Narrative therapy
in the room.
What does the therapist actually do?
A worked case across sessions, showing narrative questions in action, how the client’s answers change the direction, what happened after an experiment, and a therapist’s mistake.
What this is: a case followed across several sessions.
Why it matters: narrative ideas are easier to understand when you see the questions and what happens next.
The sharpest reframe: the next session’s feedback matters as much as the experiment.
One thing to take away: stay open to several outcomes, including “I didn’t do it”.
The short version
This page follows Rory across four sessions. His help is reliable, but he feels guilty asking to eat later when a friend visits: “I’m already enough work. I shouldn’t make it worse.” The therapist separates the practical task from the identity conclusion, helps Rory name the rule he lives by, finds an experience that doesn’t fit it, and offers an optional experiment. The page shows what happened, what would have happened if it had gone differently, and a mistake the therapist made along the way.
Rory is 37 and needs help with dressing and preparing meals. His assistants are reliable. A friend wants to visit on Thursday evening, which would mean asking for dinner an hour later. Rory hasn’t asked. He says: “I’m already enough work. I shouldn’t make it worse.”
Rory is a fictional teaching example, not a real person.
Across sessions
Separating the task from the verdict
When you say “enough work”, does that describe the practical task, how you feel about yourself, or both?
Both. I know it takes time. But I also feel I should be easy.
Would “the rule that I must be easy” fit, or would you describe it differently?
That fits.
What does that rule ask you to give up?
Spontaneity. Having people over.
The therapist also checks the practical facts: the agency can usually move a meal by an hour with a day’s notice.
Where the rule got its authority
When did you first learn you had to be easy?
Probably the residential unit, after my accident. I was nineteen. There was one nurse who’d say “we’ve twelve others, you know” every time I asked for something.
What did you take from that?
That asking costs other people. That the good patients are the quiet ones.
Then the therapist asks about an experience that doesn’t fit the rule:
Are there times your preferences have mattered without anyone making you feel difficult?
My friend Aoife always asks what suits me. Where to meet, when.
What do you think that says about how she sees you?
That I’m worth fitting around, I suppose.
The therapist asks whether Rory would like to try asking for the later meal. Rory says he’ll think about it, and might not.
The mistake
In a follow-up message, the therapist suggested Rory “practise self-advocacy” by phoning the agency to renegotiate his whole schedule. Rory did, and spent two hours on hold. He also, separately, asked his assistant about Thursday.
Repair, then feedback
I spent two hours on hold. I don’t want to be my own case manager.
You’re right. I pushed self-advocacy when what you needed was less admin, not more. I’m sorry.
I just wanted to have Aoife over.
Let’s keep it to that. And if you want help with the agency, we can think about who could take some of it on for you.
Then the feedback. Rory had asked his assistant about Thursday. The assistant said “no problem”, and Aoife came. Rory says the evening was lovely, and that he felt guilty for about an hour beforehand.
Did it change anything about the rule?
A bit. It’s quieter. But I still felt like a nuisance.
So the rule is still around, and a bit less in charge. Does that fit?
Yeah.
Re-authoring, a little further
The therapist asks whether the evening with Aoife connects with anything else.
Actually, at college, before the accident, I organised everything. I was the one who planned the trips.
And after the accident?
I stopped. I thought planning things meant asking for things.
If you were to describe yourself now, alongside the rule, what would you say?
Maybe… someone who likes having people round. Who needs help to do it. That’s not the same as being difficult.
Rory wants to keep working on the rule with his family, where it is louder. He would also like his preferred meal times written into his care plan so he doesn’t have to ask each time. He asks the therapist to help him draft what to say, and he would like his sister, who manages much of the agency contact, to raise it. That is his choice: delegating the asking is part of his autonomy, not a failure of it.
If it had gone differently
Our frameworkThe therapist stayed open to several outcomes, and began session 3 with what actually happened. Each would have led somewhere different:
- The request was welcomed (as here): explore whether the experience affected the rule, and how much.
- Scheduling prevented it: separate the logistics from Rory’s worth. A rota limit isn’t a verdict on him.
- The assistant responded disrespectfully: address that reality, and what Rory wants to do about it.
- Rory decided not to ask: explore what made the experiment unsuitable, without treating it as failure.
What needs attention here?
The help is reliable, but asking still feels wrong
Possible focus: the rule’s history and experiences that don’t fit it
What to avoid: assuming the help must be the problem
A practical limit blocks the request
Possible focus: separating logistics from worth
What to avoid: reading a rota as a judgement
The person declines an experiment
Possible focus: what made it unsuitable
What to avoid: treating “no” as resistance
Possible starting points, agreed with the person, not rules.
How Rory would know it helped
- He had the evening he wanted.
- The rule is quieter, by his own description.
- He knows where he wants to go next, and what he doesn’t want to take on.
Words you can use
For clientsQuestions worth carrying, as a therapist
Therapist Reflection- Did I separate the practical task from the identity conclusion?
- Did I check the practical facts?
- Is the experiment small enough, and optional?
- Did I stay open to several outcomes, and review what actually happened?
- Have I turned autonomy into extra work?
Evidence & sources
Sources checked in October 2026, using targeted searches rather than a systematic review. “We have not located” means our searches did not find it.
Externalising conversations, unique outcomes and re-authoring: White, M., Maps of Narrative Practice (Norton, 2007).
The sequence across sessions, the outcome branches and the guidance on delegation are this site’s synthesis, adapted from material developed for this site.
Rory and the dialogues are constructed for learning. They are not real people or real sessions.
We have not located research following narrative therapy with disabled clients across sessions.
How to cite this page: Donaghey, C. (2026). Narrative Therapy in the Room. Disability in Psychotherapy. Available at: https://disabilityinpsychotherapy.online/what-is-psychotherapy/narrative-therapy/narrative-therapy-in-the-room/ (Accessed: [date]).
Shared under CC BY-NC 4.0: you can share, adapt and teach from this page, including on fee-paying courses, with credit. See Reusing This Material.