The Multicultural Effectiveness of Narrative Therapy

Abstract
One of the most difficult situations that face counselors and their clients is the daunting task of listening with understanding while removing bias from the counselors thought process. The wall of bias and not understanding creates fear for those seeking help from the counseling institution. While there are many different counseling techniques available to the counselor many do not cross the threshold of understanding cultural differentiation as capably as Narrative Therapy. Those who live in the United States are quickly finding the problem of multicultural living and associations is drastically changing the European American influence.

The counseling paradigm of Narrative Therapy gives a voice to those who are in need of counseling and sweeps away the cultural differences in an atmosphere that is conducive to trust being developed and healing being offered as the end result. Additionally, the Narrative Therapy approach to counseling allows that patient to be viewed from within their culture that creates a healthy racial identity without the fear of being profiled or stereotyped. Moreover, Narrative Therapy offers a haven of respect with a no culpability approach that allows the persons cultural distinctiveness stay intact rather than a tool of shame.

The concept of narrative therapy was introduced to world of counseling by Michael White and David Epstein due to the fact that both men realized that people living in the modern world have begun to organize his or her life in narrative terms. In other words, people generally construct or create their evolving life story to address the past and give purpose to his or her future life. So, as therapists who are employing the narrative construct for helping people, the gift of hearing these life stories is made available for us to examine within the context of personal life events. The concept of narrative story telling is not new to us since God revealed Himself to humanity through the greatest collection of narratives ever written and it is known today as the Bible.

The Bible is a series of narratives told to the reader for the soul purpose of offering truth to be learned and seen from the perspective of many different cultures to reveal God at work through the process of conflicts, tension and relationships known throughout history. In the process of God creating humanity in His own image, the inheritance of life sharing through stories or narratives is part of the soul’s essence. In the Bible (New International Version), Galatians 6:2, tells us to share each other’s troubles and problems to obey the law of Christ as to help someone in need. So, the narrative process is the realization of an old concept renewed for the 20th century and into the future. It is conveyed to us in the text by Diller that “Narrative therapy draws heavily on postmodern ideas.

Most centrally, it posits that the self is co-created through social interactions with others and society” (Diller, 2011, p. 141). While this is somewhat disconcerting to say there is no true self but it changes with the multiple story concept may be misconstrued by White and Epstein, it is true that individuals do have many stories to tell that build on the core self and so we do evolve as a social being created to interact with others. Therefore, with that stated, the therapist is on a journey of discovery within the world that is given to them be an individual at that particular point in his or her evolving self. In the words of Adler, “The theory of narrative identity posits that, beginning in adolescence, individuals construct an internalized and evolving story about his or her life experiences that weaves together a reconstructed past, perceived present, and anticipated future” (Adler, 2011, p. 368).

So, since Adler confirms that life stories are constructed, internalized and evolving there must be a catalyst or method of interaction that is common to all of humanity’s participants. Hence, it was William Shakespeare who summed it up so eloquently with the immortal line, “To be or not to be” that conveys the truth that choices are the fundamental and continuous characteristic of his or her life as they have evolved to up to this present time sitting in the therapist’s office. It is at this point that the therapist must consider the factors that have been woven together and consider whether he or she is equipped to properly help this individual. In the textbook, Hildebrand makes reference to an interesting concept that states “Out of many, one or E Pluribus Unum, which is the motto of the United States” (Hildebrand, 2008, p.14).

Hence, most working therapists must consider the notion that not everyone comes from the same cultural background and probably has not adapted to the dominant culture in the American society as it manifests itself today. Predominately, we are a country of many cultures and sub cultures that must be considered when participating as a helper or therapist for clients who may arrive in the office on any given day. Fortunately, the narrative therapy paradigm offers flexibility to its framework so the therapist may adapt or adjust to understand the clients’ problem through the eyes of the client and his or her culture. For the therapist there is no fixed model of truth that fits all situations anymore due to the diversity of clients that will be faced.

Thus, multicultural counseling makes the therapist adapt to the demands of the client through research and understanding cultural practices which we are all entrenched. When the therapist is able to see the client without his or her cultural limitations or stereotyping then the relationship becomes one of nurturing and healing begins for the client. In the submission by Kim there is a significant trend mentioned that states “Unlike previous generations of immigrants, the advent of technology means that many people no longer leave behind relationships, connections to their homeland, and their cultural identities. People aim to keep their identities while adopting a new home country. The United States is becoming ever more a richly diverse tossed salad rather than the mythical melting pot.

Thus, people’s cultural identities provide a sense of belonging; it makes sense that to varying degrees people would continue to carry their own cultural values, beliefs, and assumptions into the intimate relationships they form in their new country (Kin, Prouty, & Roberson, 2012, p. 274). With this observation in mind it is the responsibility of the therapist to remember in their treatment considerations that cultural influences should not be diminished but seen as a powerful influence on shaping the client’s life and how his or her perception of the problem at hand is understood by the client. In view of that, there is a tremendous amount of responsibility on the part of the therapist since, according to White, “this is not a context in which therapists can presume a position of neutrality, a context in which therapists can hold out a claim to a space that is free of the relations of power and of the biases associated with their location in the social world (White, 2011, pg. 63).

In other words, the therapist does not have the luxury of remaining high above the client, protected by his or her cultural retreat, for judgment and a psychoanalytical diagnosis of the ills of his client. However, White goes on to state “This is not a context in which it is possible for therapists to entertain an objective position in his work; to transcend their ways of being and thinking that are informed by culture, class, race, and gender” (White, 2011, p.63). It is very important for the therapist to remember the previous assumption for an effective narrative collaboration to be effective for the betterment of the client. Therefore, the context of accountability that the therapist is subjected to and the client should be entitled to invites the following rapport, as itemized by White:

•Therapists to render visible certain aspects of their taken-for-granted ways of being and thinking, to expand their consciousness of their biases.
•Therapists to acknowledge their location in the social world, and the privileges and the limits of understanding that are associated with this location.
•Therapists to acknowledge the assumptions and purposes that are associated with those metaphors that guide their work.
•Persons to confront the limits of their therapists’ understandings and to express their experience of these limits. •Persons to honor the unique understandings and experiences of life that pertain to their location in the world of gender, race, class, and culture.
•Therapists to transgress the limits of their thought by stepping into alternative sites of culture. Thus, according to White “This notion of responsibility emphasizes responsibility for the real effects of our actions and interactions within the context of therapy itself” (White, 2011, p.64). Summarily, the narrative therapist should identify that many of the stories offered by the clients are problematic. The therapist should be skillful in taking note for the implications clients attach to their life stories while assisting the clients in his or her investigation those meanings on their lives.

It is stated by Hibel & Polanco that “In that process of listening, the therapist, intentionally or not, selects some expressions to be heard and others not to be heard. In much the same way that “people are living out their lives according to intentions that they embrace in the pursuit of what they give value to . . .” (White, 2007, p. 103), therapists often develop their therapeutic orientation according to the intentions that they embrace, framed by what they give value to and believe about their practice and their lives” (Hibel, & Polanco, 2010, p. 53).

For example, in a case study implemented by Santos’, Goncalves, Matos, & Savatore the benefits of listening for intentions was found and summarily stated as follows when working with a minority culture female who was in an abusive relationship. The following course of narrative therapy was delineated by model that included: “Objectives. Our aim was to explore the development of innovative moments (i-moments) in therapeutic conversation and to study how they match our heuristic model that accounts for the development of change, drawn from previous empirical research. Design. In this therapeutic process research, we analyzed a good outcome case of narrative therapy with a woman victim of intimate violence.

Methods. This case, composed of 12 sessions, was analyzed with the Innovative Moments Coding System: Version 1. This coding system allowed the identification of five different types of innovations (i-moments) that appeared during the therapeutic process: action, reflection, protest, re-conceptualization, and performing change. For each session, an index of temporal salience was computed, as the percentage of the time in the session that client and therapist spent talking about each i-moment. Our analysis procedures provided a quantitative and also a complementary qualitative approach. Results. Data showed that the types of i-moments emerged differently throughout the process. Early sessions were characterized mainly by action and reflection (low temporal salience), middle sessions were found to have mainly protest i-moments (low or middle temporal salience), and final sessions were characterized by the combination of high salient re-conceptualization and performing change i-moments. Conclusions.

Findings suggested that narrative change seems to develop in a cyclical way, in which different types of i-moments contribute to the development of a new self-narrative in different phases (Santos’, Goncalves, Matos, & Savatore, 2009, p. 449). It is interesting to note that in the study presented that Susan, the therapist, was able to externalize the problems for the client and the perspective of the client changed in a positive manner that was deemed to be a successful therapeutic intervention.

The externalization or retelling of the clients story with the intuitive leading of the narrative therapist is paramount in its’ importance for helping the client. In a different case study, done by Polanco, a client named Tatiana was a successfully concluded client as told in the following story by Polanco. He records for his paper that “I met a woman, Tatiana,* who came to the Student Counseling Center where I work, at Nova Southeastern University. She came in due to “relationship problems.” Tatiana is a woman from a Latin American country who migrated to the United States during her adolescence. She described herself as “fluent” both in English and Spanish. However, she identified Spanish as the language in which she can “feel.” Tatiana and I had a conversation in English about love. Tatiana told me that although her current partner, a North American man, whom she met a few months before our meeting, would use love as a word to express his feelings toward her, she couldn’t do it.

I inquired about Tatiana’s definition of love, to which she replied that this was an “empty word” for her. Love had no meaning for Tatiana; therefore, there was no purpose in using it. At this moment I switched the conversation to Spanish and asked Tatiana about the translation of the word love in that language. Tatiana spoke about amor. I asked her if amor was filled with familiarity or if it was as empty as word love. Our conversation followed the distinction between amar and querer. For Tatiana the word amor was mostly used in novelas, but not in everyday life. Therefore, querer was more suitable as a vocabulary of her sentiments. I invited Tatiana to define this word as close as possible to her sentiments, which moved us to the notion of te quiero.

These words evoked a very deep experience that connected her with the voice of her mother uttering those words: “yo te quiero, te quiero mucho.” Tatiana added to this memory the look in her mother’s eyes, while touching her cheek with her hand running down her face. Tatiana was able to feel the warmth of her mother’s voice all over her body. For Tatiana the word love was empty from these kinds of experiences. Tatiana’s sentiments belonged only to the Spanish culture. She hadn’t yet translated them into the English culture. I invited Tatiana to the possibility of translating the quiero into love, English being the language of her current relationship. Tatiana welcomed this idea with curiosity. Tatiana told me that from her English frame of mind, she was now able to “see” how love could look like by knowing what it meant in Spanish. This led her to discover what love would be like by experiencing her partner’s warmth, look in her partner’s eyes, tone of his voice, and caring gestures.

Tatiana adopted an apprenticeship position to discover what to quiero meant in a new language, exploring in turn a new practice of love” (Polanco, 2010, p. 10, 11). Since the therapeutic cases aforementioned in this paper demonstrate how narrative therapy can work effectively with multicultural clients it is a necessity of the highest priority for the narrative therapist to get personally prepared to work within the narrative paradigm. As suggested by Sommer, Derrick, Bourgeois, Ingene, Yang, and Justice state in their study, “Stories have long been used in various cultures and settings to help make meaning and enhance awareness. The authors describe how reflection on and discussion of myths and fairy tales in supervision may help transcend cultural boundaries and increase multicultural understanding” Sommer, Derrick, Bourgeois, Ingene, Yang, and Justice, 2009, p. 206).

Moreover, the above statement behooves the narrative therapist to actively pursue more than a casual acquaintance with the culture with which they intend to help throughout the narrative therapist career. In a concluding remark concerning the value of stories to offer better communication when working at the multicultural level, Sommer, Derrick, Bourgeois, Ingene, Yang, and Justice states “Further investigation into the use of stories and multicultural competency is needed. Future researchers could focus on sharing stories in practicum, internship, or multicultural classes and qualitatively analyzing recorded group discussions. In-depth interviews with selected individual participants could add perspective on the use of stories to enhance multicultural understanding.

As humanity’s social fabric becomes increasingly diverse and the world in which people live becomes more of a global community, counselors and supervisors must be prepared to work with individuals from multiple ethnic and cultural backgrounds” (Sommer, Derrick, Bourgeois, Ingene, Yang, and Justice, 2009, p. 215). So, what is the key element in the magical process of storytelling bringing forth healing and helping for the clients involved in the therapeutic process with the narrative therapist? As with any relationship there must be a trust established for a  collaborative healing and helping to be attained over the many sessions of talking and listening. For this trust to be established then client must feel there is a safe haven when he or she walks into the office of the therapist. In a concluding remark by Wallis, Burns, and Capdevila, it is written in the presented study, “If therapists are to demonstrate the effectiveness of models of therapy, specifying ‘what we do’ and ‘how we do it’ is vital.

The accounts identified in this study may assist practitioners in identifying an approach to narrative therapy that reflects their values and practice” (Wallis, Burns, and Capdevila, 2011, p. 495). So, following that conclusion the logical conclusion is that the therapist must have the knowledge and skills that can work within the culture of the client, listen to the story of the client with an understanding from within his or her culture and be able to transition or reauthor that story of pain and anguish. From the therapist perspective, to reauthor the story is to go from the failure or despair that is perceived by the client to a narrative that is one of healing of the past and hope for the future. However, there is a forewarning concerning the narrative therapy approach and this does trail back to the post-modernist roots as stipulated earlier in this submission.

Since, this is not a modern or fixed truth paradigm there is a heavy reliance on the client-therapist identity differences which will transcend the ethnic and cultural values the client-therapist live within on a daily basis. While we are multifaceted beings and very complex in so many ways, the identity of each participant is also formed by factions as stated by Tsang, Bogo, and Lee, “the complexity of client-practitioner identity differences that often go beyond ethnicity and culture, involving multiple contingencies related to dimensions such as gender, sexual-orientation, age and generation, religion, rural-urban context, lifestyle, and subcultural systems such as the street-kids culture.

Such understanding, coupled with emotional attunement, will enable successful engagement, which will then provide favorable conditions for the development of the therapeutic alliance, thus increasing the likelihood of positive client change” (Tsang, Bogo, & Lee, 2010, p. 88). In conclusion, it is a necessity of the highest priority to keep the mitigating factors listed above in mind when starting the narrative therapeutic process. This will help both the client and therapist build a trusting relationship that can lead to healing and a positive outcome for those involved in the narrative process. Also, within the constructs of the narrative paradigm, the above mentioned factors and the flexibility within narrative framework all come together at the discretion of the narrative therapist. Ultimately, for the narrative therapy to be successful, the processes discussed are tools for the discerning therapist to use or not use depending on the individual client.

Each client is tied to the cultural landscape they daily interact in and the people who surround them are either resource of strength or negative impacts on their lives. It is the therapist who will guide their client around these obstacles or restructure the perception of the client to see some people or life traumas differently. The therapist should be grounded in wisdom and able to discern and separate the client from the life experiences. Thus, this will allow the client to rid themselves of internalized negativism that has been constructed by the client over a particular season of their life. Additionally, the demeanor of the therapist must be one of curiosity and optimism as the client reveals themselves during the narrative therapy sessions.

As the therapist listens, just as Christ did to so many almost 2000 years ago, there will be a liberating and empathetic feeling of concern for the suffering and anxiety of the client. This will translate from the therapist to the client and both may realize the truth of the statement by G. T. Straub, “Works of mercy are about establishing relationships. It is through the movement of grace on relationships between two persons that wonderful, even miraculous, things happen.”

References

Adler, J. M. (2012). Living into the story: Agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy. Journal of Personality and Social Psychology, 102(2), 367-389. doi:10.1037/a0025289 Diller, J. V. (2011). Cultural diversity: A primer for the human services (4th ed.). Belmont, CA: Brooks/Cole. Hibel, J., & Polanco, M. (2010). Tuning the ear: Listening in narrative therapy. Journal of Systemic Therapies, 29(1), 51-66.
doi:http://dx.doi.org/10.1521/jsyt.2010.29.1.51 Hildebrand, V., Phenice, L., Gray, M., & Hines, R. (2008). Knowing and serving diverse families (3rd ed.). Upper Saddle River, NJ: Pearson Kin H., Prouty A. M. , & Roberson P. , (2012). Narrative Therapy with Intercultural Couple s: A Case Study. Journal of Family Psychotherapy 23:4, 273-286. Lenz, S. A., Zamarripa, M. X., & Fuentes, S., (2012). A Narrative Approach to Terminating Therapy. Journal of Professional Counseling: Practice, Theory & Research 39: 2-12. Santos, A., Goncalves, M., Matos, M., & Salvatore, S., (2009). Innovative moments and change pathways: A good outcome case of narrative therapy. The British Psychological Society 82:449-466. United Kingdom Sommer, C. A., Derrick, E. C., & Bourgeois, M. B., (2009). Journal of Multicultural Counseling and Development 37:206-218. Tsang, A. K. T., Bogo, M., & Lee, E. (2010). Engagement in Cross-Cultural Clinical Practice: Narrative Analysis of First Sessions. Clinical Social Work Journal 39:79-90. Wallis, J., Burns, J. and Capdevila, R. (2011), What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston’s (1990) approach to narrative therapy. Clin. Psychol. Psychother., 18: 486–497. doi: 10.1002/cpp.72 White, M., (2011). Narrative Practice (1st ed.). Narrative Practice: Continuing the Conversations. W.W. Norton and Company. New York, London