Narrative Therapy is an approach to therapy which enables individuals to take charge in owning and sharing their story, using language that is empowering, to reshape their experience. Individuals in narrative therapy are seen as the leaders of their own mental health care as the act of story-telling removes any kind of pathology language from their experience.
Those struggling with depression, post traumatic stress disorder, anxiety, and complex grief can benefit from this therapeutic approach.
Key Concepts of Narrative Therapy
Narrative therapy works by identifying individuals separately from their lived experiences, and empowering those individuals to use that same approach when dealing with their problems. By removing blame and others’ perceptions, individuals are able to re-author their stories and re-establish their experiences in the here-and-now. Over time with the use of narrative therapy, individuals are able to understand themselves better and separately from their problems and recognize how the language of their stories shape their life and identity.
One of the major differences with narrative therapy and other “talk” therapies is that narrative therapy is client-driven. In this format, the therapist doesn’t take the lead as much as they help to facilitate a dialogue with the client about their story and the lived experience of their story. By doing this, the focus is on the present as opposed to other psychotherapies which dig into the past of the client. The past can be helpful in understanding why the clients’ story-telling is the way it is, however the goal in narrative therapy is to help clients feel empowered to make those determinations for themselves.1
Techniques of Narrative Therapy
There are several techniques used in narrative therapy that helps individuals understand their story as it is currently, discovering their goals for their life outside of their current story and learning how to re-narrate their experience to help individuals live their best lives.
Understanding the Current Story
It is important for a therapist and an individual to start from the beginning of the story before trying to unpack it. From this starting point, an individual shares their full story and experiences and shares with the therapist their current understanding of their story. In this phase, the therapist actively listens to the language and tone used by the individual to fully understand the story from the perspective of the individual. This phase is important in uncovering patterns and positioning that next to goals of the individual.
Externalizing the Story From Identity
Once the story is understood, the individual would next take steps to recognize their story separate from their identity. Therapists would first start by asking open ended questions aimed at understanding an individuals goals and reframing that back to individuals to confirm both are on the same page before moving forward.
The repetition of asking these questions and highlighting how the language individuals use for their goals have differed from the language used to story tell can be very powerful. Once an individual is able to see this juxtaposition of their own words, therapists would help to facilitate a conversation to bridge these two viewpoints.
Once an individual is able to see the patterns of their own language, the ways in which the individual thinks about the language they use will change. Inner monologues are very powerful and the impact of sharing a story can help individuals use more empowering language.
Re-Authoring the Story
The individual by this point understands their story, the impact of their language, the differences between their current story and the story they want to tell, and how impactful sharing our experiences can be on our whole identities. The individual at this stage re-narrates their story, understanding how the old language was harmful and working with the therapist to create a new language, for that experience.
The repetition of this practice helps to validate new language patterns and impacts more positive thought processes as well. Once the inner voice is using encouraging language, the story telling from that point onward will be empowering.
What Can Narrative Therapy Help With?
Narrative Therapy can help manage and treat a wide array of mental health concerns including:
- Depression
- Anxiety
- PTSD
- Family and couples counseling
- Complex grief
- Complex trauma
- Acute trauma
- Attachment issues
Narrative Therapy for Depression
When an individual is dealing with depression, self-talk tends to be very negative. The repetition of discouraging thoughts worsens depression however narrative therapy can change that story. Through narrative therapy, individuals are able to re-narrate their story with more positive interpretations and challenge their inner monologue to consider alternative language.
Since narrative therapy is a modality that is very culturally considerate by its nature of giving power back to individuals, it’s an effective intervention for essentially anyone dealing with depression. In a study aimed at examining the impact of narrative therapy for adults dealing with depression, it was found that individuals who received narrative therapy expressed greater feelings of hope and positive emotions. Adults were able to form a healthier identity and feel empowered to speak to themselves with stronger self-affirmations.2
Narrative Therapy for PTSD
Trauma can be experienced just once and/or repeatedly over a period of time and both can leave a lasting impact on the individual. Narrative therapy helps trauma survivors in the most crucial way by helping them retell their story in such a way that the experience can be healing. One method of doing so is journaling the experience and paying attention to the choice of word while practicing this activity.
This empowers the individual to reclaim themselves and recognize that their identity is not based on trauma. By doing this, individuals are able to improve their feelings of self-worth and begin to heal from their trauma. In fact, in one study, it was found that narrative therapy for trauma can help with post-traumatic growth, which essentially is the desired outcome for any kind of therapy for trauma.3
Narrative Therapy for Couples
Those dealing with family concerns or attachment issues in their current romantic relationships can also benefit from Narrative therapy. Narrative therapy can help families or couples understand their respective roles in the context of all their familiar relationships. By doing this first step, individuals are able to understand and recognize how one sees themselves and how others in the family/couple unit sees the other(s).
By discovering these perceptions from everyone, individuals can recognize how those perceptions can help shape one’s own identity and contribute to dynamics and dysfunctions in the family/couple unit. By sharing these unique points of views and how they are received by others, individuals in the family/couple unit can learn to communicate their actual visions of themselves to others and open up an avenue for understanding and compassion as opposed to conflict and contention.4
Narrative Therapy for Attachment Issues
From the lens of attachment issues, narrative therapy aims to resolve the conflict by creating a safe and client-driven environment for the individual to share their story. Individuals are able to reconstruct a new narrative by understanding their current version of their story isn’t the end. By doing this, internal working models of how one views themselves is challenged and it begins working to correct negative thought processes and ideas of the self.5
Finding a Narrative Therapist
Finding the right therapist can take some time. As you embark on your journey to heal and locate the therapist that will be best suited for your healing journey, remember to have some grace with yourself. One way to find a therapist is word-of-mouth. Sometimes in our circles, we know someone who has gone through therapy and has had a wonderful experience. Talking with close friends and family whom you trust and taking any of their recommendations can be helpful and encouraging.
Remember, not everyone will get the same gain out of going to the same therapist, so if you find yourself feeling as though a therapist is not right for you, don’t feel discouraged and keep looking.
Another way is by asking your physician for anyone they recommend. This also gives your physician an opportunity to collaborate with you and find you the right type of treatment. A holistic approach to any kind of therapy should also involve your physician or any specialists you are known to.
If there are no recommendations, locating a provider from your in-network list of counselors is another option. You can locate this information on the back of your insurance card or by calling your insurance company to obtain a list of in-network providers. They may give you a list of individuals, practices or community-based programs that are available to you.
To ensure your narrative therapist is qualified, they must hold a state license for counseling, psychology, mental health or social worker. LCSW, LSW, LPC, LMHC, MFT or PsyD are the most common types of mental health providers. Copays and coverage of treatment will depend on if the provider you choose is in-network or out-of-network.
It is not uncommon to have a copay even with an in-network provider, however many providers are able to offer a sliding scale payment model should the copay be too costly. It is important to have all the facts so asking your provider about this before therapy is recommended.
Additional questions to ask your therapist are:
- How long does narrative therapy last?
- How will you know if it’s helping me?
- Do you have experience with the type of issue I have?
- Will I need medication?
- If I need to bring my partner, child or other significant relationship, do you treat families or couples as well?
- How long have you been practicing?
After you’ve found your therapist and asked all your questions, you will be asked to come in for your first initial therapy session. It can feel overwhelming, scary, exciting, vulnerable, hopeful and many other emotions all at once. This is to be expected when embarking on a healing journey with somebody who does not know you and whom you do not know.
What to Expect at Your First Sessions
At the beginning of narrative therapy, you will share your story and reason for seeking narrative therapy at this time and your future goals. It is important to own this part of therapy and be honest to get the most of your experience. As therapy continues, usually once a week, the therapist will continue to learn about your story by paying attention to how you speak and your projection of your story. Over time, from session to session, your therapist will challenge you to consider alternative language choices to tell your story and will explore this with you.
Your therapist will also help you identify aspects of your story that may have been glossed over and ask you questions to learn if parts of your story were left out of your narrative. By doing this, the goal is to bring that voice and ownership of your whole story back to you, without shame. Narrative therapy is very client-driven, so your therapist will ask you open ended questions to help you broadly think about your experience and empower you to re-shape your story from a position of self-worth and power over your own life and experiences.
This process can take as long or as little as needed by the individual. There is no set time-frame for narrative therapy as it is client-driven, but at the end of therapy, individuals will learn a host of techniques they can use when dealing with challenging situations or experiences in their future.
Is Narrative Therapy Effective?
Narrative therapy has proven to be beneficial for many types of mental health conditions as well as for various ages and groups, whether it’s a family, a couple or a larger support group. In children, narrative therapy assists children with their social skills, empathy and decision making. Children were also found to have better relationships with their peers.6
To add, in a group setting with adults dealing with anxiety and depression, narrative therapy was found to improve quality of life. As a result, according to surveys before and after group narrative therapy, symptoms of anxiety and depression were lessened.7 In another study by Ghavibazou, Hosseinian & Abdollahi, it was hypothesized that women and couples were able to benefit from narrative therapy. In this study, investigators looked at how marital satisfaction can be improved for women experiencing low levels of satisfaction.8
It was found that after 8 weeks, women were reporting high levels of marital satisfaction as well as less withdrawal from their relationships. In addressing anxiety, narrative therapy has also shown to be effective. In another study, women were given a questionnaire before and after narrative therapy interventions regarding generalized anxiety disorder and found that the women after treatment reported improved symptoms of generalized anxiety disorder.
In addition, these women also reported having better coping mechanisms as a result of the tools learned from narrative therapy in understanding and re-imagining their story with empowering language.9 Narrative therapy approaches have benefits for diverse mental health conditions and populations.
Pros & Cons of Narrative Therapy
The pros of Narrative therapy include:
- Can be used as a stand-alone therapy or alongside other forms of therapies such as Cognitive Behavioral Therapy
- Non-blaming, holistic approach to problems as separate from the identity of the individual with the problems
- Encourages individuals to consider different, more positive perspectives of their problems
- Positions individuals as the expert of their life
- Works from a strengths-perspective framework
- Individual learn skills that can help them lead happier lives
One of the major cons of Narrative Therapy is that it is not helpful for those with intellectual disabilities or language issues.
History of Narrative Therapy
Narrative Therapy was originated in the 1980s by two social workers, Michael White and David Epston, who felt that individuals’ problems and identity should be seen separately. This framework lent itself to a holistic approach to therapy that naturally feels more empowering for individuals in treatment. White and Epston were strong believers that individuals should not label themselves as the problem they are dealing with, for example, encouraging individuals to say, “an individual dealing with depression” as opposed to “a depressed individual.”
Since the 80s, it has been used in many forms however given that it is a relatively new approach to therapy, there is still a great deal of research going into Narrative therapy approaches, techniques and outcomes. From the current literature on Narrative therapy, it appears that it has been proven effective in various uses including groups, with children, with adults and families. In addition, it has shown effectiveness when dealing with depression, addiction, anxiety, trauma, family issues, attachment issues and grief.
Narrative therapy has shown to have a great deal of positive qualitative outcomes by widening individuals’ views on their problems and empowering them to use more positive narratives when sharing their stories and experiences.
Additional Resources for Narrative Therapy
The following are helpful additional resources for narrative therapy:
