Therapies for First Nations Australians: Post-modern

Clinicians working with Aboriginal peoples have noted that post-modern therapies such as narrative and solution-focused can be helpful.

Related articles: Therapies for First Nations Australians: Expressive, Somatic, and Trauma-sensitive; Therapies for First Nations Australians: Rogerian/Person-centred; Therapies for First Nations Australians: Positive Psychology.

Introduction

In the Mental Health Academy course, Sitting with Aboriginal Clients: Context and Strategies, we posed the question of how dominant-culture mental health professionals could better serve Aboriginal clients in counselling. To that end, we interviewed western and Aboriginal mental health professionals who have worked with Aboriginal clients over a long period of time. The insights gleaned have allowed us to suggest which types of therapies may be more effective with Aboriginal populations and which employ concepts or assumptions that are incompatible with Aboriginal customs, beliefs, or cultural mores.

Thus, today we begin a series examining which broad groups of counselling modalities may be most appropriate with First Nations Australians, and which may be ineffective at best, or even harmful. In this first article of the series, we examine post-modern narrative therapy – with a note on its “cousin”, solution focused therapy.

Narrative therapy: The key points and why they work with Aboriginal clients

At the heart of narrative therapy – and the crucial aspect distinguishing it from more empirically-based therapies (such as CBT) – is the question of how we can know reality. Empiricism tells us that there a single “truth” waiting for us to discover it. Narrative therapists, on the other hand, recognise that the operative word is “realities”, as individuals, families, and cultures each come to create their own. This philosophical stance shows up in the following chief assumptions (sourced from the Mental Health Academy course, Narrative therapy: The Basics).

That realities are socially constructed

We may take for granted that in western cultures, for instance, we greet people with “How are you?” and often shake hands, hug, or kiss. Aboriginal cultures, too, have social protocols, probably much more complex than western ones due to wider kinship connections, but they are different. Thus, for a dominant-culture professional to assume (or unconsciously believe) that another culture is deficient because it does not have the same protocols is a grievous but typical response. For a majority-culture (i.e., western) person to believe that his or her perception of reality is the only “real” one is to subtly disrespect the social constructions of another culture’s reality.

Given the history of colonisation and oppression to which Aboriginal people have been subjected, it is understandable that many Aboriginal people would be sensitive to any perception that a western professional was regarding their culture as somehow deficit and/or not manifesting “real” reality. Narrative therapy, by definition, respects the narratives (social constructions) which comprise the Aboriginal (or any other) culture. That respect is both subtly and overtly manifested in the ways in which narrative therapists work with their clients.

That realities are influenced by and communicated through language

Empirical and modernist-based therapists would argue that language represents a one-to-one correspondence with the external world; thus, language is said to represent external realities so that a person’s internal experience accurately mirrors the outside world. Narrative therapy, conversely, looks at how language is used to constitute a world view and beliefs rather than mediate between those and the outer world. Language is not neutral, then, but something that collaboratively brings forth reality.

We have only to look at language used by the dominant culture – particularly in reference to Aboriginal people – to understand how a colonising, oppressive stance has been subtly maintained. In addition, some therapies tend to use language which puts the health professional in a superior position: determining the course of the therapy, asking all the questions, telling the client/patient what to do, and generally showing control of the session and the “patient”. An anthropologist working with doctors to improve their communication with patients noted, for instance, that many doctors told Aboriginal patients what they should do without helping people realise what they could do for themselves. As a result, “people felt talked down to”.

Instead, in narrative therapy new meanings are constantly negotiated for beliefs, emotions, and behaviours causing problems in clients’ lives and from this can emerge new possibilities for meaning and for choosing courses of action. There is a more solid stance of social equality.

That realities are organised and maintained through stories

Through language we construct our truth, says narrative therapy, and through stories and narratives we maintain it. The Aboriginal cultures – traditionally oral cultures – are nothing if not consummately well-storied. Many informants spoke about Aboriginal creation stories, stories that formed a sense of history, and stories that helped those hearing them know how to behave, and how to understand life. Where a narrative stance can best become therapy is at the edge of the stories; no person’s (or culture’s) narratives can include all the stories of their experience. Thus, there is room to grow toward wholeness where narratives of strength, resourcefulness, and resilience which have been left out can now in therapy be included, and maladaptive stories can be re-storied to show adaptation and success in the light of major challenges.

Given that numerous informants commented on the coded, indirect communication and teaching/learning style of Aboriginal people and also the supreme importance of learning the stories of their local tribe/clan, a therapy that engages the co-construction of stories as its way of operating can find high congruence with Aboriginal cultural values and ways of relating. This observation is supported by our Jungian counsellor-informant, who stated that appropriately qualified narrative therapists can get the Medicare rebate for doing narrative therapy with Aboriginal clients.

That there is no “objective reality” or absolute truth

This assumption, the lynchpin of narrative therapy, insists that what is true for us may not be true for another person. In the narrative, social constructionist paradigm, there are no essential truths, and we cannot know reality; we can only interpret experience. While the empirical world view urges us to be like technocrats, following the rules to arrive at the correct conclusion about what is happening, the narrative mind frame exhorts us to bring forth our novelist selves. This means that we can understand our client’s story from many perspectives. The work of narrative therapy is to elicit various experiences of the client’s whole self, determine which selves (parts of the client) are preferred in the new narrative, and then support the growth and development of those new selves and their accompanying stories (Ackerman, 2017; Archer & McCarthy, 2007). Obviously, a stance which helps to construct an understanding and appropriate storying of Aboriginal peoples’ resilience, capacity for survival in the harshest of conditions, and spiritual qualities will do much to not only restore individual clients’ pride in themselves and their cultural origins, but also to bolster the status of that culture to both cultural members and the broader society.

What does not fit when counselling Aboriginal clients

Because in narrative therapy clients are deemed to be the expert on their own life and the therapeutic alliance is formed as a partnership in which the therapist is a consultant, typical counselling concepts such as “resistance” (more on the topic here and here), “denial”, or “mental disorders” are not to be found in the sessions. Too, those using a narrative approach have little use for the DSM: the Diagnostic and Statistics Manual of symptoms describing the various personality and mental disorders. Those would describe, after all, someone else’s story about the client, not that of the client. If a therapist comprehends how profoundly colonisation and the resultant oppression by the dominant culture are still affecting (if only covertly) Aboriginal clients, then concepts of resistance and denial do not belong in the discourse. They, after all, describe the efforts of one party to not be subjugated by another rather than two socially equal beings coming together to improve someone’s quality of life. The inherent pathologising of the DSM is alien to the narrative effort to positively re-story painful, unhelpful, or maladaptive behaviours or beliefs. Notions such as resilience and denial are, however, not part of narrative therapy, so a counsellor who is genuinely working with a narrative approach should not be stymied by them.

Caveat and summary

Narrative therapy may be the modality par excellence for Aboriginal clients. It does presume the capacity to engage consciously and with trust on both sides; most informants stressed how much time it had taken them to build trust with their Aboriginal clients, so we could not say that narrative work would turn out to be brief therapy. Too, our psychiatrist-informant noted that he deals with a lot of schizophrenia in rural and remote areas; clients with severe mental health issues undoubtedly need medication and may not always be capable of engaging relationship to the degree that effective narrative work requires. When they can, narrative therapy may be “just what the doctor ordered”.

Solution-focused therapy: workable with these assumptions and concepts

Solution-focused therapy has many workable and some incompatible aspects for Aboriginal clients. We have sourced this discussion of both from the Mental Health Academy course, Solution-focused Therapy: The Basics.

“Truth” negotiated within a social context

Like its “cousin” narrative therapy, solution-focused therapy emanates from a post-modernist, social constructionist paradigm, meaning that it shares with narrative therapy the understanding that there is no such thing as an objective, absolute reality. Rather, reality is co-constructed, so the “truth” of a client’s life is negotiable within a social context; fixed, objective “truths” are unattainable. Clients’ lives have many truths (O’Connell, 2006). Thus, in solution-focused therapy, there is no sense in which the therapist has “the truth” which must be communicated to and accepted by the client; this would be a proposition of inequality.

Miracle question and future focus recruit innate resources

The miracle question, and much of solution-focused therapy, has a present or future focus, in which the therapist elicits the client’s preferred future, basing any suggestions for change on the healthiest, most empowering vision of themselves and their lives that clients can generate. (Seligman, 2006; Archer & McCarthy, 2007). Because every human being is unique, potential solutions to the client’s problems will also be unique and counsellors must therefore be open to creative solution possibilities for each client, especially those that come from each client.

Solution-focused therapists assume that people inherently have the ability to resolve their difficulties successfully, but they present for counselling because they have temporarily lost confidence, direction, or awareness of resources. Solution-focused therapists therefore assume that clients are doing the best they can at any given moment and that they have myriad competencies and resources, many unacknowledged. The therapists focus on increasing clients’ hope and optimism by creating expectancy for change, even small change. Clients thus become more aware of what is working and what is not. Becoming aware of possibilities for positive change, their empowerment and motivation increase; the positive change fuels their belief that change can happen, which enhances motivation and efforts to change, leading to even more positive changes (Seligman, 2006).

All of these assumptions, if enacted in actual practice, may do much to re-balance a “deficit” view of Aboriginal peoples that has been present ever since the beginning of colonisation (Bond, 2010), and which Aboriginal people themselves may have subtly (unconsciously) taken on from the dominant culture (see Hilary Bond’s discussion on this in the Mental Health Academy course: Counselling from an Indigenous Worldview). Our informants at the Warlpiri Youth Development Aboriginal Corporation (WYDAC) stated that solution-focused therapy worked well with their client base.

The aspects that may make it incompatible

Solution-focused therapy shares, as noted, several significant assumptions with narrative therapy that would seem to make its use with Aboriginal clients ideal. But it is a rose with prickly “thorns”. The thorns are the questions, compliments, and goal-setting efforts that are the primary tools of the solution-focused approach.

Questions

Aboriginal cultures tend not to prefer the direct form of communication involved in questions. As one client told the psychiatrist we interviewed, “When I’m being interviewed by white people [who ask so many questions] it’s like being stuck by needles; it’s that painful”. This aspect is simply not congruent with how Aboriginal cultures tend to structure their discourse with one another!

Compliments

The compliments that solution-focused therapists give may be equally problematic. While compliments do notice formerly unrecognised strengths and skills, there is the problem in Aboriginal cultures that the compliment – especially if given in a group situation – is “guilty” of “spotlighting”, a technique in which group facilitators zero in on a particular member of a group, often causing shame or at least embarrassment as a result. This is due to the nature of most Aboriginal cultures which are, with few exceptions, cultures of the collective rather than the individual. Receiving a compliment, especially in a group situation, might make an Aboriginal person feel like they were somehow perceiving themselves or being perceived by others as better than the rest of the group: a situation to be avoided.

Goals

Finally, solution-focused therapists focus on identifying the client’s goals. Aboriginal peoples tend to be very relationally-based, living and experiencing in the moment and not being as focused on goals. As a counsellor explained, “White people have an individual perspective. They are results-oriented, wanting to get the job done. Aboriginal people are family-oriented and highly relationship based”. Thus, a therapist may be disappointed in the client’s seeming unwillingness to accomplish a goal generated; this would add a challenge for the counsellor of maintaining a stance of unconditional positive regard. Finally, the scaling questions widely used in solution-focused therapy to increase motivation to achieve a goal may be irrelevant.

Summary

If you are a solution-focused therapist and want to use this therapy with an Aboriginal client, note that the aspects related to the social co-construction of reality will be helpful, but take careful note of the drawbacks. You could derail much of your progress toward a robust therapeutic alliance merely by following the natural dictates of this modality’s process, which is to ask a lot of questions, give a lot of compliments, and set a lot of goals. Unless the client is solidly “westernised” (i.e., living, say, on the east coast of Australia and living and working with mainstream people), you would probably need to seriously modify the solution-focused way of working with them.

Key takeaways

• Post-modern therapies, such as narrative and solution-focused, may work well with Aboriginal clients because, understanding that “reality” is subjective, they see that the client organises their own socially-constructed reality, which they are encouraged to maintain and develop through adaptive stories and envisioning a preferred future
• In cases of severe mental illness, clients may not be able to engage relationship enough for narrative therapy to be successful.
• The “miracle question” and the stance that clients have myriad strengths and resources which may be recruited for problem-solving is a useful aspect of solution-focused therapy, but such therapists must beware of asking many questions, giving compliments, or focusing on goals over in-the-moment relational experience.

References

From Mental Health Academy courses

• Counselling from an Indigenous Worldview
• Narrative Therapy: The Basics
• Sitting with Aboriginal Clients: Appropriate Modalities
• Sitting with Aboriginal Clients: Context and Strategies
• Solution-focused Therapy: The Basics

Other references

• Ackerman, C. (2017). 19 narrative therapy techniques, exercises, & interventions (+ PDF worksheets). Positive Psychology Program. Retrieved on 10 October, 2017, from: https://positivepsychologyprogram.com/narrative-therapy/               
• Archer, J., & McCarthy, C.J. (2007). Theories of counselling & psychotherapy: Contemporary applications. Upper Saddle River, N.J.: Pearson Education, Inc.
• O’Connell, B. (2006). Solution-focused therapy. In Feltham, C., & Horton, I., Eds. (2006). The SAGE handbook of counselling and psychotherapy. London: SAGE Publications.
• Seligman, L. (2006). Theories of counseling and psychotherapy: Systems, strategies, and skills, 2^nd ed. Upper Saddle River, NJ: Pearson Education, Inc.