Narrative Therapy Techniques

Many clients in therapy share narratives they’ve constructed about themselves—including their behaviors, character, or experiences—that speak to static unhelpful beliefs. To change these beliefs, it can be helpful to employ narrative therapy techniques, such as narrative exposure therapy.

It’s common for therapists to encounter clients who define themselves in terms of their problems. As counselors, we often hear comments like “I’ve always been an anxious person” or “I just can’t move on from what happened” shared throughout sessions. 

We recognize these self-descriptions as a tight infusion of our clients’ identities with their struggles. These types of statements can cause therapists to feel as if we’re talking in circles—producing an obstacle to therapeutic growth as clients remain stuck in their problems. 

In cases like these, an approach including narrative therapy techniques may benefit clients’ progress and growth.

What is narrative therapy?

Narrative therapy is a counseling approach in which clients learn to separate themselves from their problems. Developed in the 1980s by David Epston and Michael White, narrative therapy teaches that our lives are composed of multiple stories. 

In narrative therapy, each person is the narrator of their own life stories. What’s more, their attitude of narration and perspective on the events in their lives has influence on their present and future actions.

When they view themselves as the narrator of their own lives, clients can take more responsibility to tackle their problems. Their optimism can grow as they reevaluate negative events from an objective stance. They can re-author unfavorable or troublesome life stories during therapy to produce a healthier outlook. 

How to apply narrative therapy techniques 

A key facet of narrative therapy is objectifying the problem. This approach offers clients more emotional and mental distance to help them develop healthier life narratives. 

For instance, in narrative therapy, a client who has long wrestled with anxiety is not considered an “anxious person” but one who is “struggling with anxiety.” The counselor will ask the client to describe anxiety in tangible terms, from a detached perspective.

Counselors may offer examples, such as anxiety taking the form of an angry old lady who just won’t leave and who constantly criticizes the client. 

Then, the counselor and client can more easily discuss anxiety’s origin (When did you first meet her?), symptoms (How does she affect you?), and management (What can be done to make her go away?). 

Candidates for narrative therapy techniques 

Characterized by themes of personal accountability and resiliency, narrative therapy is well-suited for treating depression, anxiety, grief, trauma, and anger. 

All these presenting problems tend to elicit a defeatist or pessimistic attitude in clients, which restricts therapeutic change. 

Clients with depression and anxiety

A study published by the Japanese Psychological Association monitored the effects of narrative therapy on women with anxiety and depression who were transitioning out of psychiatric care.

Clinicians conducted group therapy with the seven women that employed narrative therapy techniques and monitored their feedback throughout treatment. The researchers used the measurement-based care tool known as the Beck Depression Inventory-Second Edition (BDI-II),  in addition to conducting a writing exercise called “Take Back My Life.” 

According to the participants’ written responses and BDI-II results at the end of treatment, five out of seven women reported they were “less distressed about themselves and/or their past and were more self-accepting.”

Clients of faith 

According to therapist Helen Hofman, LMHC, narrative therapy is especially suitable for people of faith. Clients who believe in a higher power and have access to spiritual resources can offer them substantial strength. Through incorporating their faith, clients can more easily reconsider their problems and adopt a hardy mindset. For instance, narrative therapy techniques paired with Christian perspectives equips a client who ascribes to that belief system with a poised, hopeful lens. 

They recognize their life story as just one being played out in  a predestined diety’s greater story, that they have a place and role to play in a higher power’s story, and are to become a co-author with God or a higher power’s plan in the future of their life.  

Narrative therapy and trauma

Clients who’ve experienced trauma or those who view life from a victim mindset should also be considered for narrative therapy. Non-blaming and gentle in its style, clients with posttraumatic stress are very receptive to narrative therapy—they’re more likely to engage and feel empowered by narrative therapy techniques when compared to other therapeutic interventions. 

With this approach, these clients can reevaluate their traumatic experiences from a more distanced standpoint. Consider a woman who underwent extensive emergency surgeries and now experiences flashbacks and nightmares. Using narrative therapy, a counselor can help her develop a story about these events which helps her stay calm when  processing the details.

For example, a clinician could say the following to address their client’s trauma:  There once was a lady who stayed at the hospital for a long time. She needed a lot of operations because she was in so much pain. The lady felt scared to go to the hospital and began having nightmares about her time there. She avoided talking about her pain and missed her doctor’s appointments. She wanted to be brave and overcome her fears, so she started working with a counselor in therapy.

Narrative therapy for childhood trauma

Narrative therapy is an advantageous tool for addressing childhood trauma, particularly while our clients are still children or adolescents. 

Storytelling is an activity which develops during childhood, making it an easier approach for young clients.

Counselors may incorporate art activities for their client, such as making a “Life Book” in which the client writes chapters or draws pictures of significant life events, including their traumatic experiences. The counselor may also use play to help their client compose a narrative, such as facilitating a puppet show or playing dollhouse as they reenact traumatic events. 

Many studies are available regarding the effectiveness of narrative therapy for posttraumatic stress. The Dulwich Centre in Australia, which was originally directed by narrative therapy co-founder Michael White, provides access to multiple reports. These include narrative therapy’s usefulness in treating children who’ve been orphaned or abandoned, and individuals mourning the death of loved ones. 

The Center for Combating Human Trafficking, based in Wichita, KS, also promotes the benefits of narrative therapy. Their research emphasizes the suitability of this approach for survivors of human trafficking as these clients are approached in a humble manner with the retelling of their stories.

Narrative exposure therapy

If you’re working with clients who have posttraumatic stress from multiple or complex traumas, narrative exposure therapy (NET) may be particularly appropriate. 

Narrative exposure therapy was initially designed to help refugees process their intense traumatic experiences while also documenting human rights violations. This subset of narrative therapy is intended for short-term use and incorporates powerful visuals as clients construct their life narratives. 

During NET, clients are taught to consider their life as one long rope. Clients then mentally place various symbolic items onto the rope: flowers and stones (happy and traumatic events, respectively), sticks (acts of aggression), and candles (grief). 

The counselor helps the client put these events in chronological order and processes each one throughout therapy. At the end of treatment, the counselor presents a documented autobiography to the client, which includes all their processed life events. 

Narrative exposure therapy  is a popular choice for counselors facilitating trauma work because it presents as an in-depth, private interview between counselor and client. The metaphor of the client’s life as a long rope, dotted with events of importance, allows them to share details more comfortably than when blatantly asked questions about their trauma. 

When clients become triggered during these retellings, counselors guide them through their remembering with appropriate coping skills (i.e., deep breathing, physical grounding). 

Furthermore, the goal of receiving a recorded testimony, a real “life story,” can motivate clients to fully engage throughout the entirety of therapy.  Narrative therapy techniques give counselors an opportunity to help clients distance themselves from their problems. It’s especially applicable when working with clients whose self-identity is meshed with their troubles—particularly helping clients with posttraumatic stress.

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