Narrative Therapy: How It Works & What to Expect

What Is Narrative Therapy?

Narrative therapy is a type of experiential therapy that works by separating individuals from their lived experiences, and empowering them to use that same approach when dealing with their problems. By removing blame and others’ perceptions, people are able to re-author their stories and re-establish their experiences in the here-and-now.

Over time, 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.

In Narrative Therapy, the Client Is the Expert

One of the major differences between narrative therapy and other “talk” therapies is that narrative therapy is client-driven and uses a strength-based approach. 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 people feel empowered to make those determinations for themselves.¹

Narrative Therapy Techniques

There are several techniques used in narrative therapy that can help clients understand their story as it is currently, discovering goals for their life outside of their current story and learning how to re-narrate their experience to help them live their best lives.

Understanding Your Current Story

It is important for a therapist and client to start from the beginning of the story before trying to unpack it. To start, someone shares their full story and experiences, and tells 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 their perspective. This phase is important in uncovering patterns and recognizing future goals for sessions.

Externalizing Your Story From Your Identity

Once the story is understood, the client takes steps to recognize their story separate from their identity. The therapist starts by asking open ended questions aimed at understanding the person’s goals and reframing and restating them back to the client to confirm both are on the same page before moving forward.

The repetition of asking these questions and highlighting how the language people use for their goals have differed from the language used to tell their story can be very powerful. Once an individual is able to see this juxtaposition of their own words, the therapist can help to facilitate a conversation to bridge these two viewpoints.

Once someone is able to see the patterns of their own language, the ways in which they think 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 and veer away from negative self-talk.

Deconstruction of the Story

Deconstruction is a technique used in narrative therapy to break down a problematic story into smaller, more manageable parts. This allows the client to get to the core issue more efficiently and avoid feeling overwhelmed. In this process, the client acts as a detective, examining the details of a challenging story in their life in order to rewrite the narrative in a healthier way, freeing their personal identity from the problem.²

Understanding Unique Outcomes

In narrative therapy, the therapist may work with the client to identify exceptions, or unique outcomes, that contradict the problem narrative. Understanding unique outcomes can be a powerful tool that can help a client move toward change. For example, a divorcee whose narrative is that they are unlovable will benefit from identifying a person who has shown love to them. A rebellious teenager who sees themselves as a troublemaker could begin to view themselves differently after exploring a situation in which they resisted temptation and did the right thing. This strengths-based approach aims to shift the narrative from problem to success.³

Re-Authoring Your 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 for our identity formation. 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 they tend to engage in extremely negative self-talk. The repetition of discouraging thoughts worsens depression, but narrative therapy can help change that story. Through narrative therapy, someone with depression is able to re-narrate their story with more positive interpretations and can challenge their inner monologue to consider alternative language.

In a study aimed at examining the impact of narrative therapy for adults dealing with depression, it was found that those who received narrative therapy expressed greater feelings of hope and positive emotions. They were able to form a healthier identity and feel empowered to speak to themselves with stronger self-affirmations.⁴

Narrative Therapy for Trauma

Trauma can be experienced just once or repeatedly over a period of time, and both can leave a lasting impact on someone. 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 through narrative exposure therapy, which involves journaling the experience and paying attention to the choice of words while practicing this activity.

This empowers the individual to reclaim themselves and recognize that their identity is not based on trauma. By doing this, people are able to improve their feelings of self-worth and begin to heal from their trauma. In fact, one study found that narrative therapy for trauma can help with post-traumatic growth, which is essentially the desired outcome for any kind of therapy for trauma.⁵

Narrative Family Therapy

Those dealing with family concerns can also benefit from narrative therapy, which 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 unit sees the others.

By discovering these perceptions from everyone, family members can recognize how those perceptions can help shape one’s own identity and contribute to dynamics and dysfunctions in the family unit. By sharing these unique points of views and how they are received by others, people in the family 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.⁶

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. People are able to reconstruct a new narrative by understanding that their current version of their story isn’t the end. By doing this, the way someone views themselves is challenged and it begins to correct their negative thought processes and self-conception.⁷

Narrative Group Therapy

Narrative group therapy has been studied and shown to be effective in addressing a wide range of challenges, including substance abuse, body image concerns, social phobia, history of abuse, depression, anxiety, trauma and severe mental illness.⁸ In narrative group therapy, small groups of four to ten clients gather together, most often on a weekly basis. This intervention is especially applicable in cases of community-based trauma.⁹

Activities You Might Do During a Narrative Therapy Session

While narrative therapy sessions are an ongoing dialogue, there are a few activities therapists might use to continue the conversation:

My Life Story

In this exercise, the client is asked to create a title for their life story, and 5-10 chapter titles that represent the major events in their personal timeline. A brief description of each chapter can provide more depth and insight to this exercise. As the client realizes the past is truly in the past, they can begin to write the future, envisioning what might happen in their story next.¹⁰

Statement of Position Map

This worksheet provides an opportunity for the client to identify the problem, map out the effects of the problem across all areas of their life, and explore how the impacts of this problem deeply affect the client and their personal values.

Expressive Arts

Employing expressive arts into the storytelling process can be incredibly beneficial for some clients. This could look like incorporating meditation, journaling, drawing, dance, or other modalities to tell the client’s story. This is especially helpful in working with children and adolescents, but could be a great opportunity for creative adults seeking healing as well.

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
• People learn and practice skills that can help them lead happier lives

While narrative therapy has many benefits, there are a few cons to this approach that are important to be aware of. They include:

• Not appropriate for those with intellectual disabilities or language issues
• Non-directive approach may be overwhelming for some clients
• Can progress slowly and be time intensive
• There is a smaller body of evidence for narrative therapy as opposed to other therapeutic interventions
• Some posit the danger of oversimplifying complex problems into simple storylines

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. For children, narrative therapy can assist with social skills, empathy and decision making. Children were also found to have better relationships with their peers.¹¹

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.¹²

In another study, 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.¹³ 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. 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.¹⁴

Limitations of Narrative Therapy

Narrative therapy is limited to use with clients who have a strong command of language, preferably the same native language as their therapist. This therapeutic approach comes with complex terminology that can be off-putting to some clients, and can create a barrier between the client and therapist in some cases. Clients also must have some measure of self-insight and a strong reflective capacity in order to tell a cohesive narrative and examine it thoroughly.

Some clients may also be overwhelmed by the non-directive nature of narrative therapy and prefer an approach in which they do not have to take the lead in discovering the solutions to their own problems, or imagining their future goals. In this case a more directive, structured, therapist-led intervention would be preferable.

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.

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.

Copays and coverage of treatment will depend on if the provider you choose is in-network or out-of-network. If you’re paying cash for the therapy sessions, don’t be afraid to ask if the therapist offers a sliding scale payment model or to look into other more affordable therapy options.

What to Ask a Potential Narrative Therapist

In addition to asking about licensure and payment options, here are some additional questions to ask a potential therapist:

• 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?

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.

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.