By Peggy Gold, MS, NCC, LMHC

Click here to contact Peggy and/or see her GoodTherapy.org Profile

This video was submitted by Craig. See his comment here.

A few months ago, I was confronted with an issue that no parent wants to tackle. My 3-year-old daughter became constipated, was scared to go to the bathroom, and subsequently began soiling her underpants. All this was occurring shortly after I’d given birth to our second child, and life was feeling very overwhelming for both of us.

It was important to me that I preserve my daughter’s sense of self confidence, refrain from doing anything that would damage her future toileting rituals, and also find a quick solution to the problem. I was changing underpants as often as I was changing diapers, and I wanted to get on with taking care of a newborn without experiencing the monotonous whining and crying associated with my daughter’s fears, discomfort, and neediness that went along with her constipated state.

As a trained Narrative Therapist, I used an approach written about by fellow Narrative Therapist, David Epston. I found a moment in which we could be alone, sat down with my daughter, and in a pretty animated voice I said, “You sure have a sneaky poopy. It wants to sneak right into your underpants, doesn’t it?”

At this my daughter enthusiastically said “Oh, yeah.”

I continued, “When you are playing and reading books, that Sneaky Poopy wants you to think that you don’t need to get up and go to the potty, right?”

Again, “Oh, Yeah!”

“Do you think you could outsneak that Sneaky Poopy? Do you know where it’s supposed to go?”

“In the Potty.”

“That’s right! But the Sneaky Poopy wants us to think that you don’t know where it’s supposed to go, and it’s tricking you into letting it get into your underpants. Do you want to let Sneak Poopy do that?”

“NO!” she said excitedly. She was taking a stand against the problem.

“What can you say when Sneaky Poopy wants to go into your underpants instead of the potty?”

“Don’t go in my underpants, Sneaky Poopy. You go in the potty!”

“That’s a good idea! You aren’t going to let it sneak, are you?!”

“NO!”

It’s been 3 ½ months and there has been no such problem since.

The short conversation illustrated above embraces the tenets of a Narrative Approach to Therapy. The Narrative Approach is one in which problems (in this case, soiling underpants and constipation) are externalized in conversation to make them less troubling for a person to deal with and talk about. To externalize a problem is to talk about it in the third person, thereby providing distance between the person and the problem. Very often, children and families are experiencing so much pain and frustration from a problem, that they internalize it (i.e. “Joey is the problem”). Dealing with the internalized problem can seem daunting, useless, and shameful. An externalized problem is much easier to talk about and understand, creating opportunities for learning and change (i.e. “Joey is dealing with the tantrums.”)

In this case, the externalized problem took on a name, “Sneaky Poopy,” which was age-appropriate for my 3-year-old, and helped her feel playfully involved in the solution-making process. Once her identity was removed from the problem through externalization, she was able to change her relationship with it (by outsneaking Sneaky Poopy) and feel a sense of power over it. She was able to find a solution, implement it, and find success. If she had soiled her pants again, instead of feeling shame and guilt, we could have talked together and said something like, “Boy – that Sneaky Poopy was really sneaky that time. It must not like it very much that you’ve been doing such a great job at making sure it goes into the potty.” Again, the externalizing conversation allows her to maintain her dignity, feel understood, find solutions to the problem, and continue developing her sense of control in the situation. As these conversations continue, reiterating her role as the one who can outsneak Sneaky Poopy, an alternative story begins to develop in which she is the one able to handle herself in what could have been considered a very stressful and demoralizing situation. In fact, this new story can later be generalized to deal with other circumstances down the road.

Quite often, children resist going to—or returning to—counseling because they themselves have been identified as being the problem. Externalizing the problem through narrative conversations relieves the pressure of blame and defensiveness, which makes this type of therapy appealing to those who may be wary of seeing a counselor. Narrative Therapists listen carefully to the stories of people’s lives and help people identify alternative stories that are wider in scope and integrate relevant facts about the person’s strengths that might not be identified in a narrower version of the story. The alternative story allows people to place more emphasis on their hopes, abilities, values, beliefs, desires, and commitments, and begin to live life in the context of these preferred ideas and experiences.

Narrative Therapy is strength-based, non-threatening, and even playful (i.e., “sneaky poopy!”) in its approach to dealing with problems, which makes it particularly suited for children. A meeting with a narrative therapist is more like a conversation or interview than a session in which the counselor takes a role as expert. Problems are treated as separate from the person, and everyone works together to shrink the negative effects of problems in one’s life. This is accomplished through images, metaphor, and descriptions of the problem in order to understand the motivations, goals, and effects of the problem. Once the problem is named and more fully understood, people can take a stand against it and reduce its negative influence.

For example, 3 weeks ago in my practice, I met with a 13 year-old girl for the first time. The first words out of her mouth were “I hate my life,” followed by a long list of reasons why. I asked her lots of questions about “the depression” she was experiencing—its effects on her relationships, schoolwork, feelings about herself. Throughout our conversation, she began seeing herself as separate from the depression, and I helped her tell me about who she is outside of the depression’s influence. It was beautiful to watch as she took claim of the hopes, values, and commitments that mean something to her; she identified herself as being caring, having goals for her life, and “searching for happiness.”

By the end of our session, she was sitting straight up in the chair, and completely unprompted by me, she said, “Depression wants to take over my life. I’m not going to let it.” Narrative conversations create meaning for every person in the therapy room, and often therapy can be short lasting and highly successful.

To get a true sense of the process of Narrative Therapy, I have included below some of the basic tenets of the narrative approach using specific examples of common childhood problems. The Narrative Therapy (NT) response is contrasted with a less helpful one, with explanations of each.

Problem 1: Bedwetting

NT response: Naming the Problem. A child might desire to name it “The mistake.” This allows the therapist, the parents, and the child to understand the way in which the child is interpreting his bedwetting experience (as a mistake), and honor it that way as it is spoken about.

Less helpful response: “Do you want to be like a baby? Only babies wet their beds.” This response damages self esteem and increases feelings of shame and guilt, making problem solving much more difficult for everyone.

Problem 2: ADHD

NT response: Uncovering the effects of the problem. Talking with the child and the parents about the effects of the ADHD in many facets of life.

“How does the ADHD interfere with school?”

“How does the ADHD get in the way of your ability to make friends?”

“What keeps the effects of the ADHD going?”

“When does the ADHD have the most power?”

Less helpful response: Using ADHD as a means to blame the child for his/her behavior OR for making excuses for the behavior. This helps the child internalize himself/herself as “being ADHD,” instead of being in relationship with it, in which the relationship can be changed, lessened, or more controlled.

Problem 3: Depression

NT response: Identifying moments which run counter to the problem’s influence. Seeking out opportunities to learn when the problem doesn’t have as much power.

“Can you think of a time when the depression doesn’t seem as strong?”

“How are you able to get out of bed and go to school?”

“When happiness is available to you, what happens to depression? Where does it go?”

“What allows you to keep happiness around?”

Less helpful response: “Look on the bright side!” It may be very difficult to find the “bright side” until the effects of the problem are laid out, acknowledged, and dealt with. Moments which run counter to the problem always exist, but they need to be generated by the person, not told by someone else.

Problem 4: Parents fighting

NT response: Connect the problem to what is important to the child. We can learn tremendous amounts about ourselves, our desires, values, commitments, and hopes by exploring the reasons for our feelings toward the problem.

“Is it OK with you that the fighting keeps going?” (“NO!”)

“What does that say about what you want for your family?”

“What do you think that tells me about you and what you hope for?”

“If the fighting stopped, how would that make life more like the way you want it to be?”

Less helpful response: Telling the child that even though the parents fight, they still love him and it’s not his fault. Certainly this is not a bad thing for a child to hear, but doing so stops the child from learning more about himself, what’s important to him, and what he wants for his own life.

(Note: the next 4 problems utilize Narrative Therapy responses which would be useful following a conversation in which the problem had already been externalized, named, and fully explored)

Problem 5: Inability to make friends

NT response: Help the child identify his/her important relationships that serve a role similar to friendship and build upon this new emerging story.

“Who or what in your life has been able to see friendliness in you?”

“What would that person say about you that made you friendly?”

“Would that person be surprised to know that it has been hard for you to make friends?”

“Why would that person be surprised?”

“What does it say about you that this person would be surprised?”

Less helpful response: Pointing out behaviors which other children might not like. Doing so strengthens the dominant perception that the child is “unlikable,” which can be harmful to his/her self esteem.

Problem 6: Sibling Fighting

NT response: Name and explore the unique times when the sibling fighting does not occur. (Note: this conversation could occur in front of parents or other siblings with time for them to reflect later in the session)

“When the fighting is not happening, what would you call it?” (answer: “getting along.”)

“How do you feel about yourself during the getting along times?”

“How do you feel about your sister during the getting along times?”

“What do you notice in the way your family runs during the getting along?”

“When the getting along is happening, how do you and your parents get along?”

“Is this OK by you?” (answer: “yes”)

“Why is it OK?”

“What does that say about what you want for your family relationships and for your home life?”

Less helpful response: Yelling and punishment. Ongoing sibling discord can lead to all members of the family fighting and living at odds for prolonged periods of time. Most families, when given the opportunity, express a desire and preference for peace at home.

Problem 7: Dislike of school/Poor grades

NT response: Identify and re-author a preferred story. Help the child identify events, occurrences, or occasions where the problem was not present. Help them link these events through time and add meaning to them, making them more accessible in the child’s thoughts, ideas, and feelings about him/herself.

“Tell me about a time when school wasn’t so bad or you didn’t get a poor grade.”

“Where were you when it happened, how old, how long did it last?”

“What kinds of things did you do to make it happen?”

“Who noticed what you were doing?”

“What would they say about the efforts you made?”

“What does it say about you that you were able to enjoy school at one time?”

“What does that say about what what’s important to you?”

Less helpful response: “You just need to apply yourself.” Again, this statement can be true, but just saying it to a child continues to internalize the source of the problem as being with the child. Guilt and shame can then lead to lack of motivation and ongoing frustration.

Problem 8: Hostility toward/Ignoring parents

NT response: Increase helpful communication by uncovering what is not said, but implicit, in negative or hurtful statements. (Note: this conversation would be served well with the parents present, witnessing, and later given time for reflection.)

Child statement: “I just want them to leave me alone!”

“What is it about being left alone that would be helpful to you?”

“When your parents do leave you alone, what do you think they are thinking about you?

“When you are able to have space to make your own decisions, what do you think your parents are most worried about?”

“Does that worry you too?”

Less helpful response: Responding with the same level of hostility. Communication with children who are defiant with their parents can be challenging because of the strong feelings behind the words. Conversations thick with anger, frustration, and hurt feelings (between both parents and children) quickly become unproductive and often perpetuate the very problem that is being communicated.

Anyone who wants to live their life more happily and in keeping with what they value, believe, and desire for themselves will benefit from Narrative Therapy. People of all ages enjoy the process, but it can be particularly effective with children and families because of its engaging and non-threatening approach. Narrative Therapy can help people who are dealing with the following problems or concerns: depression or sadness, anxiety, substance misuse, parental divorce or discord, tantrums, problems in school, grief and loss issues, encopresis/enuresis(pants soiling/bedwetting), anger, explosive behavior, eating problems, fear, or other problems that interrupt or overtake happiness in one’s life.

It is a pleasure to be a Narrative Therapist. I enjoy the opportunity to hear the complexities and richness in the stories that make up people’s lives. I am privileged to witness children, teenagers, and their parents and families take a stand against the problems that are disrupting their lives. I am inspired by learning what people are committed to, what they hold most dear, and how they learned to hold these values. I am often moved to do something different in my own life by hearing someone else’s courageous acts to change a problem’s hold on their life.

Everyone has a story. In fact, everyone has multiple stories. Narrative therapy helps us live the story we most prefer, and allows us to reach our greatest potential.

©Copyright 2008 by Peggy Gold, MS, NCC, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Peggy and/or see her GoodTherapy.org Profile