What is narrative therapy? How does it work?

Imagine sharing the details of your life as though you were telling a story. This premise, that we are both the experts and narrators of our own lives, is the basis of narrative therapy. Narrative therapy holds that people's lives can be understood through both the content and telling of our stories. But telling stories is only one-half of narrative therapy. The second half lies in "restorying,"  which means working with a narrative therapist to retell your story in a way that gives you power over the problem. 

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Social workers Michael White and David Epston created narrative therapy after meeting at an Australian-New Zealander family therapy conference in 1981. Narrative therapy is based on the idea that our personal stories provide critical insight into how we live and relate to our environment (Sommers-Flanagan, 2018). The narrative approach stresses that people's identities are separate from their problems. Once people realize they are not the sum of their problems, more beneficial alternative stories can be told. These new stories give people agency over their lives and difficulties (Etchison, 2000). 

The public's introduction to narrative therapy came in 1990 when White and Epston published their first book, Narrative Means to Therapeutic Ends (Frank, 2018). White also co-founded the Dulwich Centre in Adelaide, Australia, in 1983. Since then, the center has served as a home for narrative therapy, training health professionals, and engaging in community work. 

Narrative therapy is focused on the telling of stories and the role society plays in shaping the way you view yourself in front of a therapist (Freedman, 1996). Narrative therapists act as collaborative co-authors in the deconstructing and re-authoring of your story (Carr, 1998). 

Narrative therapists work with you to deconstruct a particular way of thinking: the misconception that things that influence our lives are part of us instead of external factors. Narrative therapists help you see problems, societal constructs, and power relationships in your life as the outside influences they really are. 

For example, if you have anorexia, narrative therapy might focus on seeing your desire to be thin as something fueled not by you but by dominant cultural narratives that celebrate slim bodies. This restorying puts people in control of their life stories in an empowering way.

Narrative therapists work with a wide range of clients, including those dealing with grief, childhood trauma, eating disorders, and marital problems. Though narrative therapy can help people living with mental health conditions, people's lives are the focus of therapeutic conversations as opposed to their diagnoses (Sommers-Flanagan, 2018). 

One significant focus of narrative therapy is something called “externalization.” It means creating a distance between you and your problems, which helps you see problems as separate from your identity (Markham, 2016). For example, instead of describing yourself as an “unhappy person,” your therapist will help you uncover the problems causing your unhappiness thereby separating the problem from you. Your therapist will ask you to map out the influence the problem has on your life and relationships. From there, you'll identify what control you have over the issue. This narrative practice allows people to see issues in non-blaming ways (Carr, 1998). 

To help you create your own story, one that gives you agency, your therapist will help you find unique outcomes—times in your life where the problem didn't weigh you down. Once you identify these unique outcomes, you'll begin to work them into your new storyline. You will also learn how to extend this story into the future (Carr, 1998).

Narrative therapy may also include letter writing. This is something the therapist does to help highlight the progress you've made and commit your preferred story to writing. Your therapist may also write you letters of prediction, letters to be opened at a later date, that showcase a future they predict for you where the problem you went to therapy for is in the past (Bjorøy, 2016).  

Narrative therapy is most commonly used as part of family therapy. Narrative therapists may work with children, families, or married couples.  Narrative techniques can be helpful in family sessions where parents identify the child as the source of the problem. This child-related issue might present as behavioral challenges or difficulties in school. Using narrative therapy, families learn how to change their language and storytelling to move away from a narrative defined by the problematic behavior (Etchison, 2000). 

Narrative therapists will also ask families to attend sessions for family members utilizing narrative therapy. For example, after working to create a new narrative, families may be invited to come to therapy sessions to share their perspective on the problem and later hear the new narrative (Carr, 1998).  

Narrative therapy is not traditional psychotherapy. In fact, it's critical of psychoanalysis and psychological thinking (Frank, 2018). Because narrative therapy is a younger therapy, it does not have as much empirical evidence as other therapies.

Of the studies that do exist, narrative therapy shows the most benefit in matters related to family therapy, such as grief related to death and divorce, family violence, sibling aggression, problems in school, and parent-child conflict (Jordan, 2007). 

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Current version

June 17, 2021

Written by

Jordan Davidson

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.