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ARTICLE CRITIQUE 8
Article Critique
Article Critique
Introduction and Purpose
In the article “Standing on the Shoulders of Giants: Narrative Practices in Support of Frontline Community Work with Homelessness, Mental Health, and Substance Use,” Brian Dean Williams and Barbara Baumgartner (2014) focused on the use of narrative therapy and narrative techniques for the purpose of supporting individuals with homelessness, mental health, and substance use issues. Narrative therapy is considered to be a multi-disciplinary approach as it is not just used in the psychology but also used in various other disciplines including anthropology, sociology, queer theory and social work. Williams and Baumgartner (2014) referred to narrative therapy as an “anti-oppressive” and “non-individualizing” technique that can be used as critical lens to deduce the context of the problems experienced by the Assertive Community Treatment (ACT) program participants.
Williams and Baumgartner (2014) worked along with the members of the ACT team to seek solutions to homelessness and mental health issues in Vancouver, Canada. Williams and Baumgartner (2014) provided the ACT team members with detailed guidance in using narrative practices to further support the program participants. Williams and Baumgartner (2014) discussed extensively about narrative therapy and narrative techniques in the article, and how they were relevant to community work. One of the program participants, Roy, was invited to share his stories and contribute to the article.
Williams and Baumgartner (2014) were members of the RainCity Housing First Assertive Community Treatment (ACT) Team in Vancouver, British Columbia, which was one branch of the At Home / Chez Soi research demonstration project conducted by the Mental Health Commission of Canada. Beginning in 2009 in five cities across the country, the At Home / Chez Soi study looked into solutions to chronic homelessness for those diagnosed with mental illness by comparing ACT, Intensive Case Management (ICM), and congregate housing interventions, to a treatment-as-usual cohort. Williams and Baumgartner (2014) shared their lived experiences and what they learned in providing the services to the community in the article.
The purpose of the article is to demonstrate that using key concepts of narrative therapy - including seeing the person as expert; recontextualizing the problem; externalization; story as a metaphor; and re-authoring – front line workers will be able to see and support the telling of program participants’ hopes, dreams, and untold abilities.
Research Question and Hypothesis
The research question and hypothesis of the article are to find out how nitrative techniques could be used to better support the program participants of the ACT. Williams and Baumgartner (2014) analyzed how narrative techniques were used by ACT members to better communicate with program participants. Williams and Baumgartner (2014) mentioned that they successfully used narrative therapy along with the ACT team members to learn about the journey of the program participants from being homeless to reaching the status of being housed. Narrative therapy also helped Williams and Baumgartner (2014) learn more about the intimate details of program participants’ personal lives.
Description of the Study Design
Williams and Baumgartner (2014) used qualitative research design model. Williams and Baumgartner (2014) were concerned with understanding ACT program participants’ lives experiences including their feelings, thoughts, and behaviours. Data were collected through participants’ reflection, observations, and interviews.
There were around 90 program participants in the study. The ACT team members also used a combination of “Housing First” and “Assertive Community treatment model” to resolve the issues of all the people included in the study. The participants were provided with residential facilities through “Housing First” approach. “Housing First” was adopted by the team members as ”recovery-oriented approach” that is provided to the patients on the basis of their choice. The fundamental belief of “Housing First” is that housing is a basic human right so people suffering from mental illness do not have to prove themselves eligible for this right. Housing First approach is the way to provide people suffering from mental illness with a comfortable residence in which they can start getting better with the help of either ACT or ICM. The Housing First approach in combination with ACT is more effective in comparison to providing ACT to homeless people as it provides such people with the security of having a welcoming and comfortable home. When a mentally ill person feels himself secure in any environment, his recovery process gets more speedy. Apart from Housing First and ACT, the authors have also sought help from the case study of Roy who was the participant of ACT program. At that time of the research, Roy was around 37 years old and had spent almost 22 years dealing with homelessness, mental health and substance abuse issues. The authors not only listened to Roy’s story but they also gathered data from some of the other participants by asking them different type of “Narrative candidate questions” (Williams & Baumgartner, 2014).
Data Analysis
Most of the data collected for this study was available in question answer form as the data was gathered either through the help of case study or by asking narrative questions to the participants. In order to derive the data from the patient’s conversation, the authors created a documented that was specifically designed to meet their expectations. The authors were also aware that most of the programs focused on substance abuse usually require the subject’s history so that the reasons behind his drug addiction can be revealed. This is the reason they created a document containing the questions borrowed from different psychotherapists including David Epston, Vikki Reynolds and some of the others. The questions asked the participants regarding the instances when the participants were compelled to do something against their norms and values while being under the influence of drug. The questions also asked the participants regarding such instances where participants were under the influence of drug but they resisted doing something wrong. The questions further asked the participants regarding their reaction towards the life they are leading as a result of substance abuse and whether they feel positive about their future or not (Williams & Baumgartner, 2014).
The authors also gathered data from different participants and claimed that they always approached every participant with the intention that they need to learn something new from him. They considered it to be an important starting point as the participants seemed willing to tell them the things that they never told anyone before them. The authors also gathered data by following different stages of narrative therapy for instance, the expertise of a person regarding his/her own life, putting the problems into different contexts, refraining from shifting blame on the other person, externalization, use of story as a metaphor and at the end re-writing that story. The authors asked relevant questions to the participants during each stage and at the end derived meaning from all the stories (Williams & Baumgartner, 2014).
Conclusion, Application and Ethics
The authors adhered to different ethics of narrative therapy while conducting their study. While having conversation with the participants, the authors made a careful selection of the words. They also tried to maintain professionalism and respect the boundaries of all the participants in order to refrain from any sort of emotional harm. They were also of the opinion that every single participant has an expertise over his own life so instead of judging the participants they were there to learn from them. They also showed respectful and unbiased behavior towards the individuals while framing their problems. The authors also respected Roy’s desire to remain confidential through this study. In order to maintain his privacy, they used a pseudonym instead of his original name. They also gained proper consent from him prior to publishing the excerpts of his conversation and his story in the study. The study concluded that narrative therapy is an effective way for the psychotherapists to gain access to the intimate knowledge regarding a person’s life in order to resolve his mental and substance abuse issues (Williams & Baumgartner, 2014).
Critical Analysis
The abstract of every study includes the purpose of the study, the research method used within the study and the number of participants that took part in the study. However, the abstract of this study is quite different and seems incomplete as it does tell about the model and therapeutic practices that will be used in the study but it does not provide any information regarding the participants included in this study. The only participant mentioned clearly in the abstract is Roy but the issue is that study does not just revolve around him but it also includes the other participants as well. It has also not been mentioned in the abstract or the introduction of the paper whether the narrative therapy is a qualitative technique or a quantitative technique. The entire structure of the narrative therapy has also not been discussed in detailed and only a brief overview regarding the narrative therapy has been provided. Even though, the steps of narrative therapy have been mentioned but the data analysis is not mentioned and also the results derived from any data are not made evident in the conclusion of the study. This might have happened due to the fact that authors mentioned at the start that they are not going to provide results of the study.
The absence of proper literature review within the study makes it hard for reader to believe in the validity or significance of the study. The authors do mention that they have conducted the study from unique perspective but how do they know that without mentioning any previous studies in this field. They have also failed to mention the significance and the importance of this study for the field of psychotherapy. They have indicated at different places that this study is bound to make a difference which cannot be considered a realistic approach as did not consider the limitations of the study. Even though, there are various loopholes in the study, still it is quite informative as it enlightens one regarding a different way to gain access to intimate information of a patient’s life. In order to resolve the mental health issues or substance abuse issues, it is important for a psychotherapist to gain access to a patient’s personal history. However, the issue is that most of the substance abuse patients or mentally disturbed patients are not in the condition to share their history. The steps of narrative therapy introduced in this study are quite effective in enabling a psychotherapist gain access to important data from all the information provided by the patient.
This entire study thrives on the fact that patients suffering from mental health issues and substance abuse are also alienated by the society due to which they are desperate to talk to someone. However, understanding such people or motivating them towards a clean life is not an easy task. This study is quite effective as it uses narrative therapy in a conversational way to derive important data from the conversation held with such patients. This data then helps the psychotherapist understand the reasons behind the condition of the patient and find out a way through which he can motivate the patient towards a better life. Another positive aspect of the study is the authors’ adherence to the research ethics and ethics of narrative therapy. Nowadays, following research ethics has been made mandatory for the researchers to maintain the privacy of the participants and validity of the study. The authors specifically mentioned that they have adhered to the ethical practices while conducting this research which is a positive step.
While concluding the study, the authors revealed that narrative therapy is an effective strategy because it enables the psychotherapists to show respectful and humane behavior towards the people who have been marginalized by the society. By allowing the patient to be an expert of his life, the psychotherapists pay him the respect that he craves from the society but never gets. By re-writing the patient’s story after following all the steps of narrative therapy, the psychotherapist gets access to a patient’s hopes, desires and hidden abilities. Gaining access to such information not only enables the psychotherapist to find a way to treat the patient but it also motivates him that there is still hope for the patient.
References
Williams, B. D., & Baumgartner, B. (2014). standing on the shoulders of giants: Narrative
practices in support of frontline community work with homelessness, mental health,
and substance use. International Journal of Child, Youth and Family Studies, 5(2),
240-257. doi:10.18357/ijcyfs.williamsbd.522014
