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Joumat ofMentat Heatth CounsetingVotume 31/Numb er 3/Juty 2009/Pages 225 233

Using Puppets with Children in N arrative Therapy toExternalize the ProblemSue Butler

Jeffrey T GutermanJames Rudes

clinical application is presented or using puppetswith children in narrative therapy to externalizetheproblem. A case exampleillustrates the clinicalapplication. Implications for thepractice of narrativetherapy areconsidered

In the past two decades an increasing num ber of counseling and psychother-apy models have emphasized narrative conceptualizations of problems andchange. Narrative therapy was developed by Michael W hite (199 5,20 00,2 007 )and his colleagues (e.g,. White & Epston, 1990, 1992) at the Dulwich TherapyCentre in Australia. It views clients' problems as dominant stories or restrain-ing narratives that are influenced by one's culture (White & Epston, 1990), Innarrative therapy, clients are helped to replace problem-maintaining dominantstories with preferred narratives about their lives (M. White, 2000).

A fundamental principle in narrative therapy is externalizing the problem (M ,W hite, 1989; White & Epston, 1990).According to White and Epston, external-izing the problem refers to an approach , . , that encourages a person to objec-tify and, at times, to personify the problems that they experience as oppressive(p .38), The principle of extemalization is aimed at helping clients view them-selves as separate from their problem s. In effect, they are encouraged to see thatthey are not the problem; the problem is the problem (White, 2004; White &Epston). The principle of extemalization has been applied to a variety of clini-cal problems and clients. For exam ple, V,E, White (2002) developed an exter-nalization intervention for mental health counseling to help clients discriminatebetween their personal strengths and the pathologizing language of the


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6 JOURNAL OFMENT LHEALTHCOUNSELING

Diagnostic and Statistic Manual of Mental Disorders PSM -IV-TR\ AmericanPsychiatric Association, 2 000).

This article presents a clinical application for using puppets with children innarrative therapy to externalize the problem. Puppets have often been used inplay therapy, a therapeutic modality that has been integrated into various clini-cal theories, including behavioral (Rrop & B urgess, 1993); family therapy (Gil,1994); and gestalt (Blom, 2006). Puppets have been used in counseling andpsychotherapy for different purposes, such as assessment and diagnosis (e.g.,Irwin, 1993) and addressing specific clinical problems (e.g.. Brown, 1996;Bernhardt & Praeger, 1985; Carter, 1987). Some m odels have used puppets as cotherap ists for their approaches, including narrative therapy (e.g.. Freem an,Epston, & Lo bovits, 1997; W hite & Morgan, 200 6). For example, these authorsused puppets in narrative therapy with a nonresponsive child experiencing sep -aration and bereavement issues. Freeman et al. described a case of a narrativetherapist who imbued a puppet with personal characteristics that enabled theclient to begin identifying with and addressing the problem.

To date no clinical application has been found in the narrative therapy litera-ture for using puppets with the specific intention of promoting the fundamentalprinciple, externalizing the problem. M. White (1989) developed the principleof externalizing the problem in his work with young children with the intent ofengaging their imaginations.

We suggest that puppets are an effective tool for externalizing the problemfor two reason s: First, using pupp ets objectifies the problem . Second , the app li-cation beg ins to create distance betw een the problem and the client, which is afirst step in the process of externalizing the problem (White & Epston, 1990).

In what follows, first, the theory and practice of narrative therapy aredescribed. Next, a case is presented to illustrate the clinical application of usingpuppets with children to externalize the problem. Finally, we consider implica-tions for the practice of narrative therapy.

NARRATIVE THERAPYNarrative therapy is a strength-based clinical model informed by postmod-ernism, an intellectual movement developed in various disciplines that rejectsmodernist conceptions of objectivity (da Costa, Nelson, Rudes, & Guterman,

2007;Freedman & Com bs, 1996; Lyotard, 1984; V.E. W hite, 2002). In partic-ular, narrative therapy has been influenced by Foucault's (1987) sociocultural


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Butter Guterman andRudes/ USING PUPP TSWITH CHILDREN 227

constraining stories that are significantly shaped by one's history (White &Epston, 1990). These constraining narratives are considered dominant storiesand are experienced as oppressive in the lives, identities, and relationships ofpeople who seek counseling. The change process in narrative therapy involveshelping clients deconstruct and challenge their dominant stories and createmore empowering narratives about their lives (M. White, 2000; White &Epston).

Narrative therapy typically has five stages, though they are meant to servemainly as a guide, because detours are common. Because each client is unique,the stages do not account for nuances that are distinctive to each case. Theprocess described is meant to be used during the initial and subsequent ses-sions. Nevertheless, the recursive (circular, interrelated, and overlapping)nature of narrative therapy's clinical process makes it applicable to all subse-quent sessions. Despite its recursive aspects, the process is explicated below interms of discrete stages, though they are not meant to be understood as havingclear boundaries. The stages consist of (a) defining the problem; (b) mappingthe infiuence of the problem; (c) evaluating and justifying the effects of theproblem; (d) identifying unique outcomes; and (e) restorying (cf. M. White,2007;White & Epston, 1990).

In defining the problem. the mental health counselor attempts to obtain adescription of the problem irom the client. Here it is important to identify thewords that most closely approximate the client's experience of the problem.Doing so allows clients to achieve a near-experience oftheproblem and servesto privilege their descriptions (M. White, 2006, 2007; White & Epston, 1990),Clients are often encouraged to put a name to the problem (White & Epston).For example, M. White and Epston described the case of 6-year-old boy witha history of encopresis. During family counseling the boy and his parentsdefined the problem as fi-equent soiling and described a pattern of the acci-den ts sneaking up and wreaking havoc on the family and taking on a life of itsown. It seemed fitting, then, for the boy to name the problem sneaky poo.Nam ing the problem is often a first step in the process of externalizing. It cre-ates a linguistic separation between the problem and the client. But just anyname will not do. As shown in the example, it is critical for the name to berelated to the words used by the client. In some cases defining the problem isdifficult and for various reasons is not achieved during the first stage, or eventhe first session. If clients cannot define the p roblem , it might be preferable toproceed to the next stage,mapping the infiuences ofth problem.


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functioning. An example of such questioning might be, Ho w is the problemaffecting the picture you have of you rself? By identifying ways a prob lem hasaffected their lives across different domains, clients are encouraged to viewthemselves as separate fi-om the problem. Another purpose of mapping theinfluences is to increase a sense of agency for the client by recognizing oppor-tunities for identifying unique outcomes later during the clinical process. Afterthe client has mapped various influences, the counselor can go back to theseinfluences later and inquire about unique outeomes (described below).

Evaluating a nd ustifying the effects of the problem invites clients to considertheir own position in relation to the problemgood or bad, helpful or unhelp-ful, self-defeating or self-helpingin an effort to elicit for the first time a clearevaluation of the problem. This line of questioning can be novel and unex-pected for clients because often other people (e.g., family members, friends,teachers) already hold positions regarding the problem. If the client evaluatesthe problem as negative, then the counselor seeks a justification through aseries of questions. For example, the counselor might ask clients to articulatehow the negative effects of the problem are at odds with their goals and inten-tions. If a client does not evaluate the effects of the problem as negative, itmight be necessary to consider whether the problem is a problem for theclient. In some cases, it might be helpful to return to previous stages and rede-flne the problem or map its influences.

The next stage in narrative therapy is identifying u nique outcom es. A uniqueoutcom e is any thought, behavior, feeling, or event that contradicts or is at oddswith the dominant story (M. White, 1995; White & Epston, 1990). In somecases, unique outcomes have been identifled during the previous stages in nar-rative therapy. Counselors use questions to help clients identify unique out-com es; for example, How were you able to not let the problem influence youat this time? or W hat did you do to overcome the problem in this situation?Again, the influences identified during the mapping process can be used lateras a basis for identifying unique outcomes. For example, if a client were toreport an influence related to worry about financial issues, the counselor mightask a series of questions to identify unique outcom es related to the worry in thisdomain.After identifying unique outcomes, clients are helped to ascribe meaning tothese events through restorying a therapeutic process designed to help themcreate a sense of empowerm ent, self-efficacy, and hope (Guterman & R udes,2005;M onk, Winslade, Crocket, & Epston, 1996; M. White, 2000). R estorying


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utter Guterman andRudes/USIN PUPPETS WITH CHILDREN 229

CASE EXAMPLEAn 8-year-old boy, Eric, was referred by his school for mental health coun-seling due to disruptive behavior and fi-equent, almost daily, fights with class-

mates. Eric was an only child residing with his mother. His father had movedout the year before and his parents' divorce had become final three monthsbefore the referral. In a phone conversation with the counselor before the firstsession, his mother reported that Eric's most recent aggressive episode hadresulted in one of his classmates requiring medical attention. His mother alsoreported that Eric had been defiant, disrespectful, and threatening toward herever since he was a very young child, but that his behavior had escalated sinceshe separated ^om his father. She described Eric as an uncaring child who didnot consider the consequences of his behavior.

Eric came to the first session accompanied by his mother. At the start of thefirst session, the counselor began the first stage of narrative therapy, definingthe problem.The mo ther stated that when things do not go Eric's way at school,he gets very angry and often gets into fights with classmates. She also said thathis teachers had expressed concern that when he gets angry he erupts like a vol-cano.She added that the pattern at home w as similar. When the counselor askedEric to describe the problem, he would not respond.After several unsuccessful attempts to elicit participation from Eric, thecounselor chose to move to the next stage,mapping the influences ofth problem.The counselor considered that identifying the effects ofth problem at thispoint might help Eric define the problem and begin to understand how it wasaffecting various aspects of his life. This stage was also designed to create som espace in language between Eric and the problem. The mother reported thatEric's anger often got him in trouble at school and led to his losing privileges.She described how his anger had contributed to frequent arguments betweenthem, which in turn underm ined their relationship. At this point, Eric began tonod his head indicating some recognition of the problem 's influence. The coun-selor then asked Eric, "Is your nodding a sign of agreement that the anger hascome between you and your mother, and steals your privileges?" Eric replied,"I think so " Eric went on to describe several effects of the influences of theproblem.

The counselor summarized Eric's understanding of the problem and sug-gested that it had led to a host of negative feelings and experiences. Upon hear-ing the counselor's summation, Eric began to describe the problem as anannoyance in his life that had interfered with things he enjoys. This was a real-


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help children with their problems. She asked Eric to choose the puppet thatmost closely represented his annoyance. He became more animated as he care-fully examined the puppets. He eventually ch ose a large bug puppet. The coun -selor asked Eric a series of questions about how he cam e to choose the bug pu p-pet and how it represented the problem . Eric began to move the puppet aroundthe room while making a loud buzzing sound. He showed the bug sneaking upon his mother and the counselor. "Then what happens?" the counselor asked.Eric m oved the bug closer and closer to his mother and the counselor. Eric onlystopped when his mother playfully raised her voice, "It's bugging m e " At thatmoment laughter filled the room.

Through the use of the puppet, the annoyance became a thing, an entityineffect, an objectification of the problemwhich, in turn, enacted the external-izing process. Toward the end ofth flrst session, the counselor asked Eric andhis mother if they would like to take the puppet home between sessions. Thecounselor suggested that it might be useful for Eric and his mother to observethe bug's annoying ways. She also suggested that Eric be assigned to consultwith his mother when he was able to control the puppet, and also when it gotthe better of him . Both Eric and his mother agreed to the task.

At the start ofth second session, the counselor followed up on the task. Themother, wearing a broad smile, said it had been a much better week, althoughthere were a few instances when annoyance came between them. With puppetin hand, Eric was attentive to his mother's descriptions of the good week. Thecounselor was not surprised when, upon seeking input from Eric, he only nod-ded in agreement with his mother's descriptions. At this point, the followingtranscribed conversation transpired :

Counselor: Maybe I should ask the puppet how things have been this pastweek?Eric (still with puppet in hand): I'm not sure if it's okay.Counselor: It's okay.Mother: It's alright, Eric.Eric (speaking as the puppet): I like to bug, I like to sting.Counselor: OhEric: But I hurt my stinger. My stinger got torn a little by Eric. When I triedto bug him. It hurt when he did that.(Mother smiles.)Counselor: How is it now? The stinger?


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After eight sessions of mental health counseling over three months, Eric'sanger had dissipated. His coping skills were markedly improved, and he alsoimproved his social skills. The counselor, Eric, and his mother reached a con-sensus that the counseling was no longer needed, but that counseling could beresumed if the need should arise. At the end of the final session, the counselorasked Eric if he wou ld like to keep the puppet, Eric declined, saying, M aybethe puppet can help some other kids,

CONCLUDING REMARKS

In our clinical work, we have found puppets to be an effective tool for exter-nalizing the problem in narrative therapy. In some cases, however, it is not nec-essary or preferable to use puppets for this purpose. The counselor might assessthat narrative therapy will be more effective and efficient without puppets, orthat puppets might be contraindicated. Some children might be distracted, fear-ful,or otherwise not amenable to using a puppet for externalizing the problem.

We have typically used puppets in narrative therapy only with young chil-dren. Older children, adolescents, and adult clients might also benefit fi-om theuse of objects to help externalize the problem. Clients of all ages are routinelyencouraged to objectify the problem in narrative therapy through various clin-ical processes, such as letter writing and naming the problem (Monk et al,,1996;White & E pston, 1990), When counselors deem it appropriate, clients canbe invited to select from an array of objects, personal or otherwise, to serve astools to enhance the externalizing process. For example, an adult client mightidentify a work of art that most closely represents the problem.

Finally, we wish to underscore the important role that imagination plays dur-ing mental health counseling, especially the extemalization process in narrativetherapy (White & Epston, 1992). In narrative therapy, it is largely the child'sabilify to imagine the puppet as the problem that crystallizes the extem alizationprocess and thus contributes to change. That is why we consider children'simaginations to be one of the most valuable resources in narrative therapy. Ofcourse, imagination is a ubiquitous resource that all clients possess. As coun-selors, it is important to recognize that our imaginations are also valuableresources as we w ork with clients toward therapeutic ends,

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