Introduction
Narrative therapy entails the application of clients’ narratives in the course of treatment to offer different meanings from their experiences and use them to address current situations. This form of therapy can be used to treat anxiety and depression. This paper presents John Walter’s case as he narrates his problems. The paper identifies the different concepts related to narrative therapy and uses them to provide a treatment plan for the client.
Narrative Therapy
Key Philosophers
Narrative therapy is a modern therapeutic approach invented by Michael White and David Epston. In 1990, they released “Narrative Means to Therapeutic Ends” book, which served as a manual to narrative therapy (BĆ©res, 2022). When they met in 1980 in Australia, they immediately connected over their mutual interest in anthropology and its application to family therapy (BĆ©res, 2022). They feel that each person’s story is distinct and shaped by their experiences and perspectives. Other influences of the theory include Jill Freedman, Stephen Madigan and Gene Combs. Narrative therapists do not see themselves as experts in therapy but as active participants in the therapeutic process.
Philosophical Underpinning
From a philosophical underpinning point of view, the therapy is a postmodern approach and the stories as socially constructed rather than objective truth. The therapy aims to change a problematic story into a healthier and more productive one. It helps the clients separate themselves from their problems and empowers them to rely on their skills to minimize the effects of their problems in their lives.
Techniques
In narrative therapy, therapists can use various techniques to help their clients heal and move past their problematic storylines. The therapist needs to put together their narrative and attentively listen to them. The problem is then externalized to create space between the individual and their problem. Deconstruction of the narrative occurs when the therapist breaks down the story into manageable parts to clarify the problem (Shakeri et al., 2020). Unique outcomes are established to enable their client to alter their story and help them consider alternative narratives.
Distinctions with Solution-Focused Therapy
Solution-focused therapy was developed in 1980 by Steve de Shazer and Insoo Kim Berg, while Michael White and David Epston developed narrative therapy. Philosophies behind solution-focused therapy reflect on problems in the best ways they are solved by focusing on how the clients would like to live rather than on the past. Philosophies of Narrative therapy, on the other hand, focus on interpreting clients’ experiences through narratives to change their story. The identity in solution-focused therapy based on helping clients identifies challenges bothering them and organizing their identity to find solutions to the challenges (Zhang et al., 2018). In narrative therapy identity of the individual integrates with their life experiences and provides the person with a sense of purpose and unity in life. In solution-based therapy, change is reached once the clients’ goals have been achieved by forming positive interactions with others and the situations in their lives. Change in narrative therapy is identified when the client pays attention to their unique outcomes to change their narrative to a positive story.
Presenting the Case
Introduction to the Client and Significant Others
Walter White is a male aged 50 who works as a high school chemistry teacher in Albuquerque, New Mexico. The client is white and a heterosexual married to Skyler White, aged 40, who works as a bookkeeper in Albuquerque firm Beneke fabricators. The clients’ children are Walter Jr. (RJ Mitte), a student at J. P Wynne high school, 14 years old, with cerebral palsy and Holly White, who is eight months old. This family lives at 308 Negra Arroyo Lane, Albuquerque, New Mexico.
Presenting Concerns
Walter White has recently been diagnosed with stage III lung cancer which has led to tremendous changes in his life. His current condition influences his decision to manufacture methamphetamine due to the pressure of supporting his family after his death. His son, Walter Jr., has cerebral palsy, resulting in his being bullied by other children in school. Additionally, the client is facing marital problems as his wife Skyler has cheated on him with her boss resulting in divorce, leading Walter to lose her and his son Walter Jr.
Background Information
The client has a history of trauma and abuse; he reports that he was born in a poor background, and his father was a drunkard who kept beating him for no reason at all; anytime, he came home drunk. Walter White is also alcoholic, which has affected his family relations and life decisions occasionally. The client additionally has reported aggressive behavior due to stress which has affected his relationship with his wife and friends.
Precipitating Events
The client’s family was doing well until the present diagnosis of the client with terminal cancer. The recent life changes have drastically affected the family, with Walter being forced to start preparing meth to provide for his family. The situation has escalated to challenges in the family where his wife disapproves of him and cheats on him with her boss. His son’s health condition has been a challenge to him, having to see his son going through challenges, and he cannot assist him. The recent divorce and the loss of his family have also become stressful factors for the client. The client had tried to seek marital counseling, but things did not change. The wife also feels that Walter has been physically abusive, leading to her falling into the temptation of cheating.
Strengths and Social Location
The client strongly desires to be a good parent to his children Walter Jr. and holly white, and indicates being a strong parental figure. He’s willing to put himself on the line for the sake of his family, which shows that he is incredibly considerate and caring when it comes to the people he loves. The client offers his children, especially Walter Jr., strong support by helping him go through his daily challenges due to his cerebral palsy condition. Based on the client’s social location, unique resources used to support the family include family support and disability support for their son Walter Jr. Potential limitations for the clients include the divorce, family values in religion, and the fact that Walter White is an alcoholic.
Family Structure
The family is currently divorced, with an adolescent child and an infant. The problems in the family escalated, leading the couple to have difficulty dealing with the family situation. The separation leads the client to detachment from his son and has been left with the younger child Holly. Walter Jr. feel his father is responsible for the divorce as much as he sympathizes with his illness. Skyler tends to be the most lenient parent in the family. At the same time, Walter White is left with the majority of the daily financial responsibilities, has necessitated him to take action after he feels that his death is close.
Treatment Plan
Early Phase Clients’ Goals
The major goal of narrative therapy is to router the client’s story. In contrast, the therapist I am supposed to work with the client as he tells his narrative and asks questions needed to understand the situation. I encourage the client to use questioning to think of new methods to tell their story. The news story that the client tells needs to be more satisfying and positive. This method is appropriate to Walter White’s narrative as it helps him be an expert in his life. As a result of his depression and anxiety, the client has noticed increased agitation towards other people, especially his wife and snaps at them without any reason. Walter reports feeling purposeless, helpless and despaired due to his current medical condition and related financial stability. The departure of Skyler has shattered his hopes and made him feel worthless and useless. These feelings have made him more irritable and unable to control his emotions towards others.
Mapping unique outcomes are essential for the client’s case as part of his story as it helps establish the goals of the therapy as it becomes part of his preferred story. The unique outcomes are the parts of the story that differ from the client’s normal narrative (Shakeri et al., 2020). Identifying Walters’s unique outcomes will establish goals highlighting his strength in overcoming his depression and anxiety. The questions asked will invite Walter to acknowledge and recognize actions, personal qualities and intentions that contradict his dominant story. They will give him positive beliefs that will guide him through his difficult experience. The plan will identify his strengths to help boost his self-esteem. Reaching out to family and friends and participating in outdoor activities will help minimize the influence of depression on the client. Walter must face his fear and avoid doing things that make it difficult to maneuver, live, and make better life decisions. He additionally needs to minimize drinking to enable him to have more self-control and find efficient ways to deal with financial problems.
Working Phase Client’s Goals
Decrease the Influence of Depression
In most cases, the problem for the client has been internalized to present their problem or inner self in connection to their problem. Externalization will help locate the client’s problems not as a result of themselves but as a product of circumstances. The practice will make Walter realize that he and the problem are different. As a therapist, I will help the client change the adjectives they used to describe themselves, such as ‘I am I depressed man’ into noun form by using phrases such as does the depression influence your’ or ‘what does the depressive state tell you about yourself?’ I will identify the problem as’ it’ and ‘them’ as a technique to personify Walter’s problems. Externalizing his depression involves identifying these statements such as ‘I am useless’ by responding with statements such as I am right to feel that your current challenges define the type of person you are. I would ask the client if his problems convince him that he is in despair or helplessness. I would alternatively ask, ‘how often does the hopelessness feeling engulf you?’ and ‘Are there times in your life when you feel the hopelessness is more or less?’
Mapping depression versus the unique outcomes will help the clients understand the causes of his negative emotions and help him position himself in a way he can solve them. The unique outcomes will give the client a better relationship with his depressive state and allow him to tolerate the challenges with the idea that he can cope with stressors (Chan & Sage, 2021). The therapy will facilitate aspects that allow the client to account for his encounters and establish better stamina in life. Identification of strength will give Walter more hope and self-worth to tame his emotions and feelings.
Increase Sense of Agency
Once the problem has been externalized, metaphors are essential in combating the clients’ relationship to depression. This metaphor may be sensual as it may be used to accurately fit descriptions of what the clients may be going through. The metaphors should be less centred on the person’s life and help minimize the effects of the problem on the client. The metaphors I will use in this case include ‘educating the problem’, ‘negotiating with the challenge’, ‘organizing a truce with a problem’ or ‘taming the problem’. These metaphors will help the problem become less intense in the client’s life. They will help the client decide which invitations for the challenge they wish to take up to help reduce the influence of the challenge in their lives.
The externalizing conversations will help Walter to take a position concerning the problems he experiences. The position will articulate the effects of the client’s practices and how they think to enable them to become more aware of the consequences in their lives (Shakeri et al., 2020). The position statement will help the client define his problems and the challenges he is facing. Questions such as ‘what are the effects of your problems, and what is more important to you?’ will be used. The effects of Walters’s problems will be evaluated in terms of cost to himself, his family and the community. Finally, the evaluation will be justified by using questions such as why the effects are not acceptable in his life of what kind of relations he wishes to have.
Increased Actions that Support Preferred Identity
Scaffolding is essential to assist the client in identifying their unique exemptions and outcomes built on positive events that occurred in the past. The therapy will create tasks that drive Walter away from his problems by creating activities that remind him of his past victories. While dealing with Walter, I will take him through narratives that give accounts of his past achievements. These stories will convince him that he can overcome the present challenges and show him that the current problems are just minor setbacks in his life. The scaffolding process will help Walter change his attitude and develop his potential to achieve his dreams despite the current situation.
Statements in the position map may be used to ask questions such as why the client feels they are against these problems and why they feel their challenges are getting in the way of what they want. The questions will assess the client’s ambitions and hope to try to maneuver through the challenges (Farrell & Gibbons, 2019). They will also help gather their values from the kind of life they are interested in, and the changes they feel are currently most beneficial.
Closing Phase Client Goals
To expand the influence of preferred identity and evaluate the effects of action, I would ask the client questions such as ‘do you feel better or ‘have you realized any change in your depressive sensor’?. Definitional ceremonies will help provide the client with options of performing or telling his story before an audience of outsider witnesses. Walter faces relationship problems with his family and friends and has found himself withdrawing from these relations because of agitation and irritation fostered by depression and anxiety. Outsider parties will listen to his side of the story according to what he feels most comfortable sharing. With the presence of this party, he will release some of the information that can help them identify with his experiences. The audience will have a chance to hear his thoughts and feelings and share feedback that may help him realize that his family and friends are concerned rather than feel ashamed of his circumstances. The practice will help Walter feel closer to his loved ones as they may empathize with his problems.
A therapeutic letter will be documented that gives general statements in observation of the client throughout his treatment process. The letter will be a form of positive success and build a strong contextual meaning in the client’s journey of subduing depression and anxiety. The narrative reflecting team will consist of about five therapists who will observe the therapy session and make observations regarding the process for better outcomes for Walter. The team will additionally be essential for further consultations on the client’s case.
Treatment Tasks
As the therapist, I am entitled to create a working therapeutic relationship with the client. I will interact with Walter freely without implementing any form of coercion. I will tolerate all that Walter says and give him ample time to explain himself without interrupting his narrative. Confidentiality will be promoted throughout the session to make him freer to share information. I will always empathize with his situation and offer him an optimistic and hopeful position while dealing with his challenges.
Cultural Dynamics
Walter’s beliefs, cultures and values will be considered throughout the therapy session. Different cultures are involved in viewing their stories from different perspectives. In other places, people may need to share their narrative apart from everyone’s experience in life, while others may need to give a collectivist view. The client may feel embarrassed due to their challenges and may not tell the truth or share half of it to camouflage their shame. Questions asked need not insult their client’s beliefs or cultures. Dominant discourses that may support depression may include discrimination due to having a physically challenged child and financial instability.
Crises Issues and Referrals
From the crisis assessment intervention, the crisis issue the client may suffer is the risk of substance abuse. Walter may benefit from resources in the community, such as gyms for physical fitness. Engaging in physical exercises has been found helpful in reducing the occurrence of mental illnesses. A social group may help increase interpersonal interactions, and the church may be helpful for religious empowerment to cope with depression and anxiety.
Conclusion
A hope prevails that through narrative therapy Walter White will be able to manage and deal with his problems. Using this approach, the client will rediscover his potential and quit commenting on his predicament. Narrative therapy will be helpful to change Walter’s life story to a more positive one that will help him overcome depression and anxiety. The client has faced challenging situations that have caused considerable changes in his life, and knowledge of dealing with these issues will help him persevere through the emotional stressors that come with life difficulties. Support from the community and family will be essential in the healing process of Walter.
References
BĆ©res, L. (2022). 1 The Self/Identity in Narrative Therapy. The Language of the Soul in Narrative Therapy: Spirituality in Clinical Theory and Practice, 57. Web.
Chan, C., & Sage, M. (2021). A narrative review of digital storytelling for social work practice. Journal of Social Work Practice, 35(1), 63-77. Web.
Farrell, I. C., & Gibbons, M. M. (2019). Using narrative therapy to assist collegeāage Latino immigrants. Journal of College Counseling, 22(1), 83-96. Web.
Shakeri, J., Ahmadi, S. M., Maleki, F., Hesami, M. R., Moghadam, A. P., Ahmadzade, A., & Elahi, A. (2020). Effectiveness of group narrative therapy on depression, quality of life, and anxiety in people with amphetamine addiction: A randomized clinical trial. Iranian Journal of Medical Sciences, 45(2), 91. Web.
Zhang, A., Franklin, C., Currin-McCulloch, J., Park, S., & Kim, J. (2018). The effectiveness of strength-based, solution-focused brief therapy in medical settings: a systematic review and meta-analysis of randomized controlled trials. Journal of Behavioral Medicine, 41(2), 139-151. Web.