Narrative exposure therapy (NET) is a short-term treatment that blends components of behavioral exposure, narrative testimonies, and neuroscience.1 While it is a newer method, research has shown that NET is helpful for complex trauma patients, particularly refugees; it has gained conditional approval from the American Psychological Association (APA) to treat PTSD.1,2
What Is Narrative Exposure Therapy?
NET is a short-term therapy method that derives from narrative therapy and focuses on creating a chronological narrative about a client’s trauma. Clients will re-experience certain emotions while narrating their stories, but are instructed to remain in the “here and now” to facilitate a new sense of reprocessing and meaning.3 Throughout the work, the therapist will evaluate the client’s thoughts, feelings, physiological responses, and observations.
In its overarching form, NET is rooted in the universal need to tell stories and stay connected to others. Although it revisits trauma, this therapy should not be confused with exposure therapy. In NET, clients are not actively exposed to traumatic stimuli, and they do not undergo in vivo exposure.
Hot & Cold Memories in NET Therapy
NET incorporates the theory of dual representation of traumatic memories, which hypothesizes that a client’s autobiographical memory is divided into two categories: “hot” and “cold” memories. “Hot” memories refer to emotional and sensory moments, while “cold” memories tend to be more fleshed out and incorporate “hot” memories with cognitive, physiological, sensory, and emotional elements. For example, a “hot” memory might be pain, fear, and bright lights, while a “cold” memory associated with the same event could be, “I was in tremendous pain while in the hospital for emergency surgery last week.”
What Is NET Therapy Used For?
NET has gained conditional APA approval for PTSD treatment, and can be used to treat the following:3
- Childhood trauma
- Complex trauma
- PTSD in children
- PTSD flashbacks
- PTSD affecting relationships
- PTSD after a car accident
- Medical trauma and PTSD resulting from medical emergencies
How Does NET Therapy Work?
Narrative exposure involves processing traumatic events at a slow, appropriate pace. Therapists will ask questions about various sensations and feelings (“hot” memories) while contextualizing the facts and cognitive elements (“cold” memories). Therapists typically write down this exposure and review it at the start of each session.
Typically, NET therapists do not maintain a neutral or objective stance. Instead, they aim to be validating and compassionate–they readily acknowledge a client’s personal experiences. There is a sense of “togetherness” in moving forward and healing.
By the end of treatment, traumatic memories are reconstructed, and any fragmented reports become consolidated into an appropriate narrative. With the client’s permission, recorded statements or autobiographies may be used for ongoing advocacy.
What Are NET Therapy Sessions Like?
NET therapy sessions aim towards linking “cold” and “hot” memories in the context in which they were experienced. The long term goal of these sessions is to help reshape and reimagine the meaning of the traumatic experience from the perspective of who the person was when that event occurred instead of feeling like it is a retraumatization experience.
Phase 1: Diagnosis & Psychoeducation
This phase focuses on helping the client understand the broad overview of what sessions will be like, the aim and techniques the therapist will use to facilitate this intervention and what the client can expect. There is a focus on education around trauma processes, how different parts of the brain work, risks, and readiness from the client to participate in further sessions.
Phase 2: Laying Out the Lifeline
This phase is optional but utilized by many therapists. In this phase, there is an activity facilitated by the therapist in which the client places certain objects (representing an experience or event) along a rope that signifies certain emotions and experiences happening over their lifetime.
Phase 3: NET Therapy Sessions
In each of these sessions within this phase, the client will discuss the topic of each object and address the themes that come up that have been triggering their trauma symptoms.
Phase 4: Final Session Rituals
In this final phase, there is some more psychoeducation around how the client was able to reshape their experience. The client is empowered to take ownership of their story and discuss their future goals and hopes.
What Are the Benefits of NET Therapy?
There are many benefits of using NET therapy to improve trauma symptoms, such as:4
- Longer lasting effectiveness
- Quicker effectiveness
- Effectiveness in-person and virtually
- The exercises within this therapy creates a new story for the client to keep with them
- Attendance for this therapy type is high
- Better ability to manage future emotions around traumatic events
- Better emotional regulation and understanding of self
Is Narrative Exposure Therapy Effective?
NET is evidence-based, and a recent international meta-analysis on its long-term efficacy showed that clients who received NET experienced a significant reduction in PTSD symptoms compared to control subjects. The study draws upon data from 56 studies spanning 30 countries with 1370 participants.7
Limitations of NET
NET reveals sustainable treatment results, particularly for people who have experienced chronic and complex trauma. However, most studies have reviewed people living in low-income or adverse circumstances, so experts recommend further research be conducted in societies with well-developed healthcare systems.7
How to Find a Narrative Exposure Therapist
NET is recognized internationally, and the NET Institute is a great starting point to learn more about its originators and clinical vision. Consider working with a practitioner who has completed their specific workshops if you are interested in working with a NET-trained therapist.8
Finding the right therapist often entails finding the “right match” in a provider. Sometimes, this process can resemble that of a typical trial-and-error search. If you’re not sure where to start, consider asking your healthcare provider or looking through an online therapist directory to find qualified trauma providers near you.
What to Ask a Therapist Before Getting Started
Before you begin any therapy, it is important to ask your therapist any questions or reservations you have going in.
Some questions to consider asking a new therapist include:
- What is your experience with treating my kind of trauma?
- What is your success rate?
- What is your experience with this intervention?
- How often do you use this approach?
- How effective has it been in your practice?
- Do you have specific training around this type of trauma?
- Do you have specific training around this type of approach?
- What if I get overwhelmed during a session?
- How do I know if it’s working?
- What if this approach doesn’t work?
Cost of NET
NET is a relatively new model of treatment and doesn’t yet appear to be as popular in private practice settings as other therapeutic models, but you should expect to pay anywhere from $65-$250 per hour of therapy.6
Unfortunately, there isn’t a standardized formula for predicting the cost of therapy in general and for NET. Your treatment may depend on your location, your therapist’s credentials and experience, their hourly rate, whether you have behavioral health insurance, how much your insurance covers, and whether you are eligible for financial subsidies through your health insurance.
Final Thoughts
Narrative exposure therapy is an effective, short-term model for treating complex trauma. While it is newer and therefore not as popular as models like CBT, EMDR, or even narrative therapy, it’s likely to become more mainstream in the future. If you are struggling with trauma symptoms, you’re not alone. Reaching out for professional support can make all the difference in your recovery and healing.
For Further Reading
Narrative Exposure Therapy Infographics
