Narrative therapy is a psychotherapeutic approach that helps clients explore, challenge, and reshape the life stories that fuel their struggles, working collaboratively with a therapist.
It treats individuals as the ultimate authority on their own lives, separating problems from personal identity.
Through this process, clients build a deeper understanding of their values and skills, helping them face present and future challenges.
This article is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician, therapist, or other qualified health provider with any questions you may have regarding a medical or mental health condition. Never disregard professional advice or delay in seeking it because of something you have read on this site.
Key Takeaways
- What It Is: Narrative therapy treats a person’s problems as separate from their identity, helping them re-author the stories that shape how they see themselves.
- Founders: Developed in the 1980s by Michael White and David Epston, working out of the Dulwich Centre in Australia and Epston’s practice in New Zealand.
- Core Techniques: Key methods include externalizing the problem, deconstructing unhelpful stories, and identifying “unique outcomes” that contradict the dominant narrative.
- Preliminary Evidence: Most supporting studies are small, uncontrolled, and conducted in single countries, so findings should be read as promising rather than proven.
- Meta-Analyses: Large pooled analyses (2024, 2026) report very large effects but rate the certainty of that evidence as very low, due to bias and a lack of blinding.
- Who It Suits: The approach can be very in-depth, so it may not suit everyone, particularly those who find it hard to separate themselves from their problems.
When was narrative therapy developed?
Narrative therapy was developed through the 1980s by therapists Michael White and David Epston. White worked from the Dulwich Centre, a family therapy centre established in Adelaide, Australia, in 1983, while Epston practiced in Auckland, New Zealand.
Their approach grew out of family therapy rather than individual clinical psychology. It remains empowering, non-blaming, and non-pathologizing.
Its founding statement is White and Epston’s 1990 book Narrative Means to Therapeutic Ends, which set out the narrative metaphor and the practices that followed from it.
What is a narrative?
A narrative is a story. As humans, we have many stories about ourselves, others, our abilities, our self-esteem, and our work, among many others.
The development of these stories is determined by how we have linked certain events together in a sequence and by the meaning attributed to them. As more and more events are selected and gathered into the dominant plot, the story gains richness and thickness.
Identity follows the story.
The idea is that an individual’s life narrative forms identity, and several narratives are at work at once. This shapes thinking, feelings, and behavior.
Many narratives are useful and healthy, whereas others can result in mental distress. Mental health symptoms can come about when there is an unhealthy or negative narrative, or if there is a misunderstanding or misinterpretation of a narrative.
What is the aim of narrative therapy?
Narrative therapy seeks to change a problematic narrative into a more productive or healthier one. This is often done by assigning the person the role of narrator in their own story.
Narrative therapy aims to:
- Empower individuals to see themselves as separate from their problems.
By challenging negative labels and self-definitions, the therapy supports people in reclaiming agency over their stories and responses. - Create a respectful and supportive space for self-exploration.
It honors the client’s courage to reflect on personal challenges and encourages compassionate dialogue rather than critique. - Encourage non-blaming, non-judgmental conversations.
Clients are guided to shift away from self-blame or blaming others, and instead focus on how unhelpful narratives can be understood and reshaped. - Position the client as the expert of their own life.
Rather than offering directives, therapists work collaboratively, trusting that clients have the knowledge and insight to guide their own growth. - Acknowledge the influence of social, cultural, and political contexts.
The therapy invites clients to explore how external systems shape their personal narratives, helping them reframe problems within a broader perspective.
Psychologist Michael Hoyt explains the narrative therapy premise: problematic stories can trap people in patterns of distress, and reshaping them opens up new possibilities:
“As people live their lives, they may be doing fine, but when they get stuck, it’s often because they’re telling themselves a story that isn’t fulfilling—it’s frustrating. People come to therapy, in essence, for a new story.”
What is the role of the therapist?
The role of the narrative therapist is to search for an alternative way of understanding a client’s narrative or an alternative way to describe it.
The belief is that telling a story is a form of action toward change. The therapist helps clients objectify their problems and frame them within a larger sociocultural context. This makes room for other, more helpful stories.
During therapy, the therapist acts as a non-directive collaborator. They treat the client as the expert on their own problems and do not impose judgments.
Instead, the therapist is purely curious and investigative. They are not particularly interested in the cause of a problem but are open to a client’s perception of the cause.
Narrative Therapy Techniques
Putting together the narrative
This involves the therapist listening as the client explains their stories. The client explores events in their life and the meaning they place on them. The client leads the telling.
“Problem-saturated” narratives may crop up, which the therapist will identify as causing the most distress to their client.
The therapist uses the same language and terms the client uses throughout this stage. This reflects the principle that the client is the expert in their own narrative.
Externalizing the problem
Externalizing means the therapist encourages the client to create distance between themselves and the problem, becoming an observer of it rather than someone defined by it.
The problem becomes external. It stops being a fixed part of who they are.
The therapist may ask the client to name the problem, so it is seen as separate, and the client uses that name whenever they talk about it.
Naming it helps. It is easier to change a behavior than to change a core personality characteristic.
They are not the problem. The problem is the problem.
Deconstruction
The narrative therapist works with the client to deconstruct their stories, breaking them into smaller, more manageable parts. This clarifies the problem and reduces overgeneralizing, overwhelm, and confusion.
Deconstruction can also apply to identity itself. Gender, class, race, culture, and sexual identity all shape the meanings people give to events. Examining this raises awareness of the wider social and political forces acting on the client.
Unique outcomes
When someone’s problematic stories are well established, people can become stuck in them, unable to view alternative versions of the story. A narrative therapist helps people challenge their stories and consider alternatives.
Unique outcomes are the exceptions to the dominant story: the moments that don’t fit the problem-saturated plot. They are also called “sparkling moments.” The dominant story has no place for them, so they are easily dismissed or forgotten.
There are hundreds of possible stories. Everyone interprets their experience differently and finds their own meaning in it.
Unique outcomes contrast with the problem, reflect something the person recognizes as their own, and supply the material from which a new story can be built. Building upon stories from another perspective can help to overcome problems and build the confidence the person needs to heal from them.
Re-authoring Conversations
Re-authoring (also called re-storying) is the ongoing work of growing an alternative story from unique outcomes until it feels solid enough to live by.
The therapist asks questions that move between two “landscapes.” The landscape of action covers what happened, when, and with whom. The landscape of identity covers what those events say about the person’s values, intentions, and hopes.
Moving between the two keeps the new story balanced. A story built only from events stays a list of incidents, while a story built only from values floats free of evidence.
How effective is narrative therapy?
Research on narrative therapy is still emerging, but several small studies suggest that it may support emotional and relational well-being in a variety of settings.
Below are examples of areas where narrative therapy has shown potential benefits. These findings are preliminary and should not be interpreted as medical advice.
“It’s only been a few sessions, but I’m finding it really helpful in terms of having a complete story in my head as opposed to a bunch of random parts… Being able to piece together a cohesive narrative has really already started helping me … identify the specific things that I’m struggling with within the narrative itself.”
Major Depressive Disorder
Aim: Vromans and Schweitzer (2011) set out to test whether narrative therapy improves symptoms and relationships in adults with major depressive disorder.
Method: Forty-seven adults with major depressive disorder received eight sessions of manualized narrative therapy, with no control group. Symptoms and interpersonal functioning were measured before and after treatment, and again at three-month follow-up.
Results: Depressive symptoms improved substantially (d = 1.36). Most participants improved: 74% showed reliable improvement, 61% moved into the functional range, and 53% achieved clinically significant improvement.
Interpersonal functioning improved less (d = 0.62). That gain faded by follow-up.
Conclusion: This is the strongest single study of narrative therapy for depression to date. Without a control group, though, the improvement can’t be separated from natural remission or the general benefits of any therapy. That makes narrative therapy plausible, not proven, for this population.
Intimacy and Relationships
Khodabakhsh et al. (2015) studied twenty Iranian couples. All were experiencing marital difficulty. Couples who received narrative therapy showed significant gains across all three intimacy dimensions measured: emotional, communicative, and general.
Ghavibazou et al. (2020) extended this to communication itself, randomly assigning thirty women with low marital satisfaction to eight individual sessions or a waiting list.
Satisfaction improved.
Demand-withdraw communication patterns fell, with the gains still holding eight weeks later.
A follow-on study by the same team found no significant improvement in attachment style or emotional expressivity. That null result is a reminder: these positive findings come from small, unblinded samples with waiting-list rather than active comparators.
Depression and Anxiety
Shakeri et al. (2020) ran a randomized trial with 26 patients treated for amphetamine addiction in Kermanshah, Iran, allocated to ten sessions of group narrative therapy or routine psychiatric care.
Depression and anxiety scores fell significantly in the narrative therapy group but not in the control group. Quality of life did not improve significantly, so the trial points to a symptom-level effect rather than a broader gain in wellbeing.
Emotional Skills in Children
Beaudoin et al. (2016) analyzed 813 problem-solving stories generated by children aged 8–10 in a school-based narrative programme. The study found gains in self-awareness, self-management, empathy, and responsible decision-making.
The story corpus is large. But the unit of analysis is stories, not randomly assigned children, so the design can’t support strong causal claims about individual outcomes.
Narrative Therapy with Autistic Young People
Aim: Cashin and colleagues (2013) took a first step toward finding out whether narrative therapy helps autistic young people with emotional and behavioral problems.
Method: Ten autistic young people aged 10–16 received five one-hour sessions over ten weeks, with no control group. The main outcome was a parent-rated questionnaire, alongside distress and hopelessness scales and a salivary stress biomarker.
Results: Emotional symptoms and psychological distress improved significantly. The stress biomarker also responded, and the researchers judged a larger study was warranted.
Conclusion: Narrative therapy showed merit with this group, though the tiny, uncontrolled sample means this is a feasibility signal rather than proof of effectiveness.
Behavior and Attention in Children with ADHD
Aim: Looyeh and colleagues (2012) explored whether group narrative therapy improves the school behavior of girls with ADHD.
Method: Clinic-referred girls aged 9-11 with an ADHD diagnosis were randomly assigned to group narrative therapy or a wait-list control. Teachers rated symptoms one week after treatment and again after thirty days.
Results: Teacher ratings showed a significant reduction in ADHD symptoms one week after treatment, sustained at the thirty-day follow-up.
Conclusion: Using teacher raters who had no part in the therapy strengthens this small study, but the wait-list comparison cannot rule out the effects of attention and expectancy alone.
Trauma
One client shared that narrative therapy “helps us focus on the way we responded to trauma… remembering [our values] can help us move towards a more positive and balanced sense of ourselves.”
This illustrates a broader pattern in how narrative therapy approaches trauma. The emphasis falls on how a person responded to what happened, and on the values that response reveals, rather than on the traumatic material alone.
Critical Evaluation
Most studies on narrative therapy involve small samples or a limited scope. Beyond that evidence gap, four further criticisms recur.
- Unstable construct: Researchers have documented eight distinguishable accounts of what narrative therapy actually is (Wallis et al., 2011), and pooled trials mix it with narrative medicine and narrative nursing.
- Measurement tension: As Etchison and Kleist (2000) noted, an approach built on scepticism about objective measurement sits awkwardly with the culture of testing by which treatments earn empirical status.
- Overreaching theory: As philosophers Daniel Hutto and Shaun Gallagher explain, the claim that narrative constitutes the self is stronger than the philosophy of mind can support (Hutto & Gallagher, 2017).
- Practical limits: The intensive exploration involved can be emotionally demanding, and it may not suit clients who find introspection difficult or want symptom-focused, time-limited help.
Larger, more rigorous research is needed to understand how well narrative therapy works across different populations.
Contemporary Research
Large Meta-Analyses, Low Certainty
Hu and colleagues (2024) pooled 54 randomized controlled trials (4,879 participants) testing narrative therapy for depressive symptoms in adults with somatic disorders. The pooled effect was very large: SMD = −1.64 (95% CI −1.95 to −1.32).
The researchers rated the certainty of this evidence as very low. That downgrade reflects a striking pattern. Fifty-two of the 54 trials came from China, none used blinding, and statistical tests pointed to publication bias.
An effect this large would outperform every well-established treatment for depression. That is a warning sign, not reassurance.
A second synthesis, by Çetiner and colleagues (2026), reached a similar conclusion pooling 11 randomized trials of narrative interventions with cancer patients. Effect sizes were again implausibly large: Hedges’ g = 2.18 for quality of life and 1.60 for self-efficacy.
Evidence certainty ranged from low to moderate, and eight of the eleven trials came from China.
What Exactly Is Being Tested?
Both meta-analyses pooled “narrative therapy” together with related but distinct practices like narrative medicine and narrative nursing. Wallis and colleagues (2011) ran a Delphi survey and Q-sort study of UK narrative therapy practitioners and found eight distinguishable accounts of what the approach actually is.
Together, this means the outcome literature is not yet able to say whether narrative therapy works, for whom, or better than what.
How to get started
Finding the right narrative therapist can mean searching online directories or asking a doctor for a referral to someone with the right training.
Choose someone you feel comfortable discussing personal information with, and don’t be afraid to try a different therapist if the fit isn’t right. Think about your deal breakers and the qualities that matter most to you.
What questions can you ask yourself when considering therapy?
1. What type of therapy do you want? – Do you want individual, couples, family therapy, or another type?
2. What are your main goals for therapy?
3. Whether you can commit the time each week – what days and times are most convenient for you?
What can be expected during the first therapy session?
The therapist may also want to know about how your problems are affecting your life and what your goals for the future are.
Furthermore, they are likely to discuss aspects of treatment, such as how often you will meet and how your treatment may change from one session to the next.
What are some considerations for narrative therapy?
It also involves talking about problems as well as strengths which may be difficult for some people.
The therapist will help you to explore your dominant story in-depth and discover how it may be contributing to emotional distress, as well as uncover strengths that can help you to approach your problems differently.
You should expect to re-evaluate your judgments about yourself since narrative therapy encourages you to challenge and reassess these thoughts and replace them with more realistic or positive ones.
It also challenges you to separate yourself from your problems which can be difficult, but this process helps you learn to give yourself credit for making the right decisions for you.
Do you need mental health help?
USA
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
1-800-273-8255
UK
Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email jo@samaritans.org .
Available 24 hours a day, 365 days a year (this number is FREE to call):
116-123
Rethink Mental Illness: rethink.org
0300 5000 927
Further Information
Morgan, A. (2000). What is narrative therapy? (p. 116). Adelaide: Dulwich Centre Publications.
References
Beaudoin, M. N., Moersch, M., & Evare, B. S. (2016). The effectiveness of narrative therapy with children’s social and emotional skill development: an empirical study of 813 problem-solving stories. Journal of Systemic Therapies, 35(3), 42-59.
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.
Çetiner, E., Turan Kavradim, S., & Özer, Z. (2026). Effect of narrative interventions on psychological outcomes, sleep quality and quality of life in patients with cancer: Systematic review and meta-analysis of randomized controlled trials. European Journal of Oncology Nursing, 83, 103259. https://doi.org/10.1016/j.ejon.2026.103259
Etchison, M., & Kleist, D. M. (2000). Review of narrative therapy: Research and utility. The Family Journal, 8(1), 61–66. https://doi.org/10.1177/1066480700081009
Ghavibazou, E., Hosseinian, S., & Abdollahi, A. (2020). Effectiveness of narrative therapy on communication patterns for women experiencing low marital satisfaction. Australian and New Zealand Journal of Family Therapy, 41(2), 195-207.
Hu, G., Han, B., Gains, H., & Jia, Y. (2024). Effectiveness of narrative therapy for depressive symptoms in adults with somatic disorders: A systematic review and meta-analysis. International Journal of Clinical and Health Psychology, 24(4), 100520. https://doi.org/10.1016/j.ijchp.2024.100520
Khodabakhsh, M. R., Kiani, F., Noori Tirtashi, E., & Khastwo Hashjin, H. (2015). The effectiveness of narrative therapy on increasing couples intimacy and its dimensions: Implication for treatment. Family Counseling and Psychotherapy, 4(4), 607-632.
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.
Shakeri, J., Ahmadi, S. M., Maleki, F., Hesami, M. R., Moghadam, A. P., Ahmadzade, A., Shirzadi, M. & 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.
