Difference between narrative therapy and cbt

Deborah C. Escalante

Clients often seek therapy because they are stuck in a positive feedback loop and cannot break a cycle of negative thinking. Negative thinking typically leads to poor choices, negative coping strategies, identity issues and relationship problems. Both cognitive-behaviour therapy (CBT) and narrative therapy techniques help a client break out of these negative patterns and find positive ways of viewing themselves and their world, which reduces symptoms of mental disorder and increases positive behaviours.

1

How Problems are Formed

CBT practitioners help clients learn positive coping skills to replace negative behaviours.

Both CBT and narrative therapy seek to change a client’s negative thought patterns. It is the belief of practitioners of both of these therapy techniques that negative thought patterns lead to negative behaviours and a self-defeating attitude toward life. Therapists using CBT take an educational approach to therapy and work with the client to assist him in recognising negative patterns of thought, behaviour and mental imaging. Narrative therapists focus on the stories people tell about their lives and assist clients in finding the positive, often untold, stories that are also true for their lives.

  • Both CBT and narrative therapy seek to change a client’s negative thought patterns.
  • Therapists using CBT take an educational approach to therapy and work with the client to assist him in recognising negative patterns of thought, behaviour and mental imaging.

2

Restructuring and Reframing

Thoughts, feelings and behaviours are like blades on a pinwheel: change one and the others change as well.

CBT practitioners seek to restructure their clients’ thought processes through goal-oriented assignments. These assignments are aimed at self-knowledge and recognition of counterproductive thinking patterns. CBT operates on the premise that thoughts, behaviours and feelings are three points on a triangle, and changing either one of these points will change the other two. Narrative therapists seek to reframe the problem by exploring with the client the client’s stories about their lives and finding positive and unexcavated perceptions of the events of the stories.

  • CBT practitioners seek to restructure their clients’ thought processes through goal-oriented assignments.
  • These assignments are aimed at self-knowledge and recognition of counterproductive thinking patterns.

3

Externalising the Problem

Narrative therapy and CBT both externalise the problem, defining the problem behaviours or symptoms as separate from the client. This approach takes the blame and guilt away from the client and allows her to develop a more positive self-identity. When self-esteem is low and a client feels like she faces monumental oppression or opposition, she often identifies herself as the problem. For instance, society often refers to an individual who is dependent upon alcohol as an alcoholic. CBT practitioners help clients overcome the problem through skill-building. Narrative therapists externalise the problem so it can be explored in context of culture and personal life stories and changed by rewriting the stories.

  • Narrative therapy and CBT both externalise the problem, defining the problem behaviours or symptoms as separate from the client.
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4

Therapist as Co-creative of a New Reality

Socrates educated his students through questions leading to discovery.

Narrative therapists and CBT practitioners use Socratic questions to assist the client in discovering a new reality. The CBT practitioner asks questions to probe, clarify and explore implications of the client’s current way of thinking. Through this type of questioning, often presented as homework assignments, the CBT practitioner seeks to help the client change his thought patterns and reach his stated goal of therapy. Narrative therapists use Socratic questions to help the client find alternative ways of viewing an event, leading to reframing and creation of new — and positive — stories.

  • Narrative therapists and CBT practitioners use Socratic questions to assist the client in discovering a new reality.
  • The CBT practitioner asks questions to probe, clarify and explore implications of the client’s current way of thinking.

Finding a Narrative Therapist

Finding the right therapist can take some time. As you embark on your journey to heal and locate the therapist that will be best suited for your healing journey, remember to have some grace with yourself. One way to find a therapist is word-of-mouth. Sometimes in our circles, we know someone who has gone through therapy and has had a wonderful experience. Talking with close friends and family whom you trust and taking any of their recommendations can be helpful and encouraging.

Remember, not everyone will get the same gain out of going to the same therapist, so if you find yourself feeling as though a therapist is not right for you, don’t feel discouraged and keep looking.

Another way is by asking your physician for anyone they recommend. This also gives your physician an opportunity to collaborate with you and find you the right type of treatment. A holistic approach to any kind of therapy should also involve your physician or any specialists you are known to.

If there are no recommendations, locating a provider from your in-network list of counselors is another option. You can locate this information on the back of your insurance card or by calling your insurance company to obtain a list of in-network providers. They may give you a list of individuals, practices or community-based programs that are available to you.

To ensure your narrative therapist is qualified, they must hold a state license for counseling, psychology, mental health or social worker. LCSW, LSW, LPC, LMHC, MFT or PsyD are the most common types of mental health providers. Copays and coverage of treatment will depend on if the provider you choose is in-network or out-of-network. If you’re paying cash for the therapy sessions, don’t be afraid to ask if the therapist offers a sliding scale payment model or to look into other more affordable therapy options.

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In addition to asking about licensure and payment options, here are some additional questions to ask a potential therapist:

  • How long does narrative therapy last?
  • How will you know if it’s helping me?
  • Do you have experience with the type of issue I have?
  • Will I need medication?
  • If I need to bring my partner, child or other significant relationship, do you treat families or couples as well?
  • How long have you been practicing?

After you’ve found your therapist and asked all your questions, you will be asked to come in for your first initial therapy session. It can feel overwhelming, scary, exciting, vulnerable, hopeful and many other emotions all at once. This is to be expected when embarking on a healing journey with somebody who does not know you and whom you do not know.

What to Expect at Your First Sessions

At the beginning of narrative therapy, you will share your story and reason for seeking narrative therapy at this time and your future goals. It is important to own this part of therapy and be honest to get the most of your experience. As therapy continues, usually once a week, the therapist will continue to learn about your story by paying attention to how you speak and your projection of your story. Over time, from session to session, your therapist will challenge you to consider alternative language choices to tell your story and will explore this with you.

Your therapist will also help you identify aspects of your story that may have been glossed over and ask you questions to learn if parts of your story were left out of your narrative. By doing this, the goal is to bring that voice and ownership of your whole story back to you, without shame. Narrative therapy is very client-driven, so your therapist will ask you open ended questions to help you broadly think about your experience and empower you to re-shape your story from a position of self-worth and power over your own life and experiences.

This process can take as long or as little as needed by the individual. There is no set time-frame for narrative therapy as it is client-driven, but at the end of therapy, individuals will learn a host of techniques they can use when dealing with challenging situations or experiences in their future.

Is Narrative Therapy Effective?

Narrative therapy has proven to be beneficial for many types of mental health conditions as well as for various ages and groups, whether it’s a family, a couple or a larger support group. In children, narrative therapy assists children with their social skills, empathy and decision making. Children were also found to have better relationships with their peers.6

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To add, in a group setting with adults dealing with anxiety and depression, narrative therapy was found to improve quality of life. As a result, according to surveys before and after group narrative therapy, symptoms of anxiety and depression were lessened.7 In another study by Ghavibazou, Hosseinian & Abdollahi, it was hypothesized that women and couples were able to benefit from narrative therapy. In this study, investigators looked at how marital satisfaction can be improved for women experiencing low levels of satisfaction.8

It was found that after 8 weeks, women were reporting high levels of marital satisfaction as well as less withdrawal from their relationships. In addressing anxiety, narrative therapy has also shown to be effective. In another study, women were given a questionnaire before and after narrative therapy interventions regarding generalized anxiety disorder and found that the women after treatment reported improved symptoms of generalized anxiety disorder.

In addition, these women also reported having better coping mechanisms as a result of the tools learned from narrative therapy in understanding and re-imagining their story with empowering language.9 Narrative therapy approaches have benefits for diverse mental health conditions and populations.

Pros & Cons of Narrative Therapy

The pros of Narrative therapy include:

  • Can be used as a stand-alone therapy or alongside other forms of therapies such as Cognitive Behavioral Therapy
  • Non-blaming, holistic approach to problems as separate from the identity of the individual with the problems
  • Encourages individuals to consider different, more positive perspectives of their problems
  • Positions individuals as the expert of their life
  • Works from a strengths-perspective framework
  • Individual learn skills that can help them lead happier lives

One of the major cons of Narrative Therapy is that it is not helpful for those with intellectual disabilities or language issues.

History of Narrative Therapy

Narrative Therapy was originated in the 1980s by two social workers, Michael White and David Epston, who felt that individuals’ problems and identity should be seen separately. This framework lent itself to a holistic approach to therapy that naturally feels more empowering for individuals in treatment. White and Epston were strong believers that individuals should not label themselves as the problem they are dealing with, for example, encouraging individuals to say, “an individual dealing with depression” as opposed to “a depressed individual.”

Since the 80s, it has been used in many forms however given that it is a relatively new approach to therapy, there is still a great deal of research going into Narrative therapy approaches, techniques and outcomes. From the current literature on Narrative therapy, it appears that it has been proven effective in various uses including groups, with children, with adults and families. In addition, it has shown effectiveness when dealing with depression, addiction, anxiety, trauma, family issues, attachment issues and grief.

Narrative therapy has shown to have a great deal of positive qualitative outcomes by widening individuals’ views on their problems and empowering them to use more positive narratives when sharing their stories and experiences.

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