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TitleExternalising the Illness a Narrative Therapy Technique
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INITIAL ASSESSMENT: Externalisation

EXTERNALISING THE ILLNESS: A NARRATIVE THERAPY
TECHNIQUE
Carey, M., & Russell, S., (2002) Externalising – commonly asked questions. International Journal
of Narrative Therapy and Community Work, 2002 No.21.

The following questions and answers about ‘externalising’ have been created in response to regular
requests from practitioners. We’ve tried here to respond to some of the questions we are most
commonly asked in training contexts. We’ve enjoyed the collaborative process of coming up with these
questions and answers. A wide range of people have been involved and we’ve really appreciated this.
We hope this document will be of assistance to those engaging with narrative ideas. We look forward to
receiving your feedback!

1) What is externalising?

‘Externalising’ is a concept that was first introduced to the field of family therapy in the early 1980s1.
Initially developed from work with children, externalising has to some extent always been associated
with good humour and playfulness (as well as thoughtful and careful practice). There are many ways of
understanding externalising, but perhaps it is best summed up in the phrase, ‘the person is not the
problem, the problem is the problem’.

By the time people turn to us as therapists for assistance, they have often got to a point where they
believe there is something wrong with them, that they or something about them is problematic. The
problem has become ‘internalised’. As we’re sure you’re aware, it is very common for problems to be
understood as ‘internal’ to people, as if they represent something about the nature, or ‘inner-self’ of the
person concerned.

Externalising practices are an alternative to internalising practices. Externalising locates problems, not
within individuals, but as products of culture and history. Problems are understood to have been socially
constructed and created over time.

The aim of externalising practices is therefore to enable people to realise that they and the problem are
not the same thing. As therapists, there are many ways in which this is approached. One way is through
asking questions in which we change the adjectives that people use to describe themselves, (‘I am a
depressed person’) into nouns, (‘How long has this depression been influencing you?’ or ‘What does
the depression tell you about yourself?’). Another practice of externalising involves asking questions in
a way that invites people to personify problems. For instance, when working with a young child who
wants to stop getting into so much trouble, an externalising question might be: ‘how does that Mr
Mischief manage to trick you?’ or ‘when is Mr Mischief most likely to visit?’.2 Through these sorts of
questions, some space is created between the person and the problem, and this enables the person to
begin to revise their relationship with the problem.



1 Accessed on 1 August 2007 from the Dulwich Centre for Narrative Therapy website http://www.dulwichcentre.com.au/externalising.htm

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It’s not only problems that are externalised. Personal qualities, such as ‘strengths’, ‘confidence’ and
‘self-esteem’ which are commonly internalised (viewed as if they are inherent or internal to individuals)
are also externalised in narrative therapy conversations. We’ll describe more about this later on.

It’s also important to note that externalising involves much more than ‘linguistic techniques’.
Externalising is linked to a particular way of understanding, a particular tradition of thought, called post
structuralism.

This way of understanding places a considerable emphasis on language, questions of power, and the
ways in which meaning and identities are constructed. (For more information about this see Thomas,
‘Post structuralism and therapy – what’s it all about’ International Journal of Narrative Therapy and Community Work
2002 No.2).

2) What are externalising conversations?

Externalising conversations focus on problems that may once have been internalised and externalise
them (as we showed in the examples in relation to ‘the depression’ and ‘Mr Mischief’). But this is just
the beginning. Once problems are externalised (i.e.. viewed as if they don’t simply exist as an inherent
aspect of a person) they can then be put into story-lines. For instance, it is possible for us as therapists
to ask questions about how long the depression has been an influence in someone’s life, when it came
into their life, if there were factors that contributed to its entry, what the real effects of the depression
are (on the person, their relationships and others), when these effects have been strongest and
weakest, what sustains the depression and what acts as remedies in certain situations. These sorts of
questions, and many others, begin to place the existence of the problem into a story-line.

Placing problems, like the depression and Mr Mischief, into story-lines can begin to shed more light on
how they’ve come to have such a big influence on someone’s life. It can also begin to provide people
with a lot of information and richer understandings of how they might be able to reclaim their lives from
the influence of problems.

One of the most significant aspects of externalising conversations, is that within them, broader
considerations can also be taken into account. When it is understood that people’s relationships with
problems are shaped by history and culture, it is possible to explore how gender, race, culture,
sexuality, class and other relations of power have influenced the construction of the problem. By giving
consideration to the politics involved in the shaping of identity, it becomes possible to enable new
understandings of life that are influenced less by self-blame and more by an awareness of how our lives
are shaped by broader cultural stories. In this way, we see externalising conversations as small ‘p’
political action. They put back into the realm of culture and history what was created in culture and
history. This opens up a range of possibilities for action that are not available when problems are
located within individuals.

3) How do you know what to externalise?

The process of externalising happens in collaboration with those who consult us. We enter therapy
conversations believing that the problems people are consulting us about are not located within them
but instead have been shaped by the broader stories of the particular culture in which they live. This
then shapes the questions we ask and the conversations we share.

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There are a whole lot of effects that externalising conversations have on our experiences as therapists
too. We’ll talk about some of these towards the end of this document!

6) How does externalising fit with other narrative therapy practices?

Basically, externalising conversations are the doorway to preferred stories and all the delightful skills,
ideas and knowledges that people have. When problems are externalised, when the person no longer
believes that they are the problem, this opens the door to exploring their knowledges and skills and ways
of addressing the effects of the problem.

During externalising conversations, as therapists, we are on the look out for what we call ‘unique
outcomes’. These are moments when the influence of the problem has not been so strong. When we
notice one of these, this is an opportunity to begin to explore what made this possible. While we won’t
go into detail about it here, there are a whole range of ways that we try to place these ‘unique
outcomes’ into alternative story-lines.

Take, for example, the person who came into the therapy room believing she was worthless. Let’s call
her Judy. After externalising ‘the worthlessness’ and exploring its history and influence, we might
discover that there are certain times when worthlessness is less influential in Judy’s life. These times
(unique outcomes) might be associated with a particular time or place or friend. Or these unique
outcomes might be associated with certain things that Judy does at this time, certain thoughts she has,
or physical activity she is engaged in etc. Over time, these unique outcomes might be placed into an
alternative story-line. For the sake of this example, let’s say Judy decided to name this alternative story
of her life ‘competence’. Through externalising conversations we would then engage in lots of
explorations about this ‘competence’. We would explore its history and ask questions about all those
events and people that have contributed to this ‘competence.’

Externalising conversations don’t just focus on problems. As narrative therapists we also use
externalising conversations in relation to positive internalised qualities (like competence). Because we
understand that ‘competence’ is also a product of history and culture, it is possible for us to ask
questions about how this ‘sense of competence’ was created in Judy’s life, who else helped to create it,
who the people are who’d be least surprised to hear about it, what sustains it, what it makes possible,
what it means to her, and what particular problem-solving skills it may be linked to. This process can
make these qualities (like competence) more meaningful and relevant to people in addressing the
effects of problems in their lives.

At this point in our conversations with Judy, externalising will have provided the opportunity for us to
now engage with other narrative practices. Once the problem is externalised and we have begun to
generate, through unique outcomes, an alternative story, then other narrative practices such as re-
membering conversations, outsider witness processes, the use of therapeutic letters, documents, rituals
and celebrations all become more relevant. All these other narrative practices are used to generate ‘rich
descriptions’ of the alternative stories of people’s lives.4 It is through generating rich descriptions of
these alternative stories of people’s lives that, we believe, leads to people being able to make
significant changes in their lives.

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7) As practitioners first begin to engage in externalising conversations, are
there any particular aspects which people struggle with?

Like any new way of working, it takes time, practice and rigour to become adept at externalising
conversations! Initially, some practitioners feel awkward with the different way of using language that
externalising involves. It can feel clumsy at first and even as if the therapist is centred in the
conversation in an uncomfortable way. It can take some time, and much practice (both within and
outside the therapy room) for the different language practices to become a seamless part of one’s work.

What’s more, it also takes time to fully engage with the different ways of thinking that externalising
conversations represent. Externalising involves questioning the internalising practices that are such a
pervasive part of everyday life. Externalising therefore represents more than simply a therapy
‘technique’. Those consulting us are having to routinely contend with internalising practices that seek to
locate the problem within them. As narrative therapists we see it as our role to provide some
frameworks for alternative understandings and alternative actions. When we first begin to engage with
externalising conversations, the implications of these new ways of thinking can take a bit of getting
used to. For many of us it has represented a very different way of looking at our own lives as well as the
lives of those with whom we work.5

On a practical note, there is one specific aspect of externalising conversations that practitioners
sometimes struggle with early on. This relates to the dilemma of which metaphors to privilege in
externalising conversations.

Sometimes, when a problem is externalised, families consulting us might use metaphors of ‘combat’ in
relation to the problem. They might mention how they’d like to ‘beat’, ‘war against’, ‘fight’ or ‘vanquish’
the problem. As practitioners, this can be a bit confusing. Metaphors of combat and competition are
very common. Are these metaphors that we as therapists should engage with? Sometimes, engaging in
metaphors of combat and competition can contribute to stress and tension and can mean that subtleties
of experience can be missed. Engaging in metaphors of conflict and combat might also replicate ways
of being in the world that we do not wish to be associated with. In other circumstances, however, where
people may literally be struggling for their lives (in relation to life-threatening eating disorders, or the
voices of self-hate for example) people may believe that combat metaphors are the most accurate and
fitting descriptions for what they are going through.

What seems important, is that as therapists we don’t introduce metaphors of conflict or combat, and
that we are aware of the wide range of other metaphors about how problems can become less centred
in people’s lives. These include metaphors of reclaiming one’s life from the effects of the problem,
escaping the effects of the problem, revising one’s relationship with the problem, educating the
problem, negotiating with the problem, organising a truce with the problem, taming the problem,
undermining the problem. Further metaphors can involve people deciding which invitations from the
problem they wish to take up and which they are declining. There are countless non-violent, non-
adversarial and non-competitive ways in which people go about reducing the influence of problems in
their lives.

Very little of the literature about narrative therapy has ever emphasised combat metaphors, or attempts
to vanquish problems from people’s lives. Most of our work as narrative therapists involves engaging
with people around an enormously wide range of alternative metaphors.

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About these questions and answers

We have compiled these answers to commonly asked questions about externalising in response to
regular requests. Maggie Carey and Shona Russell, with assistance from other people working at
Dulwich Centre Publications, generated the questions and sent them out to a range of practitioners. A
number of conversations were also held here at Dulwich Centre. The responses were combined and a
draft document was then circulated widely for further discussion and refinement.

We’d like to acknowledge the following people who were involved in the generation of this piece:

Gene Combs, Jane Speedy, Stephen Madigan, Yvonne Sliep, Michael White, Carolyn Markey, Mark Hayward, Amanda Redstone,
Patrick O’Leary, Jill Freedman, Jeff Zimmerman, Sue Mann, Iain Lupton, Dean Lobovits & Mary Pekin. We’d like to
especially acknowledge the role that David Denborough played in drawing together the contributions.

Notes

• Externalising was first introduced to the field by Michael White and has since been engaged with
and developed by a wide range of practitioners.

• A personification for an older people is described later in this paper in relation to Mr/Ms AIDS which
is an externalisation that has been used in community projects in Malawi, Africa.

• For more information about this work in Malawi see Sliep & CARE Counsellors (1998), or write to
Yvonne Sliep c/o [email protected]

• To read more about these other narrative practices, see Morgan, A, ‘What is narrative therapy? An
easy-to-read introduction. Dulwich Centre Publications 2000.

• For more information about the different way of thinking that externalising is associated with, see
Thomas, ‘Post structuralism and therapy – what’s it all about’ (2002) International Journal of
Narrative Therapy and Community Work #2.

• Where acts of violence are concerned, this ‘checking out’ requires care and processes of
accountability whereby the voices and views of those most affected by the violence are privileged.

Further reading about externalising

Companions on a Journey: an exploration of an alternative community mental health project 1997:
Dulwich Centre Newsletter No.1. Republished in White, C. & Denborough, D. 1998: Introducing Narrative Therapy: A
collection of practice-based writings. Adelaide, South Australia: Dulwich Centre Publications.

Morgan, A. 2000: What is Narrative Therapy? An easy-to-read introduction. Adelaide, South Australia: Dulwich
Centre Publications

Epston, D. 1998: Catching Up With David Epston: A collection of Narrative Practice-based Papers. Adelaide, South
Australia: Dulwich Centre Publications.

Freeman, J., Epston, D. & Lobovits, D. 1997: Playful Approaches to Serious Problems: Narrative therapy with children and
their families . New York. W.W. Norton.

Freedman, J. & Combs, G. 1996: Narrative Therapy: The social construction of preferred realities. New York.
W.W.Norton.

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Payne, M. 2000: Narrative Therapy: An introduction for counsellors. London: SAGE Publications.

Sliep, Y. & CARE Counsellors, 1996: ‘Pang’ono pang’ono ndi mtolo – Little by little we make a bundle.’
Dulwich Centre Newsletter, No.3. Republished in White C. & Denborough D 1998: Introducing Narrative Therapy: A
collection of practice-based writings. Adelaide, South Australia: Dulwich Centre Publications.

Thomas, L. 2002: ‘Poststructuralism and therapy – what’s it all about?’ International Journal of Narrative Therapy
and Community Work, No.2.

White, M. & Epston, D. 1990: Narrative Means to Therapeutic Ends. New York: W.W.Norton

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