I run a weekly group based on Narrative Therapy, which begins with "externalizing the problem" as a way to separate the problem from the person who has the problem. In Narrative Therapy parlance, "the person isn't the problem. The problem is the problem." In other words, the problem is not personality, nature, temperament, or other intrinsic qualities, but something removed from the person's identity. Viewing it this way opens up new choices and possibilities for the the person to change his or her relationship with or response to the problem.
I've written before about the objection sometimes raised that externalizing the problem absolves people of the need to take responsibility for their problems. In that post, I presented an argument that the reverse is true - that externalizing the problem is what actually makes it possible to take responsibility for change. I wanted to talk a little more about this topic today, following an interesting interaction in group yesterday.
I asked the group to do a write letters from and to their problem. They all wrote for several minutes. Little did I know that one of them was writing something totally different. When it was her turn to share, she stated that she did not believe in personifying the problem because she had used a similar strategy as an excuse for not working to change it - basically, that she had claimed the problem was its own entity, and she therefore had no control over it. Therefore, she says she wants to avoid taking a similar approach in treatment.
Ok, I can accept that some people have reservations about this approach, and may take some convincing before they are able to try it (and, by trying it, experience how it is actually empowering). However, what she chose to write instead of the group activity seemed (to me, at least) even more likely to become a way to avoid responsibility for change: she wrote about the possible neurological etiology of the problem (an etiology, mind you, that has not been clearly demonstrated by research to date).
A neurological explanation of the problem is the kind of construction of person-as-problem that Narrative Therapy is trying to undo. It seems much more likely to me that this woman will see herself as unable to change something neurological - and therefore not responsible for changing - than that she claim no responsibility for changing her responses to an outside influence (e.g., the personified problem). In fact, a goal of Narrative Therapy, and other postmodern therapies, is to counteract the way the medical model of mental "illness" disempowers clients by pathologizing them. The goal is to see clients, and help them see themselves, as having agency in their own lives - to help them see that they are actually able to accept responsibility for the shape their lives take.
It seems there is no one-size-fits-all approach to doing so, however. Perhaps any way we might frame the problem could be experienced by clients as a way to accept or avoid responsibility, depending on the particular client and his or her worldview, etc. I happen to think externalizing the problem is more likely than other approaches to empower the majority of clients, but it's still important to recognize that (1) it may not work for everyone, and (2) it's not the only way to achieve that end.
How do you think about and help clients to accept responsibility for shaping their lives?