Narrative Processes Coding System Research Articles

Being able to see your child: the journey of a single mother in a MBT group for high-risk parents, through her representations of the child

ABSTRACT This paper explores the parental representations of the child, through the case study of one participant in a mentalization-based intervention for parents of young children aged one – two years old, involved with the child welfare system as a result of their child’s maltreatment. A single mother’s representations of the child are analysed during the programme, through a qualitative lens. Narrative Processes Coding System (NPCS) and Thematic Analysis (TA) are used in combination, to elicit the mother’s representations by identifying language modes and themes from her narratives about both her own and other children. The maternal representations of the child appeared to be less negative as the programme reached its end. The mother’s reflexive language grew significantly in the middle phase of the programme and regressed during the last phase. However, the combined use of NPCS and TA showed an overall richer and less negative portrayal of the child during the ending phase. These findings suggest that during the course of the programme, the mother’s journey through her representations of the child, was characterised by progressions and regressions. There was also an emotional richness in the last phase of the programme that indicates the mother’s engagement in the group and her overall positive journey towards the development and the strengthening of a less negative representation of the child. Despite its limitations, this study hopes to provide insights for clinicians establishing and promoting interventions that aim to empower parents to clearly see their children.

A Review of Empirical Studies Investigating Narrative, Emotion and Meaning-Making Modes and Client Process Markers in Psychotherapy

Despite the importance of narrative, emotional and meaning-making processes in psychotherapy, there has been no review of studies using the main instruments developed to address these processes. The objective is to review the studies about client narrative and narrative-emotional processes in psychotherapy that used the Narrative Process Coding System or the Narrative-Emotion Process Coding System (1.0 and 2.0). To identify the studies, we searched The Book Collection, PsycINFO, PsycARTICLES, PsycBOOKS, PEP Archive, Psychology and Behavioral Sciences Collection, Academic Search Complete and the Web of Knowledge databases. We found 27 empirical studies using one of the three coding systems. The studies applied the Narrative Process Coding System and the Narrative-Emotion Process Coding System to different therapeutic modalities and patients with various clinical disorders. In some studies, early, middle and late phases of therapy were compared, while other studies conducted intensive case analyses of Narrative Process Coding System and Narrative-Emotion Process Coding System patterns comparing recovered vs unchanged clients. The review supports the importance to look for the contribution of narrative, emotion, meaning-making patterns or narrative-emotion markers, to treatment outcomes and encourages the application of these instruments in process-outcome research in psychotherapy.

Therapeutic conversations: Therapists' use of observational language contributes to optimal therapeutic outcomes.

Reflexivity is the process of critically examining one's own experience. Emerging literature suggests that reflexivity is a positive predictor of outcomes in psychotherapy. However, limited research has been conducted regarding therapists' use of reflexivity as a therapeutic technique. In particular, we have a limited understanding of how therapists use language to initiate reflexive conversations. This study investigates the characteristics of therapist language that elicit reflexivity focused on internal and external processes. Therapeutic outcomes of 42 trainee-therapists who provided psychotherapy to 173 clients were tracked with the OQ-45.2 with the view of identifying client-trainee-therapist dyads (CTTDs) with the best and poorest outcomes. Six best outcome and six poorest outcome CTTDs were identified. Thirty-six therapy transcripts were initially coded with the Narrative Process Coding System to identify each Narrative Process Mode (NPM). Sixty external, internal, and reflexive NPMs (N=180 NPMs) were randomly selected across all therapy transcripts for the best outcome group and the same number for the poorest outcome group. The Narrative Initiating Language Element Coding Manual, developed for this study, was used to code therapists' use of language to initiate each NPM. Therapists belonging to the best outcome group utilized more observational language to initiate internal and reflexive NPMs. Therapists belonging to the poorest outcome group evidenced high proportions of questioning language to elicit each NPM. Examining how therapists use language to elicit NPMs provides further insight as to how therapeutic language may contribute to successful therapeutic outcomes. Reflexive therapeutic conversations characterized by a greater use of observational language were associated with positive therapeutic outcomes. Therapeutic conversations characterized by a high proportion of questioning language were associated with poorer therapeutic outcomes. Supervisors of trainee-therapists have a key role in coaching supervisees to use language that contributes to client treatment outcomes.

Mechanisms of Change in Psychotherapy for People Diagnosed with Schizophrenia: The Role of Narrative Reflexivity in Promoting Recovery

Narrative reflexivity was investigated as a potential mechanism of therapeutic change during a 12–18 month trial of Metacognitive Narrative Psychotherapy for people diagnosed with schizophrenia. Participants were nine adult clients (8 male, 1 female) aged between 25–65 years (M = 44, SD = 12.76) with a diagnosis of schizophrenia consistent with DSM-IV criteria and seven female provisional psychologists aged between 25–29 years (M = 26.8 years, SD = 1.47 years). Recovery and narrative reflexivity were measured at three time points using the Recovery Assessment Scale (RAS) and the Narrative Processes Coding System (NPCS). Results were reported descriptively due to limited sample size (n = 9). The majority of clients (n = 7) reported an increase in recovery over the course of treatment. For six clients, an overall increase in recovery was associated with an increase in narrative reflexivity. This study provides preliminary support for narrative reflexivity as a potential mechanism of therapeutic change in the psychotherapy of people diagnosed with schizophrenia.

Narrative Processes Coding System: A Dialectical Constructivist Approach to Assessing Client Change Processes in Emotion-Focused Therapy of Depression

Drawing on a Dialectical Constructivist model of therapeutic change, this paper addresses the fundamental contributions of client narrative disclosure, emotional differentiation and reflexive meaning-making processes in emotion-focused treatments of depression. An overview of the multi-methodological steps undertaken to empirically investigate the contributions of client storytelling, emotional differentiation, and meaning-making processes, using the Narrative Processes Coding System (NPCS; Angus et al., 1999) are provided, followed by a summary of key research findings that informed the development of a narrative-informed approach to emotion-focused therapy of depression (Angus & Greenberg, 2011). Finally, therapy practice implications for the adoption of a research-informed approach to working with narrative and emotion processes in emotion-focused therapy are described and future research directions discussed.

Toward an integrative understanding of narrative and emotion processes in Emotion-focused therapy of depression: Implications for theory, research and practice

This paper addresses the fundamental contributions of client narrative disclosure in psychotherapy and its importance for the elaboration of new emotional meanings and self understanding in the context of Emotion-focused therapy (EFT) of depression. An overview of the multi-methodological steps undertaken to empirically investigate the contributions of client story telling, emotional differentiation and meaning-making processes (Narrative Processes Coding System; Angus et al., 1999) in EFT treatments of depression is provided, followed by a summary of key research findings that informed the development of a narrative-informed approach to Emotion-focused therapy of depression (Angus & Greenberg, 2011). Finally, the clinical practice and training implications of adopting a research-informed approach to working with narrative and emotion processes in EFT are described, and future research directions discussed.

Adult attachment insecurity and narrative processes in psychotherapy: an exploratory study

Different types of client attachment insecurity may affect the psychotherapeutic process in distinct ways. This exploratory study compared the in-session discourse of clients with dismissing and preoccupied attachment states of mind on Adult Attachment Interviews conducted prior to therapy in the context of a randomized clinical trial of psychoanalytic and cognitive-behavioural psychotherapy for bulimia nervosa. In a subsample of six sessions from each of eight therapy dyads, preoccupied clients were found to talk more and have longer speaking turns than dismissing clients, who in turn generated more pauses. Using the Narrative Processes Coding System, preoccupied clients were found to show more narrative initiative; whereas, differences in terms of narrative process modes were not as clearly interpretable. Contrary to expectations, the two insecure states of mind were equally different in the relationship-focused psychoanalytic therapy and in the symptom-focused cognitive-behavioural therapy. Suggestions for further investigations of the in-session discourse of clients with different attachment states of mind are given.

Narrative Process Coding System in Marital and Family Therapy: An Intensive Case Analysis of the Formation of a Therapeutic System

The aim of this study is to investigate whether the method (Narrative Processes Coding System) for studying the narrative sequences of individual psychotherapy developed by Angus and Hardtke (1994) can be applied in a family therapeutic process. According to the results narrative process coding system adds new dimensions and gives new depth in the narrative understanding of family therapeutic process. In micro-analytic interactional level it shows the complicated interactions between narration, plot, and narrative process type.

A metaphor analysis in treatments of depression: Metaphor as a marker of change

This paper examines the use of ‘burden' metaphors relating to the experience of depression in one good and one poor outcome process-experiential short-term psychotherapy dyad. Burden-metaphors are meaningful as they appear to characterize the way these clients experience the course of their depressions (e.g. Korman & Angus, 1995). Understanding how these experiences are dealt with in productive therapies, as compared to less-productive treatments, can aid in therapist training and in developing therapeutic programmes for depressed clients. The Experiencing Scale (Klein et al., 1970) and the Narrative Process Coding System (Angus et al., 1996) are used to examine the processes at play when burden-metaphors are used in the good and the poor therapy. Results indicate that, in the good outcome dyad, metaphors of ‘being burdened' were transformed into metaphors of ‘unloading the burden' over the course of the therapy, while there was no transformation evident in the poor-outcome dyad. The good outcome therapy tended to have a higher level of experiencing when discussing burden-metaphors, in comparison with the poor-outcome therapy. Furthermore, the successful dyad tended to more often use internal narrative sequences (as identified by the NPCS) in the exploraiton of metaphoric expression.

Narrative processes in psychotherapy.

AbstractThe concept of narrative, its various definitions and its role in process of meaning construction in psychotherapy is reviewed. Despite current theoretical interest in this area, we lack a shared understanding of what term refers to in context of therapy session. To address this problem, term is coined to incorporate conceptual and experiential strategies which lead to construction and reconstruction of stories. The Narrative Processes Coding System (NPCS), a systematic method of unitizing therapy text is described. The NPCS is a two step process which enables raters to a) reliably subdivide therapy session transcripts into topic segments according to thematic content shifts, and b) further subdivide and characterize these topic segments in terms of three process codes i) external description of events (actual or imagined), ii) subjective/experiential description, and iii) reflexive analysis of current, past and/or future events. The findings from a pilot study using NPCS are reported and implications and future applications of NPCS as a generic method for unitizing and characterizing therapy text are discussed.Representing a wide range of specialty areas within psychology clinicians and researchers alike have increasingly drawn on concept of to conceptualize entailed in generating explanations of everyday events and organizing these experiences into a coherent self - identity or life - story (Bruner, 1990; Howard, 1991; Mitchell,1980; Polkinghorne, 1988; Russell & Van den Broek, 1992; Sarbin, 1986). While a wide ranging theoretical debate is taking place about roles that plays in process of meaning construction in psychotherapy (Howard, 1991; Polkinghorne, 1988; Russell, Van den Broek et al., 1991; Schafer, 1980; Spence, 1982; White & Epston, 1990), only a few empirical studies (Angus, Hardtke & Levitt, 1992; Nye, 1990) have attempted to address these concerns within context of psychotherapy discourse itself. A major stumbling block for psychotherapy researchers has been absence of a shared understanding of what term means in context of dialogical interchange of therapy session.The aim of this paper is twofold. First, it will be argued that along with stories told to therapists by clients, conceptual and experiential strategies which lead to construction and reconstruction of stories about self and others should be included in a comprehensive definition of in psychotherapy. Second, we describe rationale for and development of Narrative Processes Coding System (Angus, Hardtke, & Levitt, 1992) - a rating system which allows researchers to segment sessions according to type, irrespective of therapeutic modality. Process research applications for Narrative Processes Coding System (NPCS) will be discussed and preliminary results from a pilot project using coding method reported.Definitions of Narrative in PsychotherapyBased on a critical review of relevant clinical research literature, it appears that there are three primary ways in which has been conceptualized as being central to psychotherapeutic enterprise. Each perspective adopts a different unit of analysis as representative of in psychotherapy. In order to clarify meaning of in psychotherapy, following definition of terms will be adopted: a) term will refer to individual stories clients tell therapists during therapy sessions, b) thematic story - line which weaves together many different stories or narratives into a cohesive, coherent whole, will be referred to as the (Polkinghorne, 1988) and c) term narrative processes will be used to describe modes of inquiry or cognitive/affective which help clients to understand themselves and their relationships with others in a more comprehensive, differentiated manner. …