A close look at therapist contributions to narrative-emotion shifting in a case illustration of brief dynamic therapy

Abstract

Objective: In a secondary analysis of Friedlander et al.'s [(2018). “If those tears could talk, what would they say?” multi-method analysis of a corrective experience in brief dynamic therapy. Psychotherapy Research, 28, 217–234. doi:10.1080/10503307.2016.1184350] case study of Hanna Levenson’s Brief Dynamic Therapy over Time (from APA’s Psychotherapy in Six Sessions DVD series), we re-visited the Narrative-Emotion Process Coding (Angus, L. E., Boritz, T., Bryntwick, E., Carpenter, N., Macaulay, C., & Khattra, J. (2017). The Narrative-Emotion Process Coding System 2.0: A multi-methodological approach to identifying and assessing narrative-emotion process markers in psychotherapy. Psychotherapy Research, 27, 253–269. doi:10.1080/10503307.2016.1238525) to identify specific therapist behaviors that may have facilitated the client’s movement from expressing mostly Problem markers in early sessions to expressing considerably more Transition and Change markers in later sessions. Method: Using open coding and constant comparison qualitative methods, we identified Levenson’s behaviors immediately preceding the client’s “change shifts” (Problem → Transition/Change and Transition → Change) and “problem shifts” (Transition/Change → Problem). Results: Compared to problem shifts, change shifts were preceded by more therapist behavior reflecting Attaching New Meaning (e.g., linking the client’s self-deprecation to her avoidant behavior) and Exploring/Expanding emotions (e.g., inviting the client to give voice to her tears), cognitions (e.g., pointing out the client’s self-talk) and motivation (e.g., reflecting on the client’s dissatisfaction with her defenses). Conclusions: In this successful case, facilitative therapist behavior reflected common therapeutic responses (e.g., validating the client’s perspective) as well as responses characteristic of brief dynamic therapy (e.g., interpreting the client’s defenses) and the therapist’s personal style (e.g., repeating the client’s words for emphasis).