Finding an audience to life:outsider-witness practices in oncologyCassandra TaylorBA, BSW (Hons I), Grad Cert Adol Health (Oncology)

Psychosocial Team Leader & Senior Counsellor

CanTeen Australia

Masters of Narrative Therapy and Community Work student

University of Melbourne x Dulwich Centre, Adelaide

We are on Aboriginal

land.• The traditional owners of lutruwita (Tasmania) where we meet

today are the muwinina (traditionally written without use of capital letters)

• I wish to pay respect to those that have passed before us and to acknowledge today’s Tasmanian Aboriginal community who are the custodians of this land

• I wish to acknowledge and grieve Tasmania’s post-colonial history

• I acknowledge the ongoing impact of colonisation in this country

• The 2019 Closing the Gap report found that Indigenous mortality rates from cancer are rising and the gap in cancer mortality rates is widening. This is unacceptable.

• I also acknowledge the spirit of survival and resilience evident in First Nations communities and am inspired by their acts of resistance

• I socially locate myself as a beneficiary of white privilege and acknowledge my settler/immigrant ancestry

Art by Charlotte Allingham – a 26 year old proud Wiradjuri woman

Unique footprints: recognizing the biopsychosocial implications of the cancer site

Identity as an affected site: loss of

role, changes in appearance

Possible thin descriptions & negative identity conclusions brought by cancer

• I deserve this, I haven’t taken care of myself

• Everything always goes wrong for me

• I’m unlucky/cursed

• I am ‘the cancer kid’

• I can’t take care of my family

• I can’t cope

• I am useless and have nothing to contribute

• I’m not a real woman / man anymore

• I don’t know how to relate to people anymore

• I’m lost and without a purpose in life

There’s always more to the story

• When we can see the multistoried nature of life, we can challenge these thin descriptions with richer, thicker stories

• This way we can see that they do not represent the ‘full truth’ of our lives

• These preferred narratives and identities can be powerfully affirmed by witnesses who are invited to reflect back our reclaimed or redefined sense of self and community

• This is where outsider witnessing comes in!

Before we jump to outsider witnessing, a little background

on narrative therapy!

Key positions of narrative therapy

Morgan (2000):

• Respectful and non-blaming; collaborative

• Views problems as separate from people

• Assumes people have skills, competencies, beliefs, values, commitments, hopes and abilities

• People’s lives are multistoried: different stories can be told about the same event

• Broader social contexts influence how problems show up in people’s lives, discourses and systems of power/inequality sustain them

• Therapist is de-centered (client’s meaning and agenda) and influential (uses skills/knowledges)

Where did it come from?

Narrative therapy was initially developed by Michael White (AU) and David Epston (ANZ), two social workers in the field of family therapy

Informed by feminism, anthropology, literary theory, queer theory, critical theory, Indigenous knowledges, the stories and insider knowledges of those we meet with: ‘always on the move’

Origins of outsider witnessing: Barbara Myerhoff, an American anthropologist and film-maker coined the term ‘definitional ceremony’(1982, 1986) to describe the process by which communities of people actively construct their identities – this inspired White to bring these ideas into the therapy realm

What is outsider and acknowledging witnessing?

Carey and Russell (2004):

• An outsider witness is a third-party audience invited into a therapeutic conversation to acknowledge ‘preferred stories and identity claims of the person consulting the therapist’

• The witnesses may be other workers, other current or former clients, their family and loved ones

• The hope is that the work of therapy can be more easily translated into action in day to day life through the affirmation of identity

How is it done?

1.) The telling: The therapist interviews the person who has come for consultation while the outsider witnesses listen. Alternatively it is recorded (audio or video), or documented in the written form to be responded to at a later stage.

2.) The re-telling: The outsider witnesses talk with each other in the presence of the client about the narrative they have just heard, asking questions of one another, reflecting on what it meant to hear the conversation, using structured questions provided by the therapist.

3.) The re-telling of the re-telling: The therapist then interviews the client about their experience of hearing the outsider witness group.

4.) The therapist, client and outsider witness group can talk together and reflect on the experience (not always possible)

This process is called a ‘definitional ceremony’.

Questions for the witnessesWhite (2002):

1. Expression: As you listen to the stories of the lives of the people who are at the centre of the definitional ceremony, which expressions caught your attention or captured your imagination? Which ones struck a chord for you?

2. Describing the image: What images of people’s lives, of their identities, and of the world more generally, did these expressions evoke? What did these expressions suggest to you about these people’s purposes, values, beliefs, hopes, dreams and commitments?

3. Embodying responses: What is it about your own life/work that accounts for why these expressions caught your attention or struck a chord for you? Do you have a sense of which aspects of your own experiences of life resonated with these expressions, and with the images evoked by these expressions?

4. Acknowledging transport: How have you been moved on account of being present to witness these expressions of life? Where has this experience taken you to, that you would not otherwise have arrived at, if you hadn’t been present as an audience to this conversation? In what way have you become other than who you were on account of witnessing these expressions, and on account of responding to these stories in the way that you have?

Responses for witnesses to avoid

Carey and Russell (2004):

• Praise/congratulating: well intentioned but may be experienced as condescending or patronizing, puts witness in a position of judging what is positive

• Giving advice/imposing values: witnesses are not positioned as experts

• Focus on the problem story: the purpose of witnessing is to thicken the preferred narrative/identity

• Talking as an individual/too much: in-person witnesses function as a team in conversation

• Talking about your own experiences too much: witnesses are not storytellers, but in a reflective and supportive role for the client

Confidentiality: the potential elephant in the room

• Narrative practice is an anti-individualizing or pro-collective practice

• Sometimes confidentiality contributes to an unhelpful silencing, isolation and individualizing of problems

• Of course – all parties need to give informed consent and understand this is not within the ‘traditional’ bounds of confidentiality

• This about spreading the good news and socially affirming a new identity and new possibilities for the client

Where have I seen this before?

Humans of New York:

almost a definitional ceremony (but witnesses without guidelines can provide unhelpful responses!)

Outsider Witnessing at CanTeen

• Sensing Our Grief group

• PEER psychosocial overnight program

• The Jar narrative

• ‘Insider knowledge’ contributions and responses via webchat

• Catching up letters

• Online community responses

Let’s practice: The JarWrite an anonymous response and I will send it back to the young person

It’s like I have a jar and it overflows and has to go somewhere and ends up as physical pain. I bottle up more than I let out. When the jar is overflowing, it leads to isolation, not eating, not taking care of myself.

I need to create a safe space where I can open the jar. If loneliness becomes too much in the safe space, I can invite some people in that I am close with. If they become too frustrating, I can kick them out.

The jar has never been opened before. It contains the last 17 years of my emotions. I have only ever explained the overflow of the jar to others. The expiry date on the jar is the day I die, but because it is already overflowing, I need to open it if I want more space.

The jar contains depressing stuff, stuff I dwell on. It is dark and black. The overflow is black with a bit of grey, because that stuff hasn’t been bottled up as long. The dark stuff is kind of going off.

There’s no room for good emotions. They sit on top and around it to try to cover up the black bits and mask the pain. It’s not really helpful.

A better option than masking the pain is dealing with it, facing up to my emotions and not bottling them up. That would make it possible to get out, make good memories and have good experiences.

I’d still need a safe spot if the jar was open, but I would be more aware of what is unsafe. The overflow makes it hard to tell what is unsafe sometimes.

Let’s practice: why did you become a social worker? OR why did you decide to work in oncology?

Break into groups and take on the following roles:

• Storyteller (1 person)

• Expression

• Images

• Embodying responses

• Transport

Listen from the role you’re taking (you may take more than 1 if required)

Please ‘rescue’ moving phrases (Newman, 2008 –rescuing the said from the saying of it)

Swap roles if time permits!

How could you use this and who could you use it with?• At the end of life – the definitional ceremony could

be documented for the family to keep

• In group settings: carers, women with MBC, partners, AYA, parents etc.

• Witnessing efforts of staff in traumatic situations as a form of acknowledging debrief

• For individuals who are resonating strongly with thin descriptions of themselves as cancer patients

• Insider knowledge about dealing with cancer (i.e. fear of recurrence, dealing with uncertainty) could be documented and then witnessed with responses send through to the author/s

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And more!

References

Carey, M. & Russell, S. (2004). Narrative therapy: responding to your questions. Adelaide: Dulwich Centre Publications

Morgan, A. (2000). What is narrative therapy? An easy to read introduction. Adelaide: Dulwich Centre Publications

Newman, D. (2008). “Rescuing the Said from the Saying of It”: Living Documentation in Narrative Therapy. International Journal of Narrative Therapy and Community Work, (3), 24

White, M. (2007). Maps of narrative practice. New York: WW Norton & Company.

Thank you and questions