Narrative Therapy: Definition, Techniques, & Exercises

Narrative therapy practices were first shared in White & Epston’s book Narrative Means to Therapeutic Ends, published in 1990, which served as a guide to using “restorying” techniques in family therapy (White & Epston, 1990). By using storytelling approaches in a therapeutic context, White & Epston believed that individuals could better dissociate the self from individual actions, events, or mistakes, avoiding blame or judgment and achieving clarity. 

Here are some other major themes and principles in narrative therapy (Morgan, 2002): 
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• An individual with a problem is not a problematic individual, meaning that we are not defined by our mistakes, issues, or challenges—every client is worthy of respect and dignity.
• The client is the expert in their own life, and the therapist is an ally in the process of reshaping perspectives and behaviors.
• Having a clear narrative helps us to organize and understand our reality, making sense of our experiences.
• There is no “right” direction a narrative can take, and curiosity and a willingness to explore unknowns are essential to narrative therapy.
• By helping clients develop their own narrative or story, therapists can help them to find new meanings in their experiences and “re-author” their perspective. 

​These underlying principles guide the many techniques that practitioners and clients use in narrative therapy.

1. Developing a story – By directing a conversation and asking questions, a therapist can help a client establish or re-establish their identity and see experiences from different perspectives. Also called “re-authoring” or “re-storying”, this approach can help clients see parts of their story from new angles, find new meaning, and reach conclusions that better fit their sense of self. 
2. Externalization – This technique is grounded in the idea that it is easier to make changes to your behaviors or attitudes than it is to change core parts of your personality. Therefore, clients are encouraged to view their problem as external to themselves, even characterizing it as a separate thing or person. For example, children struggling with behavioral outbursts may use externalization to view “Temper” or “Worries” as two separate entities from themselves that they must work with to improve the scenario (Ramey et al., 2009). By doing this, clients can focus on working with specific behaviors or attitudes rather than being at odds with the self as a whole.
3. Deconstruction – Deconstruction refers to the breaking down of a scenario into the specific problems a client is experiencing, enabling them to see the “big picture” more clearly. In doing so, solutions can become more clearly available to the client. Suppose a woman in therapy complains that her wife doesn’t care about her and is becoming increasingly distant. When framed in this vague way, the problem feels overwhelming and lacks a clear course of action. A therapist could encourage this client to deconstruct the issue to its root components: Perhaps the woman is frustrated that her wife is forgetting to do things she asks her to do, which makes her feel ignored, or that she hasn’t been initiating activities and she misses sharing experiences together. By reducing the problem to its component parts, clients can begin to identify routes to overcome it. 
4. Identifying Unique Outcomes – This technique builds from the basic approach to developing a story in narrative therapy. To explore unique outcomes, clients are encouraged to entertain new possibilities for the storyline they build about their own life. As they rework their narrative, clients may identify outcomes not originally predicted by their dominant storyline and that may vary from their typical self-perception (Gonçalves et al., 2009). 
5. Existentialism – This idea may seem strange at first, as existentialism is the belief that the world has no inherent meaning. But because narrative therapy is all about developing your own story with meaning and purpose, rather than seeking absolute truth, existentialist concepts are well-aligned with the approach. 

Check out this video to see some of these techniques in action, including externalization and unique outcomes, during a therapy session.

Here are some exercises that may be employed in narrative therapy sessions: 

• Journaling – Journaling can provide a great space for clients to unpack their problems and personal narratives outside of conversations. 
• Art – Art therapy techniques can be integrated with narrative therapy, allowing clients to engage with concepts and directions that may be complex or uncomfortable to explore through language alone (Carlson, 1997).
• Visualization – Visualization can be a useful tool for clients envisioning unique outcomes. Visualizing the path of their story into the future and seeing how its ultimate outcome may change with changes to the narrative may help clients engage more deeply with narrative therapy. 
• ​Puppets – Especially for children, using puppets can be an excellent way to construct and explore in a more tangible way. Additionally, research has demonstrated that use of puppets in narrative therapy may help children externalize problems by assigning them to a concrete outside persona, the puppet (Butler et al., 2009).

• Roots – Where do you and your family come from? Has your perception of your roots changed over time? Does your past influence your current identity? 
• Ground –  What is your present life like? Is the “ground” fairly stable or more dynamic? What impacts you on a daily basis? 
• Trunk – What talents, abilities, and coping skills do you have? How do you feel others perceive your skills? What strengths do you value in others? 
• Branches – What hopes and personal goals are prominent in your life? What needs to happen in order to achieve them? Do they feel attainable? 
• Leaves – Who are the most important people in your life? How have they influenced your life, and how do you think you’ve influenced theirs? Where do you see your relationship going in the future? 
• Fruit – What kinds of gifts or lessons have important people bestowed upon you? How have they helped you? What have you given them in return? 
• Storms – What challenges have you experienced in the past, and how are you managing current “storms?” What storms could you see in the future? 

The video below provides an excellent overview of the process of creating a Tree of Life.

• Identify the specific behaviors in question
• Discuss the impact these behaviors have on all parties 
• Attach new meanings to the behaviors (i.e. defiant behavior as a result of frustration/feeling unheard)
• Explore instances that are exceptions to this issue 

One study of family clients’ feedback to narrative therapy reported the following statement from a client: “The therapist was not into blaming anyone for the problem. I like that. In our situation what was found was not one person in particular.” (St. James-O’Connor, 1997). Narrative approaches can allow families to communicate and solve problems in a non-judgmental way, avoiding shame and resentment.

• In what ways do trust issues injure your relationship? 
• How does this sense of trust align/not align with your individual strengths and priorities and your identity as a couple?
• How do you see a lack of trust impacting your relationship a month from now? A year from now? 
• How could you envision a repairing of trust influencing your relationship over the same timeline? 
• What actions can you take individually and as a couple to improve a sense of trust?

• A study of ten young people with autism who underwent five sessions of narrative therapy found significant improvements in measurements of psychological distress and emotional symptoms (Cashin et al., 2013). 
• Group narrative therapy improved levels of depression and anxiety in a sample of patients with methamphetamine addiction, though it did not impact measures of their quality of life (Shakeri et al., 2020). 
• A study of 9- to 11-year old girls diagnosed with ADHD found that narrative therapy significantly improved teacher-reported ADHD symptoms relative to a waitlist control group and that improvements were sustained at 30 days post-treatment (Looyeh et al., 2012). 

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A 2000 review by Etchison & Kleist also explored the findings of several earlier studies of the effectiveness of family narrative therapy and can be found here.

• Ackerman, C. (2017, June 18). 19 Best Narrative Therapy Techniques and Worksheets. 
• Butler, S., Guterman, J. T., & Rudes, J. (2009). Using puppets with children in narrative therapy to externalize the problem. Journal of mental health counseling, 31(3).
• Carlson, T. D. (1997). Using art in narrative therapy: Enhancing therapeutic possibilities. American Journal of Family Therapy, 25(3), 271-283.
• Cashin, A., Browne, G., Bradbury, J., & Mulder, A. (2013). The effectiveness of narrative therapy with young people with autism. Journal of Child and Adolescent Psychiatric Nursing, 26(1), 32-41.
• Cotter, L. (2009, December 2). Narrative Couples Therapy: The Power of Externalization. 
• Etchison, M., & Kleist, D. M. (2000). Review of narrative therapy: Research and utility. The Family Journal, 8(1), 61-66.
• Gonçalves, M., Matos, M. & Santos, A.. (2009). Narrative therapies and the nature of “unique outcomes” in the construction of change. Journal of Constructivist Psychology, 22, 1-23.
• Looyeh, M. Y., Kamali, K., & Shafieian, R. (2012). An exploratory study of the effectiveness of group narrative therapy on the school behavior of girls with attention-deficit/hyperactivity symptoms. Archives of Psychiatric Nursing, 26(5), 404-410.
• Morgan, A. (2002). What is narrative therapy?: An easy-to-read introduction. Dulwich Centre Publications. 
• Ncube, N. (2006). The tree of life project. International Journal of Narrative Therapy & Community Work, 2006(1), 3-16.
• Ramey, H. L., Tarulli, D., Frijters, J. C., & Fisher, L. (2009). A sequential analysis of externalizing in narrative therapy with children. Contemporary Family Therapy, 31, 262-279.
• Shakeri, J., Ahmadi, S. M., Maleki, F., Hesami, M. R., Moghadam, A. P., Ahmadzade, A., … & Elahi, A. (2020). Effectiveness of group narrative therapy on depression, quality of life, and anxiety in people with amphetamine addiction: A randomized clinical trial. Iranian Journal of Medical Sciences, 45(2), 91.
• St. James-O’Connor, T., Meakes, E., Pickering, M., & Schuman, M. (1997). On the right track: Client experience of narrative therapy. Contemporary Family Therapy: An International Journal, 19, 479-495.
• White, M., & Epston, D. (1990). Narrative means to therapeutic ends. WW Norton & Company.