Expanding the landscape:

Narrative practice in rehabilitation services for adults

affected by intellectual disability in Hong Kong

by Ocean Hung

Ocean is a clinical psychologist working in social welfare setting in Hong Kong. He focuses
on providing support and consultation for care staff working with adult persons affected by
intellectual disability. He can be reached at hoiyeung.hung@gmail.com

Abstract
This article proposes the adaptation of narrative practice to the field of psychological services
for adult persons affected by intellectual disability. The author advocates such adaptation
in order to help anchor the agenda of rehabilitation service to the service users’ hopes and
dreams instead of the traditional notion of ‘behavioral problems’. In particular, the author
discusses the use of narrative-based practices to facilitate the service users’ participation
in the co-construction of identity conclusions about themselves and their relationship with
others within the care system. The use of narrative ideas and enquires in case consultation
is discussed. In addition, three extended practices, namely ‘Group re-authoring’, ‘Identity
revisiting documentation’ and ‘Action dialogue’ are described and illustrated with stories of
two service users.

Key words: intellectual disability, Hong Kong, externalising, re-authoring conversations,

group reauthoring, identity-revisiting documentation, narrative practices

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Introduction
This article begins with a brief overview of the development
of therapeutic approaches for adults affected by intellectual
disabilities followed by a review of Hong Kong’s local context
of rehabilitation services. Observations on the marginalising
effect of the sole reliance on behavioural approaches are also
discussed. Along with the stories of the people my colleagues
and I have worked with, I propose an adaptation of narrative
practices (White, 2007) in our work so that the intentions,
hopes, and dreams of our service users can be foregrounded
and respected. In particular, I will discuss some processes to
invite care staff in the support system to expand their ways
of understanding and relating with their service users so that
new opportunities can be generated in support of the users’
pursuit of their hopes and dreams in life. Two methods called
‘group re-authoring’ and ‘identity-revisiting documentation’,
which are adapted from narrative practice, are proposed to
serve such a purpose. The practice of ‘action dialogue’ and
the ideas behind it will also be discussed as a way to expand
the participation of the service users in the co-construction
of their social identity and preferred ways of being and
interacting in their daily lives.
Overview
Until today, behavioural approaches still occupy a central role
in working with persons affected by intellectual disabilities
(for example, Bhaumik, Gangadharan, Hiremath & Russell,
2011; Carr et al., 1999; Rush & Frances, 2000). Although
many studies and concerned bodies have been advocating
for wider service perspectives such as the incorporation and
inclusion of humanistic values and psychosocial support
(such as National Institute for Health and Care Excellence,
2015; Shogren, Faggella-Luby, Bae & Wehmeyer, 2004),
the development of therapeutic work models in this field
is still relatively limited in diversity and breadth. Apart
from behavioural approaches, the use of direct individual
psychotherapy such as cognitive behavioural therapy and
psychodynamic therapy for persons affected by intellectual
disabilities is still controversial (Lynch, 2004; Prout & Nowak-
Drabik, 2003; Sturmey, 2005; Willner, 2005). One reason is
the heavy dependence on the use of verbal communication
between the therapist and the person receiving therapy in
many psychotherapeutic approaches (Bhaumik et al., 2011).
Apart from the application of direct individual therapy,
another line of important development in this field is the use
of systemic and family approaches in working with persons
and family members of persons affected by intellectual
disabilities. Models from family therapy (such as Baum 2006,
2007) and systems theory (Jenkins & Parry, 2006; Lynggaard,
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Donati, Pearce & Sklavounos, 2001; Smyly; 2006) have been
adopted to work with the support systems of the persons
affected by intellectual disabilities in order to resolve issues
in their lives and promote their wellbeing. Along with such
development, Scior and Lynggaard (2006) provided an
in-depth discussion on the theoretical relevance and
practical adaptability of narrative therapy in working with
persons affected by intellectual disabilities and their families
and caregivers. Case studies on using narrative therapy
with persons affected by mild ID who have basic verbal
ability have also been documented together with suggestions
for modifications to meet their unique needs (for example
Figueras Costa, 2006; McFarlane & Lynggaard, 2009; Scior
& Lynggaard, 2006). The practice proposed in this article is
a development along this line of thought. In particular, the
practice I describe in this paper has a special focus on using
narrative ideas and practices to engage with the processes
of socially constructing the identity of service users. The
local contexts in which such practice developed will be
discussed below.
My observations about
Hong Kong’s local contexts
Institutionalised service has been the major mode of service
provision for persons affected by intellectual disabilities
in Hong Kong (Hong Kong Special Administrative Region
Government Social Welfare Department, 2004). Due to
societal factors such as population density, economic
ideology, and welfare philosophy, such a framework for
provision of services is likely to continue in the foreseeable
future. This is a contrasting development compared to the
trend of transitioning from large facilities to small-scale
community settings that has been happening in many western
countries (Lakin, Prouty, Polister & Smith, 2002). I personally
believe the contexts of institutional service provide both
challenges and opportunities to our therapeutic services.
I will first discuss two major contextual challenges and review
the phenomenon of the dominance of behavioural approaches
to which these challenges contributed. I will then explore the
opportunities of expansion of therapeutic practice in our local
institutional services.
Resource limitations and the agenda of management
The first contextual challenge is resource limitations which
lend support to the agenda of management. Most institutional
services in Hong Kong cater for around 50 to over 100 service
users in one to two service units, generally with high user
to staff ratios. During busy hours, two staff members may
have to look after up to 50 users in a common area while
the rest of the staff are engaged with other duties. A frontline
staff member once shared with me that, instead of love and
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patience, ‘What we cannot afford the most to spend on our
users is time!’ I believe this would generate tremendous
resonance in most care staff in Hong Kong. Such tight staff
ratios in institutional settings can lead to a tendency to
favor the agenda of behavioural management and control
which is believed to be the easiest and most efficient way to
attain discipline. Under these situations, any deviation from
normative ways of being by a user is often perceived as an
extra demand on already stretched and busy staff.
Lack of diversity in therapeutic approaches and limited
momentum to change
The second contextual challenge is the lack of diversity
in therapeutic approaches. Since the beginning of the
establishment of psychological services for persons affected
by intellectual disabilities, behavioural approaches have been
a major treatment of choice (Yau, 1997). Such a situation
remains pretty much unchanged until today as very limited
alternative theories and practices have been introduced to
our field. This lack of diversity leads to a sense of
mundaneness and relatively low sense of job satisfaction,
which drove many helping professionals such as
psychologists to opt for careers in other fields (Yau, 1997).
The more that helping professionals are discouraged
from joining the field, the more the status quo remains
unchallenged and unchanged. It was under this situation that
psychological services for persons affected by intellectual
disabilities in Hong Kong become almost equated with
behavioural analysis and modification.
Sole dominance of behavioural approaches and its problems
The above contextual challenges provide the background for
the dominance of behavioural approaches in psychological
service for persons affected by intellectual disabilities in Hong
Kong. However, from my experiences, the sole reliance on
behavioural concepts and methods not only limits our work
but also runs the risk of objectifying and further reducing the
voice of our service users who are already marginalised by
culture and disabilities. In particular, there are three points
that I would like to make about this:
First, a sole reliance on behavioural approaches can
contribute to the skewedness of care staff’s attention to
the users’ ‘problem behaviours’. Many recording methods
of behavioural approaches invite care staff to observe and
document the occurrence of problem behaviours for further
analyses. This inevitably accentuates the problem behaviour
while diverting attention from other non-problem related
actions. It also habitually invites care staff to collect a pool of
biased and problem-saturated experiences for making sense
of the service users, which often becomes the foundation
for the development of problematic identity conclusions
about them.
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Second, the language of behavioural approaches tends to
limit the ways the staff can make sense of the service users’
actions. Popular tools within behavioural analysis tend to
restrict ‘functions’ or ‘motivation’ of the behaviour into a few
categories, namely sensory needs, escape from demand,
attention seeking, and tangible requests (for example,
Durand & Crimmins, 1992). Undoubtedly, this provides a
lot of convenience for care staff to form a parsimonious
hypothesis and serves decisive functions under the agenda
of behavioural management. However, this is done at the risk
of severely truncating and reducing the possibilities of human
intentions and interactions. After all, the power of language
and cultural construction can never be overestimated in our
work. The choice of language can influence our understanding
on whether a user was ‘seeking attention’ or ‘expressing
hopes and needs for connection and affection’; ‘escaping
from demand’ or ‘resisting imposition’; ‘requesting tangibles’
or ‘exercising preferences and choices’. These differences in
understanding can make a huge impact on whether defensive
handling or empathetic attunement will emerge and direct the
subsequent interactions.
Third, the power politics behind behavioural approaches
are much less exposed and studied compared to its
powerful effects. Most behavioural approaches emphasise
the assignment of rewards and sometimes punishment to
achieve the desired behavioural changes. However, these
approaches are mostly concerned with how to bring out the
‘desired behavioural change’ and often leave the question
of ‘desired by whom?’ unexamined. Certainly, there are
times we can generate target behaviour desired by both the
user and the care staff. Nonetheless, it is usually the care
staff who have the final say in defining the ‘desirability’ of a
behaviour. Quite often, such power is recruited to serve the
agenda of management and control. Many staff who deliver
a behavioural plan often hold benign intentions such as to
help a user adapt to the environment or to get along better
with others. However, when the target behaviour is only
desirable to the care staff, then from the user’s perspective,
the punishment can be perceived as a threat while the
reward can be seen as a bait. The behavioural plan may then
unwittingly turn into an oppressive power which usually leads
into counterproductive interactions. When such unintended
oppression occurs repeatedly, the most common effects are
the erosion of the relationship between care staff and service
users, and the development of highly negative feelings and/or
identity conclusion in respect of each other (though one may
question how much users’ identity conclusions in respect of
care staff would carry weight).
When behavioural approaches predominantly direct the
relationship between care staff and service users, some users
might be driven into power struggles and unconstructive
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interactions which in turn yield more ‘behavioural problems’.
For some other users, this may lead them into increasing
docility and loss of animation in life. Meanwhile, the monopoly
of behavioural approaches may give rise to burnout and
resignations of some care staff as they might feel pressured
to work against their own values and beliefs. For others, this
may lead to increasing rigidity and restrictive practice that
may derail them from their original purpose of joining the
helping professions. In the worst case, the result can be a
gloomy scene in which everybody suffers.
Fertile ground for social construction of identity
In spite of the above challenges, our local institutional
settings also provide therapeutic opportunities through
the formation of a stable immediate community or a care
staff system with multiple caregivers who hold diverse
attitudes, beliefs, experiences, and knowledge about each
user. Such a system is often a fertile ground in which social
construction of the users’ identities takes place continually
and intensively. From my experience, the care staff system
can be a cultivating ground for both problem-saturated stories
as well as alternative stories to flourish, depending on the
culture and ecology of the setting. If a problem-focused and
restrictive framework dominates the setting, development
of understandings and identity conclusions about a user by
the care staff system can be severely limited and problem-
saturated. Contrarily, when more respectful and flexible
perspectives are introduced, the care staff system will be
capable of generating new possibilities and initiatives to
bring important improvement to the users’ daily experiences
and, sequentially, psychosocial well-being. In this regard,
narrative practice which has a philosophical root in social
constructionism and a range of versatile methods to work
with social construction processes (for example, Freedman &
Combs, 1996; White, 2007; White & Epston, 1990) can have
much to offer to our services.
Narrative practice and alternative
agendas in rehabilitation service
Above the inspirations and skills, I believe the most important
thing narrative practice can offer to our field is the value of
taking a decentred position (White, 1997). It can help reset
the agenda of rehabilitation from managing behaviours to
helping service users align their actions with their intentions
and, thus, to support their development of a sense of personal
agency. I believe that such a decentred position provides a
direction towards a more responsible use of power by helping
professionals and care staff. It is only with such a value in
mind that the practices discussed in the rest of this paper
would make the most sense. I will now turn to a discussion
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of the use of narrative ideas and enquiries during consultation
to services as well as the practice of ‘action dialogue’ with
the story of Alice.1 The practice of ‘group re-authoring’ and
‘identity revisiting documentation’ will then be discussed along
with the story of Ben.
Alice’s story
Alice’s situation was brought up for consultation by her social
worker, Liz, due to her ‘chronic work refusal’. For more than
ten years, she mostly refused to leave her hostel and go to
the workshop; this happened almost every day. She could
normally verbalise a few single words or a short phrase, but
she would remain silent when care staff asked her about the
reason for skipping work. Alice had no problem waking up
in the morning, nor was there a problem for her to finish the
morning routine like grooming and eating breakfast. However,
when it came to leaving her room for the workshop, she would
suddenly become highly withdrawn and defensive. She would
hide herself in the corner of her room mutely or yell at those
who insisted on getting her to work. Every time when hostel
staff saw her staying in the hostel during work hours, they
would ask her why or invite her to go to work. This almost
always led to her further withdrawal or temper outbursts.
Nevertheless, there were some ‘good days’ on which she
would manage to go to the workshop. On those ‘good days’,
her mood, work performance, and social interaction in the
workshop would be stable and fine. She showed no signs of
fear or avoidance of her work duties, people, and things in her
workplace. After work, she would return to the hostel happily
and tell staff that she went to work. Most staff recognised
these occasional ‘good days’ but felt that it was based on a
‘randomness which they had no control over’. Throughout the
years, many different behavioural plans were used to promote
her work attendance (including the use of tangible items or
social recognition as reinforcements, usage of punishment,
or the combination of both, at various frequencies and
intensities). However, none had yielded a lasting effect.
All these led her social worker, Liz, to conclude that instead
of any reward or punishment, ‘what mattered the most was
how she felt that day’.
Seeing and conversing from
a narrative perspective
For over ten years, the hostel staff’s view of Alice was
dominated by the ‘work refusal’ problem. Their interactions
with her were also dominated by this topic and their
repeated efforts to motivate her to work had led to a sense
of helplessness among staff as reflected in their expression
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of ‘randomness which they have no control over’. Even when
some staff later conceded that ‘what mattered the most was
how she felt’, their efforts were still focussed on achieving the
target behaviour of going to work instead of addressing her
emotional concerns and hopes. The unique outcomes of the
‘good days’ remained insufficiently explored for years under
the restraints of the traditional behavioural approach, as no
concrete and consistent ‘behavioural antecedent’ could
be identified.
Based on the above understanding, I reckoned the first
important thing to do was to help Alice’s care staff unpack
the ‘randomness which they have no control over’ in order
to support them to resist the sense of helplessness and
regain some sense of personal agency in working with
Alice. This was facilitated by inviting the staff to expand their
understanding of Alice’s difficulties in terms of her frustrated
hopes and wishes and, more importantly, how their interaction
with her might make a difference to the difficulties she
experienced.
Therefore, based on Liz’s realisation that ‘what mattered the
most was how Alice felt that day’, we shifted the focus of
the consultation away from getting her to work and moved
towards understanding what she felt about living in the hostel,
and what she felt about herself and her relationship with
others. Some helpful questions included:
• W
 hat do you think that Alice feels about living in the
hostel? ... She might not be able to express it in her own
words, but what do you think she would say if she could
borrow your words?
• W
 hat situations do you think might give her these
feelings?
• H
 ow might her feeling of ‘not being liked’ affect her overall
involvement and participation in daily life activities?
• If she could tell us with her words, would you think she
likes or dislikes that feeling?
These questions were first discussed with Liz and then
shared with other care staff through Liz. Liz identified that
Alice always had the feeling of ‘not being liked’ in the hostel.
Meanwhile, being questioned about her work refusal was a
situation in which staff might unwittingly give support to the
feeling of ‘not being liked’ and thus lead to her withdrawal
and defensiveness. Liz also believed that Alice was suffering
much from this feeling of ‘not being liked’ and was, therefore,
eager to help Alice to stay distant from it. The consultation
process then moved towards the exploration of unique
outcomes:
• A
 re there some situations you have noticed in which she
might be feeling differently?
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• W
 hat is your guess about how she might be feeling when
she has one of her ‘good days?
• C
 an you think of some situations in which Alice is not
as withdrawn?
• W
 hat is your guess about what she was hoping for and
feeling when she offered to give staff a hand? What may
this reflect about what she considers as important in her
life here?
Liz shared some unique outcomes of Alice which spoke
outside of the general description of her as withdrawn,
including Alice’s readiness to give staff a hand whenever
invited to, and her active seeking of reassurance from Liz
and two other staff who had long-standing caring relationships
with her. These realisations made Liz believe that Alice
actually hoped to be ‘liked and accepted’ by the caregivers
and that she would feel proud about herself when she could
meet their expectations.
These understandings, no matter how sound and sensible,
were still very much limited to Liz about her self-‘reality’.
It was important for her to validate such understandings
with Alice and share such alternative knowledge with other
care staff in the system. However, Alice gave a very limited
response to Liz’s sharing of her new understandings.
Moreover, Liz believed that even if Alice did make some
verbal acknowledgment, it would not be enough to help other
care staff to resonate with this alternative understanding, as
the other staff would probably have reservations about the
reliability of Alice’s report.
Action dialogue
From my experience, it is quite common for care staff to have
reservations about the reliability of verbal reports of persons
affected by intellectual disabilities. At times, care staff are
concerned that the users are just giving a ‘model answer’
and, at other times, care staff might find the users’ self-report
to be inconsistent with their own observation. I believe the
core problem behind these situations is the difficulties of our
service users to use verbal language to precisely represent
their lived experiences. As a result, it is necessary to find
a way to support a trustful communication between users
and care staff so that there can be a common ground for
negotiation of meaning. On this matter, I find it very helpful to
invite both the care staff and the service user to resort to the
‘language’ we use to communicate before the acquisition of
verbal language – action and emotion.
As Bruner (1990) and many others have shown, human
beings use the actions of others as a basis to make sense
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of their intention. Meanwhile, many researchers have
demonstrated that nonverbal emotional cues play a significant
role in human communication (Knapp, Hall & Horgan, 2014).
Actions and emotions are highly communicative of a person’s
intention. For instance, we might be ready to believe that a
person showing shame and shedding tears is regretful of
their action and this action may not totally represent their best
judgment or intention. Meanwhile, we might be convinced
about a person’s commitment to an activity when they showed
very stable participation without any external demand or
reward, and would often show enjoyment with a smile of
satisfaction. The same applies to how care staff make sense
of their service users’ intentions.
‘Action dialogue’ is a method we developed to foster
communication between care staff and service users. It aims
to expand participation of the user in the co-construction of
alternative knowledge about his or her intentions, hopes,
and dreams as postulated by care staff. The staff can
initiate new action and interaction based on their alternative
understandings and get feedback through the user’s actions
and emotional responses. The user’s actions and emotional
responses in turn help care staff understand if their alternative
understandings are in line with the user’s preferred ways of
being and relating. I will now continue to illustrate how action
dialogue can be applied with Alice’s story.
Action dialogue in action
Due to Liz’s amazing effort, the team took the following steps
to initiate an action dialogue over a few months’ time:
• W
 hen Alice did skip work, instead of questioning her,
care staff would greet or chat with her as they would
on her ‘good days’.
• C
 aregivers created more opportunities for Alice to offer
help in hostel duties.
• L
 iz mobilised the care staff team to re-invite Alice to
various pleasurable activities to brighten her hostel life.2
• L
 iz invited more caregivers to spend time with Alice
during activities to expand the network of Alice’s trusted
staff members.
Soon, various care staff noted that Alice became more
relaxed and cheerful. She joined and obviously enjoyed the
activities which she had not participated in for years. These
‘replies’ from Alice affirmed the alternative understandings
about Alice’s hope for ‘being liked and accepted’, which was
postulated by Liz and then circulated among the rest of the
care staff. Moreover, to the care staff’s surprise and joy,
Alice’s work attendance doubled (from 1 to 2 days a week to
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3 to 4 days a week). This reflected how Alice could be more
ready to ‘make herself and the care staff proud’ when the
feeling of ‘being liked and accepted’ became more accessible
to her. In spite of some occasional ups and downs, Alice’s
increased enjoyment and participation in hostel life as well
as improved work attendance have been maintained for two
years already. These changes all began with an unpacking
process about the ‘randomness’ (which was developed under
the restraint of a sole reliance on a behavioural perspective)
and a highlighting of Alice’s unique outcome of ‘helping staff
out’ and was sustained by a continuous action dialogue.
These might never have happened if behavioural approaches
continued to dominate the mode of working with Alice.
Ben’s story
Ben joined his current hostel about seven years ago. He was
among the most capable and verbal service users living there.
However, his care staff found him very quick-tempered and
difficult to relate to. I had therefore been invited to support the
team to search for more constructive interactions with him.
Instead of focusing on a particular problem behaviour as in
ordinary consultation, we began with a process called ‘group
re-authoring’ which I will explain below.
Group re-authoring
‘Group re-authoring’ is a group-work process we developed
based on the idea and practice of re-authoring conversations
(White, 2007). It focusses on developing subordinate
storylines through the exploration and connections of unique
outcomes. When problem descriptions emerge, this process
also assists care staff to derive understanding about the
position the user may want to take towards the problem which
was affecting him or her and their relationship with others.
This way of working around a problem story is based on the
idea of externalising conversations (White, 2007). Regardless
of working from a problem description or a unique outcome,
the care staff are invited to focus on intentional-state
understandings such as users’ preferences, values, hopes,
and dreams, as well as their relevant skills and knowledge
in life (White, 2007).
Participation of both care staff and family members is highly
important as they each carry valuable histories of, and
knowledge about, the user’s life. The group re-authoring
process provides a platform on which these histories and
knowledge can be exchanged and carefully examined.
Unique outcomes as well as subordinate or alternative stories
can then be identified and developed during the process. The
learnings and realisations from the process can provide care
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staff with a foundation to proceed to support users’ lives or • ‘He cares about his mother and shows real concerns
address their predicaments in ways that are in harmony with for her …’
users’ intentions and hopes. As in many narrative therapeutic
• ‘He cares about his weather announcement duty in the
conversations, the group re-authoring often takes us to places
hostel. He would remind staff to assign this duty to him
where we could not have expected in the beginning.
and ask staff to teach him to pronounce words he could
not read.’
I usually begin the group re-authoring with the following types
of questions: • ‘He is very devoted to joining our volunteer visits to the
home for the elderly people. He works hard on his skills
• W
 hat interactions did you have with [the user], or
on balloon twisting and he can make some simple things.
moments you witnessed about him or her, that impressed
He totally beamed when the elder people laughed when
you the most?’
receiving his balloons.’
• W
 hat would be a good description of [the user] in your
• ‘He wouldn’t really care to comply with our instructions
view? What experiences did you have with him or her
unless we suggested we remove his hostel duty or
that gave you this feeling or understanding?
chance to participate in volunteering activities.’
• If we wanted to learn about [the user’s] life and write up a
story about it based on your experiences with him or her,
After the group meeting with care staff, Ben’s mother was
what experiences would you like to share with us?
also invited to enrich our understandings with her memories
and experiences with Ben. She shared how Ben became
These questions are not intended to evoke a specific type
more self-disciplined and conscious of the house rules and
of problem-focused nor problem-free descriptions. Instead,
his household duties after his father passed away some years
I try to provide an open platform to identify what sort of
ago. She mentioned how Ben had solved certain maintenance
understandings and descriptions are the most likely to emerge
problems at home without her assistance. She also shared
in the group process. It is important for me to have a sense
that since many years ago, Ben had liked to stay in a park
of the dominant story circulating among the system of care
near their home and listen to the radio by himself. He was
staff. Meanwhile, it also provides me with an opportunity to
attracted to news and programs with rather serious content.
notice who might be holding some unique outcomes in their
However, she never really thought about why he spent so
experiences with the user, which could pave the way for
much time doing this.
development of subordinate storylines about the user’s life.

Across different interviews, various caregivers contributed to

During the group re-authoring process with Ben’s care staff,
they provided a range of descriptions in response to the
above questions. They began with mainly problem-saturated
descriptions about him, but then some other stories which
could provide hints about Ben’s preferences and values also
emerged as the conversation developed:
• ‘Ben has a very rude attitude towards staff!’
• ‘He can scold you and use foul language when you were
just calmly giving him a reminder about the rules …’
• ‘He hates when others point out his mistakes and will
show temper easily …’
• ‘If we try to stay firm or implement consequences,
his emotion will escalate.’
• ‘When we ignore him for a day or two, he will try to initiate
some irrelevant conversation with us as if nothing had
happened. But this only happened in the last one to two
years. Before that, he would simply ignore us as long as
he liked.’
• ‘He does not really join the crowd. He would rather spend
time on his bed listening to the radio … We don’t really
know what he listens to.’
a pool of valuable stories and images which were much richer
than the dominant description of Ben as an ‘angry person
who it is hard to approach’. The dominant problem stories
were being unpacked and their representativeness being
questioned while unique outcomes were beginning to build up
and form into alternative story plots about Ben’s life. During
this process, the caregivers were invited to make further
meaning about Ben’s intentional states based on the identified
unique outcomes. Some of the key questions which aided our
meaning-making process are listed below:
• W
 hat’s your guess about why he has been fully
respecting his house rules after his father passed away,
but seemed to have disregarded the rules in the hostel
beforehand? What might such a discrepancy tell us about
his stance and considerations about when to respect and
when to resist certain rules?’
• ‘Why do you think he would initiate some irrelevant
conversation with you if you ignored him for a day or two?
How do you make sense of his intentions at those times?
What do you think this may reflect about your position in
his mind as compared to the time you just started working
with him?’

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 • ‘What would you make of his remarkable concern and
effort paid to his weather announcement duty and
volunteering activities? What do you make of the beam
on his face when he saw the elderly person laugh after
getting his balloon? How might these reflect what he
accords value to in his life?’
• ‘What do you think might be going on in his mind when
he listens to those news and serious programs by
himself?’ ‘What is your guess about what made this such
a long and important habit of his?’ ‘What might he be
experiencing or trying to achieve by listening to those
radio programs?’
Many new understandings and descriptions emerged during
the series of group re-authoring meetings. These included
understandings about Ben’s hopes and longings towards
‘exercising his capabilities’ and ‘having a level of freedom in
accordance to his level of ability’. In particular, the image of
Ben’s ‘listening to radio news every day in the park’ led to
one of the most powerful new realisations about what was
important to Ben in life. Specifically, staff became aware of
his longstanding hope and dream to ‘connect with and be part
of the outside world’. These new understandings and themes
constituted an important basis for further developments
of subordinate storylines as well as the construction of an
alternative social identity in Ben’s hostel life.
Identity-revisiting docu mentation
The ‘identity revisiting documentation’ is a practice we
developed in line with the tradition of using therapeutic
documentation in narrative therapy (White & Epston,
1990). There are two main purposes for the processes of
identity-revisiting documentation. The first is to counteract
the overemphasis on problem histories and disabilities in
traditional documentation (such as case files). The second is
to provide a sharable foundation for negotiating and initiating
action dialogues.
The writing of the identity-revisiting documentation itself
allows the interviewer to play two therapeutic roles, including
that of an investigative journalist as well as an outsider-
witness (White, 2007). For the role of investigative journalist,
the interviewer can make use of the document as a written
editorial, summarising both the old and new understandings
generated from the group re-authoring process. From my
experiences, a helpful document needs to be experience-
near to generate resonance in caregivers and, at the same
time, novel enough to evoke their curiosity into the person’s
preferred way of being and relating. For these reasons,
the inclusion of the old problem storyline, contradictions to
and unique outcome ‘against’ the problem story, and new
THE INTERNATIONAL JOURNAL OF NARRATIVE THERAPY AND COMMUNITY WORK | 2016 | No.3
understandings which may give rise to subordinate storylines,
are all important parts to be included in the documentation.
For the role of outsider-witness, the document allows the
interviewer to add in personal resonances and conjectures
which work as a retelling to help enrich the outcomes of the
group re-authoring.
In many cases, it may not be feasible to involve all staff and
family members in the same meeting. The group re-authoring
process may therefore take place over a few interviews
with different participants. At this point, the documentation
becomes particularly important, as it can capture and
pool together the contributions from different members of
the support network. The documentation also allows for
circulation among members of the support network, as well
as wider communities of concern in order to generate further
retellings and the expansion of action opportunities.
Inviting the interviewees to come together over a meeting to
share the identity-revisiting documentation is very helpful in
several ways. First, it provides a chance to receive feedback
and suggestions on the content of the documentation from
these important members in the user’s support network.
Second, after reading the documentation, the members
often share more memories and feelings about the user
which are in line with the new themes. This provides further
opportunities for us to enrich and consolidate the subordinate
stories. Third, the meeting is an important occasion to explore
and negotiate new actions and interaction opportunities which
lay the foundation for the subsequent action dialogue.
Ben’s identity-revisiting docu ment
After a meeting to share the identity-revisiting documentation
we wrote for Ben, the care staff began to explore new
ways of relating and interacting with him, which were more
acknowledging of his hopes and dreams. This brought us to
the stage of action dialogue and the followings were some of
the ideas and attempts the care staff came up with:
• T
 he hostel manager initiated a reading exercise with Ben.
It was hoped that the process of helping him learn to do
some basic reading could be validating of his relatively
high ability among the users. Moreover, the content of
the readings was to be about wisdom and interpersonal
relationships in Chinese culture which could hopefully
raise Ben’s awareness and sense of connection with
the ‘outside world’.
• H
 ostel staff invited Ben to share what he heard and learnt
from the radio during centre activities.
• H
 ostel staff agreed to arrange, when feasible, more
opportunities for Ben to get connected with the ‘outside
www.dulwichcentre.com.au 53
 world’ through activities like volunteering visits and
participation in running balloon booths at carnivals.
• Instead of simply demanding his compliance to hostel
rules, some hostel staff also tried to invite Ben to share
his views over certain hostel rules that he disagreed with.
In a follow-up meeting a few months later, most hostel
staff shared that the above processes had opened up
new possibilities and helped generate ideas on building
constructive relationships with Ben. As the action dialogue
unfolded, they unanimously found that Ben got along with
them more peacefully and respectfully. Ben responded
well to the manager’s reading invitation. He would also
enthusiastically deliver ‘news updates’ to staff upon invitation.
The ‘news updates’ were soon turned into a regular initiative
by Ben, which the staff welcomed and enjoyed. Ben also
continued to enjoy external activities like volunteering visits
and other chances that allowed him to get in touch with others
in the community. Ben’s ‘replies’ in the action dialogue were
loud and clear: he preferred a mutually respectful relationship,
and welcomed the chances to ‘exercise his ability’ and
‘connect with the outside world’. By acknowledging his
preferred ways of being and relating through his actions
and emotions, he had made significant contribution to the
co-construction of his social identity within the care system.
In addition, many staff shared that Ben was less affected
by anger and impulsiveness when he was invited to follow
certain hostel rules. They attributed such changes to their
improved relationship with Ben. In fact, Ben’s care staff had
always been trying to show care and concern and to build
relationships with him in the past years. However, these
were rarely well received, if not apparently rejected, by
Ben. The group re-authoring process helped us revisit our
understanding of and relational practices with Ben so that
we could realign our interaction to be more supportive of his
pursuit of his hopes and dreams. Such realignment provided
a key to the change in the relationship between Ben and
his care staff. This resulted in a heartwarming and joyful
enrichment of their interaction, which dissolved many initial
problems and complaints.
THE INTERNATIONAL JOURNAL OF NARRATIVE THERAPY AND COMMUNITY WORK | 2016 | No.3
Journey forward
The currently proposed practices widen our service users’
participation in the co-construction of their social identities
in two ways. First, the group re-authoring processes help
include a wider range of lived experience for storying and
development of social identities of the users compared to
traditional problem-focused approaches. Second, and more
directly, the action dialogue provides a common ground for
the users and care staff to communicate and negotiate on a
shared meaning. These could help service users and their
caregivers to get around limitations of verbal communication,
to participate in the co-construction of the users’ social
identities, and to bring about real changes in their daily lives,
which are more in keeping with their preferred ways of being
and relating with others. Because of their low reliance on the
verbal ability of the user, the currently proposed practices also
have the potential to be used with service users who have
very limited verbal abilities.
Although these methods are not designed to ‘manage
problematic behaviour’, they do allow for more constructive
understandings and interactions to emerge, which often
help reduce, if not dissolve, the impact of the problems.
I personally feel that the most rewarding part of this work is
the excitement and joy of becoming curious and explorative
in my work with persons affected by intellectual disabilities,
whose possibilities in life have long been seen as pre-
determined and highly limited. Even though these practices
are in the stage of initial development, the experiences they
have given me have been encouraging and heart-warming
thus far. I witnessed that every time a new meaning or
understanding emerged during the process, it helped the
care staff to renew their empathic capacity for their service
users. This provided a great contrast to the heavy drainage of
empathic energy when they solely focussed on dealing with
problematic behaviour in their work. It is hoped that these
ideas and practices can contribute to a step in expanding the
landscape of rehabilitation services and the ways we relate
with our service users.
Notes
1.
All names are pseudo-names.
2.
 lice’s participation in outing activities was suspended for years
A
due to her runaway history and low initiatives to express interest
in joining. Liz made important efforts to remove logistic roadblocks
and relight Alice’s hope and interest in these activities.
www.dulwichcentre.com.au 54
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