Unpacking Psychological Disorders: An experience with narrative ideas… – by Bhavna Lalwani

All of us have a story to tell.. Young or old; we all have something to share.. Some people enjoy sharing their personal experiences and dreams, others like to share a story about their childhood or their journey when faced with trials and tribulation, or simply a story about what’s ‘going on’. Each of these stories is made with myriad emotions, memories of events and experiences. When we narrate these stories we experience events and ourselves in different ways. Sometimes it reconnects us to happiness. Sometimes it can bring relief and at yet other times it could bring sadness. Regardless of what we feel, the mere act of sharing stories with someone can make us connect with them. And this sharing and connection and common history often forms the basis of our deepest and cherished relationships.

When people visit a professional for counselling, it is often because they have met with lows or negatives that bring with them sadness, anxiety or other less preferred emotions. This could bring them distress sometimes make them unsure of their abilities to cope.When people decide to meet a counsellor or psychologist, their stories are often heard as ‘presenting complaints’. Based on detailed history taking, professionals arrive on a diagnosis like ‘mood disorder or anxiety disorder’ etc. The intervention then becomes about treating the ‘depressed/anxious person’

As a student of psychology, I took great interest in reading different theories and therapies, because importantly, it helped me learn about the ‘diagnosis’ and get a clinical picture of the person. For instance, most psychological disorders are manifested at the thought (belief) level (for e.g., ‘I believe that life is not worth living’), at an emotional level (for e.g., ‘I feel extremely low and sad’) and at behavioral level (for e.g., ‘I refrain from doing any daily work and other routine task’.) While this is appealing (and important), I realized in my practice that these ‘disorders’ are not simply about individual’s thoughts and perception alone. Instead, there is a story of how and why and what led them to even think in a particular way and how these instances have shaped the ways in which people think, act and feel. For example, a woman who is constantly abused in marital family and has no support system in her family of origin may experience distress because of the context of abuse. This in turn would bring depression. In this instance it becomes extremely crucial to explore not just her current onset of depression but explore her journey so far – how and why she is thinking the way she is, what it has been like to get married, what is making her live with the abuse, how is she coping so far, what are some of the dreams she holds about her life, why are these important to her…. Acknowledging these aspects is not so easy because our training is geared toward becoming an ‘expert professional’, we want to ‘correct’ or rather ‘fix’ things – fix thoughts, beliefs etc. And not delve in the story and people’s abilities to cope.

Having been introduced to narrative ideas and practices is like a relief for me! This is because the process of narrative therapy pays great attention to the stories of people’s lives and how they view their story. The goal becomes developing an alternate, preferred story. Narrative therapy works with different ‘maps’ that guide the professional to facilitate rich story development. It is a process of asking questions that make it possible for clients to see their skills of living and coping and their hopes and dreams for their lives. These questions form a scaffold that help them think what, why and how their actions are based what they value in their lives, their principles and their commitments.

One of the maps of narrative practices is the technique of externalizing. The underlying idea of externalizing is looking at the problem as a problem and NOT the person as a problem. Another critical aspect of externalizing is naming the problem. The client in the process is encouraged to give a metaphor or name to the entire experience he or she is narrating. This is of significance as the person asserts what the problem looks like for him or her. The resultant name or metaphor can be personified and questions regarding when or how it developed are ‘unpacked’ or ‘uncovered’. For example, a person may call the depression that he experiences as ‘The silent wave’. Questions like what does the ‘The silent wave’ look like for the person, how often does the wave come into their lives, when did he or she first see ‘The silent wave’ entering could be examples of ways in which we can start exploring the nature of the problem. This process helps people to not confuse their own identity with problems but look at the ‘problems’ as the problem.

We do want to work on the diagnosis of ‘depression’ or any other disorder. But not by labeling the person as the problem (we commonly say she/he is a depressed person or she/he is always depressed). Instead, we ‘unpack’ the history of the problem in itself. This technique of externalizing the problem brings relief to the person as well because he views the problem away from himself. It helps the person to be more objective and see the effect the problem has on himself, his dreams, his goals, his daily routine, and significant others etc. When one is able to see the impact the problem has on so many different areas of his/her life, it makes it possible to take a stand about the same and actively work on what he/she wants. The therapeutic process then actively draws the skills and the know-how of the person. The very fact that we are able to draw from our own resources helps us to acknowledge ourselves!

To conclude, the process of narrative therapy brings forward personal agency and empowers people to make a decision about the problem or the diagnosis. The conversations in narrative practices respect the individual, his life story and the lived experiences.

– Written by Bhavna Lalwani, a part of the current Mental Health Training Program (2014), Ummeed Child Development Center, Mumbai in collaboration with Narrative Practices, Adelaide.

2 Comments Add yours

  1. Anita says:

    I do agree with Bhavna. Externalization often frees imagination and hopes. For me Externalizing means” outside you”. The moment you use the word “outside” there is less threat- threat of being judged, threat of being good or bad, threat of being right or wrong.As a result the negative feeling decreases and positiveness comes in.

    I have used Externalization with intellectually disabled adults in exploring the feeling of ANGER. They have given names to their anger like- Lion, Steam, Angry bird, Fire, Barking dog etc. After doing the externalization one adult went home and told her mother that Anger is not inside me, it comes from outside! She goes to the balcony and listens to Music when The Anger visits her.

    Another adult counts from 1 to 10 and the Fire vanishes.!

    This technique has helped them cope with anger and deal with it in a socially appropriate way.

    Anita Kumbhani from The Anchorage

  2. Nadi Jalali says:

    If i was asked, what i found most fascinating about adopting Narrative practices in my Therapy sessions, it would surely be – The Value of Respect it brings into every moment shared.

    Bhavna your article is so well writ, reflects my thoughts entirely.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s