Narrative Exposure Therapy (NET)

What is Narrative Exposure Therapy (NET)?

Originally developed to be used with refugees, this treatment helps individuals establish a life narrative in which to contextualise traumatic experiences. It is particularly effective for those who have suffered from multiple and complex trauma, and who have been diagnosed with PTSD or C-PTSD.

How does Narrative Exposure Therapy (NET) work?

Narrative exposure therapy (NET) is a treatment for trauma disorders, especially in individuals suffering from complex and multiple trauma. The way a person conceptualises his or her life into a story affects how the person understands and experiences life. Framing one’s life story only around the traumatic experiences leads to a feeling of persistent trauma and distress. Narrative Exposure Therapy helps to contextualise one’s trauma as only one part of one’s life story thereby removing the power the trauma has over an individual.

With the guidance of the therapist, a patient begins by laying out a “lifeline” with a rope symbolising one’s life, stones representing traumas, and flowers representing positive events. In future sessions, working through the events laid out in the lifeline, the patient establishes a chronological narrative of his or her life, concentrating mainly on their traumatic experiences, but also incorporating some positive events. It is believed that this contextualises the network of cognitive, affective and sensory memories of a patient’s trauma. By expressing the narrative, the patient fills in details of fragmentary memories and develops a coherent autobiographical story. In so doing, the memory of a traumatic episode is refined and understood.

Key elements of the therapist’s behaviour include compassionate understanding, active listening, therapeutic alliance and unequivocal positive regard.

The therapist asks the patient to describe his or her emotions, thoughts, sensory information and physiological responses in detail. The patient is asked to narrate the traumatic experience and relive the emotions experienced without losing connection to the present. Staying present is achieved by utilising permanent reminders that the emotions and physical responses that occur in response to memories are linked to episodic facts (such as time and place) but are then reprocessed and unified with meaning. When treatment ends, a documented autobiography that has been created by the therapist is presented to the patient.

By engaging in narrating their whole life story, the patient does not need to choose one particular traumatic occurrence from numerous ones experienced across the lifespan. Rather, NET grants the patient the freedom to reflect on their entire life, cultivating a feeling of personal identity. Going over the biography helps to highlight understanding of experiences and contextualise interrelated emotional responses, which facilitates integration and comprehension of behavioural patterns and schemas that emerged during development.

NET is distinct from other treatments in its explicit focus on recognising and creating an account or testament of what happened, in a way that serves to recapture the patient’s self-respect and acknowledges their human rights. For many, the knowledge that she or he will receive a written biography at the end of treatment is an incentive for treatment completion.

[Adapted from other sources including the APA]