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To cite this article: Elaine Hannen & Kevin Woods (2012) Narrative therapy with an adolescent
who self-cuts: a case example, Educational Psychology in Practice: theory, research and practice in
educational psychology, 28:2, 187-214, DOI: 10.1080/02667363.2012.669362
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Educational Psychology in Practice
Vol. 28, No. 2, June 2012, 187–214
Introduction
Educational psychologists (EPs) and therapeutic intervention
There is a high prevalence of mental health problems in children and young people
(CYP) in the United Kingdom (UK), and growing evidence to support the efficacy
of psychological therapies (MacKay, 2007). The promotion of emotional well-being
in CYP was a UK Government priority under the Labour Party because of the
direct effect of early mental health difficulties upon social, physical, and cognitive
development, and well-being in later life [Department for Education and Skills
(DfES), 2004]. The Coalition Government has committed to the former govern-
ment’s “Improving Access to Psychological Therapies” (IAPT) initiative which aims
to improve the access of CYP to evidence based psychological therapies [Depart-
ment of Health (DOH), 2011].
The Professional Practice of Educational Psychologists [Division of Educational
and Child Psychology (DECP), 1998] states that therapeutic work with children and
their carers should feature prominently in the work of EPs. However, MacKay and
Greig (2007) observe that little has changed in educational psychology practice
since Indoe (1995) commented that the term “therapy”1is seldom heard in the
profession. The high involvement of educational psychologists (EPs) with special
educational needs (SEN) policy, process and practice has reduced the scope of their
work (DECP, 1998), so that innovative interventions in schools are often seen as
the responsibility of other professionals (Baxter & Frederickson, 2005). The
demands of statutory assessment work have prevented EPs from making more than
a limited contribution to improving children’s emotional health, although many
school staff would welcome EPs providing therapeutic interventions (Farrell et al.,
2006).
Some EPs may consider that professionals in Child and Adolescent Mental
Health Services (CAMHS) are more able to provide therapeutic interventions
(Pomerantz, 2007). However, EPs, with their knowledge of child and adolescent
psychology, and experience of the educational context, are well placed to deliver
appropriate therapies effectively (MacKay, 2007), particularly in schools, which
may be the best way of helping children given the familiarity of the school environ-
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ment to both children and parents (Greig, 2007; Woods, Bond, Farrell, Humphrey,
& Tyldesley, 2009). EPs are named in recently published public health guidelines
as appropriate specialists to deliver interventions that promote the emotional well-
being of children and their families [National Institute for Clinical Excellence
(NICE), 2008]. Integrated working between EPs and the professionals in CAMHS
should ultimately promote improved outcomes for CYP through the coordination of
delivery of therapeutic interventions (Fallon, Woods, & Rooney, 2010; Farrell et al.,
2006; Scottish Executive, 2002).
A UK wide survey of EPs’ involvement in delivering therapeutic interven-
tions is currently being undertaken by Manchester University and is due to
report in 2012 (Atkinson, Bragg, Squires, Muscutt, & Waslisewski, 2011). The
purpose of this article is to contribute to the early stages of empirical evalua-
tion of the specific therapeutic practice of narrative therapy (NT). The impor-
tance of each specific therapeutic approach developing its own evidence base
is amply illustrated in the “Serious Case Review Report on Baby Peter”
[Local Safeguarding Children Board (LSCB) Haringey, 2009]. Developing an
evidence base for innovative approaches means they can then be used to
respond flexibly to meet the needs of individuals as outlined in the Coalition
Government’s plan for Improving Access to Psychological Therapies (DOH,
2011).
2007; Hawton & Harriss, 2008). This suggests that EPs may regularly come into
contact with CYP who may engage in self-harming behaviours and that the needs
of this group of CYP are unlikely to be completely met by other specialist services
such as CAMHS. Individuals differ widely with regard to the number of previous
self-harming episodes, motives for self-harm, and psychological characteristics
(Slee, Arensman, Garnefski, & Spinhoven, 2007). Many self-harming adolescents
have experienced family problems (Hawton & Harriss, 2008), such as low parental
support and acceptance (Jones, 1991), or early neglect, violence or abuse (Best,
2005). Young, Sweeting, and West (2006) found an increased incidence of self-
harm within the Goth subculture.2 The findings suggest this was possibly due to
emulation of icons or peers within this subculture group, who accept self-harm
despite wider social sanctions, and also due to the selection of the Goth subculture
by young people with a propensity to self-harm, with the latter cause perhaps being
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more likely.
Those who self-injure exhibit more frequent and intense negative emotions,
such as depression and anxiety, self-directed anger and dislike, than their peers.
The most prevalent function of their behaviour is to alleviate these emotions
(Klonsky, 2007; Klonsky & Muehlenkamp, 2007). For some, self-harm may help
to create a sense of identity when feeling alienated from the world (Allen, 1995;
Suyemoto, 1998). It may also be a form of self-punishment (Klonsky & Mueh-
lenkamp, 2007), or a means of communicating one’s pain to others to obtain sym-
pathy (Favazza, 1989). However, self-harm offers only temporary relief and it
does not address the underlying emotional difficulties (Mental Health Foundation,
2005), although in some cases it may prevent young people from taking their
lives (Best, 2005).
In the United States many adolescents who self-harm use the internet to
access information about self-harm, and to share personal stories. Sharing poten-
tially reinforces narratives so that self-harming behaviour is normalised and sup-
ported for those engaging in the discourse, despite wider social sanctions
(Whitlock, Lader, & Conterio, 2007). There may be a similar pattern of internet
use in the UK.
There is little research on the efficacy of therapeutic interventions with young
people who self-harm, particularly with those who self-cut (Mental Health Founda-
tion, 2005), which is the most common form of self-harm in community samples of
UK adolescents (Hawton & Harriss, 2008).
HS involvement. She lived with her mother, her younger half brother and her
mother’s boyfriend, who B referred to as her “step-dad”. B had limited contact with
her biological father who had remarried and started a new family. B had some addi-
tional slight learning needs. She had attained level 3 in English at Key Stage 2 (the
average is level 4), and she was in a small class of 18 pupils who were taught for
10 hours a week by their form teacher, M. B’s learning needs were considered
when evaluating her development of narrative, in that she was potentially vulnerable
to forming a dominant problem-saturated story and she might have greater difficulty
generating alternative preferred stories about her life than her more able peers
(Stacey, 1997). Her needs were also considered when applying NT, and the
psychologist therapist adapted narrative practices and language so they were
appropriate to her.
Procedure
Prior to the intervention, B’s mother gave her permission for B to participate in the
study. The first author liaised with professionals at CAMHS who then offered B a
risk assessment, which her mother declined.
Six sessions of NT, of approximately one hour in length, were held in
school at weekly intervals outside school holidays. All sessions were audio
recorded for later analysis. The narrative practices used (see Figure 1) are estab-
lished narrative practices learned by the first author, the EP, on a six day Level
One training course in NT. Understanding of these narrative practices was
consolidated during monthly group supervision with an Association of Family
Therapy (AFT) accredited supervisor, and by reading published texts on narrative
approaches. The EP also received fortnightly generic supervision from a more
experienced EP in her educational psychology service (EPS). The EP’s develop-
ment of narrative practice is set against a background of broader therapeutic
practice and training including Solution Focused Brief Therapy, Counselling
Skills at Certificate level and Postgraduate level study of Cognitive Behavioural
Therapy and Motivational Interviewing.
Therapeutic documents are a key practice of NT (Payne, 2006), and the format
of those used in this study accorded with the guidelines for NT documents in
Freeman, Epston, and Lobovits (1997) and Fox (2003). The narrative practices (see
192 E. Hannen and K. Woods
Externalising
Externalising is designed to help persons to separate from problems they may regard as fixed or
intrinsic to their identity (White, 1995). The narrative therapist listens to the person’s description of, or
name for the problem. The person’s words are rephrased to situate the problem outside, rather than
within the person. For example adjectives (“worried”) or verbs (“worry”) might be changed into nouns
(“the Worry”). Personification can be useful in externalising conversations, for example the therapist
might discuss the problem’s “tricks”, “tactics” and“plans” (Morgan, 2000, p. 24).
Unique outcomes
The therapist listens for events that contradict the problem saturated story. These exceptions to the
problem story are “unique outcomes” (White, 2007, p. 219). A unique outcome may be “a plan, action,
feeling, statement, quality, desire, dream, thought, belief, ability or commitment ” (Morgan, 2000, p.
52). That the person attends the NT session can be a unique outcome. Questions can also be used to
elicit unique outcomes. For example “How have you managed to stop the problem from getting
worse?” (Morgan, 2000, p. 57).
Re-authoring
In “re-authoring” conversations (White, 2007, p. 61) the therapist helps the person to link present
unique outcomes with unique outcomes in their past. For example, “Have there been times in the past
when you have stood up for Fairness/got the better of Anxiety? ” The person is also questioned about
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the meaning of the unique outcomes. For example, “What does it say about you as a person that you
would do this?” (Morgan, 2000, p. 63) According to White (2007, p. 62) conversations about these
alternative storylines helps to “thicken” them, which helps the person identify preferred directions and
future problem-solving processes.
Re-membering
“Re-membering”conversations consider significant figures, either still in the person’s life or no longer
present, who might support the alternative emerging story (White, 2007, p. 129). These figures, who
hold memories of the person demonstrating certain skills or traits, are honoured with “membership” in
the person’s “club of life” (Payne, 2006, p. 173). The person is invited to speculate about what this
significant other would think and say about the emerging story. The person can also dismiss people
from their club of life. An example of a re-membering question, is “Who else would know that you
stand for ‘being there for people?’”
Outsider witnessing
“Outsider witnesses” are people, known or unknown to the person, who witness the conversation
between the therapist and the person. Outsider witnesses do not form opinions or give advice on the
person’s story. Their role is to listen to the “telling”of the person’s story. During an interview with the
therapist, they then acknowledge the problematic element and reinforce unique outcomes in a
“retelling” of the person’s story (White, 2007, p. 164–165).
Therapeutic documents
The person is consulted about whether they wish to receive a therapeutic document. They may even
create the document with the therapist (Freedman & Combs, 1996). Fox (2003) identifies four types of
therapeutic document:
1. Letters that record emerging alternative stories.
2. Documents that record knowledge of particular skills or aspects of identify that the person needs to
have available to them at times of crisis.
3. Declaration documents that communicate the alternative stories to others in the family or
community.
4. Documents that contribute to rites of passage, facilitate transitions, and celebrate achievements.
Other
Questioning is used extensively during NT (White & Epston, 1990). Creative approaches such as
games, play, and drawing can be used to identify dominant narratives and develop problem solving
abilities (Freeman, Epston, & Lobovits, 1997).
Figure 1. Description of narrative practices used in the EP’s therapeutic intervention with
B.
a result of the interview with M (see Findings section later). M also attended ses-
sion five of the intervention as an “outsider witness” within the NT process.
B’s readiness to change was assessed pre-intervention in interview using the
Model of Stages of Change (Prochaska & Di Clemente, 1982). Di Clemente and
Velasquez, (2002) suggest that change is more likely to occur if the individual is
close to Stage 3 (“preparation for change”) of the Model of Stages of Change. Prior
to the intervention, B’s response to the Model of Stages of Change suggests that
she was between Stage 2: the “contemplation” and Stage 3: the “preparation”, for
change stage of the model (Di Clemente & Velasquez, 2002, pp. 208–209). B com-
mented: “I’d love to change… I’ve always known it’s not good to do that [cutting]
… but it’s hard.”
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Data gathering
Data gathering methods are summarised in Table 1.
Findings
Which NT practices are considered to be helpful by an adolescent who self-cuts?
B’s view
B reported that she considered all the narrative practices helpful, particularly uni-
que outcome conversations, outsider witnessing, therapeutic documents and re-
membering. B also found the therapeutic relationship helpful: “You’ve helped me
a lot … I can tell you everything about my life …. Because I can tell people
things it’s better around the house, so I think it’s a fresh start for me.” The first
author had involved Social Services when B reported an adult neighbour’s sexua-
lised behaviour towards her, and it is likely that the removal of this threat, and
B’s resulting feelings of safety, also contributed to B finding the intervention help-
ful. It is noteworthy that B’s self-cutting behavior pre-dated this problem with her
neighbour.
Method Description
Parental report • B’s mother and step-father were interviewed at home. They:
identified three targets they hoped B would meet as a result of NT on a Target Mon-
itoring and Evaluation (TME) form (Squires, 2006)
provided a baseline rating for each target on a scale of 1 to 10, and a brief descrip-
tion of each baseline behaviour.
rated and briefly described the expected progress for each target.
• Post-intervention, they rated and described actual progress on the TME in a telephone
E. Hannen and K. Woods
interview.
Beck Youth Inventories Second Edition (BYI-II) (Beck, • The BYI-II were used to assess B’s perception of her negative affect pre- and post-
Beck, Jolly, & Steer, 2005) intervention.
• The BYI-II were scored according to the manual.
(Continued)
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Table 1. (Continued)
Method Description
• The NAI was completed with B and audio recorded pre-intervention. B’s responses
were recorded on a summary sheet.
• B reflected on the summary sheet in a post-intervention interview.
• The post-intervention NAIs were recorded, and summarised.
• The data on B’s pre- and post-intervention summary sheets were transferred to a table
which facilitated comparison.
Hardkte and Angus (2004) propose that the NAI potentially thickens unique outcome
stories by encouraging clients to reflect on their self-stories and change. Like the
RIQ, it is both a narrative intervention and an evaluation tool.
Therapeutic documents
• Therapeutic documents were given to B during the intervention.
• One purpose of therapeutic documents is to record preferred stories as they emerge in
conversation (Fox, 2003).
• B’s own words were used in the documents when appropriate.
• The documents were checked for accuracy with B, in accordance with narrative prac-
tice (Fox, 2003).
Educational Psychology in Practice
(Continued)
195
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Table 1. (Continued)
196
Method Description
Post intervention Likhert (five-point rating) scale • B’s responses to the questionnaire were quoted.
questionnaire and semi-structured interview • B’s responses to the semi-structured interview were audio recorded and transcribed.
• The narrative practices used were identified from transcripts of the therapy sessions.
• B’s responses to narrative practices were organised in charts according to White’s
(2007) maps of narrative practice.
• Examples of B’s responses to specific narrative practices were also quoted to allow
the reader to assess the fit between the data and its interpretations.
E. Hannen and K. Woods
Reflective diary • After each NT session the first author recorded observations on B’s responses to nar-
rative practices and processes in a reflective diary. Observations were recorded in tab-
ular form, according to:
whether they provided positive or negative evidence for the helpfulness of narrative
practices,
whether there was a need for clarification through supervision.
Researcher (R):What effect is it [anger] having on your friendships and your family?
B: When my family fall out, say if I fell out with mum, mum would be
stressed and then mum would fall out with nana, and … nana would
fall out with granddad, and I’d feel stupid because it’s all come down
on me, making all my family fall out. I feel awful.
R: Would you say that anger is limiting your life, or messing up your life, or tying
you down?
B: I’d say it’s messing up my life because I’ve lost a lot of friends through anger.
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R: So anger seems to enjoy getting you into trouble with your family, getting you
into trouble at school …. Can you tell me a little bit more about why it doesn’t
suit you?
B: Because it turns me against a lot of people …, but really I don’t mean it, and
I’ve just lost a friend.
Rather than identify her values (Inquiry Category 4), B tended to thicken the prob-
lem story.
R: So you’re not happy with anger, because often you see that the anger’s … mak-
ing you lose friends. I wonder what this suggests is important for you in your
life?
B: I don’t know, I just wish half of them would leave me alone and let me do my
own thing … If people did that I wouldn’t have much anger.
R: So are friendships very important to you, is that something that you value?
B: It’s not that I value having friendships with other people, it’s just these people
that I’ve known for quite a while and we’re very close … and I can tell them
anything … and they won’t tell a thing [to others].
Providing B with a box of objects to stimulate her imagination helped her to pro-
vide a more “experience near” definition of the problem (White, 2007, p. 40). She
modelled the anger in Plasticine: first imitating a plastic dinosaur from the objects
198 E. Hannen and K. Woods
provided, then spontaneously modelling a devil’s head that represented how she
appeared to others when angry. This practical activity at the start of the intervention
appeared to alleviate B’s anxiety at meeting somebody new, and she considered it
the most enjoyable activity of the intervention.
Unique outcomes. B named unique outcomes, and described their effects on her life.
For example, in apologising to a teacher after an incident, she had “made that teacher
proud”. It helped that B appreciated the positive effect of unique outcomes on others
whose guidance would help her to make social progress, for example, her teachers. B
had difficulty providing accounts in which unique outcomes were sustained, and she
mostly ended her accounts with references to violence: “And then I know I shouldn’t
have done it, but I grabbed her by the scruff of the neck …” Accentuating the posi-
tive in B’s account, for example that she had initially resisted violence when a girl
had spread malicious rumours about her, helped B to identify her values:
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R: So you talked to her … you got her to tell the truth to the boys, why was that
important for your friendship?
B: Because friends don’t do that, friends don’t make trouble for their friends.
Eliciting from B how she felt she should have responded also helped B to describe
her position and values in response to the Statement of Position Map 2 (see the
Appendix).
B had difficulty consistently identifying strategies that helped her to control
anger. In addition to returning to a problem saturated story, she lost track of the dis-
cussion, or even changed the subject completely. B, who enjoyed role play was
interviewed for the purpose of helping another young person deal positively with
anger. Strengths cards (Deal & Veeken, 1996) and B’s responses to earlier questions
regarding what she should have done were used to plan her responses to the inter-
view questions. This activity helped B to focus on her successes, helpful strategies,
and her preferred direction in life.
B appeared to reflect upon what was important to her in between sessions. For
example B stated in session two, “These sessions have been helping [me] think
about stuff, things in the past.” In session three she volunteered that she would like
to contact her father, and that her anger was “building up … [because] … I’m not
seeing my dad more.”
R: is there something that you learned about yourself, the fact that you did this per-
formance and got this A⁄?
B: I learned that it’s not all about my family you know, I have to think about myself
sometimes. … “It’s like I’m always there for other people, but I’m never there
for myself.”
R: You said you need to think of yourself sometimes …. Can you think of what
you’re doing at the moment that might show me you’re starting to think about
yourself now?
R: Can you think of a name for this direction that you’re moving in?
B: I want to be independent.
B agreed that “moving towards independence” was a suitable name for her project.
She identified future unique outcomes related to this theme “I’m going to come out
more to mum, I’m going to start telling her things I should have told her a long time
ago” For B, being able to confide in her mother was an important step. She com-
mented in the final session, “Now I know that I can tell my mum things … I know
things can be solved.” An action from this conversation was that B would tell her
mother that she would like to contact her father. Self-harming adolescents may be less
able than their peers to solve problems effectively (Evans, Hawton, & Rodham, 2005),
and, as B was unclear about how best to contact her father, this was decided by using
a problem solving activity. B wrote a solution focused letter to her father, with the help
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of the first author. Her mother checked this and agreed it was appropriate.
B, who wanted to be a singer, also said that she would concentrate more on her
voice. When B informed her mother of this, her mother said, “I never realised how
much you were focusing on that singing thing. If I’d known, I’d have started putt-
ing you in competitions.”
R: Why are you not surprised that B is going in that direction [moving towards inde-
pendence]?
M: For years, this is what B’s always wanted, isn’t it B, and she’s never been fright-
ened of saying this is what she wanted to do. She’s always been very ambitious
where that is concerned, haven’t you sweetheart?
Sometimes M returned the focus to the problem story. M said of the unique out-
comes in the therapeutic document, “I think B sometimes struggles to do some of
those things when she’s upset about something.” M also invited B to validate the
problem story:
B: When she said when I say something I will stick to it, she made me realise how
much I do stick to it.
M: In the past that could be something bad, it could be “I’m not doing it!” It could
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be just as much that way as something fantastic because that’s what you do, and
no talking will get you out of it, because if she’s got that mindset she’s got that
mindset, she’s stubborn, aren’t you darling!
However, M also assisted with the re-authoring process, as her established relation-
ship with B enabled her to draw attention to the link between B’s past and present
unique outcomes.
R: You wouldn’t be surprised to learn that one of B’s priorities is to be there for
people?
M: Definitely not, she’s always there for everybody who needs her … She even
wants to be there for the staff.
M described how B’s present behaviour compared positively with her past behav-
iour by commenting on B’s recent application in Maths lessons, although this was
an area in which M, rather than B, invested value. M also referred to B’s recently
acquired ability to communicate: “B’s … not been able to express her true feelings
completely. But I do feel that now she can.” In the post-intervention Narrative
Assessment Interview (NAI), B described herself for the first time as “open”. M’s
contribution as an outsider witness appeared to have helped B form this positive
conclusion about herself.
M’s continuing relationship with B was helpful in that M agreed to watch for
actions that confirmed and thickened B’s positive emerging story. M also provided
guidance between therapy sessions when B shared her therapeutic documents and
the letter she had written to her father. M said that sharing B’s story was helpful
because “I know now what’s bothering you [B] and that’s something we can talk
about.”
A difficulty of having a teacher as an outsider witness was that M responded
guardedly when questions required a personal response:
R: I wonder whether the path that B’s taken, whether it strikes a resonance with your
own life?
M: Not particularly (laugh).
Educational Psychology in Practice 201
However, M considered that B, unlike some of her pupils, was able to move easily
between relating to M on a personal level, and accepting boundaries as a pupil.
teacher, M, who discussed and thickened the more positive story and provided fur-
ther guidance for B. B appeared proud of her folder of therapeutic documents, and
she asked to include the Relative Influence Questions (RIQ) documents to further
illustrate her progress.
What effect does NT have upon the emotional well-being of an adolescent who
self-cuts?
All measures, apart from the Beck Youth Inventories Second Edition (BYI-II), sug-
gest that the outcome for B was a significant improvement in emotional well-being
over the intervention period.
According to the BYI-II there was a slight deterioration in emotional well-being
over the intervention period (see Table 2).
Note: The mean T score is 50 and the standard deviation is 10; the cumulative percentage shows the
percentage of girls in B’s normative group (ages 11–14) who had scores at or below B’s T score; on
four of the five inventories (BAI-Y, BDI-Y, BANI-Y and BDBI-Y), the higher the T score and cumula-
tive percentage, the greater the severity; on the BSCI-Y, a higher T score and cumulative percentage
indicates a less positive self-concept, and a lower T score and cumulative percentage indicates a posi-
tive self-concept.
202 E. Hannen and K. Woods
When asked what her preferred direction in life, “moving towards indepen-
dence” might mean for her future, B said, “I’m going to come out more to mum.
I’m going to start telling her things that I should have told her a long time ago.” In
the post-intervention NAI B said that she was more “open” with others. Her view
of herself as a more “open” person had been assimilated into her sense of identity.
Parental and teacher report indicated that B was more “open” post-intervention and
more able to communicate her thoughts and feelings. Communication skills can be
a significant factor in promoting resilience [Department for Education and Employ-
ment (DfEE), 2001]
B’s family narrative was that mother and daughter were alike because of their
positive “supportive and caring” characteristics. When B indicated that she wanted
to write to her father, B’s mother supported B, and praised B’s letter, although con-
tacting her ex-husband was not perhaps in her own interest. Similarly, once aware
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of B’s commitment to developing her singing, she arranged public performances for
B. In this case exploration of individual family member’s preferred ideas about
events and relationships was sufficient to modify patterns of family interaction
(Minuchin, 1998).
identified an action, but was uncertain about the best way to perform it. B consid-
ered that the problem solving activity was the most helpful of the intervention. A
suicide prevention protocol [Skills Based Training on Risk Management (STORM)
(Lever-Green and Hays, 2008)] was introduced when B referred to wanting to kill
herself. After assessment using the STORM protocol and discussion with an EP col-
league during supervision, a full mental health and psychosocial assessment was
considered unnecessary.
Discussion
Arriving at a balanced formulation of the findings
In this research case study, all qualitative and quantitative data, apart from the BYI-
II, suggest that B’s emotional well-being, resilience, and behaviour improved over
the intervention period. Much educational psychology assessment and research, par-
ticularly case study research, adopts a “mixed methods” approach, gathering and
interpreting both qualitative and quantitative data [British Psychological Society
(BPS), 1999; Plano Clark & Creswell, 2008; Yin, 2009]. The rationale for this
approach, founded in critical realist epistemology, is that the different types of data
access different “truths” (BPS, 1999). Quantitative, standardised data allow reference
to generally accepted and widely used concepts (such as “depression”, “intelligence”,
or “anxiety”); qualitative data allow access to an individual’s interpretations, and the
complex dynamics of causality (Miller and Frederickson, 2006). Whilst offering this
“best of both worlds”, mixed methods approaches in both research and assessment
do raise the challenge of data integration, particularly where data may appear to be
inconsistent.
In B’s case, qualitative, structured interview evidence of post-intervention
changes is consistent: post-intervention, B said she was happier, was no longer cut-
ting, and that less of her life was consumed by anger. Parent and teacher report con-
firmed that B’s behaviour had improved, and she was no longer having panic
attacks. B’s post-intervention account of herself introduced new positive identity
conclusions, suggesting that she was re-authoring her life to accord with her pre-
ferred alternative story, identified during therapy. Post-intervention, B’s more posi-
tive account of family life was confirmed in a telephone interview with her mother.
NT with B, and a brief exploration of the problem and preferred stories with B’s
mother appeared sufficient to modify the family style of relating (Minuchin, 1998).
Educational Psychology in Practice 205
Quantitative data from the RSCA (Prince-Embury, 2006) are consistent with this
generally improved adjustment, however, quantitative data from the BYI-II (Beck
et al., 2005) indicate some level of deterioration in measures of self-concept,
depression and anger. Three considerations are relevant:
Based upon these findings which support the utility of the NT approach as used
here, the authors propose a model of NT practice for use by EPs. This model, out-
lined in Figure 2, contains elements of the following:
The model has eight stages; the first five of which are sequential. Stage 6 is a guide
to the therapeutic process and the options within this are indicated by a broken line.
The objective of NT, “A Preferred Alternative Story”, is at the centre of the dia-
gram. Supporting methods are shown in concentric rings around Stage 6. In general,
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whether it is ethical to proceed and whether the client should be offered a risk
assessment.
Stage 3: Information gathering – Gathering information from the client, their family,
school and other agencies, helps the EP form initial hypotheses and determine
whether therapeutic intervention is appropriate.
Stage 6: The therapeutic process – In guiding the client through the NT Statement
of Position Map 1 and the Unique Outcomes Map (Statement of Position Map 2)
(see the Appendix), the EP might consider:
• A detour from NT if it appears that the client might benefit from a different
therapeutic approach.
• Moving to Stage 7 (evaluation) if the client:
does not respond to therapeutic intervention;
identifies a preferred alternative story and appropriate actions in response
to the Unique Outcomes Map.
• Continuing with the narrative process with re-authoring, re-membering and
outsider witnessing.
• Proceeding directly to re-membering or outsider witnessing with those CYP
who have difficulty responding to re-authoring conversations. Some CYP, sup-
ported by the knowledge gained in re-membering and outsider witnessing,
may then return to the re-authoring process.
• A narrative interview with parents/carers to thicken the client’s unique out-
comes identified during NT.
• Using a problem solving activity at “Action” stages of the therapeutic process.
Stage 8: Mediation – The EP mediates with other adults to develop their under-
standing of the client and their preferred story, and to problem solve how others
might support the client in positive change.
This present case study raises further considerations for psychology practitio-
ners. Though teachers are expected to assume responsibility for their pupils’ emo-
tional well-being (DfES, 2004) they may have had little training to equip them for
such a role (Rothi & Leavey, 2006). Teachers are likely to be unfamiliar with the
psychological principles of outsider witnessing, which could affect their ability to
respond appropriately to the client. In this case study, involving a teacher as an out-
208 E. Hannen and K. Woods
sider witness was advantageous in that the teacher reinforced B’s unique outcomes
in-between sessions and after the therapeutic intervention had ended. However, as
an outsider witness, she sometimes unwittingly flouted narrative conventions, rein-
forced the problem story, or referred to B as having negative character traits. In
contrast, in another case, when the first author involved an outsider witness team of
family therapists and clinical psychologists, they consistently applied narrative prin-
ciples and a non-judgemental attitude. This supports Fallon et al.’s (2010) conten-
tion that more integrated working between the National Health Service (NHS)
mental health professionals and EPs in the delivery of therapeutic approaches could
help to reinforce and maintain the gains made by the client, particularly when EPs
mediate closely with teachers and pastoral staff.
The present research usefully highlights considerations relating to the integra-
tion of therapeutic intervention with the EP’s role as a registered practitioner
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Notes
1. The Macmillan Dictionary of Psychology (Sutherland, 1995, p. 468) defines “therapy”
as “Any treatment for an illness or disorder undertaken with the intention of
210 E. Hannen and K. Woods
ameliorating or curing it”. The term is widely understood to transcend the medical con-
text (MacKay & Greig, 2007), and it is associated with concepts of “happiness”, “qual-
ity of life” and “making happier” (Indoe, 1995, p. 4).
2. The Goth youth subculture began in the UK during the 1980s. It has a dark aesthetic,
influenced by nineteenth century Gothic literature and later horror films. Goths are often
distinguished by their distinctive clothing, make-up and tastes in music (Young et al.,
2006).
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(1) Naming the problem: Negotiation with the person of the precise externalised
definition of the problem, using the person’s terms.
(2) Effects: Eliciting a description of the effects of the problem on the person’s
life and relationships.
(3) Position: Ascertaining the extent to which the person wishes things to stay
as they are or to be different.
(4) Wider values: Asking the person the reasons for their answers to (3), and
what in their life history has led them to make this evaluation. According to
White (2007) this helps people to voice, understand, and develop what they
value in life.
(1) Naming the unique outcome: Negotiation with the person of the precise defi-
nition of the unique outcome.
(2) Effects: Eliciting a description of the effects of the unique outcome on the
person’s life and relationships.
(3) Position: Ascertaining the extent to which the person is positive, negative or
ambiguous about the effects of the unique outcomes.
(4) Wider values: Asking the person the reasons for their answers to (3), and
what in their life history has led them to make this evaluation.
reflect about their own and others’ character, motives, and desires (landscape of
identity). The re-authoring conversations map consists of two parallel horizontal
timelines ranging from “remote history”, “distant history”, “recent history”, “pres-
ent” and “near future”. The person’s responses to landscape of action and landscape
of identity questions are plotted according to the time in history when they
occurred/might occur.
(1) The outsider witnesses identify the expressions that they were most drawn to
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