What is Narrative Exposure Therapy?

Updated: Mar 19

I am now offering Narrative Exposure Therapy (NET) as part of my private practice, both in-person and online. This blog hopefully outlines what it is and who may find it helpful.

What is it?

NET is a short-term, focused therapy that is evidence-based and culturally inclusive. It is designed to treat traumatic stress disorders for survivors of multiple traumatic events.

It has been largely developed to treat displaced people who have been impacted by war, natural disasters or multiple relational trauma and has been traditionally practiced with communities all over the World.

How does it work?

The focus of NET is to reconstruct difficult or fragmented memories that are traumatic into a coherent narrative. It aims to contextualise specific memories that still activate sensory, cognitive or bodily feelings of trauma, for example, flashbacks, nightmares, panic or dissociative states etc.

The therapy asks the patient to build a chronological narrative of their life while working with a therapist to reduce the potency of traumatic memories as the narrative is told. The patient is encouraged to relive emotions while narrating traumatic events to the therapist without losing connection to the present moment. This way the traumatic memories are hopefully re-processed as less traumatic.

What can I expect?

The therapy requires the patient and therapist to create a timeline of the patient’s life.

Together, they physically create a timeline with string, rocks, flowers, candles, and sticks. These represent different things in the patient’s life:

· Rocks = traumatic memory

· Flowers = memorable positive events

· Candles = significant loss (death of a parent, school friend moving away etc)

· Sticks = significant event that may not be traumatic but is also not positive

Once the timeline is created, the therapist will use specific cognitive techniques to guide the patient through the memories. Together the therapist and patient examine the thoughts, feelings, and meanings behind each trauma.

Are there any downsides I should be aware?

Dissociation.

This is a cognitive therapy that asks you to work with some of the most painful events you have survived. Because of this, our bodies and minds can resist going near such painful memories and we can dissociate. This experience can be disturbing for some. Others may find new memories surface, either in the session or in flashes or dreams after and this can also be painful.

It might not work as well as you hope.

When we have been living with a history of trauma for many years, it’s hard not to hope for something that will finally make life easier. Lots of different therapists and therapies promise to heal trauma, from evidence-based practices like NET or EMDR to more holistic or alternative therapeutic approaches.

I believe that any one therapeutic intervention can be a step toward understanding yourself and your trauma better, and with this can come better mental wellness. This does not mean NET, or any trauma focused therapy is the cure. I encourage people to have curiosity and openness towards this process, rather than have expectations set in stone. Evidence shows that with NET, patients often feel the benefits up to 12 months after the therapy ends. My personal hope is that patients are able to finish NET and feel:

Their trauma has been heard and understood
Some of the really difficult feeling, ex. shame, becomes less intense
Treat the trauma symptoms, such as heightened anger or panic, nightmares or flashbacks
Have a new perspective on their lives that can acknowledge the pain as well as some joyfulness and connection

Much like medication for physical illness or pain, not all therapies work on individuals in the same way. If you have questions, I always encourage people to speak to a trained therapist or doctor.

Avoidance.

It is natural to want to avoid telling the details of trauma. They can be embarring, shaming, we can even feel disgusted at ourselves. NET relies on the patient not just thinking about the details of the trauma, but speaking them out loud. Avoiding details or key parts of our traumatic experience can jeopardise the treatment. It is always worth asking yourself, 'do I feel safe enough to face your traumas at this point in my life?'