Narrative and emotion integration processes in emotion-focused therapy for complex trauma: an exploratory process-outcome analysis

ABSTRACT

The Narrative-Emotion Process Coding System (NEPCS) is a behavioral coding system that identifies eight client markers: Abstract Story, Empty Story, Unstoried Emotion, Inchoate Story, Same Old Story, Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Each marker varies in the degree to which specific narrative and emotion process indicators are represented in one-minute time segments drawn from videotaped therapy sessions. As enhanced integration of narrative and emotional expression has previously been associated with recovery from complex trauma, the purpose of the present pilot study was to examine the contribution of within session NEPCS markers to treatment outcomes for clients undergoing Emotion-Focused Therapy for Trauma (EFTT). The NEPCS was applied to two early, two middle, and two late videotaped therapy sessions selected from two recovered and two unchanged complex trauma EFTT clients. Exploratory statistical analyses established that unchanged clients expressed significantly more Unstoried Emotion than recovered clients, and a significant stage by outcome interaction effect was found for Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Finally, limitations of the current study are identified and implications for future research and clinical practice are addressed.

Das Narrative Emotions-Prozess-Kodier-System (NEPCS) ist ein Verhaltens-Kodier-System, das acht Klienten-Marker identifiziert: abstrakte Geschichte, leere Geschichte, geschichtslose Emotion, diffuse Geschichte, immer gleiche alte Geschichte, konkurrierende-Erzählstränge-Geschichte, unerwartetes-Resultat- Geschichte, Entdeckungsgeschichte. Jeder Marker variiert im Grad, in dem bestimmte narrative sowie Emotionsprozess-Indikatoren in Zeitsegmenten von einer Minute repräsentiert sind, welche aus Therapiesitzungen stammen, die mit Video dokumentiert wurden. Da eine verbesserte Integration des narrativen und emotionalen Ausdrucks bereits mit einer Gesundung bei komplexen Traumata in Verbindung gebracht wurde, war der Zweck der vorliegenden Pilotstudie, den Beitrag von NEPCS Markern in den Sitzungen zu untersuchen und wie die Resultate derjenigen Klienten sind, die eine Emotions-fokussierte Therapie gegen Trauma (EFTT) erhalten. Mit NEPCS wurden zwei frühe, zwei mittlere und zwei späte mit Video aufgezeichnete Therapiesitzungen untersucht, die aus Therapien von zwei gesundeten sowie zwei unveränderten Klienten mit komplexen Traumata (EFTT) stammten. Exploratorische statistische Analysen zeigten, dass unveränderte Klienten signifikant mehr geschichtslose Emotionen ausdrückten als gesundete Klienten; festgestellt wurde auch ein signifikanter Interaktionseffekt zwischen den Typen/Phasen des Erzählens und dem Outcome für die folgenden Marker: konkurrierende-Erzählstränge-Geschichte, unerwartetes-Resultat-Geschichte und Entdeckungsgeschichte. Schliesslich werden die Grenzen der vorliegenden Studie aufgezeigt und Implikationen für künftige Forschung und klinische Praxis angesprochen.

El sistema de codificación del proceso de la emoción narrativa (NEPCS sus siglas en ingles es un sistema de codificación conductual que identifica ocho marcadores de los consultantes: historia abstracta, historia vacía, emoción sin relato/historia, historia incipiente, la misma vieja historia, historia de tramas que compiten, historia de resultado inesperado, historia del descubrimiento. Cada marcador varía en el grado en que los procesos de narrativa específica y los indicadores de emoción del proceso estén representados en segmentos de tiempo de un minuto, extraídos de las sesiones de tratamiento grabadas. Como la integración mejorada de la expresión narrativa y emocional ha sido previamente asociada con la recuperación del trauma complejo, el propósito del presente estudio piloto fue examinar la contribución de marcadores NEPCS dentro de la sesión con los resultados del tratamiento para los clientes sometidos a terapia para trauma enfocada en la emoción para (EFTT, siglas en ingles). El NEPCS se aplicó a dos sesiones del principio, dos del medio y dos sesiones de finales del tratamiento, seleccionadas de dos consultantes de trauma complejo recuperados y dos sin cambio trauma. Análisis estadísticos exploratorios establecieron que los consultantes sin cambios expresaron mayor historia sin emoción que los consultantes que han mostrado recuperación, y se encontró una etapa significativa por efecto de interacción para los de historias con tramas que compiten, historias/relatos de resultado inesperado, e historias de descubrimiento. Finalmente, se identifican limitaciones del estudio actual y se agregan implicaciones para futuras investigaciones y la práctica clínica.

Le système de codage des processus narratifs-émotionnels (NEPCS) est une échelle comportementale de cotation qui repère huit indicateurs : histoire abstraite, histoire dépourvue d’émotion, émotion non narrée, histoire inachevée, histoire ancienne répétée, histoire aux intrigues contradictoires, histoires dont l’issue est inattendue, histoires découvrant des perspectives nouvelles. Chaque marqueur varie selon le degré auquel les indicateurs spécifiques des processus narratifs-émotionnels sont présents dans des segments de sessions thérapeutiques filmées, d’une durée d’une minute. Etant donné que l’augmentation de l’intégration de l’expression narrative et émotionnelle a précédemment été associée au rétablissement suite à un trauma complexe, le but de notre étude pilote était d’examiner, dans le cadre de sessions de thérapie, la contribution des indicateurs NEPCS aux résultats du traitement de clients soumis à une thérapie du trauma centrée sur les émotions (EFTT). La NEPCS a été appliquée, lors de deux sessions filmées sélectionnées en début, en milieu et en fin de thérapie, à quatre clients soumis à une thérapie centrée sur les émotions suite à un trauma complexe, deux s’étant rétablis et deux n’ayant pas évolué. Les analyses statistiques exploratoires montrent que les clients n’ayant pas changé expriment significativement plus d’émotions non narrées que les clients rétablis. Il a été mis en évidence qu’il existe un niveau significatif de résultats lié à l’interaction des histoires aux intrigues contradictoires, histoires dont l’issue est inattendue, histoires découvrant des perspectives nouvelles. Les limites de cette étude sont enfin identifiées et les implications pour de futures recherches et pour la pratique clinique sont abordées.

O Sistema de Codificação do Processo de Narrativa Emocional (SCPNE) é um sistema de codificação comportamental que identifica no cliente oito marcadores: história abstrata, história vazia, emoção sem história, emoção incipiente, a mesma velha história, história com enredos em competição, história com um resultado inesperado, história de descoberta. Cada um destes marcadores varia de grau no que diz respeito à representação dos indicadores do processo emocional e à narrativa específica – para cada minuto de gravação em vídeo das sessões terapêuticas. Uma vez que a integração da narrativa melhorada e da expressão emocional foi anteriormente associada à recuperação de traumas complexos, o objetivo deste estudo piloto foi investigar o contributo dos marcadores do SCPNE para os resultados do tratamento de clientes sujeitos à Terapia Focada na Emoção para Traumas Complexos (TFET). O SPCNE foi aplicado às gravações selecionadas de duas sessões iniciais da terapia, duas do meio do processo e duas do final do mesmo – de dois clientes recuperados e de dois clientes que não apresentavam alterações, os quais tinham sido submetidos à TFET, com traumas complexos. Uma análise estatística exploratória demonstrou que os clientes que não apresentavam alterações manifestavam, de forma significativa, mais emoção sem história do que os clientes recuperados. Detetou-se também um estádio significativo de efeito de interação dos resultados para a história com enredos em competição, a história de resultado inesperado e a história de descoberta. Por fim, são identificadas as limitações do presente estudo e são abordadas as implicações do mesmo para a investigação futura e para a prática clínica.

KEYWORDS:

• Narrative-emotion integration
• treatment outcome
• complex trauma
• emotion-focused therapy for trauma

Additional information

Notes on contributors

Naomi Carpenter

Naomi Carpenter, MA, is a doctoral student in Clinical Psychology at York University. She is a co-developer of the Narrative-Emotion Process Coding System (NEPCS; Boritz, Bryntwick, Angus, Greenberg, & Carpenter, 2012) and is author/co-author on several papers on the application of the NEPCS to various clinical populations presented at conferences. She currently holds a Canadian Institute of Health Research Doctoral Research Award for her research examining the relationship between narrative and emotion integration and treatment outcome in a complex trauma population.

Lynne Angus

Lynne Angus, PhD, CPsych, Professor, Psychology, York University is senior editor of the Handbook of Narrative and Psychotherapy: Practice, Theory and Research (Angus & McLeod, 2004) and lead author of Working With Narrative in Emotion-Focused Therapy: Changing Stories, Healing Lives (Angus & Greenberg, 2011). She has demonstrated her approach to Working with Narrative in Emotion-focused Therapy for the American Psychological Association Systems of Psychotherapy Video Series, has authored over 70 published articles and research manuscripts. She is a Past President of the Society for Psychotherapy Research and is a Professor of Psychology at York University.

Sandra Paivio

Sandra Paivio, PhD, CPsych, is a professor and director of the Psychotherapy Research Centre at the University of Windsor. She is a co-developer of Emotion-Focused Therapy for complex trauma (EFTT), and has conducted clinical trials evaluating the efficacy of EFTT. She has authored numerous publications, including co-author of Working with Emotions in Psychotherapy (Greenberg & Paivio, 2001), co-author of EFTT (Paivio & Pasucal-Leone, 2010), and author (with Lynne Angus) of a forthcoming book on Narrative Processes in EFTT. She has presented numerous workshops in EFT and EFTT for graduate students and professionals. She also received a Lifetime Achievement Award from the Trauma Section of the Canadian Psychological Association (2014).

Emily Bryntwick

Emily Bryntwick, MA, is a doctoral student in the Clinical Psychology program at York University. She completed her undergraduate degree in Honours Psychology at the University of Waterloo and her Master of Arts degree at York University. Her primary research interest involves an examination of the integration of narrative and emotion processes in psychotherapy and its relationship to outcome.