On reviewing the material of the last two seminars, I decided to discus some of the similarities and differences between the specific techniques used by practitioners of cognitive behavioural therapy and narrative therapy, as these are two frequently used methods of therapy.
One cannot consider the techniques used by a therapeutic method fully without first considering the theoretical background of the method, as this influences what techniques that form of therapy will adopt. Cognitive Behavioural Therapy (CBT) draws on the phenomenological philosophy as propounded by Husserl (Leahy, 2003) whilst narrative therapy, according to Roberts & Holmes (1999) changes its theoretical background with the type of narrative used; psychodynamic narratives draw upon Freudian theories while feminist narratives draw upon feminist and Marxist critical theories. In general, Roberts and Holmes (1999) classify narrative therapy's theoretical background as critical-constructivist. These theories are evident in the ways that therapists in the two modes of therapy approach the therapy sessions, for example the narrative therapist's collaborative approach versus the CBT therapist's more expert approach.
CBT is based on a model that hypothesises that psychiatric or psychologically dysfunctional states are maintained or aggravated by the patient's thoughts and behaviours (Leahy, 2003). As mentioned in the post by J Pederick citing Merrick & Dattilio (2006), it is a popular, well- researched method that contains elements from other forms of psychotherapy. Narrative therapy is based on the hypothesis that the act of narration gives a patient insight into the reasons for the actions of the protagonists in their life (Lieblich, McAdams & Josselson, 2004). This insight creates an environment enabling the patient to acknowledge their own problems in a different light, and perhaps find a solution to them (Leiblich, McAdams & Josselson, 2004).
The techniques used in CBT can be broadly classified into those techniques eliciting cognitive changes and those eliciting behavioural changes. The CBT techniques used to achieve cognitive change include thought challenging, use of perspective, emotional processing techniques, and schema-focused therapy (Leahy, 2003). These methods are used after eliciting and evaluating the patient's dysfunctional thoughts. Thought challenging techniques include challenging assumptions and rules, evaluating methods of processing information, errors of logic and cognitive distortions amongst others (Leahy, 2003). Emotional processing techniques include written ventilation, imagery rescripting, use of emotional schemas and narrative (Leahy, 2003). Schema- focused therapy includes activation of early memories, letter writing, motivation building, role play and use of alternative positive schemas (Leahy, 2003). Techniques used to achieve behavioural change include self-observation, stimulus control, response planning, flooding, relaxation, sanctions, aversion, positive reinforcement, exposure and time-outs to mention but a few (Lanyon & Lanyon, 1978, The Royal College of Psychiatrists, 1997, Caballo, 1998). Due to the wide range of techniques available for use in CBT and the wide variety of disorders which CBT is a treatment modality for, choice of techniques is disorder-specific (Caballo, 1998).
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.
