- a single event, like a robbery or act of violence
- large-scale events, like war or natural disaster
- multiple events that continue over time, like chronic child abuse
Unresolved trauma, whatever its cause, can have short- and long-term effects. It can shake the foundations of your identity, relationships with others, and philosophy on life as a whole. It can also create patches of mental “fog” where your memory seems vague, disjointed, or absent entirely.
Sometimes, trauma can feel too intense and confusing to think deeply about. But narrative therapy, one approach to working through trauma, can help you get more clarity on past events so your memories become less overwhelming. Once you have a clearer picture, or narrative, of the trauma you experienced, you may find those events easier to understand and cope with.
Read on to learn more about narrative therapy for trauma, including how it works, what to expect from a session, and how it might benefit you.
According to the philosophy behind narrative therapy, humans tend to make meaning out of their lives by organizing their memories into stories. Narrative therapy then uses those stories to help change how you emotionally react to the past.
Narrative therapy can be used for a range of symptoms and concerns, including:
Narrative therapy for post-traumatic stress disorder (PTSD) is called narrative exposure therapy (NET). Maggie Schauer, Frank Neuner, and Thomas Elbert developed NET in 2005 to help refugees and survivors of torture.
NET is mainly used to address complex trauma (CPTSD), which stems from prolonged harm or multiple traumatic events. Experts call this trauma “complex” because the pain from each incident can combine to grow into something bigger than the sum of its parts.
While NET is a structured approach to therapy, it’s still fairly versatile — therapists might use it in group or individual therapy, with both children and adults.
How long does NET take?
According to the original manual, published in 2005, some people noticed improvement after just three to six sessions.
The 2011 edition of the manual, however, recommends
The recommended length of treatment can vary, depending on how many traumatic events you’ve experienced.
During a traumatic event, your body prioritizes survival. As a result, it may delay non-urgent functions like digestion or memory encoding.
Scientists believe PTSD can develop when your brain creates incomplete memories of a traumatic event. You might find certain emotional and physical details, like your panic or pain, very easy to recall. But others, like the contextual details of where and when the event happened, may prove more elusive.
But without this context, your brain doesn’t know where to sort the memory. For lack of a better organizational category, it may tie the traumatic event to minor sensory details, like:
- a song on the radio
- the smell of smoke
- the weather
You might even feel as if the memory drifts in your head, simply waiting for a spark of reminder.
That’s where narrative therapy comes in. Essentially, this approach can help declutter your head.
Instead of recalling the event and then trying to remember details while already stressed, narrative therapy has you build out the context first. In short, you tell your life story from the beginning. Then you can fit the traumatic events in the gaps like puzzle pieces.
This method helps your brain anchor the traumatic memories to a specific time and place. Those threats you faced can then become something rooted in the past rather than an ever-present, looming tragedy. Confining those memories inside your narrative can rid them of some of their power.
In addition, lining up all of your experiences can help you consider those traumatic moments from a different perspective. Context can change what those memories mean to you.
Narrative therapy in action
Say an abusive marriage caused you a lot of heartache.
Narrative therapy doesn’t dismiss that pain, or its impact on your life. Instead, it puts that relationship in the context of all the times other people cared for you, admired you, and appreciated you.
Consequently, your memories of the abusive marriage can become examples of one person’s cruelty, not a reflection of your overall likability and value.
When you first start NET, your therapist may spend the first session explaining how therapy works and offering some more information about how trauma affects the brain.
From there, you begin the narrative exposure process.
- You’ll begin at the beginning. Perhaps unsurprisingly, you’ll start this narrative in your early years, moving through your childhood and adolescence before you hit the events of adulthood.
- You’ll focus on the time involving traumatic experiences. If you have childhood trauma, you’ll probably spend a lot of time talking about your early years. But if all your trauma stems from a famine you survived in your 40s, you might summarize most of your childhood and fast-forward to middle age.
- You’ll revisit traumatic events. Your therapist may ask you to recall these experiences in detail. As you describe the event, they’ll offer support with helping lower physical stress symptoms and keeping painful emotions to a manageable level. In short, they act as a mental “lifeguard,” so to speak, ready to pull you out if you find yourself in too deep.
- You’ll review the details with your therapist. After each session, your therapist creates a transcript of the story so far. In the next session, they may review the transcript with you to make sure they got everything right and add any details you missed on the first telling.
These controlled exposures to the memory can help your body unlearn its fight-or-flight reaction to various trauma triggers, plus give your brain another chance to store the memory correctly.
You’ll repeat the exposure process with your therapist until you complete the timeline. In the final session, you and the therapist will review your narrative and discuss where your story might go next.
When therapy ends, your therapist can give you the complete autobiography to use as you like.
STAIR narrative therapy
When childhood trauma leads to disrupted social and emotional development, an approach called Skills Training in Affective and Interpersonal Regulation (STAIR) narrative therapy can help you learn to better manage emotions and communicate more effectively.
STAIR narrative therapy, which combines narrative therapy and skills training, usually lasts around 16 weeks.
Sessions typically unfold as follows:
- Sessions 1-2: You’ll practice identifying and expressing your emotions.
- Sessions 3-4: You’ll learn coping strategies to navigate unwanted emotions.
- Sessions 5-8: You’ll practice skills for communicating assertively and building healthy relationships.
- Sessions 9-16: You’ll proceed with narrative work, adding emotional coping strategies as needed.
Both adolescent and adult survivors of abuse may find this approach helpful.
Narrative exposure therapy appears to be an effective approach for treating PTSD.
What’s more, NET seemed more effective than non-trauma-focused interventions. Controlled trials comparing NET with other trauma-focused interventions remain limited, and experts continue to explore how NET stacks up to other trauma-focused therapy approaches.
NET vs. prolonged exposure therapy
Researchers have compared NET to prolonged exposure therapy, which experts currently recognize as a gold-standard treatment for PTSD. In this modified form of cognitive behavioral therapy (CBT), you expose yourself to memories, activities, and places linked to your trauma with guidance and support from a therapist.
In a 2014 review comparing the two approaches, researchers emphasize that both can help address trauma. Yet while prolonged exposure therapy appears highly effective as a treatment for PTSD, NET may prove more beneficial for treating CPTSD, particularly among refugees and people seeking asylum.
In addition to high effectiveness, other potential benefits of NET include:
- Low dropout rates. Most people complete the entire treatment.
- Length. You may notice improvement after as few as four sessions.
- Convenience. Therapists can use this approach in person or remotely. It also requires no “therapy homework” on your part.
- Your biography. Your therapist organizes and writes your life story for you to keep.
Experts developed NET to help people with CPTSD, or people who lived through a long-lasting traumatic event or survived multiple traumas.
CPTSD could affect:
- people displaced by political violence
- prisoners of war
- survivors of torture
- survivors of childhood abuse and neglect
- survivors of relationship abuse
If you’ve reached the twilight of your lifespan, you probably have more memories to sort through — and possibly more traumas, too. Telling your life story repeatedly can offer a chance to reflect back on your life and take stock of your legacy.
STAIR narrative therapy doesn’t just treat CPTSD
STAIR narrative therapy was also created to address CPTSD, specifically childhood trauma. But this approach can help treat acute trauma, too.
According to 2015 research, STAIR narrative therapy helped reduce distress and improve social and emotional functioning among survivors of the 9/11 World Trade Center attacks.
Interested in giving narrative therapy for trauma a try? You’ll want to start by finding a therapist you can trust.
If you end up holding back details or censoring parts of your life in therapy, you’re not providing the full story needed for therapy to have the intended effect.
No mental health professional should criticize your choices or pass judgment on any events from your life. Therapists are there to offer unbiased guidance and compassionate support.
If you don’t get a sense you can trust your therapist, don’t hesitate to continue shopping around for someone who seems like a better fit for your needs.
Keeping these signs of a good therapist in mind can help.
You can find narrative therapists using online directories, including:
- American Psychological Association (APA) Psychologist Locator
- Department of Veterans Affairs (VA) PTSD Program Directory
- International Society for the Study of Trauma and Dissociation (ISSTD) Therapist Directory
Some mental health professionals may list narrative therapy as a specialty on their directory page or practice website. Others may only describe themselves as trauma therapists, so you may need to contact them and ask whether they provide narrative therapy.
When you do find a trauma therapist, just know you aren’t limited to narrative therapy alone. Treatment for PTSD can involve more than one type of treatment, especially if you have co-occurring conditions like depression.
Your therapist can offer more guidance with finding an approach that best fits your unique needs.
Narrative therapy can’t change the past, but it can help you get a clearer perspective of it.
Telling the story of your trauma can help you shift not only what those memories mean to you, but also how they affect you in the present.
The trauma will remain part of your story, it’s true. But you can decide how the tale is told and, more importantly, what happens next.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.