Three brief case studies
Whenever possible, I see my clients at their home. "Frances" was a VRAS client, whose younger brother Jason had been shot by a drug dealer 18 months before. Her home was spotless yet welcoming, with photos and her son's football trophies on the walls. She sat me at the kitchen table, and insisted on making a cuppa. And yet, somehow, I didn't like this woman. She was a clenched fist: mouth pursed, and the lines showed this to be a habit, shoulders rigid, movements ponderous. Her first words to me were, "Nobody likes me. It's because I am a vengeful person." Even though she was facing a stranger, I could see that tears were not far away.
Almost the entire first session was an unloading of emotion, Carl Rogers would have been pleased with me. But also I plucked some words from her account, and named her monster Ongoing Anger. By the end of that session, she also spoke of Ongoing Anger as a problem she had.
There is insufficient time to go through all the complications of her story. One example: her son Warren was very good friends with Jason, and started drinking after the tragedy. He then got into serious trouble, and Frances felt during this session that she had lost her last few remaining friends because of this secondary issue.
I lent Frances a wonderful book I always use in cases of grief: Seven Choices (Neeld, 1990). One of my (non-Narrative) interventions was to suggest that she pretend to be forgiving, using Socrates' dictum, "Seem the man you wish to be." We agreed on three items of 'homework' designed to give her opportunities for this.
At the end of the session, I felt that I had done little to help her. I left with a sense of failure. She seemed too full of bitterness and hate.
One week later, things were very different. She had read Seven Choices from cover to cover, and completed all the rest of what she had undertaken. She had decided to try and get permission to visit her brother's murderer in jail, and wrote a bridge-building letter to her parents.
However, she started the session with the belief that all this would be useless: things would never change in her life.
As I kept asking questions and reflecting back her answers, I suddenly saw her in a new light. I shared this with her, and with considerable excitement the two of us composed a Statement:
I am a person who hangs on to things.
I remember both the good and the bad.
This makes me a wonderful friend and a terrible enemy.
I'm a good person to have around when you're in trouble...
But you'd better not hurt someone I love!
I am a protector.
I am now working on not being an Avenging Angel.
At home, I made up a fancy copy on my computer, printed it and had it laminated. I posted it to her with the letter in the Appendix.
The funny thing was, I left the house this second time with a strong liking for my client. This was not 'counter-transference', as proved by the sequel. She phoned to postpone the next appointment, because her whole extended family had decided to go away together during the school holidays. And after the holidays she didn't contact me as arranged. I phoned her, and she told me the holiday was so enjoyable, and now she was getting on with her relations so well, that sorry, she forgot all about therapy.
As you can see, sending a letter is poor business. David Epston has found in some follow-up research that one good letter has the therapeutic worth of five face-to-face sessions.
"Lisa" was a young woman who came home to find her de facto raping her 7 year old daughter. She reported him to the Police. During the legal processes, the daughter was traumatised yet again. Then the perpetrator was acquitted. Child Protection, Department of Human Services retained me to counsel the family three years later, when young Anne was 10.
I won't be talking about my work with Anne, but with Lisa. She was in a state of continuous outrage, her thoughts obsessively went round and round the injustice of the man's acquittal, the trauma her daughter had suffered, her guilt at not having saved Anne from suffering, more guilt about the way the so-called justice system treated the girl, on and on. Things were so bad that the case worker from Child Protection threatened Lisa with a court order if she continued talking about things like a bleeding anus in front of her kids ever again.
Lisa and I typically talked for half an hour before the kids came home from school, and several times I took the family on an outing such as to the swimming pool. We talked while the kids played. She was into Astrology and aromatherapy, and had 'New Age' posters on her walls. She told me she believed in reincarnation, so I asked her, "Why were you put here into this life? What is the lesson your spirit must learn from these terrible events?" I told her that my clients invariably felt the need to do something new and challenging when they found an answer to this kind of question.
She honestly struggled with this question through some five or six weeks.
She never actually gave me an answer, but soon after, she decided to organise a school play, with the 'worst kids in the school'. To my surprise, the topic was to be reconciliation with Koories, not sexual abuse or the like. I questioned her about this, and she told me, "No good dwelling on the past, it only drags you back."
Was this Narrative Therapy? It was, in that I consistently used externalising language during my work with the family. I had 23 sessions with them, including perhaps 15 hours with Lisa, and she overheard much of the rest. I think that even while engaged in Logotherapy (Frankl, 1984) with me, she also picked up the way of thinking, through osmosis.
"Denise" had been a member of a Fundamentalist Christian sect. She married a man in the congregation. He started 'playful' violence on the honeymoon, and got angry when she resisted. The violence escalated, and was part of a complex including emotional abuse and financial restrictions.
Denise appealed to the Church Elders, but they told her to be an obedient wife. They forbade her from going to the Police.
Eventually, a neighbour rescued Denise when the husband was choking her at the front door. She took out a restraining order against him and left the Church. However the abuse continued, in that he took all their money, leaving her destitute, then disappeared.
Despite her terrible present and recent past, Denise chose to spend much of our first session talking about her brother, who had died four years previously. She told me she kept dreaming about him.
I offered her an insight of Michael White's to help her with this. People keep telling you to 'forget him', to 'put it behind you'. And sometimes this is precisely what keeps the grief going. I said instead, "He's been dead for four years. It is time you invited him back. Feel free to think about him. Write him a letter, ask his advice about your current troubles."
I also lent her Seven Choices.
Denise felt useless, weak, a pawn at the mercy of others. On the contrary, I saw her as admirably, incredibly strong in a situation that would have defeated almost anyone else. I made the mistake of saying this, trying to convince her that my view was correct. She resisted, so I backed off, instead asked her specific questions about where she had found the strength to continue. Her main supports were God (despite her wretched church), and the fact that her daughter relied on her. And after the second session, to my delight, she added the memory of her brother.
Denise's healing came with a reframe I'd had nothing to do with. She was thinking about some task we'd agreed on when she realised that her father, whom she'd always feared, was merely to be pitied. This insight had no obvious connection to the task. During our next session, she did an admirable Narrative Therapy analysis of what had gone wrong in Dad's life. Soon before our parting, she had started to do informal counselling for friends of hers who were grieving, and I strongly recommended that she train as a counsellor of some kind.
Not all my cases are successful. I chose these three to illustrate something Steve de Shazer once said: "Therapy is magic. I don't know how my clients do it." I cannot claim to know why these three women managed to conquer their problems. Something I did stimulated them to cut through the bonds of the problem that imprisoned them. In each case, they could complete grieving with surprising rapidity once they got rid of past emotional baggage, and then they were able to move forward.
Continued: Letter to "Frances".
Beck, Judith S. (1995) Cognitive therapy: Basics and beyond. New York: Guilford Press.
Cade, B. & O'Hanlon, W. H. (1993) A brief guide to brief therapy. London: W. W. Norton.
Frankl, V. (1984) Man's search for meaning, 4th ed. London: Souvenir Press.
Freedman, Jill & Coombs, G. (1996) Narrative Therapy: The social construction of preferred realities. New York: W. W. Norton.
Neeld, Elizabeth H. (1990) Seven choices: Taking steps to new life after losing someone you love. New York: Bantam Doubleday Dell.
White, M. & Epston, D. (1990) Narrative means to therapeutic ends. Adelaide: Dulwich Centre Publications.