Narrative therapy

Narrative therapy starts from a single principle, and that principle does most of the work: you are not the problem, the problem is the problem.

Everyone carries a story about who they are. It’s built from real events, and it’s always partial, because no story can hold everything that’s happened to you. When things go wrong, that story narrows — I’m a failure, I’m the difficult one, I’ve always been like this. The narrow story then collects evidence for itself and discards the rest. Narrative therapy works on that story: what it leaves out, where it came from, and who benefits from you believing it.

It’s one of the few therapies to have come out of Australia. Michael White developed it in Adelaide during the 1980s, alongside David Epston in Auckland. The Dulwich Centre, still in Adelaide, is where the Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder is taught internationally.

How it works

Everything here follows from treating the problem as separate from the person.

Naming the problem and putting it outside yourself. Instead of I’m anxious, the conversation is about the Worry, or the Voice, or whatever you decide to call it. What it says, when it turns up, what it wants you to do. Children take to this immediately. Adults usually find it awkward for about ten minutes, and then find it a relief.
Finding the exceptions. No problem wins all of the time, and a narrow story throws the other moments away. A lot of the questioning goes after them: the day you went anyway, the time you said no.
Building the other story. Those exceptions get connected up into a fuller account of yourself. It’s just as true as the narrow version, and there’s more room in it.
Writing it down. Therapists in this tradition often send letters afterwards, or make documents and certificates with you. A story you can re-read holds better than a story you only heard once.
Bringing in someone to listen. Sometimes a person you choose sits in, listens, and says back what they heard. It’s an unusual thing to sit through, and people tend to remember it for a long time.

The approach is also openly political, in a way most therapies aren’t. It treats poverty, racism, gender and disability as part of the problem rather than as context around it.

What a session is like

Sessions run about an hour and consist largely of questions.

The therapist asks a great deal and interprets very little. They won’t tell you what your problem means. The model holds that you’re the one who knows your own life, and that their job is to ask about the parts you’ve stopped noticing. If you’ve found other therapists too ready to explain you to yourself, this is a noticeably different experience.

You may be asked to give the problem a name, which feels odd the first time. After a session you might get a letter setting out what you said, in your words.

It’s often shorter than open-ended therapy, somewhere between six and fifteen sessions, though it’s also used over longer stretches and with families rather than individuals.

Who it tends to suit

It’s particularly useful for:

People flattened by a label. Someone cast as the difficult one in their family for thirty years, or someone who now reads their whole life through a diagnosis.
People who bristle at being treated as a case. Nothing here positions the therapist as the one who knows. For some people that’s the difference between staying and not coming back.
Young people, and schools. Separating the problem from the person comes naturally at that age, and none of it asks anyone to describe their feelings fluently.
Complex trauma. The aim is usually to tell the story differently rather than to go back through what happened in detail.

It suits you less if:

You want a specific technique for a specific symptom.
Treating your problem as a character in a story sounds like word games. That reaction is common, and it’s a fair reason to choose something else.

What the evidence says

The research is much thinner than the approach’s popularity suggests, and one of the published figures needs unpicking.

A 2023 review of narrative approaches for depression and related conditions found eighteen reports in all. It found that people improve, that the results may be similar to those of other therapies, and that the area is under-researched (Hawke and colleagues, 2023). Eighteen reports is not much for a therapy this widely used.

A 2024 Meta-analysis A study that combines the results of many earlier studies on the same question, to get a clearer overall answer than any one study gives. More in the jargon decoder , which combines the results of many earlier studies, is much bigger: 54 randomised trials, nearly 4,900 people, and a large effect on depressive symptoms (Hu and colleagues, 2024).

Fifty-two of the 54 trials were done in China.
Only two involved people whose main problem was depression. The rest were people with a physical illness.
The authors rated the overall quality of the evidence as very low.
They found signs that trials with poor results had gone unpublished.

A big number and a good number aren’t the same thing.

Closer to home, an Australian study of narrative therapy for adults with major depression reported improvements in symptoms and in relationships (Vromans and Schweitzer, 2011).

So: the ideas are well developed and widely used, and both therapists and the people they see report that it helps. What’s missing is the research to say how well — a gap in the testing, not a finding that it doesn’t work. Narrative therapy has been practised far more than it’s been studied.

What that means for choosing. If what you’re dealing with has a specific, well-tested treatment behind it — obsessive compulsive disorder is the clearest example — the trials are a reason to start there. Outside those, the research isn’t strong enough in any direction to override a therapist you trust and can work with. The fit between you and the person in the room is one of the most consistent predictors of how therapy goes. A thin evidence base is not a reason to leave a good narrative therapist you’ve already found.

Getting it in Australia

Who provides it. Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder , Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder , social workers, family therapists, school counsellors and some Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder . Plenty of practitioners borrow the techniques — externalising especially — without working narratively all the way through. Worth asking how someone actually works. Who does what covers the professions.

What Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder , and there’s an oddity here. Narrative therapy is one of the few approaches named on Medicare’s list of what can be delivered under a Mental Health Treatment Plan. Acceptance and commitment therapy and Psychodynamic therapy A therapy that looks at the parts of your life you can't quite see from the inside. Its core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early. More in the jargon decoder don’t get that. But the listing is specific: narrative therapy is named for use with Aboriginal and Torres Strait Islander peoples. For everyone else, a psychologist using it under a plan works under a broader heading, which is the ordinary situation for most approaches.

The rest of the rules are the usual ones. Ten rebated sessions a calendar year with a psychologist, Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder or Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder , and nothing for counsellors or psychotherapists.

Availability. Better than most of the less common approaches, because Australia is where it comes from. Adelaide and Melbourne are strongest. Community and youth services use it heavily, and it turns up in schools more often than in private clinics.

Telehealth A session by video or phone instead of in person. Medicare gives the same rebate for a session by video as in person. More in the jargon decoder . The whole approach runs on conversation rather than on worksheets or materials, so it carries over to phone and video well.

Person-centred therapy shares the principle that you’re the one who knows your own life, with much less structure to the questioning.

Schema therapy takes the same interest in long-standing patterns and has more evidence behind it. For a specific, well-defined problem, cognitive behavioural therapy (CBT) is the most tested option.

The therapist matters at least as much as the method. Why who you see matters more than what they do explains why. If you’re still working out whether you want therapy at all, what therapy actually is covers the basics, and would I benefit from therapy? helps you work out whether it’s worth a try.