Most of us have had the experience of going to the doctor because of a scary or painful problem. When we explain our symptoms to medical staff, they are often unimpressed. We become the fifth ankle, the tenth flu, the twelfth rash of the day, and not a human being with intelligence, knowledge, abilities, fears, and feelings. We are no longer unique, complex individuals but, rather, have been reduced to “the problem” we present. No one asks us about our ideas and experiences, or what we have done already on our behalf, or what we know about our body’s ability to heal. In other words, we have been labeled.

Labeling and Lowered Expectations

I work with labeled children in two settings: as an MFT at North Berkeley Counseling Center and as a part-time resource specialist working in a public high school with students identified as needing special education. Although the Special Education Code is very specific about the treatment of students in Special Ed – for example, it is illegal for anyone to publicly humiliate them or bar them from programs provided to regular education students – most of the students with whom I work have a long history of abuse from teachers, administrators, and peers who, inadvertently or deliberately, support the problems. The effects of this treatment are often far more harmful than the original problem is that qualified them for special education.

Whatever the setting, my experience has been that when children are diagnosed, everyone’s expectations of them go down, including their own. Parents begin to see their children from a deficit position, and the children see themselves this way as well. Talents, positive qualities, and abilities are diminished or forgotten. In fact, the problems survive and gain power by selective memory. Depression, for example, only allows the person affected to remember sad, self-incriminating, self-defeating situations that keep the depression in place. Clients with ADHD only think of the times they’ve “messed up,” missed assignments, and failed to keep on task. Often times, parents and teachers only notice the behavior that supports the diagnosis, and ignore the times the child succeeds. And so, the problem comes to dominate the child’s life.

At school, the students I see must have at least an average IQ in order to qualify for services. But even the smartest ones believe they are “stupid,” and frequently think of themselves as being flawed in some very deep way. They experience profound shame, and are often made to feel that their inabilities are their “fault.” Regular education teachers have shared with me the opinion that students in special education use their disabilities as an excuse. Some parents inadvertently support this kind of shaming. Those who are more aware must work very hard to keep their child’s beliefs from being undermined by what’s happening at school or in the world.

The Narrative Approach

I have found that the narrative approach to therapy allows me to separate the diagnosis from the child, so that the child is no longer a problem; the problem is the problem. In Narrative Therapy, the therapist helps the client to “externalize” the problem, that is, to see it as a “story” about who they are rather than a truth that defines them. Since stories are fluid and have no objective reality, they can be rewritten — thus giving the person more control over their destiny. It is much easier to get students involved in their own education if I can give them the opportunity to challenge the idea that a learning difference, or a disabling disorder, defines who they are and what they can do.

My first goal with children is to help them change their relationship to the problem, so that they can begin to assert more of this control in their lives. I do this by speaking about the problems in an externalizing fashion. If you accept the notion that we internalize our parents’ beliefs and values, then the way to challenge destructive ideas is to ask questions that begin to separate the person from the problem. So I’ve had wonderful conversations with clients about the “tantrum monster,” the “but, I just don’t want to do homework” and the “you can’t make me do it” attitudes, the “I can’t help getting distracted,” “I can’t do it,” or the “it’s so boring” beliefs, and the “but I like to hit other kids” impulse. I’ve also had more serious conversations with the beliefs, attitudes, ideas, feelings and behavior that support anorexia and bulimia, addiction, self-mutilation, violence, severe emotional and psychological diagnoses, sexual acting out, despair and hopelessness.

Regardless of the problems, for most of the people with whom I’ve worked, being a person with a problem is such a relief — after believing for years that they are a person who is a problem. When I meet a new family in therapy, I begin by asking parents to tell me things they know about their children that they regard as special... I also want them to explain their good parenting skills that helped them notice, encourage or develop these positive qualities or talents. Then, I want to know from the parents and the child how the problem affects the child and his/her relationship with the parents. I ask the child to describe who (s)he is when the problem isn’t around. These questions begin to open up an alternative picture of the child as a unique, complex person with many talents, qualities and capabilities.

Next, I will ask questions of children or their parents aimed at discovering what behaviors or problems they believe are due to the diagnosed disorder. I also assume that parents and children have already tried other ways to manage the problems, so I will ask about those. Once I am familiar with the problem and its tactics, I begin to ask questions about exceptions to the power of the problem. For example, I worked with a ninth-grader who was under a great deal of pressure to perform from both his parents and the administration. I asked him about places where his ADHD and auditory processing problem had no power. He was a terrific basketball player, and when he played, he was focused and could follow oral directions. We explored the things he knew about himself while playing basketball. We made a list of strategies he had developed to pay attention, and brainstormed possibilities for their use in his classes. He and I talked to teachers about ways to present material that would make it easier for him. Did this always work? No. But, he now has the new idea that he can work around his disability and access other learning capabilities. And he feels more comfortable advocating for the ways he learns best.

My experience has led me to respect therapeutic processes that are non-pathologizing and help children develop qualities and abilities that are counter to their problems, so that they gain a sense of influence and power in their own lives and expand their choices for who they want to be in the world.

Suggested Reading:
1. Freedman and Combs, Narrative Therapy: The Social Construction of Preferred Realities, 1996
2. Freeman, Epston and Lobovits, Playful Approaches to Serious Problems, 1997
3. Smith and Nylund, Narrative Therapies with Children and Adolescents, 1997
4. White and Epston, Narrative Means to Therapeutic Ends, 1990

Jeanine Matheson is a licensed MFT practicing in Berkeley. She is a part-time Resource Specialist working with students identified as learning disabled. Jeanine is attracted to Narrative Therapy because it helps people challenge the family and cultural beliefs that keep them from living the lives they want. She can be reached at (510) 464-4599.

Note: This article reflects the opinions of the author and not necessarily those of
East Bay CAMFT.