Narrative Exposure Therapy (NET) : Reorganizing Memories of Traumatic Stress, Fear, and Violence

Abstract

Perception results not only from the properties of a stimulus, but also from memory traces of previous emotionally arousing experiences, which become modified in the process. Memories thus develop their own intrinsic dynamics, not only driven by the original experiences themselves but also by the memories thereof, thus remodeling cognition, emotion, and behavior eventually to the extent that clinical symptoms may arise. From episodic threats to social exclusion to the continuous wear and tear associated with living in adverse situations, stressors not only cause a set of responses but also modify the body’s defensive systems. In order to readjust a disordered memory representation the experiences must be recalled and sorted along the line of life. Consequently, in Narrative Exposure Therapy (NET), a client, with the assistance of the therapist, constructs a chronological narrative with a focus on the most stressful experiences. The autobiography is recorded by the therapist in written form and corrected and filled with details during moments of high emotional arousal. Aim of this procedure is to transform the generally fragmented reports of traumatic events into a coherent narrative. For traumatic stress experiences the therapist asks in detail for sensory information (visual, auditory, tactile, olfactory and gustatory), emotions, cognitions, and physiological reactions, probes for respective observations and records these information meticulously. The patient is encouraged to relive these emotions while narrating without loosing the connection to the “here and now”: using permanent reminders to detect how feelings and physiological responses result from memories, the therapist links the experiences to episodic facts, i.e., time and place. The exposure to the traumatic experience is not terminated, until the related arousal presented and reported by the client does show a significant diminution. In this way, the narrative is driven forward in a supportive but rather directively guiding style by the therapist, in order to counter avoidance and to recover the full implicit information of the traumatic experience. At the end of treatment the patient receives the written report of her/his-story. If requested by the client, this document may be used for rights and human rights advocacy.