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Narrative therapy is a form of psychotherapy, or talk therapy, centered on the concept of a life story. As a theoretical model of therapy, it assumes that each individual understands the various aspects of their life—be it their own identity, the scenarios they go through, those around them, and the world at large—through the stories they tell themselves, which help them make sense of what would otherwise be a fragmented and greatly confusing series of experiences. Through narrative therapy, the patient—who is referred to by the non-pathological term “client”—is able to rewrite their own story in a way that encourages a greater sense of agency, while offering a more compassionate and beneficial perspective on their life.
Narrative therapy was originally developed in the 1980s by Australian therapist Michael White and his colleague, New Zealand therapist David Epston. Influenced by French theorist Michel Faucault, White and Epston aimed to create a therapeutic, theoretical model that challenged the social constructs under which individuals live their lives. Thus, narrative therapy was born.
At its purest form, narrative therapy is a postmodern and constructivist approach: it emphasizes social justice, questioning the dominant narrative that may be counterproductive, and at times even destructive. Instead of accepting the demands of society and those of one’s own history, narrative therapy wishes to develop an awareness of the social, cultural and political constructs acting on each individual.
As part of narrative therapy’s emphasis on growth and health, patients are referred to as “clients,” and not “patients.” This helps solidify their ability to receive the mental health support that can help them gain a sense of agency, while refraining from illness-centered terminology.
An initial goal of narrative therapy is to better understand how a key problem, viewed by the client within an existing life story, influences or impacts their life. To do so, the therapist begins by asking them a great deal of open-ended questions, leaving room for the client to choose how to tell their story. Narrative therapy looks to explore the client’s past, present and thoughts of the future, connecting between their history, goals, and how their actions and choices may have influenced the problem at hand.
As the client begins to recount their existing narrative, problem-saturated dominant stories tend to arise. These are unhealthy, negative, misunderstood, or misrepresented perspectives that can cause them emotional pain and interfere with their ability to facilitate change.
In addition to the dominant story, unique outcomes are also identified within the client’s narrative. These are exceptions, or moments of a more independent perspective, which help loosen their adherence to the more dominant story. Unique outcomes are also called “sparkling moments” in narrative therapy.
Identifying values and themes within the client’s life narrative is another important goal within narrative therapy. Values and themes that are either easily identified or are “absent but implicit” in the client’s story tend to run through their narrative, tying it together while adding tension to conflicting goals or demands.
Once a more comprehensive knowledge of the client’s existing perspective has been attained, a new, more beneficial narrative can be considered. Such a narrative allows the client to re-author formative relationships or experiences, aspects of their own identity or how they approach their goals, within a productive framework that is both cohesive and meaningful.
Yet another goal of narrative therapy is to externalize the problem identified by the client, by separating it from the client themselves: the therapist helps the client view themselves as dealing with a problem, such as depression, instead of identifying as being depressed. As a popular adage of narrative therapy states, “The person is not the problem. The problem is the problem.”
An essential aspect of the theory and practice of narrative therapy, the language a client relies on when constructing their life story can tell just as much about their perspective and how they identify as what they are describing.
Paying close attention to the language they have used a narrative therapist will typically ask their client why they chose a particular phrase or metaphor. Together, client and therapist will backtrack to a certain point in the story, and try to understand whether the language used in it authentically represents their stated goal, or if it suggests a competing narrative the client may be struggling to acknowledge? After reviewing these issues, a narrative therapist can then encourage the client to select words and a language that reflect the story they wish to tell, further promoting their agency.
A narrative therapist’s central position is a combination of an investigative reporter and co-collaborator. Rather than positioning themselves as an all-knowing expert, narrative therapists utilize their curiosity about the client’s existing narrative and perspective. They are not looking to focus on etiology (the cause of the problem), but are curious about the nature of the problem, and how it presents itself. They want to hear the client’s perception of what brought about their problem, as they work together to reconstruct the client’s life story into a more beneficial one.
A narrative therapist does not aim to provide clients with a psychopathological diagnosis. Though their mental health symptoms are explored, a narrative therapist would not attempt to neatly fit them into a specific diagnosis. Instead, narrative therapy looks to empower and promote a sense of affirmation within the client, by helping them decide how to tell their own story in a way that benefits themselves.
To provide clients with the ability to reframe an existing perspective through an alternative life story, narrative therapists rely on their own curiosity, close listening skills and a great attention to detail. Together, these attributes help them encourage their client’s belief in their ability to enact change.
Letters, emails and other forms of written communication can also play an important part in narrative therapy. By putting pen to paper (or typing it out), the client can examine their thought and emotional patterns from a more collected standpoint, as they attempt to further flesh out an alternative narrative.
Narrative therapy seeks to construct (or rather, reconstruct) an alternative story with the client. It believes that positive stories lead to preferable outcomes, or unique outcomes. A narrative therapist would then try to see that this new narrative is able to facilitate the kind of change the client is looking for. As a result, narrative therapy aspires to instill a sense of hope in the client, which can help negate the hopelessness, negative self-image and lack of energy symptomatic of depression.
A key way in which narrative therapy can help clients battling depression through the significance it places on the client’s own agency. With depression symptoms including a deep sense of hopelessness, a belief that things will not improve, and guilt over their situation, individuals contending with depression can end up immobilized under the weight of their own sadness.
By taking a look at what in their life may have led to their depression, or contributing to it at present, clients can understand their condition better, thus encouraging them to believe in their ability to facilitate the necessary changes in their life that could lead to some alleviation. And as they are doing this within a therapeutic setting, they may also feel less lonely—another debilitating symptom of depression.
The sense of structure gained through narrative therapy is another aspect that can greatly benefit those facing depression. Often described as an engulfing sensation, clients can feel as if they have been plunged into their depression, causing them to lose touch with their sense of security or stability. With narrative therapy, they are able to begin reconstructing their life story. Though they may continue to struggle making sense of what has happened to them, with the accompaniment of their therapist, they are given a source of guidance and stability that could eventually enable them to find such attributes within themselves.
Though certain studies have found some benefit to narrative therapy, in cases of depression, anxiety or post-trauma, a central criticism of narrative therapy is the lack of substantive, empirical evidence that supports it as a preferable form of therapy.
A suggested reasoning for this is that while empirical studies seek to arrive at an objective truth, narrative therapy views truth as subjective, in accordance with each client’s own point of view. Therefore, narrative therapists have proposed it should be studied qualitatively, relying on in-depth interviews with individual clients. Indeed, a qualitative approach works well with the comprehensive and immersive aspects of narrative therapy.
That said, the effectiveness of narrative therapy can nevertheless be gauged by scientific measures, examining whether a client’s goals have been reached or their symptoms reduced, thereby continuing to make the case for quantitative research on this form of psychotherapy.
Narrative therapy can be used to treat individuals, couples and families, helping reconnect and replace negative communication with a more positive dialogue.
Narrative therapy could also be incorporated into other forms of psychotherapy, such as psychodynamics or cognitive-behavioral therapy (CBT). It could also be added to a comprehensive mental health care regimen that includes other types of treatment, such as psychopharmacology or transcranial magnetic stimulation (TMS).
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