A Narrative Approach to Therapy

Author: Dr. Alistair Campbell, BA (Hons), M Psych (Clinical), Ph.D.

Narrative approaches to therapy originated in Australia in the late 1970s and early 1980s, and are useful in the treatment of depression, anxiety and trauma.

In the early days, they were introduced as a form of strategic therapy, which has its roots in family therapy and hypnosis, by two South Australian social workers, Michael White and David Epston.

The narrative approach to therapy was based on information theory concepts introduced by Gregory Bateson and was originally called “cybernetic” therapy.

Through the 1980s and 1990s White and Epston revised their theoretical bases for therapy and were much influenced by postmodernist and social constructivist philosophy. This essentially resulted in the development of Narrative Therapy. but the underlying techniques were still strongly informed by cybernetic and information theory.

Why Narrative Therapy is Misunderstood

In some ways, the term “narrative” has been misunderstood by some people, as simply referring to people’s experiences being encapsulated in a story form.

Unfortunately, this leads to a simplistic and potentially disrespectful approach to therapeutic intervention by encouraging clients to “simply” tell themselves a different story.

In fact, the notion of “narrative” is drawn strongly from postmodernist views of truth and reality. Essentially, the narrative assumes that there is no single truth and that reality is a socially constructed experience. Therefore, the narrative assumes that people’s experiences of problems and difficulties are related to the ways in which they have been taught to think and experience. So, problems and difficulties are seen as both developing in and are maintained by, the dominant social, political and cultural “narratives” in the person’s environment.

What is the Narrative Approach?

Narrative approaches, as they have been developed since the inclusion of postmodernist ideas, have been associated with a range of creative and respectful interventions with issues of mental illness, violence, gender, sexuality, racism at individual, family and community levels.

This does not mean that a narrative approach is only of use in addressing social issues. Narrative approaches have a different understanding of the development of problems in people’s lives, compared to the individualistic and medically oriented frameworks which currently characterise much of mental health. The approach assumes that a person’s experience of their own selves and their situation is only one way of understanding, and that the purpose of therapy is to explore multiple perspectives in order for clients to be able to experience their lives in different ways.

Essentially the narrative framework maintains that the problems which people experience are primarily due to the way that they explain or understand their experiences. Generally, there is a dominant paradigm or description which locates problems within individuals and identifies them as the problem. This process tends to leave people feeling helpless and unable to challenge or address problematic experiences.

A Narrative Approach to Depression

For example, someone who is depressed may feel that this is a condition which is internal to them and over which they have little or no control. They understand and describe their experience as the depression being in charge, and of them having no power to effect change. To some degree, this experience is supported by the current psycho-biological paradigms that are used to explain depression.

A narrative approach does not directly challenge this view; rather, it is understood that this framework may be problematic where it leaves clients feeling helpless and unable to address their problems. When people accept and adopt problem-saturated descriptions of their lives they will tend to privilege or notice, events that reinforce this particular description. From a narrative perspective, the problem is not the problem so much, as the adoption of a problem-saturated or disabling narrative.

It is important to recognise that narrative approaches are not about getting people to simply think differently or to change their style of thinking to address problems.

The first step in narrative therapy is to explore, carefully and respectfully, the dominant “story” that the person has about their life and their problems. The intention in doing this is to map the influence of the problematic descriptions of their life without accepting that this is the full or only “story”. More frequently than not when people have any sort of problem, it tends to be experienced by them as total and all-consuming.

But, the reality is that no problem is held at all times and in all places. There are always times when people do not have the problem. But, they cannot notice these exceptions primarily because the problem-saturated description obscures or minimises any different experience.

So, in mapping the influence of the dominant narrative, the therapist’s purpose is also to begin to notice and have questions for the client about exceptions that occur. This is not to try and minimise or ignore the individual’s lived experience; it is something that needs to be done carefully and respectfully. Through a process of exploring how it is that the individual has challenged or stood up to their problems, they begin to develop a sense of personal agency invested in being able to feel and behave differently. A key technique in fostering this is to position the person as “having a problem”, and not “being the problem”.

Narrative Therapy for Anxiety

For example, I had a client who experienced agoraphobia and was unable to leave her home to go shopping or visiting with friends and family. The way that she described this problem was that it was always present and that she was never able to go out without fear. Fear was her constant companion.

The first step in a narrative approach to her dilemma was to reframe the problem as her being manipulated and pushed around by The Fear. Rather than talking about her as a fearful person, we were able to talk about the influence of The Fear in her life. This led to a different approach to questions in which I was able to map differences in the times when The Fear was able to keep her home, and other times when she was able to stand up to The Fear and leave home to do things that she wanted to.

Initially she described the times when The Fear did not keep her home as failures, because The Fear was still with her and her outings were minor ones like collecting mail or visiting a corner shop. She still felt that The Fear was in control of her.

By carefully exploring how it was that she had been able to stand up to and contain The Fear, the client slowly developed a different understanding of these exceptions.

She began to talk about them as successes, even though they were small, in an ongoing battle to deal with the intrusion of The Fear into her life. We used these small successes as the basis for developing conversations about strategies for increasing the courageous times in her life. Once she understood herself as a “courageous” individual, the view of herself as “weak and fearful” began to have less and less of a hold. The last time that I heard from this client she had just completed her third road trip around Australia and was planning her first overseas holiday.

Narrative Therapy for Trauma

Mostly where people have experienced trauma they will have a description of themselves, shaped by the effects of that trauma on them. Frequently therapy for trauma focuses on the effects of the trauma and on the events that led to those effects. People’s stories about the events include descriptions of what happened and how they felt.

Normally these are descriptions of themselves as helpless victims experiencing fear and terror. It is not the purpose of a narrative approach to deny the reality of how people respond to life-threatening events; fear, terror, and uncontrollable physiological responses are normal and undeniable. Commonly where people have been subject to traumatic events they will have developed descriptions of themselves as helpless and unable. This becomes the dominant narrative about the trauma event itself and also about the way that they have managed in the aftermath.

But there are multiple ways of understanding and interpreting people’s experiences of life-threatening events. Whilst a person may be dominated by their experience of fear and terror, they may be unable to identify or recognise other behaviors and responses which stand in contrast to that particular description.

The purpose of a narrative conversation in relation to a traumatic event is to identify and elicit different descriptions of the same event.

One way of doing this is to focus not on effects, but on the person’s responses. Frequently, people do not recognise essentially brave or courageous behavior in that way at the time of the event. By actively seeking conversation with the person about what it was that they actually did, rather than how they felt, it is possible to identify behaviors that are in contrast to the overwhelming feelings of helplessness, terror, or rage. Simply by asking what they did during an event, a narrative therapist can begin to identify responses that demonstrate elements of courage and survival.

Treating Military Trauma

One of my clients had been involved in a military incident on deployment in which he had experienced paralysing fear whilst being shot at by insurgents. He had been the NCO in command of the small patrol and felt that he had failed his mates because felt the fear.

In exploring with him what it was that he had actually done during the events he was able to recall touching several of his team on the shoulder and making eye contact as a way of trying to reassure them. Initially, he did not identify this as a, particularly meaningful act. He was very much in the grip of the idea of what it was to be a “hero” under fire; that being “brave” meant acting in a strong and “manly” way and, especially, engaging the enemy.

I explored with him how difficult it must have been to make contact with his team when he was experiencing so much fear. I wondered whether he had any idea of how his team felt about his effort to make this connection with them? I wondered also whether his behavior reflected a person who was prepared to act for others despite the fear in himself?

This led on to conversations about the nature of heroism. In the process of that conversation, we were able to unpack the idea that a hero was necessarily someone who fought back against an enemy; that there was heroism in feeling fear and staying focused on the needs of others at the time.

Over a period of time it was possible to build this objectively small action into a meaningful reinterpretation of the event itself. As a consequence, the client began to take quite a different approach to his recall of the event and to his understanding of himself.

This also led him to being able to talk about the incident with some members of his team, and he was surprised to find that they had thought him to be both heroic and courageous during that event – because of his capacity to make contact with them despite the threat of the gunfire.

In essence, narrative conversations with people are not particularly different from normal conversations. However, the focus of the therapist is on eliciting or identifying difference that allow for the development of a different “story” to the one that the client initially presents with.

A narrative therapist assumes that the richness of the client’s experience has been captured by a single way of describing their experience. The purpose of the narrative conversation is to explore the detail of the client’s behaviors and feelings in order to identify actions, thoughts, and feelings that stand in contrast to the dominant themes.

It is as the therapist is able to draw attention to those contrasting experiences and explore how they are meaningful and valid demonstrations, that the client develops a richer and more varied experience of their responses to the problems in their lives. By privileging these differences, whilst not disrespecting the problems, the client is able to access more helpful ways of behaving and feeling, rather than being dominated by problem saturated and disabling understandings.

Dr Alistair Campbell is a Clinical Psychologist working with individuals, couples, and families. He is trained and experienced in a wide range of therapies including Narrative; Systemic; Solution Oriented; Narrative; Cognitive; Behavioural; and Hypnosis approaches.