Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter

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Abstract

Background

Narrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people's lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change.

Aims

This paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement.

Methods

A definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described.

Results and conclusions

Results from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit.

Educational objectives: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.

Highlights

► Brief overview of narrative therapy (NT). ► Application of NT to stuttering. ► Description of the process of definitional ceremonies within NT. ► Analysis of definitional ceremony for a 23 year old PWS. ► Involvement of significant others in stuttering therapy.

Introduction

Narrative therapy (NT) was developed during the 1980s by Michael White and David Epston, who presented its central ideas in the book Narrative Means to Therapeutic Ends in 1990. NT has been applied to stuttering therapy by various researchers and authors since then, including, for example: DiLollo et al., 2002, Leahy and Warren, 2007 and Logan (2007). A brief introduction to NT is provided here in order to set into context the place of witnessing stories related to definitional ceremonies – a central focus in the process of NT, and the main focus in this paper.

‘Narrative structures organize and give meaning to experience’ (Bruner, 1986, p.143). The process of NT begins with the narrative as told by the client, which for people who stutter (PWS) is the dominant stuttering-saturated narrative, how stuttering is central in the life of the client. The goal of externalising the problem is achieved though externalising conversations (Morgan, 2000, White, 2007), which assist the client to separate the problem from oneself. This process leads to the discovery and realisation that the person is not the problem; the problem is the problem (White & Epston, 1990). During the early stages of NT, the effects of the problem are mapped, with client strengths and resources highlighted. During this process, the selection of ‘unique outcomes’ (White, 2007) is emphasised. Unique outcomes (also known as ‘sparkling events’ or ‘sparking moments’), reflect feelings and lived experience that are not fully encompassed by the dominant narrative (Bruner, 1986), as they demonstrate successful management of events, when the problem had little or no influence. An example of a unique outcome is where the PWS spoke out spontaneously in a situation that was usually avoided. As such, unique outcomes tend to be contradictory or aberrant in terms of the usual form that the story takes. Taking these significant occurrences to a conscious level will open the door for them to be used as a point of entry into an alternative story, which in White's (1995) words provide ‘significant as alternative presents’ which can be used by the client in re-authoring his/her story.

Section snippets

Wider discourses and power relations in stuttering

There are many stories or discourses about stuttering in society. The use of the term discourse here, has been adopted by White (1995) and others working in NT (e.g., Madigan & Law, 1992) from Foucault's (1980) suggestion regarding the prevailing discourses of society. Foucault (1980) suggests the term discourse refers not only to words and statements used, but to the connection of the words and statements to the complexities of social and power relations in a given context, which constrain

Roles of clinician and client

Clinical decision-making is necessarily influenced by the client's needs, capabilities and goals. In NT, the alliance between client and clinician is one of trust, encouraging participation behaviour on the part of the client. This is facilitated by the clinician taking a non-expert stance, so that the client can take the lead in the therapy process, as expert regarding his/her own life (Stewart & Leahy, 2010). In an analysis of how characteristics of clinicians are perceived by PWS, Plexico,

The definitional ceremony involving the outsider witness

White (1995) draws on the work of Myerhoff, 1982, Myerhoff, 1986 a cultural anthropologist, who coined the metaphor of definitional ceremony when working with an isolated Jewish community in Venice, California. Myerhoff (1986, p. 267) describes definitional ceremonies as dealing ‘with the problems of invisibility and marginality… strategies that provide opportunities of being seen and in one's own terms, garnering witnesses to one's worth, vitality, and being’. Outsider witnesses respond to the

Kate's definitional ceremony

The client involved in the definitional ceremony is Kate,1 a young woman of 23 years of age, who had attended for therapy previously at age 12/13 years, and again on entering college at age c. 18 years. Kate had also been involved in therapy more recently, having weekly sessions over a period of 6 months, and had attended the residential 6-day FTS…FTS programme in May 2010. Since then, she has attended review days held every 2–3 months. Kate had reported that the

Methodology

The definitional ceremony was video recorded, transcribed and analysed by two of the authors, separately exploring two different approaches to analysis: Interpretative phenomenological analysis (IPA) and Heideggerian hermeneutic phenomenological research. IPA is a qualitative research approach committed to the examination of how people make sense of their major life experiences (Smith, Flowers, & Larkin, 2009), attempting to capture particular experiences as experienced for particular people.

Results

The purpose of this definitional ceremony was to allow Kate an opportunity to present herself to be seen by people from her network, on her own terms, according to her preferred story, and to her identity claims. Reporting on it came about as two of the authors explored different approaches for analysis of narrative therapy in general and definitional ceremonies in particular. There was a great deal of agreement between the initial results from both approaches. Both analyses revealed that

Discussion

On the Free To Stutter… Free To Speak programme, participants reach an acknowledgement of their ability to contribute to the lives and the identities of others and of themselves. The ability and contribution are linked with the fact that participants are people who stutter. Rather than shunning and reviling stuttering, the process moves from the PWS finding it difficult to tolerate the stuttering aspect of themselves to a place where they accord value to it. This insight can open many doors and

Conclusion

Stories are constructed within a social context. Narrative therapy involves facilitating clients to identify their preferred stories and establish them across the various domains of their lives. The use of definitional ceremonies facilitates this process. The impact of stuttering is not only felt in the life of people who stutter but also on their wider networks. The particular definitional ceremony described here allowed that impact to be explored, creating new meanings and playing a role in

Margaret M. Leahy, Associate Professor, Trinity College Dublin, is a fluency specialist. Her current research interests involve the application of Narrative Therapy to stuttering; Attitudes and Attitude change in stuttering; and the education of therapists.

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    Margaret M. Leahy, Associate Professor, Trinity College Dublin, is a fluency specialist. Her current research interests involve the application of Narrative Therapy to stuttering; Attitudes and Attitude change in stuttering; and the education of therapists.

    Mary O’ Dwyer works as a speech and language therapist and is an ECSF graduate. She has experience of working with people who stutter in individual, group and intensive settings. Her doctoral research study focuses on the relationship between the stories people hold, the development of these stories and the person's stuttering.

    Fiona Ryan, Clinical Specialist in Fluency disorders; is a practicing speech and language therapist and ECSF graduate with many years experience of working with people who stutter. A doctoral student she has a particular interest in narrative therapy, its application to stuttering and outcomes from this process.

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