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 >

 

 

Advertisements

Literature Review – Narrative Practice

Narrative practice theory developed by Michael White is a relevantly innovative and incomplete area of study, especially due to the death of Michael White in the midst of his research. This has left a wide spectrum of narrative practice that is yet to be studied and built on.  A specific area of interest in this review is narrative therapy regarding mental health, specifically the resulting effects of narrative therapy on the individual; whether it is positive or negative. Therefore this article will review in detail three academic journal articles to determine their relevance for further research and what areas are clearly being missed within the field.

Narrative practice is predominately used in psychology in order to discover context around a value or incident the client is describing. Morgan (2000) defines narrative therapy as a; ‘respectful, non-blaming approach which views problems separately from people’, therefore, it is obvious that narrative practice is versatile and able to be undertaken in multiple areas. Although we are mainly seeing this practice take place in physical health. Slowly the practice is being transitioned into other areas such as education, career and specifically mental health; though how often are the negative results of this practice being taken into account?

Doan (1998) is a fantastic article for initial research regarding this topic due to its pessimistic view of narrative therapy. Doan (1998 p.1) details how the human race has always employed a sense of narrative practice, where he examines the case study of Native Americans and European Christians. Through this example Doan (1998) is attempting to illustrate that narrative practice is often a group or individual believing their narrative is ‘truth’ compared to another individual or group. This is shown in his example with the Native Americans and the Europeans where he distinctly draws a connection to the Native Americans openly disagreeing with the Europeans ideal of God and the onslaught that followed.  Doan (1998) progresses to research what is narrative practice at its core but then attempts to degrade the practice by asking “Does it practice what it preaches?” (Doan 1998 p.2-3).

Doan’s conclusions are that we as a post modernism world are documenting history by telling stories of what happened, thus dismissing any genetically underpinning circumstances. Doan (1998) rather than exploring narrative practice is detailing what is wrong with the practice. Doan (1998) believes that researchers are disregarding previous factors such as genetics and are purely investigating the individual’s opinions, resulting in the individual’s opinion being held in a high regard. This article provides a practical resource as it is an example of possible negative outcomes from narrative therapy, however, that is all it offers. Rather Doan (1998) more presents a series of questions that he never attempts to answer, thus leaving this open to be further built on. Especially as his range of literature is often dated with the oldest reference used being published in 1948. Though these gaps can be filled and his conclusion of narcissism can be faulted through the discussion of the absent but implicit ideology.

The absent but implicit ideology is significant within narrative practice. Absent but implicit is based on how we interpret texts, what we hear and what we derive from them; though it extends this to being concerned about the ideals and items that we are not hearing. Ideally to simplify the ideology the absent but implicit is concerned with what is not said and it is up to the narrative practice practitioner to listen for the missing elements to derive the actual meaning. Carey, Walther and Russel’s (2009) academic article on the absent but implicit provides an in-depth view of the theory and how to undertake the methodology.

Carey, Walther and Russel (2009)’s article concludes that the absent but implicit is a further step in narrative practice that offers an extra line of support (Carey, Walther and Russel 2009 p.14), that allows individuals to see themselves in a different light. Thus helping them to reach a sense of being active within their own lives (Carey, Walther and Russel 2009 p.14). This article contrasted against Doan (1998), is trying to build on Michael Whites prior research rather than degrading the theory. Cary, Walther and Russel (2009) have provided a scaffold that describes eight directions that a practitioner can take to inquire about the absent but implicit. This is a beneficial source as each of these directions are facilitated through example conversations that provide example questions to ensure that the practice is undertaken efficiently. This article has also sighted multiple resources with the earliest having been published in 1986, therefore, rendering this article current and well resourced. However, Carey, Walther and Russel (2009) do not address negative effects of this type of narrative practice. Rather they state that this enquiry will provide the individual information about what value they are actually providing the community. Nonetheless, what if the conclusions are negative? Doan (1998) fears that many individuals are narcissistic with their opinions and what if this result for these individuals results in a negative outcome? As Morgan (2000) states some scenarios can result in seeing the individual dis-empowered. Regardless, Carey, Walther and Russel (2009) present an informative article, though it needs to be addressed how to undertake narrative practice on individuals whom are already emotionally sensitive; leading to techniques to talk about this sensitivity and possible negative solutions.

Narrative practice can uncover sensitive topics for the interviewer and the interviewee and it is important that these topics are dealt with in a respectful manner. Often whilst undertaking an interview the interviewee may reveal an unexpected topic, this topic may also be unexpected for themselves. It is imperative that the interviewer handles this topic sensitively and it can be difficult to construct questions to build on this information. This is also the case if you are implementing the absent but implicit methodology as detailed by Carey, Walther and Russel (2009) and as an interviewer it becomes apparent there are sensitive underlying issues. This can be supported by Ferguson (2014), whom discusses mental health stigma within the workplace through a case study she has undertaken with a man who suffers from depression and anxiety.

Ferguson (2014) is attempting to battle mental health stigma in the work force through narrative practice. She believes that narrative practice will illuminate triggers and help to re-connect the work environment to the broader world (Ferguson 2014 p.13), though this practice must be undertaken by an external source. This article goes through the narrative process at each step, defining stigma stalker, the client opening up regarding how he sees himself, to undertaking the absent but implicit to determine what is missing from what she is being told, to initialising this change in her client and resulting in defeating the stigma.  Each of these steps are broken down with dialogue from the interviews as well as correspondence with her client’s place of work. Ferguson (2014) provides brilliant methodologies for addressing sensitive topics, strengthened in the article by Ferguson having to address her client’s suicidal attempt. This academic article strengthens the findings in Carey, Walther and Russel (2009) by in-depth evidence of the absent by implicit being put into action. Furthermore this article has utilised a range of academic references from relatively recent sources.

Ferguson (2014) is also an Australian study, hence it holds similar cultural traits and values that will be examined within my further study. This research will be informative into how to practically implement narrative practice into a sensitive topic, though it is yet again missing any negatives that this form of narrative practice can result in. As discussed earlier, not all conclusions are positive and can lead to lower self-esteem, however, this article does not cover how to sensitively address a negative outcome with an emotionally unstable client. Also as mentioned in Doan (1998), Ferguson has ignored genetically present mental health issues, another issue that should also perhaps be addressed.

Throughout all three academic articles each has presented a different view of narrative practice and how they believe it should be addressed. Overall it is clear there is a significant gap within the literature regarding negative outcomes of the practice, and this is what my final report will seek to build on. Carey, Walther and Russel (2009) have provided an interview scaffold which is undertaken by Ferguson’s (2014) in-depth case study, especially with her methodologies of dealing with sensitive topics. Completed with Doan (1998) initialising ideals regarding the negatives on narrative practice, as well as posing a series of questions that can be built on in further research. Overall, these academic articles together provide a fantastic background for further study focusing on the singular gap found in all articles; the possible negative resolutions of narrative practice.

References:

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

Doan, R 1998, “The King is dead; Long live the king: Narrative Therapy and practicing what we preach”, Family Process, vol.37, no.3, p.379-385.

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.

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

 

>

Digital Story Project Reflection

My Digital Story: Day in the life of a Mobile Phone Addict

For my digital story I decided to narrate a day in the life of a mobile phone addict named Mia. I was attempting to show an average day in her life and her dependence and use of her mobile phone in conjunction with interviews from her close family and friends who answered questions relating to mobile phone usage and Mia’s usage. It also includes academic sources within the narration, providing an analysis of research undertaken by these academics which relate to the characteristics that Mia was displaying.

This project has taught me many things throughout this process. Firstly I have learnt many academic research conclusions regarding mobile phone addiction. This is what I found most engaging in the process of making my project, trying to incorporate these sources so the narrative still flowed. I also enjoyed learning about the different theories such as the optimal flow theory (Salehan & Negahban 2013). Theories such as this were interesting to research and engaged me to try and give more attention to detail in my film. Secondly, I perhaps have become more aware of how I use my mobile in front of people and consequently pay more attention to their body language when I do check my mobile phone in front of them. I  now better understanding the negative social effects of mobile phone usage and I am more cautious of how I use my mobile in a public space.

I found that conducting my interviews were a very affirming and engaging part of my project. These interviews helped me to set a direction for my story and added emotional weight. I found this an interesting task to undertake as I had to ensure that everyone was in agreement to being filmed and being identified by their real name or a pseudonym due to ethical issues. To conquer these ethical issues I also employed a survey through survey monkey. This allowed individuals to still answer questions relating to mobile phone usage but they were able to do this anonymously. Another ethical issue I encountered was the use of the Facebook advertisement, however, due to it being an advertisement this usually means the item is in the public domain and the copyright act (Copyright Act 1968 (Cth)) states I can legally use this clip due to it being used for educational purposes.

I uploaded my project on YouTube and then shared my link on Twitter and Facebook. This was in an attempt to receive feedback and views on my content. My story received positive responses as well as some laughs from minor humour elements, e.g the toileting scene. Though I also found that many of my audiences members, whether it be comments on my Facebook link or my family and friend’s comments, found my video educational and also tended to see parts of themselves within Mia which allowed the audience to be further engaged, as individuals tend to better connect with a story if they find common elements of themselves in the main character. This was a significant achievement for me as I often felt my story did not have enough emotive language in its narrative.

When I analyse my project there are a few things I would perhaps change if I was to undertake a project such as this again. As noted by Kajder, Bull & Albaugh 2005 a basic script is the starting point to a good digital story thus, I would go further than a story board and I would create a proper narrative. My narrative started weak and was formed around scenes I wanted to convey and quotes from academic sources. Next time I feel I would benefit from constructing my narrative around the story I hope to convey and then incorporate my academic sources into my project. However, I did learn the benefit of having a recorded narrative before conducting filming, unlike Kajder, Bull, & Albaugh 2005 who suggested to do the latter first. I found producing the narrative first beneficial as this allowed me to visually see the length of parts I needed to film this also allowed me to better deconstruct my narrative.

I did find the narrative a significant challenge and found this project quite puzzling in the way I needed to incorporate an emotive narrative in conjunction with journal articles as mentioned above. I found it difficult to grasp the concept of a narrative that flowed efficiently as a story and not as a report when it had to incorporate academic sources. I often struggled with ensuring that my project remained a story rather than a verbal essay. However, I learnt this issue through my many play backs of my project which allowed me to return and record further narrative to try and bring my project back to the basis of a wholesome story. Though I believe that in future presentations I have learnt a better way to attempt my task and this feature will be improved.

Thus I believe my project was effective in telling the story of a mobile phone addict through an academic and emotive manner. I did struggle finding a balance between the amount of narrative and academic sources, however, I have learnt many things from undertaking this project that I would employ next time.

Reference:

Copyright Act 1968 (Cth) part 4, Copy Right in subject matter other than works, Division 6

Kajder, S. Bull, G & Albaugh, S 2005, ‘Constructing digital stories’, Learning and Leading with Technology, vol. 32, no. 5, p. 40.

Salehan, M & Negahban, A 2013, ‘Social networking on smartphones: when mobile phones  become addictive’, Computer in Human Behaviour, vol. 26, no.6, pp. 2632-2639