Enhancing Narrative Couple Therapy Process with an ... - Springer Link

ENHANCING NARRATIVE COUPLE THERAPY PROCESS WITH AN ENACTMENT SCAFFOLDING Andrew S. Brimhall Brandt C. Gardner Branden H. Henline

ABSTRACT: Despite the growing popularity of narrative approaches to couple and family therapy and the demonstrated effectiveness of enactments—a clinical process typically articulated and utilized in more modern or positivistic approaches to therapy—there is very little, if any, literature exploring how enactments may fit within a narrative therapeutic framework. In this paper we suggest: That narrative therapy theoretical assumptions, principles, and therapeutic processes may coexist within an enactment framework articulated by Butler and Gardner; that such assumptions and processes may be enhanced when clinicians use an enactment “scaffolding” throughout the therapeutic process; and that this enactment framework “empirically informs” the narrative therapy process and strengthens the stance of narrative therapy under the scrutiny of those claiming a need for an evidence basis in psychotherapy. KEY WORDS: enactments; narrative therapy; couples therapy; scaffolding.

Since the introduction of narrative therapy (White & Epston, 1990) and constructivist theory, the field of psychotherapy has seen a significant philosophical shift and has realized alternative approaches to working with clients. The understanding of the human condition has been expanded, the art of therapy enlightened, and the tendency to Andrew S. Brimhall, MS, Brandt C. Gardner, MS, and Branden H. Henline, MS, contributed equally to this paper and are doctoral students in the Marriage and Family Therapy Program, College of Human Sciences, Texas Tech University. Address correspondence to Andrew Brimhall, Box 41162, Lubbock, TX 79409-1163 (andrew.s.brimhall@ ttu.edu). Contemporary Family Therapy 25(4), December 2003  2003 Human Sciences Press, Inc.

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move toward systemization has been challenged (Amundson, 2001; Freedman & Combs, 1996; Neimeyer & Mahoney, 1995; White & Epston, 1990). Due to its unique contributions, narrative therapy has caught the attention of many within the counseling field (Etchison & Kleist, 2000). It has been noted that more than 2,000 bibliographic resources have been devoted to narrative therapy in scholarly journals, book chapters, and doctoral dissertations (Hevern, 1999). Research investigating narrative therapy is still considered in its infancy (Etchison & Kleist, 2000). Some may argue that the existence of more than 2,000 bibliographical resources (Hevern, 1999) does not constitute a stage of infancy. However, it is important to note that, of those resources, many are clinical vignettes, conceptual in nature, or debates of philosophical stances. Relatively few are dedicated to empirical research delineating the effectiveness of narrative therapy (Amundson, 2001; Etchison & Kleist, 2000). One possible explanation for this lack of empirical inquiry is that the process of documenting and validating therapies seems counterintuitive to a theory that denies the possibility of research objectivity (Kelley, 1998). This incongruity has lead to a discussion of the future of narrative therapy. Amundson (2001) argues: Narrative therapy should continue to stand as counterpoint against the systemizing tendencies of empirically validated therapy guidelines. However, it has a better chance to stand as something useful if it considers itself an ‘empirically informed therapy’ (p. 180). In our minds, narrative therapy theory and process and empirically informed clinical processes are not incompatible domains, but may coexist comfortably. While objectivity in the narrative therapy process— a necessary component for empirical validation—is contrary to the postmodern nature of the model, the process of narrative therapy can become increasingly “empirically validated” as Amundson (2001) has suggested by, first, clarifying what works (and what does not) and, second, incorporating other empirically informed clinical processes that do not diminish the subjective nature of narrative therapy. Regarding what works in therapy, many sources suggest that a core component of narrative therapy involves helping families move from an individual, intrapersonal construction of the problem to a construction that is more interpersonal and relational (e.g., Sluzki, 1992;

393 ANDREW S. BRIMHALL, BRANDT C. GARDNER, BRANDEN H. HENLINE

White & Epston, 1990). In one of the few outcome studies involving narrative therapy, Coulehan, Friedlander, and Heatherington (1998) uncovered three progressive themes that their participants reported as essential in helping families successfully make this transformation. Families who experienced more positive relational outcomes following participation in narrative therapy reported that they had improved their ability to: 1) recognize multiple descriptions of the problem; 2) change and soften their affect; and 3) attribute positive meaning to one another. While the general practice (and associated interventions) of narrative therapy is aimed at helping families accomplish these three themes, an overarching framework facilitating this process does not exist (Coulehan, Friedlander, & Heatherington, 1998). One possibility for such a framework lies in the clinical process of enactments. Enactments—typically characterized as partner-partner interaction, with therapist coaching, as opposed to therapist-partner interaction—offer the narrative therapist a clinical process which favors clients’ experiences, beliefs, and understanding and reduces therapist teaching, labeling, and advice giving (Butler & Bird, 2000). Therapist coaching of partner interaction—with an emphasis on the process of interaction over the content—facilitates dialogue between partners regarding problem description, affective experience, and attributed meaning. Such dialogue is elicited within the couple context as opposed to the therapist-client context, thereby facilitating progression through Coulehan and associates’ (1998) three stages of transformation, which are suggested to be the primary change processes in narrative therapy. Furthermore, enactments—and other clinical processes that favor client interaction and participation over therapist-centered processes— have been shown to contribute to both proximal and distal therapeutic outcomes (Butler & Bird, 2000; Butler & Wampler, 1999). As such, the incorporation of enactments is one way in which narrative therapists may withstand scrutiny from those who believe that the therapeutic process should consist of empirically validated models. The goal of this paper, therefore, is to demonstrate how enactments may be used to promote narrative therapy principles and processes. As an example, we draw from a recent article by Butler and Gardner (2003), which outlines a developmental approach to using enactments over the course of therapy. In using Butler and Gardner’s five-stage model as an outline, we provide a description of each stage, followed by a discussion of how such a clinical process fits within narrative theory. We offer a fictional vignette of what that clinical process


might look like, and conclude each section with a discussion of how this process is consistent with specific narrative interventions as well as Coulehan and colleagues’ (1998) three stages of transformation. We begin with a brief review of narrative therapy research followed by a selective review of literature examining enactments and other clinical processes.

CLINICAL INVESTIGATIONS OF NARRATIVE THERAPY The research investigating narrative therapy is sparse, but that which exists has demonstrated some consistency in findings. O’Connor, Meakes, Pickering, and Schuman (1997) examined the perceptions of family members who participated in narrative family therapy. Eight families were interviewed, using an ethnographic research design, to measure their perceptions of what was useful in their therapy sessions. The ethnographic design was utilized due to its similarities with the narrative therapy process, in order to maintain the participants’ role as co-researcher, and due to the complex nature of the participants’ responses. Families participating in the study were asked: (a) “What has been helpful in therapy?” (b) “What has not been helpful in therapy?” (c) “What is your overall experience of narrative therapy?” and (d) “What is an image or symbol that describes your experience of therapy?” From these interviews, participant responses concerning what was helpful in therapy were summarized into six major themes. They included conversations externalizing the problem, alternate stories based on unique occurrences, the development of personal agency, the use of reflecting/consulting teams, creating an “audience,” and a therapeutic stance of non-blaming and caring—all themes that are congruent with a narrative approach. Results of this study indicated that families who invested in longer periods of narrative therapy did better than those who stayed for shorter amounts—suggesting that those families exposed to narrative therapy for longer periods of times have a better chance of making cognitive shifts that positively affect their family’s functioning (O’Connor et al., 1997). Furthermore, all families reported a decrease in the presenting problem. In an additional study based on narrative therapy, Coulehan and colleagues (1998) sought to understand better how clients moved from


an individual, intrapersonal construction of the presenting problem to a construction that was more interpersonal or relational. The sample consisted of eight families experiencing difficulties that were assigned to one particular person within the family. The initial interviews were taped and a questionnaire was administered immediately following the interview to assess the family’s description of the presenting problem. Along with the questionnaires, an observational coding system was developed to analyze the interviews and monitor the family’s use of language connoting their construction of the problem. In every case the family presenting to therapy reported an intrapersonal—or blaming—construction of the problem (i.e., “It’s his fault.”). In those sessions that were reported as successful the families showed a transition from the original intrapersonal construction to a more relationally based interpersonal construction. Also of note, in the sessions that were successful, the authors found a commonality—each family followed a three-stage model of transformation. The first stage of transformation took place when families began to hear and express multiple descriptions of a problem—multiple stories that helped them expand their view of the origin of the problem. The shift to the second stage was indicated by a change in the family’s affect—a softening occurred once their perceptions expanded. The third, and final, stage involved the ability of the family to ascribe positive meaning to each family member and to the family as a whole. Those sessions in which participants were unable to expand their perspective, change their affect, and attribute positive meaning to their families were reported as being unsuccessful (Coulehan et al., 1998). In summary, outcome research suggests that participants in the narrative therapy process consider their experience a success when a transformation has occurred in their family. O’Connor and colleagues (1997) assert that successful narrative therapy outcomes are the product of six themes, which occur throughout the therapy process and each contribute to a shift in family mentalities regarding their problems. Coulehan and associates (1998) explain that this transformation occurs in three stages through which families progress from an intrapersonal construction of the problem to a more systemic story of the problem’s influence on the family. While each of these studies show that a transformation is necessary they stop prior to articulating how clinicians may assist families in making such transformations. Enactments provide a scaffolding that can be integrated within the context of narrative therapy to facilitate these and other changes in-session.


ENACTMENTS IN COUPLES THERAPY Enactments may be loosely defined as therapist-coached couple interaction, and are typically initiated when a therapist invites partners to turn toward each other and talk about a particular issue, as the therapist observes and/or coaches the interaction (Butler & Gardner, 2003; Nichols & Fellenberg, 2000; Woolley & Wampler, in press). We conceptualize enactments as a “scaffolding” that may be placed over nearly any theoretical or clinical model of couple or family therapy. That is, enactments constitute a framework of clinical process—as opposed to a specific intervention or technique—within which the assumptions and interventions of many different theories may operate. Indeed, a number of well-established theories utilize enactments as a fundamental clinical process, such as structural family therapy (Aponte & VanDeusen, 1991), behavioral marital therapy (Jacobson & Margolin, 1979), and emotionally-focused couples therapy (Johnson, 1996). Enactments may be used to help clinicians develop a better understanding of client narratives and understand couple interaction in context, as well as assist clients in understanding their own and their partner’s narratives, to adjust existing narratives or mutually create new ones together, and to experience one another in a different way. From our perspective, and for the purposes of this paper, we conceptualize the overall purpose or goal of enactments as couple self-reliant interaction (Butler & Gardner, 2003). This is consistent with the strong emphasis in narrative therapy to de-center the therapist and allow the client system to take the lead in navigating and re-storying their lived experiences.

Clinical Process Research Large bodies of research literature linked to particular models of therapy (e.g., behavioral marital therapy, emotionally-focused therapy; Holtzworth-Munroe, Jacobson, DeKlyen, & Whisman, 1989; Johnson, 1996) suggest that one aspect of successful clinical process is high engagement or participation from clients. More recent research not tied to any particular theoretical model supports these findings. For example, Butler and Wampler (1999) found that couples in therapy tend to prefer a clinical process characterized primarily by couple interaction to a process in which the therapist channels interaction through herself


or himself. Clinical interaction in which the therapist encouraged partners to take responsibility for their own interactions resulted in less resistance or struggle in the session. In their review of research on in-session client resistance—or therapist-client struggle—Butler and Bird (2000) suggest a three factor model for avoiding harmful therapist-client struggle. The first is eliciting dialog, which suggests a clinical process that demonstrates “confidence in the endogenous expertise of couples/families, as evidenced by primary therapist process of facilitating successful couple/family dialogue; also, an avoidance of therapy process implicitly premised upon therapist expertise and hierarchy” (p. 134). The second factor is accommodation, which includes the clinician “preferring the couple/ family languaging, worldview, and interaction style to a clinical one” (p. 134). The third is enactments, which consist of enacting the clients’ desired change within the couple/family relationship and interaction, rather than making the clinician the central agent of change in the process. Conceptually, these suggestions—based on decades of empirical knowledge—fit closely with narrative therapy theory and practice. The narrative therapist typically holds a belief that individuals, couples, and families often know what is best for themselves, and have a better understanding of their current situation than the therapist could. Thus, eliciting couples’ conversations regarding their difficulties, strengths, and solutions reduces therapist direct involvement and hierarchy, a fundamental tenet of narrative therapy. Narrative therapists also seek to accommodate couples’ preferred world-view and communicative style, recognizing them as the “experts” on how they experience the world around them (White & Epston, 1990). Similarly, enactments allow for the clients’ wishes for change to be “enacted” within the couple relationship, using their own language and preferred interactional style rather than unfamiliar or externally imposed processes. As such, enactments offer the narrative therapist one way to organize her or his clinical process in an empirically informed manner while still remaining true to the subjective approach of narrative therapy. Although small, the body of literature specifically addressing enactments as a clinical process is growing. Recently, scholars have focused on the conceptualization, structure, and execution of enactments (e.g. Allen-Eckert, Fong, Nichols, Watson, & Liddle, 2001). These initial investigations of enactments have resulted in general recommenda-


tions to clinicians when using enactments, one of which is Butler and Gardner’s (2003) five-stage model of enactments.

FIVE-STAGES OF ENACTMENTS IN A NARRATIVE THERAPY CONTEXT For the purposes of this paper, a specific model of using enactments will be integrated into the process of narrative therapy. Butler and Gardner (2003) offer a comprehensive conceptualization of how enactments may be used over the entire course of the therapeutic process. Their model uses a five-stage progression that specifically addresses couple reactivity and maintains a client-responsible emphasis. They suggest that, as some couples present for therapy with high emotional reactivity and may not be capable of interacting with one another in a productive manner, therapy may need to begin with what looks like individual psychotherapy while allowing the other partner to just listen and try to understand. Over time, as partners become less reactive, the therapist may begin to include the observing partner, asking her or him to comment on specific statements, feelings, disclosures, or insights that the ‘active’ partner has shared. When spouses have demonstrated their ability to listen and express understanding, partners begin interacting together with coaching from the therapist. As couple interaction becomes more self-reliant—requiring less therapist coaching—the couple and therapist process more lengthy couple interactions, until the couple feels like they are ready to end therapy. Butler and Gardner’s (2003) five-stage model is a readily adaptable framework in which narrative therapy process can be conducted. In this section we describe in some detail each of the five stages and the clinical processes unique to that stage. We also demonstrate how the process is consistent with narrative therapy theory, provide a clinical vignette, and conclude by showing how the process supports the three stages and six themes deemed critical to narrative clinical practice (see Table 1; Coulehan et al., 1998; O’Connor et al., 1997). While enactments may be used with many couple and family relationships, the focus of this paper is on adapting the model specifically to narrative couples therapy. In addition, while we emphasize that not all couples or clinicians will “fit” our description of this model, we believe that it can be adapted to meet different therapeutic needs or styles. We encourage interested readers to consult the original work by Butler and Gardner (2003) for greater detail.


TABLE 1 The Five-Stage Model of Enactments as a Scaffolding for Narrative Couples Therapy

Note: This table shows an integration of Butler and Gardner’s (2003) Five-Stage Model of Enactments as a scaffolding for the process of narrative therapy (White & Epston, 1990). The table further exhibits the manner in which this integration incorporates the six major themes (O’Connor, Meakes, Pickering, & Schuman, 1997) and progresses through the three stages of transformation (Coulehan, Friedlander, & Heatherington; 1998) associated with successful outcomes in narrative therapy.

Stage One—Shielded Enactments Clinical Process Couples who present for therapy may initially be too reactive for a constructive enactment to occur in the traditional sense (therapistcoached couple interaction). Thus, Butler and Gardner’s (2003) model suggests that the clinician engage each partner individually in such a


way that the observing partner is not in a position to interrupt or interact with her or his partner. More specifically, throughout this stage, each individual’s narrative is designed to be “passed through” the therapist—filtered or reframed—to the partner in a way that encourages the observing partner to hear and understand the narrative. By using a shielded enactment, each person is allowed to share his or her story with the therapist (and, indirectly, with the partner) and to feel as though his or her story has been heard and understood. The therapist is able to hear each partner’s uninterrupted narrative and demonstrate “multi-directed partiality” for each narrative and each partner’s worldview (Anderson & Goolishian, 1988). Consistency with narrative therapy theory. From a narrative therapy lens, the “problem” that individuals present with in therapy is rooted in the telling of a story. Therefore, in narrative therapy, the therapeutic process begins with an exploration of the problem-saturated descriptions that each person has attributed to his or her life. In order to more fully understand each person’s narrative, it is important for the therapist to communicate with each partner individually and listen attentively to his or her descriptions of the dominant, problemsaturated story. Using shielded enactments facilitates this process, and is consistent with the premise in narrative therapy to de-center the therapist and establish the clients as experts on their own lives (Friedman & Coombs, 2002; White & Epston, 1990). Clinical vignette. For this, and each of the following stages, we have written a clinical vignette using a hypothetical young couple, Mike and Jen, who present for therapy due to marital conflict and “constant bickering.” This vignette is intended to be a model of what a therapy session might look like within each of the five stages of enactments. We recognize that our description of an enactment as presented throughout this vignette differs significantly from that of other wellestablished models of clinical practice (e.g., structural and emotionallyfocused). We believe that the fundamental premise of enactments is to promote couple interaction and to engender self-reliance in couple interactions. Thus, in our minds, clinical practices which may not resemble traditional enactment episodes (e.g., where the therapist turns to one partner and invites her or him to speak to the other) but which are incorporated into therapy with the purpose of eventuating such an interaction, may be considered part of the enactment process. An example of stage one is provided below. In this stage, the vignette will


show how the therapist minimizes couple reactivity by interacting with each partner individually, while the other partner is invited to sit to the side and listen. Therapist: Mike, would you mind sitting in the easy chair right now? I’d like you to just relax and listen. This is an opportunity for you to eavesdrop as Jen describes her experience in the relationship. You may feel like you want to challenge something Jen says, but I’d encourage you to just listen and see if you can understand her a little bit better than you have in the past. Mike: I suppose I can do that, as long as I have a chance to share my story because, chances are, she won’t tell you how things really are. Jen: See what I mean? He’s always harping on me, claiming that I am making things up! Therapist: It seems like both of you are really passionate about your relationship, which is really great. Yes, Mike you will get an opportunity to share your story of your experience in the relationship, but for now I’d like you to sit back and see if you can’t hear something you have never heard before from Jen; this is an opportunity for you to hear her story. Now, Jen tell me what your experience has been in this relationship. Jen: Well, Mike can be extremely negative and cynical at times. He knows that this bothers me but it seems like he almost does it on purpose, to make me angry. Therapist: Why don’t you start from the beginning and tell me your story of your relationship with Mike. [Jen shares her story while the therapist and Mike listen.] Therapist: You identified cynicism and negativity repeatedly. Would it be correct to say, then, that your problem story is really about these two issues, negativity and cynicism? Jen: Yeah, that’s pretty much what I see as the problem. I mean, we’ve had our good times, but Mike is really being ornery a lot lately. That hurts my feelings. I feel like we’ve been drifting apart, but I’ve only really noticed it more recently. I don’t know Mike anymore, and I don’t feel like he knows me. It’s kind of like living with a stranger. And it’s easy to be hostile and sarcastic to a stranger. Therapist: I think I’m starting to understand your story and how you must be feeling. Thanks, Jen, for sharing your experience. I want to ask you now if you can switch roles with Mike. I think it is important for us both to hear his story and try


to understand how he is experiencing things. [Mike and Jen switch seats and Mike shares his story of the relationship.] Therapist: Wow, it sounds like you are kind of agreeing with Jen, that negativity and cynicism are really prevalent in your relationship. Would you agree with that? Mike: Yes, I really do think that there are a lot of times when I am negative. But I’m not the only one. I’m not going to take all the blame for the problems we’re having. Narrative process themes and stages addressed. Three of the six major themes in narrative therapy (O’Connor et al., 1997) are seen through the organization provided by the first stage of the enactment. First and foremost the therapist is able to focus her or his attention on each partner individually, rather than focusing solely on regulating a balanced, positive couple interaction (Butler & Gardner, 2003). Although all of the therapeutic conversation is channeled through the therapist, by allowing the therapist to interact individually with each partner the therapist is de-centered from the “position of authority” (the role of the judge) thus allowing the therapist ability to establish a non-blaming therapeutic stance—a major theme in effective narrative therapy (Besa, 1994; O’Connor et al., 1997; White & Epston, 1990). A second theme is seen in this phase of therapy as the therapist invites the observing spouse to sit off to the side and assume an attentive, listening position. In this way, the therapist is essentially “creating an audience”—another major theme of effective narrative therapy, encouraging the observing partner to listen to the story being shared. As mentioned above, while the participating spouse is sharing his or her individual story the observing spouse, by standing meta, is able to witness this telling, thereby validating the expressed narrative (White & Epston, 1990). Finally, the main focus of the conversation between the therapist and each partner was that of defining the problem. Problem definition is an initial and essential step in externalizing the problem, an additional theme of narrative therapy (O’Connor et al., 1997). Aside from the incorporation of these themes, this first stage of the enactments process also initiates the first of Coulehan and colleagues’(1998) three stages of transformation. They found that successful narrative therapy was accomplished by helping families transition from an intrapersonal construction of the problem to a more relationally-based interpersonal construction. The first step of the transformation process focused on helping families, couples in this case, expand


their view of the origin of the problem. By creating space for the observing spouse to hear the partner’s narrative each begins to hear and develop multiple views of the problem.

Stage Two—Buffered Enactments Clinical Process According to Butler and Gardner (2003), the transition from shielded enactments to buffered enactments is subtle, and primarily involves the clinician bridging the partners’ narratives with “sidebars.” Generally, the therapist will interact with one partner at a time, and, upon learning something new or hearing something interesting, might slide her or his chair closer to the observing partner to briefly process the new information. This discussion might focus on what was just heard and how that fits with the observing partner’s story. Interaction is still channeled through the therapist during this stage in order to ensure that individual narratives are fully articulated and not threatened by the partner. This allows the therapist to demonstrate support for both narratives and to begin to encourage the observer to support her or his partner’s narrative. Couples transition from stage two to stage three when the couple and the therapist feel that they are ready to move to a clinical process that is more intense, in which the primary objective is to begin to develop a new couple narrative that accommodates both partners’ worldview and experience. Consistency with narrative therapy theory. Once the dominant, problem-saturated story has been defined by each partner, it is important to externalize the problem, meaning, to help each person view the problem as separate from self and, thus, within one’s ability to control. This leads to the recognition of personal agency rather than maintaining the debilitating position of self-identification with the problem. The externalized problem is often given a name (White & Epston, 1990), following which the focus shifts to mapping the problem’s influence in the lives and the relationships of the clients. Further, it is important to map each person’s influence in the “life” of the problem. That is, to help each person to see the ways that he or she interacts with the problem and how they each have or have not controlled the problem in their lives. Using buffered enactments in this stage of the narrative therapy process can facilitate the further development of each person’s story of the problem. Additionally, the “sidebars” that are taken with


the listening partner can be used to prompt or reinforce that partner’s awareness of the speaking partner’s alternative perception of the problem. Clinical vignette. Prior to this point, the couple and the therapist will likely have spent several sessions defining the problem using stageone enactments. As clients begin to feel that they are able to be more calm, avoid interrupting, and express some level of understanding, the therapeutic process transitions to buffered enactments, stage two (Butler & Gardner, 2003). While each person may have begun the process of experiencing her or his partner’s distinctive story, reactivity and defensiveness may continue to have a powerful effect on their relationship. Therefore, in stage two, as seen in this segment of the vignette, the therapist will continue the process of narrative therapy and will begin to facilitate increased interaction between the couple through the use of sidebars. Therapist: So Mike, it appears that the themes of negativity and cynicism continue to show up in your story of the relationship, is that right? Mike: You’ve got that right. It seems like every time I come home Jen is constantly on my back, accusing me of this or that. It’s just really frustrating. Therapist: It sounds like “the problem” has really been influencing your relationship lately. Can you talk with me about how “the problem” specifically influences you? Mike: I don’t know. I guess when Jen is always so negative I get tired of it and get negative or critical myself. Therapist: Can you tell me a little more about how it feels when “Negativity” is around? Mike: Well, when I notice “Negativity”, I feel overwhelmed or held hostage; like I don’t have any choices. Therapist: (Asking Mike for an opportunity to speak with Jen). Jen, did you know Mike felt this way when “Negativity” was around? Jen: I don’t know that I’ve ever heard Mike talk about feeling that way before. Therapist: Does it surprise you that “Negativity” has that kind of influence on Mike? Jen: Well, yeah. I thought I was the only one who felt that way. Narrative process themes addressed. Many of the same narrative themes are evident in stage two enactments as in stage one. In this


stage, each partner begins the process of developing a personal sense of agency as well (O’Connor et al., 1997). Through sidebars, the therapist seeks to help each partner understand the perspective that is being clarified by the other. Through this, working to externalize the problem, and seeking to understand and validate each partner’s story, the therapist inadvertently punctuates the agency of each person. Each is free to view the problem the way he or she does, and each perspective is valid. As the externalization and deconstruction of the problemsaturated story continues, an increased awareness of personal agency is achieved. Throughout stage two the couple continues to develop multiple views about the origin of the problem—thus remaining in the first stage of transformation (Coulehan et al., 1998). By introducing occasional breaks with the observing partner the couple begins to soften and reinforce one another’s story. This shift in focus helps the couple to begin to move into the second stage of transformation—a shift in affective tone.

Stage Three—Talk-Turn Enactments Clinical Process Before proceeding, it is important to note that this model of using enactments (Butler & Gardner, 2003) may be adapted to couples’ and therapists’ preferences. For instance, some couples may not need the initial processes of stages one and two in order to stabilize their relationship and may be able to move to more intense and interactive discussions of relational problems from the beginning of the therapy process. In Butler and Gardner’s (2003) model of enactments, stage three begins the shift from therapist-centered interaction to couple-centered interaction. The therapist, removing himself or herself from the interactional sequence, asks the couple to face one another and discuss the problem. Talk-turn enactments represent a typical enactment process, with partners talking directly to one another and the therapist coaching their interaction. This coaching may be fairly intensive initially as couples adapt to interacting with one another in this setting. It is anticipated that as the couple narrative becomes more firmly entrenched and enacted in the lives of partners that therapist involvement becomes less intense. This is one indicator for transition to stage four; this transition, like the transition from stage one to stage two, may be very gradual and subtle, such that there is no clear demarcation between stages.


Consistency with narrative therapy theory. Throughout the process of therapy, the therapist seeks to help the person find the inconsistencies, hidden assumptions, and contradictions in the dominant story. This process is known as deconstructing the problem. As deconstruction continues the person is invited to take a position regarding the dominant versus the preferred narrative. At that point, the person and therapist assume a united stance against the problem. The process of deconstructing the dominant story creates a space for the creation or recognition of alternative stories. Unique outcomes are highlighted as potential foundational ideas for a preferred or “alternative” story. Unique outcomes are experiences in the person’s past or current life that are inconsistent with the problem-saturated story. At times, unique outcomes can be formulated as a possibility of what could be rather than what has already occurred, particularly if the person is struggling to recognize times when they behaved or believed differently. Discussing unique outcomes allows for the creation of alternative stories in place of problem-saturated stories. Stage three of the enactments model (Butler & Gardner, 2003) is consistent with these narrative therapy processes in that the therapist facilitates dialogue between partners regarding the presenting problem. As the partners discuss the story, each person’s perception of the problem can be addressed, and coaching from the therapist could provide a rather meaningful way to highlight hidden meanings, gaps, and conflicts in the narrative. Therapist coaching can also facilitate a mutual validation of the multiple perspectives of the problem. Further, as partners begin to validate each other’s perspective, affective softening occurs, and partners may become less defensive and, subsequently, more willing to consider unique outcomes and alternative stories. As such, couples are able to let go of the problem-saturated story that brought them to therapy and begin to create a new narrative together. Clinical vignette. This third segment of the vignette will show the way in which talk-turn enactments are used to help the couple externalize the problem and move toward recognizing unique outcomes and creating an alternative story. At this point, Mike and Jen have externalized negativity and cynicism as “The Two-headed Beast.” The couple returns to therapy and the therapist invites the couple to talk with each other about their experience over the past week. Therapist: I was wondering if the two of you could chat with each other about both of your experiences with “The Two-headed


Beast” this past week. Now, at times I may slide over to one of you and invite you to rephrase something so that it’s easier for your partner to hear. Mike: (angrily) Well, I noticed that “it” arrived this morning when you were complaining about me working too much. That really pissed me off, because the only reason I’m doing all of this is for you. Jen: (becoming reactive) For me!? That’s always your excuse. I don’t want you to be gone all the time. I want you home sometimes, too. Therapist: (interrupting the couple) I’m wondering if the beast is here with us right now? (both partners nod their heads sheepishly). I’d like to invite you to talk about what each of you did to invite the beast into your conversation just now. Jen: I just get so frustrated when Mike blames me for problems in our relationship. Mike: I guess I was feeling defensive when Jen was complaining this morning. Therapist: Could the two of you talk about a time when you felt the same way, but didn’t allow the beast to come into your relationship? Narrative process themes addressed. Each of O’Connor and associates’ (1997) themes addressed in the previous stages continue here in the third stage of treatment. Developing personal agency is a major theme of stage three, perhaps in a more intensive way than in the second stage. Stage three marks an observable shift from therapistcentered interaction to couple-centered interaction. By removing himself or herself from the couple interaction the therapist encourages the couple to see themselves as becoming more and more self-reliant in listening and telling one another’s alternate stories. Additionally, during this process the therapist and couple solidify the externalization process by naming the problem and taking a position against it. This allows the couple to recognize unique outcomes and initiates the development of a mutual alternative narrative. A final theme that becomes evident, at times, within the third stage of treatment is the use of a reflecting team stance within the sessions. O’Connor and colleagues (1997) found that the use of reflecting/consulting teams (Andersen, 1991) was one of the six major themes that were beneficial to clients within a narrative therapy context. Although not traditional in nature, the observing partner can offer some of the same benefits of a reflecting team atmosphere. As one partner listens to and reflects on the therapeutic conversation, the active part-


ner is able to get some feedback on the therapy process. Throughout the therapeutic conversation the active partner is invited to take a step back and listen as the observing partner and the therapist comment on the interaction. By offering the active partner an opportunity to receive the observing partners’ observation, suddenly the active partner becomes the “audience” that listens to the “team” discuss their perceptions of the interaction. Every story needs a listener and a teller (Freedman & Combs, 2002). Through these interactions, the observing partner begins to validate, empathize, and show that they understand the story of the active partner. Regarding the stages of transformation presented by Coulehan and associates (1998) the couple continues to express multiple views of the problem but the use of stage three shows a marked transition from looking at multiple origins of the problem to focusing on softening the affective tone. Thus, while remnants of the first stage of transformation remain, therapy primarily shifts to helping the couple soften the tone of the therapeutic conversation.

Stage Four—Episode Enactments Clinical Process Episode enactments are characterized by a process in which the therapist does little coaching, but is involved more in processing more lengthy interactions that the couple has in the therapy session. Thus, the clinician may ask the couple questions about their experience during the interaction, how their discussion fits into their couple narrative, and what the couple believes needs to change in their interaction in order to get to a point where they feel like they don’t need therapy anymore. During this process the therapist becomes the observer to the couple narrative and interaction, and after interaction episodes offers thoughts or insights if the couple so desires. Transition to stage five occurs when therapy is terminated. Consistency with narrative therapy theory. Once the preferred story has been created, episode enactments are appropriately engaged in to clarify and solidify the new interactions for the couple. As alternative stories are lived they become more embellished and collaborative events from the person’s life (past, present, or future) support the permanence and increasing dominance of the “alternative story.” The process of authoring alternative stories invites the person to be


the “audience” for alternative story telling. In stage four, then, focus is turned to the solidification of the preferred story through telling and re-telling the re-constructed story to enrich the narrative and to performing the preferred story. Insofar as the desirable outcome of therapy is the generation of alternative stories that incorporate vital and previously neglected aspects of lived experience, and insofar as these stories incorporate alternative knowledge, it can be argued that the identification of and provision of the space for the performance of these knowledge is a central focus of the therapeutic endeavor (White & Epston, 1990, p. 31). Once the preferred story has been established concretely, clients also are encouraged to seek an “external audience,” (i.e., other meaningful people in their lives who would be sympathetic to the alternative story) with whom they can share the new story and thus integrate it more fully into their lived experience. Through this process, the reality, validity, and meaning of the preferred narrative are enhanced for both the client and their external system (i.e., family, friends, and so forth). Engaging an audience that is significant to the person and harnessing the power that is so often assigned to the written word become effective ways of validating the person’s alternative story by briefly documenting the changes that he or she has made in their life (Besley, 2002, p. 129). Involving an external audience can be accomplished by writing out the new, preferred story and sharing the written narrative with meaningful persons in the client’s life who would be sympathetic to the revised story. Perhaps more significantly, an external audience can be invited to attend one or more therapy sessions to observe and/or participate in the re-telling or performance of the preferred narrative. Actual enactment of the preferred narrative may enhance the meaning of the new story for the person as well. In any case, as is indicated in the structure of stage four enactments, the therapist is much less involved in the couple interaction than in previous stages, which enhances their autonomy and unified approach to living their lives according to the preferred story that they have created together. Clinical vignette. As the couple progresses through the stages of enactments they become more and more self-reliant, meaning the role


of the therapist becomes less and less involved. The role of the therapist during a stage four enactment is primarily one of processing the interaction after it has run its course, as is seen in the following segment of the clinical vignette. Therapist: It seems like the beast is becoming less powerful as each of you become more active in chasing it away. Today, I’d encourage you to discuss how this change in interaction has affected your relationship. I’m going to sit back here and eavesdrop on your discussion. After several minutes, if needed, I can help you process how the conversation went. Therapist: (following the couple’s seven-minute discussion of what they were able to do this past week to overcome the beast) How did the two of you feel about that conversation? Jen: I felt really comfortable, although there were times when I started feeling a little bit anxious, almost as though the beast was looking for a way into our discussion. Mike: I noticed that, too, but I thought I was able to keep “it” away from our story and not let “it” get the best of me. Therapist: I wonder if the two of you could take a few minutes and talk about what things you did specifically to keep the beast out of your story during that last conversation? Narrative process themes addressed. In this stage, while some are more central than others, each of O’Connor and colleagues’ (1997) six themes continue to occur. In particular, through stage four interactions the couple continues to move up the spectrum of personal agency. As the couple becomes increasingly self-reliant the therapist becomes less involved and the responsibility is shifted entirely to the couple, with only minor interactions with the therapist. Furthermore, in stage four an interesting shift occurs. The therapist begins the shift from involved participant to that of “audience.” Throughout the course of therapy, through a non-blaming stance, the therapist has developed a strong therapeutic stance with each individual. Such alliances allow the therapist to be a credible audience to the couple’s alternative story. In essence, the therapist becomes the witness of the couple’s new interaction. However, even though the therapist can fulfill the role of the audience it does not indicate that he or she is the only one that can act in that capacity. Others, including friends and family, can be included within the session as a reflecting team to add validation to the recreation of the dominant story. At this point, consistent with Coulehan and colleagues (1998), an


important transformation has taken place for the couple. Through the process of enactments multiple views have been expressed, the affective tone of the couple has been softened, and now they are in position to ascribe positive meaning to one another as well as to the relationship. This marks the final stage of transformation within their model for successful narrative therapy.

Stage Five—Autonomous Relationship Enactments Clinical Process According to Butler and Gardner (2003), relationship enactments represent the type of process that couples are able to engage in following termination of therapy. Partners are able to discuss their individual stories with one another, and hear their partner’s individual narrative, without engaging in processes that they believe may harm their relationship. Furthermore, partners are able to “fit” problems or difficulties into their couple narrative, deconstruct problems, identify unique outcomes, and enact their preferred narrative. In accordance with the couple’s autonomous position, they are able to move on in their relationship without the assistance of the therapist. As such, stage five enactments, or relationship enactments (Butler & Gardner, 2003), occur outside of therapy following termination. Consistency with narrative therapy theory. In narrative therapy (White & Epston, 1990), the process of therapy is concluded as the client has re-authored her or his life experiences into a new and preferred story that is meaningful and functional for her or him. Through restorying the preferred, alternative narrative and “performing” it with the therapist and for/with the external audience, the person is able to solidify and own a new story of their life that gives meaning where meaning was previously unfavorable or perhaps unavailable. As clients are able to live out the preferred story and therapy is terminated, they are provided space for engaging in new possibilities and personally meaningful life experiences without the involvement of the therapist. Clinical vignette. As autonomous relationship enactments occur primarily outside of the therapy room, we do not provide a specific example of Mike and Jen’s interactions here. However, the therapist and couple may want to spend some time prior to the completion of therapy discussing possible future difficulties, developing therapeutic


documents, and/or planning and executing an ending ceremony or ritual (Imber-Black, 1988; White & Epston, 1990). We envision that couples that engage in these types of enactments are able to live their new couple narrative and respect one another’s individual narratives within a variety of social and relational contexts (i.e., family, community, and church). Thus, Mike and Jen would be able to remain true to their new story and resist succumbing to older, problem-saturated stories and other difficulties in the future. Narrative process themes addressed. With some couples, the transition from the episode enactments (stage four) to the autonomous relationship enactments (stage five) might result in succumbing to their old, problem-saturated stories. In order to make that transition smoother, these couples may plan a celebratory session in which they invite friends and/or family members to observe their interactions from behind the mirror. Although not every couple may benefit from this type of session, some may find it helpful in solidifying their new narrative. Three narrative themes might emerge from this type of celebratory session. First, the invited guests become the external audience—witnessing the couple’s new narrative. Based on this experience, friends and family members may begin to re-create their own narrative surrounding the couple. Finally, another possibility is to invite the guests into the therapy room and use them as a reflecting team (Andersen, 1991) in order to solidify the unique outcomes expressed within this session.

CONCLUSION Success using narrative therapy is achieved when “a transformation has taken place in the family’s set of dominant stories so as to include new experiences, meanings, and actions, with the effect of loosening of the thematic grip of the set of stories on symptomaticproblematic behavior”, according to Sluzki (1992, p. 219). Through the use of enactments couples are able to identify, discuss, and deconstruct problematic narratives and themes as well as jointly create new experiences, meanings, and narratives within the couple relationship. Enactments are commonly seen as an intervention to be used at various times during the therapeutic process. From our perspective, enactments are a processual framework that may be used throughout the entire course of narrative couples therapy, allowing therapists and


couples to adapt the therapeutic process to their current needs and to allow narrative therapy to be conducted under the rubric of an “empirically informed therapy” (Amundson, 2001). Using the Butler and Gardner (2003) enactments stage model does not empirically validate narrative theory per se, but it does provide a scaffolding that empirically informs the narrative therapy process and strengthens the stance of narrative therapy under the scrutiny of those claiming a need for an evidence basis in psychotherapy.

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