Inside Narrative Therapy
Studies have found that there are over 400 different types of therapy available to clients looking for support with their mental health family therapy, cognitive behavioral therapy, multimodal therapy, and many more. With such a wide variety, clients have a choice in the treatment they receive. One of these types of therapy treatments is narrative therapy, which focuses on helping the client be a narrator to their own story, taking their concerns and forming them into roleplay, story-telling, and rewriting activities.
People use their life stories in many ways outside of therapy too, either as a way to entertain others or to cope. Journaling is one form of expressive narration. Whether we fully realize it or not, we all have our own life stories that we tell ourselves and others.
The history of narrative therapy - David Epston and Michael White
Narrative therapy was developed during the 1970s and 1980s. Its founders were Michael White from Australia, and David Epston from New Zealand, who later created the Narrative Therapy Centre. Because narrative therapy is a more modern form of treatment, many people may not know much about it. However, that doesn’t mean that people can’t learn and benefit from this approach.
Michael White and David Epston’s beliefs for counseling with narratives
Michael White and David Epston believed that people are not their problems, which was a key component of their development of the treatment. Through sessions, they helped clients separate from their problems and realize the problems did not define them. Through narration exercises and other techniques, clients could use their skills to solve their problems and develop a healthier or more effective story. With the help of narrative therapists, this therapy modality showed clients that they control many aspects of who they are and what they can achieve.
Narrative therapy techniques
Narrative therapy seeks to enable an individual to tell their life story to gain and create their own skills to solve problems and change their futures. At the beginning of therapy, they may be asked to separate themselves from their symptoms, unwanted beliefs, and external problems.
Afterward, the therapist and client can discuss the problem as part of a story, which can help clients deepen their understanding of themselves. By using an easy-to-read introduction and turning the problem into a story, people may feel less defensive about it, which often makes exploration of the emotional pain and the possible solutions less challenging and intimidating. Below are a few of the techniques commonly used in narrative therapy for solving problems.
Objectifying problems
The first goal of narrative practice is to let people look at their problems, tell their own stories, and objectify them. Instead of the problem being intangible or inherently tied to a person, it is viewed as a concrete detail in a story and less abstract. Telling one’s story and putting the problem into exact words instead of a nebulous idea can be critical.
Framing problems
In narrative therapy, stories are part of a bigger picture, and often, these stories can be looked at through a lens of a more extensive societal context. Narrative systemic therapies separate people from their own story and allow them to tell it in their own words and view it objectively for once. For example, if someone is experiencing conflict with their partner, mental health professionals may help them take their own story and frame it as an external force and then consider their partner's story.
One example of this technique is known as position maps, where therapists will encourage individuals to create distance between themselves and the immediacy of the problem they are facing. Framing the bigger picture can help clients see how they play a role in their growth over time.
Another example is social construction, where the therapist aims to help the individual focus on their abilities and what they can do rather than what is holding them back. This can be an integral part of cultivating a new outlook on past events and developing alternative stories in this type of therapy (narrative therapy).
Creating alternate stories
Another lesson in narrative approaches is that alternative life-affirming stories can be told to achieve a greater understanding of a situation. Besides discussing other people's stories, which helps humanize us and allows for empathy, the therapist may ask the person they’re working with how they would like their story to end or how they would re-author their story. Re-authoring can be a powerful exercise to expand their outlook, and the externalizing conversations that take place may be very important.
For example, someone living with depression may initially narrate their story simply as "I have depression. I'm depressed," finding it difficult to see beyond this narrative. However, with narrative therapy, the client may be encouraged to explore how they would like their story to be told and could delve further to say, "I have depression, but I'm working through it. Doing so allows me to get to know myself deeper, which is beautiful." This process may allow the client to reframe their thinking and see their story from a different perspective.
"Stories" can also be taken in a more literal sense. For example, if a client experienced an adverse childhood event. They can rewrite what occurred to imagine it in an ideal sense. For example, if their parent struggled to provide them with food and shelter, they might tell their therapist what their ideal childhood would have looked like, imagining their parents having the funds to care for them as they needed. For those looking to do inner child work, this technique can be beneficial in therapy, narrative or otherwise. Although they can't change the past, they can deeply imagine what a different past would look like and try to feel the emotions and sensations they would have felt if their needs were met.
Identifying goals
The goal of narrative therapy may not be transformation. Instead, clients can learn to take a problem and modify it to understand it in a way that makes it easier to handle. By separating individuals from their problems, or even their mental health disorders, such as eating disorders or bipolar disorder, this practice may feel more achievable. Through identifying goals, clients can start shifting perspectives, creating alternative stories to their preferred realities, and reframing thought patterns to guide their mental health onto a more positive path. Narrative therapy is often a solutions-based therapy for those looking to take control of their present and future realities.
Narrative therapy and counseling for PTSD and mental health goals
Narrative therapy may be used to treat post-traumatic stress disorder (PTSD), according to medically-reviewed studies. Often, patterns of behavior may develop to safeguard oneself from traumatic experiences. Long-term, however, these behaviors may cause challenges in an individual's daily routine.
With narrative therapy, clients can transform the traumatic experience in a way that gives them power over what occurred and allows them to feel self-compassion. This self-compassion can prompt self-serving changes.
Often, the process of meeting goals and reframing experiences is called post-traumatic growth. Post-traumatic growth allows positive changes to happen after experiencing a traumatic event.
Narrative therapy can also help the individual consider the situation's context. They can see themselves objectively, consider how they might support someone else going through that type of traumatic event, and then support themselves similarly.
When is narrative therapy used?
Many people can benefit from this therapeutic process individually, but narrative therapy can also be applied to families and couples. Groups that tell a problem often have different sides to the same events. Therefore, a narrative therapist can offer support by considering and combining the different stories of family members into one. This process can allow families and couples to see other perspectives (narratives), think outside of themselves, agree on one story (or accept that there is more than one way to see the story), and move forward to resolution.
An example of narrative therapy and mental health framing
For example, when a couple argues, they may both experience their own understanding of the argument. In each alternative story, one may believe they are the hero, and the other is the antagonist. In truth, the labels may be somewhere in the middle, where both bring positive and negative influences to the situation and have valid points. Narrative therapy can help the couple realize if there is an objective answer. Thinking more objectively might help the couple find a solution rather than arguing about who is to blame or who is correct.
Controversies and concerns with narrative therapy
Narrative therapy can be an effective tool for many, but it does have a few criticisms.
For example, narrators may be unreliable if they are the client. The client may pick the most comfortable narrative and put themselves in the best light possible, perhaps consciously or subconsciously. Often, narrative therapists work with clients to realize this. However, clients may not be honest with the therapist in every scenario.
In addition, as narrative therapy is a new form of treatment, there is less scientific evidence of its effectiveness than other types. Fewer American studies have been conducted to assess its validity. However, many clients report finding it effective, but this anecdotal evidence doesn’t necessarily constitute medical advice or official research.
If you think narrative therapy would help you open to new possibilities and feel you're a creative individual, it may allow you to tell a story more conducive to a healthy life and put your concerns into perspective.
Counseling options outside of the narratives - different therapist options
There are various ways to improve your mental health. One way is by seeking help from a therapist. By seeking help, you can take action against a challenge you want to address and resolve it. Asking for help can be challenging, but it can allow you to take the first step toward solutions.
If you're unsure if you can partake in therapy due to barriers, such as financial struggles or availability of providers, you can also try online therapy. Online therapists are trained, certified, and experienced in many treatment methods, including narrative therapy. Online therapy is also as effective as in-person therapy, with one study showing that users of an online platform experienced significant improvement in their mental health after treatment.
Online therapy from a licensed therapist with BetterHelp
If you want to try an internet-based therapy like narrative therapy, consider signing up with a platform like BetterHelp. To begin, you can fill out a quick questionnaire that enables you to be paired with a therapist based on your preferences, including your preferences for the type of therapy you want to try. Sessions are customizable and can be held anytime, anywhere via phone call, video chat, or live chat messaging within the safe platform.
Takeaway
You are the writer of your own story with narrative therapy. While you might not be able to control every aspect of life, healthily addressing concerns and rewriting your stories could positively change the unique outcomes of your story. If you feel stuck in a problem, narrative therapy can allow you to look at that problem externally and from new perspectives. You can also imagine a story where the problem isn't there or has been resolved with narrative therapy. Consider reaching out to a therapist to learn more about how you might benefit.
What is a narrative therapy approach?
Narrative therapy is a therapeutic approach rooted in individuals' understanding of their lives through their inner narratives. During the process, the narrative therapist guides the client in understanding how dominant problematic stories influence their self-perception, identity, and mental health. Once they know the relationship, they may then rethink their narrative and consider a more compassionate, beneficial perspective. Narrative therapy was first developed in the 1980s by social worker Michael White and family therapist David Epston as a collaborative, non-pathologizing approach empowering individuals as the experts of their own lives.
What are five techniques used in narrative therapy?
Depending on their unique needs, how narrative therapists apply therapeutic techniques during treatment may vary. Here are five techniques commonly used in narrative therapy sessions:
Alternate outcomes (sometimes referred to as unique outcomes technique)
This technique involves isolating moments or exceptions in the client’s life story when the individual's problem didn't dominate their life or when they found a way to counteract its influence. Such moments can be categorized apart from the problematic narrative and provide evidence that change is possible, thus allowing the client to reframe their experience in more empowering ways.
Building narratives (also known as re-authoring or re-storying)
Building narratives involves reiterating the person’s life experiences into the narrative from different perspectives. In this approach, the client may tell their life stories to their therapist multiple times from various angles, then deconstruct each storyline externally. This allows the client to understand their interpretation of their dominant story as dynamic instead of rigid and unchangeable.
Deconstruction
Deconstruction helps clients understand and work on their problems by breaking them up into smaller, more manageable pieces. This helps clients focus on specific problems, gain clarity over them, and reduce the overwhelm and anxiety associated with them. Deconstruction also helps clients identify and reinforce their strengths, cultivating a greater sense of control over their life’s direction.
Existentialism
Existentialism is a philosophy in which individuals find personal significance in a “blank” world without meaning. As a technique in narrative therapy, existentialism encourages clients to reject the assumption that their problematic story is unchangeable. While purpose is important, letting go of the concept of a pre-determined purpose in their lives can empower the individual to author their own more positive stories rather than being bound by an unhealthy fixed narrative.
Externalization
Externalization is the process of separating the individual from their challenges by personifying the problem as something outside of themselves. For example, instead of saying, "I was angry," they may reframe the feeling as "Anger showed up and ruined the conversation." This technique helps reduce self-blame and empowers the individual to address the problem more objectively.
Is narrative therapy a form of CBT?
Narrative therapy and cognitive behavioral therapy (CBT) have similarities and are sometimes used in conjunction, but narrative therapy isn’t a form of CBT. The fundamental difference lies in their focus. Narrative therapy centers around using stories people tell about their lives to explore, reframe, and improve their personal narratives. CBT primarily focuses on identifying and modifying unhealthy beliefs, thought patterns, and behaviors in the present moment, directly linking thoughts, emotions, and actions.
What are the goals of narrative therapy?
There are several goals of narrative therapy, the primary of which is to help clients gain a healthier perspective on their life stories and apply that perspective when handling future challenges. Narrative therapy can help clients:
Explore their experiences and find ways to alter or create new ones that better reflect who they want to be.
Cultivate greater self-awareness
Encourage personal growth
Gain more confidence and self-worth
Learn to regulate their emotions and behaviors better
Finding meaning and purpose
Separate their problems from their identity
Identify the personal, societal, or cultural influences contributing to their struggles.
Strengthen their mental health and overall well-being.
What are the criticisms of narrative therapy?
Narrative therapy has been criticized for several reasons. For example, some experts say there's a lack of clinical and empirical evidence to support its efficacy. Narrative therapy views truths as subjective instead of fixed, while empirical studies seek to arrive at an objective, quantifiable truth. Critics also argue that narrative therapy can oversimplify complex psychological issues by focusing solely on the individual’s narrative.
Who does narrative therapy not work for?
Because the therapy relies on an individual's ability to articulate experience through personal narratives, people with limited verbal, cognitive, or intellectual abilities might have trouble engaging with it. In some cases, individuals might prefer a more directed approach where the therapist provides clear solutions, or they may find it challenging to identify with the narrative structure used in therapy.
Who is best suited for narrative therapy?
Because of its non-blaming, non-pathological approach, narrative therapy helps individuals manage symptoms associated with a variety of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). Narrative therapy is also sometimes used to address relationship issues and to help families communicate more effectively, overcome interpersonal challenges, and learn to cope with future conflict more healthily.
Studies on narrative therapy and its potential applications are few, and further research is required to determine its efficacy in treating a broader range of mental health issues. However, a few recent studies point to the possibility of narrative therapy as a comprehensive treatment for eating disorders, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. Additionally, “Narrative Therapy: An Introduction for Counsellors” (published via Sage Encyclopedia) outlines several case studies in which people using narrative therapy experienced increased marital satisfaction, decreased symptoms of depression, and reduced PTSD symptoms.
Further, a paper published in The Australian and New Zealand Journal of Family Therapy outlined how clinicians successfully integrated narrative psychiatry with family therapy to mitigate familial violence. The approach used storytelling to help individuals externalize and reshape their experiences of psychological distress—neutralizing the risk of violence within the family unit. Clinicians discovered the combined approach not only reduced the risk of violence but also strengthened familial relationships and promoted healing.
What are the disadvantages of narrative exposure therapy?
There are several potential disadvantages of narrative exposure therapy (NET). These may include, but aren’t limited to:
The possibility of overwhelming emotional distress: Repeatedly recounting traumatic experiences can trigger strong negative emotions and physical reactions, potentially leading to dissociation or other distressful symptoms.
A potential reluctance to engage in the process: Some individuals with PTSD may avoid therapy due to the fear of reliving traumatic memories during sessions. In some cases, initially re-experiencing trauma during NET may lead to a temporary increase in symptoms before improvement.
It may be unsuitable for people with complex or chronic trauma: While it can be a practical approach for single traumatic events, NET may not be optimal for individuals with complex or chronic trauma without additional interventions.
It might be challenging to find the right therapist: Proper implementation of NET demands a highly trained therapist who can manage intense emotions and provide appropriate support during the process.
Is narrative therapy good for trauma?
Regardless of its potential drawbacks, evidence suggests that narrative exposure therapy (NET) can help reduce symptoms and improve the quality of life for people with trauma,
What are the downsides of narrative therapy?
Narrative therapy may not be suitable for people with language issues or intellectual disabilities. It may also be challenging for people who lack confidence or have other issues that make it difficult to express themselves through narrative. It’s based on a philosophical framework that can be subjective and open to interpretation. Additionally, because of its subjective nature, the therapist’s values and morals may influence the client in a way that could impede healing. Once they’ve started narrative therapy, some people find the process is too time intensive and their progression is too slow.
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