Tall person with short hair wearing bowtie, shirt, slacks, and heeled boots kicks out against splashes of paintSophia Dembling wrote, “One of the risks of being quiet is that the other people can fill your silence with their own interpretation: You’re bored. You’re depressed. You’re shy. You’re stuck up. You’re judgmental. When others can’t read us, they write their own story—not always one we choose or that’s true to who we are.”

But sometimes even when others could choose to “read” us—by being curious, asking questions, and collaborating with us and honoring what we value—they choose to write over us instead. This is particularly true when one person has more social power or when their values are already maintained by external forces. They have more permissions already; they have more of a voice. In these situations, we might not be quiet by nature so much as silenced.

Asserting Experience and Identity

Some aspects of our lives come more pre-packaged and scripted than others—namely, our stories about gender. And we haven’t got a fighting chance to tell our own gender story if it’s been decided for us before we are even able to speak or choose our own adornments—for most of us, this takes place before we are even born. Ideally, babies would come into a home where love can be flexibly provided for many variations of expression—but many of us will be subconsciously “shaped” into something “More Appropriate” if we deviate from culturally-sanctioned ideals. [fat_widget_right]

If you are cisgender, this may not feel oppressive. If your community affords men and women (and your gender is one or the other) a great deal of fluidity, flexibility, and freedoms, this may not feel so bad.

But even if this is your experience, it is not everyone’s—or even most people’s—experience. Keeping this in mind, listen for stories that differ from your own.

Transgender and gender non-conforming folks claim the permission of asserting (not choosing) their gender identity and sense of self rather than accepting what has been assigned to them. This becomes increasingly necessary if what has been given to them (“prescribed” gender, typically based on the sex category assigned to a person at or before birth) never fit that person, no longer fits that person, or sometimes doesn’t fit that person. Transgender and gender non-conforming people are claiming their own power over their bodies and voice.

It is here I want to assert my position: unless a person is directly harming another person, how they want to speak or adorn themselves is not for us to decide—unless we are that person’s parent. When we take on a parental role with a person we are not parenting, we are indicating we have decided we are not equals with the person, that we cling to a sense of power over them. (For instance, when we become the “gender police.”)

Narrative Therapy: Co-Creating Meaning

The following description of narrative therapy comes from the Dulwich Centre in Adelaide, Australia: “Narrative therapy seeks to be a respectful, non-blaming approach to counselling and community work, which centres people as the experts in their own lives.” I distinguish here between therapy styles that give people expertise over their own lives vs. the power our mental health system has traditionally exerted over those who come for help. Narrative therapists co-create meaning with the people they are treating; traditional therapy prescribes meaning onto the experiences of the person in therapy.

Narrative therapy acknowledges the power discrepancies between therapist and person in therapy but seeks to minimize them as much as possible. This modality is a collaborative, democratic style of therapy where what something means to the person in treatment is equally or more valuable than what something means to the therapist.

(I don’t want to pretend a truly democratic relationship can exist between therapist and person in therapy. Not only is there a transaction of money, but—in the case of individuals advocating for their own gender transition and especially in the case of those desiring hormone therapy—therapists are also in a position to determine whether or not the individuals they are treating are “of sound mind.” Thus they are the gatekeepers of access to desired medical treatments.)

Narrative therapy acknowledges the power discrepancies between therapist and person in therapy but seeks to minimize them as much as possible. This modality is a collaborative, democratic style of therapy where what something means to the person in treatment is equally or more valuable than what something means to the therapist. It involves listening to the words of the person receiving therapy, tracking the themes relevant to their life, and determining which stories were authored authentically by the individual and what stories were told to them and enforced by the Powers That Be.

Tactics Used in Narrative Therapy

In an attempt to subvert some of the gatekeeping power that has existed within my profession since its origin, I wanted to write about some narrative therapy tactics that can be self-taught and used by the chosen family and communities of transgender and gender non-conforming individuals in order to support and enrich their loved ones’ sense of self! Chances are, you are already using some of them.

In Practice

How can we do this? One of my favorite exercises to facilitate with multiple people in therapy is to ask them to think of a time they felt confident and tease this out. I have them name what they valued about that version of themselves and what made it possible. The other person (or people) is/are assigned to “track” instances of when they caught that person exhibiting those traits in their present life, in their present interactions. This can be effective for people battling depression, when they feel the “old” them is lost, as this can serve to remind them their “true” self still exists—but this exercise can also be of great benefit in affirming the gender expressions of those we love!

If your friend or loved one is transitioning, find out the values of the gender identity they are looking to embody and affirm them! If your friend’s experience of self exists outside of the language surrounding gender, don’t praise them for being “rational and fair” or for being “so pretty and thin.” Instead, figure out what matters to them and make an effort to witness them living these values authentically in the world. See them in the ways they need to be witnessed and affirmed.

References:

  1. Blakeslee Salkil, S. E., & Goff, J. D. (2014). LMFT Exam Preparation Workshop [Powerpoint]. Self-Published: Family Education Resources, LLC.
  2. Dembling, S. (2012). The introvert’s way: Living a quiet life in a noisy world. New York, New York: Perigee Books.
  3. Dulwich Centre. (n.d.). What is narrative therapy? Retrieved from: http://dulwichcentre.com.au/what-is-narrative-therapy
  4. Family Solutions Institute. (2011). Marriage and family therapy national licensing examination preparation: MFT glossary. Jamaica Plain, MA: Self-published.

Young woman listens to therapistDo you know what type of therapist you are seeing or are about to see? Not all therapists are the same—they have different perspectives and training. Therapists need to know what motivates their work, what they hope to accomplish professionally, and how they want to serve people in therapy. Many therapists struggle with questions such as, “What’s my niche?” or, “How, exactly, should I help this person?” Most of us come into the field wanting to help and make a difference in people’s lives; orienting ourselves professionally can help us achieve this goal.

As a person in therapy, you may expect your therapist to know exactly what they’re doing, but this is not always the case. Some degree of uncertainty and self-doubt is common and natural among therapists. However, it can become problematic when they fall back on outdated training, integrate interventions that are incompatible, or serve populations with which they have no expertise or knowledge. This can confuse both the person in therapy and the professional.

I have struggled with lack of direction in my own practice, and I have learned to view my work as a therapist from a different, more realistic angle. After working in the field and developing my professional identity, I came to understand there are four important components that describe the style of every therapist. People seeking therapy might benefit from learning about these and being prepared to ask questions when searching for a therapist.

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1. The Therapeutic Philosophy/Approach

It can be helpful for therapists to understand how their worldviews inform their therapy. As a result of their training and experience, they may automatically and unconsciously perceive people in therapy and their work with them in a specific way. As they begin to notice what makes them feel more competent in their work, therapists can become confident about the interventions they use and can identify a clear pattern in their clinical practice.

For instance, therapists who find they are interested in understanding people’s thinking patterns and processes, and adopt a deliberate intervention to redirect these, are usually approaching their work from a cognitive or cognitive behavioral angle. This may not make a lot of sense for people in therapy; however, it is the therapist’s responsibility to be informed and aware of therapeutic philosophy, or at least aspire to this level of professional self-awareness.

You may sometimes hear therapists referring to themselves as “eclectic.” This is common in the field of psychotherapy, and it means they integrate multiple therapeutic approaches, or perhaps use specific techniques borrowed from different models. Although this can be a valid lens from which to conduct therapy, it can also create confusion, diminish the efficacy of evidence-based practices, and distort the objectives of therapy. There are eclectic therapists who truly believe their best work comes from borrowing from different approaches, and then there are “eclectic” therapists who fail to take the time to develop expertise in any one approach.

It is not always easy to distinguish between these two types of eclectic therapists, but it’s important for a person seeking therapy to know the difference. Many therapeutic approaches or models are similar, but they are different enough that therapists may want to be deliberate and specific about their worldview.

2. The Delivery

You may notice therapists often identify with a delivery that matches the model they use. A therapist whose therapeutic philosophy is cognitive behavioral will frequently describe their delivery with people in therapy as “directive.” Specific therapeutic models suggest therapists who use their model should always have a particular way of conducting their sessions.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions.

I think this is unrealistic. The delivery is about the way therapists communicate with someone in therapy, how they translate the information, and how they choose to convey their messages. A therapist who identifies with a cognitive behavioral philosophy, who tries to exhibit a “directive” delivery as the cognitive behavioral model suggests, but whose personality and natural presentation are more soothing or indirect, is simply not being truthful.

One of the most common complaints from people in therapy is that therapists act like robots—they aren’t being themselves, or they don’t connect. I believe this is a result of forcing an unnatural delivery in therapy sessions. The delivery should match the therapist’s personality, not necessarily the therapeutic approach or philosophy. People pick up on these things.

As most therapists know, one of the most important factors in therapy is the relationship between the therapist and the person in therapy. How can there be a genuine relationship if the therapist is trying to be someone else? I suggest therapists simply be themselves. This is likely to be the easiest part of their clinical work. Therapists can adopt a variety of delivery styles: directive, soothing, indirect, challenging, curious, humorous, reflective, supportive, intellectual, or a combination of these. I don’t think it should be about trying to match the model, but about who the therapist truly is.

3. Skill Level

To have a big influence on another person’s life, therapists should make sure their skills are strong, sharp, and up to the challenge. When I say skills, I am not referring to experience or age of the therapist. Skill level involves the preparation, commitment, and willingness to become a better therapist. A therapist should never assume they know it all, or that they should know it all. This can be a terrible trap and one that can make people in therapy feel like they are wasting their time.

Most licensed therapists are required to participate in continuing education as required by the agency or organization that regulates their credentials. Some therapists may attend any training just to get the hours they need to renew their license, while others may research and attend training that specifically target their personal needs and contributes to their professional development.

For example, if you have a therapist who specializes in treating young girls experiencing an eating disorder who attends a training on substance abuse in middle-aged men, you may want to ask why. Your therapist may have a perfectly sound reason for this, but sometimes the reason is license renewal. An important exception to this is when therapists are curious about new modalities, or when they truly don’t know yet what their niche will be. Most therapists are quite comfortable sharing their recent training and education with people seeking therapy. This is not part of the mandatory disclosure statement, but I think it should be.

4. Awareness of Readiness to Help

Is your therapist ready to help you attain your goals? Sadly, some are not, even if they really want to help. Readiness to help can include preparation, skill level, delivery style, and even therapeutic philosophy—but it’s more than that. Therapists need to be self-aware regarding how helpful they can be within the therapeutic context. Does your therapist have the tools to navigate vicarious trauma? Have they lost their passion for therapy? Are they burned out?

Naturally, this work is difficult. Therapists are exposed to painful stories every day, all day long. This can take a toll on a therapist’s ability to perform on the job in the long run. Burnout can influence a therapist’s self-perceptions about their ability to help. When this happens, your therapist may not be ready to help, or they may be completely unaware of this and continue to do clinical work. (They also have bills to pay.)

The good news is there is hope. Therapists are used to hearing about something called “self-care,” which is necessary to maintain a healthy balance between personal and professional lives. When therapists neglect this area of their work (yes, self-care should be part of the work), they may be unaware or even in denial about the effects of their work on their emotional well-being. This in turn can affect the quality of the service they provide.

Burnout is a real thing in this field. Many therapists who work in community mental health, residential services, in-home therapy, or hospitals run the risk of becoming burned out. It is important to recognize the signs and take immediate action. You want your therapist to love what they do for a job. If they don’t, take your business elsewhere.

I have been (and am) a person in therapy myself, just like many other therapists. I don’t want my therapist, the person who is supposed to help guide me through my journey, to be unaware of where their philosophy and passion lie, to pretend to be someone else, to lack the necessary skills or education to help me overcome my challenges, or to be burned out to the point of not being helpful at all.

I will conclude with sharing the four characteristics that shape my own therapeutic identity. My therapeutic philosophy is narrative therapy, an approach that views the problem external to the person, who is the expert of their own experience, able to retell their stories in their own voice. My delivery includes some traits usually connected to narrative, such as curiosity and respect, but I am also direct, which is often associated with therapeutic models very different from narrative. As for my skill level, well, I’ll let that speak for itself. Lastly, my awareness of my readiness to help is strong because I have made it an important part of my work to practice self-care and to not allow the difficulties of this field diminish the passion that drove me to this work in the first place.

people emerging from shadowsRachel Dolezal, a Caucasian woman, has dominated recent news with her assertion that she identifies as black. Like many people, I was initially perplexed about why someone would choose to identify with an oppressed culture. What benefit is there to choosing to belong to a group of people who have been marginalized?

When people have difficult and character-forming experiences, they generally want them to be witnessed, honored, and respected. People with visible identities, as race typically is, naturally have this validating experience. For many people, parts of their identities and the way they understand themselves come from the struggles and challenges they have endured.

Poverty is a prime example. Though we may not consciously consider poverty an identity, for many people it is one. Many people who experience poverty have a shared experience of not having enough, being judged, and being marginalized. Poverty informs how people experience and interpret the world.

I worked with a 48-year-old woman—I’ll call her Nina—who consistently spoke of “being poor.” For most of her childhood, her family struggled financially and did not have their basic needs of food, shelter, and clothing met on a regular basis. When she was 14, her family’s situation changed. Her mother got a well-paying job, they bought a home, and they had financial security, as is true to this day.

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As a grown woman, Nina continued to refer to herself as poor, though she factually had not experienced poverty for 34 years. Nina’s earlier experience of living in poverty was so defining that it became part of her identity.

This phenomenon is also true for internal experiences. Consider people who have experienced, say, addiction or depression. “I’m an addict” and “I’m a depressed person” are phrases that I have heard many times. People often define their entire being by a challenging part of themselves, when in reality it is one of many aspects and identities that comprise who they are.

As human beings, we are wired to connect to others and to be recognized and understood by others. Tightly gripping an “old” identity is a way to keep that part of you visible—to keep the struggle of addiction or depression or trauma or poverty as a real and acknowledged part of your existence.

Being depressed is not all of a person. It is an experience, albeit it an unpleasant one. People who are depressed are also parents and friends and colleagues. There are many other pieces to who they are in addition to their depression. However, unlike depression, being a parent is visible. Being a colleague is visible. People see and understand these roles and identities and, in turn, validate them.

What happens when life circumstances shift and their current experiences no longer fit their description of themselves? Though Nina no longer lives in poverty and has not for more time than she has, she still very strongly identifies with being “poor.” When someone is no longer depressed, does he or she still say, “I’m a depressed person”? Many people do. They become so used to understanding themselves one way that it becomes the dominant narrative of their life, even when it no longer fits the circumstances.

As human beings, we are wired to connect to others and to be recognized and understood by others. Tightly gripping an “old” identity is a way to keep that part of you visible—to keep the struggle of addiction or depression or trauma or poverty as a real and acknowledged part of your existence.

But you can release parts and identities that no longer fit while still having them as part of you and your story.

Narrative therapy is a technique that allows people to share and tell the stories of their lives. It makes visible what is invisible. The struggles, challenges, and resilience that you have developed during your lifetime are part of your story. The ways we self-identify at one point in our lives may be different than at another point, and both identities can be true. Narrative therapy helps to weave together these many different aspects of life into a multifaceted story. It gives us the richness and fullness of our experiences as people rather than limiting us to one way of being. It helps us understand that we are not only our race or gender or depression or addiction. Instead, those aspects are pieces of a changing, evolving, and larger picture of who we are.

Woman sitting looking sad

Individuals who are “symptomatic” of post-traumatic stress disorder (PTSD) may seem sick, crazy, or irrational. They might appear dissociative, clinically depressed, anxious, highly reactive, or rageful (or all of the above). In addition, it’s common for an individual to cultivate a sense of self-loathing for displaying these characteristics. During treatment, both therapist and survivor may agree that these symptoms are a mark of disease, making it their goal to alleviate the symptoms. Alternatively, both may choose to believe that these symptoms are an expression of health versus illness. This could enable more directed treatment, internal compassion, decreasing fear of symptoms, and a relationship between survivor, therapist, and trauma.

According to the DSM IV (American Psychiatric Association, 1994) criteria for diagnosing PTSD includes intrusive memories, thoughts, or dreams of an event, a sense of reliving the event, and intense distress in response to both internal and external cues that resemble an event(s).  Individuals may thus avoid triggers or cues, increase isolation or have a sense of ‘waiting for the other shoe to drop’ (a foreshortened future), and detachment.  Sleep difficulties are common; mood liabiality, and hyper vigilance are also common (American Psychiatric Association[DSM-IV], 1994). When a survivor feels hopeless, confused, and self-loathing because of the manifestations of their trauma, the initial layer of treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves.

To begin to evaluate trauma and develop a relationship with its influence on survivors, we can draw from the practice of narrative therapy and the concept of externalizing a problem, which recognizes that the person is not the problem; the problem is the problem (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.). PTSD, as a character in a survivor’s life, uses symptoms as tools to protect us, remind us of our core values, and ensure that what happened before won’t happen again. The trauma response could even correspond to the level of violation on self and values; from this perspective, a profoundly disturbing event calls for a profoundly disturbing response. Flashbacks, dreams, invasive thoughts, and triggers provide specific information about the violation the client’s event(s) infringed upon them. These also exemplify the concept of “stuck points” in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.)

The aspect of a survivor’s past that is troublesome can be quite specific and idiosyncratic. Groups of people exposed to the same event often are disturbed by different parts of it. Interpersonal trauma such as child abuse, domestic violence, or sexual assault may render someone feeling responsible for what happened to them, feeling dirty or shameful, betrayed, foolish, unimportant, or completely exposed.  Trauma might be conveying to someone that they are at fault for an assault because it wants the individual to have a sense of mastery or agency.  Helplessness is too passive, so self-blame is an acceptable tone to assume. An individual might also begin to associate a traumatic feeling of betrayal with a feeling of foolishness, ensuring s/he does not trust people too easily and maintaining inner safety.

The way in which a survivor expresses their PTSD can vary widely and presentations can be very complex and oppressive.  It is common for survivors to blame themselves for their past experiences, and they often enter into treatment with a great deal of shame because they feel they should have “gotten over it” without help. A therapist can offer some relief from shame by viewing survivors’ symptoms as useful, even critical to their treatment.

Through the process of healing, a survivor can learn to establish trust in self to clearly identify his/her core values, to reflect his/her significance in the world, and to maintain personal safety. The character of trauma will refrain from presenting images (flashbacks and dreams) when the stuck point has been identified, and will cease making statements that the individual is culpable for what happened once there is a demonstration of mastery over the event. It will hold back on invasive, persistent thoughts once the survivor is able to look at the event rather than avoiding it.  PTSD symptoms reflect individual values and provide explicit guidance for healing; if therapist and client are willing to work with trauma, and absorb the information it has to offer, it will not invade with such rigor.

 

A shirtless boy sits on a dock, looking out over water.In The Use of Scaffolding Map in Narrative Therapy I documented my first meeting with Peter, a boy who’d experienced anger and sadness after he was exposed to domestic violence in his home.

In my second meeting with Peter, we met alone the majority of the time because his father was taking care of the other children in the family. Peter was talkative and engaged in our conversation. I checked in with him, asked how he’d felt since our last meeting, which had taken place one and a half weeks prior. Peter said he didn’t feel angry or sad, and mentioned this was a change for him. I asked what contributed to that change, and he said he decided to “focus on other stuff,” which enabled him to “worry less about things going on around him.” When I asked what other stuff he focused on, he said homework and baking. Then he smiled and told me of his recent success with baking a new type of cookie he’d discovered in a cookbook. The fact that he got the idea to bake them, asked to bake them, made them, and that they were enjoyable to others made him proud of himself. I asked questions and was able to determine that baking these cookies was a new initiative for him. I asked him to give this initiative a name, and he called it being adventurous.

Here commenced a reauthoring conversation that centered around Peter’s adventurousness. I asked Peter about both his actions and identity, as seen through the lens of adventurousness. Peter’s affect was bright and engaged during this conversation. A reauthoring conversation highlights events in a persons life (landscape of action) as well as exploration of the meaning, hopes, values, preferences, lessons, commitments, and importances to that person (the landscape of identity). My aim was to ground this initiative in Peter’s current and past actions, as well as connect this step to his beliefs about his life, his hopes, and preferences for living. This conversation is summarized in the following letter which I wrote to Peter after we had our reauthoring conversation.

Dear Peter,

Sometimes I write letters to the people I see in my counseling practice; it’s a fun way to remind them of the work they are doing. I hope getting this is a nice surprise for you. Do you like getting mail? I always do.

I enjoyed learning about your adventurousness tonight. It was so cool that you came up with that great word while we talked about the butter cookies you made. It seems like you hadn’t thought of yourself as being adventurous until we looked at it, and it was great to track all the other adventurous qualities you’ve had over the years. You have taken steps in this direction for a while now: trying out sailing at camp, picking up that craft/hobbies book at the church fair, and making butter cookies. And something about feeding alligators? It’s so nice to hear that these things made you proud of yourself. These accomplishments are so different from what sad and angry would want you to notice about yourself. Even calm, for that matter. I know you like calm, too, but your adventurousness gets you closer to feeling carefree, and that seems like a place that you would enjoy.

I hope our talk was helpful in getting your adventurous spirit going even more and that you made some great chocolate chip cookies. Maybe you’ll consider new hobbies, too. I’m interested in how you like to have a nice product at the end of your efforts. Maybe we could talk more about that next time. It makes me guess you enjoy seeing and experiencing your accomplishments, perhaps because you feel proud of them? I’m glad to know that you like feeling proud of yourself.

Will you share this letter with anyone? That is totally up to you, but there may be some people in your life that you’d like to read this. Feel free to do that, or just to keep it for yourself. I hope you have a great week exploring your adventurousness and that sad and angry stay away like they have been. If they crop up, that’s okay, but it sounds like you have some new ways to make them stay away.

I’ll talk to you soon, Peter.

Have a great week,

Peggy

The purpose of the reauthoring conversation is to make previously subjugated storylines more present in people’s lives. Often problem storylines (in this case, sad, angry, and stressed) have taken over people’s thinking, and life events are interpreted within the context of these problems. Since reauthoring conversations bring about a new way to see lives, often these conversations require some extra reinforcements. Because Peter had just discovered this place of adventurousness in his life, I chose to send him the therapeutic letter in order to reintroduce and reinforce these ideas with him a few days later.

At the end of our conversation that night, Peter’s father entered the counseling room and I recounted the developments of adventurousness. By having Peter listen to my retelling of his reauthored story, he was able to listen to the entire plotline from a place of distance, which helped it become more real for him. Additionally, I interviewed his father briefly about what he knew of Peter’s adventurousness, and Peter was able to hear these stories (one about playing soccer on his older brother’s soccer team, and one about feeding alligators in Florida), within the context of him being adventurous. The retelling, the interview with his father, and the letter all serve to bolster and reinforce the strength and power of the developing reauthored story.

Peter has continued to embrace and explore his adventurousness. One day after our conversation, he asked if he could make chocolate cookies from scratch, and he did. He has expressed that trying new things and being adventurous has him feeling proud of himself and happy. He says it helps him feel he can be more carefree and less stressed. His father has also commented that he feels like he has “gotten Peter back,” as they have had the opportunity to have fun together, and be silly and carefree.

Important Notice

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