Narrative In Psychotherapy Research Articles

Beyond the redemptive self: Narratives of acceptance in later life (and in Other Contexts)

Prior research has shown that midlife adults who construct highly redemptive life narratives tend to exhibit high levels of generativity and psychological well-being. What researchers today describe as the redemptive self, therefore, serves as a strong model for living a good life among many midlife American adults. In late life, however, and in certain other contexts, narratives that showcase the power of acceptance, rather than redemption, may prove more suitable as good life stories. In narratives of acceptance, the protagonist aims to come to terms with life and the inevitability of loss and suffering, to reconcile conflict, manage (rather than overcome) adversity, and sustain interpersonal bonds of intimacy and warmth. Narratives of acceptance may nourish valued human characteristics like grace, humility, and wisdom. Converging ideas regarding narratives of acceptance may be found in the literatures of narrative gerontology and disability studies, and from writings on the salutary effects of internalizing tragic narratives in psychotherapy and promoting social interventions designed to alleviate pain and promote well-being under conditions of significant constraint.

Olfactory imagery as a retrieval method for autobiographical memories

IntroductionThe retrieval of autobiographical memories is influenced by several factors, such as sensory modality and the emotional salience of memory cues. This study aimed at investigating the interaction between sensory modalities (olfaction, vision) and emotional dimensions (valence, arousal) of imagery cues, on the frequency, quality, and age distribution of the autobiographical memories (AMs) elicited.MethodA total of 296 females (aged between 18 and 35 years) received one out of eight brief instructions for olfactory or visual imagery. The participants were asked to create a mental image with either high arousal/positive valence, high arousal/negative valence, low arousal/positive valence, or low arousal/negative valence (e.g., ‘imagine an unpleasant and arousing odor/scene’); no specific stimulus was mentioned in the instruction.ResultsThe approach used elicited imagery with autobiographical content in the majority of participants (78%). In terms of frequency, odor imagery, compared to visual imagery, turned out to be more effective at retrieving either unpleasant memories associated with experiences in adulthood, or pleasant childhood memories. In terms of quality, the imagery was rated as less vivid in the olfactory compared to the visual condition (irrespective of valence and arousal of the imagery instruction). Visual imagery was associated with the experience of more diverse emotions (happiness, sadness, anxiety, anger) than odor imagery, which was related primarily with disgust and happiness.ConclusionOur findings indicate that nonspecific imagery induction is a useful approach in accessing AM.ImplicationThis approach presents promising clinical applications, such as in working with autobiographical memory narratives in psychotherapy.

Paradoxical nature of narrative in analytical psychotherapy

This study explored the changes, obstacles for changes and the sharing of narratives in psychotherapeutic case studies. Study 1 developed an index for analyzing the process of narratives in psychotherapy, based on 101 cases. In Study 2, 203 cases were evaluated using the index generated from Study 1. As a result, three paradoxical natures of narrative became evident. Narrative in psychotherapy is thought to include (1) recognizing the beginning of a narrative, which can also signify the completion of the narrative, (2) negative movements that hinder the development of the narrative while at the same time move it forward and (3) an individual’s narrative that is uniquely one’s own, but easily influences and is influenced by the narratives of others.

The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: update to the study protocol for the multi-center randomized controlled trial YOURTREAT

BackgroundThe trial YOURTREAT aims to compare the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) with treatment as usual (TAU) for the treatment of young refugees in Germany. This update outlines changes made to the study protocol in response to the current COVID-19 pandemic with the aim of allowing the continuation of the clinical trial while ensuring the safety of the staff and the participants, maintaining methodological quality, and ensuring compliance with legal regulations.MethodsThe major amendments to the original study protocol include (1) the possibility of using telehealth technology for the conduction of diagnostic and therapy sessions, (2) a reduction of the diagnostic set, and (3) an increased flexibility in the time frame of the study protocol.DiscussionThe adaptations to the study protocol made it feasible to continue with the trial YOURTREAT during the COVID-19 pandemic. Although the diagnostic set had to be shortened, the primary outcomes and the main secondary outcomes remain unimpaired by the amendment. Therefore, we expect the trial to provide evidence regarding effective treatment options for young refugees in Germany, a population that has received little scientific attention so far and has only very limited access to mental health care in the German health care system. In light of the current pandemic, which globally increases the risk of mental problems, the situation for young refugees is likely to aggravate further. Thus, the clinical and social relevance of the present trial YOURTREAT is even more important in these particular times.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS) DRKS00017222. Registered on May 15, 2019

How narrative source impacts convergence of ratings from the Social Cognition and Object Relations Scale-Global Rating Method with psychotherapy process measures.

This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G; Westen, 1995; see also Stein & Mulford, 2018) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) in relation to patient- and therapist-rated psychotherapy process measures. Using a university-based outpatient sample (n = 81), we found limited convergence for SCORS-G ratings across narrative type. First, paired t tests showed that the means for six of the eight SCORS-G dimensions differed significantly between the EM and PT narratives with the majority having a large magnitude of effect. Moreover, despite 29 significant correlations between a SCORS-G dimension and either an alliance or session quality variable, only two of the eight SCORS-G dimensions significantly correlated with the same process variable across narrative type (e.g., patient-rated session depth with SCORS-G Self Esteem [SE] and Identity and Coherence of Self [ICS]). Importantly, the high degree of theoretical coherence in the associations that emerged between the SCORS-G dimensions and the process variables suggest that the lack of convergence was not due to limited validity of the SCORS-G. Instead, the results underscore the importance of multi-method assessment techniques by highlighting that the manner in which a narrative is elicited will impact the object relational content patients provide. Future research and clinical implications related to the SCORS-G, alliance and psychotherapy process are discussed.

Are all narratives the same: Convergent and discriminant validity of the Social Cognition and Object Relations Scale-Global Rating Method across two narrative types.

This study examines the construct validity of the Social Cognition and Object Relations Scale-Global Rating Method (SCORS-G) by exploring the degree of convergence across different narrative sources (i.e., early memories [EM] and psychotherapy narratives [PT]) using a university-based outpatient sample (n=101). First, we examined intercorrelations between SCORS-G ratings of EM and PT. Intercorrelations between SCORS-G EM and PT revealed that three of the dimensions significantly correlated with themselves across narrative type (Emotional Investment in Relationships [EIR], Experience and Management of Aggressive Impulses [AGG], and Self-Esteem [SE]), but that only AGG had its strongest correlation with itself (i.e., EM AGG to PT AGG). In addition, EM AGG was significantly related to all but one of the PT SCORS-G dimensions. Likewise, EM SE correlated with all but two of the PT SCORS-G dimensions. Second, we examined how narrative source related to clinical findings. With the use of a multimethod approach, we assessed how SCORS-G ratings from both narrative types correlated with selected variables from the Personality Assessment Inventory (PAI) and Rorschach Inkblot Test. Findings indicated that there were only three instances in which both narrative types had significant relationships to the same variable/scale, and all three instances were with the Rorschach. Together, these findings suggest that even when using the same scale (SCORS-G), different narrative sources differentially activate aspects of object relations. In addition, the results highlight that difficulties with self-esteem and poor management of aggression in childhood interactions relates to patients' object relational functioning later in life. Clinical implications and future research are discussed.

Examining the relationship between object relations and interpersonal distress in a clinical sample.

The goal of the present study was to explore the relationship between patients' object relational functioning (Social Cognition and Object Relations Scale-Global Ratings) as rated by clinicians during the course of outpatient psychodynamic psychotherapy in a university-based clinic and patient self-reported interpersonal vulnerabilities (Inventory of Interpersonal Problems-64). Participants (n = 112) were outpatients entering treatment at a university-based psychotherapy clinic and were diagnosed primarily with mood disorders as well as Axis II relational problems and features. Participants completed the IIP-64 prior to receiving therapy, and SCORS-G ratings were based on patients' level of relational functioning during the evaluation process (i.e., the semistructured interview, follow-up and feedback) and across the first two psychotherapy sessions. Results showed a significant relationship between the IIP-64 Total score with SCORS-GSelf-Esteem (r = -.21, p < .05) and Affective Quality of Representations (r = -.20, p < .05), wherein self-reported interpersonal dysfunction was greater among patients who had lower self-worth and perceived others as more malevolent. These findings suggest that patients who rated themselves as having more significant interpersonal difficulty reported more negative expectations and experiences of relationships in their psychotherapy narratives. The utility of the SCORS-G and the IIP-64 as two different avenues of assessing patient relational functioning is explored.

The efficacy of Narrative Exposure Therapy for Children (KIDNET) as a treatment for traumatized young refugees versus treatment as usual: study protocol for a multi-center randomized controlled trial (YOURTREAT)

BackgroundGermany hosts a large number of refugees from war-affected countries. The integration of refugees, in particular young refugees from the Middle East, is one of the major current social challenges in Germany. Mental disorders, first of all post-traumatic stress disorder (PTSD) that results from war experiences, are common among young refugees and interfere with quality of life as well as functional integration. Evidence regarding effective treatment options for this population is scarce. In this trial, we aim to evaluate the pragmatic, short-term psychotherapy Narrative Exposure Therapy for Children (KIDNET) for the treatment of young refugees in Germany.MethodsIn a rater-blinded, multi-center, randomized-controlled trial, KIDNET is compared to treatment as usual (TAU) within the general health care system. A total number of 80 young refugees who fulfill the diagnostic criteria of PTSD will be randomized to either KIDNET or TAU. Diagnostic interviews will take place at baseline before treatment as well as 6 and 12 months thereafter. They will assess exposure to traumatic events, PTSD and comorbid symptoms, as well as parameters of integration.DiscussionThe results of this study should provide evidence regarding effective treatment options for young refugees in Germany, a population that has been understudied and received only limited access to mental health care so far. Next to the effects of treatment on mental health outcomes, integration parameters will be investigated. Therefore, this study should provide broad insights into treatment options for young refugees and their potential implications on successful integration.Trial registrationGerman Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS), ID: DRKS00017222. Registered on 15 May 2019.

The form of the story: Measuring formal aspects of narrative activity in psychotherapy

Objective: We ask which are the clinically relevant qualities of narratives in psychotherapy and how they can be measured. Method: On the background of psychoanalytic assumptions and narrative theory, we propose to measure formal narrative processes which stay close to the linguistic surface, because these escape conscious control. Results: We propose five aspects of narratives to be especially sensitive to distortions and therefore prone to change in successful therapies: (1) The actual chronological, stepwise narrating of events, (2) the intentional structuring of events, or emplotment, (3) the immediate evaluation, (4) the reflected interpretation of events, and finally (5) the consistency and completeness of the narrative. For each aspect we discuss ways to measure them. Finally the aspects are illustrated with excerpts from a series of diagnostic interviews. Discussion: Implications for the analysis of the co-narrative role of the therapist are suggested.

Assessment of Autobiographical Memory Narratives in Psychotherapy with Borderline Personality Disorder: An exploratory study

Autobiographical memory narratives that emerge in therapeutic discourse can aid the understanding of the client?s narrative identity and the identification of cen-tral themes or conflicts. The study aimed to examine the structure and thematic content of autobiographical memory narratives of five clients with Borderline Personality Dis-order (BPD), during the early phase of individual psychotherapy. The Biopsychosocial Interview gathered narrative material about the clients? life experiences in childhood and adulthood and explored the history of psychological difficulties and/or disorders. The interview and the first five sessions of psychotherapy for each client were audio record-ed, transcribed and coded for analysis. The Coding System for Autobiographical Memory Narratives in Psychotherapy was used to identify autobiographical memory narratives from the clients? life experiences, rate the narrative complexity, specificity and integration, and derive narrative patterns or themes. Analysis indicated that the narra-tives had a moderate level of complexity, low levels of specificity, were predominantly autobiographical, poorly integrated and revealed dominant themes of contamination. Narrative themes of agency, communion and redemption were relatively lower among the clients. The implications for therapeutic practice, training of clinicians and future re-search are discussed.

Clinical Validity of a Dimensional Assessment of Self- and Interpersonal Functioning in Adolescent Inpatients

The Social Cognition and Object Relations Scale–Global Version (SCORS–G) is a clinical rating system assessing 8 domains of self- and interpersonal relational experience that can be applied to narrative response data (e.g., Thematic Apperception Test [TAT; Murray, 1943], early memories narratives) or oral data (e.g., psychotherapy narratives, relationship anecdotal paradigms). In this study, 72 psychiatrically hospitalized adolescents consented and were rated by their individual and group therapist using the SCORS–G. Clinicians also rated therapy engagement, personality functioning, quality of peer relationships, school functioning, global assessment of functioning (GAF), history of eating-disordered behavior, and history of nonsuicidal self-injury. SCORS–G composite ratings achieved an acceptable level of interrater reliability and were associated with theoretically predicted variables (e.g., engagement in therapy, history of nonsuicidal self-injury). SCORS–G ratings also incrementally improved the prediction of therapy engagement and global functioning beyond what was accounted for by GAF scores. This study further demonstrates the clinical utility of the SCORS–G with adolescents.

Das Traumanarrativ in der Kinderpsychotherapie

The narratives of trauma in child psychotherapy The establishment of narratives is a major component of trauma-focussed cognitive-behavioural therapy for children and adolescents. According to comparative intervention studies with children and adolescents, fundamental aspects of effective treatment are the act of remembering the traumatic experience and its emotional and cognitive reprocessing. This paper defines the rationale of the therapeutic use of narratives in psychotherapy with children and adolescents, illustrated with case material. Furthermore, the authors demonstrate that this approach can also be applied in therapy with preschool children, if conducted in an age-appropriate way. Based on the principles of behavioural therapy and in keeping with other forms of treatment for anxiety disorders, the main goal of the treatment is that the patient becomes accustomed to the biographical memories that are specific to the trauma and the key stimuli associated with these. Negotiation of disorder-specific avoidance is achieved by graduated exposition and desensitization. Moreover, the trauma narrative helps the patient to reconsider and change cognitive distortions and dysfunctional beliefs and to establish an age-appropriate comprehension of the traumatic event and its impact on his or her future life. The contact with a dedicated, supportive, non-abusing and caring person improves the transfer of the therapeutic effects into daily routine and may also lead to sustained emotional and psychological relief for the caregiver - who is often equally traumatized. However, trauma-focussed therapy for children and adolescents has yet to be implemented on a larger scale: current medical practice still consists of unspecific, supportive and stabilizing interventions.

The Substrate of Transformation in Psychotherapy and Analysis

The author reviews Margaret Wilkinson’s latest book, Changing Minds in Therapy: Emotion, Attachment, Trauma & Neurobiology. Wilkinson skillfully incorporates a wealth of knowledge and recent neuroscience research with useful and thought-provoking applications for clinical practice. She highlights the central importance of the brain’s right hemisphere for emotional processes, implicit memory, and relationships. Her ‘double helix’ model of treatment suggests that psychotherapists pay equal attention to affective experiences as well as interpretations. The author provides a brief example from his practice to illustrate Wilkinson's key ideas about the reach of dissociation, the power of imagery, the need for emotional expression, and the creation of a life-bridging narrative in psychotherapy. This book is highly recommended as a valuable tool for anyone in the helping professions.

Autobiographical Memory Narratives in Psychotherapy: A Coding System Applied to the Case of Cynthia

Recent cognitive and psychodynamic oriented therapies have converged on the powerful role that narrative processing plays in psychotherapy. Although previous coding systems have examined specific aspects of memory narratives, there are no comprehensive methods for coding segments of clinical evaluations or psychotherapy sessions that zero in on the unit of a briefly recounted autobiographical memory narrative. The present single case study aims to introduce and to demonstrate the Coding System for Autobiographical Memory Narratives in Psychotherapy (CS-AMNP; Singer &amp; Bonalume, 2008) with a young female client whom we call "Cynthia." We applied this autobiographical memory narrative approach to the diagnostic interview of Cynthia in evaluation for psychotherapy and compared predictions based on its results to the clinician’s report of Cynthia's actual therapeutic outcome. This study demonstrates the utility of the coding system for personality assessment and case conceptualization in the service of ongoing treatment. In addition, implications of this coding system for future research, clinical practice, and training are discussed.

Rising to the Challenges of Identifying and Analyzing Clients' Narratives

Psychotherapy researchers and clinicians alike are faced with two primary challenges in the service of most effectively understanding the therapeutic process: first, they must identify the most generative elements from the rich flow of therapeutic dialogue; and second, they must select the most appropriate and productive tools for analyzing them. Singer and Bonalume (2010) have developed the Coding System for Autobiographical Memory Narratives in Psychotherapy (CS-AMNP), a trans-theoretical method for rising to these two challenges. In this commentary, the CS-AMNP is evaluated: its noteworthy contributions are highlighted, its potential limitations are discussed, and fruitful expansions are proposed in terms of extending it from autobiographical narratives in therapy to autobiographical narratives about therapy.

Different place, different action: Clients' personal narratives in psychotherapy

AbstractThis paper deals with clients' personal narratives in psychotherapy. Using the method of conversation analysis, we focus on actions and tasks accomplished through clients' narratives. We identify, within the overall structural organization of therapeutic talk in our corpus, two different sequential placements of clients' narratives and describe some of their distinctive features. When they are placed within an inquiry phase of the session and are solicited by therapists' questions, the clients' narratives mainly provide information for therapists in the service of their inquiring agenda. When placed within an elaboration phase of the session, personal narratives are regularly volunteered by clients and produced as responses to therapists' reinterpretations, i.e., statements working up clients' circumstances as previously described by clients. In this latter placement, they mainly offer further evidence relevant to the therapists' reinterpretations, and thus show how clients understand therapists' reinterpretations and what they make of them. The import of these findings, for both an explication of therapeutic techniques and a better understanding of the therapeutic process, is also discussed.

Personality and the coherence of psychotherapy narratives

The stories people construct about themselves and their social worlds are key aspects of their identities [Bruner, J. S. (1990). Acts of meaning. Cambridge, MA: Harvard University Press; McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5, 100–122]. Whereas certain expected life experiences (e.g., leaving home, getting a job) may be relatively easy to narrate, more unexpected and difficult events, such as undergoing psychotherapy, may pose a challenge to successful narration. Yet it is especially important to successfully narrate one’s experience in psychotherapy in order to maintain the gains from treatment [Frank, J. D. (1961). Persuasion and healing: A comprehensive study of psychotherapy. Baltimore, MD: Johns Hopkins University Press; Spence, D. P. (1982). Narrative truth and historical truth: Meaning and interpretation in psychoanalysis. New York: W.W. Norton]. The present study collected psychotherapy narratives from 76 adult former clients and coded them for the fundamental story criterion of coherence [Baerger, D. R., & McAdams, D. P. (1999). Life story coherence and its relation to psychological well-being. Narrative Inquiry, 9, 69–96]. Former clients that were high in trait Openness to experience and those at higher stages of ego development told more coherent stories about therapy. The relationship between ego development and narrative coherence remained significant even when controlling for Openness. The findings suggest that high ego development may provide narrators with the kind of sophisticated frameworks for meaning-making that are especially well-suited for the important task of making good sense of psychotherapy.

Independent comment on Audio‐visual and Print Materials

Book reviewed in this article:A Different Story: The Rise of Narrative in Psychotherapy C. C. BeelsAngels with Attitude; 48 full colour cards. $49.50 (incl. GST). Shadows: Seeing the Darkness, Looking for LightThe Therapist's Notebook for Families. Solution‐Oriented Exercises for Working with Parents, Children and Adolescents; Bob Bertolino and Gary Schultheis

Integrating Spirit and Psyche: Using Women's Narratives in Psychotherapy

Integrating Spirit and Psyche: Using Women's Narratives in Psychotherapy

The unsaid in the psychotherapy narrative: Voicing the unvoiced

In research interviews, psychotherapy clients, from different therapeutic approaches, identified silent moments entailing processes that facilitated their therapeutic progress. A grounded theory method was used to analyse these interviews resulting in three categories of productive pauses: emotional, expressive and reflective pauses. This study examines these categories in relation to their narrative context, and, more broadly, to narrative theory. It highlights what remains unsaid in the psychotherapy narrative, describes these silent processes that transform narration into a therapeutic experience and reframes the therapeutic narrative as a method for structuring introspective silences.