Magazine article Family Therapy Networker

The Economics of Narrative

Magazine article Family Therapy Networker

The Economics of Narrative

Article excerpt

How many sessions is a letter worth?

ONE MORNING A COUPLE OF YEARS ago, I was looking over the 10 charts of clients that I was to see that day and feeling discouraged about the previous day's staff meeting, in which no one had an easy solution for our long waiting list. The realities of managed care seeing more clients for fewer sessions were hitting home. As a narrative therapist, I prefer to take my time with clients so they find their own solutions, but now my ethical and professional values were coming into conflict with the agency's pressure to do short-term, cost-effective therapy. 1 wondered what additional therapeutic tools I could use that would be consistent with a narrative practice. Being familiar with Michael White and David Epston's work with narrative letters, I contemplated adopting this practice. With at least a two-week wait between sessions, perhaps the letters could strengthen the development of a new story, what Michael White calls "thickening the counterplot," while the client is waiting for his/her next interview. Nice idea, but how would I find the time to write the letters when I had at most, 15 minutes to do my charting notes?

I was still thinking about this when, Susan, a somber 14-year-old African American, came into my office with her mother, Phyllis, an elegantly dressed bank executive. Phyllis had become increasingly concerned with Susan's "out of character" behavior, which included lying, truancy and angry outbursts. As Phyllis described her worries that Susan's recent choice in friends was leading to possible gang involvement, Susan stared gloomily at the floor.

After several minutes, I asked Susan if her mother's description was accurate, anticipating a grunt or some other minimal response. To my amazement, Susan acknowledged the lying and truancy. 1 was impressed with how dearly Susan articulated the effects of the problem, which we decided to call "Trouble," and her agreement that skipping school was "ruining her future before she had a future." Then, to her mother's surprise, Susan shared that recently she had been thinking more about her future and had decided to attend school on a regular basis. In fact, she had attended school consistently for the last two weeks! She felt confident that she was going to leave Trouble behind her and take on more responsibility.

Her energy and desire to escape the "influence of Trouble" inspired me to rethink what I could do to match her commitment. Afterward, I decided to write Susan the following letter that summarized the session and highlighted Susan's change of attitude, reinforcing these new developments"

Dear Susan,

As I said in our meeting on the 8th, I am providing you with a summary of our meeting. It was nice meeting up with you and hearing your struggle with trouble. I was impressed with your honesty and straightforwardness. You were one of the few 14-year-olds I have ever met who did not say "I don't know" once!

Susan, you shared with me how you have been recruited into a trouble-making lifestyle. In relation to trouble, you have found yourself developing a lying habit, cutting school and also being influenced by your temper. You have found yourself being pressured and influenced by certain friends (or so-called friends), who encouraged you to skip school. In regard to lying, you found yourself finding it easier to lie to your parents than to tell the truth. After awhile, the lying became a habit. You agreed that the lying habit has had a negative effect on your life. You feel that you have let your parents down. You also realize that it takes a great deal of energy to continue the lying. In addition, your lying invites your parents' mistrust. Your parents feel compelled to supervise your life and worry for you rather than you supervising your own life.

I asked you if you were satisfied with what trouble was doing to your life. You clearly said "No." I asked you if you were ready to take on more responsibility or were you more attracted to a trouble-making lifestyle. …

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