Narrative Exposure Therapy (NET)

Narrative exposure therapy is a treatment for trauma disorders, particularly in individuals suffering from complex and multiple trauma. It has been most frequently used in community settings and with individuals who experienced trauma as result of political, cultural or social forces (such as refugees). Often, individuals receive four to 10 sessions of NET. It is understood that the story a person tells themselves about their life influences how the person perceives their experiences and wellbeing. Framing one’s life story solely around the traumatic experiences leads to a feeling of persistent trauma and distress. The guideline suggests NET for the treatment of PTSD.

With the guidance of the therapist, a patient establishes a chronological narrative of their life, concentrating mainly on their traumatic experiences, but also incorporating some positive events. It is believed that this contextualizes 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 behavior include compassionate understanding, active listening, therapeutic alliance and unequivocal positive regard.

The therapist asks the patient to describe their 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 utilizing 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 contextualize interrelated emotional responses, which facilitates integration and comprehension of behavioral patterns and schemas that emerged during development.

NET is distinct from other treatments in its explicit focus on recognizing 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 they will receive a written biography at the end of treatment is an incentive for treatment completion.