Narrative therapy: re-write your story

At the risk of putting the reader to sleep, I really enjoy studying counseling theory. In particular, I find it interesting how theories have evolved over time to reflect changing societal values and norms. Sounds interesting, right? I will probably write something a little more formal on that subject at another time, so you are presently off the hook.

In this blog, I wanted to introduce some of the merits of narrative therapy, or more colloquially, of taking a narrative approach with clients. In my opinion, narrative therapy offers some unique features that may really help clients gain therapeutic insights and effect personal change (a.k.a. feel better).

Lake Pukaki, New Zealand

Photo by Casey Horner on Unsplash

Relatively new theory

Narrative therapy is considered a post-modern approach in that it was articulated and recognized in 1970s and1980s, so this makes it more contemporary and more reflective of the values and systems of the last 50 years. Most other well-known approaches were established well before this, some of which have been updated to be more reflective of the times. The two founders of the narrative approach are Michael White and David Epston who based this theory on their work with clients in New Zealand, although their work has been adopted all over the world.

Distinguishing features

Reality is organized through narratives

The primary tenet is the belief that one’s reality is organized and maintained through narratives, or stories. For my professional friends, I’ll bet you have some form of elevator speech or maybe you have developed a communication strategy to talk about your work. Many people have also developed their own stories about their personal lives, their childhood, their families, or the way they met their spouse. The personal narratives I hear from some clients are pretty harsh – the person is often described as the unworthy cause of their own suffering. Since these stories begin to form in childhood, it is not a total shocker to realize that, when you actually say your story out loud or write it down in words, some of these stories are more consistent with the cognitive abilities of a child. It can be a valuable therapeutic exercise to craft an updated story with your adult brain and experiences, where your story lines are supported by evidence rather than based in uncertainty and fear. When you put a lot of time and energy into re-writing this kind of story, it can have a positive impact on one’s present health and outlook.

De-pathologizing

Narrative therapy promotes treating people like human beings rather than labeling clients and viewing them as sick or otherwise damaged goods. Narrative therapy eschews the use of formal diagnoses, so a client may talk about their stories and their problems but won’t be labeled “an anxiety client”. Personally, I can see both sides of this issue. Sometimes there can be a lot of shame associated with having a mental health diagnosis, and I imagine that can be isolating and exacerbate the original problem. However, I have met some people who felt validated when they received a diagnosis because they felt as if no one took them seriously before.

stethoscope on mobile phone — some believe that diagnosing mental health issues is problematic

Photo by Bermix Studio on Unsplash

Consideration of the impact of power/imbalances

This approach actively investigates the role of traditional gender roles, culture, race, socio-economics, etc. on a person’s well-being. A therapist using this modality might reflect with a client on the power differential between the client and the people in their lives to help them sort through their thoughts and feelings and sometimes even advocate on their client's behalf. This modality has found some success with males who batter their female partners as well as with individuals who have eating disorders.

Therapists are not neutral

Narrative therapists admit they are not really neutral and that their work reflects their own beliefs and it encourages an understanding of oppression. I think this is pretty cool. As a cis-gendered White woman, I have come to recognize that it is unhelpful at best to imagine that I am perfectly neutral, although that sounds like a good thing. For example, I believe in equality in peer relationships. This does not mean people have to be in relationships that replicate my own or that meet my approval; to me, it means that I will never be a fan of someone controlling or abusing their partner. I realize that there are folks that have what is often referred to as a “traditional” view of relationships but, unfortunately, I have seen this type of relationship where the husband makes all the decisions and it is the wife’s duty to obey often result in abuse. I did not become a therapist in order to force people to share my views but, if you want your therapist to help you get your partner to accept a role as where they are exposed to abuse, I am not going to be a good fit for you.

Popular therapeutic techniques

Telling and retelling

Clients would be encouraged to "tell their story" and then, through the course of therapy, learn to re-tell it as a method of reframing their experiences in a more healthy way that results in lessened distress.

Looking for unique outcomes or exceptions

When someone says "I don't have any friends", a narrative therapist might gently ask the client to reflect over time to see if there were ever a time that they had a friend, and use this technique to reframe this sad and likely inaccurate story.

Externalizing the problem

I like this one a lot. Sometimes when a client is experiencing a problem, it can feel overwhelming and therefore becomes difficult to look at the issue with perspective. This technique encourages a person to treat the problem as if it were a separate entity. So, for a client who is grieving, the client would be asked to "name it" or label the grief. This label could be anything such as a person's name or a meaningful term such as "the dark cloud", and then the client and therapist could discuss "the dark cloud" as something that exists as separate from the client. This might seem like I am making a big deal out of nothing. However, I have seen clients develop an increased capacity to discuss difficult things like grief and gain more mastery over their feelings of suffering and make changes to their behaviors.

WOMAN READING BOOK — What is your story?

Photo by Kelly Sikkema on Unsplash

Thick vs. thin story

Many people see themselves in an overly-simplistic manner: for example, you are a college athlete, a fun party guy, a career-oriented big finance professional, or an attractive young woman. A problem can arise if there is a challenge to that identity, where the college athlete can no longer compete due to an injury or an aging body, the attractive young woman who does not like getting older, or the career oriented professional who gets unexpectedly laid off. Individuals whose identities are too narrowly defined have a harder time coping with these challenges and, in narrative therapy terms, their stories would be considered "thin". In therapy, the client's identity could be explored and broadened to more accurately describe that person's full range of qualities such that a threat would have less of a negative impact. In other words, "thickening" one's story or narrative would have the effect of increasing their resilience.

How well supported is Narrative Therapy?

I think you may find that, upon examination, most therapy approaches are not well-researched for efficacy. One of the reasons for this generally are that there are ethical issues in play when designing a robust experiment when your subjects are suffering from mental distress. These days, research studies put a lot of focus on the whole “no harm” thing. Another reason it is difficult to find strong evidence for therapy is that therapy is pretty subjective. Is it fair to compare my anxiety to yours? Maybe one person experiences severe anxiety following a major car accident and another person is anxious on Sunday nights before returning to work on Monday morning- should they respond similarly to the same stimuli? How do you fairly measure mental health outcomes? In other words, it is challenging to operationalize the variables in a social science research study. But narrative therapists go even further, as practitioners find quantitative research to be reductionist in nature and would likely not participate in a research study.

How might I use this with clients?

Some clients really connect to discussing their lives as a series of stories or narratives. Sometimes it is because they are big readers, or they like to write with for work or for pleasure. Sometimes, such individuals already think of their lives as stories or even as comic or manga stories with heroes and villains. With such clients, we would frame our work in storytelling language and move throughout the course of treatment by looking for ways to re-write your story for accuracy and compassion. So many people have written their own life story in the harshest of terms, where they are the villain and the cause of all suffering. I imagine that people often do this because those really hard experiences in life can leave quite an impression and sometimes it overwhelms the rest of our experiences, leaving a mark. Interestingly, this method seems akin to "telling your story" in a 12-step program such as AA. Taking the time to carefully review one's life experiences with an eye to narrating them more accurately can help someone really change their perspective.

woman holding book over mouth — YOUR STORY

Photo by Natasha Brazil on Unsplash

Sources

Neukrug, Edward S., "Counseling Theory and Practice (2nd Edition)" (2017).

White, Michael. and Epston, David. "Narrative means to therapeutic ends" (1990).

Narrative therapy: Let’s re-write your story

Narrative therapy: re-write your story

Relatively new theory