A Clinician's Guide to Foundational Story Psychotherapy

Co-Changing Narratives, Co-Changing Lives

Hugh K. Marr

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9781138542105
• eBook ISBN: 9780429013881
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

A Clinician's Guide to Foundational Story Psychotherapy draws together a range of theories and models to examine the use of narrative psychotherapy in clinical practice.

Illustrated with case examples and biographical vignettes, the book outlines the importance of foundational and life stories in treatment and delineates new techniques for co-assessing and changing stories. A wealth of concrete tools are included, such as the Foundational Story Interview and Family of Origin Map, as well as diagram templates and questionnaires for use during clinical sessions.

Integrating theory and practical applications, A Clinician's Guide to Foundational Story Psychotherapy introduces a range of therapeutic options rooted in a narrative context and is a valuable resource for practicing and student psychotherapists.

Part 1
The Shoulders of Giants

If I have seen further than others, it is by standing upon the shoulders of giants.

—Sir Isaac Newton (1643–1727); from letter to Robert Hooke, 1675 (Historical Society of Pennsylvania, Simon Gratz Autograph Collection, Box 12/11, Folder 37)

Chapter 1
Major Background Theorists

The realization that stories are seminal in people’s lives, and that psychotherapy involves understanding and helping people to change their stories is an often unstated undercurrent in how many if not most psychotherapists operate. Many seminal clinicians and thinkers have contributed either knowingly or unknowingly to this view. In this section, I shall highlight a few whose impact on psychotherapy and story has been essential.

This chapter explores the understanding and contributions by major theorists to the centrality of story in making meaning in psychotherapy. The techniques and theories of a myriad of other clinicians will be integrated especially into Part Two, but also throughout the rest of the book. The major theorists and their contributions to a storied understanding in Chapter 1 include Sigmund Freud, Carl Jung, Alfred Adler, Eric Berne, Michael White, and Dan McAdams. Let us begin with Freud.

Sigmund Freud (1856–1939)

No history of psychotherapy contributions would be complete without mentioning Sigmund Freud. Freud had a profound effect on the establishment and course of psychotherapy, and he set in motion many trends, some of which inform our work today, and from some of which we are still recovering.

Freud began his medical career in Vienna as a neurologist. From early on, he had visions of a grand theoretical synthesis that explained both the mundane and the pathological. In those early years he held the view—not unlike so many professionals today—that the unifying theory would be biological in nature. You may remember from the introduction that humankind is destined to live in two equally real and overlapping worlds—the world of objects and the world of imagination—and that neither can be reduced to the other. In his early career, Freud believed neurophysiology could explain everything (the world of objects). He very quickly ran up against the limits of the tools available in the Victorian era. When Freud graduated from medical school in 1882, bleeding had fallen out of favor as a treatment for many diseases, but blistering (raising blisters on the skin by applying red hot implements or caustic chemicals) was still a common treatment for many maladies, including psychiatric disorders like hysteria and hypochondriasis; neurological tools such as the f MRI were a century away. Indeed, X-rays would not be discovered for another 13 years.

Despairing of then-current neurology, Freud began a journey to the other pole, the use of fantasy as both cause and cure of mental disorder. But he never relinquished the hope that neurobiology would eventually explain all emotional problems.

The Victorian era was replete with strange neurological/emotional illnesses, the likes of which we seldom see in modern first world countries. There were cases of paralysis and of blindness and of fainting for which no biomedical cause could be determined. Even with the neuroanatomical knowledge of the late 19 th century, it was clear to Freud and his colleagues that some of these illnesses involved separate bodily systems that were unlikely to be simultaneously affected. Thus, these illnesses were likely psychogenic in origin; they were termed “hysteria.”

Freud’s friend Josef Breuer got Freud interested in a promising treatment for hysteria called “hypnosis,” and the two of them traveled to Paris to study under the eminent hypnotherapist, Jean-Martin Charcot (Sandhu, 2015).

After returning to Vienna, Freud became disenchanted with hypnosis, and developed another “talking cure:” that of having a patient lie on a fainting couch (the fact that these small couches were called “fainting couches” speaks to how ubiquitous hysteria had become) and say whatever came to her mind. The analyst would sit behind the patient and note not only where the associations led, but when the patient hesitated or otherwise blocked herself from immediately revealing her associations.

As Freud worked with more and more young women with hysteria, he heard more and more tales of childhood sexual abuse. He wrote a paper (“The Aetiology of Hysteria”) in 1896 (Freud, 1896/1962) describing how child abuse was at the root of hysteria. Indeed, Judith Herman, in her seminal 1997 book Trauma and Recovery, talked of hysteria as trauma-related symptoms that were caused by child abuse, and which formed one of the three traumatic scourges of humankind through the ages (the other two were war and domestic abuse).

Unfortunately for the treatment of trauma, Freud recanted his position on childhood sexual abuse and hysteria. This likely set the understanding of the ubiquity of child abuse and the need for trauma treatment back almost one hundred years. It is understandable for Freud, and we should not judge him harshly. After all, he had already proposed radical theories beginning with the idea that children were not just little adults, which was the prevalent theory at the time (and, of course, that prevalent view is a short step from justifying child labor and child sexual abuse). Then he talked of the importance and ubiquity of sexual drives even though he was writing in a Victorian age. Finally, Freud was a Jewish doctor in a time when the medical establishment was overwhelmingly Gentile. Had he also (rightly, it turns out) accused male family members of sexually abusing their female children, we may never have heard of Freud. It likely would be a bridge too far, and he may have been silenced as just another crackpot.

The way that Freud changed his views on childhood abuse was to say that women’s stories of abuse did not occur in reality. Rather, it was their fantasy of abuse that drove their symptoms. Thus, he completely switched poles from neurobiology (the world of objects) to the treatment of mental fantasy and its debilitations (the world of imagination). The fantasy story of abuse had to be changed. And the way to change that story was by helping the patient gain the insight that she was reliving that story in the consulting room by placing on the analyst the characteristics of important figures from the past, and placing on her relationship with the analyst the template of her relationship with those figures.

While Freud missed the use of story to connect objects and imagination to the detriment both of understanding trauma, and potentially to the detriment of his patients feeling trusted and accepted, he did see that reliving the same anachronistic story plotline is at the root of many psychological symptoms (what Freud called the “repetition compulsion”). And Freud himself was a great storyteller. He was the fourth recipient of the Goethe prize in literature (Storr, 1998), and in 1936 he was nominated for the Nobel prize in literature. His case studies read like a whodunit mystery story, with the solution appearing at the end from putting together the overlooked pieces of evidence along the way.

Freud was seminal to the use of story in psychotherapy in yet another way as well. He was one of the first to understand that early human development proceeds through phases. Since his was a bodily psychology (given his predilection for physiology and neurology), he thought of each early phase as oriented toward a particular bodily system, with one exception. Thus, the oral phase was named for the infant’s focus on the mouth and the oral cavity in suckling. The anal phase was named for the body system involved in toilet training; and the phallic phase was named for the emphasis on the penis (or lack thereof). Psychological problems were metaphorically and literally related to these phases. Thus, a problem with dependency was connected to the oral phase; and because the oral phase precedes other phases, such problems were thought to be more primitive. So far there is a certain consistency, if illogic, to the theory. The consistency is in relating a class of problems to the bodily system to which they metaphorically relate. The illogic is in confusing the metaphorical with the literal. Thus, a person’s dependency in relationships and emphasis upon eating (or smoking cigars!) is metaphorically related to a time in life of dependency and suckling; therefore, that person’s problems must relate to that literal infancy time in his/her life.

The one inconsistent period in these stages is that of the Oedipal. The Oedipal period was hypothesized to be the period of origin of the majority of neurotic problems Freud encountered, including hysteria. And that phase is the one not named for a bodily system but, instead, for a mythical story. More to the point, it is related to a partial story, not even the whole story.

Most of us are generally familiar with the broad outline of Sophocles’ (reprint 1991) play Oedipus Rex (Oedipus the King). In it our protagonist, Oedipus, like so many mythical heroes, is raised as an orphan. For Oedipus, the orphaning occurs because of the prophecy that he would one day kill his father. When his father, the king, received this prediction, he sent the infant Oedipus into the woods with a forester who was to murder him. Instead, the forester takes pity on the baby and gives it away to be raised in secrecy. When, as a young man, Oedipus consults the oracle at Delphi, he is informed that his fate is to kill his father; and, even more, that he is to marry his mother. Not recognizing his parents (nor they him), since he did not grow up with them nor had he seen them on Facebook, Oedipus encounters his father, they duel, and he kills the older man. He then marries a beautiful older widow. This is where the story ends for Freud (but not for Sophocles; see Sophocles, reprint 1991).

Freud saw this as a template for wishes of the young (pre-operational) child—that he secretly wishes to eliminate his father so as to have his mother all to himself (this involves quite a bit of license, as the wish to possess Jocasta was not what motivated the duel for Oedipus with his father; and Oedipus was more powerful than the king). The successful ending for Freud was in identifying with the more powerful father (“identification with the aggressor”) and, in being like him, ultimately finding a mate who in important ways was similar to his mother (“sublimation”). The successful ending for Sophocles finds Oedipus, distraught over what he had done, blinding himself and wandering in the dessert. He finally emerges to claim the throne and rules with great insight. Freud seems to skip over the role of fate in the tragic part of the story—that precisely by trying to avoid one’s tragic fate, one manages to fulfill it. It is this fulfilling fate by trying to avoid it that links Oedipus with his father, not Oedipus’ personal identification with the father.

Why this large inconsistency in Freud’s theory? Why that particular story? And why only one story, when each of the proposed childhood (and later life phases) could easily be related to their own mythical narrative examples? I don’t know.¹ But expanding the story template for numerous stories that inform both a person’s life as well as her/his difficulties awaited the genius of our next contributor—Carl Jung.

Thus Freud’s contributions to narrative psychotherapy include the importance of listening carefully to the patient’s life stories (even if Freud listened through speakers pre-tuned to the psycho-sexual); seeing story as a template for emotional problems; and understanding that in psychological disorders the same plotline recurs over and over. The importance of the Oedipal period for Freud (roughly Piaget’s pre-operational period), as we will see in Chapter 4, is precisely the period that is important for the formation of foundational stories. The mechanisms which Freud noted work to protect the dreamer from threatening wishes in dreams—condensation, displacement, symbolization, secondary elaboration (Freud, 2010)—accurately describe the manner in which a young, pre-operational child thinks. In all of these ways, plus for the initiation of the broad acceptance of psychotherapy, narrative therapists in particular and the entire field of psychotherapy in general owe Freud appreciation.

Carl Gustav Jung (1875–1961)

The early 1900s was a time of incredible excitement in psychology, a bubbling cauldron of ideas and approaches. Wilhelm Wundt in Germany was one of the founders of the psychology of perception; at Cornell, Edward Tichener, student of Wundt, developed a structural theory of consciousness by having people introspect and meticulously record their perceptions, images, and feelings. Tichener is known as the founder of experimental psychology. Contrasting to Tichener’s inward journey was the behaviorist John Watson, who brashly challenged anyone to send him a child who he could then turn into a doctor or lawyer through behavioral principles (no one sent him a child). More balanced and with a broad prescient and philosophical curiosity that ranged from social psychology to religious experiences was another American, William James. On the continent was the founder of intelligence testing, Alfred Binet, and the controversial theorist Sigmund Freud and his emerging protégée Carl Jung. Also on the continent were the psychoanalyst Sandor Ferenzi, and two men who would later become Freud biographers—A. A. Brill and Ernest Jones. It was the genius of the eminent psychologist (and first president of the American Psychological Association) G. Stanley Hall to invite most of them to speak or attend a colloquium at Clark University (Evans, 1985), where Hall served as president. Unfortunately, Binet died before the conference. Wundt declined to attend (possibly to attend the 500 th anniversary of the University of Leipzig instead of the 20 th anniversary of Clark University).

This 1909 conference would be Freud’s only trip to America. He and Jung traveled by steamship, a weeklong journey, and they filled their time just as you might expect—by interpreting each other’s dreams. None of Freud’s dreams survive. Freud was intensely private, and Jung refused to reveal the older man’s confidences even after Freud died. We do have one of Jung’s dreams, as recorded in his autobiography Memories, Dreams, and Reflections (Jung, 1961/1989, p. 158). In the dream, Jung finds himself in the upper story of a “two storey (sic)” house, which he realizes is his own. It is a salon with fine furnishings and valuable paintings. But Jung is curious about the lower stories, and so descends first through a Medieval section, then into a cellar from Roman times where he finds a ring set into the stone floor. He pulls on the ring to reveal a narrow stairway which he descends into a small cave filled with pottery shards like the remains of a primitive culture. There he sees two old and desiccated skulls.

As Jung states in the first line, the dream of this house—and its interpretation—contains two stories (“storeys”). One story is that of Freud, who, seeking the aspects of the dream potentially revealing of the personal (Freudian) unconscious, asked Jung to associate to the two skulls. Freud argued the skulls were the relevant aspect of the dream, and represented for Jung a death wish toward his parents.

Here we see the contrast between the two. Freud was reductionistic and used a repetitive template to view psychic phenomena. For him, a part of one universal story (that of Oedipus Rex) would suffice.

The other story (“storey”) is that of Jung, who saw in this dream a model of the unconscious as multilayered and hierarchical. In Jung’s Collected Works he mentions the word “story” but once. Yet Jung was a mythologist and religious scholar fascinated by the universal symbols in myth which form all the layers of his dream house but the first story. Within this house (psyche) were layers which transcended the personal. For Jung, the deepest layers unite that which is human, and undergird the cultural and personal differences among people. Jung, in contrast to Freud, was expansive. ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• List of Tables
• Acknowledgements: A Professional Journey Story
• Preface
• Introduction
• PART 1 The Shoulders of Giants
• PART 2 The Aspects of Story and the Foundational Story Model
• PART 3 Life and Foundational Story Assessment
• PART 4 Changing Foundational and Life Stories
• PART 5 Trauma and the Life Story
• PART 6 Listening to Your Own Story
• PART 7 Conclusion: Weaving It Together
• Appendices
• Index