What are the ethical issues involved in psychologists taking a public stance on a controversial issue?

After reading the Haeny (2014) article, provide a summary and analysis of the topic. Be sure to address the following in your main post:

  • What are the ethical issues involved in psychologists taking a public stance on a controversial issue?
  • What specific General Principles apply to this issue?
  • How do the standards in Section 5 on advertising and other public statements relate to this issue?
  • What are some steps that a psychologist should take prior to speaking publically on a controversial issue?
  • In your opinion, is it better for a psychologist to avoid speaking publically on a controversial issue when the psychologist’s personal views do not align with the field’s general consensus on the topic? Provide your rationale.

Psychology Of Consulting And Coaching

Psychological Services Bringing Chronic-Pain Care to Rural Veterans: A Telehealth Pilot Program Description Lisa H. Glynn, Jessica A. Chen, Timothy C. Dawson, Hannah Gelman, and Steven B. Zeliadt Online First Publication, January 16, 2020. http://dx.doi.org/10.1037/ser0000408

CITATION Glynn, L. H., Chen, J. A., Dawson, T. C., Gelman, H., & Zeliadt, S. B. (2020, January 16). Bringing Chronic-Pain Care to Rural Veterans: A Telehealth Pilot Program Description. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000408

 

 

Bringing Chronic-Pain Care to Rural Veterans: A Telehealth Pilot Program Description

Lisa H. Glynn Veterans Affairs Puget Sound Health Care System,

Seattle, Washington

Jessica A. Chen and Timothy C. Dawson Veterans Affairs Puget Sound Health Care System, Seattle,

Washington, and University of Washington

Hannah Gelman Denver–Seattle Center of Innovation (COIN) for Veteran-

Centered Value-Driven Care, Seattle, Washington

Steven B. Zeliadt Denver–Seattle Center of Innovation (COIN) for Veteran-

Centered Value-Driven Care, Seattle, Washington, and University of Washington

Opioid-related harms disproportionately affect rural communities. Recent research-based policy changes have called for reductions in opioid prescribing and substitution of safe and effective alternatives to opioids for treating chronic pain, but such alternatives are often difficult to access in rural areas. Telehealth services can help address this disparity by bringing evidence-based, biopsychosocial chronic- pain services to rural and underserved patients with chronic pain. This article describes a 2-year pilot project for delivering chronic-pain care by pain specialists from central hubs at Veterans Health Administration (VA) medical centers to spokes at VA community-based outpatient clinics (CBOCs). The VA Puget Sound Pain Telehealth pilot program offered pain education classes, cognitive–behavioral therapy groups, opioid-safety education, and acupuncture education. The program delivered 501 encoun- ters to patients from 1 hub to 4 CBOC spoke sites from 2016 to 2018, and supported training, administration, equipment acquisition, and grant-writing. The quality-improvement project was rolled out using existing local resources. We present initial findings about the patients who utilized Pain Telehealth, share lessons learned, and discuss future directions for expansion.

Impact Statement A pilot project was created to bring chronic-pain care by telehealth to rural patients at Veterans Affairs (VA) clinics in their local communities. The program increased access to safer alternatives to opioid medications, including pain education and psychotherapy. New funding will expand the program to the rest of VA’s Northwest Region.

Keywords: chronic pain, opioid safety, rural health, telehealth, veterans

People with chronic pain who reside rurally are at elevated risk of negative outcomes. Rural areas of the United States have been affected disproportionately by the opioid public-health crisis, as evidenced by higher rates of opioid prescribing, opioid misuse,

substance use disorders, and unintentional overdose (e.g., Dowell, Haegerich, & Chou, 2019; Lund, Ohl, Hadlandsmyth, & Mosher, 2019; O’Brien, 2015; Palombi, St. Hill, Lipsky, Swanoski, & Lutfiyya, 2018). The co-occurrence of chronic pain and opioid use

X Lisa H. Glynn, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; X Jessica A. Chen, Denver–Seattle Center of Inno- vation (COIN) for Veteran-Centered Value-Driven Care, VA Health Ser- vices Research & Development (HSR&D) and Veterans Affairs Puget Sound Health Care System, and Department of Psychiatry & Behavioral Sciences, University of Washington; X Timothy C. Dawson, Veterans Affairs Puget Sound Health Care System, and Department of Anesthesi- ology, University of Washington; X Hannah Gelman, Denver–Seattle Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, VA Health Services Research & Development (HSR&D), Seattle, Wash- ington; Steven B. Zeliadt, Denver–Seattle Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, VA Health Services Research &

Development (HSR&D), and Department of Health Services, University of Washington.

The Pain Telehealth pilot was a quality-improvement project of VA Puget Sound. The authors thank their collaborators at Veterans Integrated Service Network 20, Bradford Felker and the Promoting Access through Telemental Health and Western Telehealth Network teams, the VA Puget Sound Telehealth Committee, and Eva Thomas and Chelle Wheat for their assistance in data preparation. The views expressed in this article are those of the authors, and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Correspondence concerning this article should be addressed to Lisa H. Glynn, Veterans Affairs Puget Sound Health Care System, 1660 South Co- lumbian Way (S-112 ANES), Seattle, WA 98108. E-mail: lisa.glynn2@va.gov

Psychological Services In the public domain 2020, Vol. 1, No. 999, 000 ISSN: 1541-1559 http://dx.doi.org/10.1037/ser0000408

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https://orcid.org/0000-0003-4150-2755
https://orcid.org/0000-0003-0415-3701
https://orcid.org/0000-0001-8017-5836
https://orcid.org/0000-0002-5752-5305
http://dx.doi.org/10.1037/ser0000408

 

disorder is associated with increased suicide risk and the co- occurrence of other psychiatric diagnoses (e.g., mood, anxiety, trauma-related, substance-use, or personality disorders), which can complicate effective care for these patients (Barry et al., 2016; Bernardy & Montaño, 2019; Dowell et al., 2019; Oliva et al., 2017).

Problem Description and Available Knowledge

Opioid medications are not only risky, but also do not clearly improve chronic-pain outcomes or confer functional benefits over less risky pain medications (e.g., Chou et al., 2015; Krebs et al., 2018). Research-based clinical-practice guidelines (Department of Veterans Affairs & Department of Defense, 2017; Dowell, Hae- gerich, & Chou, 2016) generally discourage long-term opioids for chronic pain, and instead support the delivery of biopsychosocial alternatives as first-line treatments for chronic pain, including pain education, cognitive–behavioral therapy, physical therapy and paced-exercise treatments, and self-management. Biopsychosocial modalities are effective for improving functional status (Becker et al., 2018; Gatchel, Peng, Peters, Fuchs, & Turk, 2007). They may be enhanced when combined through a comprehensive interdisci- plinary approach, which may also include nonopioid medications and complementary and integrative medicine (Department of Vet- erans Affairs & Department of Defense, 2017; Gatchel, McGeary, McGeary, & Lippe, 2014). Evidence-based psychotherapies— such as Cognitive–Behavioral Therapy for Chronic Pain (Ehde, Dillworth, & Turner, 2014; Murphy et al., 2014), Acceptance and Commitment Therapy for Chronic Pain (e.g., Veehof, Trompetter, Bohlmeijer, & Schreurs, 2016), Motivational Inter- viewing (e.g., Alperstein & Sharpe, 2016), and mindfulness or mind– body interventions (Garland et al., 2019; Maglione et al., 2016)—are safe and potent elements of comprehensive chronic- pain care that can be viable alternatives to opioids (Majeed, Ali, & Sudak, 2019).

However, effective treatment modalities for chronic pain and co-occurring conditions are not always accessible to patients who are likely to benefit from them. Comprehensive chronic-pain ser- vices are not covered by all health care systems and insurance plans (Keogh, Rosser, & Eccleston, 2010), and rural patients are more likely to be uninsured (Centers for Disease Control, 2018). The availability of interdisciplinary chronic-pain teams in the United States has decreased sharply in recent years (Schatman, 2018), and this problem is compounded in rural areas, where few specialty pain providers practice (Arout, Sofuoglu, & Rosenheck, 2017; Breuer, Pappagallo, Tai, & Portenoy, 2007; Department of Health and Human Services, National Center for Health Work- force Analysis, 2014; Eaton et al., 2018). In addition, geographical inaccessibility can exacerbate other barriers to care, such as limited mobility, lack of transportation, financial difficulties, and co- occurring medical or psychiatric concerns (Department of Veter- ans Affairs, Office of Rural Health, 2019; Rural Health Informa- tion Hub, 2016). Patients with chronic pain who reside rurally are thus high in need, but subject to significant disparities. Telehealth has been proposed as one solution to more equitably distribute specialty pain resources that tend to be concentrated at large urban medical centers.

Rationale for Telehealth

Integrative Project In Counseling

Choose a therapeutic scenario from the options at the end of the case study to serve as a direction for therapy.

Create a personal theoretical orientation based off the theories that were discussed in this course.

Write a 1,050- to 1,400-word paper to integrate theory and counseling skills with this family. Include the following:

  • A complete assessment of the family, using the assessment approaches associated with your theoretical orientation.
  • A discussion on which dyadic assessment tools you would utilize for assessing the couple and how you chose these tools.
  • A conceptualization of the family, according to your theoretical orientation.
  • A description of how you would utilize the interventions associated with your theoretical orientation with this family.

Include a minimum of 5 sources.

Format your paper according to APA guidelines.

  Title

ABC/123 Version X

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  Miller Family Case Study

CCMH/565 Version 6

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University of Phoenix Material

Miller Family Case Study

Review the following case study.

Choose a therapeutic scenario from the options at the end of the case study.

The Miller family consists of married parents (Jim, 43; Stacie, 41), and their 4 children (Mike, 19, is a freshman at the state university on a baseball scholarship; Liz, 17, is a senior in high school; Erin, 15, is a sophomore in high school; and Sarah, 11, is in the 5th grade). They live in a very comfortable, suburban, middle-class neighborhood, and have resided there for the past 10 years.

Jim came from a lower middle-class family that seemed to always struggle to make ends meet. Both his parents are still living in a town about 3 hours away. His dad worked long hours at the factory and would often head to the bar after work. The family didn’t see “Grandpa Jimmy” as an alcoholic, but he definitely liked to unwind before coming home. He was never abusive — just sort of “absent” emotionally. Jim’s mother was a homemaker and did what she could with what the family had. Jim had one older brother, but he died in a boating accident when he was 5 and Jim was 3.

Committed to providing a better life for his family, Jim learned to work hard. He is a sales rep for a large pharmaceutical company, with an annual salary of $95K. But during the last 2 years, he has earned approximately $105K. He attributes his higher earnings to his hard work, long hours, “wining and dining” his physician clients, and staying up on the latest research on the medications he reps. He was promoted to regional sales manager 3 years ago, but it didn’t go well. He did not like managing people as much as taking care of his clients, so he requested to return to his old territory and has been much happier (although his long hours mean he is home less frequently). He enjoys being a dad and sees his primary role as a provider. He misses coaching Mike’s youth baseball and basketball teams, and has adjusted to Mike being away at college by working longer hours. His daughters are his “angels,” although he admittedly feels like he is losing touch with them, their interests, their friends, etc. He believes the best thing he can do is continue providing for them the best he knows how, even though it means he spends less time at home.

In addition, the arguments between him and Stacie seem to have increased. She is beginning to resent his increased time away from home and tells him the extra money isn’t worth it. Jim resents being caught in the middle of her inconsistencies — on one hand, she wants him home more, and yet on the other, she always seems to talk about traveling, getting “upgrades” for the house, driving a nice car, etc. “You can’t have your cake and eat it too,” he reminds her. And while he would like more leisure time too, he doesn’t mind avoiding the emotional “drama” by working longer hours.

Stacie is a small-scale entrepreneur and has made a business out of her artistic and fashion interests by making custom jewelry and selling the merchandise online and in small boutiques. Her business occupies about one-quarter of the basement but is content spending 10-20 hours a week with it. Stacie has a small group of loyal customers and feels like she has found her niche. She also has visions of growing her company, but feels like she carries most of the parenting load and doesn’t have the time to expand her business. In particular, Stacie feels like there are days when she can barely keep up with the girls’ activities and demanding schedules. While she appreciates having a fairly comfortable lifestyle, she feels growing resentment that the vast majority of household and parenting obligations fall on her shoulders. She has attempted to talk with Jim about her frustrations, feeling like she is alone on the homefront, but it doesn’t take long before they both become defensive, even argumentative, so she has learned it’s best to not even bring it up.

Stacie grew up in a comfortable, middle-class home. Her father, who passed away 4 years ago from pancreatic cancer, was a strict authoritarian and was deeply entrenched in what Stacie used to call “prehistoric gender roles.” He never did any of the household work, and the only parenting Stacie remembers her father taking part in was the role of disciplinarian. She was close to her mother, but could never understand why she put up with his lack of involvement in the home. She recalls her mom would always defend her father, saying “He works hard all day providing for the family; that’s what a good father and husband does”). Stacie remembers thinking, “That’s not how my family’s going to be when I get married!” Her mother lives alone and is healthy and active. Stacie has an older brother and a younger sister, with whom she gets along well. They both have “nice” families and both live within 45 minutes of Stacie.

Mike is the only son and seems to be the “golden child.” He is good looking and charismatic, and has always been an exceptional athlete. His grades were never stellar, but he was always able to somehow pull off decent grades without much effort or extra studying. Growing up, he was fairly mischievous, but not really a behaviorally-challenged boy. Mike pushed the boundaries a bit — he got caught smoking weed once in high school — but was generally well-behaved throughout his adolescence. Mike is adjusting to college life, has worked his way into a starting position on the baseball team, and is managing to maintain a low B average while pursuing his Recreation Science degree.

Liz is a senior in high school, but has drifted from her previous plans to attend medical school and become a pediatrician. Up until the end of her sophomore year, she was a stellar student, almost obsessed about getting straight As and took pride in her academic achievements. She dreamed of saving the world one sick child at a time. However, during the summer between her sophomore and junior years, she met a group of free-spirited kids who seem to have influenced her toward a different path. She became a bit more defiant at home, and while she is not “out of control,” there is definitely a confrontational approach behind her interactions with family, especially toward Jim. In responding to her father’s requests, she typically makes comments such as, “You’re never here anyway, so why should I listen to you?” Rather than argue with her, Jim’s typical response is to withdraw, making an under-the-breath comment like, “It’s your life — screw it up if you want to.” He feels sad about the conflict, but doesn’t seem to have the energy to take a stand. Stacie has also felt the pain of the growing distance between her and Liz. She is confused about how their relationship changed so drastically, but despite the increase in arguments between them, they both report getting along “OK.”

Erin loves school and has always gone above and beyond in her studies. She takes pride in her organization skills and recognizes she is a bit more mature than many of her peers, especially the out of control boys who always seem to disrupt class). She is already preparing for college by reviewing the SAT manual and usually spends her free time reading, programming, etc. Erin is disgusted that Liz seems to have “thrown her life away by hanging out with those losers” and rarely spends time with friends her age in typical social settings. She is not socially awkward, but rather sees her peers as uninteresting, and going nowhere since all they talk about is dating, music, and the latest fashions. Erin frequently stays up after bed time, as Stacie confides in her about some of the frustrations of managing the household. This usually leads to Erin taking on extra chores, preparing meals, etc. in order to feel as though she is taking some of the load off mom’s shoulders. She is quick to volunteer to pick up the slack and seems to enjoy her relatively new role as mom’s confidant.

Sarah has always been the quiet, yet sometimes “odd” one of the family. She likes to play with her dolls and stuffed animals alone in her room, sometimes for hours. Stacie noticed some aggressive play on one occasion, where one of the stuffed animals was “killing” all of the other characters and Sarah was speaking in very angry tones. She has never had any social or general behavior problems at school, but tends to be quiet and stays to herself most of the time. Sarah doesn’t seem to be shy; she just seems uninterested in interacting with the other kids at school. According to Stacie, Sarah is just different from the other girls. When they were her age, they were into fashion dressups and wanted to wear makeup. Meantime, Sarah has shown no interest in that sort of thing. She does, however, enjoy going on picnics, visiting her grandmother, and sitting down to read. During the last few months, however, she has not wanted to visit extended family and has begun reacting to her mother’s requests to do her chores with angry outbursts that include yelling and then shutting down. Stacie assumes Sarah is going through a phase and misses her older brother.

Possible Therapeutic Scenarios:

1. Jim and Stacie have agreed to see a marriage counselor to improve their relationship.

2. Jim and Stacie are seeking family therapy, because they are worried about Liz’s defiance and Sarah’s “odd” behavior.

3. Jim and Stacie are seeking child counseling for their youngest daughter, Sarah, to help her work through her recent reactive and odd behavior.

4. Jim and Stacie are bringing their 17-year-old daughter, Liz to counseling to discuss her recent lifestyle shift and adversarial behavior. They are concerned she may be using drugs.

Copyright © XXXX by University of Phoenix. All rights reserved.

Copyright © 2016 by University of Phoenix. All rights reserved.

Comparing Systemic Models

Write a 6–8-page paper, discussing the rationale for selecting Narrative Family Therapy. Include in your rationale a detailed description of the problem you are currently working on with a client or client system.

The Problem: The case study should be about a married couple wanting to get a divorce because of infidelity. They have both been unhappy for many years that they are both having affairs. They are only staying together because of their 16 year old son.

The format of the paper: Introduction

Case Study

Model Selected: Narrative Therapy

Assessment & Interventions

Model Applied to Case

Cultural Impact

Conclusion

  • Written communication: It should be free of errors that detract from the overall message.
  • APA formatting: Resources and citations are formatted according to current APA style and formatting.
  • Number of sources: A minimum of 10 peer-reviewed journal articles.
  • Length: 6–8 double-spaced, typed pages.
  • Font and font size: Times New Roman, 12 points.

*I have attached a few articles but there needs to be a total of 10 peer-reviewed.

Witnessing and Positioning: Structuring

Narrative Therapy with Families and

Couples

Jill Freedman, MSW Evanston Family Therapy Center, Evanston

In this paper, the author describes a way of structuring family therapy that fits with the narrative metaphor, creat- ing space for stories to be understood, deconstructed and further developed. In this process, people move between positions of telling and witnessing. Family members engage in shared understanding and meaning making.

Keywords: narrative therapy, positioning, outsider-witness, couple therapy, family therapy

Key Points

1 For narrative therapists, family therapy is a context where we can deconstruct problematic stories, tell and retell preferred stories, and witness family stories and individual stories of other family members.

2 A witnessing structure in which family members listen to another member tell his or her story can contrib- ute to understanding and meaning making.

3 Through responding to questions we ask members in the witnessing position, they can contribute to thick- ening preferred stories.

4 If it is difficult for family members to listen and understand while witnessing, we can facilitate a particular position from which to listen, such as listening as one would to a friend.

5 If more distance would be helpful for people to really listen and understand, we can offer other options, such as using video so that the witnesses are actually hearing and seeing family members tell their stories at a later time.

The narrative metaphor suggests that people make sense of their lives through stories (Brown & Augusta-Scott, 2007; Duvall & Beres, 2011; Freedman & Combs, 1996; Madigan, 2011; White & Epston, 1990; White, 2007; Zimmerman & Dickerson, 1994). Although each of us has a huge number of experiences, only a few of these become the stories that shape us and through which we shape our lives. Some of these stories are about individual people and others are about family and relationships. When couples or families come to therapy each person may have different stories that are prominent for them and that they think are most relevant; there may be some shared stories that different family members tell; and there may be similar stories that different family members tell but that they have made different meaning of, perhaps emphasizing different aspects of the same event or maybe understanding the same event in different ways.

Narrative therapists focus on rich story development – the telling and retelling of pre- ferred stories. Rather than a single-storied life we are interested in helping people develop

Address for correspondence: Jill Freedman, MSW, Evanston Family Therapy Center, 1212 1/2 Elmwood Avenue, Evanston, Illinois 60202 USA. narrativetherapy@sbcglobal.net Jill Freedman is the Director of the Evanston Family Therapy Center. With Gene Combs she is the author of ‘Narrative Therapy: The social construction of preferred realities’ (W.W. Norton).

Australian and New Zealand Journal of Family Therapy 2014, 35, 20–30 doi: 10.1002/anzf.1043

20 ª 2014 Australian Association of Family Therapy

 

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multiple stories. Our focus is not on solving or eliminating problem stories. We are interested in multiple stories contributing to people’s experience. Often when a problem story becomes a single strand of a multi-storied life, the problem looks quite different or becomes less significant and people have different options about how they relate to it.

Additionally, we think of our identities as both storied and relational (Combs & Freedman, 1999; Freedman & Combs, 2004; Hedtke & Winslade, 2004; White, 1989; White, 2007). We make ourselves up as we go along in relation to each other. So not only are the stories we tell ourselves important, but the stories we tell others about our- selves and our lives, and the stories others hear us tell, and the stories that they tell about us, are important because they shape our identities.

We think of family therapy as a context where we can deconstruct problematic stories, tell and retell preferred stories, and witness family stories and stories of other family members.

This process is not quite as simple as it sounds. One complication is that people often orient to therapy not as a place to tell and retell stories, but as a place in which a ‘neutral’ third party will weigh in on different versions of a problem or advise people in terms of solutions or evaluate the situation to determine the ‘real problem’ or ask questions to connect the problem with family history or teach communication skills.

We are up to something quite different.

A Witnessing Structure

In order to accomplish the telling, retelling, and witnessing of stories, it is very useful to set up a structure. We can call this a witnessing structure (Freedman & Combs, 2004, 2008). As one family member tells a story we ask the others to be in a reflect- ing or witnessing position to hear and understand the story as it is told by the first family member. We then ask those who have been acting as witnesses to contribute to the telling and meaning making of the story. We think of their contribution as a retelling that thickens and adds richness to the story. The original speaker becomes a witness to the retelling of the story that he or she has told. We may then ask ques- tions to invite the family member who spoke originally to engage in a retelling of the retelling. Through this process family members gain understanding of each other’s stories and engage in developing and thickening preferred stories.

Initiating and/or Negotiating a Witnessing Structure

We can initiate this structure informally by beginning to engage in it or we can explicitly describe it and ask family members to join in. We usually begin informally with the therapist simply talking directly to one person and respectfully referring to the others in the third person. It is important to watch other family members to make sure that they are engaging in the process. If they seem not to be engaged or if they interrupt, it can be helpful to explain the process. We might say something such as, Would it be okay if I talk to Bethany for a bit? Then I’ll ask you some questions about our conversation. At another point each of you will also have some time to talk and I’ll ask everyone else to listen. If family members continue to interrupt or indicate by their actions that they disagree it can be helpful to reassure them about how we are listen- ing by saying something like, I am guessing that your experience of this and what you think is most important to talk about may be different than what Bethany is describing.

Witnessing and Positioning

ª 2014 Australian Association of Family Therapy 21

 

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I understand that family members often have different understandings of the same events. I am keeping that in mind and I will make sure there is time for us to listen to what you think is most important, too.

If even after this kind of reassurance family members continue to interrupt or state their disagreements we may say something like, Have you had a conversation already about this? Did it go this way with each of you saying how you disagree and what you think? Was it helpful? Is it okay if we try something different? These questions pave the way for explicitly negotiating the witnessing structure.

We may say, In our experience when people talk directly to each other about some- thing problematic, what they are listening for is how they disagree or what they want to say to counter what is being said. It is extremely hard to really listen and understand when your attention is on what you want to say next or on how someone is wrong or how they are leaving something out. We would like to create a space where you can really listen to each other. Would that be okay?

Our questions – Is it okay if we try something different? and Would that be okay? – are real questions. On occasions people have told us that they have not spoken at all about something and that they were waiting until they came to therapy to say some- thing to other family members, which they would like to do directly. We are negotia- ble about the structure. Usually though, we find the witnessing structure extremely helpful and most families and couples are happy to join in with this kind of conversa- tion.

Unpacking Problem Stories and Identities

Once we have set up the structure our task is to ask questions that will eventually help family members move into the development of preferred stories. In order to be able to do this it is usually important to have some understanding of the problem and its effects. Often it is very meaningful for people to have the experience of other family members listening to and understanding what they find problematic. As we lis- ten we can ask questions to deconstruct or unpack the problematic story. Through deconstruction we hope to expose how the problem was constructed. We are inter- ested in deconstruction to the extent that we can develop gaps that allow people to see beyond the problems to other events that may be openings to preferred stories and so that problems do not take over people’s identities. One very basic practice of deconstruction is externalizing. Through externalizing conversations we unpack prob- lem identities that are constructed through psychological and linguistic practices that identify people as problems (Epston, 1993; White, 1988/1989; Russell & Carey, 2004).

For example, a family came to therapy because in their words, Sean, the 7-year- old was ‘fearful’. His father had worries that a boy at the end of first grade who was afraid to spend the night at a friend’s house, clung to his parents’ legs at the top of the sledding hill as the other kids reveled in the snow, and would not go on a class field trip unless one of his parents went along, was likely to be made fun of by the other kids and that that was just the beginning of things that Sean deprived himself of.

At the beginning of my conversation with Sean he didn’t answer verbally but he did nod for yes and shake his head for no. In this way we determined that he agreed

Jill Freedman

22 ª 2014 Australian Association of Family Therapy

 

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with his parents that the fears were a problem and that they were even responsible for denying him a voice in the conversation with me. When I asked Sean if the fear talked to him he shook his head no. When I asked if it showed him pictures, first he shook his head again but then stopped and said, ‘Sometimes’.