Training
& Resource In Practice- Based Evidence
The
Brief & Narrative Therapy Network
Training
& Resource In Practice- Based Evidence
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Transcript
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Copyright 2001 David Epston - For
personal study only - not to be used or quoted without permission.
At The Brief Therapy Network 2003
Annual Conference David presented this conversation to the
participants. Here is the transcript as promised.
DE:Allen, Bev, Kerry, Norma and Burton, I decided I wouldn't know anything about you without you hearing what I know. So I don't know a thing but I am going to find out. First of all, I understand Alastair, that you have been Kerry's doctor. And you people, (Richard and Barbara) have worked together with everyone here. Could I ask you all a question and it's not going to be a question you have likely thought of. So I doubt if there will be a quick answer. I would like to know what your wish would be for Kerry, Allen and Bev, Norma and Burton, 'What would it be?'
A:My wish would be that Kerry could feel like how she felt two years ago. . . the level of energy she had then and the things she enjoyed and did. . . the ballet . . .
DE:Did you have the impression that Kerry was leading a pretty enjoyable life?
A:Yes, that is the impression that I've got.
DE:And has this problem taken her enjoyment away?
A:Yes. . .
DE:What would your wish be for these people?
B:I wish ME would get out of their life.
R:Mine would be that the essence of what was happening in this family . . . the love they showed for each other. . . could be fully realised. And for Kerry. . . the time I have spent talking to her and her family. . . we have talked about horse-riding. So my wish would be that she could go for a wonderful horse ride. . . just to really go for it and enjoy it.
DE:Horse riding with energy?
R:Yah. . .
DE:What would be your image of this. . . would she be riding along a beach or over some hills. . . dressage. . . or what?
R:I would just think of her really going for it, maybe galloping.
DE:Do you have a picture of what colour the horse would be?
R:Probably a chestnut but I am not sure what colour of horse Kerry likes. The one she likes.
DE:Her favourite colour?
R:Yah. . . her favourite colour. I kind of like chestnut but she might like something different. We haven't talked about that yet.
DE:From what you know about Kerry, is she a kind of person who knows what she likes?
R:Yah.
DE:She does?
R:Yah. She is very clear and there is a very strong spirit of determination.
DE:What evidence do you have for that? What told you she is a very determined sort of person?
R:She has come in here every time even though she has felt tired.
DE:Was her determination stronger than weariness on those occasions? It kept her going?
R:Yah.
DE:Alastair, from a medical point of view, what does medicine have to offer her?
A:Well, there is a bit of a story behind this problem which has been going on since the beginning of 1993. And at that stage, it was thought that Kerry had a viral infection which was related to glandular fever. And since that time, she has continued to have a lot of the symptoms that she had at that time. And whereas usually in that sort of situation the symptoms would have resolved and very rarely would one still have them after several months. But she has continued to have similar kinds of symptoms ever since then. A few fluctuations. They have been to see a number of different doctors and really the upshot of it is that medicine doesn't have anything to offer in terms of a cure or a medical treatment that we think is going to fix the problem.
DE:Is it your impression that Kerry was hoping for that?
A:I think the family has been hoping that there might be something. And we would obviously want to have some hope that there is something that would fix this. As far as we know, there isn't anything that can do that.
DE:Were you hoping that medicine would come up with an answer for this?
KV:Yes.
DE:Are you still hoping? How much of your hope are you putting in medicine and how much of your hope are you putting in yourself?
K:50/50
DE:If I had asked you that question six months ago what would you have said? Would you have had more hope in medicine and less hope in yourself or what?
KV:Possibly!
DE:Really, why are you placing more hope in yourself rather than in medicine? Medicine is really good in many ways!
K:It's not helping me.
DE:Have you given up hope on that one?
KV:Yah.
DE:And do you agree with Richard in regard to being a determined person?
KV:Yah.
DE:Prove it! Give me some examples. Why do you think you are a determined person? (to Norma) Do you think she is?
NV:Yes!
DE:Give me an example?
NV:She got up today and she is going to a social and she started practising some dances. And she didn't have to do them. But she just got up and practised.
DE:And what do you think ME would have told her to do (do you mind me talking like this?)
NV:Probably it would have told her to just go back to bed.
DE:Really!
NV:And it would try to take her over.
DE:Do you think on this occasion your sister's determination won out?
NV:DEFINITELY!
DE:Do you think ME picked on the wrong person in picking on your sister? It probably would have liked a less determined person, I guess. . . a weak-willed sort of person?
NV:Yes.
DE:Why do you think ME made a mistake like this picking on the wrong sort of person? Didn't it know your sister?
NV:Obviously not.
DE:Did you think ME got the idea that when she was weakened by the viral illness that she was a different kind of person than she really is?
NV:Mmh.
DE:Do you think it has got the wrong opinion of your sister?
NV:Yep.
DE:And you know your sister's determination. Is that something you appreciate about her as a sister or is that something that gets in the way of your sister relationship?
NV:No, I appreciate it.
DE:And what do you think she appreciates about you most?
NV:What Kerry?
DE:Kerry, what do you appreciate most about Norma?
KV:She's kind.
DE:Kind. Kindness. Why do you say that? Does she go out of her way for you? Give me an example of how she would go out of her way for you?
KV:She gets drinks for me.
DE:And she's not even grump about it?
KV:Sometimes.
NV:And I go out and buy things for her. She gives me the money.
DE:I am sort of interested in you saying that you are placing more hope in yourself at the moment than you used to. Why have you given yourself more hope? Are you getting sick of ME?
KV:Yes.
DE:Why's that? Why are you turning against it? What's wrong with it? I am not on its side but I am just wondering why you are getting sick of it?
KV:Its no fun.
DE:Has it taken your enjoyment away from you totally?
KVMost of it!
DE:What enjoyments have you held on to and what enjoyments has it taken from you?
KV:Horse-riding.
DE:Were you into horse-riding in a big way?
KV:Yah.
DE:Do you have a horse?
KV:No. .. .
DE:It's robbed you of horse-riding pleasures? What else has it stolen from you?
KV:Netball.
DE:That's a dirty trick. Did you shoot baskets or were you a defender?
KV:Defender.
DE:What else? Has it stopped you from running and jumping?
KV:Dancing.
NV:She used to be a good dancer. . . jazz dancing and tap.
DE:Can you understand how I might feel about ME doing this to you? What do you think I think about ME taking horse-riding pleasures, netball pleasures, and dancing away from you?
KV:Mad.
DE:Well if I really told you the truth, it might not be a word I should say in front of a young person. Can you guess how it might have interested me hearing that even though its taken away your dancing, jazz and tap, that you got back at it today by doing some dancing?
KV:Yah. . . sort of.
DE:What sort of dancing did you do today?
KV:The maxina.
DE:The maxina. . . do they do that? I thought they started off on rock and roll. That's pretty energetic, isn't it. . .. . the maxina?
KV:Yes.
DE:When you were doing that, did you get any sense that you were taking a little bit of your life back?
K:Yes.
DE:Did you grin or smile on the inside knowing you were taking abit of your life back?
KV:Yes.
DE:If they were watching you, would they have known you were smiling on the inside? Were you smiling on the outside too or just on the inside?
KV:Inside.
NV:She was smiling.
DE:Did you know that your inside smiling was showing on the outside?
KV:No.
DE:Did it give you any satisfaction to get a bit of your life back from ME?
KV:A little bit.
DE:If ME was like a person and had feelings and could talk, what do you think it thought about you taking your life back today and the smiling that was going on in your inside and even showed on your outside? What do you think it would be thinking? Would it be smiling or scowling?
KV:Scowling.
DE:It would be scowling. Do you mind ME scowling?
KV:No.
DE:At any time, did you think ME was sort of like a friend of yours?
KV:No.
DE:You knew from the beginning that it was taking your life away from you?
KV:Yes.
DE:Did you know that you have put 50% hope in yourself and before it was a lot less. Can you see yourself giving yourself more hope in the future?
KV:Sort of.
DE:If 50% hope meant that you were doing the maxina, what would you be doing next after the maxina? Ballroom dancing? The tango?
BV:Line dancing.
DE:Will you be into line dancing next?
KV:Yes.
DE:What do you think ME would think of line-dancing? Would it get in a bad mood?
KV:Yes.
DE:If ME got into a really bad mood and tried to get back at you, what would you do? Could you stand up to it?
KV:Not really.
DE:Have you found in the past that you have been able to stand up to ME when it got angry with you like that? Did it get that angry that it had a tantrum?
KV:No.
DE:Say you started getting your life back and putting more hope in yourself and it could see it was losing its hold over you, what would it do?
KV:Make me feel worse.
DE:And how do you make yourself feel better when it tries to make you feel worse? Got any ways?
KV:(no reply).
DE:Does it have any ways of taking your hope away from you?
KV:No.
DE:What took away your hope? Bad feelings and that?
KV:Yah.
DE:Allen and Bev, were you aware that Kerry was placing more hope in herself? Was it visible to you?
AV:Yeh. . . this last week.
DE:Thank god, I came today.
AV:Certainly the last week, I'd say.
BV:The last three days have been great.
DE:Do you mind, because you may find this a little too much, so I had better warn you . . . would you be interested in this development? It won't tire you out? Were you aware that these were your best few days for quite while?
KV:Yes.
DE:What do you make of this? What is going on here? Have you turned the corner? Have you gone ahead of ME over the last two weeks? Are you still a little unsure so you don't want to get too excited about it?
KV:Yes.
DE:How many more days or how much time will you need before you can feel confident about going ahead of ME? A month or two? When would you start to feel confident that you were starting to pull ahead of it a bit? Is it a bit backwards and forwards with ME?
KV:Yah.
DE:Do you want to be not too enthusiastic about his and see how it goes? Say you went ahead of ME and it scored a goal against you, would you be able to bear with that? It's sort of like that with ME isn't it? It's not all just winning and never getting any goals scored against you? Is it anything like a netball game getting your life back from ME?
KV:A little bit.
DE:Right now if you were playing netball, what would you say the score would be? Are you a little bit ahead of it?
Yes.
DE:Where are you in the game? Half time? One third. . . two thirds or where?
KV:One third.
DE:What's the score for you and what's the score for ME?
KV:3-2
DE:3-2 for you? 3-2 for Kerry. Is the first time you have felt you are a little bit ahead of ME? Have you been ahead of it before?
KV:Some days.
DE:Bev, what did you notice about Kerry that told you she was going into the lead here?
BV:Kerry's attitude has changed. Finally after people telling her she could do things, she is now doing them. she is listening to music. She turned on music instead of crying.
DE:Hold on, do you mind if I get all these things down. Starting to get pleasures back. Like music, Kerry? What kind of music are you getting back? What sort of music is anti-ME music?
KV:Every kind.
DE:Anything in particular that ME wouldn't like, even hate? What would ME hate the most? Anything in particular? What do you think, Norma?
NV:Classical. Anything my dad would listen to.
DE:I thought it might hate heavy metal. Do you think it would hate Metallic? Of all the music you know and like, what music do you think ME would hate the most?
NV:Classics. It would hate them.
AV:You hate them.
DE:Kerry, what do you think? Do you agree with your sister?
KV:No.
DE:Do you think it would hate classical music or something else?
KV:Heavy metal.
DE:AC/DC?
KV:Yes.
DE:have you ever thought that if ME ever gave you a hard time, you could play music it would hate back and give it a hard time? Bev, what else did you say?
BV:Going to school.
DE:Do you think ME will be happy to learn that you are getting your mind back?
KV:No.
DE:Would it like it or dislike it?
KV:Dislike it.
DE:Why do you think ME would dislike you getting smart?
KV:It likes making me sick.
DE:It likes Kerry to be sick. Have you found that it wakens your mind a bit? That you couldn't think as well as you wanted to think?
KV:Yes.
DE:Do you think it took advantage of you when you were weakened? Like did it put some thoughts in your mind that you didn't want to be there?
KV:Yes.
DE:What kind of thoughts did it put in your mind that were ME thoughts? Is that too hard to think about, that one?
KV:Yes.
DE:Let me ask you this: you know this last little while since you have gone ahead, have you had any new thoughts that are your own. . . that you really enjoyed being there? Did you have some fun thoughts. . . some happiness thoughts?
KV:Not really.
DE:What do you think your mum means when she says you are starting to get your pleasures back? What do you think she is noticing about you? Can you guess?
KV:No.
DE:Bev, can you put Kerry in the picture of what you have observed about her?
BV:She is really trying whereas in previous times, she wasn't really trying. If she has been able to or not, I don't know, but she is now trying.
DE:Do you think she has got her determination back?
BV:Yah.
DE:Do you agree with that, Kerry? Do you think your mum is right or wrong?
KV:She's right.
DE:Are you glad to have your determination back or do you wish it would go away?
KV:I'm glad.
DE:Did you say 'hello' when it came back? Were you pleased to see it again?
KV:Yes.
DE:Did you think you had lost it forever? Or did you always know it was there?
KV:Yes.
DE:Where was it, do you think when the ME was taking you over? Was your determination on holiday? Did it need a rest? ME does have the knack of putting people's determination to sleep!
KV:Yes.
DE:When it came back to you, how did you know it was there? What day did it come back?
KV:Monday.
DE:Did it arrive at any specific time?
KV:No.
DE:Were you glad to see it?
KV:Yes.
DE:Was it glad to see you
KV:I don't know.
DE:And what did it do when it came back? Did it talk you into going to school? What did it say? You can do it or. . . What did it say? Can you take a guess at what it might have said? Can I ask: why did you listen to your determination and not ME?
KV:I couldn't hear it.
DE:Really. You know when you listened to determination, did determination seem pleased you were listening to it rather than to ME?
KV:Yes.
DE:And what do you think ME thought about it - that you were listening to determination rather than ME?
KV:It was cross.
DE:Do you mind ME being cross? is that okay with you? You can cope with ME getting into a bad mood? You don't mind that?
KV:No.
DE:What else, Bev?
BV:Looking at determination, to some degree we made her go to school, no matter what. At breakfast time, she knew she was going.
DE:Did that make her easier or more at home with determination?
BV:I think too there was the fear of actually going.
DE:Do you consider that a bit of a victory going to school in the face of fear?
KV:Yes.
DE:Were you a little bit proud of yourself for having faced fear?
KV:Yes.
DE:Wow, this has been quite a week, hasn't it? Allen, have you observed this too?
AV:I think there was a lot of fear going back to school.
DE:I'll bet!
AV:After Monday and Tuesday, Wednesday, Thursday and Friday got quite easy. Not easy but easier.
DE:Say on Monday, fear was that big (stretching hands apart), where did it go to on Tuesday, Wednesday, Thursday and Friday? Kerry, can you watch your dad and see if he is right?
AV:That big on Monday, that big on Tuesday (not much of a difference) and Wednesday, Thursday, and Friday, it might be down to here (considerable difference per day).
DE:Kerry, were you surprised the fear started getting smaller?
KV:Yes.
DE:Did you think it would?
KV:No.
DE:You didn't think it would but by Friday it was about 1/2 of what it was on Monday.
KV:I suppose.
DE:What did you learn about fear that you didn't know before? Did you learn anything about fear? Can I tell you what one 10 year old boy told me: See what you think of this because he was from Auckland. He said that when he faced up to fear, the fear got smaller but when he ran away from fear, the fear got bigger. What do you think of that? Have you found that or is it different down here?
KV:Sort of.
DE:What do you mean: "Sort of." How is your Wellington experience sort of like his Auckland experience? Did it get smaller as the time went on when you stood up to it?
KV:Yes.
DE:Do you think your determination played any part in this? Is there any connection between determination and bravery?
KV:Yes.
DE:How do you see that? What is the connection between determination and bravery?
KV:There us a connection.
DE:Can you ever remember a time way back when you were scared of getting on a horse?
KV:No.
DE:You were never afraid? What about when you were a little, little girl and the horse was so big that you would have thought you would have to get a ladder. It looked so big and you were so small. Weren't you afraid of a horse then?
KV:Not really.
DE:You have always loved horses? What is there about horses that you like?
KV:Everything.
DE:Can I tell you why I love horses, even though I am allergic to them so I can't get too close? they look like they are having good time. Do you think they do?
KV:Yes.
DE:They look happy. Allen, what else have you noticed? That was certainly an interesting one of going against fear.
AV:Going back to school and being with the children.
DE:Kerry, has ME robbed you of your friendships?
KV:Some it has.
DE:How much . . . what percent of your friendship has it taken away from you? A lot of it, a middle bit of it, or a little bit of it? A teeny weeny bit of it?
KV:A little bit.
DE:Did you think you got any of your friendship back over this week?
KV:Yes.
DE:And what do you think your friends like most about you? Your determination and your bravery or the kind of person ME makes you be? If they could chose what kind of Kerry they could have for a friend, would they choose a ME-Kerry or a brave and determined Kerry?
KV:Determined and brave.
DE:Why do you think that? What would they prefer about your determination and your bravery?
KV:They would like it better.
DE:Is that what they are hoping for?
KV:Yes.
DE:Why wouldn't they want a sick Kerry for a friend? They got care for you and nurse you?
KV:I'd be no fun.
DE:Your friends are really pro-fun?
KV:Yes.
DE:Of all your friends, who do you think is most fun?
KV:Jessica.
DE:Do you know her, Norma?
NV:Yah, she lives up the road.
DE:Is she high on fun?
NV:Yah, very sporty.
DE:You're high on fun, aren't you?
NV:Yah.
DE:What's your fun?
NV:Girl guides.
DE:What about Girl Guides do you enjoy?
NV:Going away on weekends and that.
DE:Oh really.
NV:I also like going down to this place in Levin with my granddad and catch fish.
DE:Yah, what kind?
NV:Little fish we put in a jar. I don't know what they are called but they are tiny. We catch them in our hands.
DE:Kerry, what do you think is going to happen this week? Will it be a winning week for you or a winning week for ME?
KV:Winning week for me.
DE:Winning week for you. What would happen if ME got strong and scored a few baskets on you? would you lose your hope or would that make your determination stronger? What do you think? Could you stand up to having some goals scored against you?
KV:Yes.
DE:It would be hard though. Have you got much of a fighting spirit back yet?
KV:A little bit.
DE:Where did that come from? I know ME and glandular fever can take that away from you. How did your fighting spirit come back?
KV:Determination.
DE:Were you glad that they believe in or would you have rather they said on Monday morning - 'Don't go to school . . . give in to your fear and stay home'. Would you have preferred them to do that knowing what happened or would you have preferred for them to have done what they did?
KV:I preferred what they did.
DE:Do you think they knew you were ready to take it on? Could they see something about you that told them you were ready?
KV:I don't know.
DE:How did you know? What told you? I am sure you had a lot of qualms.
BV:We really believed it would be positive for her to have the company of her friends.
DE:How did you come to that conclusion? What kept you going when you had your doubts? Did you support each other? Did you have some friends encouraging you?
BV:We have seen her laugh a few times.
DE:The fact that I have seen her laugh a few times today, (if I hadn't known all about this), I wouldn't have known how special the laughs were, Kerry. What do you think? Do you think you could even laugh again before you leave? Is that possible?
KV:Yes.
DE:What did you think about turning on the tapes instead of the tears? Was that a difficult decision for you to make?
KV:Yes.
DE:Why did you turn on the tapes instead of the tears ? (No reply). Do you know the first time you laughed, did it hurt your face?
KV:No.
DE:So it hasn't been that long then? So tell me, why did you turn on the tapes instead of the tears? What was your thinking there? What was your policy?
KV:My mother got cross at me.
DE:Did that help you turn on the tapes? Do you think your mother's crossness helped? Do you think that when your mother gets cross, you end up making ME cross? Do you think your mother is getting back at ME a bit?
KV:Yes.
DE:Do you think your mother and your father could be cross that ME has robbed you of fun? Do you think they could be cross at that?
KV:Yes.
DE:Why do you think they would be cross at ME taking the fun away from their daughter? Wouldn't like that?
DE:Was that a new thing for your mum to get cross at ME?
KV:No.
DE:She has been cross at it before?
KV:Yes.
DE:Do you think when your mum is cross with ME, she is cross with you? Do you get confused?
KV:Yes.
DE:Would you like your mum and dad to let you know when they are cross with ME and when they are cross with you? I know a lot of people your age have told me it was hard for them to understand their parents. Do you know what I mean? They thought that when their parents were being cross with ME, they were being cross with them. do you ever do that?
KV:Yes. . . . sometimes.
DE:I think you said your mum was cross with you about waking up in the morning. And that somehow or other made you turn on the tapes rather than the tears. Did you think then your mum was cross with you or cross with ME?
KV:With me.
DE:What happened for you when you thought your mum was cross with you? Did it make you more determined? Sad? Upset or what?
KV:A bit of both.
DE:Could your mother be cross with you in a way that just make you determined and not upset?
KV:I don't know.
DE:Can you think of a way that would make her determined but wouldn't upset her? Do you think it is necessary that one goes with other? I don't know I am just trying to figure it out.
BV:When I get cross, Kerry takes it in a negative way.
DE:Oh, how could she get positively determined then? If we could work this out, it could really help. But I know it is complicated. Why on this occasion did you get a positive determination that getting more determined to go with ME? Do you understand what I am saying?
KV:Yes.
DE:For example, say your mum was watching you play netball and called out: 'Try harder' 'I know you can win'. If you got determined in a negative way, you would say: 'I think I'll score a goal against myself'. But on this occasion when your mum shouted out to you, you played for yourself. And maybe that had something to do with you going ahead of ME this past week? What do you think?
KV:I don't know.
DE:This is a very hard thing for parents, knowing how to be cross in a way that is positive rather than negative.
Barbara, you have worked for 12 years with children taking their lives back from asthma. I wonder if anyone you have worked with found a way to be cross in a way that is positive rather than negative?
