2016: Issue 4

Welcome to this final journal issue for the year. It’s a bumper special edition on narrative practice and mental health!

It includes hopeful papers describing creative ways of responding to bulimia, hearing voices, and suicidal thoughts. It also contains an invitation to consider alternative suicide screening processes, a narrative research project from Mexico, and a review of ‘The book of human emotions’. Lastly, we have included a revised version of a paper about gender belonging as new understandings and activism in this realm are challenging and transforming taken-for-granted ideas in therapy and beyond.

This special issue features papers from Greece, Norway, Australia, Mexico, the UK and the USA. We hope you enjoy them!

Very soon we will be announcing a new way to subscribe to this journal and to gain access to all its back issues. Stay tuned.

Thank you for your support throughout this year and wishing you well for 2017.


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    Uncovering Bulimia’s demanding voice: Challenges from a narrative therapist’s perspective— Kassandra Pedersen

    This paper presents responses to a series of challenges faced during work with a 17-year-old girl who sought to reclaim her life from bulimia’s demanding voice. Kiki was at first unwilling to participate in therapeutic conversations, and initial contact occurred through her boyfriend, who became part of an anti-bulimia team. Encouraged by her boyfriend, Kiki, who was determined to ‘stop throwing up at last’, decided to attend sessions. Through externalising conversations, bulimia was personified as ‘The Guy’, who ruled her daily life with judgements. Kiki described The Guy’s effect on her life and developed a stance resisting his influence. The process of working with Kiki raised a number of challenges: assisting a person who initially declined to participate, overcoming pathologising discourses, resisting the tactics of the problem and its allies, supporting a preferred identity in an unsupportive environment, and keeping Kiki’s preferences and beliefs at the centre of our work. This paper explores the use of narrative practices, including externalising conversations, double listening, identifying unique outcomes, and the failure conversations map, to address these issues and support resistance to bulimia.


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    Hopeful conversations about voice hearing— Chris Dolman & Michael Spurrier

    Over a period of a couple of years, Michael and Chris met in the context of therapy in relation to the presence of critical and demanding voices in Michael’s life. These conversations covered much territory and this paper gives a partial account of these conversations – an interweaving of a description of narrative ideas and practices that shaped Chris’ approach, together with Michael’s experiences of participating in these conversations, which reinvigorated his interest in contributing to the lives of other people.


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    We could be heroes: How film and comic book heroes helped a peer support group to reconnect with their gifts— Rachel Tolfree

    This paper outlines how conversations about film and comic book protagonists enabled members of a peer support group to become the heroes of their own stories, finding meaning, strength, and purpose in their difficulties and the things that make them different from others.


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    Thickly describing together – utilising collaborative ethnography in narrative therapy work with young people— Jonathan McClelland

    An ethnographic stance involves attention to the ‘exotic’ within the familiar – often using the trick of being a ‘foreigner’ to a situation as a way of teasing out what is going on behind what appears ‘natural’ or ‘obvious’ to those who are stuck in the situation. This article explores the potential contributions to narrative therapy of tools and viewpoints from anthropology, specifically the concept of ‘collaborative ethnography’. The article engages with the difficulties of maintaining an ethical approach when working with adolescents in the mental health field, which often does not take the viewpoints and contributions of adolescents seriously, and points the way toward a way of working that does not privilege the expertise or use of power often exerted in this arena.


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    Explorations with the written word in an inpatient mental health unit for young people— David Newman

    In this paper David discusses the concept of the spoken word being ‘relatively unavailable’ to the people he works with at a Sydney based psychiatric unit for young people. He discusses some of his use of the written word in responding to this relative unavailability. This includes some fine tuning of the use of the written word by considering; language use that minimises the risk of people rejecting themselves, utilising the concept of people ‘getting their language through the language of others’, ways to use Michael White and David Epston’s concept of ‘failure proofing’ questions and crafting questions that come out of the dilemmas of therapeutic work. Finally, the ethics of documenting and living documentation more particularly is discussed.


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    How we deal with ‘way out thoughts’: A living document … Ways of talking with young people about suicidal thoughts— David Newman

    In this paper, I describe some of the ways that I use the written word, in the form of ‘living documents’, to enable the sharing of stories and know-how about the ways young people deal with suicidal thoughts, or what are also termed ‘way out thoughts’ or ‘die thoughts’. These explorations take place in my work with young people in a psychiatric unit. I share here an example of a one-to-one conversation and also describe how I collect and use stories in a group work or collective context. The young people I speak with have let me know that such conversations and shared documents are important to them.


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    First steps towards an alternative suicide risk screening tool: Navigating risk assessment and encouraging life-sustaining conversations— Carly Forster and Rina Taub

    This paper explores preferred ways of working in relation to suicide screening in situations where this is a requirement of professional practice. We describe our concerns about how approaches to ‘suicide risk assessment’ were affecting our work and the young people we were required to assess. We came to see the assessment process as an intervention of itself, with the potential for negative consequences for young people, workers and the therapeutic relationship. In response, we drew on a narrative and post-structuralist framework to develop an alternative set of assessment questions. Our questionnaire is intended to scaffold conversations that externalise the problem, elicit people’s life-sustaining practices, and enable assessment of distress and suicidal thoughts. The questionnaire has so far been trialled by a young person and psychologist in Sydney, and an adult and mental health worker in Singapore. We present our findings about these insiders’ experiences of the questionnaire. We hope this article will invite readers to connect to curiosity about ways of having conversations that open up space for people to speak of despair, and questions about living, in ways that are respectful and encouraging of life-sustaining steps.


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    A narrative approach to addressing pain in hospitalised paediatric patients: Handicraft and digital interventions—

    Children who have to stay in hospital for a period of time can experience anxiety, fear and insecurity. Narrative therapy has been used to help address the traumatic experiences of hospitalised paediatric patients by promoting changes in perspective, enabling distance from pain or trauma, and identifying skills and strategies for managing the hospitalisation process. To determine the effectiveness of narrative-based interventions on reducing the negative effects associated with hospitalisation, we conducted a trial with paediatric patients in four hospitals in Mexico. Using a narrative approach that involved externalising conversations, drawing and collage, we trialled both digital and handicraft interventions. Both interventions reduced perceived pain, generated positive associations with hospital and improved patient wellbeing. However, the digital intervention, using existing applications on a digital tablet, proved a richer medium. Considering that in Mexico hospitalised paediatric patients’ care is almost entirely medical, this digital health proposal represents an improvement to health services through a more comprehensive approach to the wellbeing of hospitalised paediatric patients.


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    Deconstructing Emotion: A review of “The book of human emotions” by Tiffany Watt Smith— Zoy Kazan

    Deconstructing Emotion: A review of “ The book of human emotions” by Tiffany Watt Smith


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    Gender belonging: Children, adolescents, adults and the role of the therapist – Revised— Esben Esther Pirelli Benestad

    This paper, originally published in 2001 and then revised 15 years later, describes key principles and practice of Esben Esther Pirelli Benestad, a Norweigian transgifted medical doctor and family therapist, when working with the families and networks of children and adolescents who display non-conformist or atypical gender expressions. This piece offers definitions for a wide variety of words and terms used to describe complex realms of gender, explores how responses to gender non-conformity have changed over time and continue to change, and conveys ways of ensuring that individuals displaying unusual expressions of gender have a chance to experience a sense of positive gender belonging.