Narrative Means to Therapeutic Ends: A Book Review

Michael White and David Epston published a book, in 1990, titled Narrative Means to Therapeutic Ends. This book is a culmination of the therapeutic work of each of these authors, though much of it was constructed independently (White & Epston, 1990).  Narrative Therapy is considered one of the major models of Marriage and Family Therapy.

Story, Knowledge, and Power

The volume begins by reviewing some developments in social theory and how these are connected to therapeutic practices. The author’s purport that objective reality cannot be known, which leaves us only with our interpretations. Narrative Therapy chooses to focus on the meaning that one contributes to the interaction, instead of the interactions themselves. White and Epston (1990) write:

In regard to family therapy—which has been our areas of special interest—the interpretive method, rather than proposing that some underlying structure or dysfunction in the family determines the behavior and interactions of family members, would propose that it is the meaning that members attribute to events that determines their behavior. (p. 3)

They further state that, “…family members’ cooperative but inadvertent responses to the problem’s requirements, taken together, constitute the problem’s life support system” (White & Epston, 1990, p. 3).

Social sciences have developed their own analogies to interpret human behavior. A specific example of this is below:

If a person experiencing some form of acute crisis presents to a ‘clinic,’ and if the work of this clinic is oriented by the analogies drawn from the tradition of positivistic science, then it is likely that the crisis will be interpreted as some sort of breakdown or regression. (White & Epston, 1990, p. 7)

Positivistic science claims that absolute truth exists and can be known. Next, the person will be give some sort of psychiatric diagnosis, and clinicians will search for the root cause according to their training. The authors write that the very same person’s behavior, when interpreted through a “rite of passage analogy,” could be viewed as a necessary struggle to move forward into new territory (White & Epston, 1990, pp. 7-8).

The authors focus on text analogies, which left room for evolving interpretations. White and Epston (1990) write:

Social scientists became interested in the text analogy following observations that, although a piece of behavior occurs in time in such a way that it no longer exists in the present by the time it is attended to, the meaning that is ascribed to the behavior survives across time. (p. 9)

Based on this premise, therapy becomes an opportunity for people to create “alternative stories that enable them to perform new meanings, bringing with them desired possibilities—new meanings that the person will experience as more helpful, satisfying, and open-ended” (White & Epston, 1990, p. 15). The text analogy is also useful when examining how stories emerge from the greater sociopolitical context, and when considering the power of the dominant story.

The writers also place great emphasis on the work of Michel Foucault, a French philosopher. Foucault claims that knowledge and power are linked to each other, and that one cannot exist without its counterpart. He also states that we have all been subjected to “normalizing judgment,” which is “the evaluation and classification of persons and relationships according to dominant truths” (White & Epston, 1990, p. 31).

Externalizing the Problem

The second chapter begins with an objective definition of the term externalizing. White and Epston (1990) write:

“Externalizing” is an approach to therapy that encourages persons to objectify and, at times, to personify the problems that they experience as oppressive. In this process, the problems become a separate entity and thus external to the person or relationship that was ascribed as the problem. Those problems that are considered to be inherent, as well as those relatively fixed qualities that are attributed to persons and to relationships, are rendered less fixed and less restricting. (p. 38)

Externalizing problems has many important implications for therapeutic practice. This stance in therapy “decreases unproductive conflict between persons, including those disputes over who is responsible for the problem,” “undermines the sense of failure that has developed for many persons in response to the continuing existence of the problem despite their attempts to resolve it,” and “paves the way for persons to cooperate with each other, to unite in a struggle against the problem, and to escape its influence in their lives and relationships” (White & Epston, 1990, p. 39). In addition, externalization “opens up new possibilities for persons to take action to retrieve their lives and relationships from the problem and its influence,” “frees persons to take a lighter, more effective, and less stressed approach to ‘deadly serious’ problems,” and “presents options for dialogue, rather than monologue about the problem” (White & Epston, 1990, pp. 39-40).

Through externalization, people are able to “identify previously neglected but vital areas of lived experience” and these are referred to as “unique outcomes” (White & Epston, 1990, p. 41). In order for a person to “engage in performances of new meaning,” the unique outcome needs to be placed into an alternative story about the person’s life (White & Epston, 1990, p. 41).

The book gives a clinical case example of externalization. White and Epston (1990) treat a six-year-old boy who has an encopresis issue. They question the family to map out the influence of the encopresis problem in their lives and relationships. Eventually, the problem was dubbed “Sneaky Poo,” an entity external to the boy (White & Epston, 1990, p. 46). The boy was able to recall times were he had out witted “Sneaky Poo,” and resisted cooperating with him by smearing him on the wall (White & Epston, 1990, p. 46). The family was able to unite against “Sneaky Poo” and come up with new alternatives (White & Epston, 1990, p. 47).

The book then turns back to discussing the constructs of Michel Foucault. They continue to develop the concepts of power and control through the illustration of an architectural form called a Panopticon (White & Epston, 1990, p. 67). The Panopticon was designed as a way to fully utilize people’s labors with the least amount of supervison possible.

A Storied Therapy

In this section, the authors draw some distinctions between what they call logico-scientific and narrative ways of thinking. Narrative gives privilege to the person’s lived experience. Also, narrative focuses to temporariness of stories, and these stories are not required to with stand the test of time to be considered as truth. Narrative utilizes the resource of language and is accepting of multiple interpretations of the same story. In a narrative framework, a person is not a passive observer, but an active participant in “re-authoring” their stories (White & Epston, 1990, p. 82).

Further into the chapter, White and Epston (1990) show examples of how to use letters in the therapy process. They include specific examples of letters of invitation, redundancy letters, letters of prediction, counter-referral letters, letters of reference, letters for special occasions, brief letters, and letters as narrative. The bulk of this chapter was the content of these letters.

Counter Documents

This chapter takes a look at how modern documents can have a direct role in the re-authoring of people’s stories (White & Epston, 1990, p. 187). They review reasons why using these documents can be useful. The authors then give examples of using certificates, declarations, and self-certifications.

Critical Review

I had many thoughts as I read through this book. The first chapter, which focuses much on philosophy, is written in a more cerebral and intellectual way. I had to read, and reread to glean any genuine understanding of the material. They introduce several concepts without giving clear definitions of what they intend to convey (e.g. analogy). The second chapter was personally a more enjoyable read. I think one of the best ways to teach a new conceptualization is through case study examples. I am impressed with the uniqueness of the externalization technique, and I think it sets Narrative Therapy apart as a theory. The last two chapters included direct illustrations of how to utilize letters and other documentation in various ways. Also, I enjoyed reading the more clinically oriented sections of the book.

I would recommend that others who are interested in Narrative Therapy read this book. Yet, I think I would instruct new therapists to read some of the more pragmatic material first. I think could be an intimidating read for a new therapist. Overall, this is a foundational book that every Marriage and Family Therapist should have on their bookshelf.

Have you read this book?  What did you think?  Please, take a moment and leave a comment below.

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Reference

1. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: W. W. Norton & Company, Inc.

Check out Summit Family Therapy in Peoria, IL to learn more about Dr. Courtney Stivers’ professional work.