Ways of working

As a counsellor working for a large UK charity that supports people who are blind and partially sighted, I have been interested in how narrative therapy practices1 have often enabled people to move away from feeling stuck with medical understandings of sight loss which place much emphasis on treatment and diagnosis, often resulting in the person losing a sense of identity outside their diagnosis. Often the client group I work with are elderly, which is unsurprising given that 95 per cent of people who are registered as severely sight impaired (blind) or sight impaired (partially sighted) are over 65.2 Peter and May (pseudonyms) were a couple in their mid-80s who consulted with me during 2007 following Mays diagnosis with age-related macular degeneration (AMD) and her recent registration as blind. What follows is an exploration of our work together which documents the use of an externalising conversation, and also includes a commentary that considers the theoretical underpinning of using this kind of intervention, and excerpts from my personal journal.
Journal entry: 6 December

I spoke to May and her husband Peter today. I had met with them last week and asked them about the possibility of using their audio recording of the Grilling of Mr B for a paper I was writing. Yes, they said. We would really like you to use it, it was really fun. Im not sure you should let on that counselling is fun though otherwise you might be inundated!

Externalising has become part of the therapeutic practice of narrative therapists, and was introduced into the therapeutic arena by White and documented by him3, 4, 5 as well as by Tomm6 and Freedman and Combs.7 It represents a way of thinking and being rather than a specic therapeutic technique7 and comes from poststructuralist understandings of the world, which place much emphasis on language, questions of power, and the ways in which meaning is constructed.8 Who we are is seen as being constructed through language and within relationship with others rather than being an internal reality which has to be uncovered. Externalising conversations separate the person from the problem,5 enabling them to examine the relationship they have with the problem and its inuence on their life. It is a practice that encourages the social construction of preferred realities.3 In my work with May and Peter it became evident that May had internalised blindness. She considered herself a blind woman, but considered that this blindness had been put on me by the doctors they have labelled me with it, I even have a certicate to prove it and now it is all that I am. Within this position she was unable to see any possibilities for her life: This is not living, this is just enduring, she said.
The grilling of Mr B

Externalising conversations

The narrative therapy practice of externalising conversations can free people to take a less stressed approach to their problems. Susan Dale explains how she used the technique with an elderly couple affected by blindness
26 Therapy Today/September 2009

The grilling of Mr B

Coming home from work on the train on a cold day in February, Mays words rattled round in my mind and I wrote them (as much as I can remember) in my

notebook. These notes were Mays current description of her life, and are the backdrop against which my future conversations with May took place, and represented a thin description5 of her life experience which she perceived as the problem. I sometimes think I have lived too long, she said. I was well up to my late 70s, never had even a twinge. Then everything fell apart at the same time. This is not living, it is just enduring. I coped with the arthritis, Parkinsons, losing my son (that was the most awful time), even the cancer. But losing my sight is the biggest insult; being looked after like a baby! Ive always had my pride. The shame of it. Blindness is a real bugger! May and her husband had requested to meet with me following Mays diagnosis of AMD which had resulted in her losing most of her central vision and being registered as seriously sight impaired (blind). They both considered that blindness was affecting Mays condence, making her depressed and was coming between them. May was unsure about counselling, thinking that all that touchy feely stuff wasnt really for her: We were always told stiff upper lip and got on with it. Some weeks later when May had spoken again about how blindness was really getting her down, and upsetting Peter (Its like this malevolent person has come into our lives), I told them how interested I was in the tactics used by this malevolent person to disrupt their lives and asked whether we could

Picture caption here to ll 2 or 3 lines like this

September 2009/Therapy Today 27

Ways of working
interview him (or her) in some way. There was a signicant pause (I thought, Oh my God, have I got this right?) and then there was laughter. They both became animated, entering into the playfulness of the suggestion. Grilling Mr B, said May. I would really love to give him a good grilling. We looked at possibilities as to how this might work and made plans for the following week. May decided that she would like the black chair to be occupied by Peter who would act the part of Mr B (because he is a brilliant actor), and that it would be me who interviewed him (she would whisper suggestions to me if I didnt know what to ask). She thought that she would then like to be interviewed by me as to whether she recognised the tactics which Mr B employed and the kinds of weapons she had to ght with him. What follows is a small excerpt of the transcript of the conversation that I recorded for May and Peter to have a record of the occasion. Our conversation was not as neat as it appears below; there were a lot of pauses, laughter, stutters and mmms and ahhs which I have removed to make the transcript more accessible to readers. And of course this is just a snippet of a much longer conversation. The transcript is not the entirety of the event, only a shadow of something that has gone. And indeed within the telling it becomes something new.
The interview

S: Mr B, you are charged with disrupting the lives of May and Peter. Is this true? Mr B: Oh Yes, I have been quite successful. [Looks smug]

S: They are a couple who have lived together for nearly 50 years, and survived so many ups and downs in their lives a world war, raising of children, losing their son, cancer but I am informed that none of these were so disruptive as you have been. How have you managed to achieve this disruption when so many others have failed? Mr B: I eat away at Mays self-condence. Its not really that hard. S: You eat away at her self-condence? How do you do that? Mr B: I tell her she is useless. Its easy really. S: You tell her she is useless. May is a very resourceful woman, why, I wonder, do you think she believes you? Mr B: I am very convincing. I cash in on the fact that part of her body is not working, the part she values most her eyes. I keep her shut into a world others cant share. I stop her seeing the expressions on other peoples faces. I trap her into a world where there is just me and her. So she listens, because Im all shes got. S: So you trap her in a place where she is separated from Peter and others who care for her. Mr B: Yes. When she is alone she listens best then. S: Is there anyone/anything else who helps you with this trapping? Mr B: Yes. I have hundreds of people everywhere who help. S: That sounds like a big boast. Mr B: Its true. Most people are scared of being blind. They fear blindness more than anything. It is their worst fear, going blind, getting old, so they pity, patronise and avoid people who carry my calling card.

S: Your calling card? Mr B: The white cane of course. S: Oh [I feel totally lost for words]. Is there anyone else? Mr B: The professionals at the eye hospital help too. They tell people there is nothing we can do. You are untreatable. Their expertise and inability to do anything and their acceptance of failure convinces May that she is powerless. S: You seem to think you are invincible. Surely that isnt true? Mr B: I succeed because I keep people isolated and afraid. They cannot see beyond that. Of course I am invincible
After the interview

When May thought she had answers to all the questions she wanted asked, I asked her about what she had heard, to nd out whether there were any clues to the demolishment (Mays word) of Mr Bs power. She reported being surprised at how accurate Mr Bs account was of the effects he had on her life, and that rstly shed been angry with him, then amused (he seemed a very laughable gure), then sad and determined. Sad because of the way she had allowed him to isolate her from people who could support her, like Peter and her many friends. Determined, in that she could now see ways of avoiding his inuence. She also felt that Mr B wasnt actually the blindness. Blindness was different a physical thing which I can learn to live with. Mr B was, in fact, unmasked as fear and that fear was not about the blindness itself but about other peoples attitudes, how she felt

Who we are is seen as being constructed through language and within relationship with others rather than being an internal reality which has to be uncovered

28 Therapy Today/September 2009

about herself, that she lacked the condence to learn new skills at such an old age, and also about dying Is this the beginning of the end? I asked May how she felt about the grilling of Mr B. Amazed, now I can see him for what he is and Ive stopped feeling that uttery fear feeling inside, she said. He is well and truly grilled and eaten. We talked further about Peter and Mays experience and what it was like for Peter to act the part of Mr B. May said, It was a fun way of approaching something really serious. Im not very good at all this how do you feel about it? stuff. I suppose I come from an era of saying dont waste time crying and just get on with it. I am amazed at how much we really knew about all of this. Within the externalising conversation, May was able to systematically examine the effects that blindness had had on her life and even separate blindness from Mr B and how she could resist and redene how she related with this bloody problem. Both Peter and May had commented that blindness had come between them and was causing a rift in their relationship, and that following this particular conversation they had become closer and were working together again. They both felt that because the conversation was light and fun it helped them move from being entrenched in doom and gloom and only seeing the problem, to engaging with a therapeutic process in ways they had not thought possible. As White and Epston comment, externalising conversations free persons to take a lighter, more effective, less stressed approach to
References

deadly serious problems, and present options for dialogue rather than monologue about the problem.5 As I write this article I am aware that the writing does not constitute the reality of what happened between myself, Peter and May, but is only a reection of how it is remembered now, and that may change! But it is hoped that the grilling enabled one person to research the inuence of blindness in her life and to open up choices as to who she wanted to become in relation to this blindness. To a wider audience, it enables a unique glimpse into the lived experience of a couple (both in their 80s) who had been affected by blindness, showing how medical understandings of sight loss and blindness imprisoned May (Mays description) into a xed identity, whereas blindness is in fact only part of who she is as a person.
Epilogue

feeling that they were laughing at me for taking myself so seriously. I feel a sense of being very privileged to have listened to their stories from so many decades. I have learnt so much from my work with them, and I feel sad too because this is an ending. Although I am sure that if I telephoned and asked if I could visit again they would say yes, I know that they do not need me in my role as therapist any more, and I guess that I will not see them again.
Journal entry: 8 January

I received a postcard from Peter and May today. On the front was a poem by Spike Milligan: A thousand hairy savages Sitting down to lunch. Gobble gobble glup glup Munch munch munch. Alongside the poem was a cartoon drawing of the savages. On the back, Peter and May had written: This is us and your readers eating Mr B for lunch. Thank you. You helped us so much (and your interrogation techniques were brilliant). It was so good to talk about it with you. I hope it helps others to vanquish their Mr Bs. Susan Dale works as a counsellor for a large UK charity supporting people who are blind or partially sighted. She is interested in narrative approaches to counselling, and is involved in a collaborative research project exploring the experience of sight loss as part of doctoral studies with the University of Bristol. Email sd2510@bristol.ac.uk

Grilling: A form of cooking that involves direct heat. An act or process of interrogating a person in an intimidating and persistent manner (Encarta English Dictionary)
Journal entry: 24 November

I visited May and Peter today. I wanted to talk to them about what I had written about the grilling of Mr B. Of course you can use it... if you think that it will be of interest to anyone apart from us, said May. We did enjoy it. Its not often we get to play at our age It helped us though, and thats what makes all the difference, said Peter. As I trundle home on the train and recall their words, I have the distinct
5. White M, Epston D. Narrative means to therapeutic ends. New York: W.W. Norton & Company; 1990. 6. Tomm K. Externalising problems and internalizing personal agency. Journal of Strategic and Systemic Therapies; 1989. 7. Freedman J, Combs G. Narrative therapy: the social construction of preferred realities. New York: W.W. Norton & Company; 1996. 8. Carey M, Russell S. Externalising commonly asked questions. The International Journal of Narrative Therapy and Community Work. 2004; 2.

1. Morgan A. What is narrative therapy? An easy to read introduction. Adelaide: Dulwich Centre Publications; 2000. 2. RNIB. http://rnib.org.uk/eyeconditon. Accessed 20/05/08. 3. White M. Pseudo-encopresis: from avalanche to victory, from vicious to virtuous cycles. Family Systems Medicine. 1984; 2(2). 4. White M. Fear busting and monster training. Dulwich Centre Review; 1985.

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