominant story for these individuals (Burgin and Gibbons 2016 p.54), furthering Fergusons (2014 p.4) idea of stigma stalker.  Burgin and Gibbons predominately focused on middle aged and up individuals in their study which they found to have remarkable results. They altered narrative therapy into ‘narrative gerontology’ (Burgin and Gibbons 2016 p.55), this provides emphasis on the inside of aging and ultimately focuses on people and their stories. This had remarkable results, the study found a significant decrease in depression rates. This directly shows that narrative therapy has distinct results, especially in an older client. Burgin and Gibbons (2016 p. 58) states that narrative therapy is an ideal treatment to assist adults with a disorder such as bi-polar, as it provides them with a greater importance and power. Here rather than implementing the absent but implicit, it seems Burgin and Gibbons (2016) have implemented the re-membering technique (White 2005 p.13); where conversations are not merely a passive recollection, instead these engagements are given purpose. Burgin and Gibbons (2016 p.54) attempt to externalise the problem and revise their narratives such as attempting to have their client remember a time when a stranger said hello to them utilising re-membering to create new meaning. Ultimately they utilised this to help individuals whom felt alone revise their life to see they are not always alone and notice the little conversations they have missed.

Narrative practice is meant to develop a sense of one’s self, through discovered values and missed elements within their life. Though these results are always conveniently positive with negative outcomes never included within the studies. Ferguson (2014 p.3-4) has detailed a scenario where she felt the impacts of a possible negative outcome from her narrative therapy treatment. Her client Joe in the middle of his treatment attempted suicide. This was a setback for Ferguson (2014 p.3-4 ) whom clearly was unsure if she should continue treatment and discusses the sensitivity of the disorder. Ferguson (2014 p.13) attempts to connect Joe with the broader world by using narrative practice to help him externalise and re-author his narrative. It is clear she only achieves this technique by first implementing the absent but implicit as defined earlier. Ferguson (2014 p.3-4) started her study through the admittance of having to gain Joe’s trust, therefore, she had to apply the absent but implicit to fully comprehend Joe’s entire story and what he was leaving out, here it was clear she was able to connect him back to his love of teaching. Hence revealing to Joe that has a strong value of education and teaching, demonstrating Joe’s importance to the world. Though much of Joe’s anxiety was from his career due to stigma stalker within the work place, although narrative practice may have showed Joe how to re-author his narrative to reveal a narrative of value without depression. It was also evident that narrative practice does not solve external factors that have potentially inflamed the mental health disorder.

It is clear that narrative practice has limitations and cannot be the entire treatment for mental health disorders. Burgin and Gibbons (2016 p.58) discuss multiple limitations of the practice they encountered throughout their study. They note that for the practice to be fully successful requires the client to undertake reflective thoughts outside of the therapy (Burgin and Gibbons 2016 p. 58), whilst many individuals suffering from a mental health disorder are unlikely to continue reflective thought. They further their analysis to include that narrative therapy can be a closed practice where the ‘value of ones life can only be reflected on through one path’ (Burgin and Gibbons 2016 p. 58), where they believe this is a direct contradiction to the core of narrative therapy. Though it is evident through Anderson and Hiersteiner (2008 in Ikonomopoulos, Smith and Schmidy 2015 p.461) study, that the final negative argument by Burgin and Gibbons (2016 p.58) can be argued. As it was clear, as discussed earlier, that the youths within their study were able re-author their narrative to move past their mental health disorders and seek a future from a single path of reflection.

Narrative practice is an alternative therapy that should be considered for individuals suffering from a mental health disorder. It is clear through the detailed studies above that there has been significant outcomes, where narrative practice has allowed mental health suffers to re-author their life to envision themselves without their illness. It also has allowed these individuals to re-member their narrative to notice small conversations they may have missed, in hope they will see they are not alone but merely they were guided by their disorder. Nevertheless, this is a sensitive area where some individuals may not find solace in re-authoring and discovering their values through narrative practice, as they may not attribute positivity to them, which leads to dis-empowerment. It is obvious that narrative practice has negatives as a therapy, but this has been outweighed by the positive outcomes. However, it is clear that narrative practice should be considered for mental health disorders but perhaps coupled with other therapy methods simultaneously.

References:

Australian Bureau of Statistics 2010, ‘Feature Article 2: Mental Heath’, Year Book Australia 2009-2010, ABS, viewed 8th June, < http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1301.0Chapter11082009%E2%80%9310 >

Burgin, E & Gibbons M 2016, ‘”More Life, Not Less”: Using Narrative Therapy With Older Adults With Bipolar Disorder’, Adultspan, Vol. 15, No.1, pp.49-59.

Carey, M, Walther, S, & Russell, S 2009, ‘The absent but implicit: a map to support therapeutic enquiry’, Family Process, 48, 3, pp. 319-331.

Ferguson, S 2014 “Using narrative practices to respond to Stigma Stalker in the workplace a journey with Joe”, The International Journal of Narrative Therapy and Community Work, no.4, pp.1-15.

Ikonomopoulos, J, Smith, R & Schmidt, C 2015, ‘Integrating Narrative Therapy within rehabilitative programming for Incarcerated Adolescents’, Journal of Counseling and Developmen, Vol. 32, No. 4, pp.460-470.

Morgan, A 2000, ‘What is Narrative Therapy?’, Dulwich Centre, viewed on 30th March 2016, < http://dulwichcentre.com.au/what-is-narrative-therapy/ >

White, M 2005, ‘Workshop Notes’, Michael white workshop notes, Dulwich centre, viewed 9th June, < https://www.dulwichcentre.com.au/michael-white-workshop-notes.pdf >

 

 

Forgotten inside

Disclaimer: All names have been changed to protect the individuals

When people discuss anxiety they focus on general anxiety, panic attack disorder and obsessive compulsive disorder. Agoraphobia is often an overlooked area of anxiety and there seems to be limited discussion within this area.

I wanted to find out more about agoraphobia but not from a health profession, but from someone who has suffers from the condition. Firstly what is agoraphobia?

Merriam Webster dictionary defines agoraphobia as;

Noun: Abnormal fear of being helpless in an embarrassing situation that is characterized especially by the avoidance of open or public places

Agoraphobia in the worst cases can result in an individual being confined to their house or even worse to their room.

Recently I met up with Susan Jones, a 21 year old young women who has been struggling with agoraphobia since 2011. I wanted to understand how Susan saw her mental health condition and to receive first-hand knowledge about agoraphobia.

Susan has been clinically diagnosed with multiple anxiety types; generalised anxiety, agoraphobia and obsessive compulsive disorder. Susan has also been diagnosed with depression and hypochondria. Susan’s conditions stem from her fear of becoming ill or having an anxiety attack within a public place. Sadly for Susan, she has been suffering with her mental illness since she was sixteen years old, although her agoraphobia was not prevalent until Christmas in 2010. Susan states her agoraphobia started at  a slow pace where she was unable to sit in traffic, take certain routes on her travel to eventually resulting in her being confined to her home.

Susan has pin pointed a single aspect in her life that she believes lead to her agoraphobia being prevalent, it was in 2010 when her family had to move from their family home and were briefly homeless.  Susan remembers thinking, “I’ll feel better once I settle down in a house”, which was not the case. Anxiety attacks have a lasting effect and many suffers describe an attack to bring them to their knees. Susan informed me that she recently had a panic attack that left her in what she described a ‘vegetative state’.

Anxiety symptoms vary for each person though they may include, vomiting, dizziness, heart palpitations and tingling sensations. Anxiety is good at tricking your brain into believing it is something else, for example it is common for people who present themselves to the Emergency Room assuming they are having a heart attack to be actually experiencing an anxiety attack.

Susan states she has experienced all of these symptoms but her anxiety led to her in 2011 losing 55kgs, being confined to her house to the extent that Susan was unable to leave her bed (besides using the bathroom), Susan was not able to get up for meals or to shower. She described this time in her life as the time she was a “Prisoner within her own body, and there was no way out.” Susan then attempted to take her own life which resulted in her hospitalization. She saw this as progress in her agoraphobia recovery, due to her being forced to leave her home.

It was at this point Susan sought help. She would like to stress that if you experience symptoms to seek help immediately, through your doctor or counselor. Your University may even  provide a free counselling service, or if you are uncomfortable with seeking help face to face services such as beyondblue, headspace and lifeline provide email or instant messaging services which allow you to speak directly to a counselor.

Agoraphobia provides a double edged sword for suffers, they attempt to seek help, however, as Susan noticed it is overwhelming as Susan was unable to leave the confines of her home to seek help. This is why services mentioned above are important to utilise though they can only help to a certain point. It took Susan months of searching to find a psychologist that was willing to attend a home visit, with her first counselling session taking place in her bedroom. These session resulted in Susan being able to go for small car rides without experiencing a panic attack, though this was after months of rehabilitation and determination. However, the psychologist was unable to continue, due to being an adolescent counselor. This resulted in Susan being re-assigned to a psychologist who, ‘traumatised’ her and resulted in her having a panic attack in the middle of the street, increasing Susan’s fear of having a public panic attack.

It is important to remember that if a psychologist does work for you to discontinue your sessions and find a psychologist that will be able to work with your personality. Rehabilitation will be difficult and you may relapse but there is a difference between relapsing and being pushed into further anguish by a psychologist.

Susan has gone into recovery seven times and has undertaken multiple treatment options such as; shock therapy, exposure therapy, medication, counselling and self –help books. Susan has continued to use self-help books and medication, though it is stressed that you only try treatment advised by your health care professionals.

Though I was curious how does agoraphobia effect your loved ones? Susan has a fiancé and still lives with her parents. Susan’s agoraphobia has led her to missing out on important family events including the birth of her nephew. She notes that she has had multiple arguments with her loved ones and this hinders her recovery but she understands that her condition can frustrate her family when they often feel helpless with her condition.

Though it is important to remember that even though anxiety often results in clinging to certain individuals, this is the case with Susan and her fiancé, we must also try and ensure their mental health is looked after as well. Organisations such as Beyond Blue, Anxiety online and lifeline provide information for carers. One of the most important things to Susan is to ensure her loved ones live a normal life. If you are a carer Susan stresses to not give up on your loved one but to, ‘love them unconditionally, be supportive and treat them well, don’t not enable their anxiety’.

Susan is an inspiration to anxiety suffers, she continually is trying to rehabilitate herself whilst trying to keep a normal family life. During the past four years Susan has also gained accreditation from the Erin Shaw Academy to practice makeup, even though she has not left her house she is still trying to live as though she is not agoraphobic. Susan has overcome multiple attempted suicides, being contained to her bed and is still a remarkable inspiring woman who is a happy and a kind person. Susan is also a brilliant role model to those suffering from a mental illness to never give up, because each and every time she goes through recovery she feels she becomes stronger.

Sadly Susan is still suffering from agoraphobia and is still confined to her house. She hopes her story can help anyone else that is suffering or is a career for someone suffering from agoraphobia.

If you are experiencing any symptoms of anxiety please seek help from your health care profession. I know it is hard to sometimes face someone in real life, please do not forget there are multiple organisations that provide online services that allow you to email or instant message a counselor. In a life threatening situation please call 000 or if you are having serious thoughts of self-harm please immediately contact life line on 13 11 14.