A narrative therapy treatment plan documents how a client’s problem-saturated dominant story will be externalized, examined, and re-authored into a preferred, more empowering story — built around the client’s own values, skills, and unique outcomes rather than a diagnosis-driven symptom list. Narrative therapy treats the person as separate from the problem (“the problem is the problem; the person is not the problem”), which creates a genuine, practical tension with standard treatment-plan formats built around diagnosis and pathology.
This guide walks through how to build a narrative therapy treatment plan that reflects the actual model: how externalizing conversations, unique outcomes, and re-authoring structure goals differently than problem-focused approaches, how to document diagnosis and medical necessity within a model that actively questions pathologizing language, a worked example, and common documentation mistakes. This guide is written for licensed mental health professionals, clinicians-in-training working under appropriate supervision, and behavioral health organizations developing documentation workflows. It is educational and does not establish independent scope of practice; it does not replace clinical judgment, applicable law, payer requirements, or your profession’s practice standards.
Narrative Therapy Treatment Planning at a Glance
| Element | Narrative Therapy Approach |
|---|---|
| Problem | Externalized from the person, given a name the client helps choose |
| Formulation | The dominant, problem-saturated story and its influence on the client’s life |
| Strengths | Unique outcomes, values, skills, intentions, and supportive relationships |
| Goals | The client’s preferred story and self-defined direction |
| Objectives | Observable steps toward thickening the preferred story |
| Interventions | Externalizing, unique-outcome exploration, re-authoring, re-membering, and related practices |
| Progress | Narrative indicators, supplemented by standardized measures when clinically or administratively indicated |
| Diagnosis | Documented accurately where clinically or administratively required |
| Medical necessity | Established through symptoms, functional impairment, and clinical rationale |
| Risk | Assessed explicitly and individually, documented separately from the narrative formulation |
| Discharge | Based on the client’s individualized relationship to the problem and preferred story, not a fixed session count |
Key Takeaways
- A narrative therapy treatment plan should document the externalized problem, the client’s identified unique outcomes and preferred story, and how that alternative story will be thickened over treatment — not a detailed problem history organized around a diagnosis-driven mechanism.
- Externalizing conversations, unique outcomes, re-authoring, and re-membering are among narrative therapy’s signature practices; there’s no single official “core four,” and treatment planning should draw on the specific practices that fit this client rather than a fixed checklist.
- Narrative therapy’s critique of pathologizing language creates a genuine documentation tension: the treatment plan still needs an accurate diagnosis and functional-impairment rationale, even though the therapeutic conversation itself works to separate the client’s identity from that diagnosis.
- Current outcome research on narrative therapy is real but limited — a 2024 meta-analysis found a significant effect on depressive symptoms in adults with somatic disorders, but rated the overall evidence certainty as low, citing small samples and inconsistency in how narrative therapy was defined and delivered across studies.
- Comprehensive narrative therapy treatment plans include 12 core sections spanning diagnosis, formulation, goals, interventions, risk, family involvement, and discharge planning.
View our Counseling Treatment Plan Template, which corresponds with this guide.
Why Treatment Planning Matters for Narrative Therapy
Narrative therapy, developed by Michael White and David Epston, is built on the premise that people experience problems when the dominant stories they and others have constructed about their lives don’t sufficiently represent their actual lived experience — and that therapy is a process of examining and re-authoring those stories (White & Epston, 1990). Because the model treats identity as storied rather than fixed, and explicitly separates the person from the problem, a narrative therapy treatment plan looks different from a diagnosis-driven one from the formulation section onward — and that difference needs to be documented deliberately.
A comprehensive treatment plan still serves the same administrative purposes it does in any modality: it documents medical necessity, supports continuity of care, and creates measurable benchmarks. Narrative therapy doesn’t have a fixed, brief session count the way some other approaches do — treatment length varies considerably by presentation, setting, and how much re-authoring and thickening work the client’s preferred story needs — so the plan should reflect a realistic, individualized course rather than assuming a fixed short or long duration by default.
Complete a Thorough Clinical Assessment Before Writing the Treatment Plan
A treatment plan should never be developed in isolation. Before identifying goals, clinicians should complete an assessment covering the presenting concern, current risk, relevant diagnostic criteria, and — central to narrative therapy specifically — how the client currently names and describes the problem, early identification of any unique outcomes (moments that don’t fit the problem-saturated story), and the social, cultural, and relational context shaping the client’s dominant narrative.
Narrative therapy pays particular attention to the broader cultural and relational context contributing to a client’s problem story — including power, culture, and social discourse — without treating that context as an excuse to skip individualized risk assessment or diagnostic clarity, both of which remain necessary regardless of therapeutic approach.
If you are looking for additional guidance on collecting assessment information before creating a treatment plan, our guides to the Counseling Intake Assessment and Biopsychosocial Assessment provide more detailed recommendations for conducting comprehensive evaluations.
What to Include in a Narrative Therapy Treatment Plan
A comprehensive narrative therapy treatment plan connects the client’s externalized problem, unique outcomes, and preferred story into a clinical roadmap. It follows the same 12-section framework used across TherapyByPro’s treatment-plan guides.
Important: Narrative therapy does not prescribe a standardized 12-section treatment-plan format. The framework below is a clinical documentation structure adapted for narrative therapy — not a component of the model itself. Individual clinicians should modify it to meet applicable licensing, organizational, payer, and jurisdiction-specific requirements, which vary and aren’t established by this guide.
| Treatment Plan Section | Purpose |
|---|---|
| Client and Plan Information | Documents client demographics, treatment plan dates, review dates, plan type, clinician information, practice details, session format, frequency, and estimated treatment duration. |
| Coordinating Providers and Services | Identifies other providers, agencies, referrals, releases of information, and care coordination plans to support continuity of treatment. |
| Diagnostic Summary | Documents the client’s diagnosis and clinical evidence supporting it, kept accurate and specific even though it isn’t where most of the plan’s clinical reasoning lives. |
| Clinical Formulation and Treatment Rationale | Explains the client’s dominant problem-saturated story, the externalized name given to the problem, identified unique outcomes, existing values, skills, and supportive relationships, realistic barriers to treatment, and the clinical reasoning connecting them to the selected goals. |
| Medication and Concurrent Treatment | Documents current medications, prescribing providers, medication response, adherence concerns, and other behavioral health or medical services involved in care. |
| Presenting Problems and Functional Impact | Describes the presenting concern and its functional impact concisely — enough to establish medical necessity, without becoming the primary focus of the plan. |
| Treatment Goals and Objectives | Establishes goals built from the client’s preferred story and identified unique outcomes, each with its own baseline relationship to the externalized problem, planned narrative practices, clinical rationale, and progress tracking, with measurable short-term objectives connected to each. |
| Treatment Modality and Interventions | Documents the primary treatment modality, overall clinical rationale, session format and frequency, and between-session tasks such as noticing unique outcomes or drafting a therapeutic letter. |
| Risk Assessment and Safety Planning Summary | Summarizes relevant risk factors, assessed explicitly and individually regardless of the model’s strengths-based, externalizing stance. |
| Family, Support, and Collateral Involvement | Documents family and community participation, including any re-membering or outsider-witness practices involving significant people in the client’s life. |
| Transition and Discharge Planning | Defines discharge criteria tied to the client’s relationship to the problem and the strength of their preferred story, and referrals for continued support. |
| Plan Review and Signatures | Documents treatment plan updates, overall progress, client participation, and signatures. |
If you want to document these elements in a structured format, the TherapyByPro Counseling Treatment Plan template follows this same clinical workflow.
The following sections provide a detailed overview of each component.
1. Client and Plan Information
Document the estimated treatment duration realistically based on this client’s presentation — narrative therapy doesn’t have a fixed brief or extended course, so avoid defaulting to a generic timeframe borrowed from another modality.
2. Coordinating Providers and Services
Document any other providers involved and the plan for coordination, particularly relevant if narrative therapy is being used alongside medication management or another concurrent service.
3. Diagnostic Summary
Name the definitive diagnosis and the clinical evidence supporting it, kept accurate and appropriately concise. Verify current ICD-10-CM codes and payer requirements for the specific diagnosis being documented.
4. Clinical Formulation and Treatment Rationale
Document the client’s dominant problem-saturated story, the externalized name they’ve given the problem, identified unique outcomes, and the clinical reasoning connecting this formulation to the selected goals and practices.
Clinical Documentation Note: The formulation section is where narrative therapy plans most often default back into diagnosis-centered language without meaning to — writing the externalized problem’s name and the client’s identified unique outcomes first, before restating the diagnosis, helps the documentation itself reflect the approach.
Document identified unique outcomes and the client’s existing values, skills, and preferred identity claims, alongside realistic barriers — such as a client who initially struggles to separate their identity from a long-standing problem story.
5. Medication and Concurrent Treatment
Document medications, prescribing providers, and response; note whether medication and narrative therapy are addressing the same concern or different ones.
6. Presenting Problems and Functional Impact
Describe the presenting concern and its functional impact concisely — this section still needs to establish medical necessity, without becoming an extended problem-saturated narrative that runs counter to how the therapy itself is conducted.
7. Treatment Goals and Objectives
Goals should be built from the client’s preferred story and identified unique outcomes, translated into specific, observable terms — not a diagnosis-derived symptom-reduction goal imported from a different model. Each goal should include its own baseline: the client’s current relationship to the externalized problem (how much influence it currently has in their life) alongside current functioning; a standardized symptom measure can be added when clinically or administratively indicated, though it isn’t narrative therapy’s own primary progress indicator. Each goal should also specify which narrative practices are being used to pursue it — externalizing conversations, unique-outcome exploration, re-authoring, re-membering, outsider-witness practices, therapeutic letters — and connect each to the specific target identified in the formulation, along with a method for tracking progress.
8. Treatment Modality and Interventions
Document the primary treatment modality as a whole, session format, and frequency, and between-session tasks — often framed as noticing unique outcomes, drafting or reading a therapeutic letter, or reflecting on a specific relationship with the externalized problem — distinct from the goal-specific interventions documented in section 7.
9. Risk Assessment and Safety Planning Summary
Document current and historical risk factors with the same specificity expected in any treatment plan. Narrative therapy’s strengths-based, externalizing stance doesn’t reduce the need for explicit, individualized risk assessment — a plan that treats risk only in passing because the model works to separate identity from problems is a documentation gap worth correcting directly.
10. Family, Support, and Collateral Involvement
Document family and community involvement, including any re-membering conversations (revisiting the influence of significant people, present or absent, on the client’s life) or outsider-witness practices where others are invited to witness and reflect on the client’s preferred story.
11. Transition and Discharge Planning
Discharge criteria should be tied to the client’s relationship to the externalized problem and the strength and detail of their preferred story — not a fixed session count imported from a different modality.
12. Plan Review and Signatures
Document review dates, client participation, and signatures, reinforcing that treatment planning — including the client’s own naming of the problem — is a collaborative process the client actively authors.
Narrative Therapy Treatment Plan Example
The following example demonstrates how the clinical sections of a narrative therapy treatment plan connect together for a client presenting with generalized anxiety. This example is provided for educational purposes only and should be adapted based on the individual client’s presentation, diagnosis, and applicable documentation requirements.
| Section | Example Documentation | Clinical Purpose |
|---|---|---|
| Client & Plan Information | Plan Type: Initial Treatment Plan Service Format: Individual outpatient narrative therapy Frequency: Weekly 50-minute sessions Estimated Duration: Individualized; to be reassessed as re-authoring progresses Primary Concern: Generalized anxiety, externalized by the client as “The Worry,” affecting work performance confidence and social engagement | Establishes scope without assuming a fixed brief or extended course by default. |
| Coordinating Providers and Services | Other Providers: No current psychiatric provider or individual medical treatment. Release of Information: Not currently indicated. Care Coordination Plan: Refer for psychiatric consultation if symptoms significantly worsen or functioning declines further. | Documents current care coordination status and a plan for escalation if clinically indicated. |
| Diagnostic Summary | Diagnosis: F41.1 — Generalized Anxiety Disorder Symptoms & Clinical Evidence: Persistent worry, concentration difficulty, and social withdrawal for approximately one year, consistent with the documented diagnosis based on available assessment information. Diagnostic Considerations: Differential diagnosis and diagnostic status should be reviewed as clinically indicated. | Connects the diagnosis to specific symptoms and duration, kept concise relative to the formulation and goal sections below. |
| Clinical Formulation & Treatment Rationale | Client’s dominant story centers on being “bad at their job” and incapable of good decisions, externalized in session as “The Worry” — a separate entity that takes over and influences the client’s choices. A clear unique outcome was identified: a recent successful work presentation the dominant story doesn’t account for, tied to a specific action (talking through ideas with a colleague beforehand) the client can draw on and expand. Strengths: Supportive colleague relationship, stable employment, and a clearly identified, specific unique outcome to build from. Barriers: Client initially describes “The Worry” as “just who I am,” suggesting some fusion between identity and the problem story that externalizing language will need to address directly. Treatment Rationale: Narrative therapy was selected given the client’s strong capacity for externalizing language and clearly identifiable unique outcome, and the client’s own stated preference to examine the story they’ve been telling about their competence rather than focus primarily on symptom reduction. | Explains the clinical reasoning connecting the client’s dominant story, strengths, and barriers to the selected approach. |
| Medication and Concurrent Treatment | Current Medication: None; client is not currently taking psychiatric medication. Consideration: Medication evaluation is not part of the current treatment plan; referral or consultation can be considered if symptoms worsen, persist, or otherwise warrant additional evaluation. | Documents current medication status without asserting a conclusion the available information doesn’t support. |
| Presenting Problems & Functional Impact | Presenting Problem: Persistent worry and difficulty concentrating, externalized as “The Worry.” Functional Impact: Decision-making difficulty at work despite positive performance reviews, reduced social engagement over the past year. | Establishes medical necessity concisely, without becoming the primary focus of the documentation. |
| Treatment Goals and Objectives | Baseline Severity and Current Functioning: Client describes “The Worry” as influencing most decisions most days; GAD-7 score of 14 at intake, added to supplement the narrative-based formulation above. Employed full-time with consistently positive reviews despite significant subjective difficulty; reduced social contact outside of work. Problem Statement: “The Worry” externalized as taking over decision-making and reinforcing a story of incompetence not supported by the client’s actual work performance. Long-Term Goal: Client will develop and thicken an alternative story of competence and capability, reducing the influence “The Worry” has over daily decisions. Objective 1: Client will identify at least one additional unique outcome per week that contradicts “The Worry’s” story of incompetence. Objective 2: Client will map the specific actions and relationships (e.g., talking through ideas with a colleague) that support the emerging alternative story, and deliberately repeat at least one weekly. Goal-Specific Intervention: Weekly sessions using externalizing conversations, unique-outcome exploration, and re-authoring to thicken the alternative story; therapeutic letter drafted collaboratively once several unique outcomes are identified. Clinical Rationale for This Goal: The identified unique outcome demonstrates the client already has access to a story of competence; treatment focuses on locating and thickening additional evidence for that story rather than analyzing the anxiety symptoms directly. Goal Progress: Weekly tracking of identified unique outcomes; GAD-7 readministered at 8 and 16 weeks to supplement the narrative-based progress indicators; reassess at 8-week mark, considering referral for further evaluation if no unique outcomes have been identified and GAD-7 shows no meaningful change. | Demonstrates the full reasoning chain from baseline through the client’s own identified unique outcome to a measurable review point. |
| Treatment Modality and Interventions | Primary Modality: Individual outpatient narrative therapy, weekly 50-minute sessions. Between-Session Assignments: Notice and record any moments “The Worry” has less influence; deliberately repeat the identified supportive action (talking through ideas with a colleague) at least once weekly. | Documents the overall treatment approach and the between-session structure — distinct from the goal-specific intervention above. |
| Risk Assessment & Safety Planning Summary | Assessment Finding: Client denies current suicidal ideation, intent, plan, or access to means; denies any history of self-harm or prior mental health treatment. Clinical Interpretation: Current suicide risk is assessed as low based on the documented assessment, including current ideation, intent, plan, history, relevant risk factors, protective factors, and overall clinical presentation. This determination reflects the clinician’s overall assessment rather than being inferred solely from denial of suicidal ideation, and is not an assumption based on narrative therapy’s strengths-focused, externalizing stance. Protective Factors: Supportive colleague relationship, stable employment, no prior mental health history, active engagement in identifying unique outcomes. Plan: No additional safety-planning intervention is indicated based on the current assessment; risk and safety-planning needs will be reassessed as clinically indicated. | Documents an explicit, individualized risk assessment rather than an inference from the model’s strengths-based framing. |
| Family, Support, and Collateral Involvement | Support System: The supportive colleague is a significant figure in the client’s emerging alternative story. Collateral Involvement: Not currently indicated; client is an adult managing their own care. Outsider-witness or re-membering practices involving the colleague may be considered later in treatment with the client’s consent. | Documents relevant supports appropriate to an adult client’s autonomy, while flagging a narrative-specific practice that may become relevant. |
| Transition and Discharge Planning | Discharge Criteria: Client demonstrates a well-developed, detailed alternative story of competence, reports reduced influence of “The Worry” over daily decisions, and shows sustained improvement on the GAD-7. Aftercare Plan: Discuss how the client will continue noticing and reinforcing unique outcomes independently; client may return briefly if “The Worry’s” influence resurges significantly. | Establishes discharge criteria tied to the client’s own relationship to the externalized problem, not a fixed session count. |
| Plan Review and Signatures | Progress Status: Formal treatment-plan review scheduled after 8 weeks or sooner if clinically indicated. Client Participation: Treatment goals were constructed directly from the client’s own externalized language and identified unique outcome, and reviewed collaboratively. Client signature obtained to confirm participation in treatment planning. | Reinforces that the treatment plan was authored with the client, not imposed on them. |
Narrative Therapy Treatment Plan Template
The images below provide a preview of TherapyByPro’s Counseling Treatment Plan template, designed for mental health professionals who need a structured framework for documenting narrative therapy treatment goals, measurable objectives, clinical formulation, interventions, risk considerations, and treatment progress.
The template follows a comprehensive clinical structure that can be adapted for narrative therapy delivered in individual, family, or group settings. It includes sections for client and plan information, care coordination, diagnostic summary, clinical formulation, medication and concurrent treatment, presenting problems and functional impairment, treatment goals, objectives, interventions, treatment modality, risk assessment, family and support involvement, discharge planning, and plan review documentation.
Organized across 15 dedicated pages, the editable Word document and fillable PDF allow clinicians to customize documentation based on their practice setting, clinical approach, and documentation requirements while maintaining a consistent treatment planning workflow.
Clinicians seeking a complete treatment planning solution can access TherapyByPro’s Counseling Treatment Plan template. For clinicians who need a streamlined tool focused specifically on documenting treatment goals, objectives, and interventions, the Treatment Plan Goals template provides a simplified format for tracking progress across multiple treatment goals.
How Narrative Therapy’s Signature Practices Structure the Treatment Plan
A narrative therapy treatment plan is not simply strengths-based CBT — it doesn’t follow a problem → strengths → positive reframe sequence. It follows a different logic entirely: a problem-saturated story is identified, the problem is externalized from the person, its influence (and the client’s influence on it) is mapped, unique outcomes are located, those outcomes are connected to the client’s values, intentions, skills, and history, and the resulting alternative story is re-authored and thickened over time. That sequence — not symptom-to-strength reframing — is what the treatment plan’s formulation, goals, and interventions sections should trace.
This is the single most important structural difference between a narrative therapy treatment plan and a diagnosis-driven one. Narrative therapy draws on several signature practices rather than one fixed, universally agreed “core” set — White’s later comprehensive text organizes the model around six major practice areas: externalizing conversations, re-authoring conversations, re-membering conversations, definitional ceremonies, conversations that highlight unique outcomes, and scaffolding conversations (White, 2007). The practices most directly relevant to treatment planning are:
- Externalizing conversations — separating the person from the problem, often by naming it (“The Worry,” “The Anger”) and asking questions that map its influence on the client’s life, and the client’s influence on it (White & Epston, 1990). This reframes the formulation itself: the treatment plan targets the externalized problem’s influence, not a trait or deficit within the client.
- Unique outcomes — events, actions, intentions, or experiences that stand apart from the dominant problem-saturated story, however small. A unique outcome isn’t simply a “positive event” — it’s specifically anything the dominant story can’t account for, and it becomes the entry point for constructing an alternative story.
- Re-authoring conversations — thickening the alternative story identified through unique outcomes, connecting it to the client’s values, skills, history, and hopes so it becomes a fuller, more detailed narrative than the original problem story.
- Re-membering conversations — revisiting the client’s relationships with significant people, present or absent, and how those relationships contribute to the client’s preferred identity (White, 2007). This may also involve definitional ceremonies or outsider-witness practices, where others reflect on and help thicken the client’s emerging story.
In the treatment plan, these practices shift the formulation’s emphasis away from a diagnosis-specific maintaining mechanism, toward the externalized problem, the client’s identified unique outcomes, and the alternative story being co-authored. This is still a clinical formulation — it draws on different material than a problem-focused one, not on no formulation at all.
Relative Influence Questioning: Mapping Both Directions
Relative influence questioning is one of narrative therapy’s most clinically useful tools precisely because it works in two directions, and both should show up in the formulation.
The problem’s influence on the client: How does the problem affect the client’s behavior, relationships, decisions, sense of identity, daily functioning, and hopes or values? This maps the scope of what the treatment is actually addressing.
The client’s influence on the problem: When has the client resisted or limited the problem’s influence? What skills, values, intentions, or relationships helped? What did the client do differently in those moments, and what does that response suggest about the client’s preferred identity? This second direction is where unique outcomes and the material for re-authoring typically come from — a formulation that only maps the problem’s influence and skips this side is missing half the picture.
Avoiding Over-Externalization
Externalizing the problem doesn’t mean denying the client’s symptoms, denying responsibility for behavior, minimizing risk, treating diagnoses as clinically irrelevant, or externalizing every aspect of the client’s experience regardless of fit. The clinician should preserve accountability, agency, safety, and clinical accuracy alongside externalizing language — externalization is a therapeutic stance toward how the problem is discussed and related to, not a literal claim that the problem exists independently of the client’s actions, choices, or clinical presentation.
Clinical Documentation Note: Externalizing language in the chart itself is worth being deliberate about — writing “the client’s relationship with Anxiety” instead of “the client’s anxiety symptoms” throughout the plan isn’t just stylistic; it keeps the documentation consistent with what’s actually happening in session.
Collaborative, Not Just Client-Centered
Collaboration in narrative therapy means more than asking the client what goal they want and documenting it. The clinician actively uses narrative practices to help the client investigate the dominant story, the problem’s influence, unique outcomes, values, intentions, skills, relationships, and possible preferred directions — the therapist has an active, skilled role in that investigation, even though the client remains the author of the resulting story. A treatment plan that simply records client-stated goals without this investigative process reflects client input, not genuinely narrative-therapy-adherent collaboration.
What Makes a Treatment Plan Genuinely Narrative Therapy?
Using narrative terminology in a plan doesn’t automatically make it narrative-therapy-adherent. A few quick checks:
- The client helped define and name the problem, rather than the clinician assigning a label.
- The problem is externalized rather than treated as synonymous with the person.
- The formulation documents both the problem’s influence and the client’s influence on the problem.
- At least one unique outcome is identified and clinically developed, not just noted in passing.
- Goals reflect the client’s preferred story, values, intentions, skills, and relationships — not a generic symptom-reduction target.
- Re-authoring and thickening the preferred story is documented as an ongoing process, not a one-time event.
- Diagnosis and medical necessity remain documented accurately where required.
- Progress isn’t reduced exclusively to a symptom score.
- The client’s own language and authorship remain visible in how the plan gets revised over time.
Documenting Diagnosis and Medical Necessity in a Model That Questions Pathologizing Language
Narrative therapy’s critique of diagnostic and pathologizing discourse is more explicit than in most other modalities — the model is influenced by post-structuralist ideas about how dominant cultural narratives, including psychiatric diagnosis, can become internalized as identity rather than remaining a description of a specific difficulty. That critique is a legitimate part of the clinical conversation with the client. It is not, however, a reason to treat the treatment plan’s diagnostic summary as optional.
Most clinical and payer contexts still require an accurate diagnosis and a concise medical-necessity rationale, and that requirement doesn’t go away because the therapeutic stance toward the diagnosis is a critical one. What changes is proportion and framing: the diagnosis section should be accurate and specific, while the bulk of the plan’s clinical reasoning — the formulation, goals, and progress-monitoring sections — should reflect the externalized problem and the client’s emerging preferred story, not a diagnosis-centered narrative. A plan that skips diagnostic rigor because “narrative therapy doesn’t pathologize” misrepresents what the documentation is required to do; a plan that lets diagnosis-centered language dominate the formulation misrepresents how the therapy itself is conducted.
It can help to think of these as answering different questions rather than competing for the same space in the plan:
| Documentation Element | What It Answers |
|---|---|
| Diagnosis | What condition is being diagnosed based on the assessment? |
| Functional impairment | How is the condition affecting the client’s functioning? |
| Narrative formulation | How is the problem affecting the client’s life, identity, relationships, and preferred story? |
| Treatment rationale | Why are the selected narrative practices appropriate for this client? |
| Progress indicators | How will change actually be evaluated over the course of treatment? |
Documentation requirements vary by jurisdiction, profession, organization, and payer. The diagnostic and coding examples in this guide illustrate clinical documentation principles and shouldn’t be treated as universal payer or legal requirements — verify current requirements for your specific setting.
Selecting Narrative Therapy Delivery for Setting and Presentation
Unlike CBT, DBT, or EMDR, narrative therapy doesn’t organize around diagnosis-specific manualized protocols — it’s applied broadly across individual, family, and community settings. Current outcome research is real but still developing, with evidence quality varying meaningfully by population and study design.
Evidence in this area actually spans three different questions worth keeping separate: evidence for narrative therapy as a psychotherapy approach generally, evidence for narrative therapy applied to specific presenting problems or populations, and evidence specifically supporting particular narrative treatment-planning practices. Evidence supporting narrative therapy as a clinical approach shouldn’t be interpreted as evidence that every specific narrative practice, documentation strategy, or treatment-planning technique has been independently validated for every population or diagnosis — the table below speaks mainly to the second question, population-level evidence, which is the most directly relevant to treatment planning.
| Setting / Presentation | Treatment-Planning Priorities | Evidence Context |
|---|---|---|
| Adult depression and related concerns, particularly alongside a somatic or medical condition | Externalizing the problem from the medical diagnosis itself where clinically appropriate, alongside standard depression-focused treatment planning. | A 2024 systematic review and meta-analysis found a significant effect on depressive symptoms among adults with somatic disorders, but rated overall evidence certainty as low, citing small sample sizes, a high proportion of studies from a single country, and inconsistency in how narrative therapy was defined and delivered across the included studies (Hu, Han, Gains, & Jia, 2024). |
| Children and adolescents, including in resource-limited or post-conflict settings | Developmentally adapted externalizing language and unique-outcome exploration, often with caregiver involvement. | A randomized controlled trial found large effect sizes for anxiety and ADHD symptoms among orphaned and abandoned children in Rwanda, though this is a single trial in a specific population and setting rather than an established evidence base across child presentations generally (Karibwende, Niyonsenga, Biracyaza, Nyirinkwaya, Hitayezu, Sebatukura, Ntete, & Mutabaruka, 2023). |
| Family and community work | Involving family members in externalizing conversations, re-membering, and outsider-witness practices, given narrative therapy’s roots in family therapy and community work. | A long-standing application area for the model, historically documented through case material and qualitative work more than large-scale controlled trials. |
| Grief, identity-related concerns, and stigmatized or culturally marginalized experiences | Re-membering conversations and attention to dominant cultural narratives are often central, given the model’s origins in addressing power, culture, and marginalization directly. | A recognized area of clinical application, though controlled outcome research specific to these presentations remains limited compared to the evidence base for CBT, DBT, or EMDR. |
| Complex or higher-acuity presentations, including severe mental illness | Narrative practices may be incorporated when clinically appropriate, but shouldn’t substitute for indicated risk management, crisis intervention, medical evaluation, or higher-intensity treatment. | Evidence for narrative therapy as a standalone approach in this population is limited; this is a question of appropriate integration alongside indicated care, not a blanket exclusion. |
Clinical takeaway: Narrative therapy’s evidence base is real but genuinely more limited than CBT, DBT, or EMDR’s — the treatment plan should reflect honest confidence in what’s established versus what’s promising but still developing, rather than treating “narrative therapy works” as a uniform, well-established claim.
Establish Clinical Necessity Through Functional Impairment
Treatment plans should document more than the presence of a concern — they should describe how it interferes with functioning, even within a model that spends most of its clinical attention on the client’s relationship to the externalized problem rather than the problem’s clinical features. Describe the observable consequence: work performance affected by the problem’s influence, withdrawal from relationships, or disrupted daily routines. This section should be accurate and specific, but proportionate — a few clear sentences connecting diagnosis to functional impact, not an extended problem-saturated narrative that runs counter to how the therapy itself is conducted.
Creating Measurable Narrative Therapy Goals
Effective treatment goals should be individualized, collaborative, and measurable — and in narrative therapy specifically, they should be built from the client’s own externalized language and identified unique outcomes rather than a clinician-generated symptom-reduction target. SMART principles can help make a goal observable and reviewable, but they shouldn’t override the client’s own language for the problem or their preferred story — a technically well-formed goal that doesn’t reflect the client’s own naming isn’t a narrative therapy goal.
| Weak Goal | Stronger Goal |
|---|---|
| Reduce anxiety symptoms. | Reduce the influence of “The Worry” over daily decision-making, tracked through weekly identification of unique outcomes and supplemented by GAD-7 scores. |
| Improve self-esteem. | Thicken the client’s alternative story of competence by identifying and documenting at least one unique outcome weekly that contradicts the dominant story of incompetence. |
| Process the trauma. | Re-author the client’s relationship with the identified traumatic event, incorporating identified strengths and support relationships, with progress reflected in the richness and detail of the emerging alternative story. |
| Feel more confident. | Increase the client’s ability to independently notice and name unique outcomes between sessions, tracked via self-report and reviewed each session. |
Narrative Therapy Goal Examples
The following goal examples map onto narrative therapy’s signature practices, since — as the sections above illustrate — the goal itself should come from the client’s own externalized language and identified unique outcomes, not a diagnostic category. Not every narrative therapy goal needs to be framed around symptom elimination — goals oriented around preferred identity, relationships, and agency are equally legitimate.
Goal 1: Externalize the Problem and Map Its Influence
Typically an early-treatment focus, establishing the language the rest of treatment will build on.
Long-Term Goal: Client will externalize the presenting problem and describe its influence on their life with specificity.
Possible Objectives:
- Collaboratively name the externalized problem in the client’s own words.
- Map at least two specific ways the problem influences the client’s thoughts, relationships, or behavior.
- Map at least one way the client has influenced or resisted the problem, however small.
- Demonstrate use of externalized language independently when describing the problem in session.
Possible Interventions: Externalizing conversations and relative-influence questioning; collaborative naming of the problem.
Observable Indicator: Client independently uses externalized language to describe the problem in at least two consecutive sessions.
Review Timeframe: Typically reviewed within the first 2–4 sessions.
Goal 2: Identify and Thicken Unique Outcomes
Often introduced once the problem has been externalized and its influence mapped.
Long-Term Goal: Client will identify and build a detailed, values-connected alternative story from identified unique outcomes.
Possible Objectives:
- Identify at least one experience per week in which the externalized problem had less influence, and document what the client did that contributed to that outcome.
- Describe what the unique outcome says about the client’s skills, values, or intentions.
- Connect the unique outcome to the client’s history and other relationships that support it.
- Deliberately create conditions for a similar unique outcome to occur again between sessions.
Possible Interventions: Unique-outcome exploration and re-authoring conversations; therapeutic letters documenting the emerging alternative story.
Observable Indicator: At least four documented unique outcomes over four weeks, reviewed collaboratively at treatment-plan review.
Review Timeframe: Reviewed at each treatment-plan review, typically every 4–8 weeks.
Goal 3: Involve Significant Relationships in the Emerging Story
Often introduced later in treatment, once an alternative story has taken clearer shape.
Long-Term Goal: Client will draw on significant relationships to further support and witness their preferred story.
Possible Objectives:
- Identify a person, present or absent, whose relationship with the client supports the emerging alternative story.
- Explore how that relationship contributes to the client’s preferred identity.
- With the client’s consent, consider an outsider-witness or re-membering conversation involving that person.
- Report on the impact of that conversation on the client’s sense of their own story.
Possible Interventions: Re-membering conversations; outsider-witness practices and definitional ceremonies, with appropriate consent and clinical judgment about fit.
Observable Indicator: Client identifies and discusses at least one supportive relationship’s role in their preferred story per treatment-plan review.
Review Timeframe: Reviewed at each treatment-plan review.
Goal 4: Strengthen Preferred Identity and Sense of Agency
Can be introduced alongside or after the goals above; not every goal needs a symptom-elimination frame.
Long-Term Goal: Client will develop a more detailed preferred story of themselves consistent with their own stated values.
Possible Objectives:
- Identify at least two experiences per month that support the client’s preferred identity (e.g., “capable,” “values-directed”).
- Identify at least two ways the client has influenced or resisted the externalized problem between treatment-plan reviews.
- Articulate, in the client’s own words, how their preferred story has developed since treatment began.
Possible Interventions: Re-authoring conversations; scaffolding conversations connecting known experiences to newly possible ones.
Observable Indicator: Client articulates a more detailed, specific preferred-identity narrative at each review compared to the prior review.
Review Timeframe: Reviewed at each treatment-plan review.
Remember that these examples are starting points. The specific externalized language, unique outcomes, and goals should reflect this client’s own words and story — goals imported wholesale from a diagnostic category rather than the client’s own language don’t reflect narrative-therapy-adherent treatment planning. The same underlying goal structure can be adapted across presentations — for example, externalizing “The Sadness” for depression, “The Nightmares” or “It” for trauma-related concerns, or “The Comparison” for identity or self-worth concerns — as documentation examples of how the language adapts, not as claims that narrative therapy has equivalent evidence support across all of these presentations.
Narrative Therapy Interventions and When to Use Them
| Narrative Practice | Primary Purpose | Example Treatment-Plan Language |
|---|---|---|
| Externalizing | Separate the person from the problem | “Externalize and map the influence of [named problem] on the client’s decision-making.” |
| Relative influence questioning | Explore the problem’s influence and the client’s influence on it | “Identify ways the client has influenced or resisted [named problem] this week.” |
| Unique-outcome exploration | Identify exceptions to the dominant story | “Identify and explore at least one experience the dominant story doesn’t account for.” |
| Re-authoring | Develop and thicken the preferred story | “Connect this week’s unique outcome to the client’s stated values and history.” |
| Re-membering | Explore identity through significant relationships | “Explore the influence of [significant relationship] on the client’s preferred story.” |
| Outsider-witness practice | Support the preferred identity through witnessing | “With client consent, facilitate an outsider-witness reflection on the client’s growth.” |
| Therapeutic letters | Document and thicken the preferred story between sessions | “Collaboratively develop a letter summarizing the client’s emerging alternative story.” |
| Scaffolding conversations | Build a bridge from known experience to newly possible experience | “Identify achievable next steps between what the client already knows and what feels newly possible.” |
Documentation Language Clinicians Can Use
Narrative therapy has its own documentation vocabulary. Each line below connects a clinical finding to what it means for the plan.
- Externalized naming: “Client named the presenting concern ‘The Worry’ in session; documentation throughout the plan will reflect this externalized language.”
- Relative influence questioning: “Mapped ‘The Worry’s’ influence on decision-making at work; client identified two specific instances where they resisted its influence.”
- Unique outcome: “Client identified a unique outcome — successfully leading a work presentation — not accounted for by the dominant story of incompetence.”
- Re-authoring progress: “Alternative story of competence is developing detail; client connected this week’s unique outcome to a broader pattern of preparation and follow-through going back several years.”
- Re-membering/outsider witness: “With client consent, invited [supportive colleague] to reflect on the client’s growth as an outsider witness; client reported the reflection strengthened their own sense of the alternative story.”
Document This, Not That
| Avoid | Prefer |
|---|---|
| “Client is resistant to treatment.” | “Client has not yet identified an experience that fits the preferred story and reports uncertainty about whether the proposed between-session practice feels useful.” |
| “Client is anxious and lacks confidence.” | “Client describes ‘The Worry’ as influencing workplace decisions and reinforcing a dominant story of incompetence.” |
| “Client has poor coping skills.” | “Client has identified two strategies that have reduced the influence of ‘The Worry’ during high-pressure situations.” |
Common Documentation Mistakes When Writing a Narrative Therapy Treatment Plan
Even experienced clinicians can develop documentation habits that reduce the clinical usefulness of a narrative therapy treatment plan — the following examples highlight common mistakes and how to strengthen the documentation.
| Common Documentation Mistake | Why It Is a Problem | Example of Weak Documentation | Example of Stronger Documentation |
|---|---|---|---|
| Writing goals from the diagnosis instead of the client’s externalized language | A goal that could have been written before the client externalized the problem in their own words isn’t actually narrative-therapy-adherent, even if narrative techniques are used in session. | “Goal: reduce anxiety symptoms.” | “Goal: reduce the influence of ‘The Worry’ over daily decision-making, defined and tracked in the client’s own terms.” |
| Skipping or minimizing diagnostic rigor because “narrative therapy doesn’t pathologize” | The therapeutic stance critiquing pathologizing language doesn’t mean the diagnostic summary can be vague — medical necessity still needs to be established accurately. | “Diagnosis: struggles with worry.” | “Diagnosis: F41.1 — Generalized Anxiety Disorder, with symptoms and duration specified.” |
| Letting diagnosis-centered language dominate the formulation out of habit | A formulation that reads like a symptom checklist rather than an externalized problem story doesn’t reflect how narrative therapy actually works. | “Client has generalized anxiety disorder with excessive worry and concentration difficulty.” | “Client’s dominant story centers on incompetence, externalized as ‘The Worry’; a clear unique outcome has been identified and will be thickened over treatment.” |
| Treating unique outcomes as incidental rather than documenting them explicitly | Unique outcomes are the entry point for the entire re-authoring process; if they’re not documented, there’s no visible record of the alternative story being built. | “Client seemed to be doing a bit better this week.” | “Client identified a specific unique outcome this week — leading a successful work presentation after preparing differently — directly contradicting the dominant story of incompetence.” |
| Assuming risk is inherently low because the model is strengths-based and externalizing | A strengths-based, externalizing therapeutic style doesn’t reduce actual clinical risk; it should be assessed explicitly and individually regardless of therapeutic approach. | “No safety concerns; client is engaged and identifying unique outcomes.” | “Suicide risk assessed explicitly at intake; client denies current ideation, intent, or plan, and denies self-harm history.” |
Clinical Documentation Note: The most common documentation gap in narrative therapy treatment plans isn’t the goals section — it’s the risk section, for much the same reason it shows up in other strengths-based models: an optimistic, externalizing therapeutic stance can make explicit risk assessment feel like it’s working against the approach. It isn’t, and the two belong in clearly separate sections of the chart.
Frequently Asked Clinical Questions
The following questions address common clinical documentation considerations for mental health professionals developing narrative therapy treatment plans.
What does it mean to externalize the problem in a treatment plan?
Externalizing means naming and describing the presenting concern as separate from the client’s identity — often literally giving it a name the client chooses. In a treatment plan, this shapes the formulation and goals sections directly: instead of documenting “the client’s anxiety,” the plan documents the externalized problem’s influence and the client’s own influence on it.
What are unique outcomes and how do they affect treatment planning?
Unique outcomes are specific moments that don’t fit the client’s dominant, problem-saturated story. They become the starting material for the goals section — treatment goals should be built from identified unique outcomes and the alternative story they support, rather than a generic symptom-reduction target.
Does a narrative therapy treatment plan still need a diagnosis?
Yes. Narrative therapy actively questions pathologizing language in the therapeutic conversation, but a treatment plan still requires an accurate diagnosis and a concise medical-necessity rationale in most clinical and payer contexts. The diagnosis section should be accurate and specific even though it isn’t where most of the plan’s clinical reasoning lives.
What is the difference between narrative therapy and CBT’s approach to thoughts and beliefs?
CBT generally works to identify and modify specific automatic thoughts and underlying beliefs. Narrative therapy works at the level of the broader story a person tells about their life and identity, externalizing the problem from the person rather than targeting a belief for direct restructuring. The two can overlap in practice but reflect different formulations, and a treatment plan should be clear about which is actually guiding the work.
How long does narrative therapy typically take?
There’s no fixed, well-established session count the way there is for some brief, manualized approaches — treatment length varies by presentation, the complexity of re-authoring needed, and setting. The treatment plan’s estimated duration should reflect an individualized clinical estimate rather than assuming a fixed brief or extended course by default.
How should risk be documented in a narrative therapy treatment plan?
Risk should be assessed explicitly and individually, the same as in any other modality. Narrative therapy’s strengths-based, externalizing framing shouldn’t be treated as a reason to document risk more casually — it should be assessed with the same rigor and documented separately from the formulation and goals sections.
How do you write measurable objectives in narrative therapy?
Pair each objective with an observable indicator and a review timeframe — for example, documenting at least one identified unique outcome per week over a defined period, reviewed collaboratively at a set point. SMART principles can help make an objective observable, but they shouldn’t override the client’s own language or preferred story.
What are common narrative therapy interventions?
Externalizing conversations, unique-outcome exploration, re-authoring conversations, re-membering conversations, outsider-witness practices, therapeutic letters, and scaffolding conversations are among the model’s signature practices. Which ones apply depends on where the client is in the process — early sessions typically focus on externalizing and mapping influence, later sessions on re-authoring and involving significant relationships.
How do unique outcomes become treatment goals?
A unique outcome is identified, then explored for what it reveals about the client’s skills, values, or intentions, then connected to the client’s broader history and relationships that support it. The resulting goal is typically framed around thickening that alternative story — increasing the frequency of similar unique outcomes, or building out the story’s detail — rather than around reducing the original problem’s symptoms directly.
Conclusion: Creating Effective Narrative Therapy Treatment Plans That Support Meaningful Clinical Progress
An effective narrative therapy treatment plan does more than list goals — it documents the externalized problem, the client’s identified unique outcomes, and the alternative story being co-authored over treatment, while still meeting the diagnostic and risk-documentation standards any treatment plan requires. When thoughtfully developed, it resolves the genuine tension between narrative therapy’s critique of pathologizing language and standard documentation requirements, rather than ignoring one in favor of the other.
In practice, this generally follows a workflow: assess → externalize the problem → map its influence in both directions → identify unique outcomes → develop the preferred story through re-authoring → establish measurable goals and objectives → select the narrative practices that fit → monitor narrative and functional progress together → reassess risk, diagnosis, and medical necessity → revise the plan collaboratively as the client’s story develops.
Clinicians should remember that narrative therapy treatment plans, like any other, are living documents — and given how central the client’s own language is to this model, they should be revised as the client’s externalized naming and preferred story develop, not left to drift back toward diagnosis-centered phrasing out of habit. Regular review of the externalized problem, identified unique outcomes, and the thickening alternative story helps ensure that treatment remains genuinely narrative in approach rather than narrative in name only.
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References
- Hu, G., Han, B., Gains, H., & Jia, Y. (2024). Effectiveness of narrative therapy for depressive symptoms in adults with somatic disorders: A systematic review and meta-analysis. International Journal of Clinical and Health Psychology, 24(4), Article 100520. Resource
- Karibwende, F., Niyonsenga, J., Biracyaza, E., Nyirinkwaya, S., Hitayezu, I., Sebatukura, G. S., Ntete, J. M., & Mutabaruka, J. (2023). Efficacy of narrative therapy for orphan and abandoned children with anxiety and attention deficit and hyperactivity disorders in Rwanda: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 78, Article 101802. Resource
- White, M. (2007). Maps of Narrative Practice. W. W. Norton & Company. Resource
- White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends. W. W. Norton & Company. Resource

















