The Tree of Life narrative approach was co-developed by Ncazelo Ncube (REPSSI) and David Denborough (Dulwich Centre Foundation) to assist colleagues who work with children affected by HIV/AIDS in southern Africa. This approach has proved so successful and popular that it is now being used with children, young people, and adults in a wide range of countries across Africa, and also in Australia, Brazil, Canada, Russia, Nepal, the USA, and elsewhere. This collection is home to a growing body of research, evidence and practice relating to the Tree of Life as a therapeutic approach.
The Tree of Life research collection
The tree of life methodology: A qualitative study of service-users’ and intervention facilitators’ experiences (Alves-Costa et al., 2026)
Alves-Costa, F., Rollinson-Salter, A., Lieser, K., & Zlonteanu, M. (2026). The tree of life methodology: A qualitative study of service-users’ and intervention facilitators’ experiences. Current Psychology, 45, 443. https://doi.org/10.1007/s12144-026-09066-w
Abstract
In many healthcare settings, there is limited consideration for cultural diversity and sensitivity in existing approaches. The Tree of Life Methodology (ToL) offers a solution to this problem. However, investigations on the application of ToL within secure forensic inpatient settings are lacking. The current service evaluation sought to explore service user and staff facilitators’ experiences engaging with the ToL and provide further insight into the methodology’s implementation within this setting (a London-based forensic inpatient unit). Eight participants (two service users and six staff members) took part in semi-structured interviews. Thematic analysis was used to explore their narratives. Both service-users and staff reported enjoying their experience taking part in the group. They perceived the methodology to facilitate the contemplation and rediscovery of parts of their identity/culture in a power-neutral therapeutic environment. The methodology was also perceived to help its partakers build resilience skills and reflect on both their past and future in a positive light; findings which are in line with existing ToL research. ToL encouraged staff to incorporate culture into the treatment of forensic mental health service users and facilitate the provision of person-centered and culturally sensitive care. Our findings highlight the benefits of future use of the ToL within the forensic and other secure settings.
Metodologia Árvore da Vida: potencialidades do desenho em contextos de intervenção e pesquisa [Tree of Life methodology: The potential of drawing in intervention and research contexts] (Ncube-Mlilo et al., 2025)
Ncube-Mlilo, N., Alves, C. O., & Luz, J. M. O. (2025). Metodologia Árvore da Vida: Potencialidades do desenho em contextos de intervenção e pesquisa [Tree of Life methodology: The potential of drawing in intervention and research contexts]. In S. G. Murta, J. M. O. Luz, N. P. Pinheiro-Carozzo, C. O. Alves, & G. Trombeta (Eds.), Métodos de pesquisa baseados em arte: Fundamentos e aplicações na saúde (pp. 103–125). Editora da Universidade Federal do Maranhão (EDUFMA).
Details
The chapter “Metodologia Árvore da Vida: Potencialidades do desenho em contextos de intervenção e pesquisa” was published in Portuguese in the open access book Métodos de pesquisa baseados em arte: fundamentos e aplicações na saúde, which is pioneering in the Portuguese language for presenting the foundations and applications of arts-based research methods in the production and dissemination of knowledge in the field of health.
The chapter aims to present and discuss the use of the Tree of Life as a methodology in intervention and research contexts. Drawing on the scientific literature, it outlines possibilities for its use in diverse settings, as well as the stages and processes required for its application in research and interventions. Finally, it presents examples and findings from studies in the field of health promotion that have used this methodology. It is hoped that the chapter may inspire and support researchers interested in applying the methodology in their own studies, as well as contribute to the design of future therapeutic and community interventions.
Links:
An English translation of this chapter can be downloaded here (PDF)
The complete book in Portuguese can be downloaded here (PDF) or from https://www.edufma.ufma.br/index.php/produto/metodos-de-pesquisa-baseados-em-arte-fundamentos-e-aplicacoes-na-saude/
Adapting the Tree of Life group for adults with intellectual disabilities: A feasibility and acceptability study (Németh et al., 2024)
Németh, K., Marrington, C., McKillop, E., & Oliver, J. (2024). Adapting the Tree of Life group for adults with intellectual disabilities: A feasibility and acceptability study. International Journal of Developmental Disabilities, 1–15. https://doi.org/10.1080/20473869.2024.2420046
Abstract
Objectives
The narrative therapy tool, Tree of Life (ToL), has demonstrated positive effects for different populations. This article explores the feasibility and acceptability of ToL in a community day centre for people with intellectual disabilities in England.
Methods
ToL was delivered as a four-week group (11 attendees). The group programme, materials, and the evaluation method were adapted (e.g. easy-read format and high attendee–staff ratio). Triangulation was used with feasibility metrics, observations, an outcome measure, and qualitative feedback from participants and staff at the centre. Thematic analysis was used for the semi-structured interviews.
Results
Good feasibility indicated with high acceptability and an overall positive impact. Data from attendee interviews are captured in six themes (e.g. Relating to a tree as a metaphor) and staff feedback in four themes (e.g. Connecting via new stories).
Conclusions
The ToL intervention is feasible and highly adaptable to people with intellectual disabilities. The article provides a practical guidance for clinicians trained in ToL on how to adapt this model. Care in the community may benefit from ToL groups as this study showed to enhance community cohesion and quality of life by creating space for practicing social skills with a strengths-based approach.
Evaluation of a pilot Tree of Life group for children with epilepsy and their families (Bolt et al., 2024)
Bolt, C., Wallace, T., Brandon, N., Brayley, A., & D’Urso, A. (2024). Evaluation of a pilot Tree of Life group for children with epilepsy and their families. Clinical Child Psychology and Psychiatry, 29(3), 982–993. https://doi.org/10.1177/135910452311932
Abstract
Background
Tree of Life Groups (a narrative therapy technique) have been used successfully in a number of paediatric populations. The group intervention aims to give children a space to express their difficulties whilst also holding in mind their strengths and hopes, thereby creating a preferred identity incorporating their physical health condition. No studies were identified which described this approach in a paediatric epilepsy population or involving siblings, families and the multidisciplinary team.
Methods
The current paper describes a pilot intervention to facilitate a one-day psychoeducational Tree of Life group for children with epilepsy, their siblings and parents. Separate parent and sibling groups were facilitated concurrently. The groups were co-facilitated by Paediatric Psychology and Paediatric Epilepsy team members. Quantitative feedback was completed by the patient group. Patients, siblings, and parents provided qualitative feedback.
Results
A total of 6 patients, 14 siblings and 15 parents attended the group. Quantitative feedback indicated some improvement in patients’ confidence and knowledge of managing epilepsy, as well as some improvements in psychological adjustment and thoughts about epilepsy. 87.5% of patients and siblings detailed that they would recommend the group to others. Qualitative feedback from patients, siblings and parents indicated the helpfulness of relating to others and safely expressing difficulties.
Conclusions
The results indicated that this pilot group intervention was well received by children with epilepsy and their families. Future studies incorporating a larger sample are warranted to explore this further.
The “Team tree” professional tree of life intervention: Development and evaluation within the acute inpatient psychiatric setting (McDonald et al., 2024)
McDonald, C., Townsend, J., & Gillespie, C. (2024). The “Team tree” professional tree of life intervention: Development and evaluation within the acute inpatient psychiatric setting. Mental Health Review, 29(2), 224–238. https://doi.org/10.1108/MHRJ-06-2023-0029
Abstract
Purpose
Mental health staff often experience significant levels of stress working in the acute psychiatric inpatient setting. Team-building interventions can mitigate stress in health-care settings, via improvements in team-cohesion, staff interactions and communication skills. The “Tree of Life” (ToL) is a specific narrative therapy approach which uses the metaphor of a tree to facilitate the construction and sharing of strength-based stories. This study aims to describe the development of and evaluate the feasibility, acceptability and staff experiences of the “Team Tree”, an adapted Professional ToL (PToL) intervention.
Design/methodology/approach
A one-hour, Professional ToL intervention was designed for multidisciplinary acute inpatient staff teams working within a psychiatric hospital in London, UK. A mixed methods approach was used to evaluate the feasibility, acceptability and staff experiences of the session.
Findings
Participants were 46 multidisciplinary staff (33 women; 13 men) working across four acute psychiatric wards. The intervention was feasible to deliver and was acceptable to participants. Results showed significant improvements in self-reported mental well-being and team-cohesiveness scores post-session.
Practical implications
Psychologists face myriad barriers in working with staff teams in the acute inpatient setting. The “Team Tree” intervention was both well received by staff and practical to deliver within the challenging environment of the acute ward.
Exploring young people’s experiences of the Tree of Life narrative intervention through participatory research (Fleming et al., 2023)
Fleming, H., Paton, A., & Rowley, J. (2023). Exploring young people’s experiences of the Tree of Life narrative intervention through participatory research. Educational Psychology in Practice, 39(2), 135–153. https://doi.org/10.1080/02667363.2023.2167810
Abstract
This small-scale, qualitative, participatory study explored a group of young people’s experiences of the Tree of Life narrative intervention and ways of conducting participatory research with this particular group. The research was carried out with five co-researchers (aged 12–13 years) who attend a specialist secondary school for students with autism/social communication needs and related social, emotional and mental health needs. Visual approaches were used to answer the research question: “What did we think of the Tree of Life group?” The data were analysed using an adaptation of thematic analysis and the findings included the following themes: friendship, knowledge, fun, and self-expression. The findings suggest implications for educational psychologists regarding the usefulness of the Tree of Life approach to improve friendships, group cohesion and foster self-reflection. The research also has implications for EPs as practitioner researchers in supporting the use of participatory approaches to promote the autonomy of young people.
“Thinking about what makes you you”: An exploration of the experience of care leavers in engaging with collective narrative practice through the Tree of Life (Tobin, 2023)
Tobin, L. (2023). “Thinking about what makes you”: An exploration of the experience of care leavers engaging with collective narrative practice through the Tree of Life [Professional doctorate thesis, University of Essex]. https://tavport.eprints-hosting.org/2815/
Abstract:
Over 10,000 young people in the UK transition from being in care to being a care leaver each year (Department for Education, 2021). Despite the prevalence of mental health difficulties among this group, available emotional support is argued to be inadequate (Ofsted, 2022). The Tree of Life is an arts-based collective narrative practice intervention rooted in narrative therapy; utilising the metaphor of a tree as a platform from which to reflect upon, develop and share personal narratives (Ncube, 2006). This has been found to be positively experienced by a range of groups. To date, no research has explored the Tree of Life with care leavers. This research aims to explore how the Tree of Life is experienced by this group. Individual semi-structured interviews were conducted with six care leavers who had engaged in the Tree of Life and the data was analysed using Interpretative Phenomenological Analysis. Findings revealed five Group Experiential Themes which summarised the participants’ experiences: Uncertainty and discomfort, individual barriers and facilitators, developing identity, connecting with others and hope and motivation for the future. This research provides insight into how the Tree of Life is experienced by care leavers, thus providing valuable information as to how the emotional wellbeing of this group can be supported, by not just Educational Psychologists, but a range of stakeholders with a responsibility to this group. Findings may also be of interest to those involved in the designing and implementation of therapeutic interventions in a range of settings.
A qualitative exploration of facilitators' experiences of using the Tree of Life methodology within global community contexts (Stubbs, 2022)
Stubbs, K. (2021). A qualitative exploration of facilitators’ experiences of using the tree of life methodology within global community contexts [Doctorial dissertation, University of Hertfordshire]. http://hdl.handle.net/2299/25319
Abstract:
The Tree of Life methodology (ToL) is a Collective Narrative Practice developed to support communities to respond to collective hardships and trauma from a place of strength. In seeking more culturally appropriate, localised, community-centred approaches towards global mental health provision, ToL has great potential. However, whilst there is a growing knowledge base regarding ToL, there is a sparsity of empirical literature. In particular, little is known about what leads practitioners to use ToL and how they experience the possibilities of its use in community contexts, both important knowledge(s) to support the understanding, deconstruction, improvement, and future uptake of the methodology. Using semi-structured interviews, this inquiry sought the experiences of 19 practitioners, who work(ed) across 16 different countries using ToL in community contexts. The inquiry aimed, specifically, to understand the personal and professional impact of this work, the opportunities and challenges afforded by ToL, whether the practice differs from other practices, and what leads people to use ToL within community contexts. A Reflexive Thematic Analysis of the conversations with practitioners constructed three main themes: ‘Encountering Possibility’, ‘A Contrasting Way of Being and Doing’, and ‘Shared Humanity’. Eleven respective sub-themes were constructed, and together the analysis told a story that practitioners experience the methodology as one of ‘possibility’, different to other approaches in the way practitioners are able to work and be alongside others, sharing their stories in an authentic way and contributing to a joint humanity that leads to both connection and action. Implications for practitioners, the continued use of ToL, clinical psychology and the wider context were outlined. A critical appraisal and several possibilities for future inquiry were presented.
Tree of life with older culturally and linguistically diverse Muslim women in the community setting: An exploratory study (Khawaja et al., 2022)
Khawaja, N., Murray, K., & Bidstrup, E., (2022) Tree of Life with older culturally and linguistically diverse Muslim women in the community setting: An exploratory study, Journal of Muslim Mental Health, 16(1), 27–44. https://doi.org/10.3998/jmmh.491
Abstract:
Although Australia is one of the fastest growing multicultural societies in the world, there is a scarcity of psychological interventions to support culturally and linguistically diverse (CALD) groups settled in the country. A qualitative case study methodology was used to explore the benefits, feasibility, and acceptability of the Tree of Life, a Narrative Therapy approach to group work when trialed in a CALD community setting. Nine older Muslim women from diverse backgrounds voluntarily participated in a manualized program over six weeks, at a non-government community center for Muslim women. A case study approach was adopted. Participants provided feedback after each session. They also participated in a focus group at the completion of the program to provide information about their experiences and perceptions of the program. Facilitators recorded their observations. Analysis highlighted the therapeutic benefits of the Tree of Life (TOL) program and found it to be feasible and acceptable for use in community settings. The findings have implications for community organizations and stakeholders who work with older Muslim women. Future research and practice would benefit from further exploration of the TOL program and Narrative Therapies with older Muslim and CALD communities.
Tree of Life: Acceptability and feasibility with older Bosnian women of refugee background (Khawaja et al., 2022)
Khawaja, N. G., Murray, K., & Sadeed, S. (2022). Tree of Life: Acceptability and feasibility with older. Psychotherapy and Counselling Journal of Australia, 10(1), 1–21. https://doi.org/10.59158/001c.71066
Abstract:
There is a growing awareness that mental health issues of culturally and linguistically diverse individuals from refugee backgrounds can benefit from therapeutic intervention to promote wellbeing. However, there are numerous barriers to services for these populations. There is increasing recognition that culturally sensitive and safe therapeutic and counselling models are needed, particularly for people less likely to engage with mental health services. Consequently, researchers have begun exploring psychosocial approaches, such as Tree of Life, a relatively new narrative-based intervention which uses creative and expressive tools to enhance personal strengths and resilience. This study used a qualitative methodology to assess the acceptability and feasibility of Tree of Life in a community setting with older Bosnian women from refugee backgrounds. Five women with a mean age of 72 years attended a 6-week intervention. They provided feedback at the end of each session and participated in a focus group after the intervention. Three participants were also interviewed following the intervention. Facilitators documented their observations and any issues with the intervention process. Qualitative data revealed Tree of Life as an acceptable and feasible intervention for this population and suitable for further testing. Further, participants reported that they found the approach beneficial. Implications and future directions are discussed.
Could the Tree of Life model be a useful approach for UK mental health contexts? (Parham et al., 2019)
Parham, S., Ibrahim, J. & Foxwell, K. (2019). Could the Tree of Life model be a useful approach for UK mental health contexts? A review of the literature. Narrative Works, 9(2), 44–70. https://doi.org/10.7202/1076525ar
Abstract:
Some suggest the ethos of the Tree of Life (ToL) group aligns with the concept of “personal recovery” promoted in mental health policy. Thus, it is claimed that the group could be a useful approach within UK mental health services. This review collated 14 papers to explore whether existing literature regarding the ToL group supports this assertion. The papers were synthesized using the thematic analysis method and three broad themes were identified, which support the argument for its utility within services. These were recovery-aligned themes, the inclusivity of the model, and group processes relevant to mental health contexts. The papers are critically appraised, key concerns regarding the wider literature discussed, and clinical implications summarized.
The couple’s tree of life: Promoting and protecting relational identity (Chimpén‐López et al., 2021)
Chimpén‐López, C. A., Pacheco, M., Pretel‐Luque, T., Bastón, R., & Chimpén‐Sagrado, D. (2021). The couple’s tree of life: Promoting and protecting relational identity. Family Process, 61(4), 1403–1416. https://doi.org/10.1111/famp.12727
Abstract:
We present The Couple’s Tree of Life (CTOL) as a new collective narrative methodology to strengthen couple relationships and prevent conflicts. The CTOL, based on the tree of life methodology (Ncube & Denborough, Tree of Life, mainstreaming psychosocial care and support: a manual for facilitators, REPSSI, 2007), aims to reinforce the identity and strengths of the couple. We explain the CTOL implementation process and illustrate it step by step with a group of 14 adult heterosexual Caucasian couples who belonged to Protestant churches in Madrid (Spain). As a way to assess its usefulness before applying the CTOL to other groups of couples, we conducted a pre-post evaluation using the Dyadic Adjustment Scale of Spanier(1976). We found an improvement in dyadic adjustment, quality, understanding of, and satisfaction with, the relationship. The results, though not generalizable at this stage, suggest that the CTOL could reinforce the couple’s identity while maintaining individual identities. We also discuss the possible applications of couples therapy.
Exploring the effectiveness of the Tree of Life in promoting the therapeutic growth of refugee women living with HIV (Vitale et al., 2019)
Vitale, A., Khawaja, N. G., & Ryde, J. (2019). Exploring the effectiveness of the Tree of Life in promoting the therapeutic growth or refugee women living with HIV. The Arts in Psychotherapy, 66, 101602.
https://doi.org/10.1016/j.aip.2019.101602
Abstract:
The current study aimed to understand the experiences of refugee women living with HIV as they participated in the Tree of Life (ToL), a group-based narrative technique. A qualitative case study methodology was used. Five African refugee women took part in the study. The ToL consisted of seven two-hourly sessions conducted on weekly basis. Further, participants completed a feedback form after each session, and they were individually interviewed on completion of the ToL. The researchers kept detailed field notes. The data indicated that participants were motivated to attend the intervention in order to overcome their psychological distress, isolation and negative thoughts associated with their situation. Participants found the intervention beneficial. In a safe and supportive setting, and through the art making process, they were able to reflect on their painful past and current issues associated with their migratory stressors and with living with HIV. They identified personal strengths and qualities that enabled them to cope and build their resilience. The art making process and the discussion of the tree empowered them to re-author their life narratives. Finally, they related to each other, and they developed a sense of connectedness. The findings indicate the Tree of Life as a promising technique for use with refugees living with HIV. Implications and future directions are discussed.
The Tree of Life as a metaphor for grief in AIDS-orphaned adolescents (Hirschson et al., 2018)
Hirschson, S., Fritz, E., & Kilian, D. (2018). The Tree
of Life as a metaphor for grief in AIDS-orphaned adolescents. American Journal
of Dance Therapy, 40, 87–109. https://doi.org/10.1007/s10465-017-9243-7
Abstract
This article reports on research into using the Tree of Life
metaphor as creative expressive arts in therapy to convey the grief stories of
adolescent AIDS orphans. The study applied a qualitative arts-based research
method for data collection. Employing a critical ethnographic design afforded
attention to the study’s 16 adolescent participants’ cultural context and how
this context influenced participants’ sharing of their grief experiences.
Discourse analysis was used as a data analysis method. Sharing images from the
process along with research findings, the authors discuss how the group of
adolescents utilized the Tree of Life metaphor through creative expressive arts
to embody and express their experiences of grief. The authors further describe
what they learned about the embodiment and expression of grief in light of
adolescents’ neurobiological functioning and psychological well-being.
Narratives of healing: A case study of a young Liberian refugee settled in Australia (Schweitzer et al., 2014)
Schweitzer, R., Vromans, L., Ranke, G., & Griffin, J. (2014). Narratives of healing: A case study of a young Liberian refugee settled in Australia. Arts in Psychotherapy, 41(1), pp. 98–106. https://doi.org/10.1016/j.aip.2013.10.006
Abstract:
The Tree of Life group program is a narrative-based expressive arts intervention, designed to target the psychological difficulties faced by young people from refugee backgrounds. This study utilised a case study methodology to investigate the experience of a single adolescent from a Liberian background resettled in Australia, who participated in a manualised version of the Tree of Life program. The case study aimed to identify the underlying therapeutic processes that enabled the participant to adopt a preferred self-narrative. The participant was observed to demonstrate positive gains as a result of program participation. Five therapeutic factors were identified as particularly salient to the program’s success: the exploration of alternative stories of self; the fostering of group cohesion; the provision of corrective emotional experiences; the experience of outsider witnesses; and the instillation of hope. These factors were discussed in relation to working with young people from refugee backgrounds. Recommendations for future implementation of the Tree of Life program are provided.