When the Problem's the Problem

The possibilities of narrative therapy


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Imagine a form of therapy in which you view your problem -- be it bulimia or marriage trouble -- as an external issue outside your basically sound psyche. Now further imagine that this therapy is often effective in many fewer sessions than the more traditional three-years-and-a-couch method. Sound too good to be true? Welcome to narrative therapy, a down under import that is beginning to revolutionize mental health care. Developed by Australian therapist Michael White and New Zealand therapist David Epston, narrative therapy's key trick is to externalize a patient's problems, that is, to put them outside the person himself. As Bill O'Hanlon put it in Family Therapy Networker (Nov./Dec. 1994), 'The hallmark of the narrative approach is the credo, 'The person is never the problem; the problem is the problem.''

In narrative therapy, says Australian therapist Zoy Kazan, 'the person is freed from the burden of seeing the problem within him or herself.' Rather than dwelling on the presenting issue -- be it anorexia, obsessive-compulsive syndrome, or sexual abuse -- clients are encouraged to 'construct a new story that takes in all their strengths, and the ways they've stood up to the problem,' she says.

Narrative therapy also externalizes problems by focusing attention on their larger social and cultural contexts. For example, plenty of gays and lesbians are depressed, especially as teens, because of how society continues to pathologize homosexuality. 'If you grow up in a family, school, or church that believes homosexuality is wrong, the logical next step is to think you're not an okay person,' explains Kazan.

Because narrative therapy is not concerned with having patients re-experience their traumas, it can be a quicker way to get mental piece of mind than more traditional methods. For this reason, as well as for its newfound popularity, some critics suggest it's just another quick-fix fad therapy driven by managed care cost-cutting. While Kazan denies that narrative therapy is all about brevity, she acknowledges that when 'you don't have to peel off all the layers of the onion,' therapy can be shorter. However, she sees both narrative's brevity, and its proven effectiveness, as advantageous -- as most patients probably will as well.