Fighting monsters: psychotherapy and the battle against mood disorders

By Mike McMahan, LPC
 
It’s been said that there are only seven basic plots in the world. While this is intended to apply to novels, given that we build narratives in our own lives, there is no reason that it should not apply to narrative therapy. I previously discussed the idea that we can change our own story with a few carefully considered “edits”. If our life has a plot, there needs to be a villain; in this case, that villain will be a monster. For that reason, the plot that will be considered in this post is “Overcoming the Monster.”

A few weeks ago, I had the real pleasure of attending a signing and talk from author Justin Cronin, whose recently completed Passage trilogy is one of the best horror/fantasy reads in years. He hosted a Q&A session prior to signing, and talked about the origins of the book, noting that there are “only four kinds of monsters: zombies, werewolves, vampires and frankensteins.” I’m sure someone can dispute the veracity of this claim (hello? Elmo, duh) but I agree that this group of four makes up the vast majority of monsters. Please note I don’t consider witches to be monsters—so strike that one off the list. For The Passage, Cronin chose vampires, but if you observed that his vampires act a lot like zombies, you wouldn’t be wrong. So, in a way, Cronin had his cake and ate it too. While there may be four archetypal monsters, they can be mashed up in new and creative ways. I mean, mummies are basically zombies wrapped in toilet paper, right?

Language usage can play a very important part in the therapeutic process. Even subtle shifts in self-description can play a role in how a client perceives themselves. For example consider the very common statement: “I’m bipolar.” This suggests a person who sees a psychiatric diagnosis as a core part of their being. On the other hand, I always describe clients facing these types of challenges as “a person with a bipolar diagnosis.” This captures a client’s essential humanity as well as giving them room to think about their qualities outside of their diagnosis. Consider also the difference between “my child is autistic” versus “my child has an autism diagnosis.” Yes, there is no “cure” for autism, but with skill building and patient parenting, children with autism can certainly lead rewarding and fulfilling lives.

There is a technique used in psychotherapy called externalization. It is basically what it sounds like—a way to help clients stop thinking of their problems as an intrinsic part of who they are. This builds on the idea that a person is not defined by their problems but, instead that their problems are something that can be overcome and not necessarily a set-in-stone, permanent thing. Going back to the example of monsters that opened this piece provides an opening that can be especially effective with child or adolescent clients. Though I love fantasy type shows, books and movies as much as anyone, there is an undeniable appeal to adolescents. The idea of monsters as metaphors for teenage challenges was used to tremendous success on the long-running TV show Buffy the Vampire Slayer.

Once we accept this idea, the possibilities for narrative therapeutic techniques are virtually endless. Imagine a teenager with a mood disorder such as depression or bipolar disorder. Externalization can be used to help this young person get outside of the idea that they “can’t” overcome the challenges faced by the symptoms of this diagnosis. Questions such as “what is your depression stopping you from doing?” or “what will your life be like when you kick depression out?” are helpful in getting started.

Externalization may, as well, be useful to this process. The diagnosis can be renamed as a monster. It’s not depression—it’s a werewolf that takes control of you every so often and causes you to feel and act different than you might if you weren’t under the influence of depression. This allows the possibility that the illness/monster may be defeated. For example, a silver bullet is known to kill werewolves. So a therapist might ask “what is the silver bullet that will help you defeat the werewolf?” Having used this technique extensively myself answers can range from “being more involved in activities,” “exercising,” “not listening to what the other kids say” and more.

So keep in mind, you are NOT your problems, even though they may cause you distress and create obstacles in your life. What kind of monsters are you facing down?

 
Mike McMahan, LPC is a psychotherapist based in San Antonio, Tx.