Journal December 2025 Release - Flipbook - Page 17
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Inspired by David Epston’s successful work with eating disorders using a narrative
therapy approach (Maisel, Epston, and Borden, 2004), ever so often I dared to
broach the subject of anorexia with her, but Joanna would have none of it.
Although I loved reading about anorexia/bulimia and the anti-anorexia approach,
I did not know how to position myself as a therapist in a conversation involving
anorexia or bulimia. It is one thing to read about the therapy someone else is
doing on paper and copying the practices in real life on another human being. The
radical externalization and element of protest of anti-anorexia appealed to me,
but I was wary of sounding like an expert. It was difficult for me to accept that
despite noticing with my very eyes that something was going on with Joanna’s
eating and increases in frantic exercising, I had no room to speak about it. Joanna
attributed these behaviours to her Temporal Lobe Epilepsy experience. I
disagreed but decided to prioritize maintaining the therapeutic relationship
instead of addressing topics she chose not to discuss. Despite this, my concern
persisted, and I remained unconvinced by the explanation provided.
Session times: Are we even re-authoring?
We agreed to meet once a week. Joanna understood my concerns but kept
reassuring me that she was fine. Joanna embraced the practice of externalization
and delighted in the knowledge that she was not the problem, but that the
problem was the problem. We were discovering the problem’s voices and
isolating the demands the immediate problems were making on her life. Despite
successful externalizing practices, I doubt that we progressed beyond that, as our
efforts did little to dissolve the problem stories, which were almost allencompassing.
Naming Self-Destruction.
After several months, we identified her problems under the umbrella term "SelfDestruction” which incorporated all her psychiatric diagnoses. Regardless of
whether she experienced anxiety, depression, or de-realization, these issues led
to para-suicidal behaviour and self-harm. Joanna was firmly invested in the “sick
role of a psychiatric patient” while I tried my best to step out of my psychiatric
nursing shoes. Her suicide attempts were extremely dramatic events,
necessitating emergency medical intervention.
An Apprenticeship in Extremis
Journal of Contemporary Narrative Therapy, December 2025 Release, p. 5-44.
www.journalnft.com
