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Stuck in a Flipped Car

Adult – Trauma Management-Counselling and Art Therapy

Client Profile

The challenge.

• Emotional and physical pain hindered her ability to function to the point that she was unable to work or engage with her family.
• She felt severely traumatized and depressed.
• She constantly felt like something bad was about to happen.
• When her physical symptoms became more manageable, Nira was scared of driving in her car and she did not know where to start.

The Solution

• Nira was seen for 16 sessions
• Personalized assessment was conducted with Nira on her PTSD symptoms
• A treatment plan was formed and sent to ICBC for approval
• Initiated the treatment with a self-care schedule to elevate Nira’s mental health
• Nira was introduced to art therapy as a way of expressing her feelings
• Integrated mindfulness techniques into therapy
• Introduced Nira to various self-regulation tools
• Assessed triggers and coping methods on an ongoing process
• Nira was able to start processing her the trauma story in a safe space
• Integrated Cognitive Behavioural Therapy (CBT) and Growth Mindset modalities into therapy, helping the client to stay focused on her progress
• Implemented Exposure Therapy with Nira in order for her to gradually get exposed to her car and driving

The Outcome

• Nira changed her lifestyle and made self-care an integral part of her life
• She was able to regulate when she was exposed to her triggers
• She became more in control of her mental health rather being at mercy of her mood shifts
• She changed focus towards her passion instead of going back to her pre-Motor Vehicle Accident job, which she found unsatisfying
• She was able to experience joy and calm after being able to work through her depression and trauma
• She started driving her car again

Battling the Inner Bully

• Joshua was seen for 8 sessions
• Personalized assessment and treatment plan
• He was introduced to mindfulness techniques
• Joshua became mindful of his emotions and learned a new emotional vocabulary
• Therapist used Dialectical Behavioural Therapy to help him to make wise decisions, mediating between his logical draws and emotional needs
• He was introduced to Cognitive Behavioural Therapy (CBT) thinking traps in order to recognize his negative thinking patterns
• He was given journaling homework in order to practice reframing his negative thoughts
• Joshua became familiar with his emotions
• He refocused his energy on what gave him meaning and purpose rather than focusing on pleasing others
• He learned to reframe his negative thinking patterns on an everyday basis
• He was able to reframe some deep rooted negative core beliefs about himself
• He felt more confident in himself and started believing in his own potential
• Joshua started investing time in what made him happy

It Was Not My Fault

• Maryam was seen for 6 sessions
• Carried out a personalized assessment of her PTSD symptoms
• Formed a treatment plan that was sent to ICBC for approval
• The therapy started with a self-care schedule to elevate the client’s mental health
• She was given a safe space to talk about the story of her trauma and the day that she lost her job
• The therapist used narrative therapy techniques combined with art therapy technique to retell the story of the client to her
• The therapist reframed the negative beliefs that the client was carrying as a result of her trauma and losing her job
• She was given tools to communicate with her family in order to connect back with them
• Maryam was able to reframe some deep rooted negative core beliefs about herself
• She achieved a new sense of pride in her life story
• She was able to look into the future with hope and start looking for jobs

Allergy Panic Attacks Be Gone

• Sophia was seen for 12 sessions
• Carried out a personalized assessment
• Formed a treatment plan
• She was given psychoeducation about panic attacks and anxiety
• The therapist taught Sophia about different zones of regulation, green for when she is calm and happy, yellow for when she is stressed and uneasy, red for when she is in a fight, flight or freeze mode
• The therapist used her relationship to ask Sophia to do her best to catch herself in the yellow zone
• The therapist also provided her with multiple sensory and grounding tools to regulate herself from yellow to green when feeling triggered
• The therapist also worked with the family and gave them tools for helping Sophia

Sophia was able to prevent her panic attacks by staying mindful and using her tools when she got into the yellow zone

Ivy Leaguer or Nothing

Sara, female, seventeen years old, low self-esteem, depression, and anxiety.

• She was a high-level soccer player, she was adjusting to the challenges of being a new student, she found it hard to self-regulate after making an “error” in her play or when her team would lose, she was hoping for a scholarship to an Ivy League university, she felt like if she did not get the scholarship then her time with her efforts have been “a waste”
• She displayed a draw towards perfectionism which made her feel even worse
• She felt like she would be a “failure” unless she would get into Ivy League
• Sara was seen for 16 sessions
• She was introduced to Cognitive Behavioural Therapy (CBT) thinking traps in order to recognize her negative thinking behaviors
• She was given CBT tools for revising her thoughts
• The therapist worked with Sara on the concept of self-compassion
• The therapist carried out a family counselling session with Sara and her parents to help Sara to communicate her feelings to her father and also set some emotional boundaries
• The therapist and Sara came up with self-care strategies for the game days to help Sara with her anxiety
• The therapist and Sara talked about Sara’s life story for her to be able to process her grief in regards to the potential of not getting into an Ivy League school
• Sara was able to develop flexible thinking patterns
• She was able to regulate after her team’s losses She was able to develop more confidence and self-esteem
• She was able to set realistic and flexible goals
• She was able to start feeling “good enough” and place her value on her internal qualities

Child – Anxiety (Selective Mutism)

Tara was witness too many verbal arguments and domestic abuse between her parents

• Tara was seen for 16 sessions
• She used the dollhouse and sand tray to replay and process her family’s separation
• She used the dollhouse and sand tray to roleplay attending social situations
• Carried out parent meeting sessions with both parents, giving them tools to support Tara with her big grief and her social anxiety
• The therapist followed her play and guided her process when needed
• Tara was able to process her grief through the play therapy process
• Tara’s parents developed more tools to support Sara and meet her needs
• Tara started feeling more comfortable in social situations and initiating friendships

Overcoming Infidelity

“Alex” and “Natalie”, married for 10 years and have two children, the couple is in their late 30s, Caucasian background, looking to overcome infidelity in the marriage.

Alex committed the adultery in the relationship and the overwhelming hurt on both sides of the relationship was leading up to a breaking point in the relationship that neither wanted to happen, but felt at a loss on how to prevent it

• Alex and Natalie were seen for 12 sessions
• The therapist spent two sessions with them together, then had a session with each of them alone to understand the full dynamic
• The therapist explored the raw emotions on both sides to help each partner understand what the other is going through
• Introduced light mindfulness exercises to help the couple start the process of connecting with one another again
• When conflict arose, the therapist gave the couple the space to unpack it in session; those tools were used to help them when conflict came up at home
• Once the couple felt ready, the therapist integrated sex therapy techniques to help the couple connect more intimately
• The therapist focused on the here-and-now and helped them stay mindful of the present
• The couple was able to understand each other’s triggers and were able to communicate how they were feeling in the moment
• The therapist integrated Cognitive Behavioral, Mindfulness, and Emotionally Focused Therapy into their sessions, helping them both to stay present about themselves and their partner in the relationship
• Over time, Alex and Natalie were able to get past the infidelity that happened
• They were able to connect once again with each other and they began to “date” one another once again
• They became more in control of their feelings and were able to communicate them in a healthy way

Dealing with Heartbreak

“Lori”, Female in her 30s, moved to Vancouver for work and living alone, recently single

Raw emotions and overwhelming feelings from her recent break-up. Troubles eating, sleeping, and wasn’t engaging in any self-care that she used to do. Lori felt lost in terms of not knowing who she was without her ex-partner

• Lori was seen for 8 Sessions
• Personalized assessment
• She was given the space to tell her story and unpacked her feelings around the break-up
• The therapist introduced Lori to mindfulness techniques and getting her back into a self-care routine
• Lori became more mindful of her emotions and triggers and started to recreate her own identity and finding independence without her partner
• The therapist introduced to Emotionally Focused Therapy to Lori to recognize her emotional patterns and behaviors
• The therapist gave Lori homework, revolving around expressing her emotions through journaling and taking time for herself to actively move forward from the breakup
• Lori became comfortable with her emotions and was able to focus on her growth and starting taking pride in her own unique identity
• She learned to channel her energy into the activities that she used to love and incorporated them into her daily life.
• She felt more confident in herself and started achieving her personal goals

PTSD from Sexual Assault

“Jenny”, Female in her late 20s, moved to Vancouver to escape her past, victim of rape on multiple occasions

Severe post-traumatic stress disorder as a result of her histories of sexual assault. Frequent flashbacks before sleep and nightmares kept her from focusing at work and living her life properly. Jenny had a severe fear of dating men due to her sexual assault history as a teen. Jenny felt afraid for her life daily and incapable of re-connecting with other people and forming new romantic relationships.

• Jenny was seen for 5 100-minute sessions
• Personalized assessment was conducted with Jenny on her PTSD symptoms
• Jenny and her counsellor filled out the treatment assessment for the first, worst, and most recent time that Jenny’s boundaries were violated
• The therapist introduced Jenny to EMDR treatment to recollect her feelings, body sensations, and negative beliefs about herself in relation to the traumatic experiences
• After hours of EMDR treatment, those events lost their intensity and then transformed those negative thoughts into more pleasant ones
• The therapist gave Jenny homework, revolving around expressing her emotions through journaling during the EMDR process.
• Jenny began to heal from her past trauma thanks to EMDR
• She stopped having nightmares and flashbacks
• She became more comfortable with her ability to set boundaries and create safety for herself
• She was able to go on dates without having panic attacks
• She felt empowered and freed from her negative past

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Narrative Therapy: Techniques, Efficacy, and Use Cases

March 7, 2024.

Narrative therapy is a therapeutic practice that invites you to re-author your life story, offering a creative way to navigate personal problems. It enables a separation of your identity from your issues, fostering growth and change. We'll explore how narrative therapy works, examining its key techniques and understanding how Resilience Lab can assist. This will provide insight into how narrative therapy might be the tool you’re looking for to create a more hopeful narrative for your future.

Key Takeaways

• Narrative therapy, developed by Michael White and David Epston, is an empowering method that helps individuals separate from their problems through reframing life stories. This therapy aims to assist people in living according to their values and goals.
• Key techniques used in narrative therapy include externalization (viewing issues as separate from oneself), deconstruction (breaking problems into manageable parts), and unique outcomes (exploring and expanding alternative life narratives).
• Research shows narrative therapy can improve intimacy and marital satisfaction, as well as help to reduce symptoms of anxiety and depression, although comprehensive studies are limited due to the novelty of the approach and quantitative measurement challenges.

What Is Narrative Therapy?

Narrative therapy, developed by Michael White and David Epston, is a non-pathologizing approach that separates individuals from their problems, allowing them to reframe their life stories and develop new perspectives. This therapeutic process understands a person’s life as a collection of stories, acknowledging the significance these narratives provide to our lives, including the dominant story that may shape their identity.

The primary objective of narrative therapy seeks to empower individuals to become experts in their own lives and live in a way that reflects their goals and values. In contrast to certain approaches that diagnose behaviors as abnormal, narrative therapists consider problems as distinct from individuals, empowering them to distance themselves and reconstruct their lives with a feeling of control and optimism.

Key Concepts and Approach

At the heart of narrative therapy are fundamental principles that guide the therapeutic process. These principles include externalizing problems, deconstructing dominant problematic stories, and exploring unique outcomes to generate alternative narratives. These foundational elements significantly influence the direction of the therapeutic process and interventions within this approach.

Narrative therapy is unique in its distinction between the individual and their problems. The philosophy that ‘The problem is the problem, the person is not the problem’ encourages individuals to perceive themselves as capable of confronting and overcoming their issues, rather than being defined by them. The role of narratives is central in narrative therapy, as they are the stories, composed of events interconnected over time, through which individuals interpret their experiences.

Narrative Therapy Techniques

A variety of techniques are utilized in narrative therapy to aid individuals in comprehending and tackling their problems. These techniques include externalization, deconstruction, and unique outcomes. These methods guide clients in creating life-affirming stories that empower them to overcome their problems.

Each technique has a unique function within the therapeutic process and can vary from individual to individual. Here are the functions of each technique:

• Externalization : Encourages clients to perceive their problems or behaviors as external entities.
• Deconstruction : Systematically breaks down problems into smaller, more manageable parts.
• Unique Outcomes: These are moments when things go differently than the usual problematic stories we tell ourselves, helping clients explore and develop different, more positive stories.

Externalization

In narrative therapy, externalization refers to the concept of creating distance from the problems experienced, enabling someone to observe issues objectively and from a non-judgmental perspective. This therapeutic tool encourages clients to perceive their problems or behaviors as external entities, rather than inherent aspects of themselves, potentially fostering a positive influence on self-identity and confidence.

Externalization helps people deal with bad habits or thoughts by treating them as if they're separate from the person. Imagine giving a name to a problem – it's like saying the problem isn't part of you, but something you can face and change. This approach makes it easier for people to understand and work on these issues.

Deconstruction

Deconstruction is another critical technique utilized in narrative therapy. It involves the process of breaking down problematic narratives into smaller components, enabling clients to gain a deeper understanding of their issues and effectively address them.

During a narrative therapy session, deconstruction is employed by narrative therapists to:

• Prompt the client to articulate the specifics of their distress.
• Question dominant narratives or alternative stories.
• Investigate alternative perspectives and meanings.
• Help everyone understand and create shared meanings together.

Unique Outcomes

Unique outcomes in narrative therapy help clients explore different, more positive stories about themselves, making it easier to deal with their problems. These moments show times when clients see things differently, feeling more in control of their own story. This helps them move away from the negative stories they're used to telling themselves.

The unique outcomes technique can be implemented through:

• The exploration of alternative storylines unrelated to the client’s issues.
• Enabling them to envision the problem differently and gain new insights compared to the dominant story or problematic stories that they have been working through.
• Providing an opportunity to expand upon their stories from a different perspective.
• Aiding in problem resolution and fostering the necessary confidence for healing.

Applications of Narrative Therapy

Narrative therapy is a versatile approach that can be tailored to fit many different situations. At Resilience Lab, our therapists work to design a care plan that’s just right for each client's unique needs and goals, ensuring they get the best support possible. Narrative therapy can be used in many ways, such as in individual counseling, family therapy, and couples counseling, depending on what works best for the client.

• Individual therapy : Help clients address personal issues
• Couples therapy : Facilitate positive interactions and strengthening relationships
• Family therapy : Promote understanding and communication within the family unit

Individual Therapy

When applied in individual therapy, narrative therapy can yield transformative results. It assists clients in comprehending and addressing their personal issues using narrative techniques, helping them to become experts in their own lives and live in a way that reflects their goals and values.

Individuals engaging in narrative therapy can expect to:

• Be guided in the process of re-authoring their narrative.
• Examine the past experiences that have helped to shape their life.
• Revise their narratives or construct new ones that more accurately represent their desired identity, values, and the positive transformations they aspire to achieve in their lives.

Couples and Family Therapy

The advantages of narrative therapy are not limited to individual therapy but are also applicable to couples and family therapy. In these settings, narrative therapy is used to facilitate positive interactions and strengthen relationships. The method of externalizing issues plays a significant role in promoting positive interaction.

In a couple or family context, narrative therapy might utilize a range of techniques including:

• Constructing positive and functional storylines to promote growth.
• Encouraging members to share experiences that have shaped their lives.
• Working through alternative and healthier stories.
• Confronting unhealthy beliefs that are holding them down.
• Fostering positive communication and using family sculpting to resolve issues

Enhancing Self-Differentiation Through Narrative Therapy

Additionally, narrative therapy is an effective instrument for bolstering self-differentiation. It helps individuals recognize their own thoughts and feelings, set boundaries, and prioritize their own needs and well-being. It allows for an individual to form a clear sense of self, independent of how others view them.

Self-differentiation allows for an individual to:

• Recognize their own thoughts and feelings.
• Respect that they are sometimes different from other individuals in their life.
• Be confident and comfortable with themself, even if they differ from their loved ones.

Narrative therapy, through its focus on individual narratives and externalization of problems, aids in enhancing this self-differentiation.

Get started with therapy today.

Our team can help you find the right therapist., benefits of narrative therapy.

Narrative therapy can yield extensive and transformative benefits. It empowers individuals by guiding them to develop expertise in their own life, challenge prevailing narratives, and assists them in recognizing and nurturing alternative, healthier beliefs and stories. As the story gains richness, this process results in the reclamation of agency, heightened self-esteem, increased confidence, enhanced empathy, and improved relationships, thereby creating avenues for personal growth and development.

Moreover, narrative therapy fosters self-compassion by prompting individuals to:

• Externalize their problems and acknowledge that these issues do not dictate their sense of self.
• Identify alternative narratives to avoid being trapped in a problematic story.
• Question harmful beliefs and develop a new narrative practice.
• Cultivate a more positive and compassionate self-perception, which is crucial for personal welfare.

What Can Narrative Therapy Help With

Narrative therapy can aid in addressing an extensive array of mental health conditions and adverse experiences. It has been shown to be particularly helpful for individuals grappling with anxiety and depression, relationship issues, and low self-esteem.

Narrative therapy, especially in the form of narrative exposure therapy, shows promise for more severe conditions like PTSD. Unlike traditional narrative therapy which focuses on reshaping personal stories, narrative exposure therapy is tailored specifically for trauma disorders. It helps individuals confront and process their traumatic memories, which can effectively reduce PTSD symptoms.

Effectiveness of Narrative Therapy

Research has indicated that narrative therapy has been associated with heightened intimacy, enhanced marital satisfaction, and decreased symptoms of anxiety and depression. Comprehensive research is limited, however, due to narrative therapy’s status as a relatively new therapeutic approach, and challenges in quantifying its impact.

The effectiveness of narrative therapy will vary based on the individual as well as the therapist involved. It is important to find a therapist who can provide you with an individualistic approach to therapy that is tailored around your personal needs. The team at Resilience Lab can provide you with a personalized care plan while establishing measurable goals and outcomes.

What To Expect From Narrative Therapy

During narrative therapy sessions with a narrative therapist, clients are encouraged to:

• Narrate their personal stories
• Discuss their challenges and aspirations
• Collaborate with their therapist to explore alternative narrative ideas and address their concerns

In a typical narrative therapy session, the client:

• Creates a storyline for their experiences
• Finds meaning and develops a positive and functional identity
• Explores their narratives and actively challenges them
• Discovers their voice and examines events in their lives and the significance they have attributed to these experiences

Through open dialogues with their therapist, the individual can engage in this process and benefit from the moment they started narrative therapy.

How Resilience Lab Narrative Therapy Can Help

Resilience Lab offers therapists who specialize in a wide variety of therapeutic techniques in order to find the best strategy for your needs. As a Resilience Lab client, you can benefit from a therapist focused on providing  holistic, evidence-based, and affordable care for various mental health concerns.

Resilience Lab’s inclusive community of therapists holds extensive experience across many clinical approaches. Whether you benefit from narrative therapy or another approach, the tools you learn can help build your resilience to future challenges.

Frequently Asked Questions

Although each individual’s experience with narrative therapy and therapy as a whole will differ, below are general answers to common questions.. If you are looking for more personalized answers, we recommend you book a consultation with one of our therapists .

What is a narrative therapy approach?

Narrative therapy is a therapeutic approach that centers around storytelling. It treats individuals as the authors of their own stories, focusing on identifying and rewriting the internal dialogues, themes, characters, and plots that shape their lives. This approach helps clients distinguish between thoughts and feelings, facts and opinions, and reframes negative self-talk. It offers tools to describe experiences, feelings, and past traumas accurately, enabling the rewriting of unhelpful narratives and the discovery of one's voice in the process.

What are examples of narrative therapy?

Examples of narrative therapy involve the active and collaborative process of reframing and rewriting recurring life patterns that are not beneficial. It includes understanding dynamics, attachment styles, what one can control, and one's role in relationships. Through narrative therapy, individuals can gain clarity on their life goals and relationships, and learn new ways of engaging with the world. This therapy might involve unpacking thoughts, feelings, behaviors, and their interrelations, thereby enabling individuals to construct a more empowering and authentic personal narrative​.

What is the difference between narrative therapy and other talk therapy?

The difference between narrative therapy and other talk therapy lies in their focus and methods. While talk therapy generally involves discussing issues and exploring feelings, narrative therapy specifically emphasizes storytelling. In narrative therapy, the therapist and client work together to craft and understand the client's life story, identifying and rewriting harmful narratives. It's a process of recognizing and changing the stories people tell about themselves, which can influence their perceptions and behaviors. In contrast with other talk therapy, which may not necessarily focus on the narrative aspect of a person's experiences or delve into rewriting their life story​.

What is the main goal of narrative therapy?

The main goal of narrative therapy is to empower individuals to become the editors of their own life stories. It aims to help clients identify the themes that drive their experiences and re-story the themes that are draining or unproductive. This approach enables individuals to confront challenges confidently, rewriting narratives that inspire and energize them. Narrative therapy helps clients separate their identity from their problems, offering a space to reframe their experiences and past traumas, and discover their true voice. Ultimately, it seeks to guide individuals to a place of deep understanding and revelation, where they can learn new ways of engaging with the world and write a narrative that aligns with their true self and aspirations.

If you or someone you know is experiencing a crisis and needs immediate help, please call 911 or go to the nearest emergency room. This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

Clinically Reviewed by Christine Carville, LCSW-R.

Christine Carville, LCSW-R, is the co-founder and Chief Clinical Officer of Resilience Lab. Christine developed the Resilience Methodology, a trans-theoretical training model for therapists to provide individualized, flexible, trauma-informed care. She has also been teaching at the Columbia School of Social Work since 2016 and continues to maintain her own private psychotherapy practice.

Collection: Evidence for the effectiveness of narrative therapy

Evidence for the effectiveness of narrative therapy.

Francoise Karibwendea, Japhet Niyonsengaa, Serge Nyirinkwayac, Innocent Hitayezud, Celestin Sebuhoroa,Gitimbwa Simeon Sebatukuraa, Jeanne Marie Nteteaand Jean Mutabaruka

Background: Narrative Therapy is an efficacious treatment approach widely practiced for various psychological conditions. However, few studies have examined its effectiveness on resilience, a robust determinant of one’s mental health, and there has been no randomized controlled trial in sub-Saharan Africa.

Objective: This study sought to evaluate the efficacy of narrative therapy for the resilience oforphaned and abandoned children in Rwanda.

Method: This study was a‘parallel randomized controlled trial in which participants (n= 72) were recruited from SOS Children’s Village. Half of the participants (n= 36) were randomly allocated to the intervention group and the rest to the delayed narrative therapy group. For the intervention group, children attended ten sessions (55 min each) over 2.5 months. Data were collected using the Child and Youth Resilience Measure (CYRM) and analyzed using mixed ANOVA within SPSS version 28.

Result: The results from ANOVA indicated a significant main effect of time and group for resilience total scores. Of interest, there was a significant time by group interaction effect for resilience. Pairwise comparison analyses within-group showed a significant increase in resilience in the intervention group, and the effect size was relatively large in this group.

Conclusion: Our findings highlight the notable efficacy of narrative therapy for children’s resilience in the intervention group. Therefore, health professionals and organizations working with orphaned and abandoned children will apply narrative therapy to strengthen their resilience and improve mental health.

Link: https://www.tandfonline.com/doi/epdf/10.1080/20008066.2022.2152111?needAccess=true&role=button

Carlos A. Chimpén-López, Meritxell Pascheco, Teresa Pretel-Luque, Rebeca Bastón and Daniel Chimpén-Sagrado

We present The Couple’s Tree of Life (CTOL) as a new col- lective narrative methodology to strengthen couple rela- tionships and prevent conflicts. The CTOL, based on the tree of life methodology (Ncube & Denborough, Tree of Life, mainstreaming psychosocial care and support: a man- ual for facilitators, REPSSI, 2007), aims to reinforce the identity and strengths of the couple. We explain the CTOL implementation process and illustrate it step by step with a group of 14 adult heterosexual Caucasian couples who belonged to Protestant churches in Madrid (Spain). As a way to assess its usefulness before applying the CTOL to other groups of couples, we conducted a pre-post evalua- tion using the Dyadic Adjustment Scale of Spanier(1976). We found an improvement in dyadic adjustment, quality, understanding of, and satisfaction with, the relationship. The results, though not generalizable at this stage, suggest that the CTOL could reinforce the couple’s identity while maintaining individual identities. We also discuss the pos- sible applications of couples therapy. Link

The purpose of this study was to explore women’s experiences in a narrative therapy-based group conducted to help participants re-author their stories. Seven women who were either patients or individuals enrolled in Transition Support for Employment at a psychiatric clinic participated in the meetings, one every fortnight. Each session explored a theme based on narrative therapy techniques such as externalization. The participants wrote their reflections during each session, and completed the Beck Depression Inventory-Second Edition (BDI-II) during the initial and final sessions. An affinity diagram was developed to classify their written reflections into 22 lower categories (e.g.,  new understanding of self ,  forward-looking-understanding of life ) and 4 upper categories (“Insight,” “Sharing with others,” “Changes with understanding of lives,” “Higher motivation”). The relationship among five lower categories comprising “Insight” was explored, and it became apparent that clarification of participants’ own thoughts about social problems functioned as a mediator promoting the process. The largest portion of depressed feelings emerged during the initial session, and four participants had lower scores for BDI-II items such as self-criticism in the final session. The results suggest that the group’s purpose was realized. However, future studies should examine participants’ feelings more closely, especially during the initial session.

https://onlinelibrary.wiley.com/doi/full/10.1111/jpr.12326

Esther Oi Wah Chow, MSW, RSW, PhD, *, and Sai-Fu Fung, BSocSc, MA, PhD

*Address correspondence to: Esther O. W. Chow, MSW, MNTCW, PhD, RSW, Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong. [email protected]

Background and Objectives: We developed a new group practice using strength- and meaning-based Narrative Therapy (NT) for older Chinese living in Hong Kong (HK), to enhance their life wisdom. This paper reports on the intervention and its short- and longer-term effectiveness. Research Design and Methods A randomized waitlist-controlled trial (RCT) was conducted. A total of 157 older adults were randomly recruited, of whom 75 were randomly assigned to the intervention group which received four two-hour bi-weekly NT sessions using the ‘Tree of Life’ (ToL) metaphor. The others were placed on a waitlist. Perceived wisdom was assessed using the Brief Self-Assessed Wisdom Scale (BSAWS). Assessment occurred at baseline (T0), end of treatment (T1), and four (T2) and eight months later (T3). Over-time effects of NT on wisdom scores were assessed using latent growth curve models with time-invariant covariates for impact. Results The intervention (NT) group showed significant, sustainable over-time within-group improvement in perceived wisdom. Moreover, compared with the control group, the NT group showed significant immediate improvements in perceived wisdom [F(2.726, p = 0.041)], which were maintained at all follow-up points. This effect remained after controlling for age, gender and educational level [TML(11) = 17.306, p = 0.098, RMSEA = 0.079, CFI = 0.960]. No adverse reaction was recorded. Discussion and Implications NT underpinned by a ToL methodology offers a new theory to understand, promote and appreciate perceived wisdom in older Chinese living in HK. It contributes to psychotherapy and professional social work practice for older Chinese.

Mustafa Kemal Yöntem, Ömer Özer, Yeliz Kan

The purpose of this study was to adapt the Tree of Life application, which was developed based on narrative approach and used for trauma interventions frequently, into career counseling and evaluate its effectiveness on secondary schoolers’ career decision-making self-efficacy. Within the scope of the study, the effectiveness of career counseling program based on narrative therapy was investigated. This study is a quasi-experimental research which was carried out in Turkey. In this research, a 2X2 quasi-experimental design with pre-test and post-test measurements was used. First, two groups were formed, one as experimental and one as a control group. The career story development program based on the narrative therapy which was developed by the researchers was applied on the participants in the experimental group. All of the participants in the study were seventh grade students in the secondary school and 14 years old. The experiment group had 13 participants (6 male, 7 female), and the control group consisted of 12 participants (5 male, 7 female). Demographic Form and Career Decision-Making Self-Efficacy (CDMSES) Scale were used as the data collection tools. In order to examine the research questions, Mann Whitney U-test was conducted between the pre-test and post-test scores of the experimental and control groups. According to the findings, while there was no significant difference between the pre-test scores for all sub-dimensions and total scores of the experimental group and the control group (p>, 05), significant differences were observed in the post-test scores in favor of the experimental group (p <, 05).

Effat Ghavibazou, Simin Hosseinian and Abbas Abdollahi The current study was designed as quasi‐experimental with a pretest and post‐test evaluating the efficacy of narrative therapy on communication patterns for women experiencing low marital satisfaction. Thirty women experiencing low marital satisfaction were chosen using convenience sampling and were randomly assigned to an intervention and waiting list group. The intervention group was treated individually by narrative therapy in eight 45‐minute sessions. Results from repeated measurement ANOVA revealed significant differences between and within the groups and interaction between and within groups. Independent and paired t‐test results showed significant improvement in the intervention group in their marital satisfaction, male‐demand/female‐withdraw, and total demand/withdraw with maintenance at eight weeks follow‐up. Results included increased marital satisfaction, reduced male‐demand/female‐withdraw, and reduced total demand/withdraw. Thus, results show that narrative therapy is effective in increasing the marital satisfaction indicators of male‐demand/female‐withdraw, total demand/withdraw, and marital satisfaction. Link.

Esther Oi Wah Chow and Doris Yuen Hung Fok

Chow, E. O. W., & Fok, D. Y. H. (2020). Recipe of Life: A Relational Narrative Approach in Therapy With Persons Living With Chronic Pain.  Research on Social Work Practice ,  30 (3), 320-329.

This paper reports on the use of a culturally resonant adaptation to a narrative therapy methodology with older adults in Hong Kong diagnosed with chronic pain. The metaphor of ‘spiritual seasoning of life’ was applied throughout six group-based sessions that followed narrative therapy maps. Three themes illuminating significant life enhancements were generated from subsequent participant interviews: Rediscovery of Personal Capabilities, Validation of Preferred Identity and Fusion of Spiritual Seasoning of Life. The authors conclude that narrative therapy was shown to be an applicable and effective approach for people living with chronic pain.

De-Hui Ruth Zhou, Yu-Lung Marcus Chiu, Tak-Lam William Lo, Wai-Fan Alison Lo, Siu-Sing Wong, Chi Hoi Tom Leung, Chui-Kam Yu, Yuk Sing Geoffrey Chang & Kwok-Leung Luk

Journal of Mental Health, published online 15 Jul 2020

DOI: 10.1080/09638237.2020.1793123

https://www.tandfonline.com/doi/abs/10.1080/09638237.2020.1793123?journalCode=ijmh20

Situated in the Hong Kong context, this study utilises a methodology commonly associated with evidence-based practice to determine the helpfulness of collective narrative therapy groups for family members of someone living with schizophrenia. Until now, local programs to support family members have largely focussed on imparting skills and knowledge in caregiving. By way of an alternative, this article provides in replicable detail an account of steps taken to engage with creative metaphors and culturally-specific adaptations to narrative practice that centre the skills and knowledge family members already have. The authors conclude that the practice implications of their study point to the helpfulness of a narrative stance for eliciting stories about existing knowledge, the significance of attending to the uniqueness of culture and context, and the benefits of exploring preferred identity stories for family members with caring responsibilities.

Esther OW Chow

Chow, E. O. (2018). Narrative Group Intervention to reconstruct Meaning of Life among Stroke Survivors: A Randomized Clinical Trial Study.  Neuropsychiatry , 08(04). doi:10.4172/neuropsychiatry.1000450

This study evaluated a narrative therapy meaning-making approach in relation to stroke survival. Following a series of conversations that focussed on deconstructing dominant life stories, externalising problem-saturated experience, and re-authoring identity, participants reported sustained improvements across a range of outcome measures. Stroke knowledge, mastery, self-esteem, hope, meaning in life, and life satisfaction were all demonstrated to have increased, whereas experiences of depression had decreased. The authors conclude that the indicated effects for self-concepts and improved meaning in life were sufficiently encouraging to suggest narrative therapy may be a viable option for facilitating stroke recovery.

Sarah Penwarden (2018) [ PhD thesis, University of Waikato ]

A key concern for therapists is how therapeutic change occurs, and what particular elements of therapy lead towards change. This project investigated how one approach in narrative therapy—rescued speech poetry—might enhance another therapeutic approach, re-membering conversations. Re-membering conversations nurture connections between a bereaved person and a loved person who has died. These conversations actively weave the stories of the lost loved one back into the life of the bereaved person, so that the loved one’s values and legacies continue to resound. This research explored how a literary approach—rescued speech poetry—potentially enhanced the nearness and contribution of a loved one, through capturing stories in a poetic form.

Marie-Nathalie Beaudoin, Meredith Moersch and Benjamin S. Evare

Journal of Systemic Therapies, Vol. 35, No. 3, 2016, pp. 42–59

This article examines the effectiveness of narrative therapy in boosting 8- to 10-year-old children’s social and emotional skills in school. Data were collected from 353 children over two years, and two research assistants independently coded 813 stories. Children’s personal accounts of their attempts at solving conflicts in their daily lives were collected before and after a series of narrative conversations, and compared to stories collected during the same time interval with a control group. The control data included a set of stories from waitlisted participants and those from students assigned to only a control group. The results of the study show that children receiving narrative therapy intervention showed a significant improvement in self-awareness, self-management, social awareness/empathy, and responsible decision making when compared to their own first stories and the stories from children in the control group. Improvement in relationship skills was present in both cohorts but was significant only for the second year. There was no significant gender difference. Narrative therapy practices such as externalizing and re-authoring can significantly contribute to the development of children’s social and emotional skills. Implications of these results are discussed for all forms of therapeutic interventions, regardless of theoretical orientation.

M. Seo, H. S. Kang, Y. J. Lee, S. M. Chae. Journal of Psychiatric and Mental Health Nursing Volume 22, Issue 6, pages 379–389, August 2015 :  http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111/jpm.12200  

Narrative therapy, which allows a person to ‘re-author’ his/her life stories by focusing on positive interpretations, and emotion-focused therapy, which enables the person to realize his/her emotions, are useful approaches in the treatment of depression. Narrative therapy with an emotional approach (NTEA) aims to create new positive life narratives that focus on alternative stories instead of negative stories. The purpose of this study was to evaluate the effects of the NTEA programme on people with depression utilizing a quasi-experimental design. A total of 50 patients (experimental 24, control 26) participated in the study. The experimental group completed eight sessions of the NTEA programme. The effects of the programme were measured using a self-awareness scale, the Nowotny Hope Scale, the Positive Affect and Negative Affect Scale, and the Center for Epidemiological Studies-Depression Scale. The two groups were homogeneous. There were significant differences in hope, positive and negative emotions, and depression between the experimental and control group. The results established that NTEA can be a useful nursing intervention strategy for people with depression by focusing on positive experiences and by helping depressed patients develop a positive identity through authoring affirmative life stories.

Erbes CR, Stillman JR, Wieling E, Bera W, Leskela J. J Trauma Stress. 2014 Dec;27(6):730-3. doi:  10.1002/jts.21966 . Epub 2014 Nov 10.

Narrative therapy is a postmodern, collaborative therapy approach based on the elaboration of personal narratives for lived experiences. Many aspects of narrative therapy suggest it may have great potential for helping people who are negatively affected by traumatic experiences, including those diagnosed with posttraumatic stress disorder (PTSD). The potential notwithstanding, narrative therapy is relatively untested in any population, and has yet to receive empirical support for treatment among survivors of trauma. A pilot investigation of the use of narrative therapy with 14 veterans with a diagnosis of PTSD (11 treatment completers) is described. Participants completed structured diagnostic interviews and self-report assessments of symptoms prior to and following 11 to 12 sessions of narrative therapy. After treatment, 3 of 11 treatment completers no longer met criteria for PTSD and 7 of 11 had clinically significant decreases in PTSD symptoms as measured by the Clinician Administered PTSD Scale. Pre- to posttreatment effect sizes on outcomes ranged from 0.57 to 0.88. These preliminary results, in conjunction with low rates of treatment dropout (21.4%) and a high level of reported satisfaction with the treatment, suggest that further study of narrative therapy is warranted as a potential alternative to existing treatments for PTSD.

Majid Yoosefi Looyeh, Khosrow Kamali, Amin Ghasemi, Phuangphet Tonawanik The Arts in Psychotherapy,  2014,  41: 1: 16-20 DOI:  10.1016/j.aip.2013.11.005

This study applied group narrative therapy to treating symptoms of social phobia among 10–11 year old boys. The treatment group received fourteen 90-min sessions of narrative therapy twice a week. Group narrative therapy was effective in reducing symptoms of social phobia at home and school as reported by parents and teachers.

Lopes, Rodrigo T.: Gonçalves, Miguel M.; Machado, Paulo; Sinai, Dana; Bento, Tiago & Salgado, João. Psychotherapy Research . Nov 2014, Vol. 24 Issue 6, p.662-674.

Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.

Lambie, I., Murray, C., Krynen, A., Price, M., & Johnston, E. (2013). The Evaluation of Undercover Anti-Bullying Teams. (Report). Auckland: Ministry of Education, Te Tāhuhu o Te Mātauranga.

https://www.dulwichcentre.com.au/UABT-Final-Report.pdf

Bullying is a significant societal problem in schools, having serious implications for both victims and perpetrators. While there have been many interventions developed to try and combat bullying in schools, many of these interventions are not formally evaluated. The current study evaluated an anti-bullying intervention that adopts a restorative approach that uses peer-led Undercover Anti-bullying Teams (UABTs) to combat bullying in the classroom. To evaluate this approach, the current study implemented the use of a pre- test/post-test experimental design in additional to qualitative interview data. The results suggest that following the intervention, there was a significant reduction in victimisation and a significant increase in students’ perceptions of personal support from other students in the class. Additionally, a number of themes emerged to suggest feelings of “inclusion” and “social support” were helpful to reduce distress for victims, and to help them feel more confident in the classroom. Additionally, the central elements of “autonomy” and “teamwork” that are inherent in the UABT intervention were helpful for team members in supporting the bullying victim and reducing bullying in the classroom.

Cashin, A, Browne, G, Bradbury, J & Mulder, AM 2013 Journal of Child and Adolescent Mental Health Nursing, vol. 26, no. 1, pp. 32-41. http://dx.doi.org/10.1111/jcap.12020

The aim of this pilot study was to be the first step toward empirically determining whether narrative therapy is effective in helping young people with autism who present with emotional and behavioral problems. Autism is increasingly being recognized in young people with average and above intelligence. Because of the nature of autism, these young people have difficulty navigating the challenges of school and adolescence. Narrative therapy can help them with their current difficulties and also help them develop skills to address future challenges. Narrative therapy involves working with a person to examine and edit the stories the person tells himself or herself about the world. It is designed to promote social adaptation while working on specific problems of living. This pilot intervention study used a convenience sample of 10 young people with autism (10–16 years) to evaluate the effectiveness of five 1 hr sessions of narrative therapy conducted over 10 weeks. The study used the parent-rated Strengths and Difficulties Questionnaire (SDQ) as the primary outcome measure. Secondary outcome measures were the Kessler-10 Scale of Psychological Distress (K-10), the Beck Hopelessness Scale, and a stress biomarker, the salivary cortisol to dehydroepiandrosterone (DHEA) ratio.

Significant improvement in psychological distress identified through the K-10 was demonstrated. Significant improvement was identified on the Emotional Symptoms Scale of the SDQ. The cortisol:DHEA ratio was responsive and a power analysis indicated that further study is indicated with a larger sample. Narrative therapy has merit as an intervention with young people with autism. Further research is indicated.

Mala German Educational & Child Psychology . Dec2013, Vol. 30 Issue 4, p75-99

This paper evaluates the use of the ‘Tree of Life’ (ToL) intervention with a class of 29 Year 5 pupils (aged 9 and 10-years-old) in a primary school in North London. This was an exploratory study to see if ToL could be adapted to a mainstream education setting and could be used as a whole class intervention. This paper examines the effectiveness of ToL in enhancing the pupils’ self-esteem and in developing their understanding of their own culture and that of their peers. Findings from semi-structured interviews, preand post-intervention, were used to explore the pupils’ baseline knowledge of their own family and cultural background and in their understanding of key concepts such as ‘culture’, ‘ethnicity’, and ‘racism.’ Qualitative analysis was applied to identify key themes emerging from these interviews. Results from quantitative analysis found a significant improvement in the pupil’s self-concept post-intervention. The pupils also reported positive improvements in cultural understanding of themselves and other class members whilst some reported a reduction in racist behaviour. This paper concludes with a discussion of the limitations of the study and advocates that EPs become more involved in utilising strength-based interventions in developing cultural understanding and community cohesion.

Looyeh MY, Kamali K, Shafieian R

Family Research and Development Centre, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia. [email protected] This study explored the effectiveness of group narrative therapy for improving the school behavior of a small sample of girls with attention-deficit/hyperactivity disorder (ADHD). Fourteen clinics referred 9- to 11-year-old girls with a clinical diagnosis of ADHD were randomly assigned to treatment and wait-list control groups. Posttreatment ratings by teachers showed that narrative therapy had a significant effect on reducing ADHD symptoms 1 week after completion of treatment and sustained after 30 days.  Arch Psychiatr Nurs.  2012 Oct;26(5):404-10. doi: 10.1016/j.apnu.2012.01.001. Epub 2012 Mar 28. http://www.ncbi.nlm.nih.gov/pubmed/22999036  

Elaine Hannen, Kevin Woods

Educational Psychology in Practice 01/2012; 28(2):187-214. DOI:10.1080/02667363.2012.669362 https://www.tandfonline.com/doi/abs/10.1080/02667363.2012.669362?journalCode=cepp20#preview The National Institute for Clinical Excellence identifies educational psychologists as appropriate specialists to deliver interventions to promote the emotional well-being of children and families. A role for practitioner educational psychologists in providing specific therapeutic interventions has also been proposed by commentators. The present study reports an evaluative case study of a narrative therapy intervention with a young person who self-harms. The analysis of data suggests that the narrative therapy intervention was effectively implemented and resulted in attributable gains in emotional well-being, resilience and behaviour for the young person. The authors discuss the role of the educational psychologist in delivering specific therapeutic interventions within a local authority context and school-based setting. Consideration is also made of the development of the evidence base for the effectiveness of narrative therapy intervention with young people who self-harm.

Everett McGuinty, MA, David Armstrong, PhD, John Nelson, MA, and Stephanie Sheeler, BA Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077 http://onlinelibrary.wiley.com/doi/10.1111/j.1744-6171.2011.00305.x/abstract Author contact:  [email protected] The intent of this article is to explore the efficacy of both the literal and concrete externalization aspects within narrative therapy, and the implementation of interactive metaphors as a combined psychotherapeutic approach for decreasing anxiety with people who present with high-functioning autism. The purpose of this exploratory article is to propose the use of externalizing metaphors as a treatment modality as a potentially useful way to engage clients. Specifically, a three-step process of change is described, which allows for concretizing affective states and experiences, and makes use of visual strengths of people presenting with an autism spectrum disorder. A selective review was conducted of significant works regarding the process of change in narrative therapy, with particular emphasis on metaphors. Works were selected based on their relevance to the current paper and included both published works (searched via Psyc-INFO) and materials from narrative training sessions. Further research is needed to address the testable hypotheses resulting from the current model. This line of research would not only establish best practices in a population for which there is no broadly accepted treatment paradigm, but would also contribute to the larger fields of abnormal psychology, emotion regulation, and cognitive psychology by further elucidating the complex ways these systems interact.

Lynette P. Vromans & Robert D. Schweitzer (2010)

Psychotherapy Research , 19 March 2010, doi: 10.1080/10503301003591792 http://www.ncbi.nlm.nih.gov/pubmed/20306354

This study investigated depressive symptom and interpersonal relatedness outcomes from eight sessions of manualized narrative therapy for 47 adults with major depressive disorder. Post-therapy, depressive symptom improvement (d=1.36) and proportions of clients achieving reliable improvement (74%), movement to the functional population (61%), and clinically significant improvement (53%) were comparable to benchmark research outcomes. Post-therapy interpersonal relatedness improvement (d=.62) was less substantial than for symptoms. Three-month follow-up found maintenance of symptom, but not interpersonal gains. Benchmarking and clinical significance analyses mitigated repeated measure design limitations, providing empirical evidence to support narrative therapy for adults with major depressive disorder.

Sommayeh Sadat MacKean *, Hossein Eskandari, Ahmad Borjali , Delaram Ghodsi    

* Msc in General Psychology, Faculty of Psychology and Educational Sciences, Allameh Tabatabaii University, Tehran, Iran – Faculty of Psychology and Educational Sciences, Allameh Tabatabaii University, Tehran, Iran. Tel: +98- 912- 1868311 , [email protected]

This study was carried out according to importance of body image in overweight women, and in order to compare the effect of diet therapy and narrative therapy on the body image improvement. Materials and Methods: This was a quasi experimental-interventional study. 30 overweight women were selected through randomized sampling method within women who referred to professional clinic of nutrition and diet therapy and they randomly divided to two interventions and one control group. Group 1 only received diet therapy (for 5weeks), group 2 received narrative therapy in addition to diet therapy and control group received no intervention.

Narrative therapy was a group therapy that consisted of 12 sessions and each session last 50 minutes that performed twice a week. Control group received no intervention. Weight of subjects was measured with light cloths by a Seca balance scale to the nearest 0.5 kg and their height was measured by stadio-meter to 0.5 cm. Body Mass Index was calculated by dividing weight (in kg) to squared height (in m2). Data of Body Image were gathered through Multidimensional Body-Self Relation Questionnaire. Data were analyzed by covariance analysis, Tukey and paired t test using SPSS 16 software.

Results: The mean of body image at the beginning of the study in the control group, was 135.20 and it was134.60 after the intervention. In group 1, at the beginning of the study the mean was 148.1 and after the intervention was 147.50. In group 2, at the beginning of the study the mean was 150.80 and after the intervention the result was 163.90. Data analysis showed that at the end of the study diet therapy had no significant effect on developing of body image (P>0.05). But narrative therapy was more effective than diet therapy in developing of body image in overweight women (P<0.001). ‍Conclusion: According to effect of narrative therapy on body image development, this method is more suitable than the other methods which have greater results in weight loss. Pajoohandeh Journal. 2010; 15 (5) :225-232   http://pajoohande.sbmu.ac.ir/browse.php?a_code=A-10-1-655&sid=1&slc_lang=en

Jennifer Poolea, Paula Gardner, Margaret C. Flower & Carolynne Cooper Social Work With Groups, Volume 32, Issue 4, 2009 https://www.tandfonline.com/doi/abs/10.1080/01609510902895086#.Uk-lShBKiSo  In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.

Karen Young and Scot Cooper (2008) Journal of Systemic Therapies, Vol. 27, No. 1, 2008, pp. 67–83

Link to full article.

In this article, we will report on the Narrative Therapy Re-Visiting Project. Narrative ways of thinking shape research in ways that strive to center the voice of the therapy participant. We will present qualitative research findings that bring to the forefront the personal thoughts of the participants about what was meaningful and useful in therapeutic conversations. This contribution moves away from solely interpreted understandings of professionals and toward co-composed understandings between professionals and therapy participants. In a follow-up meeting, persons who have come to us for single session therapy/consultation, return to re-visit videotape of the earlier session.

All of the sessions took place in a walk-in clinic and in single session consultations; therefore the feedback is about narrative practice in a single session encounter. The authors systematically document the participants’ accounts and descriptions of meaningful moments and experiences of the therapeutic process using qualitative methodology and attempt to discern from them themes and implications for therapeutic practice.

Lynette Vromans (2008) [PhD thesis, Queensland University of Technology]

The research aim, to investigate the process and outcome of narrative therapy, comprised theoretical and empirical objectives. The first objective was to articulate a theoretical synthesis of narrative theory, research, and practice. The process of narrative reflexivity was identified as a theoretical construct linking narrative theory with narrative research and practice. The second objective was to substantiate this synthesis empirically by examining narrative therapy processes, specifically narrative reflexivity and the therapeutic alliance, and their relation to therapy outcomes. The third objective was to support the proposed synthesis of theory, research, and practice and provide quantitative evidence for the utility of narrative therapy, by evaluating depressive symptom and inter-personal relatedness outcomes through analyses of statistical significance, clinical significance, and benchmarking …

To support this theoretical synthesis, a process-outcome trial evaluated eight-sessions of narrative therapy for 47 adults with major depressive disorder. Dependent process variables were narrative reflexivity (assessed at Sessions 1 and 8) and therapeutic alliance (assessed at Sessions 1, 3, and 8). Primary dependent outcome variables were depressive symptoms and inter-personal relatedness. Primary analyses assessed therapy outcome at pre-therapy, post-therapy, and three-month follow-up and utilized a benchmarking strategy to the evaluate pre-therapy to post-therapy and post-therapy to follow-up gains, effect size and pre-therapy to post-therapy clinical significance … The clinical trial provided empirical support for the utility of narrative therapy in improving depressive symptoms and inter-personal relatedness from pre-therapy to post-therapy: the magnitude of change indicating large effect sizes (d = 1.10 to 1.36) for depressive symptoms and medium effect sizes (d = .52 to .62) for inter-personal relatedness.

Therapy was effective in reducing depressive symptoms in clients with moderate and severe pre-therapy depressive symptom severity. Improvements in depressive symptoms, but not inter-personal relatedness, were maintained three-months following therapy. The reduction in depressive symptoms and the proportion of clients who achieved clinically significant improvement (53%) in depressive symptoms at post-therapy were comparable to improvements from standard psychotherapies, reported in benchmark research. This research has implications for assisting our understanding of narrative approaches, refining strategies that will facilitate recovery from psychological disorder and providing clinicians with a broader evidence base for narrative practice … This thesis was awarded the Outstanding Doctoral Thesis award across the Queensland University of Technology Faculty of Health. Read the  complete thesis here . 

Read examiner comments here:  Examiner number 1  (pdf, 47 KB),  Examiner number 2  (pdf, 15 KB).

Lewis Mehl-Madrona, MD, PhD

The Permanente Journal/ Fall 2007/ Volume 11 No. 4

Narrative approaches to psychotherapy are becoming more prevalent throughout the world. We wondered if a narrative-oriented psychotherapy group on a locked, inpatient unit, where most of the patients were present involuntarily, could be useful. The goal would be to help involuntary patients develop a coherent story about how they got to the hospital and what happened that led to their being admitted and link that to a story about what they would do after discharge that would prevent their returning to hospital in the next year.

Sonja Berthold (June 2006)

Funded by Relationships Australia Northern Territory

This is an independent evaluation of a narrative therapy/collective narrative practice project conducted in two Aboriginal communities in Arnhem Land – Yirrkala & Gunyangara. The project aimed to:

• reduce suicidal thinking/behaviour/injury, self-harm and death by suicide
• enhance resilience, respect, resourcefulness, interconnectedness, and mental health of individuals, families, and communities and to reduce prevalence of risk conditions
• increase support available to individuals, families, and communities who have been affected by suicidal behaviours.  

The project was conducted in partnership between Dulwich Centre and Relationships Australia Northern Territory. For more information about the project, read: ‘Linking stories and initiatives: A narrative approach to working with the skills and knowledge of communities’ by David Denborough, Carolyn Koolmatrie, Djapirri Mununggirritj, Djuwalpi Marika, Wayne Dhurrkay, & Margaret Yunupingu.

The independent evaluation found:

Did this project work? Yes, this project worked because it:

• reminded people of their strength and of their dreams
• increased the self-esteem and confidence of individual and groups, and reinforced their ability to deal with suicide and suicidal thinking
• created an opportunity for these communities to forge links with another Indigenous community, a link which strengthens and comforts both
• provided an audience for the stories and passed on the responses
• people see that their knowledge and experience is of value to others
• the community came together to celebrate their strengths and abilities
• ensured that local workers were linked into and supporting this process
• left a resource that is still being used.

What was done well?

• Good, thorough consultation with resulted in changes
• Professional and respectful approach
• Project tried to link in outside workers to help the project continue
• The narrative approach was very successful and well accepted
• Connected very strongly with key leaders in each community
• Delivered relevant, interesting, and useful training
• Provided  learning opportunity for Yolgnu people through ensuring local people were involved in the narrative approach
• The team were flexible and able to respond to what was needed and have maintained a connection with the communities
• Made sure that they left a resource for the community to use.

To read the entire evaluation,  click here  (pdf, 307 KB).

Mim Weber, Kierrynn Davis, & Lisa McPhie (2006) Australian Social Work, 59 (4), 391–405.  doi: 10.1080/03124070600985970

This paper reports on a study conducted with seven women who identified themselves as experiencing depression as well as an eating disorder and who live in a rural region of northern New South Wales. Self-referred, the women participated in a weekly group for 10 weeks, with a mixture of topics, conducted within a narrative therapy framework. A comparison of pre- and post-group tests demonstrated a reduction in depression scores and eating disorder risk. All women reported a change in daily practices, together with less self-criticism. These findings were supported by a post-group evaluation survey that revealed that externalisation of, and disengagement from, the eating disorder strongly assisted the women to make changes in their daily practices. Although preliminary and short-term, the outcomes of the present study indicate that group work conducted within a narrative therapy framework may result in positive changes for women entangled with depression and an eating disorder.

Margaret L. Keeling, L. Reece Nielson Contemporary Family Therapy , September 2005, Volume 27, Issue 3, pp 435-452

International and minority populations tend to underutilize mental health services, including marriage and family therapy. Models of marriage and family therapy developed in the West may reflect Western values and norms inappropriate for diverse cultural contexts. This article presents an exploratory, qualitative study of a narrative therapy approach with Asian Indian women. This study adds to the small body of narrative-based empirical studies, and has a unique focus on intercultural applications and the experience of participants. Participant experience was examined along four phenomenological dimensions. Findings indicate the suitability of narrative interventions and nontraditional treatment delivery for this population.

Evril Silver, Alison Williams, Fiona Worthington, and Nicola Phillips (1998) Journal of Family Therapy, 20, 413–422.

This is a retrospective audit of the therapy outcome of 108 children with soiling and their families. Fifty-four children were treated by externalizing and 54 comparison children and families were treated by the usual methods in the same clinic. The results from the externalizing group were better and compared favourably with standards derived from previous studies of soiling. Externalizing was rated as much more helpful by parents at follow-up.

David Besa, California Graduate School of Family Psychology (1994) Research on Social Work Practice, 4 (3), 309–325.  doi: 10.1177/104973159400400303

This study assessed the effectiveness of Narrative Therapy in reducing parent/child conflicts. Parents measured their child’s progress by counting the frequency of specific behaviours during baseline and intervention phases. The practitioner-researcher used single-case methodology with a treatment package strategy, and the results were evaluated using three multiple baseline designs. Six families were treated using several Narrative Therapy techniques including externalisation, relative influence questioning, identifying unique outcomes and unique accounts, bringing forth unique re-descriptions, facilitating unique circulation, and assigning between-session tasks. Compared to baseline rates, five of six families showed improvements in parent/child conflict, ranging from an 88% to a 98% decrease in conflict. Improvements occurred only when Narrative Therapy was applied and were not observed in its absence.

Fred W. Seymour & David Epston (1989) Australian & New Zealand Journal of Family Therapy, 10 (3).

Childhood stealing is a distressing problem for families and may have wider community costs since childhood stealers often become adult criminals. This paper describes a therapeutic ‘map’ that emphasises direct engagement of the child, along with his/her family, in regarding the child from ‘stealer’ to ‘honest person’. Analysis of therapy with 45 children revealed a high level of family engagement and initial behaviour change. Furthermore, a follow-up telephone call made 6–12 months after completion of therapy sessions revealed that 80% of the children had not been stealing at all or had substantially reduced rates of stealing. This community practice, which was in part researched by Seymour and Epston, has recently been written up in some detail in ‘ Community approaches – real and virtual – to stealing ’ (pdf, 68 KB)  [Epston, D., & Seymour, F. (2008). In Epston, D.,  Down under and up over: Travels with narrative therapy , Warrington, England: AFT Publishing Limited, pp. 139–156.]

Report by Linzi Rabinowitz. Researchers: Linzi Rabinowitz and Rebecca Goldberg

Hero Books are a psychosocial support intervention developed by Jonathan Morgan (REPSSI) which are informed by narrative therapy ideas. This study presents preliminary evidence to support the contention that the mainstreaming of PSS (psychosocial support) in the South African school curriculum by means of the Hero Book is likely to produce two significant outcomes:

• learners who have undergone the Hero Book process are more likely to perform better in the learning areas of Life Orientation and Language (Home Language and first additional Language) than learners whose educators did not use Hero Books as measured by the same  learning outcomes and assessment standards
• learners whose educators used the Hero Book methodology to pursue academic outcomes are more likely to exhibit an improvement in their psychosocial wellbeing than learners whose educators do not use the Hero Book methodology.

A mix of quantitative and qualitative data collection and analysis supports these findings. While none of the findings are conclusive, and the study admittedly has limitations, the strongest quantitative finding is this one: 77% of learner’s academic performance as measured by an average mark for all three learning areas (Home Language, First Additional Language, and Life Orientation) improved overall for the Hero book group, as opposed to 55% in the control groups. This finding suggests that the hero book intervention might be pursued purely on its potential as a methodology to enhance academic learning outcomes, and where any improvements in the psychosocial wellbeing of learners is an added bonus of the intervention. The sample size consisted of four control groups and four intervention groups across two research sites, the Western Cape and KwaZulu Natal. There was a total of 172 learners in the control groups and 113 in the intervention groups. For full report, contact Jonathan Morgan:  [email protected]

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Paper 1: a systematic synthesis of narrative therapy treatment components for the treatment of eating disorders

Lauren heywood.

1 School of Psychology, Western Sydney University, Sydney, Australia

Janet Conti

2 Translational Health Research Institute, Western Sydney University, Sydney, Australia

Phillipa Hay

3 School of Medicine, Western Sydney University, Sydney, Australia

Associated Data

Not Appilicable.

There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs.

Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs.

This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview.

Plain English summary

There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-022-00635-5.

Eating Disorders (EDs) are defined in the Diagnostic Statistical Manual of Mental Disorders–Fifth Edition (DSM-5) [ 1 ] as a cluster of behaviours designed to control weight, which have negative impacts on physical and psychological functioning. The DSM-5 identifies several diagnostic categories of EDs including, but not limited to, Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED).

The restrictive and purging behaviours associated with AN and binge purging behaviours in BN can result in substantial and life-threatening medical conditions that can have long-term physiological consequences [ 1 , 2 ]. Individuals with AN have a death rate that is six times higher than that of the general population and the crude mortality rate (CMR) is estimated to be at 5% and 2% per decade for AN and BN respectively [ 1 , 3 ]. This increased mortality rate is thought to be partially due to the elevated suicide rates in individuals with eating disorders, including 7% increased risk for individuals with BN and 12% for those with AN [ 1 ].

AN and BN also have high comorbidity with other psychiatric disorders, including anxiety and obsessive–compulsive disorders [ 4 , 5 ], depression [ 6 ], and cluster B personality disorders (anxious-avoidant, obsessive–compulsive, and dependant) [ 7 , 8 ]. Additionally, individuals who have experienced significant weight loss or malnutrition may experience symptoms including low mood, difficulties sleeping, social withdrawal, decreased libido and increased irritability as a result of the physical effects associated with starvation [ 9 , 10 ]. BED is thought to be associated with significant psychiatric comorbidity which is linked to the severity of binge-eating, with the most common disorders being mood disorders (i.e., bipolar disorder and depression), anxiety disorders and substance use disorders [ 1 ].

Treatments and outcomes

Treatments for EDs have varied significantly across time and only a limited range of interventions have been empirically evaluated or delivered in a specialised format [ 11 – 15 ]. Current treatments for EDs are facilitated in inpatient, day and outpatient settings. There is evidence that CBT-based programs have found to be effective in the treatment of BN, with manualised CBT programs showing significant improvements in weight gain and decreased eating disorder (ED) symptomatology [ 13 ]. For adult AN, the Maudsley Model of Treatment for Adults [ 16 ], psychodynamic approaches [ 17 ], and Specialist Supportive Clinical Management (SSCM) [ 14 ] have been found to be effective in symptom reduction for adult AN. For adolescent AN, Maudsley Family Therapy and Family-Based Therapy (FBT) [ 18 ] have been found to be effective in symptom reduction. Despite this, there is no one treatment modality that is regarded as best practice for the treatment of AN [ 14 ]. Furthermore, psychological treatments for EDs have not been shown to be consistently more effective than treatment as usual, and no specific treatment is consistently more successful than others [ 15 , 19 , 20 ].

Further research has shown that treatments that focus primarily on eating behaviour and weight restoration may inadequately address the broader needs and preferences of those with a lived ED experience [ 21 – 25 ]. These challenges in determining best practice for treatment of EDs may be partially explained by the complexities characteristic of EDs. Many individuals with EDs report pervasive negative self-concepts, which can lead them to feel hopeless about their capacity to recover from an ED and undermine treatment engagement [ 26 ]. EDs may also be perceived by individuals as protective due to providing a sense of control, structure and/or achievement [ 27 ]. Individuals may begin to rely on and/or aspire to ongoing weight loss as the primary way of defining their identity and/or to reinstate a sense of self that may be due, in part, to others praising them when they first begin to lose weight [ 28 – 30 ]. As such, many individuals may struggle to conceptualise their lived experience of an ED as problematic, which is known as the egosyntonic features of the illness [ 23 , 31 ].

Research has also indicated that many individuals feel ambivalent about engaging in ED treatments [ 32 – 34 ]. This may be due, in part, to fear and uncertainty related to the potential loss of the ED [ 35 ]. Treatments have been described as traumatic for some [ 36 ], and the loss of the ED identity as traumatic for others [ 37 ]. Some individuals have conceptualised EDs as an enemy and a friend, and as somehow both separate and intrinsic to their own identity [ 38 – 40 ]. Likewise, other individuals have spoken about their experience as constructing and defending different ‘AN selves’, where recovery from AN involved a loss of identity or selves driven by perfection, sensitivity, competitiveness and protectiveness [ 41 ].

The perspectives of individuals on what constitutes ‘recovery’ from an ED ranges from ‘completely recovered’ to those who feel that the illness will be something they struggle with for the remainder of their lives [ 23 , 42 ]. Furthermore, individuals may experience recovery as going beyond symptom improvement, such as improving their overall quality of life [ 43 ] and gaining a sense of identity outside the ED [ 37 , 39 ].

The complexities associated with recovery from EDs highlight the need to consider how therapeutic interventions assist individuals in navigating issues of identity [ 25 ]. A need has been identified for treatments to more comprehensively focus on dismantling the ED-dominant identity and exploring the individual’s sense of self outside of the ED [ 34 , 43 ]. Individuals receiving treatment for BN have also emphasised the importance of person-centred practise that prioritises the creation of a ‘meaningful life’ [ 33 , 44 – 46 ]. Likewise, there is a growing body of literature to support the use of BED interventions that focus on developing self-compassion, rather than focusing exclusively on weight change [ 46 – 49 ].

As such, development and further research of new and emerging treatments for EDs is required in the hope of improving recovery rates, particularly in outpatient settings [ 9 , 50 ]. There is an expressed need by those with lived ED experience for interventions to explore questions of identity, including who am I outside of the ED identity? [ 31 , 37 ]. This is particularly relevant when considering the perspective that people live out or perform the meaning of their identity narratives or the stories they tell about themselves [ 51 , 52 ].

Narrative therapy

Narrative therapy, as developed by Michael White and David Epston, has been proposed as a therapeutic intervention for a range of psychological difficulties, including EDs [ 53 – 55 ]. The key treatment components of narrative therapy are first, deconstruction and externalisation of the problem story, and second finding, thickening, and performing the meaning of identity stories hidden by dominant, problem-saturated stories [ 53 , 54 , 56 – 64 ]. Narrative therapy is positioned within the broad philosophical movements of social constructionism and poststructuralism [ 53 ], which understand that the meanings a person makes of their life are shaped by social and cultural contexts within which they live. These contexts give rise to certain discourses, or taken-for-granted “truths” that are then taken up by individuals to construct versions of reality that are organised in narrative form, or as stories [ 60 , 65 ]. Narrative therapy proposes that a person’s identity is constructed in storied form and these identity stories guide how they think, feel and act in their lives [ 66 ].

Deconstruction or unpacking the meaning of dominant identity stories in narrative therapy is theoretically underpinned by post-structuralist philosophies, particularly the work of Michel Foucault [ 67 ]. The therapeutic practice of deconstruction of problematic stories is proposed to be instrumental in releasing self knowledges that were previously hidden by dominant storylines. These released self-knowledges are then available to the person to piece together an identity built on a valued sense of themselves [ 68 ]. Within a narrative worldview, a person’s identity is understood as multi-storied where their relationship with the problem is one of the many stories of their life. When a problem narrative dominates (for example the ED narrative), other stories of self are obscured. We have termed these stories, ‘hidden stories’ (as named by Daphne Hewson; personal communication) as they are hidden from view when the ED identity story dominates. These narratives, and the language that is constitutive of them, do not merely describe a person to themselves and others. Narrative therapy posits that individuals ‘perform the meaning’ of these stories [ 53 ]. That is, the stories we believe in and adopt as explanations of our reality, shape how we interact in everyday life.

There are three primary processes of narrative therapy. First, the person, family or community are invited to map the effects of the problem on their life, relationships and their identity [ 54 ]. This includes deconstruction or unpacking of meaning of problematic storylines and externalisation, where the problem is linguistically separated from the person’s identity [ 53 , 56 – 59 ] and named on the person’s experience-near terms.

The second process of narrative therapy is known as finding unique outcomes [ 60 ] and focuses on working with the person to find and reveal identity narratives that have been hidden by the dominant problem [ 54 ]. Finding unique outcomes is facilitated by relative influencing questioning to map the influence of the person over the problem that traces ways they have responded to and stood up to the problem [ 61 , 62 ] and ‘double listening’ [ 63 ] to identify what is absent but implicit in the problem story that speaks to the person’s preferred and valued stories [ 64 ]. In doing so, therapy focuses on ‘re-authoring conversations’ [ 54 ] that generate identity narratives that align more comprehensively with a person’s life, who they understand themselves to be, and their valued sense of themselves.

The final primary process of narrative therapy is thickening the meaning of hidden storylines that have been buried under the problem story through reviewing the history of the person’s influence over the problem and ways that their actions are inconsistent with the problem story. This leads to new meanings being made for old stories or ‘new-old stories’ [ 64 ]. Unique outcomes are further thickened by exploring the link to a person’s values, hopes, dreams, intentions, and possible future [ 62 , 69 ]. The presence of significant others is invited through the practice of ‘re-membering conversations’ that aim to provide rich identity accounts of memories of events where the person displayed particular values, skills or traits consistent with the revealed storylines [ 64 ] Narrative therapy also utilises therapeutic letter writing for the purposes of extending the therapeutic conversation between sessions, with a particular focus on documenting and thickening unique outcomes through prompting further reflections [ 53 , 60 ]. Letters may also be sent to family members or loved ones, to invite them to attend sessions or celebratory rituals, termed ‘reflecting teams’ [ 53 ].

Therefore, narrative therapy has scope to comprehensively address questions of identity [ 53 , 59 ], which have been identified to be important to the experiencing person across qualitative studies in ED treatments [ 25 ]. Despite this, there are few comprehensive systematic reviews on the content or treatment outcomes studies of narrative therapy conducted to treat EDs. Likewise, there does not currently exist a manualised approach to using narrative therapy in the treatment of EDs. Manualising narrative therapy is seemingly counter-intuitive to the narrative approach that is designed to be person-centred with the worldview that the person is the expert of their life and therefore need not be treated by being fitted into a pre-existing treatment framework or model. Nevertheless, there is a need to have a greater understanding of the components proposed by those who have expertise in the treatment of EDs with narrative therapy to inform future research into narrative therapy treatments for EDs.

The current study

The aim of this narrative synthesis was to synthesise information concerning the content of narrative interventions for individuals who experience EDs. It sought to understand key aspects, content, and techniques of narrative therapy interventions in EDs in order to inform their future development. Specific techniques examined in the narrative synthesis included components of the narrative worldview, deconstruction of and mapping the effects of the problem, discovering unique outcomes and hidden narratives, and thickening the meaning of new storylines.

This narrative synthesis was registered with Open Science (10.17605/OSF.IO/2KU3C) and was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 70 ].

Identification and selection of studies

The electronic databases searched were PsychINFO, MEDLINE, EMBASE, SocIndex and ProQuest Dissertations and Theses (grey literature). References were also identified and nominated by author JC’s personal library of narrative therapy resources. The dates searched included all dates from 1979 to the 4 th of July 2021. A search strategy was developed in consultation with a librarian and key search terms were (anorexi* OR anore*) OR (bulimi* or bulim*) OR (eat* or eating) OR (binge eat*) AND (intervention* OR treatment* OR therapy OR counsel*) AND (narrative).

Articles were included if they met the following criteria: (a) Published in English, (b) Focused on the content of narrative therapy interventions (including specific details of said content); (c) Included a sample of individuals in treatment for any ED, including books that describe narrative therapy interventions and case studies that use illustrative examples. Studies were excluded if they were: (a) Review papers, (b) Not published in English, (c) If full text was unavailable, or (d) Did not describe narrative therapy interventions as a treatment for any ED.

Study selection

One reviewer (LH) ran the identified search terms across all electronic databases, including grey literature. Another reviewer (JC) identified relevant articles from their personal library of narrative therapy resources. All texts were then combined and duplicates removed. The title and abstract of each paper were individually evaluated by two reviewers (LH and JC) for their adherence to inclusion criteria and any discrepancies were resolved by a third reviewer (PH). The full text of publications were obtained if they met criteria and any unavailable full texts were excluded. The first reviewer (LH) assessed eligibility of full-text references for inclusion, with assistance from the second reviewer (JC) regarding any uncertainties.

Quality assessment

All included publications were assessed independently by two reviewers (LH and JC) using independent quality appraisal assessment tools adapted from the Downs & Black Checklist (1998) [ 71 ] and the Joanna Briggs Institute’s Checklist for Text and Opinion (2015) [ 72 ]. Articles were rated based on a 10-item assessment criteria which included; reference to extant literature, clarity of hypothesis/aim/objective, description of main outcomes, reports of characteristics of participants, appropriate recruitment, description of intervention components, identification of main findings, logical presentation of conclusions, explanation for discrepancies with pre-existing literature, and evidence of ethical practice. The remaining one book text was rated based on six item assessment criteria which included: definition and quality of the source of opinion, interests of the population posited as central focus, logical presentation of conclusions, reference to extant literature, and provision of explanation for discrepancies with pre-existing literature. Each criterion was scored on a 3-point scale, where 0 = no, 1 = unclear/partial, and 2 = yes. Any discrepancies in ratings given by reviewers were resolved through discussion. All the studies meeting selection criteria were retained as it was thought that each study provided relevant qualitative data, regardless of their quality assessment score. See Additional file 1 (Tables S1 and S2) for the quality appraisal ratings for each of the included references.

A total of 1434 articles were identified from the online database search, with an additional 11 from JC’s personal library. Duplicates were removed and 998 references remained. Following title and abstract screening according to exclusion and inclusion criteria, and the addition of two records identified from book review articles, 103 articles remained. Full-text screening was then conducted, and the remaining 33 texts were included (see Fig. ​ Fig.1 1 ).

Flow chart of search strategy

Study characteristics

The 33 studies were summarised and data was extracted with regard to the following: aims and objectives, sample characteristics, and treatment details (see Additional file 1 : Table S3). Of the 33 included papers, 14 consisted of case studies with exemplar therapy transcripts ( n  = 1). Ten of the articles included case studies of between two to four clients, and six of the included papers reported on five or more client cases. Three papers did not report the number of clients from which their data was obtained. The origins of the samples varied, with the most being based in Australia ( n  = 8), followed by six from Canada, four from New Zealand, four from the United States, and three from England. Likewise, Hong Kong, Israel, Greece, and Norway each contributed one article. Thirty-one of the articles were originally published in English, with one written in Norwegian [ 73 ] and the other in Hebrew [ 74 ] prior to translation.

Across all included studies, the age range of clients spanned from eight to fifty years old. The majority of clients were female and were seen due to eating concerns. Clients were seen in various treatment contexts, including community centres, public hospitals, outpatient day programs, and most commonly, in outpatient settings ( n  = 18). Similarly, treatment sessions were provided in both individual and family settings ( n  = 28) and group formats ( n  = 5).

Quality appraisal findings

The quality appraisal revealed that a large proportion of the studies provided substantive reference to the extant literature ( n  = 26), described the hypothesis/aim/objective of the study ( n  = 25), defined the characteristics of their sample ( n  = 21), adopted a logical conclusion/position ( n  = 25), defended any incongruence with the pre-existing literature ( n  = 17) and discussed the components of the intervention described ( n  = 31). A lower number of papers were assessed as being representative of the sample size, with five articles obtaining a score of two and 25 studies scoring a one on the quality assessment rating. The most frequent reason for a low score on the quality appraisal criteria was a lack of direct evidence for ethics approval, with only two of the papers citing a process of applying for ethics approval. An additional 30 articles appeared committed to practising in an ethical manner, however, did not explicitly mention any approval by an ethics committee.

The book text was assessed according to modified quality appraisal criteria. Results indicated that this text clearly defined the source of opinion which had standing in the field of expertise, spoke to the interests of the relevant population, presented logical conclusions/positions, and referred to the extant literature. Likewise, the book was assessed as partially defending any logical incongruence with pre-existing literature.

Synthesis of results

All articles were further analysed to explore which components of narrative therapy were included in each intervention. The treatment components for each study can be seen in Table ​ Table1 1 and have been analysed according to the following categories:

• (A) Narrative worldview,
• (B) Unpacking of problem stories,
• (C) Finding hidden and new stories,
• (D) Thickening revealed and new stories, and
• (E) Safety considerations

Components of narrative therapy intervention for eating problems/disorders

*Brief reference to this component

Narrative worldview

Aspects of the narrative worldview were expressed in 28 of the identified articles. Pedersen [ 75 ] defined narrative therapy as a belief system or philosophy, rather than being limited to a collection of psychological techniques. This idea was mirrored across many of the articles identified in the search, with 18 references describing how narrative therapy encapsulates core tenants of social constructionism. This positioned narrative therapy as intrinsically political [ 53 , 59 , 61 , 73 , 75 – 88 ]. In particular, the narrative worldview was depicted by the studies as including the stance of the therapist, the client positioned as the expert on their life, and ‘the problem is the problem’ [ 59 , 85 ]. Likewise, the narrative worldview conceptualised identity as multi-storied, used non-pathologising language, and considered the person’s readiness for change. The specific results of which articles contained reference to these components of the narrative worldview can be found in Table ​ Table2 2 .

Components of narrative therapy worldview

Therapist stance

Seventeen articles had a focus on the key components of the therapist stance within NT. Robbins & Pehrsson [ 89 ] and Dallos [ 90 ] emphasised the importance of establishing safety, trust and security in the therapeutic relationship, particularly within the early stages of treatment. In five of the papers, power imbalances within the therapeutic relationship were explicitly named by the therapist and explored with the client during the intervention [ 75 , 76 , 82 , 91 , 92 ]. In particular, Borden [ 76 ] emphasised the importance of making visible and deconstructing discourses surrounding power dynamics within broader treatment settings, including public hospitals, community centres or private practice clinics. Six of the articles demonstrated or spoke to the process of regularly seeking feedback and asking for consent from their clients throughout narrative conversations [ 53 , 61 , 75 , 92 – 94 ].

Another key component of the spirit of narrative is a collaborative therapist stance. Lainson [ 82 ] and Ingamells [ 92 ] noted instances throughout exemplar clinical transcripts where the therapist took a stance of radical genuineness and self-disclosure. Likewise, Lock, Epston & Maisel [ 85 ], Nylund [ 95 ] and Maisel, Epston & Borden [ 53 ] described the therapist stance in narrative therapy as one of curiosity and respect, rather than giving advice to the client in an authoritative manner. This collaborative approach challenges the notion that therapists hold objective knowledge in dealing with problems. Instead the narrative therapist stance supports the use of ‘co-research’ in using combined therapist and insider knowledge to develop flexible client-centred solutions [ 53 , 61 , 73 , 74 , 77 , 87 , 91 , 93 , 94 , 96 ].

The person is the expert

Several identified articles indicated that placing the client in a position of authority and privileging their ‘insider’ knowledge is a fundamental component of the narrative worldview [ 73 , 76 , 77 , 84 , 96 ]. Nylund [ 95 ] argued for the importance of this when working with individuals with eating concerns, as they may have had previous negative, judgemental or pathologizing experiences of treatment. Lainson [ 82 ] and Pedersen [ 75 ] demonstrated attempts to ensure client consent to engage in the intervention at various points in the process. Eighteen of the articles asserted the importance of the therapeutic stance that positioned the client as an expert on their own life [ 75 , 87 , 89 ]. Maisel, Epston & Borden [ 53 ] positioned the person as having access to the most intimate knowledge about the problem precisely because they have lived through it. Additionally, papers by Ingamells [ 92 ], Lainson [ 82 ] and Lundby [ 73 ] suggested that viewing the person as the expert of their life was important not only in adult populations, but also when working with children, adolescents, and families. These papers emphasised the importance of the use of client-centred constructions of the problem and consideration of what recovery looks like for the individual (e.g., broadening social circles, returning to work, enjoyment of a variety of foods, etc.) [ 53 , 78 , 79 , 93 , 94 ]. Three of the articles indicated that clients were directly invited to guide the direction of therapy or contribute to the content of structured sessions, such as in group therapy programs [ 74 , 79 , 81 ].

‘The problem is the problem’

Early work by White [ 59 ] highlighted the importance of separating the problem from the person by viewing the problem as developing despite the best efforts of the individual and their family to reach a solution. A further 14 of the articles contained reference to the importance of viewing the ‘problem as the problem’. Within this framework, the individual and/or family were not viewed as inherently inadequate or deficient, but as responding to pressures and contradictory influences within their environment. This was described in White’s [ 59 ] early work through the lens of ‘cybernetics theory’. The theory proposed that clients and families have been restrained by external forces from participating in alternative interactions and have fallen into the problem as the only workable solution to a potentially broader problem. The papers by Dallos [ 90 ], Lainson [ 83 ], Brown, Weber & Ali [ 78 ] and Brown [ 77 ] extended on this to postulate that the problem likely develops to meet an internal need, whether this be an individual/personal need (e.g., for control, to gain a sense of self-worth), outstanding attachment needs within the family, and/or to meet broader societal expectations (e.g., to be seen as thin or feminine).

Identity as multi-storied

Eleven of the articles spoke to a conceptualisation of a person’s identity as multi-faceted and constituted by the stories of their lives. This included how they make meaning of a range of events, lived experiences, and relationships in the social and cultural contexts of their lives. These stories shape who they understand themselves to be or their sense of self. In particular, Borden [ 76 ] argued against unitary or ‘thin’ understandings of identity, which may inadvertently reduce the person to a problem-saturated story. Similarly, Lundby [ 73 ] proposed that the primary goal of narrative family therapy is to collaboratively create multi-storied accounts of the person’s life and identity. Kraner & Ingram [ 81 ], Ibrahim & Tchanturia [ 93 ], Lainson [ 83 ], Lundby [ 73 ], Brown [ 77 ] and Lock, Epston & Maisel [ 85 ] identified that it is essential that emphasis be given to parts of the person’s identity and life that are external to the presenting problem, such as their relationships, relative strengths, hobbies, and hopes and dreams for the future. In viewing identity in this way, narrative therapy has scope to encourage an attitude of experimentation in using individual strengths to engage in anti-AN/BN acts, including creative writing, or challenging unhelpful beliefs supported by the problem [ 89 , 92 ].

Perform the meaning

Nine papers conceptualised a person’s identity as performative and therefore lived out in everyday life. Brown, Weber & Ali [ 78 ] explored how the women communicated and performed social expectations of self-restraint through the dieting and weight control of their bodies, i.e., ‘body talk’. Likewise, other articles asserted that meaning is made through daily interactions in addition to therapy and proposed that narrative conversations explore opportunities to negotiate and perform aspects of identity [ 74 , 76 , 82 , 86 ]. In addition to this, White [ 61 ], Pedersen [ 75 ] and Lainson [ 83 ] positioned clients’ reclaiming of life as not only cognitive, but as practical, meaningful and sustaining.

All of the 28 studies that discussed some aspect of the narrative worldview explicitly or implicitly conveyed the importance of using language that does not pathologise, shame, place judgement or disempower the client. This linguistic shift included the practice of ‘externalisation’ of the problem. Specifically, Russell [ 86 ] and Pedersen [ 75 ] indicated that this process is not only a technique to be used within therapy, but is a way of understanding the problem and the client within a poststructuralist framework. Externalisation positions the problem in a way that challenges the over-responsibility and guilt that may be attributed to the client for an eating problem and their struggles to overcome it. Furthermore, Maisel, Epston & Borden [ 53 ] emphasised the use of ‘anti-AN/BN’ language that detaches and separates the person from the problem, so that they are able to discern their own identity and voice from the influence of the ED. This use of language was understood as being maintained by the therapist throughout the entirety of therapy, rather than an isolated and occasionally used technique. Narrative therapy was described as implicitly encouraging the client to also adopt externalising language and way of viewing themselves as distinct from the problem [ 87 – 89 , 95 ].

Readiness for change

Two of the articles [ 74 , 97 ] incorporated elements of the motivational interviewing intervention [ 98 ] into the intervention. In particular, they discussed the importance of working with their clients at their ‘stage of readiness to change’ [ 97 ]. This prioritises the person as having autonomy in their decisions to mobilise change in their lives. Likewise, Golan [ 74 ] concluded that the assumptions that underlie narrative therapy and motivational interviewing are able to empower the client in therapy and in their influence over the problem.

Unpacking of problem stories

All of the identified articles included one aspect of narrative therapy that unpacked the dominant problem story. These aspects were: the practices of deconstruction, externalisation, and/or experience-near naming.

Deconstruction

Thirty-one of the papers referenced the use of deconstruction of the eating problem to explore how clients had been recruited into beliefs or ideas about themselves as a person. Deconstruction was described by White [ 61 ] as the identification of taken-for-granted practices, attitudes, and ideologies that the problem story is built upon. Likewise, several articles emphasised that this process of deconstruction takes place on multiple levels, from broader social, political and cultural discourses (e.g., constructions of gender, medicalisation of EDs, the influence of media, etc.) to familial and individual factors (e.g., attachment narratives, parental scripts, etc.) [ 53 , 74 , 81 , 87 – 89 , 99 , 100 ].

The process of deconstruction was described by many of the articles as mapping the influences the problem on the person's cognitive, affective, interpersonal, and behavioural experiences [ 59 , 61 , 74 , 76 , 81 , 88 ]. For some of the articles, it was important that deconstruction was undertaken not only for the problem and its meaning to the person, but in regard to their experiences of psychological treatment. This included the authority that is often given to health professionals in defining sickness and wellness [ 76 , 81 , 88 , 91 ]. Additionally, Epston, Morris & Maisel [ 100 ] and Zimmerman & Dickerson [ 88 ] considered how resources from others who share a lived ED experience (‘Th/e Anti-AN/BN League’) could be drawn on in the process of deconstruction. This was done through individuals reading the stories of others who shared similar experiences, including societal influences that may have recruited them into a problematic relationship with eating and their body.

Externalisation

Thirty of the articles included reference to the practice of externalisation in unpacking the problem story. Lock, Epston, Maisel & de Faria [ 84 ] explained externalisation as the positioning of the problem outside of the person, meaning that it can then be objectified and a cognitive stance taken with respect to it. Many of the studies used externalisation with the person’s language forms, including the use of metaphor and personification of the eating problem [ 59 , 74 , 76 – 83 , 88 , 90 , 92 – 94 , 97 , 99 , 101 – 103 ]. Using externalising language to separate the client from the problem allowed for the tactics, intentions and agendas of the problem to be explored, assisting the person to engage critically in deconstructing the problem [ 53 , 73 , 85 , 86 , 89 , 92 , 100 ]. Some of the studies also utilised externalisation in creative writing formats, such as writing poems to personify the problem and short text passages about the negative impacts of the problem [ 85 , 89 , 95 ]. Likewise, Weber, Davis & McPhie [ 87 ], Nylund [ 95 ] and Lock, Epston & Maisel [ 85 ] used roleplaying exercises to highlight differences between the client’s voice and that of the problem. Roleplays were also used to challenge the problem directly and encourage perspective taking (e.g., family members role-playing each other to explore their varying thoughts, feelings and experiences of a situation).

Experience-near naming

Twenty-one of the 33 articles referenced the importance of using client’s own words and phrases to explore the problem and its effects, rather than using medical discourse, such as ‘eating disorder’, ‘anorexia’ or ‘bulimia’ nervosa. This was achieved by asking clients which of the available ways to speak about the problem they preferred [ 75 , 94 ] and the therapist using the client’s own words to refer to the identified problem [ 53 , 61 , 73 , 79 , 81 – 83 , 86 – 88 , 93 , 101 , 102 ]. Maisel, Epston & Borden [ 53 ] provided several examples of this, including the ‘dark tunnel’ (p. 65), ‘devil’ (p. 63), ‘evil’ (p. 92), and ‘death row’ (p. 107). These examples highlight the range of metaphors use (for example ‘dark tunnel’ is a geographical metaphor, whereas ‘evil’ is an adversarial metaphor) for their experiences. The papers outlined the experience-near metaphors that therapists took up in therapeutic conversations. Three of the articles also spoke about the importance of using the client’s words to name and thicken the hidden story once generated in therapeutic conversations, e.g., ‘caring for the self’ [ 102 ], ‘big step’ and ‘small miracle’ [ 73 ], and ‘getting well’ [ 53 ].

Finding hidden openings

Identification of hidden openings or unique outcomes.

Twenty-eight of the articles outlined ways that hidden openings or ‘unique outcomes’ were explored. This included the practice of ‘double listening’ [ 61 ], whereby the clinician explored the impacts the problem has had on the person’s life, and noticed any unique outcomes that did not fit with the dominant problem story [ 59 , 73 , 74 , 86 , 99 , 101 ]. Identification of unique outcomes was achieved in a variety of ways and involved exploring past, current, and possible future acts of resistance against the problem or anti-problem actions, thoughts, desires and attitudes [ 61 , 78 , 80 , 85 , 89 , 92 , 95 , 100 ]. Four of the studies extended this idea to suggest that any action that lay outside of stories built on socially or culturally constructed taken for granted assumptions could be understood as an act of political resistance or unrestrained expression of the self [ 53 , 75 , 83 , 86 ].

Exploring ways of living out of sync with the problem story

For some of the articles, unique outcomes were generated through ‘scaffolding conversations’. These conversations noticed and re-authored instances where the person had escaped the influence of the problem [ 102 ]. In this process, new identity stories were generated for old experiences. These new-old stories [ 64 ] were thickened through linking these previously un-authored actions with the client’s values and personal aptitudes [ 74 , 77 , 79 , 81 ] and the development of counter-narratives that stood in opposition to the problem narrative [ 59 , 85 ]. Several of the articles incorporated naming the aspects of a client’s experience and identity that had previously been left ‘unstoried’ [ 53 , 73 , 103 ].

Absent but implicit

Five of the articles explored looking for the ‘absent but implicit’ [ 63 ] to identify hidden openings. The ‘absent but implicit’ was described by the papers as engaging the person to explore what was implicit and relied upon in their discernment of their experiences as problematic [ 61 , 76 , 77 , 96 , 100 , 103 ]. For example, Howells [ 101 ] used the metaphor of ‘home’ to explore what was currently absent from the client’s conceptualisation of home that they valued. Additionally, Tsun on-Kee [ 103 ] explored what was absent but implicit in the client’s experience of guilt about their eating patterns. This revealed openings to previously hidden stories based on intentions, beliefs and hopes for the future (for example, food being culturally important and family-centred, and the need for self-forgiveness).

Thickening the meaning of hidden and revealed stories

Thirty of the articles included reference to methods of thickening and living out the hidden stories, once their openings had been revealed. The process of thickening hidden stories was described by the papers as building a detailed picture of what life outside of the problem looked like. This was done through developing and naming counter-narratives that more flexibly described the person’s experience [ 61 , 74 , 79 , 85 , 86 , 90 , 101 – 103 ]. These alternate storylines were built and strengthened by expanding on unique outcomes to explore thoughts, feelings or actions outside of the problem story in the past, present and future [ 73 , 80 ].

Likewise, several papers noted that hidden stories could be further thickened by exploring what specific acts of resistance may have to say about the individual’s values, beliefs, identity or political ideals [ 53 , 75 , 76 , 79 , 86 , 101 ]. Epston, Morris & Maisel [ 100 ] described the thickening process as establishing a ‘history’ of the values underlying anti-AN/BN achievements by exploring other instances in a person’s life where they stood against AN/BN. This in turn further strengthened the once obscured narrative. For Lainson [ 83 ], the process of thickening hidden stories and identities was centred on individuals taking up new priorities that were consistent with their values. These value-consistent values were cultivated so that they occupied more space in the person’s life than the ED. Ingamells [ 92 ] explored future implications and potential actions if the person with lived experience were to ‘live out’ their new identity (e.g., ‘Are you about to become Wilbur the Warrior?’ and ‘Is there a little bit more of warrior in Wilbur than there was the last time we met?’). The papers cited examples of other ways of thickening hidden stories, including letter writing and creating an audience to witness the stories previously obscured by the problem narrative.

Letter and creative writing

Twelve articles included the use of narrative letter writing to thicken and strengthen client’s hidden storylines between therapy sessions and at the conclusion of treatment. Many articles referenced the use of therapist written letters to the client following sessions. These letters included prompting questions and reflections to be considered at the beginning of the next session [ 53 , 73 , 75 , 79 , 89 , 95 , 97 , 100 , 101 ]. Some of the articles utilised creative or poetry writing between sessions to encourage acts of resistance against the problem or to thicken the client’s once obscured identity [ 53 , 75 , 95 , 100 ]. In particular, Lainson [ 82 ] and Nylund [ 95 ] utilised creative writing processes to highlight individual’s behaviours and activities that stood as protests against the problem story. Other articles used structured writing as a means of farewelling clients and concluding regular sessions, whilst providing them with a reminder of their developments and achievements throughout treatment [ 74 , 75 , 79 , 93 ].

Outsider witnessing

Many of the identified studies referenced the use of outsider witnessing to thicken hidden stories. This process involved inviting an audience of observers of the client’s journey to act as witnesses to the ways in which they had seen the client living out the hidden and revealed storylines in the present and in the past [ 53 ]. Seven of the articles utilised close family members and friends and/or members of the therapeutic group to witness counter-narratives to the problem story. This included how the person’s actions spoke to their underlying values or identities and acts of resistance they had witnessed the individual take against the problem [ 61 , 75 , 76 , 80 , 81 , 85 , 93 ]. Other articles included the use of rituals or celebratory ceremonies with loved ones where individuals celebrated their newly revised relationship with the problem and with themselves [ 74 , 79 , 95 , 101 , 103 ]. Two papers noted that they provided clients with a physical certificate or memorabilia to stand as tangible evidence of their recovery at these ceremonies [ 82 , 100 ]. Likewise, an additional six articles encouraged individuals to produce creative writing or works of poetry that could be contributed to ‘The Anti-AN/BN League’ or circulated within communities of others with ED problems [ 82 , 85 , 87 , 89 , 95 , 100 ].

Safety considerations

Six out of the total 33 articles mentioned the importance of establishing safety when working with indivudals with a lived ED experience and outlined how this could be integrated into a narrative therapy framework. Two of these papers reported a process of initial assessment screening and exclusion criteria to determine any clients for which the intervention may not be adequate or appropriate at the time of the assessment [ 80 , 87 ]. This included women who had multiple medical problems or life-threatening eating-disturbed behaviour, those who were assessed as having higher or different needs, and/or those who had a recent history of a previous suicide attempt. Likewise, 3 of these papers employed a multidisciplinary approach to allow physical and mental health professionals to work together to ensure medical and psychological safety for the clients [ 74 , 94 , 102 ]. Such teams were comprised of referring general practitioners, nutritionists, dietitians, nursing staff, and psychiatrists. Specifically, Scott, Hanstock & Patterson-Kane [ 102 ] and Golan [ 74 ] noted that client engagement with nutritional counselling and regular medical reviews were vital components of the treatment program [ 74 , 102 ].

Maisel, Epston & Borden [ 53 ] extensively discussed how essential medical practices may be understood and utilised whilst still maintaining a narrative worldview. In particular, the use of inpatient practices that may be imposing or coercive were considered. They asserted that whilst impositions may be needed at times to save lives, there are precautions that can be taken ahead of time to mitigate the damage caused by the experience. This included gaining information about the client’s wishes should they require tube-feeding or other invasive procedures and obtaining a kind of ‘pre-consent’.

This narrative synthesis has grouped and mapped the following components across the selected studies: (A) the narrative worldview, (B) unpacking the problem story, (C) finding hidden openings, (D) thickening the meaning of hidden and revealed stories, and (E) safety considerations.

The findings of this synthesis indicated that the underlying philosophies and frameworks of narrative therapy (i.e., ‘the narrative worldview’) were evident and well-embedded in the in the delivery of narrative interventions and practice of subsequent techniques across the selected studies. In other words, “the how” of narrative therapy was emphasised in addition to “the what” of the practice components of narrative therapy. Within the articles, this worldview was located within the philosophical traditions of social constructionism and poststructuralism [ 52 ], including an emphasis of therapy unpacking or deconstructing social, cultural and political ideas and expectations [ 60 , 65 ]. The spirit of narrative therapy was evident across the articles, including the view that the person is: (1) not the problem, the problem is the problem, and (2) the expert of their life. Many articles discussed the importance of the therapist taking a collaborative, genuine, and curious stance. Despite this, few of the articles discussed the importance of therapists working with a client’s readiness to change [ 97 ].

In relation to therapy content, all of the articles mentioned the process of unpacking dominant problem stories, including deconstruction of dominant societal ideas and expectations and mapping the influence of the problem on a person’s life [ 53 , 60 , 65 ]. The way in which externalisation [ 52 , 66 ] was described and used across the articles was of particular interest, with this narrative practice being the most frequently cited and exemplified. Many of the papers referenced the use of linguistic shifts and role-playing to externalise and unpack the problem story, however, this was infrequently linked to the overall narrative worldview where the person is positioned as the expert of their life. For some papers, externalisation was linked to the non-pathologising narrative approach and use of ‘experience-near naming’ [ 37 , 52 , 56 , 58 , 66 , 104 ].

However, the majority of the articles spoke of externalisation as a therapeutic technique rather than positioning it within the broader narrative worldview. Externalisation as a technique in interventions for EDs is not limited to narrative therapy. For example, “externalisation of the illness” has been integrated as a therapeutic practice in Maudsley Family Therapy, FBT [ 18 , 105 ] and CBT-AN [ 11 ]. The uniqueness of narrative therapy appeared not from the use of specific techniques, such as externalisation, but because of the broader spirit or worldview that informs narrative therapy practices. This includes the use of experience near naming, where the client is positioned as the expert on how the problem is talked about (e.g. as a “dark tunnel” rather than through the medical language of “illness”).

Similarly, the majority of the articles discussed the process of identification of “unique outcomes” [ 60 ] to explore hidden stories by using techniques such as “double listening” [ 61 ], analysis of “acts of resistance” and “scaffolding conversations” [ 59 , 102 ]. Despite this, few papers spoke about narrative therapy’s conceptualisation of a person’s identity as multi-storied [ 60 , 106 ] and the importance of focusing on aspects of the clients’ values, hopes and strengths that have not been taken over by the problem [ 59 , 62 ]. The papers emphasised techniques and methods of cognitively thickening hidden stories using counter-narratives and re-authoring conversations [ 54 , 69 ]. There was a noticeable lack of exploration and explanation of how identity shifts that occurred in therapy (for example, as evident in transcripts of therapy sessions) were then performed or lived out in the person’s everyday life [ 106 ]. Therefore, there was frequently little indication about whether clients cited in the papers performed the meaning of these identity shifts, including whether there was a corresponding improvement in their eating patterns and relationship with their bodies.

Sackett [ 107 ] has purported that evidence-based practice consists of client preferences, clinician experiences, and research outcomes. Some of the papers spoke to the clinician’s experience and client preferences for treatment, including how the client’s expertise was honoured in their life, and the clinician’s experience in tailoring treatment to the client. Despite this, a relatively low number of the papers incorporated a future focus on what the client’s life might look like (e.g., their thoughts, feelings, and actions) if they were to live out the identity shifts that were more comprehensively noted in the papers. This included a lack of discussion of meaningful treatment outcomes in relation to ED symptoms in most papers, conceptualised in narrative therapy as the extent to which the person performed the meaning of the identity shifts noted in therapy. Importantly, few of the papers included information regarding how therapists established safety within the narrative treatment framework. Some of the articles included safety-related exclusion criteria for narrative therapy interventions, however, even fewer explicitly mentioned practices whereby safety was assessed and established – for example, ongoing review of eating patterns and body weight. There were also few papers that raised the importance of a multidisciplinary team when working with EDs and how this fits within the narrative framework.

Limitations and strengths

Through synthesising and analysing the data from included articles, researcher judgements were made regarding the quality and contribution of each of the papers. The most frequently observed limitation in the overall quality of the papers was a lack of evidence for ethics approval or considerations for ethical practice. Additionally, the majority of articles had a small number of participants (often in a case study design format) and only half of the papers mentioned the ways that identity shifts were performed. This included a lack of focus on ways that the reported narrative interventions impacted an individual’s eating patterns and their relationship with their body. Furthermore, many of the papers were written by narrative therapists who were delivering the treatment and reflecting on the components used. This indicates that there may be a risk of bias present in the papers regarding selection and performance/confounding bias.

Despite the limitations associated with both this paper and the articles it studied, there are a number of strengths associated with this review. Specifically, this paper was developed in response to the current paucity of research synthesising narrative therapy interventions for EDs thus far. Additionally, this synthesis incorporates the findings from a variety of articles across different treatment settings and contexts and provides a synthesis of the current publications on narrative therapy for EDs. In doing so, it has illuminated the core components of narrative therapy for EDs and provides potential foci for future research.

Implications

The findings of this review demonstrated that the current literature on narrative therapy for EDs emphasises not only the use of specific therapeutic techniques but also the process of narrative therapy. This therapeutic process is informed by the narrative worldview where the person is (1) positioned as the expert of their life; and (2) not the problem but rather the problem is the problem. The selected papers provide a particular sort of evidence that is, the first-hand experience of narrative practitioners who report narrative therapy to be a helpful way to engage clients in the treatment of ED. This has been termed by David Epston as practice-based evidence [ 108 ], which is one arm evidence-based practice informed by therapist expertise [ 109 ].

The results of this synthesis emphasise the need for further research into the processes of identity shifts in narrative therapy, as performed by the person with a lived experience. This includes how they are engaging in their life, relationships, eating patterns/behaviours and their relationship with their body. This will include clinicians and researchers developing ways to observe and systematically measure of eating pattern/behaviour changes to explore the proposed inter-relationship between identity and its performance. A dilemma of researching narrative therapy has been outlined by Epston, Stillman & Erbes [ 109 ] as: “…science is about generalising broad truths that apply to everyone, while narrative is about elucidating local truths that apply to those who construct them and live them” (p. 77). Therefore, a challenge for researchers and clinicians is how to make observations and measurements in a way that aligns with the spirit of narrative therapy, which includes a non-interrogative approach, a prioritisation of the voice of the experiencing person, and maintaining the position that they are the expert of their life in this assessment [ 109 ].

Furthermore, this synthesis has identified that there are considerable gaps within our current understandings of how issues pertaining to client safety should be explored within the narrative worldview [ 1 ]. This is important given the significant and sometimes severe medical complications and life-saving nature of treatment associated with working with individuals experiencing EDs, including within multidisciplinary teams. It is vital that papers document ways that narrative therapy interventions for EDs more explicitly address safety considerations, whilst maintaining the spirit and worldview of intervention, including client respect and autonomy, positioning them as the expert of their life and the problem as the problem (not the person). In other words, what does safety look like ‘the narrative way?’.

Concluding remarks

The exploration of the nature and effectiveness of narrative therapy for the treatment of EDs is an emerging area of research. The findings of this systematic review further the understanding of the specific components of narrative therapy that are currently well documented and used in clinical practice in the treatment of EDs. Additional research is needed to further this understanding of narrative therapy in the field of EDs and how this intervention facilitates recovery of life and identity from an ED. These approaches have scope to extend the conversation about narrative therapy for EDs to more comprehensively: (1) address how safety considerations are integrated into the narrative framework and with the spirit of narrative therapy, (2) employ co-design research methodologies that include the experiences and perspectives of people with lived experience, and (3) address ways that key identity shifts are performed or lived out in a client’s life and the person-centred assessment of these, so that meaningful change becomes evidenced beyond the therapy room.

Acknowledgements

The authors would like to acknowledge Daphne Hewson, formerly Macquarie University, for her contributions to the narrative therapy framework that has guided this systematic.

Author contributions

Each of the authors have made substantive contributions to this paper; this included conception of this research (LH, JC and PH), the selection of search terms and systematic review of the databases (LH (final)), screening of papers for eligibility for inclusion in this review (LH & JC), systematic reviews of outcomes reported in the papers (JC, LH & PH), and all authors contributed to sections of the draft papers and review of the final manuscript.

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A Case Study of Narrative Family Therapy in an Outdoor Treatment Program with a Struggling Adolescent

• First Online: 31 March 2017

Cite this chapter

• Steven M. DeMille 4 &
• Marilyn J. Montgomery 5  

Part of the book series: Focused Issues in Family Therapy ((FIFT))

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Adolescent mental health is a significant societal concern with 10–20% of adolescents meeting criteria for a diagnosable mental disorder. Adolescent mental health disorders are concerning as they interfere with the accomplishment of normal development and can lead to poor school performance, dropout, strained family and social relationships, involvement with the child welfare and juvenile justice system , and other disruptive behaviors . Adolescents who do not respond to traditional services are often placed in residential treatment centers or other out-of-home treatment programs. Outdoor Behavioral Healthcare (OBH) is a viable treatment option for adolescents who struggle with emotional, behavioral or substance related problems, and one which flexibly permits an integration of the family into the treatment setting. A case study illustrating how techniques from narrative can be used to accomplish this integration is presented in this chapter, offering a view of how narrative family therapy can be used to involve families in the treatment and posttreatment process in an OBH program.

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Integrating Narrative Family Therapy in an Outdoor Behavioral Healthcare Program: A Case Study

A multilevel model to examine adolescent outcomes in outdoor behavioral healthcare: the parent perspective.

Wilderness Therapy

Anderson, N.B. (2006). Evidence-based practice in psychology.  American Psychologist ,  61 (4), 271–285. doi: 10.1037/0735-7028.39.6.658

Association of Experiential Education. (2015). Accreditation for outdoor behavioral healthcare programs . Retrieved from: http://www.aee.org/accreditation-for-outdoor-behav-health

Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39 (1), 47–61. doi: 10.1007/s10566-009-9085-7

Belfer, M. L. (2008). Child and adolescent mental disorders: The magnitude of the problem across the globe. Journal of Child Psychology and Psychiatry, 49 (3), 226–236. doi: 10.1111/j.1469-7610.2007.01855.x

Bettmann, J. E., Russell, K. C., & Parry, K. J. (2012). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants.  Journal of Child and Family Studies, 22 (8), 1039–1050. doi: 10.1007/s10826-012-9665-2

Bray, B. (2014). Going wild. Counseling Today. Retrieved from: http://ct.counseling.org/2014/12/going-wild/

Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., et al. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37 (5), 389–396. doi: 10.1016/j.amepre.2009.06.021

Carr, A. (1998). Michael White’s narrative therapy. Contemporary Family Therapy, 20 (4), 485–503.

Article   Google Scholar  

Cason, D., & Gillis, H. L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education, 17, 40–47.

Christenson, J. D., & Miller, A. L. (2016). Slowing down the conversation: The use of letter writing with adolescents and young adults in residential settings. Contemporary Family Therapy, 38 (1), 23–31.

Clark, J., Marmol, L. M., Cooley, R., & Gathercoal, K. (2004). The effects of wilderness therapy on the clinical concerns (on Axes I, II, and IV) of troubled adolescents. Journal of Experiential Education, 27 (2), 213–232. doi: 10.1177/105382590402700207

Cottrell, D., & Boston, P. (2002). Practitioner review: The effectiveness of systemic family therapy for children and adolescents.  Journal of Child Psychology and Psychiatry ,  43 (5), 573–586. doi: 10.1111/1469-7610.00047

DeAngelis, T. (2013). Therapy gone wild. Monitor on Pscyhology, 44 (8), 48–53.

Google Scholar  

DeMille, S. M. (2015). Do therapeutic factors and client gender impact treatment outcomes for adolescents participating in outdoor behavioral healthcare treatment? (Doctoral dissertation) . Minneapolis, MN: Capella University.

DeMille, S. M., & Burdick, M. (2015). A theoretically anchored and multi-modal treatment approach in an outdoor behavioral healthcare program. Journal of Therapeutic Schools & Programs, 7 (1), 19–30.

DeMille, S. M., Comart, C., & Tucker, A. R. (2014). Body composition changes in an outdoor behavioral healthcare program. Ecopsychology, 6 (3), 174–182. doi: 10.1089/eco.2014.0012

DeMille, S. M., & Montgomery, M. (2016). Integrating narrative family therapy in an outdoor behavioral healthcare program: A case study. Contemporary Family Therapy , 38 (1), 3–13. doi: 10.1007/s10591-015-9362-6

Diamond, G. S., Serrano, A. C., Dickey, M., & Sonis, W. A. (1996). Current status of family-based outcome and process research.  Journal of the American Academy of Child & Adolescent Psychiatry ,  35 (1), 6–16. doi: 10.1097/00004583-199601000-00007

Epston, D., & White, M. (1992). Experience, contradiction, narrative and imagination . Adelaida: Dulwich Centre Publication.

Faddis, T. J., & Bettmann, J. E. (2010). Reflecting teams and other innovative family therapy techniques adapted for outdoor behavioral healthcare. Journal of Therapeutic Schools and Programs, 1 (1), 57–69.

Faddis, T. J., & Cobb, K. F. (2016). Family therapy techniques in residential settings: Family sculptures and reflecting teams. Contemporary Family Therapy, 38 (1), 43–51.

Fauber, R. L., & Long, N. (1991). Children in context: The role of the family in child psychotherapy.  Journal of Consulting and Clinical Psychology ,  59 (6), 813–820. doi: http://dx.doi.org.library.capella.edu/10.1037/0022-006X.59.6.813

Freedman, J., & Combs, G. (1996). Narrative therapy: The social construction of preferred realities . New York: Norton.

Gass, M., Logan, P., Christensen, N., Hallows, G., Liebing, M., Smith, P. … Tierney, S. (2014). Manual of accreditation standards for outdoor behavioral healthcare programs (1st ed.). Boulder, CO: Association of Experiential Education.

Gillis, H. L., & Gass, M. A. (2010). Treating juveniles in a sex offender program using adventure-based programming: A matched group design. Journal of Child Sexual Abuse , 19 (1), 20–34.

Hair, H. J. (2005). Outcomes for children and adolescents after residential treatment: A review of research from 1993 to 2003.  Journal of Child and Family Studies ,  14 (4), 551–575. doi: 10.1007/s10826-005-7188-9

Harper, N. J., & Russell, K. C. (2008). Family involvement and outcome in adolescent wilderness treatment: A mixed-methods evaluation. International Journal of Child & Family Welfare, 1, 19–36.

Harper, N. J., Russell, K. C., Cooley, R., & Cupples, J. (2007). Catherine Freer wilderness therapy expeditions: An exploratory case study of adolescent wilderness therapy, family functioning, and the maintenance of change.  Child and Youth Care Forum, 36 (2–3), 111–129. doi: 10.1007/s10566-007-9035-1

Jones, C. D., Lowe, L. A., & Risler, E. A. (2004). The effectiveness of wilderness adventure therapy programs for young people involved in the juvenile justice system. Residential Treatment for Children & Youth, 22 (2), 53–67.

Kieling, C., Baker-Henningham, H., Belfer, M., Conti, G., Ertem, I., Omigbodun, O. … Rahman, A. (2011). Child and adolescent mental health worldwide: Evidence for action. The Lancet, 378 (9801), 1515–1525.

Lambie, I., Hickling, L., Seymour, F., Simmonds, L., Robson, M., & Houlahan, C. (2000). Using wilderness therapy in treating adolescent sexual offenders. The Journal of Sexual Aggression, 5 (2), 99–117. doi: 10.1080/13552600008413302

Leichtman, M., Leichtman, M. L., Barber, C. C., & Neese, D. T. (2001). Effectiveness of intensive short-term residential treatment with severely disturbed adolescents.  American Journal of Orthopsychiatry ,  71 (2), 227. doi: 10.1037/0002-9432.71.2.227

Lewis, S. F. (2013). Examining changes in substance use and conduct problems among treatment‐seeking adolescents.  Child and Adolescent Mental Health, 18 (1), 33–38. doi: 10.1111/j.1475-3588.2012.00657.x

Magle-Haberek, N., Tucker, A., & Gass, M. (2012). The effects of program differences within wilderness therapy and residential treatment center (RTC) programs.  Residential Treatment for Children and Youth, 29 (3), 202–218. doi: 10.1080/0886571X.2012.697433

Marion, J. L., & Reid, S. E. (2007). Minimising visitor impacts to protected areas: The efficacy of low impact education programmes.  Journal of Sustainable Tourism ,  15 (1), 5–27. doi: 10.2167/jost593.0

McLeod, J. (2010). The role of case studies in the development of theory and practice in counselling and psychotherapy. In J McLeods (Ed.), Case study research: In counselling and psychotherapy  (pp. 1–15). London: SAGE Publications Ltd.

Minuchin, S. (1998). Where is the family in narrative family therapy? Journal of Marital and Family Therapy, 24 (4), 397–403.

Article   PubMed   Google Scholar  

National Building Bridges Initiative. (2007). Innovative practices for transformation . Workgroup webinar.

Norton, C. L. (2008). Understanding the impact of wilderness therapy on adolescent depression and psychosocial development. Illinois Child Welfare, 4 (1), 166–178.

Norton, C. L. (2010a). Exploring the process of a therapeutic wilderness experience: Key therapeutic components in the treatment of adolescent depression and psychosocial development.  Journal of Therapeutic School and Program, 4 (1), 24–46.

Norton, C. L. (2010b). Into the wilderness—A case study: The psychodynamics of adolescent depression and the need for a holistic intervention.  Clinical Social Work Journal, 38 (2), 226–235. doi: 10.1007/s10615-009-0205-5

O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities . Washington DC: National Academies Press.

O’Connor, T. S. J., Meakes, E., Pickering, M. R., & Schuman, M. (1997). On the right track: Client experience of narrative therapy. Contemporary Family Therapy, 19 (4), 479–495.

Outdoor Behavioral Healthcare Council. (OBHC, 2015). About Us . Retrieved from: https://obhcouncil.com/about/standards/

RedCliff Ascent. (2015). Who do we serve? The Wilderness Advisor , 1 , 7–8.

Riordan, R. J. (1996). Scriptotherapy: Therapeutic writing as a counseling adjunct. Journal of Counseling & Development, 74 (3), 263–269.

Russell, K. C. (2006). Evaluating the effects of the Wendigo Lake Expedition Program on young offenders. Youth Violence and Juvenile Justice , 4 (2), 185–203.

Russell, K. C., & Gillis, H. L. (2010). Experiential therapy in the mental health treatment of adolescents. Journal of Therapeutic Schools and Programs , 4 (1), 47–79.

Russell, K., & Hendee, J. (2000). Definition, common practice, expected outcomes, and a nationwide survey of programs (Technical Report 26) . Moscow, ID: University of Idaho.

Russell, K. C. (2003). Assessing treatment outcomes in outdoor behavioral healthcare using the Youth Outcome Questionnaire. Child and Youth Care Forum. 32 , 355–381. doi: 10.1023/B:CCAR.0000004507.12946.7e

Russell, K. C. (2005a). Preliminary results of a study examining the effects of outdoor behavioral healthcare treatment on levels of depression and substance use frequency.  Journal of Experiential Education, 27,  305–307.

Russell, K. C. (2005b). Two years later: A qualitative assessment of youth-well-being and the role of aftercare in outdoor behavioral healthcare treatment.  Child and Youth Care Forum, 34 , 209–239. doi: 10.1007/s10566-005-3470-7

Russell, K. C. (2008). Adolescent substance-use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives.  Journal of Groups in Addiction &   Recovery, 2 (2–4), 68–96. doi: 10.1080/15560350802081264

Russell, K. C. & Farnum, J. (2004). A concurrent model of the wilderness therapy process.  Journal of   Adventure Education and Outdoor Learning ,  4 , 39–55. doi: 10.1080/14729670485200411

Russell, K. C., Gillis, H. L., & Lewis T. G. (2008). A five-year follow-up of a survey of North American outdoor behavioral healthcare programs. Journal of Experiential Education , 31 (1), 55–77. doi: 10.1177/105382590803100106

Russell, K. C., & Sibthorp, J. (2004). Hierarchical linear modeling of treatment outcomes in outdoor behavioral healthcare. Journal of Experiential Education, 27, 176–191.

Safran, J. D., Muran, J. C., & Proskurov, B. (2009). Alliance, negotiation, and rupture resolution. In R. Levy & S. J. Ablon (Eds.), Handbook of evidence based psychodynamic psychotherapy (pp. 201–205). New York: Humana Press.

Chapter   Google Scholar  

Substance Abuse and Mental Health Services Administration. (2012). National survey on drug use and health: Mental health findings . Rockville, MD: Substance Abuse and Mental Health Services Administration.

Stage, S. A. (1998). Predicting adolescents’ discharge status following residential treatment.  Residential Treatment for Children & Youth ,  16 (3), 37–56. doi: 10.1300/J007v16n03_03

Telep, T. (2014). The man who takes troubled youths to therapy camp. BBC News Magazine . Retrieved from: http://www.bbc.com/news/magazine-26513805

Tubman, J. G., Montgomery, M. J., & Wagner, E. F. (2001). Letter writing as a tool to increase client motivation to change: Application to an inpatient crisis unit. Journal of Mental Health Counseling, 23 (4), 295–311.

Tucker, A., Norton, C. L., DeMille, S. M., & Hobson, J. (2016). The impact of wilderness therapy. Journal of Experiential Education, 39 (1), 15–30. doi: 10.1177/1053825915607536

Tucker, A., Smith, A., & Gass, M. (2014). The impact of presenting problems and individual client characteristics on treatment outcomes in residential and wilderness treatment programs. Residential Treatment for Children and Youth, 31 (2), 135–153.

Tucker, A. R., Zelov, R., & Young, M. (2011). Four years along: Emerging traits of programs in the NATSAP practice research network (PRN). Journal of Therapeutic Schools and Programs, 5 (1), 10–28.

Walsh, V., & Golins, G. (1976). The exploration of the outward bound process . Denver, CO: Outward Bound School.

White, M. (1989). Select papers . Adelaide: Dulwich Centre Publications.

White, N. W. (2011). Stories from the elders: Chronicles and narratives of the early years of wilderness therapy . Franklin Pierce University.

Wright, A. (1983). Therapeutic potential of the outward bound process: An evaluation of a treatment program for juvenile delinquents. Therapeutic Recreation Journal, 17 (2), 33–42.

Zelov, R., Tucker, A. R., & Javorksi, S. (2013). A new phase for the NATSAP PRN: Post-discharge reporting and transition to the network wide utilization of the Y-OQ 2.0.  Journal of Therapeutic   Schools & Programs, 6 (1), 7–19.

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DeMille, S.M., Montgomery, M.J. (2017). A Case Study of Narrative Family Therapy in an Outdoor Treatment Program with a Struggling Adolescent. In: Christenson, J., Merritts, A. (eds) Family Therapy with Adolescents in Residential Treatment. Focused Issues in Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-51747-6_3

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Published : 31 March 2017

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What Is Narrative Exposure Therapy (NET) For PTSD?

Different methods are used in exposure therap y such as virtual reality, in vivo exposure, imaginal exposure, prolonged exposure, and narrative exposure. In today’s blog, we are going to talk about narrative exposure therapy.

Narrative exposure therapy is a specialized therapy technique for trauma disorders such as post-traumatic stress disorder (PTSD) . This therapy technique is effective for treating multiple or complex traumas. 

Narrative exposure therapy (NET) helps establish a rational narrative that helps contextualize traumatic experiences. Mainly, it is used for refugees but it can also be used for torture, war, rape, childhood abuse, or violence.

This therapy can help overcome trauma forced by cultural, political, or social forces. This therapy is generally conducted in a small group revolving around 4 to 10 sessions. NET can also be conducted individually. 

To put it in a nutshell, the main component of NET is to narrate a story about the client’s life which influences or perceives trauma and associated feelings. Narrating the client’s life story around traumatic experiences leads to the reframing of negative experiences. 

Quick Fact-Check: 

• The concept of narrative exposure therapy (NET) was introduced by Maggie Schauer, Thomas Elbert, and Frank Neuner in the early 2000s. 
• The therapy basically works on the fact that “trauma creates an alarm response.” Therefore, when clients talk about their traumatic experiences in chronological order, they slowly repair negative responses and associations.

What Happens During NET Sessions? 

Under the guidance of a trained and certified psychotherapist, clients establish a chronological narrative of their lives. The narratives are mainly focused on traumatic experiences combined with some positive experiences.

Psychologically, narrative exposure helps in contextualizing cognitive memories. In this way, the patient develops an autobiographical story. It also helps in developing more understood and refined memories of traumatic episodes. Throughout the sessions, the therapist works on compassionate understanding, therapeutic alliance, positive regard, and active listening. 

The therapist’s aim is to help clients describe their emotions, sensory information, physiological responses, and thoughts. After this, the clients are asked to narrate their traumatic experiences and relive the emotions while staying mindful.

Mindfulness is achieved by passing reminders. During the sessions, the memories are associated with episodic facts. At the end of sessions, an autobiography is created by the therapist and presented to the client.

This helps in mindful engagement which provides the patient the freedom to reflect on their experiences and cultivate a personal identity. NET is a different therapy program that actively focuses on traumas and experiences. This helps in restoring self-respect as well. 

How NET Helps Overcome PTSD or Multiple Traumas? 

When a client attends sessions of NET unreservedly, they gain a new perspective towards traumatic experiences and gain a better understanding of their life in a contextualized manner.

Through the session, the therapist works on establishing a chronological narrative of the client’s life focused on trauma. From a psychological perspective, when a trauma is turned into a narrative, it provides a better understanding of cognitive, sensory, and affective memories related to the trauma.

During sessions, a therapist mostly talks about the client’s senses, thoughts, physiological responses, and emotions. The therapist makes the client feel grounded so that they don’t feel overwhelmed by the memories.

During the end of sessions, when a client is able to safely reconnect from the trauma, the therapist works on developing a sense of personal identity. This helps in letting go of negative emotions and behavioral problems. 

Benefits of Using Narrative Exposure Therapy 

Below listed are some of the benefits of narrative exposure therapy: 

• Transforms the trauma into a new perspective
• Provides a new positive outlook
• Develops more empathy and compassion
• Effective therapy method for addressing multiple traumas 
• Develops mindfulness and grounding
• Fewer dropout rates 
• Short-term therapy with long-term benefits 
• Requires no homework  
• Receives autobiography 

Effectiveness of Narrative Exposure Therapy 

The main purpose of NET is to make meaning out of traumas, organize memories, and gain a new perspective. According to studies, NET can also be effectively used for a range of symptoms such as anxiety , grief, and relationship conflicts.

Narrative therapy when used for treating PTSD is known as narrative exposure therapy (NET). It basically helps survivors and refugees. Additionally, it can also address complex trauma (C-PTSD) .

A study shows that NET is more effective as compared to non-trauma-focused interventions. Additionally, research also shows that NET is more effective for treating C-PTSD meanwhile, prolonged exposure therapy (PET) can be effective for treating PTSD. 

I hope this blog helps you understand narrative exposure therapy (NET) for PTSD. Comment down your queries below or you can also write to us at Calm Sage. 

For more such content, connect with us through all social media platforms. 

Thanks for reading! 

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About The Author

Aayushi is a Content Creator at Calm Sage. She holds a Bachelor’s degree in Food Technology and a Master's Degree in Clinical Nutrition. Her constant interest in the improvement of mental health, nutrition, and overall wellness embarked upon her career as a “full-time educational writer.” She likes to make an asynchronous connection with her readers. Her mantra for living life is "What you seek is seeking you".

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