CSL 652

Narrative Therapy Response to A Boy With a Heart: The Video

By Te-Erika Patterson

Barry University

Spring 2009
Upon examining the case of young Sebastian, a child who was hospitalized in a mental

facility after attempting to choke another child with a chord, we can recognize that the

dominant story that he is dealing with about his life centers around violence as a release

of aggression. Young Sebastian, whose native language is Swedish, sat down with an

English speaking counselor, David Epston, to discuss his life and behavior.

From an early age he watched the tumultuous and often violent relationship between his

mother and father. After his mother left his father and his mother remarried, the violent

tensions at home ceased. Although his stepfather wasn’t violent, Sebastian had already

been exposed to violence as a way of living and releasing aggression.

This exposure plagued him in his interactions with others, creating the story that he was

predominately a “Bad” child. Throughout the interview, the counselor used a myriad of

techniques to discover the fact that Sebastian believed he was equal parts good and bad

and that he felt isolated within his self. The emerging alternative story line that was

conceptualized by the counselor, with the help of Sebastian, was that Sebastian was not

alone and indeed had a team of people on his side to help his good side win out over the

bad side of his personality.

An excellent technique used by the counselor was the identification of a unique outcome

which would be the antithesis of the dominant story that has plagued the client. In

Sebastian’s case, the counselor helped him to identify times when the “bad side” did not

win out over the “good side”. After a faulty beginning, the counselor helped Sebastian to
see that with the aid of the memory of his deceased sister Linea living within his heart, he

could use that as added strength to overcome the bad side.

As a part of an extended treatment plan that not only involves one on one counseling

sessions, individual sessions with the nuclear family could also be arranged without

Sebastian’s presence. By meeting with the nuclear family and setting goals for interaction

with Sebastian and reinforcement of support, the family can learn how to be a change

agent in his life. Emphasizing unique outcomes in the home on a consistent basis will

turn the unique outcomes into consistent outcomes, reducing the former dominant story

to become the alternative story.

The transcript of the conversation between Sebastian and the counselor is rich with

examples of creative intervention techniques. The counselor helped Sebastian externalize

the problem, which means to view the problem as an outside entity, completely

independent of the person. By taking a marker and drawing on the white board, the

counselor helped Sebastian use symbols to identify the good and bad side of himself.

Sebastian chose a heart to symbolize the good and a cactus to symbolize the bad.

A strategic line of questioning is often necessary to gain a deeper insight into the psyche

of the client. By using landscape of action questions like, “What would Tom Berlin do in

this situation?” the client will be empowered to imitate the actions of someone he

admires. Another approach is the landscape of meaning question like, “What would it

mean if you chose to hold your sister in your heart all the time?”
This approach’s theory of change involved enlarging the client’s sense of the good side of

himself. It involved helping the client to externalize the problem and shifting the client’s

awareness of the issue. While the issue seemed to be the majority of the client’s

identification of himself, the counselor helped him to recreate the margins and decrease

the enlarged scope of the issue. He used the client’s love for his family and outside

influences as a way to add to his support system by demonstrating how his love for them

and their love for him, could help him win out over the negative side of his personality.

By using metaphors that centered around sports, a topic the client was passionate about,

the counselor also helped ease the transition away from an issue centered train of thinking

and discussion.

If I were to see Sebastian again in the near future I would ask him what teams he was

rooting for. As I listened to the response, I could gauge his passion for life. If one has a

passion for anything, then there is passion and excitement and the will to live, love and

prosper.