Tree of Life Group
With People with
Learning Disabilities
Dr Myro Themistocleous
Lead Clinical Psychologist
Newham Community Learning Disabilities Team
Overview
• Key assumptions of Narrative Therapy (NT)
• Introduction to what tree of life is & for who
• What does it look like? 4 part structure
• What we did- the story of our tree of life day
• Outcomes
• References & further reading
Narrative Therapy:
Key Assumptions
•To maximize effectiveness knowledge of NT is needed
• The problem is the problem the problem not the person.
But, problem saturated stories are often the dominant
story. They can be experienced as oppressive as they limit
the perception of available choices for life and identity
•They obscure peoples hopes, dreams, skills, achievements
•“Life is multi-storied not single storied- there is usually a
stock of lived experiences that is un-storied” (Baum, 2014)
•Identity is seen as a project that can be created & recreated
in relationship with others
Narrative Therapy: How ? (1)
• By reducing the power of the dominant
problem saturated stories.
• By brining forth the sub-ordinate & preferred
stories of people's lives
• Facilitating connections to others
• Facilitating connections to values & what & is
important to enable preferred ways of living
Narrative Therapy: How? (1)
• Externalising
• Mapping personal histories, focusing on action &
identity
• Deconstructing language & cultural discourses
• Authenticity & Communities of acknowledgement
• Thickening the alternative story using definitional
ceremonies, therapeutic documents etc
Tree of Life:
What is it & Who is it For?
• "it is a tool that uses different parts of a tree as metaphors to
represent the different aspects of our lives" (Ncube & Denborough,
2007)
• Developed for children who have experienced losses & traumas. Used
in many contexts. Only used for people with LD’s in a group by
Lynggaard et al (2010)
• Helps to give language to people who may otherwise struggle
• Creates strength & hope for future around shared values
• Creates a safe place to stand by bringing forth preferred aspects of
identity which helps to change their relationship to the problem
What Does it Look Like?
1. Trees of life: creation of a preferred
identity by bringing forth the subordinate
stories. These encompass skills, abilities,
hopes, dreams, and the histories of them.
4 part structure
2. Forest of life: the re-telling of preferred
identities and connecting with others.
3. Storms: enable participants to talk
about their problems & how they are
responding
4. Certificates: to ensure that people
leave with a rich acknowledgment of their
skills and abilities. As well as links with
significant people in their lives.
(Denborough, 2008)
The Story of Our Tree of Life
Invitations & Participants
•Colleagues asked to refer clients
who would benefit from a
workshop to improve confidence
and self-esteem.
•22 clients referred, 10 were
invited, 6 attended.
•Most have experienced physical
or sexual abuse.
•3 facilitators.
From Individuals to Group
•Introductions & co-created rules.
•Warm up exercise.
•Images of trees around the room
for inspiration.
Part 1: Tree of Life
• Draw trees: Participants were invited to draw
trees that included ground, roots, trunk,
branches, leaves fruit and flowers. Not about
artistic skill.
• The ground: Where they are now, activities
enjoy, where they live.
• The roots: Heritage, family, culture,
country/place of origin/ significance, religion,
favourite childhood songs and games, important
teachers etc.
Part 1: Tree of Life
• The trunk: Use of stories to identify skills & abilities. Stands in direct
contrast to the totalising label of ‘learning disability’
• Adapted Post it Note exercise (Maggie Carey, 2013)
• Clients invited to tell a story whilst others listened out for skills
• Variety of stories shared from ‘breaking up a table’ to ‘passing a piano
exam’
• Phun’s story- ‘doing voluntary work in a shoe shop’
• Excerpt illustrating questions used to thicken the alternative story
• Powerful exercise- All participants surprised they had so many skills
Part 1: Tree of Life
•
The branches: Hopes, dreams and wishes for their life. E.g. wanting
to live independently, to have a partner and children, get a job, do
more sport, to travel, learn to drive
•
The leaves: Significant people from now or the past, real or fictional.
•
The fruits: Gifts they have been given. Adapted using pictures of
apples with space for writing & asking them to give each other gifts.
We began with an example:
Natasha
is brave.
Participants were generous with their gifts:
e.g. “caring person and friendly too” ,
“good at dealing with things” &
“thoughtful”
• The flowers: Gifts they have given others. Needs adapting.
Part 2: Forest of Life
• Created ‘the
forest’ by sticking
up each persons
tree
• Sharing of the
trees
•They seemed
proud
Part 3:When the Storms
Come
• Invited to name dangers for
trees “storms, fire, wind,
floods..”
• Linked dangers to what hurts
people in general sense. Keen
to avoid rehearsed single
problem saturated stories.
• They were all nodding, some
making comments such as
‘yes’ and others seeming
pensive.
Part 4: Certificates, Songs &
Photos
• Reading & presenting of certificates
• Celebration honouring
participants’ skills, hopes
and dreams and special
connections
• Collaboratively completed
certificates to ensure
focus remains on clients
priorities (de centred
practice)
• Talk of who they would
share these with to
recruit an audience
outside of therapy room
• Silence as they listened intensively.
Tree of Life certificate
Awarded to: ____________________
For proving to herself and to others that
she has many skills and abilities that help to give her
strength in her life.
She also has special dreams and hopes for the future.
____ skills and abilities include ____________
___________________________________
Her hopes and dreams are
_______________________________________She would like
to appreciate the following special people in her life:
_______________________________________Date:
____________
Signature:
By Lynggaard et al (2010)
Part 4: Certificates, Songs &
Photos serve many functions
•Join people around shared themes in ways that thicken the
alternative stories of their lives (White, 2007)
•Just as Myerhoff (1986) talks about how definitional ceremonies
serve to combat the sense of isolation and invisibility that is often
experienced by people who are socially marginisalied. The reading of
the certificates provides opportunities for people to be seen in their
preferred ways and the presence of an audience serves to
authenticate these alternative identity claims.
•They can be used later to share the alternative stories with others in
their lives to further authenticate them.
•Therapeutic documents act as a reminder to them of the day and
to stay connected to their commitments (Morgan, 2000).
•To serve as counter-documents to the problem saturated reports
that have often been written about people (Morgan, 2000)
Part 4: Photos
Tree of Life Day
• Consent was obtained to photograph each
tree for our clinical records.
• Request for a group photograph. Chorus of
voices ‘that’s a good idea.’
• Important bonding ceremony as they all
stood together in front of their trees.
• Created cards thanking them for attending
and reminding them to look at their trees
or certificates if any storms come.
Outcomes- Quantitative
•
•
•
A short questionnaire was designed despite epistemological tensions.
0-10 point likert scale where zero represented ‘not at all’ and 10 ‘totally’.
Group run twice with different people. Results for both are presented below.
Group 1 (August 2013)
Group 2 (February 2014)
Chart 1: How confident do you feel about yourself?
Chart 2: How much do you like yourself?
Outcomes- Qualitative
What did you like
about the day?
Themes
Making friends & the people
Frequenc
y
7
“meeting new people”/ “I like to help other people as well. Because they are
caring and helpful.”/ “The staff were lovely” / “People treating me with respect.
Friendly people.”
Talking
6
“ talking about myself made me feel better/ talking about
girlfriend/boyfriend/future”
Learning, Skills & Life
5
“I learnt about myself.” / “..I learnt my skills. I gained some skills today.” /
“I came on time.”
General positive & other
5
“Everything, all good” / “Listening”
Making Trees, drawing and writing
3
“creating trees in group” / “I liked doing the pictures, drawing and writing.”
Fun & enjoying day
“Having fun” / “I really enjoyed myself today. And I realty liked it so much.”
3
Outcomes- Qualitative
What did
you dislike
about the
day?
All comments on what participants disliked
“…I dislike where you have to make up a story
because I found it hard to hear.”
Frequency
1
“it was a bit long but we managed to fit it in ok”
1
“I would like it to be longer, maybe for 2 days”
1
“disliked drawing”
1
“Coming late I missed a lot.”
1
Ad hoc: growing trees!? (1)
Clients and families
• 4 requests for the photo weeks later
• 2 mothers said their daughters ‘really enjoyed it’ and were
‘excited’
• ‘I was surprised I could speak in front of the group’
• ‘seeing people like me who have jobs and their own flat
makes me think maybe I could too!’
• 5 months later a client said he looks at his tree ‘to cheer him
up when he feels down’ which he has put up inside his
wardrobe!
• Friendship? 2 requests for phone numbers “try to be her
friend”
• 3 clients who DNA’d have since contacted to apologise and
request another group.
Ad hoc: growing trees!? (2)
Facilitators
• “That’s exactly the kind of thing I want
to do more of”
• “a special memory” she will take with
her to her new job
• “life affirming & inspiring day”
• Both clients and facilitators felt inspired
and hopeful
References & further
reading
Baum, S. (2014). Presentation on Using the tree of life with people with learning disabilities. Oxleas:
Oxleas NHS Trust.
Denborough, D. (2008). Chapter 4, The tree of life: a collective narrative approach to working with
vulnerable children. In Collective Narrative Practice, responding to individuals groups and committed
who have experience trauma. Adelaide: Dulwich centre publications.
Lynggaard, H. et al (2010) unpublished resources for a tree of life group with people with learning
disabilities. Islington.
Maggie Carey in H.Fox, C. Goney and P. Ord (2013). Exercise on Level 3 Narrative Therapy module Linking
Lives, working with groups and communities. Institute of Narrative Therapy.
Morgan, A. (2000). What is Narrative Therapy? An easy-to-read introduction. Adelaide: Dulwich centre
publications.
Myerhooff (1986) In White, M. (2007). Maps of narrative practice. New York: W.V Norton & Company Ltd.
Ncube-Millo, N., & Denborough, D., (2007). Tree of Life, mainstreaming psychosocial care And support: a
manual for facilitators, Randburg, South Africa: REPSSI.
White, M. (2007). Maps of narrative practice. New York: W.V Norton & Company Ltd.
Example of contexts in which tree of life has been used
e.g. International adoption (Ames, 2006), African & Caribbean men with mental health problems in the UK
(Carlin, 2009), Vietnamese men in Melbourne (Read, 2010). Contact me for full referenceces.
My contact details
Dr Myro Themistocleous
Lead Clinical Psychologist
Newham Community Learning Disabilities Team
Myro.themistocleous@eastlondon.nhs.uk
0208 250 7500