See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/233162570
Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations Article in Social Work With Groups · October 2009 DOI: 10.1080/01609510902895086
CITATION
READS
1
292
4 authors, including: Jennifer Poole
Carolynne Cooper
Ryerson University
Centre for Addiction and Mental H…
34 PUBLICATIONS 133 CITATIONS
3 PUBLICATIONS 3 CITATIONS
SEE PROFILE
SEE PROFILE
Some of the authors of this publication are also working on these related projects: Duty to report or accommodate? Mental health and the regulation of allied health professionals View project
All content following this page was uploaded by Jennifer Poole on 10 March 2015.
The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original docum and are linked to publications on ResearchGate, letting you access and read them immediately.
This article was downloaded by: [Ryerson University] On: 10 March 2015, At: 14:21 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Social Work with Groups Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wswg20
Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations a
b
c
Jennifer Poole , Paula Gardner , Margaret C. Flower & Carolynne Cooper
d
a
School of Social Work , Ryerson University , Toronto, Ontario, Canada b
Division of Health Policy , New York Academy of Medicine , New York, New York, USA c
AIS (Accomodation, Information and Support) , Toronto, Ontario, Canada d
Centre for Addiction and Mental Health , Toronto, Ontario, Canada Published online: 13 Oct 2009.
To cite this article: Jennifer Poole , Paula Gardner , Margaret C. Flower & Carolynne Cooper (2009) Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations, Social Work with Groups, 32:4, 288-302, DOI: 10.1080/01609510902895086 To link to this article: http://dx.doi.org/10.1080/01609510902895086
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [Ryerson University] at 14:21 10 March 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations
1540-9481 0160-9513 WSWG Social Work with Groups Groups, Vol. 32, No. 4, Aug 2009: pp. 0–0
Narrative J. Poole etTherapy, al. Older Adults, and Group Work?
JENNIFER POOLE
Downloaded by [Ryerson University] at 14:21 10 March 2015
School of Social Work, Ryerson University, Toronto, Ontario, Canada
PAULA GARDNER Division of Health Policy, New York Academy of Medicine, New York, New York, USA
MARGARET C. FLOWER AIS (Accomodation, Information and Support), Toronto, Ontario, Canada
CAROLYNNE COOPER Centre for Addiction and Mental Health, Toronto, Ontario, Canada
In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy. KEYWORDS narrative therapy, older adults, group work, mental health, substance misuse
Received January 27, 2009; revised March 15, 2009; accepted March 15, 2009. Address correspondence to Jennifer Poole, Assistant Professor, School of Social Work, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada, M5B 2K3. E-mail: jpoole@ ryerson.ca 288
Narrative Therapy, Older Adults, and Group Work?
289
INTRODUCTION
Downloaded by [Ryerson University] at 14:21 10 March 2015
This approach is probably the most progressive approach I’ve encountered in my lifetime. And I think here, I’m creeping up on seventy, and I’ve never had anything that inspired me as much as narrative therapy. (Participant 6)
In 2006, a team of Canadian social work practitioners and allied researchers set out to explore what narrative therapy might look like if it were provided in a group rather than individually. Based in a clinical gerontology program at an urban mental health centre in Toronto, the team developed a process that would see the design, facilitation, and analysis of one of the first narrative therapy groups of its kind. In this article, we describe that process, outlining the literature, theoretical orientation, and questions that informed the project, our recruitment and methodology, as well as the findings. Based on our experience, we argue that narrative therapy is highly suitable for older adults coping with substance misuse and mental health issues and, in a direct departure from most of the literature on narrative therapy, may be more effective for this particular community when provided in a group.
NARRATIVE THERAPY A relatively recent alternative to traditional psychotherapy, narrative therapy helps people critically assess their lives, develop empowering life stories, and keep the “problem,” whatever it may be, in its “place” (Amundson, 2001; Besley, 2002; Nylund & Nylund, 2003). Founded by White and Epston (1990), “Narrative approaches assume that people have many skills, competencies, beliefs, values, commitments and abilities that will assist them to reduce the influence of problems in their lives” (retrieved September 8, 2009, from http:// www.dulwichcentre.com.au/questions.html). What sets narrative therapy apart is its theoretical grounding in the analyses of French postmodern theorist Michel Foucault (1988, 1990). Well known for his work on the subject, power/knowledge, and discourse, Foucault takes up and turns over modernist assumptions of truth, progress, and what it is to be “normal” (Poole, 2007). His work illustrates how dominant discourses such as those on addictions and mental health turn individuals into subjects such as “psych patient” and “addict” (Foucault 1988, 1990). Yet Foucault’s work also argues that it is possible to rework and resist these stigmatizing subject positions. Indeed, from a Foucauldian perspective, “resistance gives us the possibility of changing practices [labeled] ‘intolerable’” (Pickett, 1996, p. 462). Taking a page out of these analyses, narrative therapists believe there are multiple possibilities for resisting that which has become intolerable.
290
J. Poole et al.
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative therapists are sensitive to the use of words, phrases, and labels, understanding that how we talk or write about a problem plays a significant role in shaping choices, identities, and life circumstances. In their practice, narrative therapists have also developed a set of core tenets that guide their work. Adapted from Carr (1998), we have detailed these nine tenets elsewhere (Gardner & Poole, 2009) including “positioning collaboratively” (for the therapist is an equal participant-–observer) and “externalizing the problem” (or the process of separating the problem from the person). For this project, our Toronto-based team1 focused on four tenets: “externalizing the problem,” “developing alternate stories,” “building a team of witnesses,” and “thickening the thread.”
LITERATURE REVIEW Before starting the group, an extensive literature review was conducted on narrative therapy research and practice. Elsewhere we have detailed this review (Gardner & Poole, 2009), noting the type, breadth, and extent of the work. Highlighting the findings, we note here that although the literature on narrative therapy suggests this is a promising and successful approach for individual therapy, there are a number of gaps and issues. First, empirical (quantitative and qualitative) research on narrative therapy is in short supply. Critics have suggested this can be traced to the theoretical inconsistency between the postmodern roots of narrative therapy and the decidedly modernist research methods that dominate academic work (Besley, 2002). It follows that the few researchers who have taken up the challenge of researching narrative therapy have adopted qualitative methodologies. Indeed, O’Connor’s team (O’Connor, Davis, Meakes, Pickering, & Schuman, 2004; O’Connor, Meakes, Pickering, & Schuman, 1997) demonstrated that ethnographic methods such as participant observations and interviews lend themselves particularly well to research on narrative therapy. Others have suggested that discourse analysis has proven itself especially compatible with the approach (Gardner & Poole, 2009). Second, there is little research on the practice of narrative therapy with oppressed communities (Biever, Bobele, & North, 1998; Murphy-Shigematsu, 2000; Semmler & Williams, 2000). Although there has been some application of narrative approaches with indigenous groups in Australia (Pease, 2002), little has been written on how the approach might work for those living in poverty and/or coping with what some label as disabilities (Kropf & Tandy, 1998; Man-Kwong, 2004). Additionally, little has been written on narrative therapy with older adults, a gap which is in line with those who argue older adults are underidentified and underserved by mental health professionals in general (Grimm, 2003).
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative Therapy, Older Adults, and Group Work?
291
Extending our review for this article, we also explored the literature on older adults, group work, mental health, and substance misuse, finding arguments that treatment for mental health and addictions should shift from traditional age-neutral models to age-specific approaches (Blow, Walton, Chermack, Mudd, & Brower, 2000; Satre, Mertens, Arean, & Weisner, 2003). Indeed, there is increasing support for the notion that the experience of substance misuse is not homogeneous across age groups (Schultz, Arndt, & Liesveld, 2003). There is also some research to suggest these age-specific therapies should include group work and that for older adults this form of support may be particularly effective. In an article on groups and mental health in older adults, Kelly (1999) argued that group development with older adults is variable and more research is needed. However, the literature on group work (see Garvin, Guttierez, & Galinsky, 2006, for example) is powerful, as are the arguments that older adults are particularly enthusiastic and positive about the benefits of mutual aid groups (Lee & Ayon, 2005). For older people who live alone or are socially isolated (Burnside & Schmidt, 1994), these kinds of groups may foster friendships, decrease loneliness, promote independence, as well as provide opportunities for learning and mutual support (Burnside & Schmidt, 1994; Toseland, 1995). Additionally, when it comes to facing the isolation that may accompany substance misuse and mental health, social support is considered a key reason for considering group-based treatment (Barrick & Connors, 2002; Dore, 1994; Hinrichsen, 1984; Lee & Ayon, 2005). In short, there is an argument to be made for elder-specific supports around mental health and substance misuse issues. However, literature on narrative therapy with older adults facing these issues is limited, as is research on what this might look like in a group setting.
THE RESEARCH STUDY Research Question Seeking to address these issues, our team designed and conducted a qualitative research project. We asked, what do older group participants coping with mental health and substance misuse issues find helpful (or not) about narrative therapy? This question was addressed by first developing, and then observing, an 8-week narrative therapy group for older adults. Inspired by O’Connor’s work on narrative therapy (O’Connor et al., 1997; O’Connor et al., 2004), interviews with participants and therapists were conducted; and in keeping with qualitative research norms, these interviews were taped, transcribed, and analyzed.
Setting up the Group With the guidance of an advisory committee, and once the project had received ethics approval, we recruited participants through an advertisement
Downloaded by [Ryerson University] at 14:21 10 March 2015
292
J. Poole et al.
in a free local daily newspaper as well as through the clinic (where some older adults were already receiving individual narrative therapy). Every person who expressed interest in the project was invited to an information meeting. Those who then chose not to participate in the planned group were offered individual counseling as an option (this option was also offered to group participants at any time during the research study). Those that expressed interest in participating in the research study were invited to a second meeting where ethics, methodology, and process were discussed. In keeping with the narrative therapy goal of moving away from the “problem story,” prospective participants were not asked to fill out standard intake forms detailing their “problem histories” (although many did self-identify in the early sessions). However, staying true to mutual aid group practice (Kurtz, 1997; Poole, 2000), they were asked to help decide on the date, time, and duration of the group as well as develop norms around common issues such as lateness, disruption, and absenteeism. In keeping with qualitative research norms in mental health, all participants were given an honorarium for participating in the research study as well as bus tickets to and from each session. The final group consisted of 12 older adults ranging in age from 55 to 70 years. Seven were men and five were women, and in addition to Canadianborn participants, the group included individuals originally from Africa, South America, Germany, the United Kingdom, and France. The predominant problems self-identified by participants were mental health and substance misuse issues and in particular depression and alcohol-related issues.
Working with the Group/Data Collection Beginning in early 2006, MF and CC cofacilitated the narrative therapy group sessions, each lasting for 90 minutes and taking place over 8 weeks. Using traditional group work practices designed to build mutual support; the therapists introduced tenets, challenged, “chased” members to participate (Gitterman, 2005, p. 100), redirected, rephrased, and modeled. The first meeting included an introduction to narrative therapy and discussion around how to let go of and “externalize the problem” (i.e., the person is not the problem, but the problem is the problem). In Sessions two and three, the therapists worked with participants to identify, create, and share (alternate) life stories that included successes, memories, and accomplishments. During Sessions four and five, the therapists introduced the idea of a team of witnesses/supporters—past and present who could see participants were more than the problem. During the remainder of the sessions the therapists demonstrated how to “thicken the thread”—reinforcing the first three tenets and enabling participants to keep the problem from reinserting itself. Working through each tenet, the therapists’ task was to assist participants to
Narrative Therapy, Older Adults, and Group Work?
293
Downloaded by [Ryerson University] at 14:21 10 March 2015
see themselves not just as alcoholic, for example, but rather as multistoried, multiroled individuals with teams of friends, family, and supporters; a lifetime of accomplishments; and a set of tools to fight back against and resist the problem. The researchers’ tasks included arranging the space (placing chairs in a circle), putting up signage, and taking orders for free coffee, tea, and snacks for participants. At the invitation of the participants, the researchers also sat in on the groups, observed the sessions, and in keeping with ethnographic methods, took extensive research field notes. Upon the completion of each session, the entire team met to discuss, review, and note developing themes and issues, and upon the completion of all eight sessions, individual semistructured interviews were conducted with each participant. These taped interviews were then professionally transcribed.
THE FINDINGS: PRACTICAL AND THEMATIC We conducted two analyses of the field notes and interview transcripts. The first analysis shaped this article and followed qualitative, ethnographic norms around coding. With the overall research questions as a guide, stage one in this analysis identified key words and phrases in the data. These were then grouped and collapsed into four or five descriptive code clusters. Stage two involved pulling out quotes and notes that fit with the codes. These coded collections were then organized into categories that spoke to how participants experience narrative group therapy including key moments, themes, and what they found helpful about the process. The second analysis was guided by Charmaz’ (2000, 2003) constructivist approach to grounded theory and is detailed elsewhere (Gardner & Poole, 2009).
Practical Findings Speaking to the practical findings first, participants made it very clear that what worked about the group was the benefit of its size (“not too big, not too small,” Participant 4), the diverse mix of participants, and its timing. Held in the late morning during the worst winter months, all participants noted how important the clinical and mutual support had been to help them through the winter. They also made clear that the sunny, accessible group room (just steps from a bus stop and washroom) had contributed to their sense of comfort. Participants found particularly important the presence of two group facilitators, noting how central it was that MF was an older adult herself, with a wealth of alternate and often very funny stories from which to draw and illustrate key tenets.
Downloaded by [Ryerson University] at 14:21 10 March 2015
294
J. Poole et al.
As is often the case in support group work, participants also highlighted the importance of coffee and snacks, a tradition that made participants feel “welcome and cared for” (Participant 5). They spoke to the flexibility of the group, noting how well the group norms worked, and in a departure from most research, how the presence of the researchers in the group had actually enhanced the process, contributing to the sense of being involved in something “unique” and “important.” In the words of one participant, the group was “our class,” it was about being involved in something relevant and “on the cutting edge” (Participant 7). For those who had previous experience with narrative therapy, we also heard how it was better suited to group than individual work. “It was just a mental process . . . sometimes you’re trying—you’re ‘painting’ [a new picture together] and you’re trying to get whatever, and suddenly boom, there it is” (Participant 3). Working through the tenets collectively rather than individually, participants were able to observe and understand the process, including peer attempts at externalizing the problem and building alternative stories. If unsure or unwilling to “let go” (Participant 10) of the problem story, those more comfortable with narrative therapy gently nudged their peers along, helping them to “paint a new picture” (Participant 3) of themselves. If participants were unsure about whom they could count on their team of supporters, other group members jumped in to help, often volunteering themselves. In short, as the following vignette illustrates, the group became a team of supporters itself, embodying this central tenet of narrative therapy. It is week four in the process. Her turn to lead, MF has welcomed the members back on this cold February morning, reiterating how vital the telling of alternate and positive stories is for narrative therapy. She uses metaphor, likening the airing of participant successes to the filling of the room with balloons. To tell stories like these is to fill the room with the positive, crowding out the negative. To tell these stories is also to “change the hurt and shame tape in our heads.” Then, introducing the next tenet of the team, she gives out paper and pens, asking the participants to write out the name of someone who has been of support. She asks, “how would this person describe you, what would they say about you.” Some group members smile, remembering loving words. MF then asks, “Can you believe the voice of the person on the paper?” Everyone nods and one of the more powerful group members, one that has more “status” perhaps (Gitterman, 2005) says, “I think we’ve broken through. I needed to see these words written down to believe them, to start building my team.” The next week members come with lists of team members including those of “good” psychiatrists and “beautiful” sons. They share the voices, feel the support until one member turns to the group and says, “This whole room is my voice. I put you all on my list and can hear you believing in me as I go about my day. You are my team” (Jennifer M. Poole).
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative Therapy, Older Adults, and Group Work?
295
There were, however, some practical criticisms of the process. Some participants felt that there should be no more than 10 people in the group. Others wanted to extend the group to 12 weeks, and some wanted to create a more detailed selection process that would limit group members not only to age, but also according to issue (either alcohol or depression issues, not both). Others felt the facilitators might have made the tenets of narrative therapy more transparent: “it would be better . . . if [the therapists] could clarify where we’ve been, we are and where we’re heading with the discussion” (Participant 4). Participants also expressed particular ideas about which tenets they found useful. Although we have written about these more extensively elsewhere (see Gardner & Poole, 2009), we can say that most pointed to the tenets of externalizing the problem and developing a team as central to the process of narrative therapy in a group. On these tenets, one participant said, “By putting the problem somewhere else, whether it’s in the room or in the balcony or whatever, then you’re separating yourself from the guilt. I’m not a bad person; I’m just a person with a problem” (Participant 2).
Thematic Findings Turning now to the thematic findings, the analysis highlighted key themes such as acceptance, befriending, guilt, power, and holding on. On the topic of acceptance, we heard participants speak to the nonjudgmental attitude of facilitators and participants, the openness of the approach and the sense of tolerance that narrative therapy seems to create. The narrative process allowed participants to say, “I’ve got a problem but so what? I’ve [also] carried on with the rest of my life” (Participant 8). Befriending was another important theme, threaded through more than half of the interviews. Most pointed to the fact that unlike other clinical groups they had experienced, the tenet of building a team of supporters made befriending a central and expected part of the process. We heard, “when problems try to sneak [up] on you because [they’ve] got an army . . . you know, you’re able to say, just ‘leave me alone, I’m busy with my friends’” (Participant 6). Indeed, echoing mutual aid principles, participants were encouraged to reach out to those new friends, be in touch, and provide each other with peer support within and outside the group. Then there was the theme of guilt, for participants often noted how narrative therapy had helped them feel less guilty about the problem and how they had or had not handled it in the past. By focusing on successes instead of failures, there was a sense of feeling less burdened and more optimistic. “It gives me more . . . resources to go to in my mind for strength and for . . . talking myself out of being a fool. I think that’s one of the best ways of putting it. And giving me more inspiration” (Participant 10). Participants often talked about 12-step recovery groups during the interviews, making clear how different the narrative therapy process was to
296
J. Poole et al.
Downloaded by [Ryerson University] at 14:21 10 March 2015
that kind of experience. We heard that whereas narrative therapy insisted they focus outside the problem, their 12-step experience had taught them to “make a meal” of the problem, to make the problem their “lives,” a process some had difficulty changing (Participant 11). Indeed, “holding onto the problem” emerged as a central theme of the analysis. Five participants talked about difficulties in giving up the problem as the central story in their lives. We heard, “it was hard first to get rid of the problem, not to talk about the problem because we enjoy talking about the problem. It’s fun!” (Participant 3). Another noted, “Now another thing is being taken away. I gotta lose my car, my house, I lost this, I lost that, now I’m losing my problem. No, I want my problem!” (Participant 7). As the vignette below illustrates, resistance lasted a long time for some participants. The group starts at 10:30 a.m. each week, but by 11:15 a.m., C. has still not arrived. As a researcher/observer I am not surprised, for despite our “chasing” her to participate over the last 9 weeks, to replace the problem story with a set of alternative and positive ones, “to give up entrenched patterns is far from easy” (Gitterman, 2005, p. 102). Indeed last week’s “encouragement” from the therapists and participants may have precipitated a kind of crisis. But then the door swings open and she comes in, hair uncharacteristically pulled back off her face, clothing and mood more subdued. She takes her place, listening to the conversation about how to strengthen the good stories, strengthen the supportive team, and “thicken the thread.” S. is saying how he “gets” it now, and even B., who has also been quieter, not so involved speaks up, naming this tenet as “supportive encouragement.” Then C. clears her throat and says, “In modern society, our contact is very superficial. We have acquaintances but do we have friends? It has been very hard to distance myself from those people who had always seen me as a drug addict, but I am beginning to understand how this therapy works. We don’t say here, ‘my name is C. and I am drug addict.’ Here I say, ‘my name is C. and I am a person.’” J., another member with status, is surprised. He says, “But I thought you were so resistant to this.” C. responds, “It just took me a while to understand what was happening.” Everyone breaks up laughing.
Some related notions of holding on to power, another theme in the data. Participants discussed feeling disempowered through other group processes, feeling empowered through narrative group therapy, and the links between words and power. One participant explained: Usually people tell you you’re going to be a drug addict for the rest of your life. Like you’re going to be a diabetic or you’re going to be an alcoholic. They put a label [on you]. But . . . don’t tell me I’m going to be a drug addict for the rest of my life. Because I am not right now. I was, and so what? I was many things. (Participant 3)
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative Therapy, Older Adults, and Group Work?
297
Others related the process to rules. Participants spoke of those that exist in other groups they had experienced—rules against being in touch outside the group meetings for example. Participants also spoke of those within narrative therapy such as the strict avoidance of the problem story. This particular rule led more than one participant to ponder whether narrative therapy was as progressive as it purported to be (Participant 12). Conversely, some (including one therapist) felt there needed to be more rules in the group, more ramifications around disruption and lateness especially. Other themes emerged as well: silence and appearance. Silence was present in the data with respect to who talked in the group, one particular gentleman who did not, and whether narrative therapy was dependent on verbalizing alternate stories. Participants asked, “Could one be present and not talk?” Was the emphasis on telling stories with words too Western? How might we encourage other ways of externalizing the problem and building teams? This led to talk of appearance, as interview and field note data suggested that participants’ clothes, jewelery, and artefacts were used to help tell or augment the alternate stories of their lives. One participant made it clear through her dress and jewelery that, although she was labelled a drug addict, she had always been an artist as well (Participant 3). Another began the study in sweat pants, coming to later sessions in the suits and hats that better communicated the rest of his life (Participant 11), and a third brought texts and poems with him, keeping them tucked in pockets and coats until he was comfortable enough to share (Participant 5). Intriguingly, the researchers also noted how appearance was a theme for the facilitators as well. Indeed, when working with certain tenets and telling certain (personal) stories of her own, MF would often take off her shoes. Additionally, CC would sometimes sit with a number of notebooks, papers, and institutional identification badges on her lap in the early sessions, telling a story that communicated her professional place in the group. In the end, participants and practitioners found that “we are challenged by narrative therapy to, through awareness, to become aware of the story we’re telling ourselves and make choices of what short story we want to tell ourselves, and that there’s more than one story. There can be many stories” (Participant 10).
DISCUSSION AND RECOMMENDATIONS Our team developed a qualitative research project that asked, what do older group participants coping with mental health and substance misuse issues find helpful (or not) about narrative therapy? Speaking to that question, we learned about the power of externalizing the problem and telling alternate stories when a life has been led under the label of alcoholic or drug addict. We watched resistance, storytelling, and the power of befriending in group work. We learned about the practical importance of having two group facilitators,
Downloaded by [Ryerson University] at 14:21 10 March 2015
298
J. Poole et al.
coffee, and snacks and what a sunny, accessible room can do on a dark and snowy Canadian morning. We saw principles of mutual aid (such as collaborative norm setting) work alongside techniques (such as redirecting and rephrasing). We learned that labels stick and that sometimes 8 weeks of “externalizing” is not enough. We learned that some older adults want to hold onto the problem even though their dress or jewelry may be telling another story. We learned that we are always more than the problem, more than a label and more than meets the eye. Indeed, with the literature reviewed, data collected, and analyses complete, we argue that narrative therapy is particularly well suited to older adults coping with mental health and substance misuse issues. Most important, because of the team tenet it appears to work particularly well when taken out of the individual therapist’s office and into a group setting. Now, group work has long held a storied tradition in clinical circles. The literature is rich, the models plenty, and thanks to this journal and its sister conference, there are multiple opportunities to share stories of practice and inquiry. However, in our experience there has tended to be little discussion in group work circles about narrative therapy, and rare is the research study on this process with older adults. Reconsidering the articles in this journal, we found that as a population older adults are underrepresented save for work by Kelly (1999) on depression and Junn-Krebs (2003) on Alzheimer’s. We were also able to find just one article on narrative approaches (Gilbert & Beidler, 2001). In this piece the authors reference White and Epston’s (1990) work but conflate narrative therapy to a more general narrative approach. They also focus not on older adults but, using another label, “chemically dependent” mothers. As the population of older adults grows by the day, so do the numbers of reported substance misuse and mental health issues with which these men and women must contend (Gardner & Poole, 2009). Using what we call narrative group therapy, we see a particular opportunity for group workers to affect change with these issues and with older adults. To further the group work field, we make a number of recommendations: 1. Training and education for group workers on narrative therapy and its tenets. For group workers unfamiliar with narrative therapy, opportunities abound for training and education. Resources include the Dulwich Centre, the Narrative Therapy Centre, the Brief Therapy Network, and Websites such as Narrativeapproaches.com. Central texts have been written by Michael White, David Epston, and a host of other practitioners, and training is available locally across the United States and Canada. For those unfamiliar with the analyses of Michel Foucault, we recommend that social workers turn to the collection edited by Chambon, Irving, and Epstein (1999) titled Reading Foucault for Social Work, a text that speaks to how notions such as the subject, power/knowledge, and resistance play out in social work settings today.
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative Therapy, Older Adults, and Group Work?
299
2. Safeguard principles of mutual aid in narrative group therapy practice. In terms of practice, our experience has demonstrated that narrative group therapy successfully combines mutual aid and more traditional group work practices. According to participants, our group was strengthened by mutual aid practices such as collaborative rule setting, support for relationships between members and the all important coffee and refreshments. Indeed, members would often linger by the coffee pot long after the formal group had ended. They also carried on meeting after the eight meetings (a transition we hope to be able to report on in the future). Yet participants welcomed the structure, direction, clarification, and expertise provided by the two therapists. They wanted a tighter intake process, more rules around absenteeism, and for the therapists to make clear how they were moving participants through the four tenets. In short, based on our findings, we recommend that group workers interested in developing narrative therapy groups for older adults opt for a combination approach with more sessions and the possibility of transitioning to a peer-led group. 3. Continued research on narrative therapy and group work. Turning to research, we join with others in calling for more empirical research on narrative therapy. We call for work on narrative therapy and what Gianino and Glick (2008) called a combination of individual and group work, narrative therapy, and older adults dealing with issues such as marital breakdown or chronic illness and based on work by Brown and Augusta-Scott (2006), see particular possibilities for the use of narrative therapy with older women experiencing eating disorders. Following Lavalee (2007), we recommend an exploration of how indigenous storytelling circles might augment the narrative process. Following Besley (2002), we recommend research on the experiences of narrative group therapists as well as more theoretical work that takes up Foucault’s original notions. Would he agree with how narrative group therapists are using his ideas? In their insistence on the “positive” story are they creating a different set of oppressive practices?
CONCLUSION Three years ago, our team set out to develop and research what narrative therapy would look like in a group. Although we were rich in narrative therapy, research, and group work experience, we found the research literature wanting with respect to how to do this kind of work. Putting together a hybrid approach with four narrative therapy tenets and aspects of mutual aid and more traditional group practice, we asked what participants would find helpful about this novel approach. What pieces of it might help them in their battle with substance misuse and mental health issues? To our delight, those participants embraced the process, providing us with rich data around
300
J. Poole et al.
what works, when, and how. Although we are mindful of the limitations of this kind of research, we argue that older adults may find benefit with what we now call narrative group therapy, finding it a useful way to counter some of the labelling and limiting in their lives. We encourage other practitioners, researchers, and educators to continue the work.
Downloaded by [Ryerson University] at 14:21 10 March 2015
ACKNOWLEDGMENTS The research on which this article was based was made possible by a grant from Manulife Financial. The authors wish to thank Tara LaRose for her helpful comments on earlier drafts and Doug, who taught us all how to re-story. This paper was also made possible by a publication grant from the Faculty of Community Services, Ryerson University.
NOTE 1. Based at the Centre for Addiction and Mental Health (CAMH) in Toronto, our team included lead narrative therapist/social worker Margaret Flower, co-therapist/social worker Carolynne Cooper, lead researcher/social worker Jennifer Poole, and co-researcher Paula Gardner.
REFERENCES About narrative approaches. (n.d.). Retrieved August 18, 2008, from http:// www.dulwichcentre.com.au/questions.html. Amundson, J. K. (2001). Why narrative therapy need not fear science and ‘other’ things. Journal of Family Therapy, 23(2), 175–188. Barrick, C., & Connors, G. J. (2002). Relapse prevention and maintaining abstinence in older adults with alcohol-use disorders. Drugs & Aging, 19(8), 583–594. Besley, A. C. T. (2002). Foucault and the turn to narrative therapy. British Journal of Guidance & Counselling, 30(2), 125–143. Biever, J. L., Bobele, M., & North, M.-W. (1998). Therapy with intercultural couples: A postmodern approach. Counselling Psychology Quarterly, 11(2), 181–188. Blow, F. C., Walton, M. A., Chermack, S. T., Mudd, S. A., & Brower, K. J. (2000). Older adult treatment outcome following elder-specific inpatient alcoholism treatment. Journal of Substance Abuse Treatment, 19(1), 67–75. Brown, C., & Augusta-Scott, T. (2006). Narrative therapy: Making meaning, making lives. Thousand Oaks, CA: Sage. Burnside, I., & Schmidt, M. (1994). Working with older adults: Group process and techniques. Boston: Jones and Bartlett Publishers. Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20(4), 485–503. Chambon, A., Irving, A., & Epstein, L. (Eds.). (1999). Reading Foucault for social work. New York: Columbia University Press.
Downloaded by [Ryerson University] at 14:21 10 March 2015
Narrative Therapy, Older Adults, and Group Work?
301
Charmaz, K. (2000). Grounded theory: Objectivist and constructivist methods. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research (2nd ed., pp. 509–535). Thousand Oaks, CA: Sage. Charmaz, K. (2003). Grounded theory. In M. S. Lewis-Beck, A. Bryman, & T. F. Liao (Eds.), The Sage encyclopedia of social science research methods (pp. 440–444). Thousand Oaks, CA: Sage. Dore, J. (1994). A model of time-limited group therapy for men: Its use with recovering addicts. Group, 18(4), 243–258. Foucault, M. (1988). Madness and civilization. New York: Vintage. Foucault, M. (1990). The history of sexuality: Volume 1-An introduction (Trans. R. Hurley). New York: Vintage Books. (Original work published in 1978) Gardner, P., & Poole, J. (2009). One Story at a Time: Narrative Therapy, Older Adults and Addictions. Journal of Applied Gerontology, 28(5), 600–620. Garvin, C. D., Guttierez, L. M., & Galinsky, M. J. (Eds.). (2006). Handbook of social work with groups. New York: Guilford. Gianino, M., & Glick, A. (2008). Wearing two hats: Clinical and ethical implications for combining individual and group treatment. Social Work with Groups, 31(3/4), 273–287. Gilbert, M., & Beidler, A. (2002). Using the narrative approach in groups for chemically dependent mothers. Social Work with Groups, 24(3/4), 101–115. Gitterman, A. (2005). Building mutual support in groups. Social Work with Groups, 28(3/4), 91–106. Grimm, R. (2003). Narrative therapy with older adults. In J. Ronch & J. Goldfield (Eds.), Mental wellness in aging: Strengths-based approaches (pp. 237–271). London: Health Professions Press. Hinrichsen, J. (1984). Toward improving treatment services for alcoholics of advanced age. Alcohol Health and Research World, 8(3), 30–39. Junn-Krebs, U. (2003). Group work with seniors who have Alzheimer’s or dementia in a social adult day program. Social Work with Groups, 26(2), 51–64. Kelly, T. (1999). Mutual aid groups with mentally ill older adults. Social Work with Groups, 21(4), 63–80. Kropf, N. P., & Tandy, C. (1998). Narrative therapy with older clients: The use of a “meaning-making” approach. Clinical Gerontologist, 18(4), 3–16. Kurtz, L. F. (1997). Self-help and support groups: A handbook for practitioners. London: Sage. Lavallee, L. (2009). Practical application of an indigenous research framework and Indigenous research methods: sharing circles and Anishnaabe symbol-based reflection. International Journal of Qualitative Methods, 8(1), 21–40. Retrieved April 28, 2009, from http://ejournals.library.ualberta.ca/index.php/IJQM/article/ view/943/5195 Lee, C., & Ayon, C. (2005). The power of groups for older adults: A comparative study of European American and Latino senior mutual aid groups. Social Work with Groups, 28(2), 23–39. Man-Kwong, H. (2004). Overcoming craving: The use of narrative practices in breaking drug habits. International Journal of Narrative Therapy and Community Work, 1: 17–24.
Downloaded by [Ryerson University] at 14:21 10 March 2015
302
J. Poole et al.
Murphy-Shigematsu, S. (2000). Cultural psychiatry and minority identities in Japan: A constructivist narrative approach to therapy. Psychiatry: Interpersonal & Biological Processes, 63(4), 371–384. Nylund, D., & Nylund, D. A. (2003). Narrative therapy as a counter-hegemonic practice. Men & Masculinities, 5(4), 386–394. O’Connor, T. S., Davis, A., Meakes, E., Pickering, R., & Schuman, M. (2004). Narrative therapy using a reflecting team: An ethnographic study of therapists’ experiences. Contemporary Family Therapy, 26(1), 23–39. O’Connor, T. S., Meakes, E., Pickering, M. R., & Schuman, M. (1997). On the right track: Client experience of narrative therapy. Contemporary Family Therapy, 19(4), 479–495. Pease, B. (2002). Rethinking empowerment: A postmodern reappraisal for emancipatory practice. British Journal of Social Work, 32, 35–47. Pickett, B. L. (1996). Foucault and the politics of resistance. Polity, 28(4), 445–466. Poole, J. (2000). Making mutual aid work. Toronto, Canada: Self-Help Resource Centre. Poole, J. (2007). Behind the rhetoric of hope: A critical analysis of recovery discourses in Ontario. Unpublished doctoral dissertation, University of Toronto, Toronto. Satre, D., Mertens, J., Arean, P., & Weisner, C. (2003). Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program. Journal of Studies on Alcohol, 64(4), 520–530. Schultz, S. K., Arndt, S., & Liesveld, J. (2003). Locations of facilities with special programs for older substance abuse clients in the US. International Journal of Geriatric Psychiatry, 18(9), 839–843. Semmler, P. L., & Williams, C. B. (2000). Narrative therapy: A storied context for multicultural counseling. Journal of Multicultural Counseling and Development, 28(1), 51–62. Toseland, R. (1995). Group work with the elderly and family caregivers. New York: Springer. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton & Company.
View publication stats
Report "Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations"