Rudi Kronbichler, Austria

 

My work context is the University Clinic for Psychiatry for Children and Adolescents in Salzburg, Austria. Even though I have been working for a long time from a narrative perspective in my outpatient work, it has been only recently that we have been trying to implement narrative ideas and practices on the ward for children and adolescents. This includes the start of a small narrative practice group, that meets once a month to discuss narrative ideas and sometimes jointly works with ‘clients’.

Michael White’s ideas about externalising conversations are very well established in the ongoing therapeutic work in our clinic. Some years ago, a colleague of mine started a group with young women struggling with anorexia and bulimia that deals with the effects that anorexia has on the way how they experience their body. This group is an ongoing offer on our ward and is very well received. We try to offer some help in distancing from destructive ‘inner voices’ and discovering subordinate storylines in their lives and relationships. Among other things we use letters that come from other young persons that are faced with similar problems. These letters involve questions to the group that are supposed to stimulate a critical examination and an exposé of these problems.

In my therapeutic work with adolescents and young adults I have also been strongly influenced by Michael White’s ideas about the ‘unpacking of problems’. When Michael presented his understanding of the absent but implicit and its link with subordinate storylines, I could see a whole range of additional options for unpacking problems, and revealing and examining the often complex web of subject positions people take versus their problems. This is particularly helpful in my work with adolescents and young adults with a psychiatric diagnosis in discovering heretofore concealed traces of subordinate storylines – such as when the ‘aggressiveness’ of a young woman against her friends contains indications of a longing for protection against disappointment, or when the outward ‘display’ of callousness holds hints to a fear of failure.

All these practices happen in a context where the dominant orientation is on diagnosing psychopathology. In the ongoing work with these children, adolescents, and their families, the challenge is to develop a good relationship with them. This makes it necessary to meet and engage with them in their social and cultural environment/life/reality, with its contradictions and a whole range of social and cultural forces that often pull into different directions. This engagement is only possible if you set aside considerations of diagnosis and psychopathology. You cannot honestly meet with these young persons if psychological symptomatology and their diagnostic categorisation is at the centre of your conversations with them. Foucault’s notion about institutionalised relations of power and the inherent possibilities of resistance on an everyday basis is relevant here.

In the clinical context I work in, I can imagine the development of a concept for in-patient stays that is narratively influenced. But insofar as I consider the innovative potential of narrative therapy is partly due to the fact that it is working from the margins, I would fear there would be something lost if narrative therapy became mainstream in our clinic.

I hope for an increase of interest in narrative therapy by the development of local interest groups that currently exist in Salzburg and Vienna. A result of the first European narrative therapy and community work conference was the foundation of a group to organise the next conference. It was decided that this conference will take place in 2012 in Copenhagen. This meeting of practitioners from all over Europe was a promising start for the establishment of a network of narrative therapists in Europe.

Leave a Reply