21. 外部化

本章知识点阐述

21 Externalising As described throughout this book, integrative counsellors like to draw on useful skills from a variety of therapeutic approaches. The skills described in this and the following chapter come from Narrative Therapy and Solution-Focused Counselling and are particularly useful in enabling a person seeking help to make use of their strengths and seek solutions rather than negatively focus on their problems. These approaches are also useful in encouraging a person to take an optimistic view of the future. The skill of externalising described in this chapter has its origins in Narrative Therapy, which was originated by Michael White and David Epston. Readers interested in Narrative Therapy might like to read Maps of Narrative Practice (White, 2007). People generally come to counselling with a negative view and often see their problems as intractable, in responding to a person’s description of their problem, we can use language in a way that enables them to feel better about themselves and to take a more optimistic view about the possibility of change. This should not be taken to suggest that we are not interested in hearing about the person’s difficulties or wish to minimise them. Rather, while listening, we can be positive in using responses that help them recognise those inner strengths they have already used, while also opening up the possibility that solutions to their problems will be found. The skills involved in helping a person to make use of strengths, as described in this and the following chapter, are generally used by integrative counsellors du ling the stages in the counselling process where the emphasis is on helping the person to restructure their thoughts (see Figures 16.1 and 16.2). In this chapter we will describe how it can be helpful to a person seeking help for the counsellor to externalise the problem, or to use an externalising interview. EXTERNALISING THE PROBLEM The goal of externalising is to separate the troubling problem from the person, l he easiest way to explain this is through an example. A person might come to counselling believing that they are by nature an "anxious person’. While accepting that this is how they see themselves, it can be useful for the counsellor to describe the anxiety as though it has a separate and independent existence from the person. Hopefully, the result of this will be that the person will start to see themselves as someone who is troubled by anxiety, rather than as an intrinsically anxious person. If this happens, we say that the anxiety has been externalised, as it is now seen as separate from the person themselves, although it is troubling them. When a person is able to make such a change in their thinking, they generally become more empowered in dealing with their problem. This is because they can now start to think in terms of using strategies to control the problem rather than letting the problem control them, whereas previously they were seeing the problem and themselves as inextricably joined. In our example, if the person stops thinking about themselves as an anxious person and instead thinks about themselves as a person who is troubled by anxiety, they have a new perspective ot themselves and their anxiety. With their new frame of mind they can think about how the anxiety gets the better of them and explore ways in which they can control it. When externalising, the counsellor attempts to create a different atmosphere around the problem, one where the person sees their problem as not being intrinsic to them, but as something that is acting upon them from outside. In the example given, the person might say, 'I’m a very anxious person? The counsellor might respond to this by saying, 41 see you as a person who is troubled by anxiety. Somehow anxiety seems to get the better of you.’ The counsellor might then follow up by asking, ‘How does anxiety stop you from doing things you want to do?’ By taking this approach, the person’s frame of reference changes from 41 am an anxious person to 'anxiety causes a problem for me’. They are then in a position to be able to take responsibility for dealing with the anxiety rather than seeing the anxiety as a part of self. Externalising makes it possible for the person to experience a part of themselves that is separate from the problem. By doing this, they are able to feel that they can control their problem, or central issue, if they wish, because it is something external to them, which can be controlled, rather than something inherent in them, which cannot be controlled. Phis then opens up new possibilities for action. By externalising, the power is to some extent taken away from the problem and instead the person becomes empowered to control the problem. It can be seen that externalising demonstrates that the problem is the problem, where previously the person was seen as the problem. A good example of the use of the skill of externalising relates to helping people who have anger control problems. In such a case the counsellor might externalise the anger by asking questions such as, ‘Does your anger have control of you, or do you have control of your anger?7 and, 4How does your anger manage to trick you into letting it control you?’ Can you see how in asking these questions the person is able to see themselves not as an angry person but as a person who is troubled by anger, who has a responsibility to learn to control the anger rather than letting it control them? Clearly, externalising questions often lead to discussion about issues of control, fhe aim is to help the person gain control of unhelpful or unacceptable behaviour. Externalising requires a particular shift in the use of language. Rather than using sentences which begin with 'You are ... externalising statements use sentences beginning with the name of the problem. For example, instead of saying 'Yoh are anxious’ the language changes to 'anxiety stops you from doing the things you want to do’. Good examples of situations where it may be useful to externalise problems are when a person sees themselves as an alcoholic, a drug addict, a depressed or anxious person, or a failure. The counsellor might ask such a person how they came to think of themselves this way and encourage them to expand on their self-perceptions. If this is done, often the person will talk about how the problem influences or interferes with their behaviour. At this point the counsellor has an opportunity to separate, or externalise, the problem from the person by talking about the way that depression, alcohol, failure or anxiety is causing trouble for them, instead of talking about the person being depressed, being an alcoholic, being a failure or being anxious. Consider the case of a person who is troubled by depression. To help that person the counsellor might ask questions such as: How has depression restricted your Life? How does depression manage to trick you into letting it control you? What is the worst thing that depression has done to your life? When you try to get control of depression, what does it do to hook you back in? How is depression stopping you from doing what you'd like to be doing? How is depression holding you back? What is helping depression continue to cause a problem for you now? What have you noticed about yourself that has made you think that you might be able to overcome depression? What retaliatory measures could depression use to try to put you back where it wants you? What would depression do as a last desperate measure if you continue to become stronger and more independent? You may have noticed that some of these questions look at the way the problem has had success in interfering in the person’s life, whereas others focus on times when the person has had success in controlling the problem. Another useful way to help a person to fully accept the idea that the problem and themselves are two separate entities is to use the externalising interview as described by Roth and Epston (1996). THE EXTERNALISING INTERVIEW The externalising interview, developed by Roth and Epston (1996), appeals to those people who like to work experientially and are comfortable role-playing. The first step in the externalising interview is to help the person to recognise that the problem is separate from themselves. For example, if the person complains of being depressed, the counsellor needs to respond by saying something like, 'I don’t see you as a depressed person; instead I see you as someone who is troubled by depression. Somehow depression gets control of you at times.’ By saying this, the problem is separated from the person. I he next step is to invite the person to give the problem 'depression’ a name and, if they can, to describe it as having physical characteristics. For example, a person troubled by depression might say, 'Depression is like a big black cloud which engulfs me.’ I he counsellor might respond, 'Let’s call your depression the Big Black Cloud.’ The person can now be invited to role-play the Big Black Cibud. While role­ playing they need to be told and reminded when necessary’ that they are not themselves any more but are the Big Black Cloud. During role-playing it is best if both the person and the counsellor stand away from their chairs, so that the separateness of the Big Black Cloud from the person is made clear. The counsellor then behaves like an interviewer who questions the Big Black Cloud. Initially the questions are directed at finding out how the Big Black Cloud has had success in troubling the person and then further questions inquire about ways in which the person has been able to have success, at times, over the Big Black Cloud. After the interview the person can resume their seat so that they withdraw from role-playing the problem and revert to being themselves again. EXPLORING WHEN AND HOW THE PROBLEM HAS HAD SUCCESS IN TROUBLING THE PERSON In the first part of the interview the counsellor asks the problem how it has interfered with or influenced the person’s life. In the example where depression is the problem, imagine that the person is called Jason. The counsellor might say ‘Big Black Cloud, 1 am going to ask you some questions.’ Possible questions might include: When did you first manage to intrude on Jason's life and how did you do that? What have been your greatest successes in spoiling Jason s life? Was there one particular moment that was most gratifying? What have you managed to do in order to keep annoying Jason? Can you give some examples? Have you found ways to get back at Jason if he tries to undermine you? How do you manage to trick Jason into letting you control him? What kind of strategies is Jason especially susceptible to? What are Jason's most vulnerable moments? At these times what kind of things did you say to him? What kind of allies have you been able to recruit to aid your cause (for example, other problems, habits, beliefs, values, cultural assumptions)? Do you have any friends who help you to keep annoying Jason? When Jason tries to push you away, what do you do to trick him into letting you back? You must have had some narrow escapes. What about moments when Jason has almost managed to get the better of you? What messages do you give Jason to help you stay in his life? After asking some of these questions, next the counsellor needs to ask questions that can help the person recognise ways that they have been successful in combating the problem in the past.

EXPLORING HOW AND WHEN THE PROBLEM HAS DIFFICULTY IN CONTINUING TO TROUBLE THE PERSON Suitable questions, again addressed to the problem, include the following: Can you think of some times when Jason has frustrated your efforts to trouble him? How did Jason do this? What did he do differently? Is there anything you have noticed about Jason that has made you start worrying about the future? What are your secret fears about your relationship with Jason being undermined? When did you first realise that the good old days might be coming to an end? What plans do you have to reassert yourself in the face of Jason's defiance? What retaliatory measures could be used to try to put Jason back in his place? What would you do as a last desperate measure if Jason continues to become stronger and more independent of you? At what point do you think you would come to accept that your time is up and you will no longer be able to control Jason? Will you continue fighting for control over Jason or will you eventually give up? Questions such as these help the person to recognise that they can separate the problem from themselves, and that because the problem has an entity of its own they can, if they wish, use their own inner strength to control or manage it. After conducting the externalising interview, the person and the counsellor can process the role-play by discussing with each other anything that has been learnt from the experiential exercise. Hopefully the person will have discovered ways in which they can gain mastery over the problem in the future.

Learning summary Externalising separates the problem from the person. Externalising invites the person to take control of the problem. References and further reading Brown, C. & Augusta-Scott, I . (eds) 2007, Narrative Therapy: Making Meaning, Making Lives, SAGE, Thousand Oaks, CA. Roth, S. & EpstOli, D. 1996, ‘Consulting the problem about the problematic relationship: an exercise for experiencing a relationship with an externalised problem’, in M. Hoyt (cd.), Constructive Therapies, Vol. 2, Guilford, New York, pp. 148—62. White, M. 2007, Maps of Narrative Practice, Norton, New York.