Monday, September 5, 2011

Externalizing the Problem

One of my favorite interventions, taken from Narrative Therapy, is externalizing the problem. It can be used with adults and children, in individual, family, and group therapy, to help people broaden their perspectives on what have often become narrow problem-centric life stories.

Psychodynamic theories have used the term "externalizing" to refer to the ego defense of blaming problems on an external person or entity rather than taking responsibility for them. Obviously, externalizing from this perspective is not an asset to treatment.

However, Narrative Therapy defines externalizing quite differently. Rather than assuming people will try to avoid taking responsibility for their problems, Narrative theory suggests that people have come to see their problems as TOO intrinsic to the self. As a result, they may have developed a "problem-saturated" self-image, and feel helpless and hopeless about the possibility of change. When this has happened, an important first step in the change process is separating out the person from the problem.

This is achieved not by identifying someone ELSE as the problem, but by recognizing the problem as an entity unto itself, and seeing the problem (rather than any person) as the problem. Using some imagination and creativity, people can be encouraged to objectify, and even personify, the problem in a way that allows them to consider new ways of responding to it.

It also can be a way of beginning to identify exceptions to the problem. The therapist can invite the client to talk about times the problem was more or less strong or active, and times when the client got the upper hand over the problem. New solutions start to crystallize out of this kind of exception.

It's also an opportunity to begin to explore the client's preferred relationship with the problem.  While it may not be possible to eliminate every problem, it may be possible to establish a different relationship with the problem so that it's less...problematic.

I've been trying to use this intervention with a 10 year old boy, who stutters, and has been told (according to his mother) that it is incurable due to the physiological mechanism causing it. When asked about his goal for treatment, he says that he wants the stuttering to stop, while his mom wants him to be less frustrated by the stuttering, and more able to accept it.

My first attempt at externalizing with this client was to ask him to draw the problem as if it were a thing, creature, or person. This intervention did not work - he drew himself, stuttering. Instead, I decided to try something more personally relevant to him, and asked him to bring in his favorite video game. He brought in a WWE wrestling game, and described his favorite characters, as well as the "bad guys." When asked which character would represent his stuttering, he readily identified one of the bad guys, with a tag-team partner who could represent frustration. Since my client could describe all of the characters' favorite strategies, he was quite willing to do some observatory research for me this week, and try to figure out what the favorite moves of stuttering and frustration are. (We'll see how successful the intervention was based on what he comes back with this week!)

Have you ever tried externalizing the problem with a client, with either a positive or negative response?


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