DAFT Conference:
Narrative Approaches with
people with learning disabilities
Martha Laxton-Kane
Consultant Clinical Psychologist &
Team Lead for LD CAMHS, North Derbyshire
Martha Laxton-Kane, Consultant
Clinical Psychologist
Aims
1.
2.
3.
Briefly outline the main principles of
Narrative Therapy.
Consider how Narrative Therapy can be
used with people with learning
disabilities and their families.
Share some examples of practice.
Martha Laxton-Kane, Consultant
Clinical Psychologist
Narrative Therapy: Brief Overview
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Many ideas originated in Southern Hemisphere
with work from David Epston and Michael White
Earlier work with children, more recent
developments with many other groups of people
with variety of ways of working eg community
work with indigenous populations
From Commonly Asked Questions about NT,
www.dulwichcentre.com.au
Martha Laxton-Kane, Consultant
Clinical Psychologist
Stories in our lives
Stories – events, linked in sequence, across
time, according to a plot. Life is multistoried
Martha Laxton-Kane, Consultant
Clinical Psychologist
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Everyone has ‘dominant stories’ (that may be
problem saturated) that can be unhelpful to the
person.
The aim of NT is to help replace the dominant
story with an alternative one (to a preferred
story), that is currently more thinly described.
Dominant stories need to be ‘deconstructed’ and
then alternative or preferred ones
‘reconstructed’.
Dominant stories – never produced in isolation
from the broader world, affect what events are
attended to
Martha Laxton-Kane, Consultant
Clinical Psychologist
Some more narrative concepts
(adapted from Morgan, 2000)
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Thin descriptions – often heard early in
meetings, often created by others, leave
little room for movement
Alternative stories – identified by the
person as stories by which they would like
to live their lives, rich description
Unique outcomes
Martha Laxton-Kane, Consultant
Clinical Psychologist
The process according to Matthews
& Matthews (2005) involves:
(1)
(2)
(3)
(4)
Listening to and understanding the
person's story
Deconstructing the problem stories
Re-storying
Sustaining the change.
Martha Laxton-Kane, Consultant
Clinical Psychologist
“Briefly, Narrative Therapy uses a story (narrative) metaphor
and proposes the meaning we give to our (daily) experiences is
determined by the stories we have about ourselves. Stories
about life and ourselves are socially, culturally and historically
situated and we all have many stories about our lives and
relationships: life is multi-storied. The stronger (more dominant)
a story’s presence in a person’s life the more their life will be
influenced by it. When people come for therapy they are usually
in the grip of a (dominant) problem story about their lives.
Narrative Therapy engages in externalising conversations moving
from the dominant problem story (the known and familiar) to the
noticing of alternative and preferred stories of a person’s life (the
possible to know). These preferred stories are then
systematically ‘thickened’ to enable them to have more influence
on a person’s life”. (Hilton 2012)
Martha Laxton-Kane, Consultant
Clinical Psychologist
Externalisation
Is just one type of conversation in Narrative, but
often provides the base from which other
Narrative conversations are built upon.
Typical questions:
 If you could draw x what does it look like?
 How has x affected your thoughts and feelings?
 How has x affected your relationship with your
boyfriend?
 Is this effect a good thing or bad thing?
Martha Laxton-Kane, Consultant
Clinical Psychologist
Exercise
What might some of the common dominant
stories be in the lives of people with
learning disabilities?
Martha Laxton-Kane, Consultant
Clinical Psychologist
Martha Laxton-Kane, Consultant
Clinical Psychologist
Martha Laxton-Kane, Consultant
Clinical Psychologist
Martha Laxton-Kane, Consultant
Clinical Psychologist
Videos …….
Martha Laxton-Kane, Consultant
Clinical Psychologist
General principles of working with
people with ld
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YP with LD often described behaviourally*
It will take more time – very repetitive, need smaller steps
and realistic aims
Need to make abstract concepts more concrete – drawing,
writing, play dough, genograms with pictures, concepts into
metaphors
Do ask others how to respond and observe others
interactions… & ask Speech and Language Therapy advice
All people with LD will have different levels of ability and
understanding.
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Specialist LD-CAMHS
*challenging behaviours can mask physical causes
Martha Laxton-Kane, Consultant
Clinical Psychologist
More general principles of working
with people with ld ……
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Help retention of information with simple
letter / summary.
Simple agenda and cross off to help YP
keep focused / concentrate.
Accept going off at a tangent at times /
muddled concepts.
Martha Laxton-Kane, Consultant
Clinical Psychologist
Adapting Narrative
for people with LD
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The same principles apply as with the use of
other therapies for people with learning
disabilities
Try and use more concrete concepts (which may
be tricky with externalisation)
Give people more time to learn and get used to
different ways of talking
Most of all be creative – use visual imagery to
support ideas and act as reminders eg
plastercene, drawings, writings, letters, embrace
support workers and family etc
Martha Laxton-Kane, Consultant
Clinical Psychologist
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Adapting Narrative
for people with LD
Give the person with LD more time and opportunity
Use visual supports to make concepts more
concrete
It is suggested that for people with more severe LD
may have to invite others to give them a voice /
adopt their position if they cannot be included.
Managing questions / conversations with different
family members – clearer who asking questions to
and recap frequently.
May have to go into the home environment – be
Martha Laxton-Kane, Consultant
flexible about work
Clinical Psychologist
What I love about people with
learning disabilities
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A challenge to social rules
Small changes are very important
A lack of chips and judgements
Honoured to be part of families lives
Honesty
Laughter
Learning how other people overcome
marginalisation and challenges
Martha Laxton-Kane, Consultant
Clinical Psychologist
Thank-you
martha.laxton-kane@nhs.net
Martha Laxton-Kane, Consultant
Clinical Psychologist
Research into Narrative Therapy
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The relationship between Narrative Therapy and Evidence-based
practice
Co-research – archives of solution knowledges, asking people what’s
helpful, co-research in training and in service evaluation
Special edition of International Journal of Narrative Therapy and
Community Work (2004, 2)
Recent Forum article
Use of externalisation with children who soil (Silver et al., 1998)
Use of narrative therapy for major depressive disorder (Vromans
and Schweitzer, 2010).
Also studies looking at use of narrative therapy and eating
disorders, and childhood stealing.
Martha Laxton-Kane, Consultant
Clinical Psychologist
References and useful links
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Matthews, B & Matthews, B (2005) Narrative Therapy: Potential uses for People with Intellectual
Disability. International Journal of Disability, Community and Rehabilitation.
Hilton, A. (2012) Moving Things to Independent Life: The influence of Narrative Therapy on
working with a woman affected by learning disabilities (originally appeared in Clinical Psychology
& People with Learning Disabilities, Vol 10, no 2, Sept 2012).
Morgan, A. (2000) What is narrative therapy ? An easy-to-read introduction. Adelaide: Dulwich
Centre Publications
Morgan, A. (2002) Discerning between structuralist and non-structuralist categories of identity :
a training exercise. International Journal of Narrative Therapy and Community Work, 4, 52- 55.
Silver, E., Williams, A., Worthington, F. & Phillips, N. (1998). Family therapy and soiling: an
audit of externalizing and other approaches. Journal of Family Therapy, 20(4), 413-422.
Vromans, L. & Schweitzer, R. (2011). Narrative therapy for adults with major depressive
disorder: improved symptoms and interpersonal outcomes. Psychotherapy research, 21(1), 4-15.
www.dulwichcentre.com.au
www.narrativepractice.com Hugh Fox
Martha Laxton-Kane, Consultant
Clinical Psychologist
A Narrative Framework for
interviews (adapted from Morgan 2000)
PART 1
 Naming the problem (externalising conversations)
 Tracing the history of the problem and the effects of the problem
on the person’s life
 Situating the problem in context – deconstruction (problems survive
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and thrive when backed up by beliefs and values)
Discovering Unique Outcomes (times when the problem has had no or less
influence, stories that contradict the dominant problem story)
Tracing the history and meaning of the Unique Outcome (naming
an alternative story)
PART 2
 Thickening the alternative story
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‘Re-membering’ conversations
Therapeutic documentation and letters
Witnesses
Martha Laxton-Kane, Consultant
Clinical Psychologist