Case Vignette of Tiffany
Tiffany is a 25-year old African-American woman with an 8- month old son who came into the agency at the suggestion of her ob/gyn to be evaluated for postpartum depression. She discloses that she is having conflict with all of her interpersonal relationships and expresses that she is a bad mom. She described her mother as strict and very critical even from childhood. She reports that her relationship with her fiancé is volatile, but feels she needs his support so is considering marrying and moving with him out state because she is recently unemployed. She expresses fears of going out and seeking work because she fears that her poor interpersonal relationships will transcend into her ability to work well with others and consequently lose her job. Her last job was not an independent position in which she did not have to interact with coworkers nor have a set time to go in to work. She proceeds to explain that she is skeptical of therapy because her mother had had some bad experiences with therapist and was actually Baker Acted after being encouraged by a therapist to disclose passive thoughts of not existing to stop her pain.
Tiffany reports that she was an “A” student growing up, but always had problems making friends. She also stated that she “was bullied incessantly as a child and thought of death often- like her mother- to stop the pain. She said that she was described by others as being a people pleaser and elicited anger from her peers due to her apologetic nature. She has been accused of having poor boundaries and an inability to say, “no”, which she reports leads to poor time management. She internalizes every experience that she is a loser and is saddened about the strained relationship she has with her once supportive step-mother after the birth of her son. She discloses that she has failed at every attempt in her life and believes that she is better off dead.
Narrative therapy holds that our identities are influenced by our subjective experiences which tend to confirm and strengthen our story or narrative about ourselves and our world. “The human mind is a product of constructive symbolic activity and reality is a product of personal meanings that individuals create to explain their experiences (Mahoney, 1995). According to Neimayer (2009) “every nascent theory represents something old, something new, something borrowed, and something true at least to its adherents”. “Narrative therapy is goal directed [and] the primary goal of narrative therapy is to form an alliance with clients that accesses, encourages, and promotes abilities to enhance relationships with one’s self and with others” (Etchison & Kleist, 2000, p.61). This goal is met by deconstructing problem-saturated stories that a client is not satisfied with, externalizing the problem, and re-authoring or reconstructing ones that support positive outcomes. Narrative therapists emphasize the importance of a collaborative relationship, in which the client and therapist define and externalize the problem and look for meanings ascribed to their symptoms.
Once the problem is found and named (externalized), it can be addressed. In this process, the person does not have to change. S/he discovers a past, an identity, that was always