Clinical III. Session 9
63
The real political task in a society such as ours is to criticize the workings
of institutions that appear to be both neutral and independent,
to criticize and attack them in such a manner that the political violence
that has always exercised itself obscurely through them will be unmasked,
so that one can fight against them.
—Michel Foucault (Chomsky–Foucault Debate: On Human Nature)
O liva Espin (1995), professor emerita of women’s studies at San Diego State University, has critiqued most traditional forms of therapy as a result of being primarily informed by essentialism and the treatment
of scientifically verifiable disorders. Espin suggested that modernist/
scientific therapies have been particularly harmful to clients of color,
believing that they are often pathologized because they are not viewed as
living up to normative/dominant standards. According to Espin (Nylund,
4
The Therapy Process
http://dx.doi.org/10.1037/0000131-004 Narrative Therapy, Second Edition, by S. Madigan Copyright © 2019 by the American Psychological Association. All rights reserved.
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2006), many therapies inadvertently reproduce racist discourses. Espin
(1995) stated:
a social constructionist paradigm that sees psychological characteris-
tics as a result of social and historical processes, not as natural, essen-
tial characteristics of one or another group of people is the more
productive approach in the study of diversity than some other tradi-
tional paradigms accepted in psychology. (pp.132–133)
For Michael White and David Epston (1990), therapists are “inevita-
bly engaged in a political activity in the sense that they must continually
challenge the techniques that subjugate persons to a dominant ideology”
(p. 29). David Nylund (2006), narrative therapist and professor of social
work at California State University, Sacramento, went further to suggest
that therapists must always assume they are producing and reproducing
ideas and actions in domains of power and knowledge and operating
within systems of social control.
JESSE’S STORY
I met with Jesse,1 an 11-year-old African American boy, in Chicago as part
of a narrative therapy consultation, demonstration, and narrative therapy
training video (because of geography, I only had one therapy session with
Jesse and his mother). Prior to our meeting, I was told that Jesse had been
recently suspended from school for assaulting a White male peer from his
class (Carlson & Kjos, 1999). The school principal, the classmate’s parent,
and a counselor had supported sending him to court. The court then ruled
that he receive court-ordered therapy for anger management. According
to both Jesse and his mother, the suspension, fine, community work hours,
and required therapy were unfair. Jesse’s White classmate had not received
a suspension or any other reprimand for his part in the interaction.
1 Portions of this chapter have been excerpted or adapted from handouts I created for use in my teaching workshops. Some material in this chapter is based on information from “Anticipating Hope Within Conversational Domains of Despair,” by S. Madigan, 2008, in I. McCarthy and J. Sheehan (Eds.), Hope and Despair in Narrative and Family Therapy, pp. 100–112. Copyright 2008 by Bruner Mazel, London.
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Jesse was sent to counseling by the juvenile court system. When I
asked his mother why she thought they had come to see me, she answered
that she “didn’t think he needed counseling but just a good talking to.”
When we explored the conversation further, she let me know that her son,
Jesse, was sent to court because of a claim initiated by the White mother
of the student he had exchanged “hits” with. Jesse explained to me that
these were not “hits to hurt,” but rather “fooling around kinds of hits.” He
also stated that when they got back to class from the bathroom where the
fooling around kind of hits happened, he and his classmate had laughed
together.
As the interview unfolded, Jesse’s mother told me that not only had
her son been suspended from school, but when he went to court he was
charged with battery, placed on 1 year of probation, given 40 hours of com-
munity service work, and levied a $300 fine. Jesse’s mother said that she
believed the “White judge treated Jesse as if he knew him.” After the court
proceedings ended, the mother of the White student apologized to Jesse’s
mother because of the harsh sentencing. The other mother had apparently
initiated the court proceedings against Jesse with the understanding that
he would just get a “slap on the wrist.” Had Jesse been White, the White
mother’s understanding of legal events might have proved correct, and
she might not have needed to apologize. Jesse’s mother insinuated that
she hoped the other student’s mother had learned the hard lesson that not
all people are treated equally in the courts. Without this understanding,
Jesse suffered at the hands of the White mother’s privileged “not knowing”
internalized racist position.
Throughout the course of our 1-hour session, I became curious as to
how the issue of race might have influenced how Jesse was being viewed
and subsequently treated. It was my understanding that Jesse was not in
need of anger management counseling (and this was good because I don’t
know how to “do” anger management counseling, nor am I interested in
doing it). As an alternative, I began to introduce narrative therapy ques-
tions around the topic of internalized racism as a possible way to locate,
understand, and explain Jesse’s predicament. Being the person with power
and privilege in the session, it was up to me to broach the issue of race
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with the hope that Jesse’s mother felt safe enough to discuss it with me
(K. Hardy, 2004). I have outlined below a small fragment of our discursive
interaction.
Madigan: (addressing Jesse’s mother) Do you think race had something
to do with how Jesse was treated?
Mother: I think so because if it had been a White boy, it was a White boy,
but if it had been two White boys, I don’t think they wouldn’t have went
to court.
Madigan: Are you saying that the other child involved with Jesse was
White?
Mother: Yes, he was. He’s not a bad boy, either, it’s just that the parents,
both of them just made a big thing out of it.
Madigan: As a mother, how does it feel to have Jesse exposed to this legal
and education system where he might get treated differently because of
the color of his skin?
Mother: Well, I don’t like it.
Madigan: What part of this do you most not like?
Mother: Well, I’ve been told that this new school has not gotten used to
having Black kids—so they have to be real careful.
As the conversation continued, I began to deconstruct the racist
social practice of labeling African American male youth as deviant,
conduct disordered, and/or criminal.
Madigan: (asking the mother) Do you think that trouble [the problem
that was relationally externalized] might find the African American chil-
dren in the school quicker and they’ll unfairly develop reputations of
trouble more than the White children in the school?
Mother: Yes, I think so.
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Madigan: [later in the session] Do you have any final words you’d like to say?
Mother: I’d like to say I didn’t know we would get to tell this story but
it’s a true story.
Madigan: And I just want to tell you that I really believe your story. And
I’d like to stand behind your story in any way that I can. And I am very sad
that this story is going on for you.
Mother: Yeah, me too.
Madigan: I’m saying that as a person here with you, and I’m also saying
that as a White person. Thank you so much for coming and sharing this
story with us.
Mother: Okay. Thank you so much.
After the session, I wrote a letter to the school principal outlining
my questions and concerns regarding the treatment Jesse received by the
school, its counselor, and the judiciary system (see Exhibit 4.1). My pri-
mary apprehension was how Jesse would be written up into his school
file as a dangerous and violent student—and how this file would not only
follow him but could have long-reaching negative effects on his reputation
and his future social and academic career.
I also took time after our session to recruit members of Jesse’s com-
munity into a different telling of who he was as a person by writing them
a therapeutic letter (see Exhibit 4.2). My hope in writing this letter to the
family was to create a counter-file in support of Jesse’s “good boy” reputa-
tion brought forth as a counter-story in the interview.
The therapeutic story of Jesse and his mother (see Exhibit 4.3) outlines
how problems are often inscribed onto individuals through generalized taken-
for-granted ideas—in this case, generalizing by the school, parents, judges,
counselor, and the probation system regarding the reputation and charac-
ter of Jesse. The various forms of institutional “branding” took Jesse and his
family to a place of punishment, where a more contextual rendering of how
people are relationally constructed may have spared this family some pain.
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Exhibit 4.1
Letter Sent to the School Principal
Dear Mr.__________:
My name is Dr. Stephen Madigan. I am a family therapist who had
the pleasure of talking with one of your students, Jesse ________,
and his mother last week.
The reason I am writing is to discuss my concerns regarding the
school’s participation in events this past fall that have placed Jesse’s
reputation as a good student, friend, and son in a certain kind of
danger. To begin with, it is very clear to me that Jesse does not need
anger management treatment.
My primary concern at this time is Jesse’s future reputation
as a student in your school program. My fear is that the fugitive
reputation the court has given him is unjust, and that this unjust
reputation will be written into his school file. I fear this because it
has been documented that Jesse was charged with battery, placed
on probation, and given a hefty fine along with 40 hours of com-
munity service work. I am concerned how this negative documen-
tation of Jesse will negatively affect how his teachers, classmates,
and your administration interact with and treat him. I am also
concerned about how this negative reputation might affect Jesse’s
view of himself.
As a principal, you have certainly experienced how difficult it can
be for some students to live down a bad reputation. Jesse has done
little to deserve the harsh personal and financial punishment he
received, and I believe that other factors such as race, social status,
and class may have influenced his sentence.
I would appreciate a time set aside to talk to you about these
concerns.
Sincerely,
Stephen Madigan, MSW, MSc, PhDC op
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Exhibit 4.2
Letter Sent to Jesse’s Group of Supporters
Hello. My name is Dr. Stephen Madigan, and I am a family thera-
pist who is working alongside Jesse and his mother. I am writing to
ask for your support and to share some ideas regarding an unfortu-
nate legal matter Jesse has encountered.
Jesse and his mother were sent by the juvenile justice system to
me for anger management counseling. It quickly became apparent
to me that something awfully wrong had happened to Jesse, and as
a result, his hard-earned reputation as a good student, friend, and
son was in jeopardy.
Did you know that because of an admitted “fooling around kind
of hit” between him and another student, Jesse was forced to go
to court? He was then levied a hefty fine, probation, and commu-
nity work hours. Did you know that the young White classmate’s
mother has apologized for setting up Jesse’s court appearance
because she believed that he would merely get a “slap on the wrist?”
Did you know that the judge treated him, in Jesse’s mother’s words,
“like he already knew him?”
Jesse and his mother have let me know that the school he attends
has “not yet gotten used to having African American children in
their classrooms.” I wonder what you make of this? And I wonder if
you believe this had any influence on how he was treated at school
and in the courts?
My concern is that through this unfortunate legal experience,
Jesse might be forever viewed as a violent offender, a person not to
be trusted, and a negative student.
As all of you probably realize, Jesse does not deserve the fugitive
reputation the school and legal system have now given him. I am
writing to ask your support in helping us reclaim his real reputa-
tion as a good and hard-working student/son/friend and stand
against this bad-person reputation.
(continues)
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If it is possible, I am asking you to write a letter on Jesse’s behalf
that stands in support of him. I am asking you to include a descrip-
tion of your experience of him, what he means to you as a person,
and what future you see Jesse being able to embrace.
You can send the letters to Jesse at ____________.
Thank you for your help in this matter.
Warmest regards,
Stephen, Jesse, and his Mother
Exhibit 4.2
Letter Sent to Jesse’s Group of Supporters (Continued)
Exhibit 4.3
Return Letter From Jesse and His Mother
Stephen:
Thanks a whole lot for helping us. We got loads of sweet letters
about my son. Jesse reads them and feels good and so do I.
My pastor and friends in our church and the social worker and
a few neighbors met with Jesse’s principal and teacher. It was some
meeting and we think that everyone now feels sorry for what hap-
pened to Jesse a little while ago. The principal said he knows what
a good child he is and this made us both feel real good. Our pastor
gave the principal what for, and he told the principal to write to the
judge, but who knows if anything will happen.
Jesse says he will never do anything bad at school again and says
that his teacher is being nice to him and he got four perfect marks
on four different tests. He said his teacher thinks he is smarter than
most of the other kids.
Thanks that you paid the money to the courts for us.
I hope you come and visit.
Jesse’s Proud Mother!
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NARRATIVE THERAPY PRACTICE
Narrative therapy practice is based on the idea that people make mean-
ing in the world about who they are—and who they are in relation to
others—through a dialogic relationship that is considered shaped by the
prevailing cultural group. To offer a more colorful snapshot of their lives,
clients’ stories introduce a range of characters and “back stories” in just
the same way that any good author’s stories might. Although people live
and construct stories about their lives and relationships, stories also live
through and construct people’s lives and relationships (Bakhtin, 1986;
J. S. Bruner, 1991; Frank, 2010; K. Gergen, 2009; Parker, 2008; White,
1995a). If, for example, a young queer person is given the message that
somehow they are a less-than citizen, how that person expresses their life
will be under the influence of the dominant and generally accepted con-
struction of who the person is viewed to be, as set forth by the prevailing
cultural group (Butler, 1988; Tilsen & Nylund, 2009; see also Hardy, 2004;
White, 1987, 1988).
Narrative therapy feels the person arriving into therapy is not solely
responsible for creating the deficit-identity conclusion they often relate
to the therapist. For example, mothers experiencing a child viewed
by the preschool as “not quite fitting in” (what might be considered
“proper” preschool behavior) may blame themselves as being unfit
(following in step with a predominance of mother-blaming ideas in
our culture; Freeman, Epston, & Lobivits, 1997; Marsten, Epston, &
Markham, 2016). Young girls struggling with body perfection feel they
have personally failed (Dickerson, 2004); a heterosexual corporate
employee not able to spend more time with his or her children feels
guilty and inadequate; a queer high school student entered into a fearful
secrecy feels a sense of individual shame (Nylund & Temple, 2017; Nylund
& Tilsen, 2012; Tilsen, 2013). The ensuing story told by clients is often
one that adheres to specific “individual responsibility” for “their” prob-
lem and a desire to be “fixed.”
A belief that a person does not measure up to cultural expectations
can easily discount the alternative abilities, competencies, beliefs, values,
commitments, and ethics the person has achieved but has been restrained
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from fully appreciating. It is within the process of re-authoring (see Chap-
ter 3) that problem discussions begin to move away from the confinement
of individualized problem stories and toward thicker (Geertz, 1983) alter-
native narratives (White, 2005).
Narrative therapy interviewing is based on the person’s storied
accounts regarding experiences and actions in life (Hoyt & Nylund,
1997; Madigan & Nylund, 2018b; White, 1987). Narrative therapists are
not concerned with behavior, as in set developmental stages or categories
of behavior. Instead, they turn their attention toward expression, prac-
tices, action, and interaction—that is to say, the action and relational
interaction of experience, response, and reflections of the client. Within
the practice of narrative therapy, problems are viewed as relational,
contextual, interpretive, and situated within dominant discourse, expres-
sion, response, and cultural norms. This interplay presents the back drop
to the narrative maxim—the person is the person, and the problem is
the problem—not separate but culturally, discursively, and relationally
interwoven.
NARRATIVE STRUCTURE: LANDSCAPES OF ACTION AND LANDSCAPES OF CONSCIOUSNESS
In referring to texts, Jerome Bruner (1986, 1990) proposed that all
stories are composed of dual landscapes—a landscape of action and
a landscape of consciousness. The landscape of action is made up of
(a) events that are linked together in (b) particular sequences through
the (c) temporal dimension—past, present, and future—and according
to (d) specific plots. In any text the landscape of action provides the
reader, or in this case the therapist, with a perspective on the thematic
unfolding of events across time. Revealing the landscape of action
involves questions regarding the who, what, how, where, and when of
the story. What brings you to see someone like me in therapy at this
particular time in your life? Are there others in your life that might
agree or disagree as to what brought you here today? Who would be
most supporting of you coming today?
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The landscape of consciousness (also referred to as the landscape
of identity or the landscape of meaning) offers meaning and elucida-
tions of the characters in the story. The landscape of consciousness
features the “meanings” derived by characters and readers through
“reflection” on the events and plots as they unfold through the land-
scape of action.
Landscape of identity questions are (in part) those that are asked
regarding what the client might conclude about the action, sequences,
and themes described in response to the landscape of action questions.
Landscape of identity questions bring forth relevant categories to address
cultural identities, intentional understandings, learning, values, and real-
izations (Bjoroy et al., 2015; Madigan & Nylund, 2018b). For example:
Is this description of yourself as depressed a complete description of who
you are as a person? Why would the problems definition of you not be a
complete description of you?
Perceptions, thoughts, speculation, realizations, and conclusions
dominate this landscape, and many of these relate to (a) the determina-
tion of the desires and the preferences of the client; (b) the identification
of their personal and relationship characteristics and qualities; (c) the
clarification of their intentional states, for example, their motives and
their purposes; and (d) the substantiation of their beliefs. As the client’s
desires, qualities, intentional states, and expressed beliefs become suf-
ficiently elaborated through the therapeutic conversation, they coalesce
into commitments (I no longer wish to support a violent, less than
worthy, anorexic lifestyle) that determine particular careers in life—
or lifestyles.
If the narrative therapist assumes there is an identity between the
structure of texts and the structure of the stories or narratives that
persons live by, and if they take an interest in the constitution of lives
through stories, the therapist might then consider the details of how
persons live their lives through landscapes of action and landscapes of
consciousness.
Taken together, the landscape of action and landscape of identity
question assists in re-authoring client lives and relationships by listening
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in to find the sparkling undergrowth and unique outcomes through the
client’s understanding of events. Therapists take a full accounting of who
was involved in the creation of the problem story, how the client came to
know himself or herself in this problematic way, the life-support systems
of the problem, the possible losses involved in his or her life and relation-
ships in relation to the problem, any resistance that the person has noticed
regarding his or her response to the loss, and what all these events mean
to the person telling the story.
During the first therapeutic conversation, the person coming to
therapy is involved with the narrative therapist in two separate descrip-
tions: (a) a problem-saturated story line and (b) an alternative plot to the
problem story, which lies alongside and is often preferred. In developing
this scaffolding of curiosity and questions, narrative therapists traffic in
(a) landscape of action questions composing events linked in sequence;
through time; and according to the who, what, when and where of the story
and (b) landscape of identity questions composing identity conclusions
that are shaped by contemporary identity categories of culture—the person’s
conclusions about the story (Bjoroy et al., 2015; J. S. Bruner, 1990; Winslade
& Monk, 2007).
Combining the different landscapes, narrative therapy acts to
77 question how the “known” and remembered problem identity of
a person has been influenced, manufactured, and maintained over
time;
77 question what aspects of the social order have assisted in the ongoing
maintenance of this remembered problem self;
77 locate those cultural apparatuses keeping this remembered problem
self restrained from remembering alternative accounts and experiences
of lived experience;
77 trace alternative sites of resistance through questioning how the person
can begin to re-member subordinate stories of identity living outside
the cultural, professional, and problem’s version of them;
77 influence how discursive space can afford room for possibilities and
different discursive practices to emerge by resisting and standing up for
the performance of this re-membered and preferred self; and
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77 explore who else in the person’s life might be engaged to offer accounts
of re-membrance and provide the person safety within the member-
ship of a community of concern (Madigan & Epston, 1995).
For example, narrative therapy might pose questions about the con-
struction of men’s lives and masculinity requirements to a man or group
of men who have come to therapy (Nylund, 2004c, 2007). A therapist
might ask them what term they might use to describe the vital aspects of
masculinity and what it means to be a man. A therapist might consider
posing the following questions:
77 What are the practices of life and ways of thinking about life that
stand behind this word/term (that they have described regarding
being a man)?
77 Are their certain ways that you live because of this particular way of
thinking?
77 What are these ways of living (men’s practices)?
77 How do these ways of living have you relating to yourself?
77 Do these ways of living bring you closer in or further away (to yourself
or others)?
77 Are there any downsides to living this way with others? For yourself?
77 In what specific ways have these ideas about being a man shape your
life?
77 If you were to decide to step further along this way of living, what do
you imagine this might require you to do to your life in the future?
77 From another person’s perspective, what would appear to be for you
and against you in taking up this lifestyle?
77 What did these ideas make possible and what did they limit?
A narrative therapist might then ask the men to reflect on just one
occasion in their lives when they found themselves standing outside the
taken-for-granted thinking about being a man (Nylund, 2004a, 2004b).
The men might be asked the following questions: What do you picture
in yourself that leads to your taking this step? How did you prepare
yourself for this step? What other developments were taking place in
your life at this time that may have been related to this step you took?
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Would you consider this a giant step or a little step? Why? How did you
approach this step?
Once a history of ideas past and present has been established a nar-
rative therapist may continue in this line of questions: What does this tell
you about how you wish your life to be? What does it say about you as a
parent/partner/lover that stands in good favor to you? Thinking back now,
can you recall any other events that have happened in your life that might
reflect your preference for these steps and ways of living?
We might follow up by asking these questions: What experiences
provoked these thoughts? And what were these thoughts exactly about?
Were there specific important people in your life who contributed to
these ideas as possibilities? In what ways did they contribute? Did they
offer you some substitute ways of being with women and children that
you might have favored? At what point in your life did you step into
these other ways of being? How did you develop the know-how that was
required to accomplish this?
RELATIVE INFLUENCE QUESTIONS
Along with guiding the narrative interview through landscapes of
action and identity questions, everyday narrative therapy interviewing
involves a process known as relative influence questioning, that com-
prises three sets of questions: (a) one set maps the influence of the
problem on the person and losses experienced within this relationship,
(b) another set encourages persons to map their own (and others’)
influence in the life of the problem (White, 1988), and (c) the third set
begins to map out the unique outcomes or the occasions in which the
person experienced some influence in his or her life despite the discur-
sive power of the problem.
Woven together, relative influence questions invite a re-telling of the
client story in such a way as to evoke a discursive means of understanding
and performing aspects of the client’s abilities and skills in the face of the
problem (Nylund & Thomas, 1997). Below is the relative influence frame
and structure of a narrative therapy interview that I first learned in my
apprenticeship and relationship with Michael White.
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Mapping the Influence of the Problem
in the Person/Family’s Life and Relationships
How does the problem influence the person’s life, relationships, and loss?
Mapping the problem’s influence on the person/relationship helps to
develop a clear understanding of the experience-near, problem-saturated
story. It is crucial for the therapist to take enough time to develop this line of
inquiry for persons to feel their experience is “known” and, for the person to
get to know the problem story in a way that offers them a different and more
detailed perspective on the problem’s effects on their lives and relationships.
Tracing the negative influence the problem has had will allow for questions
about the losses that have occurred in the person’s life while in relationship
to the problem. For example, people in long-standing relationships with
drugs, anorexia, anxiety, and so on, will always report losses concerning
relationships with friends, school, jobs, hobbies, and family.
An expansive recording at this stage of therapy opens multiple oppor-
tunities for exploring unique outcomes later. It also offers a rich sampling
of people’s language habits (Madigan, 2004) around the problem. Ques-
tions to ask may include: How does worry feature in your work life? In
your life beyond work? In your relationships? When worry is having its
way with you, what happens to your dreams for the future? Are you satis-
fied or dissatisfied with the way the worry is (as you stated) “wrecking my
relationship” and leaving you no time for friends? What dissatisfies you
the most about worry’s relationship to you and your relationships?
Mapping the Influence of the Person/Family
in the Life of the Problem
Through mapping the influence of how people may be problem-supporting,
clients can begin to see themselves as authors, or at least coauthors, of their
own stories. They can then move toward a greater sense of agency in their
lives as primary author of the story to be told and lived through. A broad
mapping at this stage opens multiple opportunities for exploring unique
outcomes later. It also gives a rich sampling of people’s language habits
(Madigan, 2004) around the problem. Questions to ask may include the
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following: Are there ways in which you have unknowingly given worry
the upper hand in your life? Have there been people or situations in your
life that have helped you keep worry central to your life?
UNIQUE OUTCOME QUESTIONS
Unique outcome questions invite people to notice actions and intentions
that contradict the dominant problem story. These can predate the session,
occur within the session itself, or happen in the future.
77 Given over-responsibility’s encouragement of worry, have there been
any times when you have been able to rebel against it and satisfy some
of your other desires? Did this bring you despair or pleasure? Why?
77 Have there been times when you have thought—even for a moment—
that you might step out of worry’s prison? What did this landscape free
of worry look like?
77 I was wondering if you had to give worry the slip in order to come to
the session here today?
77 What do you think it may have been that helped support the hope in
yourself that helped you sidestep worry?
77 Can you imagine a time in the future that you might defy worry and
give yourself a bit of a break?
UNIQUE ACCOUNT QUESTIONS
Conversations develop more fully following the identification of unique
outcomes and begin to demonstrate how they can become features in
a preferred alternative story. Unique account questions invite people to
make sense of exceptions/alternatives to the dominant story of the prob-
lem being told (e.g., “I always worry”). These exceptions may not be reg-
istered as significant or interesting or different; however, once uttered
and uncovered, they are held alongside the problem story as part of an
emerging and coherent alternative narrative. Unique account questions/
answers use a grammar of agency and locate any unique outcome in its
historical frame, and any unique outcome is linked in some coherent way
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to a history of struggle/protest/resistance to oppression by the problem or
an altered relationship with the problem.
77 How were you able to get yourself to school and defy worries that want
to keep you to themselves at home alone?
77 Given everything that worry has got going for it, how did you protest
it pushing you around?
77 How might you stand up to worry’s pressure to get you worried again?
77 Could your coming here today be considered a form of radical dis-
obedience to worry?
UNIQUE RE-DESCRIPTION QUESTIONS
Unique re-description questions invite people to develop meaning from
the unique accounts they have identified as they re-describe themselves,
others, and their relationships.
77 What does this tell you about yourself that you otherwise would not
have known?
77 By affording yourself some enjoyment, do you think in any way you are
becoming a more enjoyable person?
77 Of all the people in your life who might confirm this newly developing
picture of yourself as worrying less, who might have noticed this first?
77 Who would support this new development in your life as a worry-free
person?
77 Who would you most want to notice?
UNIQUE POSSIBILITY QUESTIONS
Unique possibility questions are viewed as next-step questions. These
questions invite people to speculate about the personal and relational
futures that derive from their unique accounts and unique re-descriptions
of themselves in relation to the problem.
77 Where do you think you will go next now that you have embarked on
having a little fun and taking a couple of little risks in your life?
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77 Is this a direction you see yourself taking in the days/weeks/years
to come?
77 Do you think it is likely that this might revive your flagging relation-
ship, restore your friendships, or renew your vitality? (This conversa-
tion can lead back to unique re-description questions.)
77 If I was to interview a future you 6 months from now, what do you
think you might tell me about new discoveries in life?
UNIQUE CIRCULATION QUESTIONS
Circulation of the beginning preferred story involves the inclusion of a
community of others. Circulating the new story is very important because
it fastens down and continues the development of the alternative story
(Tomm, 1989).
77 Is there anyone you would like to tell about this new direction you are
taking?
77 Who would you guess would be most pleased to learn about these latest
developments in your life?
77 Who do you think would be most excited to learn of these new
developments?
77 Would you be willing to put them in the picture?
EXPERIENCE-OF-EXPERIENCE QUESTIONS
Experience-of-experience questions invite people to be an audience to
their own story by seeing themselves, in their unique accounts, through
the eyes of others.
77 What do you think I am appreciating about you as I hear how you have
been leaving anxiety behind and have recently taken up with a bit of
fun and risk?
77 What do you think this indicates to “X” about the significance of the
steps you have taken in your new direction?
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QUESTIONS TO HISTORICIZE UNIQUE OUTCOMES
These questions represent any important type of experience-of-experience
questions. Historical accounts of unique outcome allow for a new set of
questions to be asked about the historical context. These questions serve
to (a) develop the blossoming alternative story, (b) establish the new
story as having a memorable history, and, (c) increase the likelihood
of the story being carried forward into the future. The responses to
these produce histories of the “alternative present” (M. White, personal
communication, 1993).
77 Of all the people who have known you over the years, who would be
least surprised you have been able to take this step forward?
77 Of the people who knew you growing up, who would have been most
likely to predict that you would find a way to get yourself free of worry?
77 What would “X” have seen you doing that would have encouraged them
to predict that you would be able to take this step?
77 What qualities would “X” have credited you with that would have led
him or her to not be surprised that you have been able to ______?2
PREFERENCE QUESTIONS
Preference questions are asked throughout the interview. It is important
to intersperse many of the previous questions with preference questions
to allow persons to evaluate their responses. This should influence the
therapist’s further questions and check against the therapist’s preferences
overtaking the client’s preferences.
77 Is this your preference for the best way for you to live or not? Why?
77 Do you see drinking to get drunk as a good or a bad thing for you? Why?
77 Do you consider this to your advantage and to the disadvantage of the
problem or to the problem’s advantage and to your disadvantage? Why?
2 Once the therapist begins to get a grasp on the format and the conceptual frame for developing temporal questions (past, present, or future), unique account questions, unique re-description questions, etc., become easier to develop and eventually seem “ordinary” to the interviewer and the receiving context.
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CONSULTING YOUR CONSULTANT QUESTIONS
Consulting your consultant questions serve to shift the status of a person
from client to consultant. Knowledge a person has in relationship to their
experience with the problem—because of lived experience—is viewed by
the therapist as unique, local, and special knowledge. Close-up knowledge
is documented and made available to others struggling with similar issues
(Madigan & Epston, 1995).
77 Given your expertise in the savage ways of anorexia, what have you
learned about its practices that you might want to warn others about?
77 As a veteran of anti-anorexia and all that the experience has taught you,
what counter-practices of fun and risk would you recommend to other
people struggling with anorexia?
The structure of the narrative interview is built through questions that
encourage people to fill in the gaps of the alternative story (untold through
a repeating of the problem-saturated story). The discursive structure
assists people to account for their lived experience, exercise imagi-
nation, and circulate the remembered stories as meaning-making
resources. The therapeutic process of narrative therapy engages the
person’s fascination and curiosity. As a result, the alternative story
lines of people’s lives are thickened (Turner, 1986) and more deeply
rooted in history (i.e., the gaps are filled, and these story lines can be
clearly named).
COUNTERVIEWING QUESTIONS
Personally, I try to only ask questions in therapy, or at least I ask ques-
tions 99% of the time.3 This is certainly not the only expression of narra-
tive therapy, nor is it the “right” way. However, choosing to ask questions
99% of the time is the way I was taught by Michael White and remains
the interviewing method that has always felt the most comfortable.
3 I created the idea of counterviewing questions as a means to explore and explain the deconstructive method involved in narrative therapy interviewing.
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For the experienced narrative therapist, questions are not viewed as
a transparent medium of otherwise unproblematic communication. It is
common practice for narrative therapists to be deeply committed to the
ongoing investigation and location of therapeutic questions within com-
munity discourse as a way of figuring out the history and location of where
our questions come from (Freedman & Combs, 1996, 2002; Madigan,
1991a, 1993a, 2007; Madigan & Nylund, 2018b). The process of discover-
ing the influences that shape therapeutic questions and discussing why we
use them with the people we talk with in therapy is viewed as a practice of
therapist accountability4 (Madigan, 1991b, 1992, 2017b). Questioning ther-
apists about their therapeutic questions is also used as a primary framework
for narrative therapy supervision (Madigan, 1991a; Madigan & Nylund,
2018a; Nylund & Nylund, 2003). Experiencing a close-up rereading of
therapy allows the idea of counterviewing questions (Madigan, 2004, 2007)
to emerge. A therapy organized around counterviewing questions speaks
to narratives therapy’s deconstructive therapeutic act. Michael White
(1991) viewed deconstruction as important to narrative practice because
of considerations given to
procedures that subvert taken-for-granted realities and practices;
those so-called “truths” that are split off from the conditions and
the context of their production, those disembodied ways of speak-
ing that hide their biases and prejudices, and those familiar prac-
tices of self and of relationship that are subjugating of persons’
lives. Many of the methods of deconstruction render strange these
familiar and everyday taken-for-granted realities and practices by
objectifying them. However, we can also consider deconstruction in
other senses: for example, the deconstruction of self-narrative and
the dominant cultural knowledges that persons live by; the decon-
struction of practices of self and of relationship that are dominantly
cultural; and the deconstruction of the discursive practices of our
culture. (p. 11)
4 For further reading on accountability practices, see Hall, Mclean, and White (1994) and Tamasese and Waldegrave (1990), Dulwich Centre Newsletter, Nos. 1 and 2.
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Following in line with ideas of deconstruction, narrative questions are
designed to both respectfully and critically “raise suspicions” about pre-
vailing problem stories while undermining the modernist, humanist, and
individualizing psychological project. The specific training and super-
vision courses we offer at the Vancouver School for Narrative Therapy
(VSNT) and through TCTV.live, highlight an emphasis on a nonindividualist,
political/cultural, deconstructive practice. The VSNT faculty developed a
structure of counterviewing questions to create therapeutic conditions for
the training therapist to consider the following:
77 explore and contradict client/problem experience and internalized
problem discourse through lines of questions designed to unhinge the
finalized talk of repetitive problem dialogues and create more relational
and contextual dialogues;
77 situate acts of resistance and unique accounts that could not be readily
accounted for within the story being told;
77 render curious how people could account for these differences; and
77 appreciate and acknowledge these as acts of cultural resistance, and
rebuild communities of concern.
During the study and training in narrative therapy, VSNT’s
deconstructive counterviewing5 method of close-up therapeutic inter-
viewing engages the relational world in the following ways:
77 Counterviewing is an intensely critical and political mode of reading
professional systems of meaning and unraveling the ways these systems
work to dominate and name.
77 Counterviewing views all written professional texts (files) about the
client as ways to lure the therapist into taking certain ideas about the
person for granted and into privileging certain ways of knowing and
being over others.
77 Counterviewing is an unraveling of professional and cultural works
through a kind of antimethod that resists a prescription—it looks for
5 For a clear example of counterviewing, see the American Psychological Association six-part DVD live session set of my narrative therapy work, Narrative Therapy Over Time (2010) from https://www.apa. org/pubs/videos/4310879.aspx.
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how a problem is produced and reproduced rather than wanting to pin
it down and say, “This is really what it is.”
77 Counterviewing looks for ways in which our understanding and move-
ment is limited by the lines of persuasion operating in discourse.
77 Counterviewing also leads us to explore the ways in which our own
therapeutic understandings of problems are located in discourse.
77 Counterviewing allows us to reflect on how we make and remake our
lives through moral–political projects embedded in a sense of justice
rather than in a given psychiatric diagnosis.
COUNTERVIEWING AND NARRATIVE THERAPY: THE ISSUE OF RESPECT
Counterviewing in narrative therapy is profoundly respectful to a cli-
ent’s lived experience. The method attempts to (a) do justice to the
stories people tell about their distress, (b) respect the experience they
have with the problems of living, (c) appreciate the struggles they are
embarking on, and (d) value and document how they have responded
to the problem. The therapist’s task is to work within these descrip-
tions and acknowledge the complexity of the story being told, so that
contradictions and suspicions are used to bring forth something dif-
ferent (by sustained reflection), moving toward a “sparkling under-
growth” needing attention (White, 1997). Noting a problem story’s
incongruities allows for the elaboration of competing perspectives as
the person’s story unravels. These different competing perspectives
seem to lie side-by-side and fit together, but there is a tension between
them as they seem to try and make us see the world in different ways
at one time.
A one-perspective story holds the person in the grip of the problem’s/
professional’s point of view. Against this professional standpoint is the
perspective that flows from the client, who is simultaneously trying to
find ways of shaking the problem and perhaps escaping a branded diag-
nostic name altogether. To be respectful to the differing viewpoints does
not mean abandoning our own standpoint, but it does mean acknowl-
edging where we stand.
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COUNTERVIEWING AND NARRATIVE THERAPY: THE ISSUE OF CRITIQUE
Counterviewing in narrative therapy is intensely critical of many
therapy practices that are embedded in images of the self and others
that systematically mislead us as to the nature of problems. Narrative
practice does not presuppose a self, which lies “under the surface” as it
were. Counterviewing also alerts us to the ways that dominant ideas of
the self get smuggled into therapy under the disguise of helping others
(Madigan, 1997).
Dominant narratives of mental distress can all too quickly lock us
back into the problem at the very moment we think we have found a way
out, (Madigan, 1994; Madigan & Law, 1998). The task of a counterviewing
therapist, client, and interview is to locate problems in (cultural) discur-
sive practices in order to comprehend how patterns of power/knowledge6
provide people with the idea that they alone are to blame for these prob-
lems, they are helpless to do anything about these problems, and they
should not maintain much hope (Madigan, 2008, 2017a). In counter-
viewing practices, change is seen to occur when we are working collab-
oratively through the spaces of resistance that are opened up and made
available by competing accounts, alternative practices and remembered
values and ethics once important to lives and relationships. It is within
these experienced landscapes that hope may rise up again.
NAMING AND WRITING PRACTICES
Narrative therapy views the idea of change, what constitutes change,
and what is considered change under the direct influence of a therapy’s
conversational boundaries, linguistic territories, cultural structures,
6 Michael White (1995a, 1995b) wrote that “since the pathologizing discourses are cloaked in impres- sive language that establishes claims to an objective reality, these discourses make it possible for mental health professionals to avoid facing the real effects of, or the consequences of, these ways of speaking about and acting towards those people who consult them. If our work has to do with subjecting persons to the ‘truth’ then this renders invisible to us the consequences of how we speak to people about their lives, and of how we structure out interactions with them; this mantle of ‘truth’ makes it possible for us to avoid reflecting on the implications of our constructions and of our thera- peutic interactions in regard to the shaping of people’s lives” (p. 115).
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and performance of theory (Madigan, 2007, 2017a). Therapeutic
understanding, response, and action is shaped by and shaping of these
discursive parameters, offering discursive “life” to both hopeful and
despairing ideas (sometimes simultaneously) concerning the possibil-
ity of change.
Narrative therapy attempts to render transparent the process of
cultural productions and reproductions in therapy, while also offering
a possible alternative to current institutionalized naming and writing
therapy practices (Bjoroy, Madigan, & Nylund, 2016; Parker, 1989, 2008).
Narrative practices address the influence these processes have on the
construction of hope, ethics, and change. There are numerous narrative
methods to address the possibility of hope, ethics, and change through
a variety of writing and naming practices.7 The psychological practice of
classifying persons and writing their histories into historical documents
(files), through the template of “soft” scientific research and investiga-
tion, has, for narrative therapists, acted to reproduce set cultural and
institutional norms (Foucault, 1973; Parker, 1998; Said, 2003; Spivak,
1996). What gets reproduced within the name given to a person is not
only a newly inscribed identity politic but also a verification (perhaps
a valorization) that uplifts the legitimacy of scientific research and the
status of the profession itself.
Within a name (e.g., obsessive–compulsive disorder, borderline
personality disorder), one’s body is naturally inscribed by science and
the privileged status given to the naming and writing context (Grieves,
1998; Sanders, 1998, 2007; Strong, 2014). Unfortunately, the everyday act
of professional naming and writing the bodies of persons (and groups
of persons) into categories is often a finalized, decontextualized, and
pathologized account of who persons are and who they might become
(Caplan, 1995; S. Spear, personal communication, 2009). The client
is often instructed to anticipate the limits of his or her life course in
particular and nonhopeful ways (Caplan, 1995; Sanders, 1998).
7 My particular version of narrative therapy includes a focus on narrative values, the use of Foucault’s and poststructural ideas, counterviewing questions, remembering conversations, therapeutic letter- writing campaigns, and the creation of communities of concern.
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Deciphering the person/problem named is usually a matter of inter-
preting and categorizing a “cause” to explain the presenting problem
(Dickerson & Zimmerman, 1996). The cause (more often than not) is
located and privatized within the person’s abnormal body and geneti-
cally linked to other members of their family unit and their abnormal
bodies. Within this model of scientific naming and writing, the body of
the subject/client (you and me) is viewed as the passive tablet on which
disordered names are written.
Entering a helping system like a psychiatric hospital, a child-care
center, or a therapy clinic, the client is often required, because of insur-
ance company claims and third-party billing, to accept a disordered
name before therapy can proceed. The name is further secured by the
naming performance when it is entered into professional filing sites
(Foucault, 1979) like insurance, education, medical, judicial, or corpo-
rate files. The history of our life file is cumulative and can sometimes
last forever.
Professional stories written and told about the person—to the person
prescribed and to others—can maintain the powerfully pathologized plot,
rhetorically embed the problem name (and personal life), and assist in piec-
ing together states of despair (Zimmerman, 2017). For people looking for
help and change, the naming and writing process of therapy used in North
America can be both confusing and traumatic (Epston, 2008; Jenkins, 2009;
Madigan, 2007). Their answer to hope and possibility is to undergo further
practices of therapeutic technology/pharmacology deemed hopeful and in
concert with the practices of help offered to them by the very institution
that named them. If they fail to change within the therapeutic parameters
prescribed, the body will be further named (Moules, 2003).
The consequence of an ideologically biased commerce of problems
regularly finds a person’s constructed identity misrepresented and
underknown by dominant knowledge and sets of agreed-on “thin con-
clusions” (M. White, personal communication, 1990). Both the process
of spoken and written pathologizing and the technologies imported to
implement the discourse of pathology speak volumes about the dom-
inant signifying mental health culture but little of the person being
described.
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NEW FORMS OF WRITING AND NAMING: THERAPEUTIC LET TER-WRITING CAMPAIGNS
Therapeutic letter-writing campaigns8 (Madigan, 2004, 2008; Madigan &
Epston, 1995) assist people to re-member lost aspects of themselves. The
campaigns assist persons to be re-membered (Hedtke & Winslade, 2017;
I. McCarthy, personal communication, 1998; Myerhoff, 1992; M. White,
personal communication, 1994) back toward membership systems of love
and support from which the problem has dis-membered them.
The logic behind the community letter-writing campaign is one
response to the problem identity growing stronger within the structures
of the institution (see Gremillion, 2003; Madigan & Goldner, 1998) and
within the many other systems that seem to help problems along. There
is a correlation between the person being cut off from hope and forgot-
ten experiences of themselves and relationships that lived outside of their
“sick” identity and the rapidly growing professional file of hopelessness.
Creating letter-writing campaigns through communities of concern
was a therapeutic means to counterbalance the issue of the problem-
saturated story and memory (Madigan, 1997). Campaigns recruited a
community of re-membering and loving others who held on to preferred
stories of the client while the client was restrained by the problem. Their
lettered stories lived outside the professional and cultural inscription that
defined the person suffering and were also stories that stood on the belief
that change was possible.
Letter-writing campaigns have been designed for persons as young as
6 years and as old as 76 years. Community-based campaigns have assisted
persons struggling with a wide assortment of difficulties, including anxi-
ety, child loss, HIV/AIDS, bulimia, depression, perfection, fear, and couple
conflict. The campaigns create a context in which it becomes possible for
people struggling with problems to bring themselves back from the depths
of the problem’s grip, formidable isolation, self-harm, and attempts to
choose death over life (Madigan & Epston, 1995).
8 I created therapeutic letter-writing campaigns as an extension of Epston’s and White’s numerous practices of the written word.
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Persons receiving letters begin to rediscover a discourse of the self
that assists them to re-member back into situations from which the prob-
lem has most often dis-membered them (Hedtke & Winslade, 2004/2005;
Sanders, 1997; Sanders & Thomson, 1994). These include claiming back
former membership associations with intimate relationships, school,
sports, careers, and family members and becoming reacquainted with
aspects of themselves once restrained by the problem identity. Over the
years, VSNT faculty have encouraged international writing campaigns
that net dozens of responses and have had equally successful three-person
problem blockades. Throughout this time, letters of support have arrived
from some very curious authors. For example, letters of support and hope
have been “written” by family dogs, teddy bears, cars, dead grandparents,
unborn siblings, and unknown movie stars (see Letter Campaign Con-
tributors later in this chapter).
TRAVELS WITH OSCAR
A colleague referred 70-year-old Oscar and his wife, Maxine, to me. In our
first session, Oscar informed me that he had been struck down by a truck
at a crosswalk a year before. He was not supposed to have lived, but he did;
he was not supposed to have come out of his 3-month-long coma, but he
did; and it was predicted that he would never walk again, but he did; and
so on. As you might imagine, it didn’t take me long to realize that I was sit-
ting before a remarkable person. However, it seemed that Oscar had paid
dearly for his comeback because somewhere along the way he had lost all
“confidence” in himself. He also told me he would panic if Maxine was not
by his side “24 hours a day.”
Maxine had spent the year before organizing the complicated task of
Oscar’s medical care and was, at the time of our first visit, looking forward
to getting back to her own business pursuits. Unfortunately, her interests
were being pushed aside and taken over by what they both called anxiety.
The conversational experience of anxiety that had been the “legacy” of
Oscar’s accident had him believing that “I am only half a man,” “Maxine
will leave me for another man,” and “I believe she is planning to put me in
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an old-age home.” Anxiety also had him believing that “I did not deserve
a good life” and, furthermore, “I should kill myself.” The relationship with
anxiety was allowing him to remember to forget the life he had lived prior
to the accident. Oscar also let me know that he was becoming more and
more “isolated and depressed.”
Oscar and Maxine told me that they had moved from England to
Canada 10 years earlier and that their life together had been “blissful”
before the accident. In the first session, we all agreed that the anxiety
was gaining on Oscar and the situation was, as Oscar stated, “desperate.”
During the next session, we decided to design an international anti-
anxiety letter-writing campaign. As Oscar was concerned that his friends
might consider the letter “a crazy idea,” he insisted that I include my
credentials to give it “credence” (Oscar’s words from our sessions are in
quotation marks).
The structure of campaign letters is usually the same. Together with
the client, I write a letter to members of the family/community (whom the
client and/or family member selects) and ask them to assist in a temporal
re-membering and witnessing process through lettered written accounts
outlining (a) their memories of their relationship with the client, (b) their
current hopes for the client, and (c) how they anticipated their relation-
ship growing with the client in the future.
The written accounts are directed squarely at countering the prob-
lems’ strategies to rewrite a person’s past as only negative, projecting
a future filled only with the hopelessness of worst-case scenarios. The
letters also begin to rewrite any negative professionalized stories found
to be unhelpful to the person and helpful to the problem. And, the letters
sent to the person are always diametrically different from what had been
written previously in the client’s file. Campaign letters written by the
person’s community of concern re-present a counter-file. Documenting
alternative versions counteract the infirming effects of the professional
and cultural problem story and the pathologized names inscribed onto
the person’s body.
During the weeks that followed, Oscar would bring the campaign
letters to my office and request that I read them out loud to him (his
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eyesight was poor on account of the accident). I happily did so and my
reading was accompanied by Oscar crying, laughing, and telling me “of
his good fortune.”9 The letters helped him begin to remember more alter-
native stories; he also made the decision to “get off ” the medication his
psychiatrist had prescribed him over a year before. We also invited a few of
his friends and family to come to the sessions to read out loud the letters
they had written to Oscar (see the discussion of campaign therapy session
structure below).
As the content of the letters documented, Oscar had affected many,
many lives. Not surprisingly, his community of concern welcomed the
opportunity to reciprocate by writing to him with their support and
love. His anti-anxiety support team wrote from places around the globe,
including Europe, the United Kingdom, and North America. A few
months later, Oscar wrote to me from his long-awaited “anti-anxiety”
trip to France with Maxine. He once stated how the trip to France would
mark “my arrival back to health.” He wrote on the postcard that he was
sitting alone, drinking espresso, while Maxine had gone sightseeing for
the day. He wrote, “I am thanking my lucky stars that I am no longer
a prisoner of anxiety.” His said that the only problem now was “keep-
ing up with all of his return correspondence!” He stated the return
correspondence was a problem he could manage and was willing to take
“full responsibility for.”
Without the recruitment of a community of concern, Oscar might
never have rebounded to re-member all his personal abilities/qualities and
the contributions he had made during his lifetime that the problem was
“insisting” be overlooked and he be dis-membered from.
Letter-writing campaigns are viewed as attempts to counter the prob-
lem’s cultural and professional disinformation. They also inform the client,
family, and community about those “stories” of the person that are at odds
with the problem-saturated story. Campaigns are viewed not only as ceremo-
nies of re-definition (White, 1995b) but also as protest and counter-struggle
to undermine a problem-contextualized dominant story.
9 It is now the everyday practice of letter-writing campaigns to bring the writers into the session to read their letters to the person as an act of retelling.
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The logic behind the community letter-writing campaign is also an
attempt at finding ways to respond to certain problem identities grow-
ing stronger within the structures of the institution (Bjoroy et al., 2016).
Often a tension exists between persons in the hospital/institution/youth
facility (because of being cut off from hope and forgotten experiences of
themselves) and the relational identities that live outside of their “sick”
identity. This is a tension worthy of exploration. My practiced of narrative
therapy in part hinges on creating counterbalances within the tension by
including a community of re-membering and loving others who hold
the stories of the client while the client is temporarily too restrained by
the problem to remember these preferred and alternative memories. These
desired stories live outside the professional and cultural inscription that
defines the person suffering and stand on the belief that change is always
possible (Smith & Nylund, 1997).
LET TER-WRITING CAMPAIGN STRUCTURE
Letter-writing efforts can take on a variety of shapes and forms, but
the most standard campaigns involve the following (Madigan, 1999,
2004, 2008):
1. The campaign emerges from a narrative interview when alterna-
tive accounts of who the person might be are questioned, revived,
and re-membered. Persons are asked to consider whether there are
other people who may regard them differently from how the problem
describes them. These different accounts are then spoken of. I might
ask the following questions: “If I were to interview X about you, what
do you think they might tell me about yourself that the problem
would not venture to tell me?” Or “Do you think your friend’s tell-
ing of you to me about you would be an accurate telling, even if it
contradicted the problem’s telling of you?” Or “Whose description of
you do you prefer, and why?”
2. Together, the client and I (along with the client’s family, partner,
friend, therapist, insiders, and so on, if any of these persons are
in attendance) begin a conversation regarding all the possible other
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descriptions of the client as a person the client might have forgotten
to remember because of the problem’s hold over them. We dialogue
on who the client might be, who the client would like to be, and who
the client used to be well before the problem took over their life. We
recall the forgotten alternative lived experiences of themselves that the
client may have forgotten through the problem’s restraining context.
3. We then begin to make a list of all the persons in the client’s life who
may be in support of these alternative descriptions. Once the list is
complete, we construct a letter of support and invitation.
4. If finances are a problem, VSNT supplies the envelopes and stamps
for the ensuing campaign.
5. If privacy is an issue, we use the VSNT as the return address.
6. The preference is for as many of the letter writers from the com-
munity of concern to attend the sessions as possible. If the person
comes to the next session (with the letters) alone, I will offer to read
the letters back to the person as a textual retelling.
7. The client is asked to go through the collection of letters as a way of
conducting a “co-search” with themselves.
The general structure for reading and witnessing letters in therapy is
as follows:
1. All campaign writers are invited to the session (if this is geographi-
cally possible), or virtually attend, and in turn are asked to read aloud
the letter they have penned about the person. In attendance are usu-
ally the client, myself, the other writers from their community, and
sometimes a therapy team that may include insiders.
2. After each writer reads aloud, the client is asked to read the letter back
to the writer, so both writer and client can attend to what is being said/
written from the different positions of speaking and listening.
3. After each letter is read by the writer and discussed with the client,
the community of others who are sitting and listening offer a brief
reflection of what the letter evoked in their own personal lives.
4. This process continues until all letters are read, reread, responded to,
and reflected on.
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5. Reflecting team members10 (usually but not always professionals;11
T. Andersen, 1987) then write and read a short letter to the client and
his or her community. They reflect on the counterview of the client
offered up by the person and his or her community, the hope that was
shared, and aspects of the letters that moved them personally.
6. Copies are made of each letter and given to everyone in attendance.
7. I then follow up the session with a therapeutic letter addressed to
everyone who attended the session including the client, the commu-
nity of concern, and the reflecting team.
LET TER CAMPAIGN CONTRIBUTORS
The repercussions of many problems can often push persons to dis-member
themselves from the support systems that surround them and coerce them
toward isolation, detachment, and withdrawal. Similarly, problems and pro-
fessional systems may compel support persons to move away from the per-
sons struggling by encouraging hopelessness, anger, and despair.
Our experience has shown that once support persons have received a let-
ter inviting them to contribute to a campaign, they will often feel compelled to
write more than once (three and four letters are not uncommon). Contribu-
tors often state that they have had the experience of feeling “left out” of the
helping process. Contributors to the campaign have reported feeling “blamed”
and “guilty” for the role they believe they have played in the problem’s domi-
nance over the person’s life. They suggest that many of these awkward
feelings about themselves have been helped along by various professional
discourses and self-help literature. Being left out can often leave them with
the opinion that they are “impotent” and “useless” (Madigan, 2004).
Letter campaign authors explain how their contributions have helped
them feel “useful” and “part of a team.” In addition, the writing of a
10 After playing at the World Ultimate Frisbee tournament with Canada in Oslo in 1990, Norwegian psychiatrist Tom Andersen, who invented the practice of reflecting teams, was gracious enough to take me along on a 4-day holiday with him and his family to his summer home in Christensen, Norway. I interviewed him day and night about his new reflecting team practice and his ideas on the art and importance of listening in therapy. They continue to influence me to this day.
11 In some campaigns, I have asked former client insiders or members of the Anti-Anorexia/Bulimia League to sit in on the session as insiders.
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re-membering text offers family members and other support persons
an opportunity to break free of the problem’s negative dominance
in their own lives and allows for an alternative and active means for
renewal and hope. As one older man who committed himself to an
antidepression campaign for his 22-year-old nephew explained, “The
letter campaign helped me to come off the bench and score big points
against the problem so my nephew could pull off a win. In helping him
I helped myself.”
Therapeutic letter-writing campaigns act to re-member alternative
accounts of a person’s lived experience that a problem often separates them
from. The campaign encourages the person to become reacquainted with the
membership groups that the problem has separated them from (e.g., family,
friends, school, sports, teams, music, painting). Therapeutic letter-writing
campaigns are designed as counter-practices to the dis-membering effects
of problem lifestyles and the isolating effects that psychological discourses
often create in persons’ lives. The letters form a dialogic context of preferred
re-membering and meaning. The following is an account of one such
campaign.
TRAVELS WITH PETER
The social work department of an in-patient, adult psychiatric ward asked if
I would see Peter, a 38-year-old White, heterosexual, married, middle-class
man who worked in the local film industry. This particular psychiatric ward
had referred individuals and families to me in the past. The referring social
worker also knew that I was the primary therapist responsible for the film
and television industry personnel in Vancouver. So it seemed from the social
worker’s point of view, Peter and I were potentially a good therapeutic match.
Peter was described to me by hospital professionals as “chronically
depressed” and was given very little hope for change. The pessimism was
triggered by a recent attempt to kill himself while on the ward and having
to be physically restrained from pushing a male orderly. The hospital’s
plan for health and change involved group and individual cognitive–
behavioral therapy together with numerous medications. Despite these
attempts, hospital staff described how “nothing seemed to be working.”
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I was also informed that the staff was beginning to think that after
6 months of ward time, “change was impossible.”
Peter had a total of nine visits with me over the course of 4 months.
After the first six meetings, he was able to return home from the hospital.
All therapy sessions included a narrative response team (Madigan, 1991a).
On five of the visits, volunteers in the letter-writing campaign (including
family members; long-time friends; and his former partner whom he had
separated himself from) were invited into therapy to perform their writ-
ten work “live” in front of Peter.
During the first interview, Peter explained that 11 months prior to
our talk, his 3-year-old daughter (whose mother was his former partner)
had died in a tragic drowning accident. He stated that initially he had only
felt “bitter and angry” and cut off from the “real meaning to life” and he
had “turned down support from anyone that mattered.”
Peter stated that he responded to his daughter’s death by “barricading
myself away from the world” and that “I blamed myself.” Shortly thereaf-
ter, he separated from his marriage “to be alone.” In a short period of time,
Peter had virtually removed himself from anyone who cared about him.
He was eventually admitted to the ward after a neighbor found him “in
the garage with the motor running.”
The problem, which he referred to as “an inability to go on,” had taken
over his daily life. He let us know that he was “haunted day and night” and
“couldn’t remember much of his life” from before the day his daughter,
Mara, died. He said that he “felt hopeless” and could not remember the
“sound of Mara’s voice.”
Briefly, below are a few therapeutic counterviewing questions from an
unaltered transcript12 Peter and I engaged in:
77 Do you think that “giving up on hope” is the way in which your conver-
sations with hopelessness find a way to help you believe that giving up
is a good answer—the only answer?
12 My strong ethical preference is to use only unaltered transcripts of the session. A few therapists have recently argued for the use of rendered transcripts. My feeling is rendered transcripts only act to fictionalize and alter exactly what the client and therapist have actually stated, thereby making the presenting therapist’s voice primary/expert/powerful, the client voice seems like it wasn’t good enough in the original, and an unlikely presentation of their therapy skills as perfect.
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77 How do you think the community looks on a father who has lost his
3-year-old daughter?
77 Do you feel it is fair that everyone keeps telling you that you’ll “get
over it”?
77 Do you believe that these people believe that there is a proper time line
for a grieving father?
77 Are there places of past hope that you can remember that are currently
blocked out by hopelessness and despair?
77 How is this hope possible?
77 Do you feel that it is a fair accusation to blame yourself for Mara’s
death? What supports this accusation?
77 Was the hospital accurate in diagnosing you as depressed or do
you think it might be about your experience of not knowing “how
to go on”?
77 Are there people in your life and community, including the hospital
staff, who you believe blame you for Mara’s death?
77 Has this deep sorrow you’ve explained to me been a sorrow that you
could share with anyone else?
77 Is there anyone in your life, looking in on your life, who you think
holds out hope for you—by holding your hope for you—until you
return to it?
77 If for a moment you could imagine that hope could be rediscovered
in your life, what present qualities in you would give it staying power?
77 Is the love you hold for Mara in any way helpful to the restoration of
hope in your life?
After three sessions, Peter, the team, and I drafted a letter to his com-
munity of concern (see Exhibit 4.4). He chose a dozen people to mail
the letter to. Personally, I found the reflections and readings with Peter
and the eight members of his community of concern who attended to
be extremely profound. Our letter-writing campaign meetings some-
times lasted 2 to 3 hours (we scheduled them at day’s end). Suffice it to
say that the texts written by the community of concern acted on Peter’s
anticipation of hope, acceptance of who he was, and his willingness to
further live his life.
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Four weeks later, Peter left the hospital on a forward-stepping path
to become free of medication and concern. He and Mara’s mother then
entered into couple therapy with me as a possible way of looking at
restoring their marriage. They brought the letters. Together they antici-
pated the possibility they could reconstruct their marriage. Hope is a
wonderful potion.
There are many other wonderful narrative therapy practices that
continue to come forward, and many others that I wish I could have
Exhibit 4.4
Letter Sent to Peter’s Friends and Family
Dear Friends and Family of Peter,
My name is Stephen Madigan, and I am a family therapist working
alongside Peter. Since Mara’s tragic death, Peter has let me know
that “he hasn’t known how to face the world.” Until recently, a sense
of “hopelessness” pretty much “took over his life” to the point that
it almost killed him. Another debilitating aspect of this profound
loss is that Peter can’t “remember much of his life” since before
Mara’s death. Peter also feels in an “odd way responsible for Mara’s
death,” even though he knows “somewhere in his mind” that he
“was out of town the day of the accident.” Peter believes that there
is a “strong message out there” that he “should just get on with his
life.” Peter says he finds this attitude “troubling” because each “per-
son is different” and he believes that he “might never get over it but
eventually learn to live alongside it.”
We are writing to ask you to write a letter in support of Peter
explaining (a) memories of your life with Peter, (b) what you
shared, (c) who Mara was to you, (d) how you plan to support
Peter while he grieves, (e) what Peter has given to you in your life,
and (f ) what you think your lives will be like together once he
leaves the hospital.
Thank you for your help, Peter, Stephen, and the Team
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unpacked and attended to more in this chapter. However, space restraints
will not allow this.
LEAGUES AND CO-RESEARCH
During the early 1980s, David Epston and Michael White invented an
approach to therapy that involved therapeutic letter writing. At least
half of their seminal book, Narrative Means to Therapeutic Ends, explains
their work through the use of therapeutic letters. Therapeutic letters are
viewed as counterdocuments to those files being compiled throughout
other systems. White and Epston (1990) wrote that “the proliferation and
elevated status of the modern document are reflected by the fact that it
is increasingly relied upon for a variety of decisions about the worth of
progress” and in the domain of professional disciplines, a document can
serve several purposes, “not the least of which is the presentation of the
‘self ’ of the subject of the document and of its author” (p. 188).
Much of the information on the history of documents and the file
was garnered from the works of Michel Foucault and psychologist Rom
Harre13,14 (Davies & Harre, 1990). In contemplating psychiatry, Harre put
his efforts toward uncovering the “file speak” within a client document
(file) and how, over time, the file began to take on a life of its own. Harre
wrote that “a file has an existence and a trajectory through the social world,
which soon takes it outside the reach of its subject” (p. 59).
Epston and White regularly sent letters to clients after their session.
They wrote to secure subordinate stories, recap stories of appreciation
and survival, and ask more questions about the knowledges and alterna-
tive stories the client gained through the re-authoring session. Epston
took the practice of letter writing a step further and circulated a few of
his letters and the client’s return letters to other clients (Epston & White,
1990). He collected their client wisdom in what he called an archive. The
13 Letter writing was such an integral part of their therapy practice that their initial title for their seminal book Narrative Means to Therapeutic Ends was Literate Means to Therapeutic Ends.
14 For a full reading of therapeutic letter writing, see White and Epston (1990) and Dulwich Centre Publications.
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archive contained audiotapes and letters that represented a rich supply of
solutions to an assortment of long-standing problems such as temper tam-
ing, night fears, school refusing, bedwetting, bullying, asthma, and anorexia
and bulimia. These clients never met face-to-face but were in touch with
a rich reserve of wisdom and experience with a common problem. He
patched together a small network of clients with the purpose of consulta-
tion, information, and support. He called these client networks Leagues.
THE ANTI-ANOREXIA/BULIMIA LEAGUE
During the mid-1990s, I accepted an invitation to consult and run narra-
tive therapy groups at a large urban Vancouver hospital in-patient eating
disorder ward. From these beginnings, I was able to stretch and build upon
the concept of Leagues and together with an amazing group of patients
and former patients who had all once lived on the eating disorder ward,
we formed the Vancouver Anti-Anorexia/Bulimia League.15 The primary
and novel difference from Epston’s work was that as a large group, we met
with each other in a large groups and in person.
From its inception, the Vancouver Anti-Anorexia/Bulimia League
offered a clear mandate for outspoken, experienced voices to be heard,16
and quickly moved toward practices of public education and political
activism (Vancouver Anti-Anorexia/Bulimia League, 1998). The Anti-
Anorexia/Bulimia League uses an “anti-language” to
77 establish a context where women recruited by anorexia/bulimia experi-
ence themselves as separate from the problem;
77 view the person’s body and relationships to others not as the problem—
the problem is the problem (counters the effect of labeling, pathologiz-
ing, and totalizing descriptions);
15 In general, leagues use an “antilanguage” for explaining their philosophy and ideological position (e.g., the Anti-Depression and Anti-Anxiety Leagues). In doing so, League members act to externalize previously internalized problem discourse collectively.
16 I presented many conference workshops alongside members of the Vancouver Anti-Anorexia League. On numerous occasions, a League member’s therapist was in the professional audience listen- ing to their past and present clients. Affording opportunities for a person’s “status” to be raised from patient to consultant is primary in the work of narrative therapy.
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77 enable people to work together to defeat the complexities involved with
the problem;
77 consider the cultural practices of objectification used to objectify
anorexia/bulimia instead of objectifying the woman as being anorexic/
bulimic;
77 relationally externalize the objectification of the problem that chal-
lenges the individualizing techniques of scientific classification and
looks at the broader cultural and relational context for a more complete
problem description;
77 relationally externalize to introduce questions that encourage the per-
sons taken by anorexia/bulimia to map the influence of the problem’s
devastating effects in their lives and relationships;
77 relationally externalize to deconstruct the pathology, “thingification,”
and objectification of women through challenging accepted social
norms; and
77 relationally externalize and thereby allow for the possibility of multiple
descriptions and re-storying by bringing forth alternative versions of a
person’s past, present, and future.
Radical in its philosophy, the Vancouver Anti-Anorexia/Bulimia
League’s mandate was to hold accountable those professional and con-
sumer systems that knowingly reduce women with “eating disorders” to
dependent and marginalized. Dependency and marginalization occurs
through practices of pathological classification; long-term hospitaliza-
tion; medication; funding shortages; lack of community support pro-
grams; and messages of hopelessness, individual dysfunction, and blame.
The League’s agenda was to win the “war” they believed was being waged
on women’s bodies on both the professional and community front.
Through the process of reclaiming their lives back from anorexia
and bulimia, League members refused to accept the popular misconcep-
tion that they alone were responsible for their so-called eating disorders.
League members began to make a crucial shift in their identities from
group therapy patients to community activists and experienced consul-
tants. In helping at the level of community, they assisted other women and
families and, in turn, helped themselves.
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The purpose of the Vancouver League (Madigan & Law, 1998) was
also to traverse the questionable ideological and fiscal gaps that lay within
a traditional treatment terrain of mental health. The League promoted the
idea of independence and self-sufficiency by gaining government grants,
forming a nonprofit society, having an office space and phone lines, and
producing a free magazine. Its playing field was twofold: (a) preventive
education through a call for professional and community responsibil-
ity and (b) an alternative and unconventional support system for those
women caught between psychiatric hospitals and community psychiatry.
Through our regular meetings, League members, families, lovers, and
friends took a direct action17 approach to the problems of anorexia and
bulimia. For example, through their development of a media watch com-
mittee, the League acted to publicly denounce pro-anorexic/bulimic activi-
ties against women’s bodies through letters written to a wide variety of
magazines, newspapers, and company presidents. This enabled the League
to return the normative gaze through anti-anorexic/bulimic surveil-
lance directed toward professional, educational, and consumer systems.
The school action committee developed an anti-anorexic/bulimic program
for primary and secondary school students (however, they found out that
diets and concerns with body specification were now the talk of toddlers
in preschool programs). League T-shirts were made with the words “You
are More Than a Body” emblazoned across the back, with the League name
and logo printed on the front (they were always a hot-selling item). The
League also held a candlelight vigil each year in front of the Art Gallery to
honor their League friends who had died anorexic/bulimic deaths.
It is common practice for us to pay ex-clients and League members
to act as consultants to therapists in training and as response team
members. Given the choice of using a League member or another
therapist for an anti-anorexic therapeutic response team consultation,
I always prefer, whenever possible, to access a League member. New clients
struggling with disordered eating are struck by the member’s compassionate
and direct reflections.
17 Much to the delight of the membership, the league activities were highlighted in a 1995 Newsweek article on narrative therapy.
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ANTI-ANOREXIA CO-RESEARCH
Below is an unaltered excerpt from a videotape made for the explicit pur-
pose of circulating veteran ideas in the training of therapists on what they
might need to know when working with the problem of anorexia and
bulimia. This interview represents the narrative practice of using hard
won experienced knowledge as co-research.
Madigan: What do therapists need to know when working with persons
taken by anorexia and bulimia?
Catherine [Vancouver Anti-Anorexia League member]: Well, I guess
that it’s important that therapists know that anorexia and bulimia have
to be dealt with on a number of different levels, and that you can’t just
focus in on the individual. What’s happening for them, or what’s happen-
ing in the family, or what’s happening in the environment or society is all
important and all together. You have to deal with it on all levels, or else
you’re just dealing with just part of what the problem is, and I think it’ll
always come back if you don’t.
Madigan: Is there anything that you have discovered that professionals do
that is unhelpful in going free of bulimia and anorexia?
Catherine: Well, when they look at you as a bulimic person, you begin
to look at yourself—entirely—that way too. You begin to identify purely
with your anorexia and your bulimia, and you lose yourself. You deny you
have another aspect to yourself. You think about your eating disorder, and
everyone is saying, well, “you’re bulimic” or “you’re anorexic,” and any-
thing you do wrong is attributed to you being a bulimic or anorexic. This
way really denies them a lot, denies them their personhood. You could
say that because I struggled with bulimia and anorexia once, but that’s
just one aspect of my life. I feel it gets really hard because you’re trying so
hard in the struggle to hold on to yourself, to the inner person, the person
that needs to come out, and then when everyone is focusing just on the
bulimia and your anorexia, the behavior, then they push you and yourself
down. Every time people and professionals do that, you become smaller
and smaller.
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Madigan: What did you find helpful?
Catherine: I guess it had a lot to do with separating bulimia from myself. Being able to see it as one aspect of me and just that! And giving me my
voice back, giving myself back my voice and pushing bulimia back, or
trying to put bulimia back where it belongs; I don’t know how to say that.
Just trying to give it a sense of, I guess, separate yourself from it. You know,
allow my voice to become louder and turning down the volume on the
bulimic voice.
Madigan: Was there one tactic of bulimia that stands out for you as being particularly horrible?
Catherine: Well, yes, it was such a secretive thing. It told me that secrecy was the only way for me and it to survive. And I guess it caused me not
only to have to keep it a secret to people on the outside, but it insisted I
keep it a secret from everyone close around me and through this it impris-
oned me. I couldn’t reach out, I couldn’t talk to people. And, as time goes
on, you don’t trust those people. Because it becomes your best friend. It’s
the only thing that made me feel better. Having a binge was to get rid of
some of the rage by purging. It became everything. An all-purpose best
friend and coping mechanism, and it also kept me trapped and kept me
doubting myself and the people around me.
Madigan: Is there anything that you have come up with to combat bulimia’s compliance with secrecy?
Catherine: When I feel that it’s trying to put a stranglehold of secrecy around me, I really actively think about it and say, okay, what am I doing?
Am I isolating myself? Is the bulimia causing me to withdraw? Then turn-
ing down the volume and going, no, I’m not going to let it have control,
and I actively really think of it as something separate. I call it for what it is
and that’s an abusive partner—it’s just very abusive to me. By saying no to
the abuse and reaching out for those people that are there, and have always
really been there, really helps diminish its grip. The bulimia has kept me
in prison and isolated me and denied me my own sense of self-worth and
denied me the feeling that I am a good person and I am worth caring
about and people do want to share and be a part of my life.
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Madigan: I find your paralleling bulimia to that of an abusive relationship
fascinating. Could you tell me more about this idea of yours?
Catherine: I was once writing a letter to my body and saying, “I’m sorry
for all the abuse” and da, da, da, da, and I really began to identify just
how abusive bulimia is! And how it acts exactly like an abusive partner.
It attacks me at the moment I’m most vulnerable, and it tries to keep me
down. It tells me I’m no good. It tells me that no one else will like me, and
I can always depend on it and no one else will be as dependable. It tells me
it’s doing this because it really cares, and it wants to do something really
nice. You know, it finds all sorts of really insidious ways of destroying
every sense of self and self-worth that you have. It keeps you distracted,
and then it slowly abuses you physically and mentally. It keeps saying that
“I care about you” and “nobody loves you like I do.” That’s what kept it so
firmly planted in my life. When anyone disappointed me, even a little bit,
I said, “Well, it’s [bulimia] right.” I am worthless, that’s why this is hap-
pening, and I went to have a binge and yeah, it made me feel good for the
short term, and you know I tried to nurture myself by filling myself up and
get rid of the rage by purging. It did help in the short term, the very short
term, but it has disastrous consequences.
Madigan: How did you manage to get free of bulimia’s abuse?
Catherine: I think it was a number of things. First, the thing I really had to
come to grips with was that it was an abusive relationship. Knowing about
abusive relationships, I know it’s not going to go away unless I get some
help, right? (laughs) So, I really had to look at it, and whatever intellectual
or emotional thing that kept me holding on to it had to go. I looked at it
as separate from me, me in relation to an abusive partner, and I realized
nothing was ever going to get better. I knew I would never gain control of
it, that it doesn’t really love me. That it really hates me, and it has its own
purpose and its own agenda, and that was to destroy me. And I had to really
look at that and start letting go of all the lies that it had for keeping it in my
life. And just like when you leave an abusive partner, you have to reach out,
I found there were some very persistent and good people, League people,
positive people that were really working hard at letting me know that they
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T H E T H E R A P Y P RO C E S S
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were there, and they would be there. They were a heck of a lot better than
a bulimic partner. Slowly, by just beginning to trust and realize, yes, they
were there, and they know me pretty well now.
Madigan: How did you put an end to the abusive relationship?
Catherine: I just kicked the bulimic bum out!
Is it any wonder that participating in the League’s “What Every
Therapist Needs to Know About Anorexia and Bulimia, But Were Afraid
to Ask” workshop sessions,18 the room of professionals and laypersons
thundered with applause, interest, and tears? I was working with Dr. Elliot
Goldner, at the time, the director of the hospital eating disorder pro-
gram in Vancouver (and also a long-time friend). I asked Dr. Goldner
to offer his reflections after reading excerpts of the League’s ongoing
coresearch project. He wrote the following:
The writings of the League underscore a potent fact: people strug-
gling against anorexia and bulimia possess a wisdom and exper-
tise that must not be marginalized. Their research is pulled from
the pores of experience and has not been limited to eight hours a
day academic blinders, and political or financial motivations. To
ignore their insight would be folly. Yet, psychiatry and therapy
practices have too often disregarded such careful and painstaking
research, and have preferred promises of quick fixes, and electrify-
ing solutions from technology and scientism. (Madigan & Epston,
1995, p. 56)
When I listen to League member wisdom, these are some of the things
I hear:
77 Collaboration is helpful in fighting anorexia and bulimia; leagues
such as the Vancouver Anti-Anorexia/Bulimia League can offer such
collaboration.
18 TCTV.live has extensive interview footage of consultations with Vancouver Anti-Anorexia/ Bulimia League members.
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77 Anti-anorexic/bulimic actions help to combat eating disorders for indi-
viduals and societies; in contrast, nonaction (which characterizes some
“therapy” or “support efforts”) is not helpful.
77 Empowerment of those persons fighting anorexia and bulimia is help-
ful in combating eating disorders; such empowerment is supported by
respect and by separation of the person and the problem.
77 Anorexia and bulimia can hold a person with the vice grip of an abu-
sive partner; secrecy and shame can form the glue that adheres these
problems to the person.
77 Others (including those in “helping” professions) may worsen the prob-
lem; this often occurs when people confer certain knowledge about a
person and constrain that person’s identity and selfhood.
When we presented the League ideas in a public forum, we were con-
tinually reminded of their social impact on therapeutic possibilities. It is
from within the wisdom of these coresearch projects that therapists can be
moved toward a reflexive accountability. We would argue that the weight
of therapeutic accountability should be privileged and mediated through
the knowledges of the once marginalized, not through a professionalized
discourse.
Co py
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t Am
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an P sy
ch ol og ic al A ss oc ia ti on . No t fo r fu
rt he
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st ri
bu ti
on .