When the Problem’s the Problem

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

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.

In-depth coverage of eye-opening issues that affect your life.