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Revista Portuguesa de Psicossomática
ISSN: 0874-4696
revista@sppsicossomatica.org
Sociedade Portuguesa de Psicossomática
Portugal
Torres, Sandra; Guerra Prista, Marina
Application of narrative therapy to anorexia nervosa: a study case
Revista Portuguesa de Psicossomática, vol. 4, núm. 1, jan/jun, 2002, pp. 141-156
Sociedade Portuguesa de Psicossomática
Porto, Portugal
Available in: http://www.redalyc.org/articulo.oa?id=28740112
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Revista
Portuguesa
Revista
de
141 Application of narrative therapy to anorexia nervosa
Portuguesa
Psicossomática
de
Psicossomática
Application of narrative therapy
to anorexia nervosa: a study case
* **
Sandra Torres , Marina Prista Guerra
Abstract INTRODUCTION
In this article the psychological inter-
vention undertaken with a teenage girl The Re-authoring Model by
with Anorexia Nervosa diagnosis is des- White and Epson
cribed. The intervention was based on the Our intervention in the field of
Re-authoring Model by White and Epson anorexia nervosa is based on the re-
and focused the analysis of the "fear of -authoring model by White & Epson
becoming fat" as being the most distur- (cf. 1-3). The sessions of our intervention
bing one identified by the teenager. Three were planned and adapted to ano-
essential dimensions were emphasized in rexia nervosa according to the gui-
the therapeutic process of the anorexica: dance developed from this model and
(a) the externalizing language; (b) the dis- proposed by Gonçalves and Henri-
(2)
cursive context of the problem; and (c) the ques .
identification and amplification of mo- In White & Epson's model, thera-
ments of active resistance to anorexia py is characterized as a creative pro-
nervosa. The continuous and contextual cess co-built by the client and the
assessment suggests the importance of the therapist. As mentioned by Gonçalves
(2, p.27)
construction and projection of alternative and Henriques , "the collaborative
narratives, that is, more flexible narra- relationship is an aim in itself, and not a
tives adapted to new contexts for the reso- simple means so that the client can admit
lution of the body related fears and, con- what the therapist wants. The therapist
sequently, for the anorexic’s better func- raises questions to know and not because
tional life. he already knows".
Key-words: Anorexia nervosa; Nar- The generic aim of the psycho-
rative therapy. therapy is the construction of alterna-
tive narratives, more flexible and
adapted to reality.
In this model there are three essen-
* PhD Student; Teacher of Faculty of Psy- tial dimensions in the therapeutic pro-
chology and Sciences of Education of cess: (I) externalizing language; (II)
Oporto University discursive context of the problem; (III)
** Assistant Professor of Faculty of Psy- identification and amplification of
chology and Sciences of Education of unique outcomes.
Oporto University
Vol. 4, nº 1, Jan/Jun 2002
142
Sandra Torres, Marina Prista Guerra
The externalization consists in mak- intervention proposed by White and
ing the problem become a separate Epson, points to the analysis of the
entity, external to the individual. It is ideas and beliefs resulting from social,
an attitude which should be taken by cultural and discursive factors which
the client and stimulated by the thera- strengthen the continuity of the prob-
pist. lem (2). During the question process
Throughout this process two as- the person's attention should be
pects are concretely analysed: (a) the called to the established interactions
influence of the problem on the indi- and to the impact resulting from the
vidual, and (b) the individual with- political, social and cultural environ-
out the influence of the problem. The ment where the narrative was built.
latter is explored through the projec- In ano-rexia nervosa the study of this
tion of alternative metaphors to the dimension is of utmost importance as
problem (which the problem does not the ideals of beauty and of a thin body
dominate), and through the streng- are extremely stressed in our society.
thening of the sense of authorship, As the discursive context and the
that is, the stimulation of the indivi- externalisation of the problem are de-
dual's leading role in this process of veloped, it is common for “exceptional
(2)
solving the problem . moments not dominated by the problem”
(2, p.20)
The use of metaphors in psycho- to emerge . Those moments are
therapy has shown good results. called “unique outcomes” and are events
Metaphors can simplify the introspec- contradicting the speech saturated by
tion providing new solutions and in- the problem. The tendency is to ignore
creasing communication between the or undervalue those moments when
client and the therapist. They ease the the narratives show a higher grade of
expression and the structuring of lack of functionality.
thoughts and actions and can also The minimum changes should be
motivate a certain move away of explored as examples of the strength
people in relation to threatening af- over the dominant story or as indica-
fective experiences. tors of the emergence of a new story.
As to the application of the exter- Even the microscopic changes at the
nalizing language in the anorexia level of thought or behaviour should
nervosa intervention, we can summa- be seen by the narrative therapist as
rize that the aim of this work with the important starting points for the con-
(4)
anorexic girl is to help her understand struction of new narratives . Thus,
what type of strategies the "anorexia the therapist's function is to bring to
nervosa" (as a separate entity) uses to the conscious level of the patient these
influence her and what strategies she unique outcomes. To achieve that pur-
herself could implement to reduce its pose he should consider with the
impact. client certain inconsistencies in his/
The discursive context of the problem, /her narrative (they could be either
another dimension of the therapeutic at the level of situations, thoughts or
Revista Portuguesa de Psicossomática
Revista
Portuguesa
de
143Psicossomática Application of narrative therapy to anorexia nervosa
emotions), or attempt that the indi- In short, the application of this di-
vidual might analyse the problem in mension of the therapeutic process to
different ways (for example, by im- anorexia nervosa can be summarised
aging him/herself in another time or in the identification and evaluation of
in another context), or suggest that the moments of active resistance to ano-
individual anticipates unique out- rexia (e.g., to voluntary ingest food
comes in a near future or even analy- without losing control, not to weigh
(5)
ses imagined unique outcomes . every day, not to do excessive exer-
However, the identification of the cise, to avoid the social isolation) and
unique outcomes should not be un- the extension of those moments as a
derstood by the individual as a de- means of acceding to new and more
valuation or negation of the problem, adaptable narratives.
nor should it be made before its im-
pact is carefully checked. Brief Comments on the Applica-
The change in the individual is tion of the Re-authoring Model
strongly associated to the expansion to Anorexia Nervosa
and consolidation of the unique out- Food disturbances have often
(2)
comes . The new narratives that are emerged in clinical contexts mainly in
built, contributing to a re-story of the adolescent and young adult girls.
subject’s identity, require to be so- Anorexia Nervosa has as main fea-
cially validated so that they can also ture a severe food restriction, with the
be consolidated. The social validation inherent complications, leading to a
involves the presence of other signifi- significant biological, psychological
cant persons for the subject. Monk and sociological morbidity which
(4,p.20) (8)
called this process the "creation may sometimes lead to death . Ac-
(9, p.559)
of audience" and suggested that this cording to DSM-IV , the diagno-
audience could be made by the thera- sis of anorexia nervosa is confirmed
pist, family members, neighbours, when the following criteria are
friends or other people important to present: "(A) Refusal to maintain body
the subject. Another form of social weight at or above a minimally normal
validation could be to assign the weight for age and height; (B) Intense fear
consultant’s role to the client by en- of gaining weight or becoming fat, even
couraging him to participate in though underweight; (C) Disturbance in
clients’ clubs (e.g., anti-anorexia the way in which one’s body weight or
league) or to help other people with shape is experienced, undue influence of
(2)
the same problem . When playing body weight on self-evaluation, or denial
this role the subject shows his/her of the seriousness of the current low body
skills and goes from a position of a weight; (D) In postmenarcheal females,
dependent help-needed person to a amenorrhea, i.e., the absence of at least
position of "expert". This principle is three consecutive menstrual cycles".
(6,7)
emphasized by Guerra in other con- Quite often this disease means a
texts of psychological intervention. psychological difficulty in accepting
Vol. 4, nº 1, Jan/Jun 2002
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