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?
The narrative therapy approach is designed to focus on collaboration between patients and therapists, taking a non-judgemental look at a patient’s life. A narrative approach views problems as separate from people and assumes people have skills and abilities that can lead to proactive change. It requires interpreting the patient’s life in a broad context, looking beyond problems and concerns to find strengths that might be leveraged into meaningful growth. The stories in narrative therapy are made of events linked by a common theme. A plot-based story emerges as specific events reveal themselves as more important or meaningful than others. Through the development of this story, a patient and therapist can work together to shift the patient’s perspective on their lives.
What are five techniques used in narrative therapy?
Narrative therapy requires the guidance of a trained mental health professional. While there are many techniques available and different ways to approach narrative therapy, some are used more frequently than others. Some common techniques used in narrative therapy include:
- Narrative construction. This technique allows the therapist and patient to work together to tell the patient’s story in their own words. The therapist often asks questions to encourage reflection and helps the patient explore alternative interpretations of their personal narrative.
- Externalization. The therapist helps the patient separate their identity from their problems, helping them to understand that their problems don’t define them.
- Deconstruction. Patients identify a problem, examine its history and effects, and place the problem in an appropriate context.
- Unique outcomes. The therapist helps the patient look for new meanings in their story that may help them alter or create new stories that address the problems at hand.
- Challenging narratives. The therapist helps the patient question and reframe narratives the patient holds about themselves, their main concerns, or how they perceive their identity.
Is narrative therapy a form of CBT?
Narrative therapy and cognitive-behavioral therapy are distinct psychotherapeutic approaches, although they may sometimes be used conjointly. They are also able to treat many of the same concerns, and evidence suggests they both have use cases where they are likely to benefit the patient. A combined form also exists called narrative CBT. Narrative CBT is part of the “third wave” of CBT-based therapies. It combines the theory of narrative therapy with the theories of cognitive psychology and behaviorism to gain the benefits of each approach.
What are the goals of narrative therapy?
Narrative therapy seeks to help patients treat mental health conditions, recover from adverse circumstances, solve problems, and achieve meaningful change. Michael White and David Epston, the creators of narrative therapy, sought to help people “re-author” their identity through the use of stories. The development of narrative therapy continues at the Dulwich Centre, a mental health facility where Michael White served as director from 1983 until his death in 2008.
The Centre continues to serve as a main source of research, training, and community work surrounding narrative therapy. White’s work, combined with David Epston’s, led to narrative therapy becoming further generalized. Today, narrative practice is incorporated into the treatment for many mental health conditions and is recognized as a viable treatment for many diverse concerns. Many mental health professionals use contemporary resources like Alice Morgan’s What Is Narrative Therapy? An Easy-to-Read Introduction to incorporate modern narrative therapy principles into their practice.
What are the criticisms of narrative therapy?
Michael White and David Epston designed narrative therapy as a collaborative, non-pathologizing approach to mental health concerns. Narrative therapy does not rely on prescribed procedures or regimes, such as those commonly found in more structured therapies like cognitive-behavioral therapy. This has led some to criticize narrative therapy as an unstructured approach that is difficult to standardize. Some professionals view narrative-based therapeutic conversations as useful tools for helping patients gain insight or engage in self-reflection but fall short when trying to help problem-saturated patients whose concerns do not arise from problems related to the perception of their identity.
Who does narrative therapy not work for?
Narrative therapy may not work well for patients who struggle to engage with stories and common story structures. While a narrative approach works for many, some people find it challenging to view their own lives as progressive stories and may not see substantial benefit from the techniques used in narrative therapy.
Who is best suited for narrative therapy?
Narrative therapy can be used to treat almost any concern, but it tends to be most effective with those who are likely to benefit from techniques that help them reframe their circumstances or identity. Narrative therapy is based on empowering individuals to develop expertise in their own lives and challenge unhealthy narratives they hold about themselves. Narrative techniques are also adaptable, allowing them to be incorporated into many other therapeutic approaches. It is likely that most people will experience at least some benefit from narrative approaches.
What are the disadvantages of narrative exposure therapy?
Narrative exposure therapy is a variation of narrative therapy designed specifically for those with post-traumatic stress disorder or other trauma-related disorders. It is more effective at treating trauma-related conditions than traditional narrative therapy but requires a high level of therapist skill and experience. A therapist must be well-practiced and have received substantial training in narrative methods before using them to address trauma-related disorders. Because of this, narrative exposure therapy may not be appropriate for all patients and practitioners.
Is narrative therapy good for trauma?
Traditional narrative therapy can be used to address trauma-related concerns, and many patients who have experienced traumatic events benefit from a narrative-driven approach. However, narrative therapy may lead to retraumatization if the therapy is not applied properly. A variation of narrative therapy, narrative exposure therapy, is typically used when treating patients with trauma-related disorders. Like traditional narrative therapy, narrative exposure therapy requires extensive training to ensure that the therapist can successfully help the patient rebuild narratives related to their traumatic experiences.
What are the downsides of narrative therapy?
While narrative therapy can effectively address many concerns, it may not be suitable in all cases. Narrative therapy typically requires substantial training and practice to administer effectively, meaning many practitioners may prefer more direct, procedural techniques that do not require as much experience to apply successfully. In addition, narrative approaches might not be suitable for all individuals. Some people find it challenging to engage with narratives and story structures, meaning narrative therapy is less likely to be effective. Narrative therapy might also take longer than other approaches, especially if the complexity of the patient’s personal stories increases as therapy continues.
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