Research, evidence, and narrative practice
We’re pleased to launch this new section of the Dulwich Centre website dedicated to providing information about the evidence-base for narrative practices. The development of this research repository was announced in a recent edition of Context: The magazine for family therapy and systemic practice in the UK. We’ve received such enthusiastic responses from readers that we have fast-tracked its launch! Over time, we hope that this repository will be a place that people can turn to access information about the evidence base in relation to narrative practices. We also hope it will be a place to foster debate, dialogue, and discussion about the politics and possibilities of researching narrative practice.
Inviting your contributions
There is a significant and ever-increasing amount of evidence for the effectiveness for narrative therapy practices. Here we present a summary of the research literature on narrative therapy, including some evidence-based studies.
Family therapy and soiling: An audit of externalizing and other approaches
Evril Silver, Alison Williams, Fiona Worthington, and Nicola Phillips (1998)
Journal of Family Therapy, 20, 413–422.
This is a retrospective audit of the therapy outcome of 108 children with soiling and their families. Fifty-four children were treated by externalizing and 54 comparison children and families were treated by the usual methods in the same clinic. The results from the externalizing group were better and compared favourably with standards derived from previous studies of soiling. Externalizing was rated as much more helpful by parents at follow-up.
Process and outcome of narrative therapy for major depressive disorder in adults: Narrative reflexivity, working alliance and improved symptom and inter-personal outcomes
Lynette Vromans (2008) [PhD thesis, Queensland University of Technology]
The research aim, to investigate the process and outcome of narrative therapy, comprised theoretical and empirical objectives. The first objective was to articulate a theoretical synthesis of narrative theory, research, and practice. The process of narrative reflexivity was identified as a theoretical construct linking narrative theory with narrative research and practice. The second objective was to substantiate this synthesis empirically by examining narrative therapy processes, specifically narrative reflexivity and the therapeutic alliance, and their relation to therapy outcomes. The third objective was to support the proposed synthesis of theory, research, and practice and provide quantitative evidence for the utility of narrative therapy, by evaluating depressive symptom and inter-personal relatedness outcomes through analyses of statistical significance, clinical significance, and benchmarking … To support this theoretical synthesis, a process-outcome trial evaluated eight-sessions of narrative therapy for 47 adults with major depressive disorder. Dependent process variables were narrative reflexivity (assessed at Sessions 1 and 8) and therapeutic alliance (assessed at Sessions 1, 3, and 8). Primary dependent outcome variables were depressive symptoms and inter-personal relatedness. Primary analyses assessed therapy outcome at pre-therapy, post-therapy, and three-month follow-up and utilized a benchmarking strategy to the evaluate pre-therapy to post-therapy and post-therapy to follow-up gains, effect size and pre-therapy to post-therapy clinical significance … The clinical trial provided empirical support for the utility of narrative therapy in improving depressive symptoms and inter-personal relatedness from pre-therapy to post-therapy: the magnitude of change indicating large effect sizes (d = 1.10 to 1.36) for depressive symptoms and medium effect sizes (d = .52 to .62) for inter-personal relatedness. Therapy was effective in reducing depressive symptoms in clients with moderate and severe pre-therapy depressive symptom severity. Improvements in depressive symptoms, but not inter-personal relatedness, were maintained three-months following therapy. The reduction in depressive symptoms and the proportion of clients who achieved clinically significant improvement (53%) in depressive symptoms at post-therapy were comparable to improvements from standard psychotherapies, reported in benchmark research. This research has implications for assisting our understanding of narrative approaches, refining strategies that will facilitate recovery from psychological disorder and providing clinicians with a broader evidence base for narrative practice … This thesis was awarded the Outstanding Doctoral Thesis award across the Queensland University of Technology Faculty of Health. Read examiner comments here: Examiner number 1 (pdf, 47 KB), Examiner number 2 (pdf, 15 KB).
Narrative therapy for adults with a major depressive disorder: Improved symptom and interpersonal outcomes
Lynette P. Vromans & Robert D. Schweitzer (2010)
This study investigated depressive symptom and interpersonal relatedness outcomes from eight sessions of manualized narrative therapy for 47 adults with major depressive disorder. Post-therapy, depressive symptom improvement (d=1.36) and proportions of clients achieving reliable improvement (74%), movement to the functional population (61%), and clinically significant improvement (53%) were comparable to benchmark research outcomes. Post-therapy interpersonal relatedness improvement (d=.62) was less substantial than for symptoms. Three-month follow-up found maintenance of symptom, but not interpersonal gains. Benchmarking and clinical significance analyses mitigated repeated measure design limitations, providing empirical evidence to support narrative therapy for adults with major depressive disorder.
The effectiveness of narrative therapy with young people with autism
Cashin, A, Browne, G, Bradbury, J & Mulder, AM 2013
Journal of Child and Adolescent Mental Health Nursing, vol. 26, no. 1, pp. 32-41.
The aim of this pilot study was to be the first step toward empirically determining whether narrative therapy is effective in helping young people with autism who present with emotional and behavioral problems. Autism is increasingly being recognized in young people with average and above intelligence. Because of the nature of autism, these young people have difficulty navigating the challenges of school and adolescence. Narrative therapy can help them with their current difficulties and also help them develop skills to address future challenges. Narrative therapy involves working with a person to examine and edit the stories the person tells himself or herself about the world. It is designed to promote social adaptation while working on specific problems of living. This pilot intervention study used a convenience sample of 10 young people with autism (10–16 years) to evaluate the effectiveness of five 1 hr sessions of narrative therapy conducted over 10 weeks. The study used the parent-rated Strengths and Difficulties Questionnaire (SDQ) as the primary outcome measure. Secondary outcome measures were the Kessler-10 Scale of Psychological Distress (K-10), the Beck Hopelessness Scale, and a stress biomarker, the salivary cortisol to dehydroepiandrosterone (DHEA) ratio.
Significant improvement in psychological distress identified through the K-10 was demonstrated. Significant improvement was identified on the Emotional Symptoms Scale of the SDQ. The cortisol:DHEA ratio was responsive and a power analysis indicated that further study is indicated with a larger sample. Narrative therapy has merit as an intervention with young people with autism. Further research is indicated.
Evaluating narrative family therapy using single-system research designs
David Besa, California Graduate School of Family Psychology (1994)
Research on Social Work Practice, 4 (3), 309–325. doi: 10.1177/104973159400400303
This study assessed the effectiveness of Narrative Therapy in reducing parent/child conflicts. Parents measured their child's progress by counting the frequency of specific behaviours during baseline and intervention phases. The practitioner-researcher used single-case methodology with a treatment package strategy, and the results were evaluated using three multiple baseline designs. Six families were treated using several Narrative Therapy techniques including externalisation, relative influence questioning, identifying unique outcomes and unique accounts, bringing forth unique re-descriptions, facilitating unique circulation, and assigning between-session tasks. Compared to baseline rates, five of six families showed improvements in parent/child conflict, ranging from an 88% to a 98% decrease in conflict. Improvements occurred only when Narrative Therapy was applied and were not observed in its absence.
Narrative therapy, eating disorders and groups: Enhancing outcomes in rural NSW
Mim Weber, Kierrynn Davis, & Lisa McPhie (2006)
Australian Social Work, 59 (4), 391–405. doi: 10.1080/03124070600985970
This paper reports on a study conducted with seven women who identified themselves as experiencing depression as well as an eating disorder and who live in a rural region of northern New South Wales. Self-referred, the women participated in a weekly group for 10 weeks, with a mixture of topics, conducted within a narrative therapy framework. A comparison of pre- and post-group tests demonstrated a reduction in depression scores and eating disorder risk. All women reported a change in daily practices, together with less self-criticism. These findings were supported by a post-group evaluation survey that revealed that externalisation of, and disengagement from, the eating disorder strongly assisted the women to make changes in their daily practices. Although preliminary and short-term, the outcomes of the present study indicate that group work conducted within a narrative therapy framework may result in positive changes for women entangled with depression and an eating disorder.
An approach to childhood stealing with evaluation of 45 cases
Fred W. Seymour & David Epston (1989)
Australian & New Zealand Journal of Family Therapy, 10 (3).
Childhood stealing is a distressing problem for families and may have wider community costs since childhood stealers often become adult criminals. This paper describes a therapeutic ‘map’ that emphasises direct engagement of the child, along with his/her family, in regarding the child from ‘stealer’ to ‘honest person’. Analysis of therapy with 45 children revealed a high level of family engagement and initial behaviour change. Furthermore, a follow-up telephone call made 6–12 months after completion of therapy sessions revealed that 80% of the children had not been stealing at all or had substantially reduced rates of stealing. This community practice, which was in part researched by Seymour and Epston, has recently been written up in some detail in ‘Community approaches – real and virtual – to stealing’ (pdf, 68 KB) [Epston, D., & Seymour, F. (2008). In Epston, D., Down under and up over: Travels with narrative therapy, Warrington, England: AFT Publishing Limited, pp. 139–156.]
An evaluation of an intervention using Hero Books to mainstream psychosocial care and support into South African schools via the curricula (March 2009)
Report by Linzi Rabinowitz. Researchers: Linzi Rabinowitz and Rebecca Goldberg
Hero Books are a psychosocial support intervention developed by Jonathan Morgan (REPSSI) which are informed by narrative therapy ideas. This study presents preliminary evidence to support the contention that the mainstreaming of PSS (psychosocial support) in the South African school curriculum by means of the Hero Book is likely to produce two significant outcomes:
- learners who have undergone the Hero Book process are more likely to perform better in the learning areas of Life Orientation and Language (Home Language and first additional Language) than learners whose educators did not use Hero Books as measured by the same learning outcomes and assessment standards
- learners whose educators used the Hero Book methodology to pursue academic outcomes are more likely to exhibit an improvement in their psychosocial wellbeing than learners whose educators do not use the Hero Book methodology.
A mix of quantitative and qualitative data collection and analysis supports these findings. While none of the findings are conclusive, and the study admittedly has limitations, the strongest quantitative finding is this one: 77% of learner’s academic performance as measured by an average mark for all three learning areas (Home Language, First Additional Language, and Life Orientation) improved overall for the Hero book group, as opposed to 55% in the control groups. This finding suggests that the hero book intervention might be pursued purely on its potential as a methodology to enhance academic learning outcomes, and where any improvements in the psychosocial wellbeing of learners is an added bonus of the intervention. The sample size consisted of four control groups and four intervention groups across two research sites, the Western Cape and KwaZulu Natal. There was a total of 172 learners in the control groups and 113 in the intervention groups. For full report, contact Jonathan Morgan:
An exploratory study of the effectiveness of group narrative therapy on the school behavior of girls with attention-deficit/hyperactivity symptoms.
Looyeh MY, Kamali K, Shafieian R.
This study explored the effectiveness of group narrative therapy for improving the school behavior of a small sample of girls with attention-deficit/hyperactivity disorder (ADHD). Fourteen clinics referred 9- to 11-year-old girls with a clinical diagnosis of ADHD were randomly assigned to treatment and wait-list control groups. Posttreatment ratings by teachers showed that narrative therapy had a significant effect on reducing ADHD symptoms 1 week after completion of treatment and sustained after 30 days. Arch Psychiatr Nurs. 2012 Oct;26(5):404-10. doi: 10.1016/j.apnu.2012.01.001. Epub 2012 Mar 28. http://www.ncbi.nlm.nih.gov/pubmed/22999036
The comparison between efficacy of narrative therapy and diet therapy on body image in women with overweight and obesity
Sommayeh Sadat MacKean *, Hossein Eskandari, Ahmad Borjali , Delaram Ghodsi
This study was carried out according to importance of body image in overweight women, and in order to compare the effect of diet therapy and narrative therapy on the body image improvement. Materials and Methods: This was a quasi experimental-interventional study. 30 overweight women were selected through randomized sampling method within women who referred to professional clinic of nutrition and diet therapy and they randomly divided to two interventions and one control group. Group 1 only received diet therapy (for 5weeks), group 2 received narrative therapy in addition to diet therapy and control group received no intervention. Narrative therapy was a group therapy that consisted of 12 sessions and each session last 50 minutes that performed twice a week. Control group received no intervention. Weight of subjects was measured with light cloths by a Seca balance scale to the nearest 0.5 kg and their height was measured by stadio-meter to 0.5 cm. Body Mass Index was calculated by dividing weight (in kg) to squared height (in m2). Data of Body Image were gathered through Multidimensional Body-Self Relation Questionnaire. Data were analyzed by covariance analysis, Tukey and paired t test using SPSS 16 software. Results: The mean of body image at the beginning of the study in the control group, was 135.20 and it was134.60 after the intervention. In group 1, at the beginning of the study the mean was 148.1 and after the intervention was 147.50. In group 2, at the beginning of the study the mean was 150.80 and after the intervention the result was 163.90. Data analysis showed that at the end of the study diet therapy had no significant effect on developing of body image (P>0.05). But narrative therapy was more effective than diet therapy in developing of body image in overweight women (P<0.001). Conclusion: According to effect of narrative therapy on body image development, this method is more suitable than the other methods which have greater results in weight loss. Pajoohandeh Journal. 2010; 15 (5) :225-232 http://pajoohande.sbmu.ac.ir/browse.php?a_code=A-10-1-655&sid=1&slc_lang=en
Narrative therapy with an adolescent who self-cuts: a case example
Elaine Hannen, Kevin Woods
Educational Psychology in Practice 01/2012; 28(2):187-214. DOI:10.1080/02667363.2012.669362
The National Institute for Clinical Excellence identifies educational psychologists as appropriate specialists to deliver interventions to promote the emotional well-being of children and families. A role for practitioner educational psychologists in providing specific therapeutic interventions has also been proposed by commentators. The present study reports an evaluative case study of a narrative therapy intervention with a young person who self-harms. The analysis of data suggests that the narrative therapy intervention was effectively implemented and resulted in attributable gains in emotional well-being, resilience and behaviour for the young person. The authors discuss the role of the educational psychologist in delivering specific therapeutic interventions within a local authority context and school-based setting. Consideration is also made of the development of the evidence base for the effectiveness of narrative therapy intervention with young people who self-harm.
Externalizing Metaphors: Anxiety and High-Functioning Autism
Everett McGuinty, MA, David Armstrong, PhD, John Nelson, MA, and Stephanie Sheeler, BA
Journal of Child and Adolescent Psychiatric Nursing ISSN 1073-6077
The intent of this article is to explore the efficacy of both the literal and concrete externalization aspects within narrative therapy, and the implementation of interactive metaphors as a combined psychotherapeutic approach for decreasing anxiety with people who present with high-functioning autism. The purpose of this exploratory article is to propose the use of externalizing metaphors as a treatment modality as a potentially useful way to engage clients. Specifically, a three-step process of change is described, which allows for concretizing affective states and experiences, and makes use of visual strengths of people presenting with an autism spectrum disorder. A selective review was conducted of significant works regarding the process of change in narrative therapy, with particular emphasis on metaphors. Works were selected based on their relevance to the current paper and included both published works (searched via Psyc-INFO) and materials from narrative training sessions. Further research is needed to address the testable hypotheses resulting from the current model. This line of research would not only establish best practices in a population for which there is no broadly accepted treatment paradigm, but would also contribute to the larger fields of abnormal psychology, emotion regulation, and cognitive psychology by further elucidating the complex ways these systems interact.
An evaluation of undercover anti-bullying teams in New Zealand
A study conducted by the University of Auckland Psychology Department into Undercover Anti-Bullying teams in two Auckland high schools. Bullying is a significant societal problem in schools, having serious implications for both victims and perpetrators. While there have been many interventions developed to try and combat bullying in schools, many of these interventions are not formally evaluated. The current study evaluated an anti-bullying intervention that adopts a restorative approach that uses peer-led Undercover Anti-bullying Teams (UABTs) to combat bullying in the classroom. To evaluate this approach, the current study implemented the use of a pre-test/post-test experimental design in additional to qualitative interview data. The results suggest that following the intervention, there was a significant reduction in victimisation and a significant increase in students’ perceptions of personal support from other students in the class. Additionally, a number of themes emerged to suggest feelings of “inclusion” and “social support” were helpful to reduce distress for victims, and to help them feel more confident in the classroom. Additionally, the central elements of “autonomy” and “teamwork” that are inherent in the UABT intervention were helpful for team members in supporting the bullying victim and reducing bullying in the classroom.
To read the report, click here
'Back from the Edge’ project evaluation
Sonja Berthold (June 2006)
Funded by Relationships Australia Northern Territory
This is an independent evaluation of a narrative therapy/collective narrative practice project conducted in two Aboriginal communities in Arnhem Land – Yirrkala & Gunyangara. The project aimed to:
- reduce suicidal thinking/behaviour/injury, self-harm and death by suicide
- enhance resilience, respect, resourcefulness, interconnectedness, and mental health of individuals, families, and communities and to reduce prevalence of risk conditions
- increase support available to individuals, families, and communities who have been affected by suicidal behaviours.
The project was conducted in partnership between Dulwich Centre and Relationships Australia Northern Territory. For more information about the project, read: ‘Linking stories and initiatives: A narrative approach to working with the skills and knowledge of communities’ by David Denborough, Carolyn Koolmatrie, Djapirri Mununggirritj, Djuwalpi Marika, Wayne Dhurrkay, & Margaret Yunupingu.
The independent evaluation found:
Did this project work? Yes, this project worked because it:
- reminded people of their strength and of their dreams
- increased the self-esteem and confidence of individual and groups, and reinforced their ability to deal with suicide and suicidal thinking
- created an opportunity for these communities to forge links with another Indigenous community, a link which strengthens and comforts both
- provided an audience for the stories and passed on the responses
- people see that their knowledge and experience is of value to others
- the community came together to celebrate their strengths and abilities
- ensured that local workers were linked into and supporting this process
- left a resource that is still being used.
What was done well?
- Good, thorough consultation with resulted in changes
- Professional and respectful approach
- Project tried to link in outside workers to help the project continue
- The narrative approach was very successful and well accepted
- Connected very strongly with key leaders in each community
- Delivered relevant, interesting, and useful training
- Provided learning opportunity for Yolgnu people through ensuring local people were involved in the narrative approach
- The team were flexible and able to respond to what was needed and have maintained a connection with the communities
- Made sure that they left a resource for the community to use.
To read the entire evaluation, click here (pdf, 307 KB).
Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations
Jennifer Poolea, Paula Gardner, Margaret C. Flower & Carolynne Cooper
Social Work With Groups, Volume 32, Issue 4, 2009 http://www.tandfonline.com/doi/abs/10.1080/01609510902895086#.Uk-lShBKiSo
In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.
Witnessing stories: Definitional Ceremonies in Narrative Therapy with adults who stutter
Margaret M. Leahy,Mary O’Dwyer, Fiona Ryan
In press Journal of Fluency Disorders (2012), doi:10.1016/j.jfludis.2012.03.001
Narrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people’s lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change. This paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement. A definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described. Results from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and revised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit. Educational objectives: (1) to describe and explain to readers the process of narrative therapy, with special attention to the use of definitional ceremonies; (2) to provide detail regarding the clinical processes involved with a specific definitional ceremony with one client; (3) to have the reader appreciate the specific importance of involving outsider witnesses in the therapy process; (4) to discuss the outcomes of the use of this particular definitional ceremony.
What is narrative therapy and what is it not? The usefulness of Q methodology to explore accounts of White and Epston's (1990) approach to narrative therapy.
Wallis, J., Burns, J. and Capdevila, R. , Clinical Psychology & Psychotherapy, n/a. doi: 10.1002/cpp.723
Externalizing questions: A microanalytic look at their use in narrative therapy.
Strong, T. (2008). The International Journal of Narrative Therapy and Community Work, (Issue 3), 59-71.
This paper examines the narrative therapy practice of asking and answering externalisation questions. It looks at some of theoretical and clinical literature related to the use of these questions and then turns a micro-dynamic look at some examples of how such questions were asked and answered in the course of therapeutic dialogue. The focus is on learning from these analyses to enhance therapists’ ability to engage clients in collaborative and resourceful externalising conversations.
A Sequential Analysis of Externalizing in Narrative Therapy with Children
Heather L. Ramey, Donato Tarulli, Jan C. Frijters, Lianne Fisher
Contemp Fam Ther (2009) 31:262–279DOI 10.1007/s10591-009-9095-5
Externalizing, or separating the person from his/her problem-saturated story, isa central approach in narrative therapy. Michael White, one of the therapy’s founders,lately revised his map of the externalizing process in therapy according to Vygotskian theory. In this study we sought to determine whether White’s proposed process was evidentin therapy sessions. Sequential analysis indicated that therapists scaffolded children’s responses according to White’s map, and therapists’ and children’s utterances tended to advance across the levels of the map over the course of a session, indicating that White’s model of narrative therapy matched the therapy’s empirical process
Change in group psychotherapy: understandings from narrative therapy / Mudança em psicoterapia de grupo: reflexões a partir da terapia narrativa.
CARRIJO, Rafael Santos and RASERA, Emerson Fernando. Psicologia Clínica [online]. 2010, vol.22, n.1, pp. 125-140. ISSN 0103-5665. http://dx.doi.org/10.1590/S0103-56652010000100008.
This case study aims to understand the change process of a person in group psychotherapy, from a narrative perspective. Participant observation and an analysis of the notes of twelve sessions of a short-term group allowed us to investigate episodes and therapeutic interventions that had contributed to the construction of a narrative in which the person self-described as more autonomous, surpassing the previous narrative saturated by the problem. It was observed that narrative resources such as, the identification of unique outcomes, externalizing the problem and the reinforcement of confrontational narratives have helped to construct new meanings through the creation of a dialogical space in the group context. In spite of the fertility of the use of narrative proposals in the group field, our reflections pointed out some challenges to be faced in this approach.
Innovative Moments and Change in Narrative Therapy
Marlene Matos, Anita Santos, Miguel Gonçalves and Carla Martins
(2008) Psychotherapy Research, http://dx.doi.org/10.1080/10503300802430657
Narrative therapy suggests that change happens by paying close attention in therapy to ‘‘unique outcomes,’’ which are narrative details outside the main story (White & Epston, 1990). In this exploratory study, unique outcomes were analyzed in five good-outcome and five poor-outcome psychotherapy cases using the Innovative Moments Coding System (Gonc¸alves, Matos, & Santos, 2008). Across 127 sessions, innovative moments were coded in terms of salience and type. In accordance with the theory, results suggest that innovative moments are important to therapeutic change. Poor- and good-outcome groups have a global difference in the salience of the innovative moments. In addition, results suggest that two particular types of innovative moments are needed in narrative therapy for therapeutic change to take place: re-conceptualization and new experiences. Implications for future research using this model of analysis are discussed.
Narrative Therapy and the Nature Of “Innovative Moments” in the Construction of Change
Miguel M. Gonçalves, Marlene Matos & Anita Santos, University of Minho, Portugal
In the narrative metaphor of psychotherapy, clients transform themselves by changing their life stories. According to White and Epston (1990), the construction of change occurs from the expansion of unique outcomes—or innovative moments, as we prefer to call them—that is, the development of episodes outside the problem-saturated narrative. Unique outcomes operate as exceptions to the rule (i.e., to the problem-saturated story) that can be changed to a new rule (i.e., a new narrative). We suggest that some forms of unique outcomes can operate as shadow voices (Gustafson, 1992) of the problem-saturated story, allowing a temporary release from the problem, but facilitating a return to it. In our view, there is a particular type of unique outcome—reconceptualization—that facilitates sustained change. This kind of innovation facilitates the emergence of a meta-level perspective about the change process itself and, in turn, enables the active positioning of the person as an author of the new narrative.
Decentering therapy: textual analysis of a narrative therapy session.
Kogan SM, Gale JE. Fam Process. 1997 Jun;36(2):101-26.
Postmodern models of therapy stress the participation of the clinician in a nonhierarchical, non-objectifying role, and highlight the therapist's embeddedness in the same processes of social construction as are the individual and the family. While much theory has been published in recent years, the actual conduct of a therapy session derived from the premises of postmodernism remains unclear. We investigated how a postmodern therapist manages talk in an actual session. We used textual analysis to examine a couples therapy session conducted by a prominent narrative therapist. Analysis of the talk led to descriptions of the couple's and therapist's agenda, and their interaction. The therapist's agenda is described in terms of "decentering" both the local unfolding narrative and its embeddedness in larger cultural stories. Five conversational practices: matching/self-disclosure, reciprocal editing, turn management to deobjectify, expansion questions, and reversals are examined. These practices inform the deployment of a decentering agenda in this specific text.
Narrative Therapy Intervention Project for Patients with Diabetes and Depression
Brian. L. Lewis, Ph.D., ABPP, VA Medical Center, Salem, Virginia, USA
Dr. Brian Lewis received a research grant from the Shine-A-Light Narrative Therapy Research Fund to conduct this study at the University of Miami beginning in 2011. The stated goal of this research fund is to “facilitate rigorous research on narrative approaches to individual, family and community psychological practice (as developed by … Michael White)”. The research study was started at the University of Miami but has since been transferred to the VA Medical Center in Salem, Virginia when Dr. Lewis changed professional positions. The purpose of this research project is to test the effectiveness of an innovative 8-10 session “semi-manualized” narrative therapy intervention in assisting patients with Type-2 diabetes to make healthy lifestyle adjustments known to have an impact on diabetes management and to improve quality of life (QoL). Outcomes of interest include: improvement in depression/QoL; change in diet, exercise, and medication adherence; and ultimate reduction in blood glucose levels. The study is small (N=20) but involves a randomized control design utilizing both qualitative and quantitative methodology, with the goal of developing preliminary data to justify a larger RCT study in the future to demonstrate its effectiveness as a true evidence-based intervention. The VA is considered an excellent location for this research because of the large percentage of veterans who are currently diagnosed with diabetes and because of the potential for future multi-site collaboration on a larger study. The current study is projected to be completed by June, 2014.
The Tree of Life: Narrative approach to responding to vulnerable children
David Denborough (Dulwich Centre) in collaboration with Joh Henley and Julie Robinson, (Flinders University)
The Tree of Life is a narrative therapy approach to responding to vulnerable children which was developed by Ncazelo Ncube (REPSSI) and David Denborough (Dulwich Centre). A research project took place recently in two primary schools in South Australia, evaluating the effectiveness of the Tree of Life with children from refugee families. The data from this project has now been generated and we are in the process of analysing it. This project is being conducted in partnership with Dr Julie Robinson, School of Psychology, Flinders University and Joh Henley (PhD candidate).
Research focused on narrative therapy and trauma
John Stillman, MSW at Kenwood Therapy Center in Minnesota, USA in collaboration with Christopher Erbes, PhD at the University of Minnesota and the Veterans Affairs Medical Center, USA were among the first recipients of the Shine A Light: Narrative Therapy Research Fund. This award is geared toward continuing Michael White’s legacy through rigorous research of Narrative Therapy. Phase one of the project involves John Stillman writing narrative therapy practice guidelines for working with trauma titled, Moving narrative ideas into practice: Trauma practice guidelines (MNIIP-TPG) extracted from his book, Moving narrative ideas into practice: A handbook for study (in press) and based on Michael White’s work with trauma. Phase two of the project, which is funded by the Shine a Light Research Fund, involves a study to train therapists in applying the practice guidelines at the Veterans Affairs Medical Center in Minnesota, and gathering preliminary data on the effectiveness of the narrative ideas and practices captured in the practice guidelines.
The Tree of Life in Aboriginal and Torres Strait Islander contexts
Claire Rabaa, BSocWk. MAASW (Acc), of the Remote Area Child and Youth Mental Health in Cape York, is currently implementing the three part Tree of Life program with Indigenous students in Cape York and researching the outcomes of this. This project is using Scott Miller outcomes scale as a pre and post measure with the children.
Narratives of strengths research
The Impact of Strengths development upon performance and professional aspirations of students in the 'helping professions' is a pilot study to evaluate the usefulness of StrengthsQuestTM coaching in shaping the aspirations of students in the 'helping professions' in New Zealand and to investigate the potential usefulness of a new approach, provisionally known as 'Narratives of Strengths' to complement StrengthsQuestTM coaching. We hope to find that narrative interviews will enrich student's understanding of and relationship to their strengths and further shape their career choices. The data from the project is being analysed from December 2009 and the results will be available from mid-2010. The research is a joint project between the Social Practice and Nursing departments at UNITEC Institute of Technology, Auckland, New Zealand. If you are interested in knowing more, please contact Kay Ingamells at
Innovations in narrative therapy: Connecting training, practice and research
Laura Béres, King’s University College,
Jim Duvall, Hincks-Dellcrest Institute,
The first research project with which we were involved incorporated grounded theory and anthropological forms of exploratory research. We generated field notes from day-long involvement one day each week for two ten-month training periods at the Hincks-Dellcrest Centre, Gail Appell Institute in Toronto, Ontario. The research team was made up of faculty from the Hincks-Dellcrest Institute and from the University of Toronto and King’s University College. Through the review of taped interviews and field notes, inductive and deductive themes were generated in research team meetings. This research project has resulted in a contract with W.W. Norton and development of a manuscript entitled Innovations in narrative therapy: Connecting training, practice, and research. Three chapters will review new ideas about storyline structure, pivotal moments, and the circulation of language. Four practice chapters will integrate these ideas into practice examples.
Ethically-based practice: Process, pivotal moments, and effects (phase 2)
Jim Duvall, Hincks-Dellcrest Institute,
& Karen Young,
This is a research project on which Michael White and David Epston have both consulted. This project, now in it's second phase of development, examines the process and the pivotal moments within that process of reaching those particular outcomes. Michael White was particularly interested in looking at the parallel effects on therapists working from a narrative perspective, rather than only looking at the effects on those people consulting us. Therefore, the project explores both of those aspects. This research will be taking place at R.O.C.K. in Burlington, Ontario and at Hincks-Dellcrest Centre, Gail Appell Institue in Toronto, Ontario. The research team is made up of Jim Duvall, Karen Young, Nancy Cohen and Maryam Ebrahimpour.
Dulwich Centre is vitally interested in the development of new methods of research that are congruent with narrative practice principles and also rigorously test/demonstrate/examine the real effects and outcomes of narrative practices. A number of practitioners/researchers are engaged with this task of developing research methods that are congruent with narrative approaches and meet conventional research standards (quantitative and qualitative). For instance, see Lynnette Vromans' thesis (listed above). The research that Dulwich Centre is currently undertaking in relation to the Tree of Life approach (in partnership with Flinders University) is also engaged in this process. It has developed ‘double-storied’ questionnaires and adapted existing reliable scales in ways that remain congruent with conventional scientific research principles.
Other papers that consider the relationship between narrative therapy and research include:
Narrative therapy and research
Compiled by Dulwich Centre Publications (2004)
International Journal of Narrative Therapy and Community Work, (2), 29–36.
There are rich connections between narrative therapy and practices of research, and considering these links has been a source of creativity for many practitioners. This short piece seeks to describe how narrative therapy first began to be described as co-research, and describes some of the common research practices that are engaged with by narrative therapists. This piece also considers the powerful challenges that Indigenous researchers are making to the field of research. This paper has been collaboratively created. Marilyn O’Neill, Shona Russell, Makungu Akinyela, Helen Gremillion, David Epston, Vanessa Jackson, and Michael White all responded to the questions listed below, and David Denborough then wove their responses into a final form. To download this article, click here (pdf, 132 KB).
Repositioning traditional research: Centring clients’ accounts in the construction of professional therapy knowledges
Stephen Gaddis (2004)
International Journal of Narrative Therapy and Community Work, (2), 37–48.
As a boy, I was subject to the ideas that therapists had about how to help me. In my experience, the ideas they used were not helpful to me and may have inadvertently created more suffering for my family and me. This experience and my interest in narrative therapy led me to want to challenge the sources that shape what therapists think is helpful for clients. One important source that constructs therapists’ ideas about therapy is research. One of my greatest concerns has to do with how traditional research practices privilege professionals’ interpretations and understanding over those of clients. I have attempted to re-consider therapy research so that its main purpose is to honour clients’ accounts of therapy. My hope is that this will enable us as therapists to be taught as much by clients as by other professionals. The research project I undertook resulted in the participants (i.e., ‘therapy clients’) reporting that their experience of the project helped them with the problems they struggled with in their lives and relationships. This was an outcome I had not anticipated but is quite exciting to consider. To download this article, click here (pdf, 164 KB).
Living a more peopled life: Definitional ceremony as inquiry into psychotherapy ‘outcomes’
By Jane Speedy (with Gina Thompson and others) (2004)
International Journal of Narrative Therapy and Community Work, (3), 43–53.
This paper raises questions about the current European and North American culture of ‘evidence-based practice’ and troubles the conventions of ‘psychotherapy outcomes’ research. Outsider-witness practices and definitional ceremonies are suggested as collaborative re-search processes that sit more congruently with narrative, post-structuralist and feminist ideas and with narrative therapy practices that may, equally, be effective ways of influencing policymakers and shaping future services. Narrative practitioners and the people consulting them are invited to contribute to an international narrative therapy outcomes re-search conversation. To download this article, click here (pdf, 180 KB).
Decentring research practice
By Andrew Tootell (2004)
International Journal of Narrative Therapy and Community Work, (3), 54–55.
This article presents a brief account of one therapist’s journey to develop a research approach that was consistent with their values and practice as a therapist. This journey led to the development of a ‘De-centred research practice’ based upon an ethic of collaboration and equity, which seeks to document the ‘local’ skills and knowledge of the research participants. To download this article, click here (pdf, 139 KB).
Working for ethical research in practice
By Kathie Crocket, Wendy Drewery, Wally McKenzie, Lorraine Smith, John Winslade (2004)
International Journal of Narrative Therapy and Community Work, (3), 61–66.
As counsellor educators, therapists, and researchers practising from social constructionist understandings within a university context, we are called frequently to think about the interrelationships between practice and research. In this paper, we suggest that as practices, research and therapy have much in common. Furthermore, we explore the possibilities that are created when both therapy and research are considered to be ethical relational practices. To download this article, click here (pdf, 169 KB).
Measuring the Narrative: The Challenge of Evidencing change in Narrative Therapy
Weatherhead, Stephen and Jones, G. J. (2008) Measuring the narrative : the challenge of evidencing change in narrative therapy. Clinical Psychology Forum, 188 (1). pp. 38-41. ISSN 0269-0144
Making Sense of Epistemological Conflict in the Evaluation of Narrative Therapy and Evidence-Based Psychotherapy
by Robbie Busch, Tom Strong & Andy Lock http://mro.massey.ac.nz/handle/10179/3388
This paper outlines the epistemological and theoretical formation of narrative therapy and implications for its evaluation. Two authoritative paradigms of psychotherapy evaluation have emerged in psychology since the mid- 1990s. The Clinical Division of the American Psychological Association established the empirically supported treatment (EST) movement. A more inclusive but medically emulative model of evidence based practice in psychology (EBPP) then emerged. Some therapies such as narrative therapy do not share the theoretical commitments of these paradigms. Narrative therapy is an approach that values a non-expert based, collaborative, political and contextual stance to practice that is critical of normalising practices of medical objectification and reductionism. Post-positivist theoretical influences constitute narrative therapy as a practice that values the social production and multiplicity of meaning. This paper problematises a conflictual relationship (a differend) between the evaluation of narrative therapy and evidence based psychotherapy. Firstly, it briefly outlines the EST and EBPP paradigms and their epistemology. This paper then provides an overview of some of the key epistemological and theoretical underpinnings of narrative therapy and concludes with some cautionary notes on its evaluation.
Over the past two decades, extensive documentation has developed in relation to how narrative approaches have been engaged with by practitioners in diverse cultural contexts in ways that fit with local cultural practices/philosophies/values. This has involved local practitioners taking the key ingredients of narrative approaches and then co-developing their own locally diverse practices that fit for their local context. This evidence of cultural resonance and adaptability and the histories of cross-cultural partnership is valued highly here at Dulwich Centre. Examples of this documentation of cultural resonance within Indigenous Australia include:
‘Reclaiming our stories, Reclaiming our lives’
An initiative of the Aboriginal Health Council of South Australia (1995)
Dulwich Centre Newsletter, (1).
This publication documents a partnership between the Aboriginal Health Council of South Australia and Dulwich Centre in responding to Aboriginal families in South Australia who had experienced the loss of a family member due to death in custody. This publication describes a form of narrative community gathering that was developed through this cross-cultural partnership.
Part One of this document is called 'Aboriginal deaths in custody: Placing counselling in a social justice framework'. It includes a section describing ‘narrative therapy and its role in the project’. We will include an extract here:
At Camp Coorong, several things were identified by Aboriginal people as particularly helpful:
- Naming injustice
Aboriginal people were able to identify the 'dominant story', which was about personal guilt and inadequacy, and rename it as injustice and oppression. The freedom to use words 'murder’ and 'racism', and to publicly name their experiences of injustice, was experienced as profoundly freeing.
- Listening teams
The practice of using 'listening teams' in which members of the counselling team formed an audience to Aboriginal people’s stories, and then reflected upon what they had heard. A number of Aboriginal people commented that hearing their own stories reflected back in this way enabled them to see themselves differently, and to reclaim a pride in who they were. It also allowed them to recognise the remarkable strengths that they had demonstrated in surviving in the face of so much injustice.
- Caring and sharing
The emphasis placed on 'caring and sharing' and the building of community connections was identified as being central to Aboriginal ways. As one participant said about the listening groups, 'This reclaims the strengths of Aboriginal culture. Aboriginal culture has always had this. This has reiterated it, rejuvenated it. This is going on every day really around people’s kitchen tables – so all you are doing now is going much wider and getting back to our culture'.
- The 'journey' metaphor
The narrative approach makes considerable use of the 'journey' metaphor. Moving from dominant stories about one’s life to preferred stories is like making a journey from one identity to another. The provision of metaphoric 'maps' of the sorts of experiences, feelings and pitfalls that can happen on this journey by other people who have already made it, can play an important part in enabling people to more forward in their lives … A number of Aboriginal people commented on the usefulness of the journey metaphor. (pp. 19–20).
To order the Reclaiming our stories, reclaiming our lives journal/report, click here.
For more information about the Reclaiming Our Stories, Reclaiming Our Lives project, contact Dulwich Centre at
Telling our stories in ways that make us stronger
by Barbara Wingard & Jane Lester
Dulwich Centre Publications (2001)
This book includes descriptions of how the narrative therapy concept of externalising conversations has been taken up and used within Aboriginal communities to respond to issues of diabetes and grief. This includes within both urban and remote Aboriginal communities. It also includes a section on ‘Working together: towards culturally appropriate services’. Barbara Wingard is a descendant of the Kuarna People and worked as an Aboriginal Health workers for 24 years. Jane Lester is a descendant of the Yankunytjatjara/Antakarinya People from Central Australia and works in Adelaide as a consultant on various Indigenous projects.
To order Telling our stories in ways that make us stronger, click here.
Yia Marra: Good stories that make spirits strong
From the people of Ntaria/Hermannsburg
& Creating storylines: What is it about these stories that ‘make spirits strong’? And how did these stories come to be?
by David Denborough, Barbara Wingard, and Cheryl White
Dulwich Centre Foundation (2009)
This document and CD is the result of a collective narrative project within the community of Ntaria/Hermannsburg. This involved telling and documenting special stories that ‘keep spirits strong’. It also involved linking the stories of the people of Ntaria with communities in Port Augusta and Arnhem Land. The documentation includes descriptions of what this process has meant to the people of Ntaria:
‘It makes us proud to know that our stories are now helping other people. We know that other people also go through a lot of things, and it’s good to know that our stories are now touching other people’s hearts … Now our stories are traveling. They have touched people in different countries. We really liked the stories that came back to us from different places. They are sharing their stories and somehow our story has got bigger.
Now we are bringing the old people’s stories forwards. These are important stories that were given to us. They are stories of our history. We are carrying them. Sometimes the stories might not be our own, someone else may have told them – but we are all carrying them. We are all bringing the stories forward now. The stories may be small. Or they may be stories from the past that have remained untold. All these stories bring pride. We are proud to bring the old people with us. And the stories are getting stronger now.
Now we need to thank the people who first shared their stories with us – the people of Port Augusta and Arnhem Land. We would like to thank then very much for sharing their words with us, for opening their hearts to us. Their stories came first … We had lost so many in our families, especially in the big car accident and the whole community felt sad. We’d lost loved ones and we were all in sadness. We didn’t have anyone to tell our stories to until their stories came. We heard their stories and they touched our hearts. Then we decided to do our story. We wanted to share our story with them and with other communities. A few people started doing their stories and then it grew bigger. Now our stories have gone all over. It was really generous of those people in Port Augusts to tell us about how they were dealing with so many losses. Please pass our thanks onto them.’
For more information about the Yia Marra project, click here.
Finding hidden stories of strength and skills: Using the Tree of Life with Aboriginal and Torres Strait Islander children
DVD Dulwich Centre Foundation (2009)
The Tree of Life narrative approach to working with vulnerable children is being used in creative and effective ways by Aboriginal and Torres Strait Islander workers and community members. This DVD features a range of Aboriginal and Torres Strait Islander workers describing their use of the Tree of Life approach. For more information about this DVD, click here.
‘These stories are like a healing, like a medicine …’
The special skills and knowledge of the Aboriginal communities of Port Augusta, Yirrkala, & Gunyangara (Ski Beach) (2006)
This collection of stories was the result of a narrative therapy/collective narrative practice project conducted in two Aboriginal communities in Arnhem Land – Yirrkala & Gunyangara. The project was initiated in response to recent suicides in the community. For more information about the project, click here. This collection of stories articulates the power and possibility of narrative practice in the sharing of stories of skills and knowledges between communities:
‘We have been feeling for our community, but our hearts are for all people. We would like to share these words with others, with the wider world. We would like you to know about what is happening here. We would like to exchange ideas with other communities. We must not hide ourselves. We must openly share ourselves. We are alive and our words must travel, they must go on journeys, further and further to enable people to see us’, Djerrknu (Eunice) Marika, Senior Elder at Yirrkala (p. 3).
‘Even though the distance is far, the spirits have become one. We are joined. Your words and our words are matching. Our two spirits from north and south are sitting around the fire. Their spirits have come to agreement. Our two spirits are shaking hands, sharing knowledge. We have been lost in the darkness and need to find the place where the water is. Wherever there is water, we know that there is also the sounds of frogs. When we hear this, the frog leads us to the streams, to where water is running. We have been lost in darkness, looking for a way to survive. These stories are like the call of the frog. We can’t see the frog in darkness but the sound tells us that the water is there, the future is there. We must follow the sound of the frog. We must follow these stories to where they will lead us’, Djuwalpi Marika, Senior Elder at Yirrkala (p. 50).
Further readings about narrative practice and cultural resonance
For further discussion about narrative practice, cultural resonance, considerations of cultural appropriateness, and de-colonisation, see:
Akinyela, M. (2002). De-colonizing our lives: Divining a post-colonial therapy. International Journal of Narrative Therapy and Community Work, (2), 32–43.
Arulampalam, S., Perera, L., de Mel, S., White, C., & Denborough, D. (2005). Avoiding psychological colonisation: Stories from Sri Lanka – responding to the tsunami. In Denborough, D. (Ed.), Trauma: Narrative responses to traumatic experience (pp. 87–102). Adelaide, Australia: Dulwich Centre Publications.
Rojas, R., Montgomery, P., & Tovar, J. (1999). Reflections on language, power, culture and spirituality: Our experiences of the conference. In Dulwich Centre Publications (Eds.), Narrative therapy and community work: A conference collection (pp. 173–177). Adelaide, Australia: Dulwich Centre Publications.
Waldegrave, C., Tamasese, K., Tuhaka, F., & Campbell, W. (2003). Just Therapy – a journey: A collection of papers from the Just Therapy Team, New Zealand. Adelaide, Australia: Dulwich Centre Publications.
Yuen, A., & White, C. (2007). Conversations about gender, culture, violence & narrative practice: Stories of hope and complexity from women of many cultures. Adelaide, Australia: Dulwich Centre Publications.
As we continue to accumulate and develop differing forms of research and evidence in relation to narrative practice, there are many questions we are keen to consider:
- How can research processes contribute to an ever-increasing originality and diversity of practice?
- How can research contribute to the development of culturally diverse, culturally appropriate and continually adaptable forms of narrative practice?
- How can forms of research / evidence-gathering be congruent with local cultural traditions of knowledge-making?
- How can forms of research / evidence-gathering be congruent with the ethics and principles of narrative practice
- How can research processes contribute to de-colonisation?
We would welcome your input on any of these questions. We would also welcome your reflections on any aspect of the material listed on this site. Please contact us c/o
This repository, ‘Research, evidence, and narrative practice’, was compiled by David Denborough on behalf of Dulwich Centre Publications, November 2009.