Narrative Exposure Therapy with Refugee Clients

In my last blog, I explained how I like to use elements of storytelling and creative arts when working with refugee clients – to help develop a coherent narrative of events, and to process the emotional and visceral impacts of trauma. Last time, I focused on the Tree of Life intervention. Here, I want to share how I use another narrative approach, Narrative Exposure Therapy, with clients who are refugees.

Narrative Exposure therapy (NET) is a NICE endorsed treatment for trauma, and is particularly effective where there are multiple exposures to trauma over the lifespan. Following the initial timeline developed in the first session, each trauma memory is explored in detail. It is the first stage, the development of the timeline, and how this in itself can be healing for people, that I am focusing on.

In my practice, this often takes more than one session, which is an adaptation to the original NET treatment model. I also include the client’s person of safety (the named contact who has supported them in between sessions, checked in on them and is part of their recovery plan) as a constant in the room alongside the interpreter.

In this way, by the end of the process, we have a coherent narrative of their experiences to date, in a co-created space where it has been witnessed, validated and contained safely.
 

Using NET to process trauma

As with any trauma work, I begin with grounding techniques. NET tries to help people process the trauma they have experienced by talking about the thoughts, feelings and sensations involved in the memories. This helps the brain to store the memory away, instead of it coming back in flashbacks, nightmares or bad thoughts.

But we don’t just talk about the difficult memories. The client is invited to make a timeline of their whole life, including the good as well as the bad experiences. By ensuring that we mark their good memories too, we pay attention to the whole, and note that they have had some positives and can experience pleasures, which can often be misplaced with depression and trauma.

Creating the client’s timeline

In NET, a ribbon or rope represents the person’s life, with the flowers to represent good experiences (as well as hope and possibilities), stones to represent the traumas they have survived, and a short label for each event. This is how I might introduce the session to my client:

Today we are going to create a bird’s eye view of your life story, with all the good things and all of the trauma. We will start at your birth and work through your life until we have come to the coiled up part at the end that represents life to come – your future.

We’ll place flowers and stones on the lifeline as we talk through your life. It might be difficult to think and talk about some parts of your life story. This is normal, and I will be here for you to turn to when things get difficult. We won’t go into any details about the traumas today.

We’ll lay your timeline to the current date in these sessions so we can use it as a guide or map to talk though your experiences. We will focus on dates, facts, your age and names as a way of marking the time. Once we have a map of your timeline, we can start to look at the stones and flowers in detail to create a coherent narrative of your experiences to date.

Presenting the timeline

Once we have completed the timeline, I type it up and present it as a written story of the client’s life, to keep as a reminder of what we have created. We read the final story together. This in itself is an intervention that has an impact on the client. All the memories are now contained in one place and presented as a coherent narrative that ends on where they are now, and their hopes and aspirations for a future yet not written.