Most addictions come with a story, often one that is difficult to relive and process. These stories reinforce inaccurate narratives about self-worth, ability, and the future. Unfortunately, these narratives are actively becoming part of the problem. Whether you realize it or not, they influence how you view yourself, how you view your ability to recover, or if recovery even seems possible. But there is a way to rewrite them.
Narrative therapy takes an approach that starts to address and challenge those stories at their root level. It doesn’t ask for the past to be ignored; rather, it asks whether the story being told about it is the complete truth. For many people in recovery who have been affected by substance use, asking that question can be a life-altering experience.
What Is Narrative Therapy?
Narrative therapy is a non-pathologizing, collaborative type of psychotherapy that examines the stories you tell about yourself and your life in greater depth, as well as creating new, more empowering stories to replace the existing ones. Narrative therapy originated through the work of two therapists — Michael White and David Epston — in the 1980s, and this work has changed the way mental health and substance use conditions are treated around the world. Narrative therapy is a widely used therapeutic approach that has been applied internationally to support individuals with mental health and substance use challenges.[1]
The first principle of narrative therapy is that you are not your problems. Problems, including addiction, exist outside of the person and are influenced by social, cultural, and relationship contexts that are also capable of examination and challenge. In narrative therapy sessions, you will be able to examine the stories that have shaped your identity, identify the assumptions embedded in those stories, and create new, unique stories that accurately reflect your values, beliefs, and capacity for change.
Narrative therapy is delivered by trained therapists and social workers in inpatient, outpatient, and residential treatment facilities. At All In Solutions, we provide comprehensive, holistic services that integrate narrative therapy into individualized treatment plans.
How Narrative Therapy Works
The Problem Story and Externalization
In narrative therapy, the first step is to identify the problem story you have created about your addiction, your identity, and your life as a result of your addiction. Many people struggling with addiction have a totalizing story that has established their self-identity and accounts for all of their failures in life, as well as determining whether change is possible or not. For instance, the statement “I am an addict” creates no logical alternative in your mind.
Externalization is one of the main practices of narrative therapy, which separates the person from the problem. Instead of classifying addiction as a characteristic of an individual, narrative therapy classifies addiction as a force in your life that has influenced you, and that has an opportunity to be examined, challenged, and significantly diminished. When you start viewing yourself as having a relationship with a problem, rather than as the problem, you create a psychological distance that provides space for meaningful self-examination and change.
Deconstruction
Deconstruction in narrative therapy is the process of evaluating the assumptions, cultural messages, and social contexts that have contributed to the creation of the problem story. Those with addiction generally have ingrained feelings about themselves. For example, they may feel they are weak, broken, or different from other people who do not struggle with substances.
Narrative therapy enables you to examine where those beliefs came from, whose voice spoke them, and whether they have any truth at all. By deconstructing your problem story, you take away its power and allow other meanings to be assigned to the same events.
Unique Outcomes and Re-Authoring
A central technique in narrative therapy is looking for unique outcomes. A unique outcome is a moment in the client’s life story that contradicts their problem narrative. Some examples are: a time the client resisted the substance, a time where they showed up for a loved one, or where they chose their values over their addiction.
These unique outcomes should not be overlooked as exceptions. Rather, they are proof of an alternative story that has been present all along but overshadowed by the dominant narrative.
Re-authoring builds an alternative narrative off of these unique outcomes. The alternative narrative is a new story in which the client is the author of their own life instead of defining themselves through the addiction. The alternative story is not fictitious; it is composed from the client’s own words, history, values, and strengths. The narrative therapist’;s job is to help the client find, identify, and claim that alternative story as their own.
Reframing Identity in Recovery
One area where narrative therapy has been especially useful for persons recovering from substance use is through its emphasis on narrative identity. The term “addict,” whether it is applied by another or by the person themselves, can take on a life of its own as a self-fulfilling prophecy.
When the majority of a person’s identity is based on substance use, recovery is not solely dependent on behavior change; it requires a complete reconstruction of how that person identifies. Narrative therapy assists the person by providing an alternative means of developing a recovery-oriented identity that remembers the past but does not imprison the person within it.
How Narrative Therapy Helps With Drug and Alcohol Addiction
Narrative therapy is designed to help people on a level that clinical treatment doesn’t: their level of meaning, identity, and narrative. While therapies like cognitive-behavioral therapy (CBT)(is a structured, goal-oriented form of psychotherapy (talk therapy) designed to help individuals identify and change dysfunctional thinking patterns, emotions, and behaviors.) and dialectical behavior therapy (DBT) look to modify dysfunctional thought patterns and develop emotional control and distress tolerance skills, narrative therapy focuses on what story makes the client’s behavior understandable, and, consequently, how the client can alter that story.
Narrative therapy is useful for a variety of reasons in addiction treatment. The externalization of the problem lessens the shame a client feels and helps them to challenge their internalized beliefs associated with, and sustaining, the problem. As narrative therapy highlights the positive evidence of strengths and resilience that were hidden by the problem story, the client’s sense of self-worth, self-empowerment, and recovery-oriented identity grow through identifying, in their own words, what they want to be and how they want to be it. The client’s motivations for recovery are enhanced by connecting the client with their values and the life they want to live.
Narrative therapy is also valuable in group therapy, as members of the group create a sense of validation, connectivity, and collective empowerment through shared experience.
Family therapy based on a narrative therapeutic model can also assist with repairing ruptured relationships between family members by exploring how family members have been positioned within each other’s stories and creating space for the development of new stories.
The Efficacy of Narrative Therapy in Addiction Treatment
The evidence base for narrative therapy as an approach to treating people struggling with addiction is growing at a rapid pace. Research suggests that narrative therapy can improve self-concept, increase a sense of personal agency, and support engagement in treatment.[2]
It also suggests that narrative therapy helps people to separate their identity from substance use, increase their sense of personal agency, and engage more meaningfully in the treatment process.[3]
Finally, narrative therapy is supported by research documenting its effectiveness in treating co-occurring mental health conditions that are prevalent among the addiction population, such as depression, anxiety, trauma, and PTSD.[5] Since the same types of destructively totalizing, shame-based narratives contribute to the development of co-occurring mental health conditions as well as addiction, the techniques and processes central to narrative therapy resolve root causes rather than symptoms, making narrative therapy a powerful supplement to evidence-based clinical practices for comprehensive treatment programming.
What to Expect From Narrative Therapy
Narrative therapy is facilitated by trained therapists who integrate it into individual, group, and family therapy. The focus remains on the client as the expert of their own life, and discussions are collaborative and conversational. Clients never find themselves positioned as a passive recipient of treatment, but as the sole expert of their own life story.
The process usually goes as follows:
- In the beginning, the therapist and client work together to explore the stories and themes that the client has created around their addiction and their identity, and how these stories have impacted their choices and how they see themselves.
- As therapy continues, the therapist and client work together to identify unique outcomes by deconstructing the assumptions that have sustained their addiction story.
- Together, the client and therapist work on developing a new story for the client.
There is no set timeline on how long this will take or a specific protocol for completion of the process. This will depend on many different things, including the client’s background, history, recovery objectives, and motivation to get better. Narrative therapy is incorporated within the client’s overall treatment approach, and work is tailored to each client’s level of care and need for further treatment.
Narrative Therapy at All In Solutions
At All In Solutions, we recognize that addiction is not just a physiological or psychological disease. People also create and repeat stories about themselves that continue their patterns of addiction, and narrative therapy is our way of supporting clients and helping them identify and rewrite those stories. Our therapists are trained in narrative approaches and deliver this work as an integrated component of each client’s treatment plan, not as an extra add-on.
Whether you’re dealing with shame from your years of addiction, rebuilding yourself after an extended period of substance use, or you’re still trying to figure out how you got to this point, narrative therapy is a method to support you in your recovery journey. Your recovery will be about recreating your life story, and narrative therapy will help you find the words to tell it.
