Psychology: CBT vs Narrative Therapy

The main technique that is used by narrative therapists is that of narration, or story telling (Lieblich, McAdams & Josselson, 2004). In addition to this, Lieblich, McAdams & Josselson (2004) and White (2007) identify some of the other techniques used in narrative therapy to be philosophical counselling, sociodynamic therapy, ecological therapy, autobiographical reasoning, deconstruction, reasoning, therapeutic letters, ceremony, song and bearing witness. The major difference between the techniques of philosophical counselling, sociodynamic therapy, ecological therapy and autobiographical reasoning and the techniques in CBT is that these narrative techniques are considered to be postpsychological whereas the CBT techniques are mainly psychological (Lieblich, McAdams & Josselson, 2004). Another difference is between narration as a technique in narrative therapy and CBT; in narrative therapy the narration is guided by the therapist but not curtailed in any way, whereas in CBT the narration must follow the preset agreed-upon agenda, else be curtailed (Leahy, 2003).

Some CBT techniques draw on narrative therapy, such as the eliciting of patients’ thoughts, which is done by allowing the patient to tell their story, allowing the therapist to visualise their thought processes (Leahy, 2003). Thought challenging, errors of logic and cognitive distortions are techniques very similar to the narrative technique of re-authoring, where the therapist offers an alternative take on the patient’s story, in an effort to enable the patient to view their position in a different light (Lieblich, McAdams & Josselson, 2004). These CBT techniques are different from the narrative technique of philosophical counselling, as the latter normally involves the patient having to read something and think on it to find a meaningful worldview (Lieblich, McAdams & Josselson, 2004). Another technique in CBT, emotional processing, is similar to narrative therapy in that the patient is allowed to sit and tell a story of their emotions which the counsellor then assists them to see in a different way (Lieblich, McAdams & Josselson, 2004), thus bringing about cognitive changes (Leahy, 2003). Use of alternative positive schemas (Leahy, 2003) is yet another instance of a technique in CBT where aspects of narrative therapy are present, as the therapist suggests alternatives modes of thinking abut a situation.

The behavioural techniques in CBT have some similarities to techniques used in narrative therapy such as letter writing (White, 2007) but in general are quite different in that they are more prescriptive therapies that are often to be done by the patient as homework (Leahy, 2003). Also, while narrative therapy aims to bring about behaviour changes by letting a patient observe alternative stories and behaviours that will better suit them, CBT aims to bring about behaviour change by methods of training a patient into positive cognitive and behavioural patterns. And while homework is a dominant feature of CBT (Caballo, 1998), it is not a fixed technique in narrative therapy, and different therapists use it or not according to the needs of their patients.

While there are many similarities between the specific techniques used in CBT and narrative therapy, there are also many differences. Ultimately, the choice of therapy and technique is up to the therapist. It is important therefore that therapists are aware of the different techniques in different therapeutic modalities so that they are able to pick techniques, and even maybe mix techniques, so that therapy is tailored to the patient perfectly and the patient gains the most that they can from the experience.