Using narrative

approaches with a
young girl in India
Kalyani Vishwanatha & Uma Hirisave

Kalyani Viswanatha is completing a PhD at the National Institute of Mental Health and
Neurosciences (NIMHANS), in Bangalore, India. Her doctoral research is in the area of
narrative therapy and children, and the following paper draws on this work. Kalyani can
be contacted by email: kalyani.vishwanatha@gmail.com

Uma Hirisave is a professor in the department of Mental Health and Social Psychology,
NIMHANS and the research guide for the project outlined in this article.

This paper summarises conversations with a ten-year-old girl in India, using

ideas and practices from narrative therapy to revise a relationship with fear and
‘helplessness’. The paper also includes a discussion of children and mental health
issues in India, and suggestions for school-based early intervention programs for
children at risk of developing emotional problems.

Keywords: children, India, fear, helplessness, narrative therapy, narrative practice

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INTRODUCTION sources of strength that makes change attainable
(Lichenstein & Baruch, 1996). Second, instead of
This paper describes using a narrative approach
pathologising the child, narrative practices look for
in a school setting in India with a young girl at risk
alternative perspectives and emphasises children’s
of developing emotional problems. This case study
knowledge and expertise. It is also ideally suited
illustrates some basic principles of narrative therapy
for the school setting as it takes into account the
and the feasibility in implementing a school-based
cultural and power aspects of the playground and
primary preventative program. It also highlights the
the classroom (Wiest, Wong & Cervantes, 2001).
necessity of adapting any approach to the relevant
Third, gentle, non-provocative, and non-intrusive
socio-cultural setting. The case is part of an
narratives provide an alternative restorative
outcome research study evaluating the efficacy of
experience that can change destructive internalised
the narrative approach for childhood problems.
understandings (May, 2005). Finally, narrative
Before recruiting the child for the study, informed
approaches assist children to construct positive
consent was obtained from the principal of the
life stories that influence identity formation
school where the child was studying, the parents,
(Desocio, 2005).
and the child. Identifying information has been
changed to protect the child’s identity.
Children and mental health in India
Narrative therapy seeks to be a respectful,
non-blaming approach, that centres people as Studies conducted in Indian school settings
the experts in their own lives. It views problems have indicated a high prevalence of ‘sub-syndromal’
as separate from people and assumes people have or ‘subclinical’ problems in children who attend
many skills, competencies, beliefs, values, ‘normal schools’ (Dalal, 1990; Sarkar, 1990;
commitments, and abilities that will assist them Shenoy, 1992). While problems relating to mental
to reduce the influence of problems in their lives health, trauma, abuse, and so on, can be responded
(Freeman, Epston & Lobovits, 1997). Narrative to, unless such an endeavour is systematically taken
therapy is sometimes known as involving up, these children are often likely to be included in
‘re-authoring’ or ‘re-storying’ conversations, and, the rubric of ‘difficult to handle’ children, and the
as these descriptions suggest, stories are central mental health origins of these issues are largely
to an understanding of narrative ways of working overlooked – an approach which encourages
(Zimmerman & Dickerson, 1994). Within a narrative responses of punishment rather than help. Not only
understanding, events as they occur will be can such problems interfere in children’s everyday
interpreted according to the dominant plot of one’s lives, but they can also have long-term implications
life at that time. However, there is also a constant for adjustment in adulthood (King, Ollendick &
mediation between the dominant and alternative Mattis, 1994; Ronka & Pulkkinen, 1995). And,
stories in our lives, that are influenced by while such problems often do not come to the
the broader stories of the culture in which we live. notice of clinicians for many reasons, studies also
In practice, narrative therapists engage in point to the fact that intervening at an early stage
conversations that seek out alternate stories of is likely to bring forth a more effective response to
identity that reduce the impact of the problem/s treatment (Durlak & Wells, 1998). Developmentally,
on one’s life (Morgan, 2000). children who have a predominantly negative external
Earlier research has indicated the usefulness representation of themselves are likely to progress
of the narrative approach in childhood problems to develop negative self-identities. Hence it is of
(Desocio, 2005; Lichenstein & Baruch, 1996; paramount importance to intervene at this stage
May, 2005; Wiest, Wong & Cervantes, 2001). when it is possible to change this kind of
These authors offer several possibilities to explain developmental trajectory.
the utility of narrative approaches: first, children’s In India, child mental health has received very
traumatic memories are often stored as wordless little attention of the policy makers. There is no
sensations, and translation of these memories into government aid for child mental health nor
a verbal narrative allows them to identify the origin insurance coverage. However, mental health
and meaning of current difficulties, and identify problems are fairly widely prevalent in the

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schoolgoing child population. Provision of effective sought. We then completed questionnaires with the
intervention strategies in schools would go a long students, designed to give some indications as to
way in alleviating child mental health problems in which of these might have some emotional or
the community setting (Kapur, 1995). Though the mental health difficulties. This paper reviews the
Integrated Child Development Service (ICDS) is subsequent narratively-informed conversations with
available in India, it caters only to the nutritional one of these students.
and physical health needs of the children. Mental
health needs are poorly addressed (Nithya Meeting ‘Smita’
Poornima, 2007). Considering the poor ratio of
service providers in relation to the prevalence of ‘Smita’, the focus of the current case study,
mental health problems in India, preventive was one of the children who was allocated to the
measures for at-risk groups become particularly experimental group in this study. She is ten years
important. In the Indian education system, a old and lives with her parents and younger brother.
paucity of school psychologists or counsellors and The family have what could be considered a lower-
lack of an effective referral network to mental health middle socioeconomic status. Both parents work in
services often lead concerned authorities to ignore a milk dairy and, as Smita is the older of the two
the problem (Akoijam, 2003). Even when identified siblings, she is left to take care of the younger
and referred, parents are unable to access help, as sibling until the parents return home. The family
there are relatively few hospitals with child and spends little time together, as they are busy with
adolescent mental health services. Children often their individual chores. While the girl interacts with
lack help and support at home as both parents both parents, she usually does not confide in either
spend most of the day working outside and expect of them. According to the teacher’s report, the girl
the teacher to be the primary source of help for the was rather solitary; often seemed worried, unhappy
child. Intervention studies in school settings have or tearful; was very nervous and not very popular
been carried out both in western and Indian settings among other children; and often did not complete
and have been found to be effective. These studies tasks given to her. Academically, the child’s
have used the school infrastructure as an entry functioning was ‘average’, although the teacher felt
point for intervention. I consider the use of the she could do better in oral exams if she was more
narrative approach in intervention for childhood confident.
problems to be particularly relevant given the high When Smita was interviewed, she agreed with
number of stressors of social origins that children most of these problems reported by her teacher.
face, which place a tremendous burden on them. She also reported experiencing anxiety, persistent
With these in mind, the current study was designed sadness, frequent mood shifts, and temper
to provide a narrative-based assistance to children tantrums. Smita tended to highlight her negative
in the school setting. attributes readily and was hesitant to list out her
The school chosen for this study was positive attributes. In initial basic ‘relative
government-aided, and has a primary focus is on influence’ questioning from narrative practice, on
academic performance. Annual school functions a ten-point rating scale, she rated the intensity of
here are restricted to two or three, and these problems as ‘10’. She did not think it would
extracurricular activities take a backseat. Parents be possible to reduce the interference of these
are from a lower socioeconomic group and often not problems on her life, and rated her own competence
available to join in with regular sessions. To identify in dealing with the problem as 2 on a ten-point
the at-risk students for the project, questionnaires rating scale.
were completed for randomly picked children to When we explored some of the context of these
identify those who might be at risk for mental problems, Smita said her approach at home was to
health problems, and the parents of these children avoid getting any negative attention. Early childhood
were contacted and informed about the program experiences where her parents had to spend a lot of
and asked for their consent. The program was also time away due to work demands also contributed to
explained to the children and their assent was also a lack of a confiding figure in her immediate home

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environment. In order to make meaning out of these would also reduce the prominence of guilt and self-
daily experiences, a dominant story was formed blame in Smita’s accounts of being ‘helpless’.
where she viewed herself as ‘helpless’, and that As part of the externalisation, I asked Smita to
there was no alternative but to accept the influence draw the problem and give it a name. She was able
of the problems in her life. Additional negative to do this easily, and drew a picture of the problem
experiences with authority figures served to thicken separately from a picture of herself. She was able
this plot. This dominant plot led her to act in ways to give it a name and label it as the cause of all
that reinforced this story, such as not revealing the her difficulties.
source of her worries to either parents or peers. Next, to map the influence of the problem in
As Smita found social interactions with her peers her life, I asked Smita to describe all the situations
difficult, she was not very popular with them, and in her life where the effect of the problem is
this further reinforced her notion that she was persistent, and how things might be different if the
‘helpless’ and that the broader problems could not problem were not there. She described that she had
be overcome. The beliefs and the ideas inherited difficulties while writing in exams, even though she
from her culture also contributed to thickening the was adequately prepared for them. Smita explained
dominant plot. By not talking about the difficulties that, when she had to study more than one subject
she was experiencing, she was acting according to at the same time, she found her efficiency reducing.
social expectations, in relation to how hardships When she was assigned more than one chore to do
should be endured, and in relation to the place of simultaneously, she was not able to do any of them
women and children. properly. She also told me that she was not able to
move around alone in the dark at night, even if
Renegotiating ‘helplessness’ there was a little light to help her find her way. She
found performing on stage a very terrifying
Together, we settled on a definition of the main experience and tended to make mistakes, even
problem as ‘being helpless and incompetent to though she had rehearsed earlier. She would avoid
change any circumstances in life’. Hence, our goal car rides because of her fear of travelling in cars.
was to discover alternative stories of competence She also acknowledged that not all these effects
and control over the problems in Smita’s life. From were equally distressing, and rated exam
a narrative point of view, this story of ‘helplessness’ performance as the situation of least severity.
was viewed as a ‘thin description’ in which there In the third session, we began to generate ideas
was little scope for acknowledging contradictions about ways to deal with the problem of feeling
and her competence in dealing with the problem helpless. Smita was initially very reluctant to do
(Morgan, 2000). The goal of seeking out alternative this, as she appeared overwhelmed by it. In order to
stories led to conversations of identity that assisted make this more feasible, I asked her to take each
Smita to break from the influence of the problem situation individually and think of alternative ways
and build a rich description of the alternative story. of responding to each one in turn. I asked Smita to
This was done in three phases – externalisation of start with the situation where she felt the
the problem, acknowledging a new self-narrative, interference of the problem was least. Smita then
and re-authoring a new narrative. proceeded to engage in a conversation about her
‘The problem is the problem, the person is not experience in examinations, and said she was not
the problem’ is an oft-quoted maxim of narrative able to identify the cause of her difficulty in
therapy. The linguistic practice of externalisation, remembering exam answers. To facilitate her
(White, 1988/9; White & Epston, 1990) which discovery of her competencies, I asked questions to
separates persons from problems, is a playful way to identify unique outcomes: I asked Smita to think of
motivate children to face and diminish difficulties. situations where she had been able to do well in
I used externalising conversations with Smita to exams. She was able to remember a few such
emphasise that she was not the problem; rather, she situations, so I wrote the differences between the
had a relationship with the problem that needed to two situations in two columns on a piece of paper.
be modified. My hope was that this perspective Smita was not able to identify much of a difference

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in the exam preparation phase, as she did elaborate further commented that, with this knowledge, she
preparation in both situations, but she did identify was able to identify a new self-description of ‘being
that negative, ‘catastrophising’ thoughts would often able to overcome difficulties in exams if she was
be very prominent in exams she found hard. These well-prepared and followed her plan of action’.
thoughts primarily concerned the possibility of her I invited Smita to elaborate further on this
not performing well, leading to a series of other redescription by accounting for possible reasons
thoughts about possible consequences, ending that the problem had exerted its influence over her
eventually with a conviction that she was unable to all these days, and how it might attempt to continue
do well because she was not adequately prepared. to do so now. Smita speculated on possibilities that
However, when she reflected on the unique the problem might ‘fight back’, and that it might
outcomes, she said that the absence of these not always be possible to use this new solution of
catastrophising thoughts always accompanied answering easy questions first, and said that she
situations when the first few exam questions were also had to figure out ways of dealing with difficult
easy – if the beginning questions were easy, the rest questions in order to do well in exams. At first, this
of the exam usually went well. I thought this was an seemed like a big jump – a ‘very high level
amazing act of both discernment and memory! distancing’ task (White, 2007) – so I instead asked
her ‘circulation’ questions, as I thought it was
necessary to anchor this new narrative. While Smita
From old to new skills and knowledge
said that she never thought she could get rid of
We then spoke about how she might make use fear, other people – specifically her teacher –
of this knowledge in her attempt to overcome the seemed to believe she was capable of this. I asked
influence of the problem in this situation. Smita what it was that could have led her teacher to
was initially unable to think of any plans regarding believe she was capable of overcoming the influence
this situation. However, aware now of the role that of fear. Smita hypothesised that the times when she
easy questions had played, I asked questions to find had been able to perform well would have helped
out more about her knowledge of these. Smita said her teacher believe that she could overcome fear.
that easy questions did not have lengthy answers, She then suggested that trying to overcome her fear
and that it was usually possible to finish answering about hard exam questions should be tried out
them quickly. Because of these features, doubts of initially in the presence of the teacher. Smita
performing poorly would be nipped in the bud. suggested one way she might do this: volunteering
I asked if she thought it might be possible to look to answer a question in class when she was sure the
back at a few of her recent exam papers together answer was correct. She explained that she rarely
and identify possible easy questions. Smita agreed tried to answer questions aloud in class, as she was
this could be a good idea, and when she brought afraid that she might forget the answer due to the
some to the next session, she was able to identify pressure of everyone watching her and listening.
that all papers had at least a few easy questions – However, she thought this was an extension of her
although they may not begin with these questions. idea of answering easy exam questions – in this
Once she worked this out, she suggested that she case, she would choose questions she knew the
could scan the paper initially, identify questions answer to and then attempt to answer them,
that were easy and she was confident about, and despite the fear she felt about speaking in the
start answering the paper with those questions. This group. I marvelled at the originality of her
would answer the niggling doubt that she might not proposed solutions.
be able to perform well and the consequent series Between this session and the next one a week
of negative thoughts. I asked her to speculate on later, the teacher contacted me and commented
the possible consequences of her making use of this that she had noticed a significant change in Smita’s
knowledge in order to help her perform better in initiative in class. While previously Smita was
exams, and she suggested a series of positive reluctant to answer even questions the teacher was
thoughts this would trigger off, again ending with certain she knew the answers to, in the past week
strong statements about her own capabilities. She she had begun to volunteer to answer questions.

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The teacher had made this observation to the child most of the situations that were problematic for her,
as well and told her that she appreciated her Smita moved from the position of a client to that of
initiative. Following this, Smita was even more eager a consultant – I asked her to contribute her
and optimistic in class. The teacher again shared knowledge about revising the influence of the
her observation of this with Smita, who acknowledged problem in her life to an archive, that could be used
that, while it was difficult to overcome her to help others who were having difficult moments
hesitation, the teacher’s encouragement was very similar to hers. Smita wrote a letter to other
helpful in overcoming this. Smita therefore children affected by fear and listed, as allies in this
recognised that strong positive feedback from others project: perseverance; the ability to implement the
was a possible ally in her efforts to renegotiate the plans she thought of; and memory. She also
role that fear played in her life. suggested that doubts and darkness could act as
‘friends of fear’.
Further outcomes At the end of ten sessions, Smita said there had
been a significant reduction of fear in all the
Smita was eager to explore other situations
relevant areas of her life, and a sense of
where she could try to deal with fear and the sense
competence to deal with problems had increased.
of helplessness. We began by talking about
The teacher also reported a reduction in Smita’s
situations where she had to deal with more than one
difficulties in school. The teacher said Smita was
task at a time; two examples she gave were when
more eager to voluntarily participate in class
she was asked to go to the shop without a written
discussions, and attempted to solve problems in
shopping list, and when she had to study more than
new situations. The teacher also observed that
one subject at a time. Smita said that, in the first
Smita’s relationships with other children were
situation, she usually experienced a lingering doubt
improving; she was becoming more popular with
about remembering all of the items on the list.
others and the number of friends she had was
However, she was able to identify unique outcomes
increasing. I met with Smita after three and six
and identified that she had been actively using
months following therapy and she reported that
some strategies, like grouping the items according
all gains had been maintained.
to categories, when she had remembered all of
them. She also recognised that difficulties in
studying more than one subject at a time were
Reflections
because of switching between subjects frequently, This example highlights many issues I think are
and suggested that she should again use the of relevance. It is an example of the principle of
strategy of finishing off easy parts before starting on narrative therapy that people have the requisite
the more difficult ones. She also suggested that she skills and competencies to reduce the impact of the
could rely on her teacher to explain something again problem in their own lives, and that they are the
if she failed to understand. experts of their own lives. It highlights the
We continued like this over the next three possibility that a narrative approach is well-suited
sessions, and Smita was able to work through all for a primary prevention program for working with
the other situations where she experienced fear or Indian children. It also points to the feasibility of
was unsure of her own abilities. As she built on utilising the school infrastructure as an entry point
previous unique outcomes, and employed her new to identify children ‘at risk’ of developing emotional
ideas, the redescription of her being less fearful and problems. This seems particularly relevant as
more confident grew thicker. During this time, I also parents may not be aware of some challenges their
used re-membering conversation questions (Morgan, children are facing, such as in social or academic
2000) to ask about who in her life would be contexts of school, which means that schools have
interested in these developments and what they more of a responsibility in these matters. The
might say about them; I also used puppets as narrative approach therefore appears to be a
outsider witnesses (Morgan, 2000) to consolidate promising avenue to be explored in this socio-
the gains she was making. As she worked through cultural setting.

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