Narrative Therapy

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If someone pointed a gun to my head and forced me to admit what my preferred counseling method was, I could not say I was a reflective eclectic. That would get me shot. It’s not really an answer. I would have to confess that I have a soft spot for narrative therapy. I might get shot anyway because few know what that is. Continue reading

Multiple

There aren’t many mental illnesses that therapists are accused of creating, but dissociative identity disorder, or multiple personality disorder, as it officially used to be known, is one of them.

It may be the only one. Blaming people for creating mental illness has mostly gone out of style since we made too many enemies blaming parents, mothers mostly, for their screwed up kids. These days we prefer to blame genetics, which I suppose is another way of blaming parents, albeit for something they don’t have any control over. Mostly we prefer not to dwell on issues of etiology and get right down to the business of patching people up.

DID (or MPD, if you are old school) is the significant exception to this rule. In case you don’t read a selection of the DSM-IV-TR (the Diagnostic Statistical Manual, the mental health practitioner’s Bible) every night before going to bed, DID is when the person behaves as though he or she is really several distinct persons all inhabiting one body. In classic cases, the individual alters have no knowledge of each other or memory of what the others do. One actor appears on stage at a time and all the others go to a kind of sleep. In the natural world, however, we frequently see alters who have consciousness of each other, as the patients drop in and out of therapy, gaining insight along the way.

Cheryl/Marcy was one such patient, although Marcy only gave me a general sense of how many of them there were. “Oh, a half dozen or so.” She was certain that Cheryl knew about none of them. Marcy had great contempt for Cheryl, whom she considered an incompetent, befuddled nincompoop, cloyingly dependent on others for reassurance. Well, if you had a half dozen or so people inhabiting your body and doing things with it without your knowledge; you might be befuddled, too.

“There’s Sarah, who’s three and doesn’t do anything but cry; Monique, who’s six and likes to play; Joe, who likes cars and computers; Bubbles, who picks up guys; and Chloe, well, you don’t want to meet Chloe. She’s a violent bitch.”

I added, “And there’s you, who takes care of her.” There’s always one who takes care of the host personality.

Then I asked what I always ask, “Is there a stage manager? Someone who decides who’s going to take over?”

But nobody ever knows. “We just do whatever needs to be done.”

The theory is that patients develop DID early in life as a way of coping with early childhood trauma. Alters, in some cases, originate in the invisible friends many children create to hold the disavowed aspects of themselves. Are you tired of hurting? Well, it’s not you who are hurting, it’s Sarah. Are you violent and promiscuous, but can’t face yourself afterwards? Bubbles and Chloe will take the fall for you. Are you all grown up, but want to feel as carefree as a child? Ever secretly want to change your gender? There’s always Monique and Joe. Are you concerned that if you act independently and assertively no one will take care of you anymore? Marcy to the rescue.

Do you want to write freely without an inner censor crossing everything out with his blue pencil? Create an S. Harry Zade, as I have, or any other fictional character.

The difference between a patient with DID and an author of fiction is that the patient is better at creating characters. Cheryl’s alters are as real as a person can be without actually having a body to call their own. Unlike any other person with an inner conflict, they all possess a separate compartment of memory. Unlike any other divided, ambivalent person, they can act decisively, without remorse.

The fact that Cheryl must share her body with this whole crew is an inconvenient flaw in the design. Other people are unlikely to recognize when alters take over. Men who go to bed with Bubbles wake up with Joe. Chloe commits a crime and they all serve the time.

The other flaw is that, if Cheryl were to go to a therapist for help with this, or if Marcy were to on her behalf, there’s a good chance she’d encounter a clinician who does not believe that the condition exists. Here’s the problem: the host personality, Cheryl, in this case, is often one who is hysterically dramatic and needy, the very kind of person you’d expect would make all this up.

If you were to go to a clinician who believed in the condition, it would really make his day. This is this very kind of juicy case we shrinks live for. Your therapist would be the star of case conferences, he could really rack up the billable hours, he might even start writing a book and imagine who’ll play him in the movie. He might be more invested in your condition than you are.

The people who don’t believe the condition is real will contend that it is created when a sticky, dramatic, suggestible patient meets an absorbed, energized, naive therapist. It is not produced out of the traumas of childhood, they say, it’s fashioned when client and therapist want to get together and need a cover story to do so.

Here’s where I stand on the subject: I have met people who presented with DID whose condition was convincing and those in whom it wasn’t. I have tried to meet them all on their terms, as tolerant and respectful as I could.

I’ve come to believe that any ideas we have about the self, whether we say it’s singular or plural, are teetering constructs at best, and delusions, at worst. A person is real, but what he says about his personality, or personalities, is always very much a fiction; a fiction that is forever fashioned in collaboration with the people around him.

Story Blindness

Sometimes a story will cause us to go blind. Let me tell you how it happened to me.

Years ago, I was traveling by Greyhound bus, scheduled to transfer at the Port Authority Bus Terminal in New York. This was in the early Eighties when New York was in the midst of a cocaine epidemic and the South Bronx looked like a war zone. All the talk among us passengers on the way to the Big Apple was how dangerous The City was. Most were happy to say that they had little time to wait for their next bus. I had two hours.

“Don’t talk to no one,” said the man sitting across the aisle. “Don’t even look at ‘em or they’ll take it as a challenge; but if they look at you, give ‘em the old stare down, right in the eye. That’s what tells ‘em not to mess with you.”

“Aren’t there police at the bus terminal?” asked the cute young woman sitting next to me by the window.

“Oh, the police don’t care. Most of ‘em are on the take. They just walk by and wink.”

The man across the aisle had a suitcase where his knees should’ve been, his legs were in the aisle, and his hand grasped, as if it were a scepter, a fishing rod with the hook still attached. A spoon lure waved by my eye whenever he moved the rod around. He was the kind that could take all the room he wanted because he never asked you if it was OK and never listened to you say that it wasn’t.

“But don’t you worry, honey. You can walk with me and I’ll look after you. I’m going to Raleigh.”

He had her hooked and was reeling her in, nice and slow. She gave him a smile that made me wish I wasn’t there in the middle. However, seeing that I was there, I just wanted this leg of the trip to be over and to see for myself how dangerous a bus terminal could be.

“The ones you have to watch out for the most are the Blacks wearing colors,” he said. “Red bandanas mean one kind and blue ones mean another. If you see both, don’t get between ‘em.”

The bus entered the city and we craned our heads to look at the buildings.

“Don’t look up or everyone will know you’re from out of town.”

The bus began a long ascent up a curved ramp into a parking garage. The fumes gagged us. He pulled his wallet out of his back pocket and the spoon lure swung in front of my face.

“I’m putting my wallet in my front pocket; otherwise the pickpockets will get it. Better safe than sorry.”

The young woman clutched her bag, even though we were still in the bus. “I’m so excited,” she said, “and scared.”

“When you walk with me, put your bag under your arm and keep it between us.”

At last the bus applied its brakes. We began to file out. They left together. “Stay close to me,” he said.

The two went off like young lovers, instead of the strangers I knew they were. Her long hair swung behind her. He held his suitcase in the same hand as the rod, leveled like a lance.

I went to find a place to spend the next two hours. There was a crowded café. I bought a coffee, a New York Times, a package of cookies, and turned to find a seat. There was only one available, with a large Black man sitting at the table; he wore a red bandana.

The seat wasn’t taken, so I sat, opened my paper, and sipped my coffee. He reached over, opened the package of cookies sitting on the table between us, took one out, and ate it. Just as the man with the fishing rod had warned, this place was lawless and dangerous.

My companion’s arms had more bulges than I thought possible. I would not still confront him directly. Not over a package of cookies. I was not going to be intimidated, either. I, too, took a cookie and ate it.

He looked up at me as he munched. This must’ve been the stare I was told about. I stared back. He took another cookie and ate that, too. I took a second, dipped it in my coffee and sucked it dry, never breaking our gaze.

This continued until all the cookies were gone, then, without another word exchanged between us, he stood up. I was in for it now and looked around for someone who would come to my aide. However, all the muscled-bound man did was to take the empty wrapper and throw it away as he left.

It took the rest of the layover before my heart rate died down to its proper pace. I didn’t want to be late for the bus that would take me out of this city. I finished the coffee and folded up the paper. Sitting there, underneath my New York Times, was my package of cookies.

Evidently, I had been eating his.

I told you this tale to illustrate how a narrative had influenced me so much that I initially failed to perceive the kindness and generosity of the man at the café. I could’ve gotten my ass kicked.

It’s necessary to always keep two things in mind and keep them separate: things as they are, and our stories about them. When we are at our leisure and feeling safe and secure, then we may be able to attend to things as they are without getting too caught up in stories. Listening to music, good food, work with our hands, a walk through the woods, worship, meditation; these activities often permit us to perceive things as they are. We lose ourselves in the moment. On the other hand, when we encounter something strange, or when we are called upon to perform or understand; then things as they are is not enough. We then look for an interpretation of things as they are. We create or accept a story that explains everything.

The man with the fishing rod had his own reasons to indoctrinate us to fear New York City. He wanted the girl to need to depend on him. I had my own reasons to listen. I was going to a new place, a strange place for me. The things he told us about the city provided me with a means to interpret what I would see. Certain things: the race of the man at the café, the color of his bandana, the stare, all things I normally would not have paid much attention to, gained special significance because he warned me about them. I thought I perceived signs of danger largely because I was expecting to see them.

Story telling is second nature to us, we often do not realize we are doing it, and we often confuse things as they are with our stories about them.

Powerful stories can come to blind us to alternate interpretations; just as I was so dominated by the danger story that I failed to see generosity. Many people who struggle with depression, anxiety, trauma, or anger problems are blinded by a story. The depressed person sees everything through a lens of hopelessness and loss. The anxious person is busy warning herself of the extreme risks she runs. The traumatized one is stuck in a horror story that gets retold over and over. The angry man has lots of examples of oppression and injustice.

Most of the time these stories that people tell to themselves have a kernel of truth. The New York City Story did. New York really was having a crime wave. But, at best, a story only captures general trends; it summarizes the gist of the data. It does not account for all of the exceptions to the rule.

What are the powerful stories that have dominated your life? What wonderful surprises might be waiting for you if you were to stop thinking and talking about things, but, rather, saw them simply as they were?