Case of the Week - N° 32: double description to provide a new therapeutic view

Submitted by Joke on Nov 28, 2018 in Case of the Week

Case of the Week - N° 32: double description to provide a new therapeutic view

This week’s case points out the usefulness of the process of “double description” to generate new therapeutic responses. Double description is not a technique but an ongoing process for the therapist and clients to co-operatively draw new distinctions. The case of 11-year-old Tim illustrates the possibilities of double description. Tim was presented as having separation anxiety. He became anxious and nauseous when having to spend time away from his parents although initially he looked forward to those get-away’s. Tim’s description of his problem implicated deep psychopathology rooting in the parent’s upbringing since it was associated with the bonding process. This description restrained the family. The parent’s endless attempts to reassure Tim and convince him of their love resulted in Tim feeling oppressed and losing control. Furthermore this view cemented the description of a serious problem inside Tim making the problem self-perpetuating.

The therapist provided new information in framing the complaint as ‘external tyrants’ in contrast to ‘separation anxiety’. In narrative therapy this is called externalising the problem. This new description empowered Tim to possibly ‘stand up to’ rather than ‘come to terms with’ it. Additionally the therapist used phrases such as ‘being pushed around by fears’ and ‘fears interfering in your life’ to paint the fears as enemies separate from Tim’s psyche. This new description enabled Tim to face the issues. He came up with a metaphor suited to his hobby as a medium-paced bowler: he described the fears as an experienced bowling team going up against him. The therapist assigned him to register when the team was scoring and how much they were hitting. If the metaphorical team were hitting fours and sixes, Tim was instructed to do 10 minutes of strenuous bowling practice. The therapist also underscored the important role of the parents as the coaches. They were told to keep reminding Tim of the seriousness of the contest and the strength it demanded but also to compliment him on his practice.

After two weeks, Tim was able to bowl out his fears and could attend an important sporting event of his school’s cricket team. 
The follow up session revealed that the family made persisting changes in drawing distinctions about difficulties. Their newfound view had freed them from the oppression of their old ways. These changes were possible with the help of new information provided from the double description. After the therapist provided a new outlook on the problem, the family adapted the new information into a suitable solution for themselves.

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double description , framing,