Externalising conversations

Jordi Freixas Dargallo: January 2, 2010

There has been no comments to this post up to now.

I would like to say that in his Workshop Notes (Published on www.dulwichcentre.com.au September 21st 2005), Michael White speaks of

Four categories of inquiry, that constitute externalising conversations, and that contribute to the:

1. Negotiation of an experience-near, particular, and non-structuralist definition of the problem/concern (as an alternative to an experience-distant, global, and structuralist definition of the problem/concern).

2. Mapping of the effects/influence of the problem through the various domains of living in which complications are identified (home, workplace, school, peer contexts; familial relationships, one’s relationship with oneself, friendships; purposes, hopes, dreams, aspirations and values; life’s horizons, one’s future possibilities, etc.).

3. Evaluation of the effects/influence of the problem in these domains of living (Is this okay with you?; How do you feel about this?; How is this by you?; Where do you stand on this?; What it your position on this?; Is this a positive or negative development? Or would you say both a positive and a negative development, or neither of these? Or would you say an in-between development?; and so on).

4. Justification of these evaluations (Why is/isn’t this okay for you?; Why do you feel this way about this development?; How come you’re taking this stand/position on this development?; Would you tell me a story about your life that would help me to understand why you would take this position on this development?; and so on).

Point 1 has been often alluded to as “naming the problem”. To me, it is very important to take into account that “naming” is often the outcome of the negotiation Michael White mentions. And, in my opinion it is the negotiation that is useful -even if it does not end in a “naming”, which sometimes happen. But consulting the “experience near” perception of a concern is very usefull in my experience.

And I would say that the same holds for the rest of the “categories”. The map is negotiated, and so is the evaluation of the effects and the justification of the evaluations. Negotiating a definition, a map, an evaluation is a way to check your records and to find out that there are cracks in your former versions. This is an evidence that the whole thing has to be re-historized and, at the same time the beginning of the process of re-historization itself.

Somebody agrees with me?

Rachel Williams: March 31, 2010 (Narrative Practices Adelaide)

Thanks for your post Jordi – I agree. I have only just started to get more comfortable with externalising conversations. I work with children and young people and often find that they take a little while to ‘get it’ when I suggest naming the problem – often i have given suggestions as they have looked at me and been unsure what i am talking about…leading me to give some ideas and then i think i have potentially not got as an experience near description as i could. I guess with more reading and practice i will get better with my questions. They are usually very well aware of the effects of the problem – in particular on their relationships as they usually come with a parent who they often say might find for example ‘the worry bug’ very frustrating. I have noticed in my starting to use externalising conversations that the children and young people i work with have visably become more relaxed and have more open facial expressions and some have been very keen to draw ‘the problem’ or if initially reluctant report after that it was fun!

Does anyone have any tips with questioning i can use as a beginning narrative user to help with supporting a more experience near description for children / young people? And also perhaps ways of engaging parents to share in this naming when the problem is in their relationship?

Bonnie: April 1, 2010

Hi Rachel-

I had to think a little bit, before responding… just to review what I remember working… (and of course, you may already be doing these things)

One thing that I do is ask people about relative size of the problem -(it might have a generic name, like the worry, or the anger at this point.)

I sometimes ask what kind of animal it might be like… or if it hangs out in certain places I might ask about effects before I get to a name- so it might sound like:

” so this problem has you losing sleep, not eating much, sitting close to your mom, and feeling upset in your stomach-‘ then I might suggest a description of these actions, like ‘ so is this a stealing kind of problem, or a sneaky problem, or a bossy kind of problem?- that might lead to a naming that is more linked to the persons understanding and experience of the problem- like “Bossy Fears” or “the sleep stealing worry” or something like that.

In thinking about your question, it occurs to me that this is how it goes for me more often than not- the naming comes along a bit further in the conversation- it helps the naming of the problem be a bit more richly detailed, and more vividly connected to the persons actual experience…

Bonnie

Jordi: April 2, 2010

Dear Rachel

First of all, I wanted to recommend you the book “Playful Approaches to Serious Problems: Narrative Therapy with Children and Their Families (Norton Professional Books) by Jennifer Freeman, David Epston , Dean Lobovits”, that we read in this study group last year. I have found lots of tips in it that help me in situations like the ones you mention.

Second, would you mind if I tell you some devices that I have used so far, like:

A “magic” toy cell phone that allowed us to speak with the problem

An imaginary film in which we can see the look and the deeds of the Problem; that we can freeze and rewind when necessary.

A “magic” toy camera to take snapshots of the Problem, that we then draw on a paper.

A “magic” toy voice recorder where the Problem has left some messages for us –the child and I.

“Magic” toy spectacles that allow us to see something that can not be seen without them.

I also want to tell you something funny about the participation of the family: I am treating a nice and clever 10 years boy that had been diagnosed with ADHD. Ad the very start he called the Problem “Tention” (that’s the way he wrote it). But some session later it was evident that his father got nervous when he was avoiding to have a quarrel with the mother, so he was not very sympathetic with the children; the boy’s older sister had already been treated by a psychologist because she had serious nightmares; so, she was seen as somebody who was fragile and must be treated with special care; and my young client was the one who resented the more the circulation of anger in the family. So, we named the Problem “ANGER” and I offered the family a pair of toy glasses so that they helped them to see Anger before it was too late –by then, my young client’s behavior at school had changed noticeably. The father put on the toy glasses, looked at his wife and child and said “Oh, now I can see Anger much more clearly”. He then passed the glasses to his wife who put them on and went “So can I”. The boy was eager to see through the glasses. They were handed to him, he put them on on looked a bit disappointed. “I don’t see anything special!”, he said.

But then his father and his mother encouraged him “Don’t you notice the Anger, a bit of his color and shape?”, they say with a large smile on their faces. “Look at me! Don’t you notice some traces of anger, even if I’m not angry now?”. The boy smiled and say “Oh, yes! I’m starting to see a little bit of it.”

And as to teenagers, things become much more difficult. They often take attempts at externalising as childish. So, I myself feel that I have to be much more cautious. It is much more of a challenge and I need much more feedback on their part. Sometimes writing together a logbook or clinical reports on them helps. It obliges them to find or negotiate names for what happens to them. Names that we may carefully use then to externalise.

Sonja Bar-Am: April 5, 2010

Hi All – Peggy encouraged me to jump into the broader postings from the NPA sections, so I have copied my response to Rachel’s original post and plonked it here as well. Your feedback is most desired. Cheers Sonja.

I have been trying out externalising conversations with some adult clients whom I would not have previously thought of doing so. What I have found helpful is to stay with exploring the effect of the problem even before naming it. My particular client on Monday went through so many possible names when really describing the effects, but kept coming back to one particular description of the problem that really stood out for her. Only at the end of the session could she adopt that one phrase description and really feel comfortable with that. So this was good because this client has been coming to counselling for a year with various counsellors and I felt that she was able to sum-up her experiences and link her history together under this one phrase, rather that have different phrases for each different experience. It was really a different kind of session for us both I think. Next session I would really like to solidify that naming for her in kind of a review – but then go into positive territory – which she started to do – of an alternative story. I can give more specific details of the client history, circumstance etc if this would help.

Anyway I am actually thinking allot about MW’s idea of politics (principally from Foucault) – I am understanding this better in the reading this time around. I may write more about this.

Cheers & happy easter, passover and sikh and hindu holy days and all the other stuff – but most of all relaxing days off with your loved ones

/Sonja

Jordi-Freixas-Dargallo: April 10, 2010

Here’s a surprising “Hot tip” that I have just found

A colleague of mine, Therese Steiner, a child psychiatrist who lives near Zurich, Switzerland, tells the following case example:

A 7-year-old, Wilfred, was brought to see her and of course he was frightened about this new adventure of meeting a doctor. In fact, he was so afraid of the unknown that he started to cry and refused to step into her office. Of course mother’s reassurance fell on deaf ears. Recognizing this, Therese picked up a red balloon and blew it up and handed it to Wilfred. Of course he was very surprised at this unexpected gesture and became very interested in the balloon.

Therese told the child that a fully blown balloon is the most afraid anybody can get about coming to visit a new doctor and not knowing what to expect. Then she asked Wilfred to slowly let the air out of the balloon until the size of balloon that showed that he can stay in the room and talk to the doctor, even though he was still afraid. Wilfred took the balloon and let the air out slowly until it became about half full and handed it back to the doctor, saying, “Now, I can talk.” He looked around the room and proceeded with looking around the room and looking at all the toys that Therese had in her office. In no time, he almost forgot about his mother and was fully engaged with the therapist.

It’s signed Insoo Kim Berg !?!

More details in https://brianmft.talkspot.com/aspx/templates/topmenuclassical.aspx/msgid/362957

(By the way, is there some other place name Zurich that is not in Switzerland?)

Greetings from Barcelona

Peggy Sax: April 9, 2010

Jordi, this is a great addition. Thanks! Insoo Kim Berg is a well known and revered Korean-American family therapist. Alas, she died suddenly 3 years ago. I will always remember her workshop that I attended – like Michael White, she was a gifted presenter and interviewer. She was a master of “the miracle question” and of “scaling.” I have watched several of Insoo’s videos – each one is a gem. Insoo and her husband, Steve De Shazer, were some of the pioneers of Solution-focused brief therapy. Sadly, they both died about 1 1/2 years apart, in their mid 70s – since they seemed so young and vital.

I want to get some balloons to have around, just waiting for the chance to try this out. Peggy

Jordi: April 9, 2010

Sorry, I’m afraid that I didn’t make myself understood. I know very well who is Insoo Kim Berg. What I meant by “!?!” was that in a paper about solution focused therapy (that she practiced and taught) she mentioned this tip that seems to me a metaphor in action, very caracteristic of narrative therapy-

Sonja: April 9, 2010

Hi Jordi & Peggy – this is wonderful metaphor and insight into what looks like a useful method of engaging with a child in a potentially unknown situation as well as objectifying fear. My meta-reflection on both Brief Solution Focused and Narrative is that both being somewhat Post-structuralist family therapy methods so the roots and methods could be paralleled (though I would privately consider Narrative as more deliberate and conscoius post-structuralist in really privileging the clients knowledge).

I have a trick that helps with both children and adults: A Jar of lolly snakes (Jelly Snakes). This came from my memories of going to the doctor to get an injection as a child. We would always be offered a lolly (sweet) from a jar afterwards. The pain and courage it takes from my clients to sit with their stories and offer them up to me for consideration always, each time, astounds me. An offer from the lolly jar can represent many things for the client and for me – but it is basically a nice gesture I think. Now I have a Male 30 year old who just takes the jar during the session and helps himself – offering to me too!

I have a dilemma that came up during a session yesterday – a 35 year old Male. We were externalizing the problem using his words – really moving around the territory of the effects of the problem. Then in the later part of the hour he asked “does that fit with any professional definitions?” I tried to say that from my practice I really honour your own words as a description of what is happening for you – but I am not sure. I feel a bit stuck when clients expectations of counselling dont match what is happening in the session. What does anyone else think about this? Would anybody be interested in sharing if they have been concerned about this – if it has come up? and what they did?

Jordi: April 13, 2010

Dear Sonja,

Being psychiatrist I am soon confronted with this kind of issues. “What do I suffer from?; what’s the name of my condition”? When people go to a physician, they usually want to know:

• diagnosis
• treatment
• prognosis.

When asked something like “does that fit with any professional definitions?” I usually answer “you mean does this problem fit with any professional definitions or do you yourself fit with any professional definitions?” That usually allows us to engage in a conversation that further emphasize the difference between the person and the problem.

If after that my client sticks to the question “does that fit with any professional definitions?” I tell them that it’s difficult for me to know for sure, I then open the DSM and propose them some disturbances, the description of which I read aloud. It often needs long and boring explanations. Then I ask them if they think that those definitions fit with words they have used when externalizing the problem. Usually, they soon get bored and found some more interesting issues to talk about.

In the very rare case that this strategy doesn’t work, I propose them to postpone the issue till we will have further explored their worries (problems, effects, ways of coping, etc).

I can’t remember any case in which the patient has come back asking again “does that fit with any professional definitions?” -let aside those for whom I have to fill an application in which I have to specify a diagnosis in writing.

Somebody things that could be usefull? Can somebody offer different strategies?

Kevin Neilsen: April 14, 2010

Hi everyone,

I have found the reading on externalizing conversations and the posts very enriching and thought provoking. Several things stand out for me. One, is the value of not trying to name things right off. I sometimes encounter difficulities here where people offer what they think I want to hear, or what seems a bit immediate and not as closely connected to their experiences. I noted what you said Bonnie how naming often happens further along in the conversation. I was also struck by the use and possibilities of tangible material objects as metaphorical devices. Jordi, thanks for posting the hot tip from Insoo Kim Berg (I bookmarked that site). I loved the idea of using a balloon, or the toy glasses. I wonder for some if there isn’t a power and immediacy to touching something that represents the problem or maybe the solution. Maybe some magical tools? A magical shovel? In working with individuals who struggle with different kinds of substances, I sometimes invite them to describe their substance as if it were a person going to a party. What kind of personality does it have? Finally, I wanted to say that I appreciated reading in “Externalizations–commonly asked questions” the bit about working with men who are violent: being careful and not seeing or using externalization as avoiding taking responsibility for one’s actions. It’s a complex topic. Kevin

Sonja: April 16, 2010

Hey All,

Thanks to Jordi – I really like your strategy: elicit boredom in relation to professional lingo . I will try to use a version of your first “reflective question as answer” reply. I also really like the idea of postponing, as I suspect that there are always different events and contexts that the client can talk about to move away from this kind of seeking “professional diagnosis.”

I am also really curious as to others experience of this…

Also Kevin – i like your idea of introducing a substance or addiction as if it were a person going to a party, trying to understand its personality.

With Men and violence – as in our Men’s Group. We don’t necessarily Externalize the violence as such – but really loiter with some elements that have Men taking up a sense of entitlement – it is this entitlement that can be then challenged, contextualized and politicized. So for example we can sort of externalize “tiredness” -“so you are tired when you come home from work?” “So what does the tiredness have you saying to your partner?” “What does the tiredness have you expect of what your partner should do when you get home?” “Do you think that is fair?” “So what does that say you are entitled to? Do you think that is OK to be entitled to have dinner ready when your partner is equally as tired? So what does she say about that. etc etc – do others do similar or something different? But actually cant wait for our sessions with Rob Hall for an understanding on his thinking around this…

Kevin: April 19, 2010

Hello. Sonja, I enjoyed reading your post in regards to working with men and violence and externalizing elements of entitlement. I wondered what your experience has been with these men providing sufficient details and accounts of the tiredness. What have you found helpful that thickens these accounts. For me it has been a challenge working with some men who “don’t wan’t to talk about it.” (Actually there is a book, which I haven’t read, that deals with men and depression and is called I don’t want to talk about it.)

Sonja: April 19, 2010

Hi Kevin – you might have written previously but I wish to understand are your guys mandated to attend? Ours are not, so I think this helps that they are there of their own volition. Then overlaying this there seems to be an absence or a lessening of the “us (guys) and them (facilitator)” power relations – we dont do a lot of “eductation” per se but rather have loose topics around entitlement, language, inventory of violence, that we go through and encourage the guys to talk about. Then we have just started a new format where we have an open group as a mixture of new guys with guys who have been in the program for between 6 months to a year (or even more than a year). So all this contributes, I think, to the guys talking. Though there have been groups that I have been told where the guys really shut down, though I havent witnessed this. I intend to sit in on a mandated group with DV services here to see how that is but I know they use CBT there. I will check out that book – usually I buy cheap second hand from ebay and have it sent down (or up) here to Australia from the US. Interesting conversation – thanks Kevin – cheers Sonja

Kevin: April 21, 2010

Hi Sonja,

Good to hear your comments. Yes, many of the men in my group are mandated, though not everyone. Of those that are mandated, they are usually either trying to get their driver’s license back (and so many counseling hours are required) or their probation officer has referred them. It’s interesting that you have a mixture of young and old members. I have found having members who have been there a while certainly helps the others talk. The topics you mentioned sound fascinating. I am curious how these conversations change and evolve. Do you get a sense that some are able to externalize their problems while also taking responsibility? It seems like a tricky thing. I think it is easy to blame others and not recognize the choices one made. And many have lives that are burdened with a great deal of problems and stress where it is helpful to get some space.

Kevin

Sonja: May 1, 2010

Hi Kevin, Hi Everyone – I reflected on your posts by posting over in the Group Work topic thinking that it may relate there as its sort of about Men and responsibility taking in our Group work. I would like to let you all know that we have just had a fantastic three days with Maggie Carey on Re-authoring – she does this physical standing up on the chair thing to illustrate the distancing needed from the Landscape of Action to understand more The Landscape of Identity. So what I found really exciting (as well as the whole lot more of exciting elements of Narrative Practice) and helps in all instances whether dealing with the Problem Story or the Preferred Story, where the “I don’t know” answers come up is to make the questions really small and really really specific – so the very low, very very low and ultra low distancing questions. Its got me really excited to try it out more in session and to tape record some of those sessions to get some transcript that I can really unpack the mechanics of that – to see how I go!! I look forward to posting on the Re-authoring topic to let you know how it turns out. Cheers /Sonja

Kevin: May 12, 2010

Hi Sonja,

So good to read your comments. (I was away last week). I really love the idea of standing on the chair.

What an intriguing physical way of representing distancing. I wondered if you could give some examples that illustrate the low, very low and very very low kinds of distancing questions.

Thanks,

Kevin

May 12, 2010

Hi Sonja, Jordi, Kevin and others,

I just want to give you the ‘heads up’ that I just posed one of Tod Augusta-Scott’s chapters in module 2 under “Ethics and accountability.” See if you can find it. I’d love to “hear” your reflections. Tod is also available to join in the discussion (I will send him our reflections and questions). Peggy

Margaret Wells: March 19, 2012

I just wanted to add a few things…Have recently been referred to a book which I understand is very powerful, may have some Buddhist leanings called Turning Vinegar into Honey (sorry don’t know the publisher) and am aware of some Strength Cards for Men which are available through Google, available if used for non profit therapeutic interventions. They were developed by a person who works for Domestic Violence here in Australia (hope you can all access them, am a bit Disabled with technology so hope I’m not misleading people.) Hope this is helpful information.

Ítalo Latorre Gentoso: September 26, 2010

Hi all

I have engage very much with your post also in the ‘Responding to your questions’, Jordi unfortunately leaves Study Group, but have very interesting post!

I want to share some ideas I have. Firstly, I am very interest in the theme that Exteralization is not only a thecnique but an ethic. Puting the problem out side or separate from person is an ethic vision that put problems in broader context. When I learn the first time about externalization, I saw all of this, was so evident for me. But I have experience in conversations with other therapist here in Chile, Systemics, or also postestructuralist therapist, always mentioned externalized like only a technique.

For me this is very important and shapes in considerable way my work in this. I am working with the words that client bring to consult, doesn’t matter if is ‘depresion’ or ‘personality disorder’ or wahatever (I dont know many diagnoses in English) but I begin to speak with clients, and make questions in function to separate the intentions of the problem with the persons intention. I try to link clients with their own intentions, commitments, hopes and dreams, and to ‘see’ how the problem doesn’t fit with this. In my experience, clients describe their experiences whit dealing with problems, their effects in life, and I try to be very very care of listening the words that clients use to describe it. Then I make question to the client if ‘x’ word that he/she said, fits better for them as a description of the problem that the first word or concept (‘depresion, etc’) Whether is more familiar for her/him this manner to talk about their own knowledge of her/his experience with dealing with this problem, and I say to client that in this context, because I am not medical, I am psychologist I prefer to honour their own form to speak and their own words, in this way, he/she and me can understand better about what we are talking about and maybe this can facilitate to see clearer the problems and the possible future actions that he/she can do to addres the problem toward his/her own intends. Is evident that this is an explanation for this study context but I have all of this in mind and can share with clients when could be pertinent to do so. Then I take the words and make some questions about the meanings they give to words that are using to describe the effects of the problems or the problems (many times some effects fit much better that early ‘proffesional’ concepts they bring). Many times they say to me ‘I have never think in this, what does mean for me the description of happines, or fear, or whatever’, and this can provide engaging with a interesting conversation about what client think about the world and life and how some problemas led this knowledges invisible.

All of this liberate me of searching for names, taht many times are undervalued by clients, in my country with great validation of ‘proffesional discourses’, and the mapping of conversation becomes fluider and make more sense for people/clients.

This have been a process for me and I feel that recently is more available for my work, but many times is a great challenge for me!

I am transcribing some of my interviews but in Spanish, I will give a time for translating parts to English and share with all of you to get coments and feedbacks.

Hoping hear from you

Margaret Wells: March 18, 2011

I was interested to read the dilemma related to a client seeking perhaps a diagnosis? I have a thought about this which I think is different. Having grown up in the medical model, I tend to think diagnosis, treatment. Is it ok to offer a hypothesis around a diagnosis and externalise the diagnosis? I find clients have already done a fair bit of reading by the time they arrive and can be confused. Sometimes a diagnosis can be helpful, particularly if offered tentatively for the client’s consideration. Sometimes using Z codes in ICD 10, instead of a diagnostic category can be helpful for clients too. Not sure if this is clear or helpful?