LAST AUGUST, LORRAINE GRIEVES fell into a familiar pattern: "The rule in my head was, I couldn't have any food, and if I did, I had to Purge." Fearing for her life, the 21 year-old Vancouver woman's doctor sent her to a psychiatric ward where, for three weeks, she sat surrounded by fellow sufferers with feeding tubes dangling from her nose. Under the house rules, anyone who left a meal unfinished was fed liquid calories or plugged into a feeding machine. And if a patient resisted that drill, she was eligible for a straitjacket. Hospital staffers monitored the ward closely, but the women found ways to evade them. Though Grieves weighed just 103 pounds, she did situps in bed and ran in the shower. When hooked up to a feeding machine, she would wait until no one was looking and then disconnect the tubes. "We'd all sit there sometimes with our tube dripping into the garbage," she recalls. "After all, they were giving you the thing you're most afraid of."
Today, Grieves carries a healthy 125 pounds on her 5 foot, 5-inch frame, and she's no longer dominated by the craving to be thinner. What finally kept her from starving herself was not the prison-style discipline of the hospital, she says, but the perspective she gained through her conversations with a local psychotherapist named Stephen Madigan. Unlike the professionals she'd consulted in the past, Madigan didn't reinforce her sense that there was something wrong with her. Instead, he worked at driving a wedge between her and her problem. He got her to think about the rare moments when anorexia and bulimia didn't control her life. He coaxed her to focus on what that experience felt like. And as she began to think of anorexia as a hostile oppressor, not the whole of her own being, he inspired her to fight back. If a person told you to deprive yourself of food and water, he asked, wouldn't you revolt? Yes, she realized, she would revolt. And with the support of other sufferers, she did.
Like Madigan, a small but growing number of psychotherapists are shedding ideas that have dominated their field for a century. Loosely united by what they call a "narrative" approach, they're forging a new conception of mental suffering and devising new strategies for easing it. The psyche, from their perspective, is not a fixed, objective entity but a fluid social construct -a story that is subject to revision. And the therapist's job is to the people "re-author" stories that aren't doing them justice. The new approach is still far from orthodox, but its adherents-mainly family therapists in Australia, New Zealand and North America-are applying it to everything from marital conflict to psychosis. And as Lorraine Grieves's experience suggests, their efforts are changing people's lives. Narrative therapy is "more than a new set of techniques," Omaha therapist Bill O'Hanlon wrote recently in The Family Therapy Networker. "It represents a fundamentally new direction in the therapeutic world."
At the heart of the new approach is the postmodernist idea that we don't so much perceive the world as interpret it. The buzz of sensory experience would overwhelm us without some frame of reference, says Michael White, an Australian therapist who helped launch the narrative movement in the late 1980s. So we collapse our experience into narrative structures, or stories, to make it intelligible. As we forge identities, we inevitably give some patterns of experience more weight than others, and cultural pressures help determine which patterns define us. If our "dominant stories" happen to center on problems, they can become spiritual prisons. As the Berkeley, Calif.-based therapists Jennifer Freeman and Dean Lobovits have written, a "problem-saturated" dominant story tends to "filter problem-free experiences from a person's memories and perceptions," so that "threads of hope, resourcefulness and capability are excluded from a person's description of self."
That's where therapy comes in. Conventional Freudian psychotherapy tends to assume that people's problems stem from internal pathologies that need to be identified, scrutinized and corrected. Narrative therapy, as conceived by White and his colleague David Epston of Auckland, New Zealand, takes a different tack. Instead of looking for flaws in people's psyches, the therapist helps people spot omissions in their stories. "No problem or diagnosis ever captures the whole of a person's experience," says Epston. "The person has other ways of acting and thinking, but they get neglected because they lie in the shadows of the dominant story." Practitioners have different tricks for helping people recover forgotten strengths, but the process follows a predictable arc.
The first step is to initiate what's known in the trade as an externalizing conversation. "People come in thinking, 'I'm depressed. This diagnosis defines me. I'm a failure'," says Freeman, the Berkeley therapist. "There's usually very little distance between the person and the problem. That feeling of being defective can immobilize people." To counter that feeling, the therapist typically invites the client to personify the problem-to give it a name and talk about how it's affecting his life. As you see from a videotaped conversation between White and a 5-year-old named Danny, the effect can be transformative. Danny has already seen many counselors when his mom brings him to White's office at the Dulwich Centre in Adelaide, Australia. No one has been able to toilet-train the bubbly, sweet-natured kindergartner; he won't bother with a trip to the bathroom, no matter how awful the consequences. But White engages Danny in a conversation about two characters named Sneaky Poo and Sneaky Wee, and within minutes the child is talking about how they take advantage of him.
How does Sneaky Poo make you feel?
I start to have tears. It just sneaks out.
So it makes you feel sad. How else does it make you feel?
It makes me feel angry.
Yes, it stinks and it sticks to me. It hurts and it's hard to get Off.
Does Sneaky Poo cause trouble in your friendships with other kids?
Sometimes they just want to go away.
I can see that Sneaky Poo is causing a lot of trouble in your life. What would you like instead?
I'd be happy if it didn't come out any time except in the toilet!
Danny is soon scheming to put Sneaky Poo in his place, and doing timed laps around the office to show that he's a faster runner than his newfound adversary. Throughout the exchange, White proposes nothing directly. He simply asks questions that create an opening for the boy to act on the problem without acting against himself "[The other] therapists had succeeded in making him think of himself as the problem," White says. "No one had invited him to recount the problem's effects on his own life." Danny returned for several visits, but within six weeks Messrs. Poo and Wee had been vanquished.
To "externalize" a problem is not necessarily to solve it. The i)ext step in the therapeutic process is to identify "unique outcomes"-those sparkling moments when the person seeking help has not been dominated by the problem. Those small discoveries can have big effects. Consider what happened last year when Epston had an hourlong conversation with Jermaine, a black 17-year-old from Ann Arbor, Mich. Jermaine had always suffered from life-threatening asthma, and as a teenager he'd grown so indifferent about treating and monitoring it that file was rarely out of the hospital for more than three days at a stretch. Despairing over his irresponsibility (he had also started committing petty juvenile offenses), his mother had recently placed him in a state institution.
In chatting with Epston, Jermaine quickly establishes that asthma has been messing up his life, and that he'd like to assert some control over it. Then Epston asks a pivotal question: "Tell me, has there ever been a time when asthma tried to pull the wool over your eyes and somehow you didn't keel over?" It turns out that he has staved off a trip to the hospital just that morning, by testing himself and taking his medication. Epston bears down enthusiastically on the meaning of the event, and Jermaine is soon proclaiming himself "asthma smart" and predicting a winning streak. A year later, the streak is all but unbroken.
There's more to changing a life than noticing a "unique outcome." The value of those moments is that they illuminate the resources a person can use to succeed on a larger scale. "We're not just telling people, 'You can do it!"' says therapist Jill Freedman of the Evanston Family Therapy Center, outside Chicago. "We're asking questions, in the hope that they'll help people see things about themselves that they weren't seeing before."
Liz Gray, a 52-year-old, self-employed accountant, used to think of herself as a servant. That was the assigned role of girls in her Irish Catholic household, and she continued to play the role as an adult. She laughs when she remembers teaching a course for tax preparers at an H&R Block office-and voluntarily cleaning the bathroom while she was there. When she started suffering panic attacks a few years ago, the therapists she consulted declared her "codependent" and told her she'd been psychologically damaged as a toddler. But the conversation changed when she started seeing Gene Combs at the Evanston Family Therapy Center.
Combs wanted to know how Gray, 20 years divorced, had managed to run a household, raise two children, look after her aging mother and run her own business. What did it say about her that she was able to do all that? Was she a victim, or was she a survivor? What resources had she drawn on? "As the patient identifies the exceptions to the dominant story of pathology," says New York psychiatrist Christian Beels, "the plot becomes thick and many-stranded." After two years of monthly sessions with Combs, Gray still suffers occasional panic attacks, which she treats with a tranquilizer. But she says she doesn't feel "broken' anymore. "I'm rewriting a story that someone told me a long time ago about what happens to women in this world," she says. "The idea of a queen keeping track of a house is a very different story from a victim saying,'Oh my God, I'm overwhelmed'."
Unlike most other approaches, narrative therapy isn't a secretive transaction between the therapist and the client. Since the stories that ' define us are "negotiated and distributed within communities," White observes, it's o reasonable to "engage communities in the renegotiation of identity." In Vancouver, Lorraine Grieves and others have organized an "antianorexia/anti-bulimia league" to fight the social pressures that encourage women to starve themselves. In Berkeley, Jennifer Freeman encourages the children she sees to chronicle their struggles for anthologies like "The Temper Tamer's Handbook" and "The Fear Facer's Handbook." And narrative therapists everywhere are incorporating audiences into the therapeutic process.
It's not an entirely new idea. With the client's consent, a family therapist will often have other therapists observe a session from behind a screen. Normally, the observers share their impressions only with the therapist who recruited them. But narrative practitioners often invite their clients to watch the "reflecting team" deliberate. The Moore family had that experience last fall, when they spent an hourlong session with Michael White at the Evanston Family Therapy Center. Jane Moore and her second husband Clint, an Episcopal priest, had been married for several years when jane's 16 year-old daughter, Jennifer, left her father to five with them. They felt they needed help in becoming a family, but as they listened to the reflecting team, they realized they had already started to function as one. "It was a wonderful surprise to find out that other people perceived you as having the qualities you thought you were looking for, says Jane.
There are of course limits to what any of these exercises can accomplish. No form of talk therapy is likely to eliminate a biologically based depression or psychosis. And traumatic experiences, such as childhood abuse, don't just go away when people focus on their strengths. "There is such a thing as true mental illness," says San Diego psychiatrist Harold Bloomfield. "Some people just need drugs." Many proponents of narrative therapy would agree, but they would add that there's more than one way of living with an illness. "The question is how you want to face the experiences you're stuck with," says Beels. "What kind of relationship are you going to have with depression? What have you found effective? It's not an either-or situation, where you're cured or defeated. It's a lifetime battle."
Some experts worry that narrative enthusiasts, in their reluctance to "pathologize" people, will give their problems short shrift. They fear that by focusing solely on the problem at hand-anorexia, pants-soiling or panic attacks-a therapist may ignore larger issues that need to be confronted. But to narrative purists, such questions simply reflect a particular view of the world. "In traditional therapy, the audience is the therapist," says Beels. "What does the therapist expect? He expects that we have not gotten to the bottom of this problem yet. He expects that things are not better than we thought, but worse." In fact, he says, the sources of people's suffering traumatic memories, low self-esteem, whatever-are not that mysterious. Any line of inquiry will draw them out, and they need to be acknowledged. But they don't need monuments built to them. As Epston puts it, "Every time we ask a question, we're generating a possible version of a life." Narrative therapy doesn't have all the answers people need. Its beauty is that it incites them to ask different questions. ..MR.-
No diagnosis captures the breadth of one's experience ..MR0- ..MR.-
Narrative therapists think of personal identity as a story that can be retold and redeemed ..MR0-