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 to complex trauma patients, particularly refugees;2 it has gained conditional approval from the American Psychological Association (APA) to treat PTSD.1
What Is NET?
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.
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.”
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 either.
What Is NET 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 Work?
NET is a short-term treatment plan typically lasting no more than 12 one-hour sessions completed within about eight weeks, usually conducted at community-based agencies, hospitals, or schools.4 NET consists of two main parts, the first of which is typically psychoeducation, where the therapist will likely teach their client about the brain model and fear network. At this time, they will also obtain informed consent and review the potential risks of therapy.
The second part consists of mapping a lifeline, during which a rope is often used to line up memories, with “stones” to mark the various negative events and “flowers” to mark the various positive events.5 In NET, the lifeline is completed chronologically, and clients focus on the stones as part of the work.
Narrative exposure includes processing traumatic events at a slow, appropriate pace. Therapists will question their clients 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.
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 NET, or therapy in general. 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.
Is NET 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
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.
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.
Narrative Exposure Therapy Infographics
