An Exploration of Narrative Therapy

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08/02/20 Psychology Reference this

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Narrative theory posits that the human experience is contained within the stories that we tell (Phipps & Vorster, 2015). We tell these stories to others and ourselves so often that they become reality, whether they are accurate or inaccurate. We often emphasize certain dominant details and forget other details when we tell our experience stories. Incongruence occurs when we tell “problem-saturated” stories that do not match our lived experiences (p. 257). Narrative therapists help their clients create new stories using a process called reauthoring. Reauthoring involves working with clients to change the contexts of problem-saturated stories and ultimately create new, positive stories that no longer focus on problems. Narrative therapists use a variety of techniques to aid their clients. Externalization is used to separate perceived problems from clients’ stories. Narrative therapists also look for positive exceptions in their clients’ experiences and use those exceptions to help clients change how they view their stories and problems.

Narrative Therapy History

 Narrative therapy has its roots in postmodernism and the social constructionism and interpsychic movements that both flourished during postmodernism. Starting as a philosophical movement, postmodernism features a rejection of reason and objective knowing that permeated the arts and eventually spilled over into religion and science (Phipps & Vorster, 2015). Because knowing is no longer objective, knowledge cannot be acquired through external means; instead, postmodern knowing is a subjective experience both created and interpreted by the knower. Social constructionism builds on postmodern thought by adding that the knower not only creates his or her own reality but that the knower’s reality cannot be disputed without another person attempting to create an objective reality (Corey, 2017). Social constructionists believe that the knower’s language is the subjective tool used to create his or her indisputable reality.

Even though the knower’s subjective reality is understood to be indisputable, the intrapsychic perspective holds that the knower’s thought and reasoning processes can be studied (Phipps & Vorster, 2015). The emphasis moved from psychologists and psychiatrists studying affect, behavior, and cognition between the minds of two or more people; with the intrapsychic perspective, the focus is wholly on the knower’s subjective experience and what can be learned from investigating the knower’s subjective experiences during psychotherapy.

Modern narrative therapy is a combination of social constructionism and the interpsychic perspective and can be traced to the publication of Narrative Means to Therapeutic Ends by Michael White and David Epston in 1990 (Phipps & Vorster, 2015). Providers used narratives in family therapy before White and Epston wrote about narrative therapy. However, it is their focus on how stories create experience, how telling those stories sometimes causes pain, and how creating new stories can ease pain that defines modern narrative therapy (White & Epston, 1990).

Narrative Therapy Process

 The narrative therapy process has four distinct phases: joining, examining patterns, reauthoring, and moving on (Neukrug, 2016). According to White and Epston (1990), clients experience incongruence when the stories they tell about their own lives, or the stories others tell about clients’ lives do not match all the clients’ lived experiences. The gaps between clients’ narratives and their reality create the pathologies that often bring clients to therapy. During the joining phase, narrative therapists establish therapeutic relationships with their clients, as clients tell their “problem-saturated” stories (Neukrug, 2016, p. 131). Narrative therapists pay close attention clients’ use of language and how clients have constructed their stories over time.  

 During the second phase of narrative therapy, examining patterns, clients are invited to examine their problem-saturated stories with the goals of finding contradictions and inaccuracies (Neukrug, 2016). Narrative therapists primarily use questions, externalization, and unique outcomes during this phase to help clients realize, often for the first time, that their narratives may not be accurate (White & Epston, 1990). Narrative therapists question problems to separate, or externalize, those problems from client narratives. When problems are externalized, clients generally find it easier to discuss details of their narratives that were previously missing. Adding those missing details to the narrative, or finding unique outcomes, marks the end of this phase. 

 During the third phase of narrative therapy, called reauthoring, therapists work with clients to incorporate unique outcomes identified during the examining patterns phase into the construction of new, positive narratives (White & Epston, 1990; Neukrug, 2016). After creating their new narratives, clients practice telling their new stories first to themselves and then to others (White & Epston, 1990). By telling their new stories to themselves, clients learn to ascribe new meaning to earlier life experiences. In addition, clients tell their new stories to audiences. When clients tell their reauthored stories to other people, they use audience verbal and non-verbal feedback to enhance and extend their stories in ways that emphasize unique outcomes.  

 The final phase of narrative therapy is called moving on and features clients using new narratives to make differences in other areas (Neukrug, 2016). During this phase, clients believe their new stories so much, they begin to see positive changes in affect, behavior, and cognition. Clients in this phase successfully use language to create new experiences. After therapy concludes, some narrative therapists use written language to strengthen clients’ new narratives. Narrative therapists may use certificates and written declarations to certify or declare that clients are free from the problems present in their earlier stories (White & Epston, 1990). Narrative therapists may also write letters of prediction to their clients, stating what they believe will happen in their clients’ futures; these letters often serve as self-fulfilling prophecies for clients.

Narrative Therapy Suitability

Clients Likely to Benefit

 The socially oppressed. Many counseling theories and approaches assume that client pathology is of the client’s making. While that may often be the case, those approaches do not consider the sometimes-harmful impacts that society, politics, and culture can have on client pathology. Narrative therapy works well for socially oppressed clients because the approach does account for society’s effects on clients (Neukrug, 2016). As previously addressed, narrative therapy recognizes that we create our experiences with the language we use to tell our stories, and the language we use may be tainted by social, political, or cultural expectations and negative feedback from social institutions. Narrative therapists work with clients to separate external problems from clients so they recognize that in some cases, the problems they have internalized were not of their own creation. Narrative therapists address social factors during treatment, making this treatment a good fit for those who are oppressed.

Clients with formal diagnoses. Narrative therapists use an anti-objectivist approach that places little value in models that claim to objectively understand and explain reality (Neukrug, 2016). As a result, narrative therapists are not overly concerned with formal diagnoses; instead, they focus on the psychological damage caused by formal diagnoses. Clients with diagnoses often respond well to narrative therapy because techniques like externalization and reauthoring can help clients separate themselves from their diagnoses. Clients may overidentify with their diagnoses, and as they tell their stories, it may become difficult for the client to see himself or herself as anything but a mental disorder. Narrative therapy helps clients with formal diagnoses see that there is more to their stories and experiences than a diagnosis; the diagnosis can be externalized; and the client can create new stories and experiences independent of diagnosis.

Clients Not Likely to Benefit

 Clients seeking expert solutions. Narrative therapy is a postmodern approach to both therapy and living. As such, it represents a shift from the premodern concepts of knowing and accepting knowledge based on faith and absolutes, to rejecting objective knowledge in favor of subjective creation and experience (Corey, 2017). For these reasons, clients who view the narrative therapist as an expert with the answers are not likely to benefit from narrative therapy unless they are able to accept a different worldview. Research shows that members of minority groups are more likely than their non-minority counterparts to view the narrative therapist as an expert (Corey, 2017). Those clients may respect and revere the narrative therapist and expect the therapist to fix their lives based on expertise; those clients are less likely to understand and accept that they own their own solutions. Narrative therapists can counter this by explaining that while they may be process experts, only clients can truly know what will work in their own lives.

 Christian Theists. A Christian theistic worldview is based on the beliefs that God is “infinite, personal, triune, transcendent, immanent, omniscient, sovereign, good,” and that His will is revealed in revelation (Sire, 2009, p. 28). A strict narrative approach will likely not work for Christian theists because client will likely see utility in creating subjective experiences when God’s very being shapes human life and experience. For Christian theists, truth and knowledge are found in God’s revelation, a concept counter to postmodern beliefs that objective knowledge and truth do not exist (Phipps & Vorster, 2015). The narrative therapy concept reauthoring may be used to counsel Christian theists if narratives are strengthened by using spiritually-sound unique outcomes. The concept externalization may hurt Christian theists if narrative therapists view sin as pathology and attempt to separate sin from clients’ narratives. Christian theists may benefit from its techniques, but a strict narrative approach to therapy may cause harm.

Narrative Therapy Efficacy

Narrative Therapy Successes

Use in family therapy. Narrative therapy appears to work well countering conflict in family therapy. Besa (as cited in Etchison & Kleist, 2000) used a case study research design and showed narrative therapy to be successful in reducing parent-child conflicts, defined as “defiant behavior, keeping bad company, abuse of drugs, school problems, and other conduct problems” (p. 62). St. James-O’Connor, Meakes, Pickering, and Schuman (as cited in Etchison & Kleist, 2000) used an ethnographic research design and found that narrative therapy helped families experiencing parent-child conflict by reducing negative symptoms associated with conflict and empowering individual family members. Finally, Weston, Boxer, and Heatherington (as cited in

Etchison & Kleist, 2000) used an exploratory study and found that when families undergo narrative therapy, children are more forgiving of their parents following parent-parent conflict.

People living with depression. Vromans and Schweitzer (2011) found narrative therapy to be moderately successful in relieving depressive symptoms in adults with major depressive disorder (MDD). The researchers noted significantly lower measured depression using the Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 for participants after eight narrative therapy sessions. Significant differences were present at completion but not between completion and a three-month follow-up. In a study comparing narrative therapy to cognitive-behavioral therapy (CBT), Lopes, Gonçalves, Machado, Sinai, Bento and Salgado (2014) found both forms of therapy benefitted adults with MDD. However, researchers noted a significant difference between the groups after completion when using the BDI-II to measure depressive symptoms; those in the CBT group improved more than those in the narrative therapy group. Narrative therapy is an effective treatment for adults with MDD but is not as effective as CBT.

Narrative Therapy Failures

 Transforming construction of problems. Narrative therapy is a postmodern approach that relies on clients’ abilities to construct subjective experiences and realities by manipulating language (Etchison & Kleist, 2000). However, Coulehan, Friedlander, and Heatherington (as cited in Etchison & Kleist, 2000) found that narrative therapy is not always successful when therapists try to help clients with problem construction. Specifically, they found that when family therapy sessions are not successful, the culprit is often an inability for family members to move from viewing problems intrapersonally to viewing them systematically. The difficulty in helping families to construct problems may be due to the therapist attempting to objectify subjective problems. The process of agreeing on what constitutes a major issue for the family requires objectivity, as members are asked to change the context in which they view their own problems. The issue is that narrative therapy is based on the belief that reality is known only to the knower.

 Lack of qualitative research. A lack of qualitative research continues to plague narrative therapy today. Postmodernists do not believe in objective knowing which is at the heart of qualitative research (Etchison & Kleist, 2000). Narrative therapists are generally opposed to qualitative research on their findings because qualitative research is a contradiction to the theories upon which narrative therapy was founded. This phenomenon causes two major issues for those attempting to complete qualitative research. First, narrative therapists attempting to complete qualitative research may lack proper training, which may result in research errors. Second, non-narrative therapists may attempt to complete qualitative research on narrative therapy, its techniques, and outcomes, and research may contain errors because the researchers may lack information about how narrative therapy works. Regardless of the sources of errors, it is recognized that there is a lack of qualitative narrative therapy research and more is needed.

Addition Training for the Narrative Therapist

There are currently no gatekeeping organizations or associations for narrative therapy, meaning any therapist can call himself or herself a narrative therapist. Additional training beyond the requirements to become a therapist is available but is not a requirement. For example, the Dulwich Centre in Australia, which was co-founded and directed by Michael White until his death, offers intensive training and a Master of Narrative Therapy and Community Work degree (Dulwich Centre, n.d.). That degree is accredited by the Australian Counseling Association. 

Ethical Considerations

Narrative therapists are generally anti-objectivists who challenge theoretical models used to define, objectify, or classify people (Neukrug, 2016). As a result, they tend oppose diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders. Narrative therapists could do harm to clients and potentially be held liable if they miss or refuse to acknowledge when clients have diagnosable mental disorders that remain unaddressed. Every issue cannot be corrected with talk therapy; thus, narrative therapists must remain vigilant and address disorders or refer clients to other specialists when they encounter issues beyond their scopes of practice.

 Conclusion

Narrative therapy is relatively new, yet it offers promise for clients reporting with issues that have social, cultural, and political contexts; clients who over-identify with formal diagnoses; clients living with depression; and for families resolving parent-child conflicts. However, narrative therapy may be problematic when counseling theists or clients seeking expert solutions.  

Narrative therapy is also plagued by a lack of qualitative research and standardized specialty training. Despite these limitations, narrative therapy is used extensively to counsel families and individuals, and its techniques are used by therapists with varied theoretical backgrounds.

References

  • Corey, G. (2017). Theory and practice of counseling and psychotherapy (10th ed.). Boston, MA: Cengage Learning.
  • Dulwich Centre. (n.d.). Masters program in narrative therapy and community work. Retrieved from https://dulwichcentre.com.au/training-in-narrative-therapy/masters-program-in-narrative-therapy-and-community-work/
  • Etchison, M., & Kleist, D. M. (2000). Review of narrative therapy: Research and utility. The Family Journal: Counseling and Therapy for Couples and Families, 8(1), 61-66. doi: 10.1177/1066480700081009
  • Lopes, R. T., Gonçalves, M. M., Machado, P. P. P., Sinai, D., Bento, T., & Salgado, J. (2014). Narrative therapy vs. cognitive-behavioral therapy for moderate depression: Empirical evidence from a controlled clinical trial, Psychotherapy Research, 24(6), 662-674. doi: 10.1080/10503307.2013.874052
  • Neukrug, E. (2016). The world of the counselor: An introduction to the counseling profession (5th ed.). Boston, MA: Cengage Learning.
  • Phipps, W. D., & Vorster, C. (2015). Refiguring family therapy: Narrative therapy and beyond. The Family Journal: Counseling and Therapy for Couples and Families, 23(3), 254-261. doi: 10.1177/1066480715572978
  • Vromans, L. P., & Schweitzer, R. D. (2011). Narrative therapy for adults with major depressive disorder: Improved symptom and interpersonal outcomes, Psychotherapy Research, 21(1), 4-15. doi: 10.1080/10503301003591792
  • White, M., & Epston, D. (1990). Narrative means to therapeutic ends. New York, NY: W. W. Norton and Company.
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