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Introduccin (Laura)

Marco terico (todas Laura, Ruth, Adriana

Narrative therapy

In many ways, WWII and its consequences resulted as a defining point for humankind.
Postmodern era brought a different perspective of the world and a new way of thinking which
tried to give sense to what had happened during the catastrophic event.

At this point language got relevance being that through it, ideas, thoughts and internal
speeches are transmitted. People create systems of beliefs trough language in order to
understand the world and the experiences that are lived in it. Individuals are active when
building knowledge through experience, which is also affected by culture (Nichols, 2006).

By this means constructionism appears, with premises such as considering that human
beings know and experience the world by means of its own subjective view, which is
influenced by external forces such as the culture and social interactions. In this manner,
internal dialogues become actions that fit into the world in order to be accepted. Generally,
peoples narratives are very rigid and could be modified only by deep reflection that allows
new ways to perceive the world in order to interact with others (Steinglass et al, 1988).

Narrative therapy the arises consisting in an analytical and interpretative strategy of

experiences and systems of beliefs and the meaning that an individual gives to this
constructions, in order to help others to understand where their beliefs come from and give
suggestions of different perspectives with the purpose of creating new conversations. We live
our relationships in a narrative way as if it were a story and talk about it as a novel with
actors, actions, goals, scenarios, issues, with a beginning, a climax and resolution (White,
1994).

Morgan (2002), defines narrative therapy as a respectful approach and not as a guilt inflector
that situate individuals in the role of expert of their own life and stories, the individuals from
the system help therapist to understand the situation deconstructing the stories, the prejudice
immerse regarding gender, race, social class etc. and facilitates self-description of the
problem. The problem is the problem, the person is the person, they are not the same entity
therefore they have to be perceived separately, this happens when the problem is
externalized. This separation facilitates the analysis of the dynamics and interactions of the
individuals with the problem and the creation of an alternate story.

Alternate stories constructions are possible by means of exploring and deconstructing what
maintains the problem as the dominant story in the life of the family or consultant. Isolated
achievements may form part of the new construction of the problem in order to explain life
from a different perspective.

Loss, illness, disability and death

Within family context, any present affection has a deep impact in the extension, severity and
treatment (Stern, 2002).

Loss of a love one or the loss of the expectation created on a particular person such as a
newly born, a son or an adult with an acquired disability during the cycle of life may create a
huge emotional impact in the family system. Every member of the family copes with the
situation accordingly to their own resources, which become relevant when trying to overcome
and adapt to the new situation.

Illness, disability and death are challenging experiences for individuals and families; they
could lead to a lot of stress, trauma and suffering. The loss of the expectation or the lost itself
of a family member affects the whole system. Families suffer from the deterioration of their
quality of life, their adaptability or capability to overcome crisis (Rolland, 2000).

Badly managed mourning may lead to miss adaptation problems such as anxiety and
depression meanwhile a good managed one improves capabilities to face the loss, frustration
and suffering. It is important that emotions are expressed within family and society by different
means such as rituals that help adapt to the new situation.

In this order of ideas Bowlby (1983) defines mourning as a psychological process that starts
when losing a love one as the result of an attachment behavior. In his model, Bowlby
identifies three characteristics of pathological mourning: 1. Individual characteristics of the
person that suffer the loss, 2. Suffering and loss childhood experiences, 3. Cognitive process
of loss.
According to Bowlby (1983) there are three different groups of people that are more
vulnerable to develop dysfunctional mourning: those who develop anxious affective
relationships, those who stablish affective relationships by taking care of others in a
compulsive manner and those who affirm in a compulsive way their self- sufficiency and
independence of affective bonds. This groups tend to react with guilt and self-criticism when
mourning could also be an experience of growth and learning.

Regarding the constructivism model of trauma, according to Sewell at al (1996) stressful

experiences such as loss may block the person abilities and keep it isolated this considering
that people is not currently exposed to painful or extreme experiences and have no
information about this this is why organize and process the new information becomes difficult
or impossible for some. This temporary disruption within the personal narrative, provokes
meaningful changes in the vision of one self and the world.

Treatment alternatives for families with special needs

A circular perspective within the context of family in front of a disability or illness, lead to
consider globally of human experience by reading it as an ensemble of meanings for one
subject, his primary affective inner circle and for the community to which he belongs
(Sorrentino, 1990)

As seen, illness and disability within the family may cause a lot of stress, anxiety and trauma,
therefore an undivided plan to face the situation must be developed and addressed, to
accompany and content family to facilitate or reinforce valuable resources to the family in
order to help them face, deal and cope with the situation. Among others, the next approaches
need to be consider:

Social. Institutions focused on a special disease, social groups or networks may be

helpful in order provide support to the families relieving the burden, diluting stigma
against the family including the member affected.

Community. Neighborhood, support groups, church, school, workplace may arise as as

supportive entities in order to help families to carry on, as (support groups, school,
workplace, neighborhood)
 Medical (doctors, hospitals, information groups)

Psychological. Support groups lead by psychologists in which family may find empathy,
understanding and experiences that may help them to cope with the situation. Family
therapy is a must considering that they will have emotional contention, mourning
management,

According to Sorrentino (1990), physical or mental deficiency constitute an strange data

within the family system, bared by an aggression from destiny, therefore accompanied with
intense feelings of rejection and rebellion. This rebellion needs to be address in multi-stress
families. Therapist need to reorient their strengths, resources and knowledge as some of the
effects within the system could be caregiver syndrome, stigma, overprotection, reassigning
roles and parental children, divorce, interruption of life projects etc.

According to Morgan (2004) at this point, narrative therapy emerges as an option of

treatment:

To deal with the problem and separate it from the family member suffering from it

To change the perception and meaning of the problem within the system by creating a
new story among it

To work with the emotional consequences such as guilt and deception

By facilitating resolution and address mourning

As an strategy to battle different consequences arising during the process such as

acceptance the reality of loss, adapting to the prevailing situation and the new
environment, relocating the loss in some fashion that allows the rest of the family a
functional living

By this means, narrative therapy is useful to treat mourning by addressing its different stages:
denial, negotiation, angry, sadness or depression and acceptation. Narrative therapy is also
helpful to discover families own resources and capabilities in order to help them satisfy the
demands of the situation (Steinglass, 1988).
The fact that families meet the demands is a result of determination for adjustment.
Adjustment and adaptability of the family may be easier if their main characteristics are: they
live in the present; socialization; emotional intelligence; accurate communication; focus to
solutions; they are certain to be able to cope with the situation.

CASE STUDY

(Orden

Laura: resumen del caso y aterrizar el marco terico al mismo: familia white,

Ruth, aterrizar el marco terico al caso familia White,

Adriana =>

Proposed treatment for the White family

As stated in the theory, disability and illness not only impacts the person suffering but to his
family but to his environment. Family therapist emerges as a support in the reconstruction and
new perspective of it and as a consultant that educates and advises the family so they are
more aware of their abilities and resources, their alternatives in the social, community and
medical fields acting a drive shaft helping them to organize information and act in
consequence (Rolland, 2000):

Psychoeducation. The White family including Pam, needs to know how the Alzheimer will
progress in Pams body and what will be required from each member of the family in terms of
medical and psychological treatment (Morgan, 2004).

Medical. Medical support is necessary so Alzheimers progression is correctly assess. A

stretch relationship with the doctor must be developed as he plays the role of a supporter in
the medical field when necessary during the treatment and is a good contact point to access
the most current information regarding treatment (Acosta, 2012)

Social and community. Communitarian and social support groups may be a great option for
the White family, they are in need for social contact that can provide information, back up an
even advocacy. This networks could not only be helpful in order to cope with the situation by
providing caring and contention, but also to make a larger change of perspective regarding
Pams illness; community and social network may act as agents of change in a wider range
(Morgan 2004).
Family therapy. Narrative therapy will not only provide the opportunity to deconstruct and
reconstruct the idea of the problem (Morgan, 2002), but also to understand their roles as a
family, the way they see each other. In this order of ideas, they will be able to reconnect with
each other in Pams ordeal and with her, even though sometimes she seems not to be there.
At this point mourning should be addressed in therapy so the Whites process the idea that
Pam will never return to them, as they knew her, and in fact will lose her a beat each time
(Bowlby 1983).

The White family needs to consider entering a process of therapy in order to find support,
contention, a listener, empathy and understanding of their feelings. Being Alzheimer a
degenerative illness, that takes away the best of someones personality and functionality, they
need to understand that Pam is not her illness (Morgan 2004), and separate both entities, by
trying to reconstruct the idea of the problem (illness) and of Pams, as a person suffering from
that illness (Morgan 2002). Among the meanings or ideas to be reconstructed with narrative
therapy could be considered different beliefs about:

Alzheimer as a disease and the disability that results from it.

Forecast, treatment and healing expectations.
Ask for help. This approach could be useful for Pam most of all and her husband who
is in risk of acquiring caregiver syndrome (Rolland, 2000). Preferences of each
member of the family regarding their participation in the caring should be addressed as
well, as not all of them are in position of providing support and help is what Pams
husband is in need of.
What it is normal, healthy and favorable.
Expectations of a certain response regarding the prevailing situation within the system,
and the processes that emerges during the family members and caregivers
interactions.
Idea of dominium and control. Regarding Pams illness and loss of her abilities and the
way family is able to face the situation.

It is important to know where beliefs and stories come from as well as understand needs
emerging as a result of the experiences and the meanings they construct every day
(Steinglass, 1988).

Conclusions
Without a doubt Alzheimers is a disabling disease that may result in stress, isolation, anxiety,
depression, disorganization not only in the person suffering from it but also for the family
around. Individuals need help to learn to cope with the situation with the help of a
multidisciplinary team that includes family, community, social, medical and psychological help
among others.

This multidisciplinary team will help families to manage the different situations arising among
the illness of a love one. At this point narrative therapy is a great tool to provide new
perspectives regarding illness and the way it is possible to manage it or cope with it, as well
as a font of emotional contention that provides new perspectives related to the way people
built their meanings regarding illness and disability.

Narrative family therapist may result as a support figure for the entire system as according to
the need may result in a figure of consultation and accompaniment that helps to see beyond
and to find new ways to solve problems by changing meanings.

As Alzheimer is a degenerative illness, it is important to have an adequate mourning process

with the family suffering the continuous loss of a love one. By working with the construction of
new meanings, families may emotional contention; in therapy, full expression of feelings is
possible, and allows family members to deal with guilt, remorse and deception. By rebuilding
meanings, it is possible to recover positive memories that lead to focus life in love, towards
the love one.

Through narrative therapy, individuals and families, may find some resolution and hope to
enjoy life after illness and lost, by perceiving disease and disability as an experience of
learning, resilience and growth.

Referencias (***de acuerdo a format APA incluir las del resto del equipo, verificar que
no este repetido *** ;)

Bowlby, J. (1983). La prdida afectiva. Tristeza y depression. Buenos Aires: Paidos.

Morgan, A. (2004). What is narrative therapy? Australia: Dulwich Centre Publications.

Nichols, M. P. (2006). Family therapy. Concepts and methods. (10th ed.). New Jersey:
Pearson.

Sewell, K., Cromwell, R.L., Farrell-Higgins, J., Palmer, R., Ohlde, C., & Patterson, T.W.
(1996). Hierarchical elaboration in the conceptual structure of vietnam combat veterans.
Journal of Constructivist Psychology, 9. Rando, T. (1993) Treatment of complicated mourning.
Champaign, IL: Research Press

Sorrentino, A.M. (1990). Handicap y rehabilitacin. Una brjula sistmica en el universo

relacional del nio con deficiencias fsicas. Barcelona: Paidos.

Steinglass, P. y Horan, M.E. (1988). Families and medical chronical illness. En: Anderson C.,
Chronic disorserds and the family. New York: The Hawoth Press.

Stern, M. (2002). Child-Friendly Therapy. Biopsychosocial Innovations for Children and

Families. New York: Norton.

White, M. (2002). El enfoque narrativo en la experiencia de los terapeutas. Barcelona:

Gedisa.

White, M. (2004). Guas para una terapia familiar sistmica. Barcelona: Gedisa.