Deconstructing the Problem and Mapping Influences

Biggs and Hinton-Bayre (2008) cite Monk, who in 1997 developed a seven-stage approach to applying Narrative Therapy. Taking apart, or deconstructing the problem ‒ is the first stage of Narrative Therapy, and in this time, the therapist asks questions in an attempt to get the client to explore various dimensions of the situation and to reveal underlying assumptions. Of course, therapy is fluent and attentive to the needs of the client, and the authors warn that these stages are not a formula or recipe, and that strategies can differ significantly from client to client.

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According to her direct head at work who called me during her early therapy, Cara is well respected at work, where she has been for many years, consistently moving up through the ranks. Her company granted her quite a bit of leeway after her father’s passing, as Cara found it difficult to complete full working days.

The youngest of four children, Cara was always very close to her parents, especially her father. She was probably seen by her siblings as indulged and spoiled. Cara describes her childhood as one of close ties between family members in general, but with undertones that were less pleasant. Both her parents consumed alcohol regularly and became intoxicated. She also knows of affairs both her parents had, each one blaming the other for “starting first”. Remembering back, she recalls her mother getting “ready to go out” for the afternoon and packing a bag, while the teenage Cara looked on and was caught between keeping secrets versus telling her father, risking trouble. She felt she carried too many secrets, more than she felt was appropriate for her age.

From the outside, family life seemed perfect, with her parents often acting lovingly towards each other in public. In private however, things were quite different and screaming matches between them were common. Her father, although a loving parent and “a really good man”, abused alcohol regularly.

Cara’s relationship with her siblings was not very close, as the age gap between them caused the elder siblings to be close to each other, and herself emotionally closer to her parents. She recalls however how she was ordered to make her elder brother’s bed in the mornings when they were young. Cara felt a distinct difference in the expectations of girls from boys. She surprised everyone when she studied at university after school and became a successful professional woman.

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During the time of her narrative grief therapy, Cara became romantically involved with a man she had a casual friendship with before. This relationship had a very particular emotional impact in this time – one of comfort, and one reflective of her growth.

7.3 Thickening the Narratives

After school Cara planned to study veterinary science, and was accepted to the course.

Her mother died of cancer in this time, and her father became retrenched after taking too much time off from work to take care of Cara’s mother. Because of these circumstances, there was no way to support Cara studying full time, and she let go of her dream, and started working. After a while her father came to stay with her and she took care of him. The role of caretaker was one she frequently adopted, even though she was the youngest. This is a role she still slips into quite naturally, one we re-examined in our many therapeutic conversations.

Cara studied part-time whilst working, and completed a degree, as well as further courses. She became financially independent, yet a strange co-dependence developed between her and her elder brother. He suggested that she came and live in his house, “a mansion” according to Cara, while he worked overseas. Her brother suggested that she take over some of the caretaking and expenses, for the “privilege of living in luxury”.

Looking back, Cara regrets this decision deeply, as she lost not only a lot of money without having an asset to show in the form of property after the years, but her brother’s influence grew stronger, an influence that was not healthy and often bordered on paranoia and contained frequent recriminations. Cara felt like she was being controlled and manipulated to do too much in terms of taking care of her brother’s property.

However, the strong caretaker role she always adopted kept her tied into the arrangement through feelings of obligation and guilt. As therapy continued, Cara started examining ways of relating that have brought her much anguish through the years. This was most dramatic in Cara’s emotional emancipation from her brother and the reshaping of this relationship to a more equal one.

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Cara lost her mother at the start of her adult life. This loss had a profound impact on her development as a young woman, as well as on her family dynamics. When I met Cara three years before, she was still trying to make sense of the undercurrents of the ‘new normal’ in her family. At the time the focus of her attention was taking care of her father with whom she lived at the time. During our new series of therapeutic conversations, the complex and often covert forces at work among her siblings took her attention again.

In the midst of her grief she also struggled with disillusionment, disappointment and shock at decisions and judgements by her siblings. As often happens after a passing, old familial patterns are repeated and old roles acted out. Cara’s family crisis developed in this time precisely because she aspired to change the roles she played so long - particularly the role of caretaker, the role of youngest daughter, and the role of a woman in a previously fairly chauvinist system.

During the later stages of our conversations, the loss of her mother was discussed more, and the impact it had on Cara’s life. Cara felt she was in a male dominated environment after her mother’s passing. As the youngest daughter she felt the need to “be tough and strong”. Yet looking back she can see how she missed her mother’s guidance with dating and how to behave as an adult woman. Like her father, her mother died from cancer, but with her mother Cara remembers the illness and final stages as less harrowing. Cara and her mother were not as close as she was to her father, and as a young woman with a father who could make the decisions and take care of his wife, she wasn’t so involved in dealing with doctors and so on, and could concentrate on their relationship. So, in a sense the loss of her mother was much less traumatic to Cara than the recent loss of her father. She grieved her mother’s loss very differently, and remembers conversations she had with her mother in hospital, and feeling sad in the car on the way back home after she finally passed. When a person dies of cancer or a protracted illness, loved ones sometimes have time to say goodbye and a fair amount of anticipatory grief takes places before the person dies. It is a strange mixture of hope and despair – sadness at the inevitability of the passing whilst still being able to pick up the phone and call them.

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When Cara’s father died she felt that she had been orphaned by losing her second parent. Suddenly, she felt she had to fend for herself and it seemed just too overwhelming. Her father wasn’t there to shield her from her siblings who seemed to be quite jealous of the close relationship she enjoyed with her father. The tough exterior she worked so hard at creating began to crumble.

7.4 The Loss

When Cara booked her first appointment, her father had passed away of pancreatic cancer less than two months before and she was in the acute first phase of grief. She was extremely distressed, weeping uncontrollably and feeling overcome with sadness. Cara missed her first appointment, made another one, missed that one too, and then at last came at the time we set up for a third. The shock of his passing, the way that her father had suffered in the end and the loss of his company was almost too much for her to bear.

The extreme pain seemed devastating, just too raw, and her grief completely disrupted her life. Shortly after our first therapeutic conversation, Cara was hospitalised. She had developed pneumonia and the loss and sadness had completely exhausted her. Various authors have mentioned the effect of grief and the accompanying stress on the immune system (APA, 2006. Gray, 2012).

Cara was in hospital for two weeks. Her feelings of anguish and despair were so acute and intolerable she thought she would never heal. She felt unable to cope with life and its demands, lost her appetite, couldn’t sleep, and felt helpless, hopeless and lonely. The world was rushing by as normal but Cara felt unable to get on the merry go round and laugh and participate. It was only after Cara’s discharge from hospital that grief therapy could begin in earnest.

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Zisook and Shear (June 2009, p. 70) write “First, grief is not a state, but rather a process.

Second, the grief process typically proceeds in fits and starts, with attention oscillating to and from the painful reality of the death. Third, the spectrum of emotional, cognitive, social and behavioral disruptions of grief is broad, ranging from barely noticeable alterations to profound anguish and dysfunction.”

Certainly this was very true for Cara who was living through one of the most gut-wrenching and painful experiences a human can go through. Bereavement must be the most difficult emotional experience for most of us. Interestingly, the feelings that characterise it often come in waves with breaks of almost normality in between. Where at first the numbing daze of shock is most profound, when the feelings come back they come in waves. In the beginning the waves are harsh and tall, crushing one under a weight of pain and anguish, mercifully the waves gradually become less frequent and less painfully overwhelming, and eventually a memory may bring only a bittersweet teary smile.

Klopper (2009) describes the waves of grief as a slowly upward winding sinus curve with symptoms such as confusion, lack of concentration and memory loss, loss of joy and interest, weepiness, anxiety, fatigue and weight loss.

After all the medical intervention that this family has experienced, I was very cognisant of the need for the therapeutic process to be respectful and collaborative (Anderson, 1997;

& Hedtke, 2000), and for the necessity of the pacing to be established by what she felt comfortable with.

Cara tried to keep a brave face. Her thoughts were preoccupied with memories of her father, particularly of his last weeks. These thoughts and the accompanying sadness seemed to seep into every waking and sometimes sleeping moment. Sometimes she would wake from an exhausted sleep with a cry before she had time to open her eyes, as the awful thought struck her awareness. Unfamiliar dysphoric emotions like regret,

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anger, emptiness, nervous free floating anxiety and utter, desperate sadness filled her days and dreams. It is important for a therapist to allow the grieving person to freely express these feelings and reassure them that it is normal, as I did with Cara. The grieving process in itself can be quite scary to go through and it is not uncommon for people to wonder if they are crazy or if they will ever heal. Normalising the experience can be a great relief.

During our second conversation and the first after her hospitalisation, I encouraged to express as clearly as she felt natural all the many emotions she was experiencing, giving them a name and a story.

“This one is all over me, its name is sadness. It tells a story of how much I miss my dad.” “This one is loneliness, it sits in the pit of my stomach, it reminds me of how empty my life is without him, how quiet it is around me.” “This one is… hmm, I think it’s guilt. It tells me I wish we could have done more. It’s not always there, but when this one comes it’s the hardest to bear.”

It soon became clear that her grief consisted of different elements: the shock of dealing with the physicality of her father’s illness and passing; the many different undertones of resentment and suspicion among her siblings; coming to terms with what ‘death’ means;

and finally, the loss of the companion and friend she had in her father.