Three key concepts may be salient to the integrated model described on this website, of which the first two are the most likely to be drawn upon:
- challenging problem-saturated stories
- developing alternative narratives
- externalising narratives
1. Challenging Problem-saturated Stories
Dominant themes that families re-enact over and over can contribute to emotional and behavioural problems as dominant stories of self, relationships and of the world in general become increasingly negative and problem-saturated.
These are invariably based on perceptions of powerlessness, cognitive beliefs for example how ‘luck’ was against them. This thinking style locates control as external rather than members possessing an internal locus of control; other people, social structures or ‘fate’ hold the power over family life rather than the family collective.
As Froma Walsh has described, an interest in resilience offers a very different standpoint to facilitate problem-resolution. She advocated the importance of recognising strengths, resources, and spiritualism to challenge problem-saturated narratives; their grip loosened, a new sense of control is experienced.
The therapist was curious about how David managed in school, as his attendance was pretty good and he seemed to get on well with his teachers. Mandy, rolling her eyes with a mixture of disdain and frustration, stated that his deputy head teacher thought he was ‘wonderful’, as did David’s art teacher, although (described by Mandy with satisfaction) the rest of the teaching staff in school perceived him as a ‘class clown with a temper’. It was necessary for the therapist to carefully walk a line between two tasks, that of making sense of Mandy’s ambivalence on the one hand, and on the other developing an understanding of David’s strengths, where in at least two different contexts he appeared to be managing well.
By actively seeking exceptions to problem-saturated stories, a greater understanding of family resilience is reached, opening up exploration of alternative options.
2. Developing Alternative Narratives
However, before establishing the beginnings of an alternate story, it is first necessary to understand the meaning of dominant stories for families i.e. to try to view the world from their perspective in their language. Freedman and Combs emphasize the importance of this engagement process before any alternative can be co-constructed, but it is of course an essential requirement for Integrated Family Therapy. Indeed for any model that seeks to fully explore a family’s difficulties and co-construct an understanding of these.
Co-construction = a process whereby new meanings and solutions are jointly generated by two or more parties. To co-construct an alternative story, the problem-saturated narrative must be deconstructed first (taken apart, bit by bit, in order to understand what, who influences who, and in which context this occurs). No assumptions and patterns of behaving are accepted as being ‘the way it is’, all must be understood – the ‘given’ of each must be challenged. Any societal discourses of power relations that support a family’s problem-saturated story must be similarly explored in the deconstruction process.
An explicit purpose of developing alternative narratives is to redirect the internalised problem, which has been held at an individual or family level (often loaded with blame and guilt, serving as obstacles to problem- solving) to an externalised status. Employing curiosity-based questions, the beginning of an alternative family narrative becomes established.
As the therapist enquired about the detail of life in the art class where David’s natural talents were emerging, his posture relaxed. He described focus, ambition for the future and aspirations to use his particular talents once an adult. Mandy’s posture also relaxed as she listened to David’s hopes, hearing for the first time of competence that was not dependent on her presence.
3. Externalising Narratives
This is not as far from the principles of the McMaster approach as one might first think. The function of externalising a problem is to objectify it, separating the individual from it and thereby creating room within an alternative story to discover other aspects of life and of relationships. A dispassionate non-judgemental exploration of the presenting problem is a key feature of the McMaster approach. However, its use of language is empirical, rational, down to earth; it does not extend to using metaphors where a therapist expertly externalises some aspect of the family’s story.
However, gently undertaken, such use of language to change an adjective into a noun is an exercise of an ‘expert’ role. By externalising problems in this way, the family member involved is no longer the problem but ‘something else’. That something might be ‘exhaustion’, ‘temper’ (or Michael White’s ‘sneaky poo’), or a diagnosed condition, such as ‘anorexia nervosa’ or ‘depression’. By distancing unhelpful but often disabling emotions of guilt, shame and blame, a freer exploration is possible of the impact of the various social structures and relationship patterns that led to the problem or maintains it.
However, by objectifying the cause for concern within an initial family meeting, there is far less possibility of obtaining a co-constructed formulation of the family’s problem, which the Integrated Family Therapy model considers essential. Nonetheless, freed of guilt, shame and blame, family members may more readily explore the impact of the problem (its course through its lifetime and what strengthens and weakens its power), and create alternative stories that discover other aspects of their life and of relationships. So the approach has a clear place during later therapeutic work with a family.
David and Mandy started to list times when ‘Anxiety’ had got in the way of ‘Independence’. The therapist helped them reflect on when this happened the most and when the least. Mandy started to notice that when she was feeling low and tired and they were both home, anxiety more often got the better of David. The therapist noticed the slight shift in the conversation, from blame and shame to a shared (co-constructed) understanding of the course of Anxiety.
This example demonstrates that externalising the problem can allow its various components to be deconstructed. Other examples might include the impact of gender oppression in a woman diagnosed with depression, or the impact of social constructions about age for a previously socially active person who finds after retirement that their opinions about areas of knowledge less valued by others. Such socially constructed factors are important, but everyday clinical practice requires that mapping each problem involve the unique variables of each individual and family.
An externalisation process also allows unique outcomes or exceptions to be recognised i.e. where the family has ‘resisted the influence of the problem’, allowing successes and problem-resolution to be recalled and explored.
The developing shared meaning of the problem ‘Anxiety’ between David and Mandy facilitated an opening for the therapist to ask Mandy when David had got the better of it. Recalling his description of the art class, Mandy remembered times when David was also able to stay in his bedroom on his X-Box, easily tolerating her absence.