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Department of Psychology,
Department of Psychology,
Department of Psychology,
ABSTRACT
The Narrative Processes model is focused on the strategies and processes by which a
client and therapist transform the events of everyday life into a meaningful story that both
organizes and represents the clients sense of self and others in the world. Some investigators
have elected to use clients' within-session descriptions of relationship events or micro narratives
as their unit of narrative analysis. In contrast, we are centrally interested in the development of
the macro narrative framework in which the singular events described in a therapy relationship
(ie micro narratives) come to be articulated, experienced, and thematically linked together in
such a way that the client's sense of his or her life story -- in essence, the sense of self -- may be
transformed at the conclusion of the therapeutic relationship. The following paper details the
Narrative Processes theory of therapy and the coding system which has been developed to
identify and empirically evaluate key components of the model. Findings emerging from the
analyses of successful psychotherapy dyads are described and the implications for future research
Psychotherapy researchers (Goncalves 1995; Luborsky, Barber & Diguer, 1993; McLeod
& Balamoutsou, 1996; Neimeyer, 1995) have recently begun to address the role of narrative in
psychotherapy, and in so doing, have largely borrowed from the conventions of written narrative
form to guide their selection and analysis of stories told in therapy sessions. A growing chorus of
psychotherapy process researchers ( Angus & Hardtke, 1994; Angus, Levitt & Hardtke 1994) are
suggesting that the stories which unfold in the context of the co-constructive, spoken dialogue
of the therapy session are different in form, and at times function, from written accounts of life
events.
This perspective on the therapy dialogue is consistent with Schafer's (1992) notion of
narration in psychotherapy in which he argues that oral narratives in therapy sessions are not like
"literary fiction" in which there is a clear beginning, middle, and end to the story. For Schafer,
the acts of narrating, giving an account, presenting a version, developing a story-line, telling,
revising and reinterpreting are all core components of the narrational approach and are key to
studies (Levitt 1993; Greenberg & Angus 1993; Angus & Hardtke 1994; Hardtke 1996)
analysing narrative discourse parameters in psychotherapy sessions, and drawn from a variety of
therapy approaches, are beginning to establish empirical support for a broader application of
Some investigators (Luborsky, Barber & Diguer, 1992; McMullen & Conway, 1993)
have elected to use clients within-session descriptions of relationship events or what we term
micro-narratives as their unit of narrative analysis. In contrast, we are centrally interested in the
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macro-narrative framework in which the individual events described in therapy sessions (ie
micro-narratives) become thematically linked together in such a way that clients views of their
Specifically, the Narrative Processes theory of therapy (Angus & Hardtke, 1994) is predicated on
the assumption that all forms of successful psychotherapy entail the articulation, elaboration and
transformation of the client's self-told life story which is reflected in the emergence of macro-
narrative themes which predominate across therapy sessions. Both client and therapist achieve
this goal by collaboratively engaging in 3 distinct modes of inquiry : 1) External Narrative Mode,
which entails the description and elaboration of life events in which the question of what
happened is addressed; 2) Internal Narrative Mode, which entails the description and elaboration
of subjective feelings, reactions and emotions connected with the event which addresses both the
question of what was felt at the moment the event was occurring as well as what is experienced
now in the therapy session; and finally 3) Reflexive Narrative Mode, which entails the reflexive
analyses of issues attendant to what happened in the event (external) and what was felt (internal)
in which the question of what does it mean is addressed. These narrative processing modes
encompass both the cognitive and experiential strategies which both clients and therapists engage
in when co-constructing stories about self and others, irrespective of therapeutic modality, and
encompass almost all of the dialogue spoken in the context of the psychotherapy relationship. In
essence, the narrative process modes are viewed as essential components of a distinctive mode
of human meaning-making which creates, maintains and when needed, revises our sense of self
in the world.
5
The Narrative Processing approach to psychotherapy has clear implications for both
psychotherapy researchers and practitioners. In the following paper the components of the
Narrative Processes Coding model, namely narrative process sequences and topic segments, as
well as the Narrative Processes Coding System will be addressed first followed by a discussion
of relevant research applications for the coding system and practice implications for
psychotherapy practitioners.
According to the Narratives Processes theory of therapy, the goals of productive therapy
are threefold. First, the client and therapist focus on the remembrance of past events and the
description of current events and imagined experiences in order to "fill the gaps" of what has
been forgotten or never fully acknowledged, and hence, not understood. Second, client and
emotions and thoughts, such that the lived experiences of the event can be engaged and perhaps
articulated for the first time. The third goal entails the reflexive analysis of the related
experiences and circumstances of "what happened" such that a new understanding or story is
formed which either supports or challenges the implicit beliefs about self and others that
In the context of psychoanalytic psychotherapy, Nye (1994) argues that much of the work
of exploring and reconstructing the meaning of events or memories happens in the reflective talk
about the events which have occurred in the client's life. Accordingly, in order to understand
how narrative functions in psychotherapy, it is also critical that we examine the reflexive talk
about events in which client and therapist collaborate in the generation of new ways of
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conceptualizing and seeing the client's life story. In the context of the Narrative Processes
model, the descriptions of subjective experiencing and relationship events are viewed as
providing both clients and therapists with a rich spawning ground for the creation of new
In terms of the functions of spoken narratives, we argue that in the External sequences the
narrator or client attempts to verbally show the therapist -- by means of descriptive, specific
details -- the scene, setting and actions entailed in an event. The more detailed and specific the
description provided by the client, the more opportunity the therapist has to develop an imagistic
rendering of the event and to empathically adopt the internal frame of the client. Additionally, a
number of investigators ( Salovey & Singer, 1994; Borkovec, Roemer & Kinyon, 1995; Bucci,
1995) argue that the articulation of a detailed description of an episodic memory may provide the
client with an opportunity to more fully access emotions and thoughts experienced in the context
of a past event. Accordingly, some therapists will intentionally shift clients into an External
narrative sequence, by asking the client to give a detailed concrete example or life event to
1984; Janoff-Bulman, 1992; Salovey & Singer, 1994) are suggesting that key episodic memories
may function as schemas or templates in the context of the development of the individuals self-
theory or what we term the clients macro-narrative. Epstein (1984) points out that a persons
theory of self and the world, or macro-narrative, is a preconscious experiential and conceptual
system that automatically structures experiences and directs actions. A key therapeutic strategy to
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memories present in conscious awareness and to encourage the articulation of important but
forgotten past experiences and events in the context of External narrative sequences. The
generation of new experiential and conceptual meanings in the context of the External narrative
sequences emerges from the engagement in both Internal and Reflexive narrative process
sequences.
Internal sequences function to show or describe to the therapist the emotions and feelings
reexperienced by the client in the showing and telling of the event (external) or entail the
description of new emotions or feelings emerging in the moment during the therapy session. In
the context of dealing with physical and psychological trauma, Harber & Pennebaker (1992) have
provided compelling research findings which demonstrate that emotional disclosure in the
In a similar vein, Borkovec, Roemer & Kinyon (1995) argue that obsessive worrying in
distressed clients functions to suppress the key psychological change processes of imagery recall,
affect and emotional processing in the context of the experienced traumatic events. For
Borkovec et al, the articulation and processing of distressing emotions is a key therapeutic task
when working with chronically anxious clients. While a growing consensus of psychotherapy
researchers (Greenberg, Rice & Elliot, 1993; Greenberg & Safran, 1989; Mahoney, 1991;
Pennebaker, 1995) are recognizing the importance of emotional disclosure as a basis for the
generation of new meanings of self and others and macro-narrative change, psychotherapy
approaches differ to the extent in which they priorize the description of what was experienced in
the past versus focussing on the processing of emotion schemes emerging in the session. The
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more evocative and descriptive the client can be regarding his or her experiencing in the session,
the greater the opportunity the therapist has to empathically resonate with and attune to the
client's feeling state (Angus, 1990). We have found the use of individual metaphor phrases
(Angus, 1996) to be particularly productive within the context of Internal narrative sequences.
Finally, in the Reflexive sequences the client attempts to make meaning of his or her
both the self and those individuals who play significant roles in the clients life. It is in the
context of reflexively processing current and past experiences that the client and therapist begin
reformulation, which coherently organizes, and provides an understanding of the clients current
In terms of with-in session patterns, Reflexive narrative sequences ideally follow upon a
depth of engagement in either External or Internal narrative sequences in the therapy session such
that both the client and therapist engage in a process of shared meaning-making in relation to the
clients understanding of self and others in the world. Greenberg & Pascual-Leone ( in press),
citing findings from Pennebakers (1995) work with trauma survivors, argue that reflexive
emotional expression if the therapist actively facilitates the clients focussing on the creation of
new meaning (ie Reflexive narrative sequence) from the aroused emotional material (ie Internal
narrative sequence).
Reflexive narrative processing which does not emerge from the detailed description of
events and emotional expression may be a client marker of shallow, automated processing
9
(Borkovec, Roemer & Kinyon, 1995) in which the client appears to be retelling a well rehearsed
script. By asking the client for a specific example of the problem or concern, and hence shifting
the client to describing and showing a specific instance (External narrative sequence), the
therapist may help the client to engage in a kind of depth of Internal and Reflexive narrative
processing such that deeply painful and at times disturbing feelings and beliefs about the self can
be articulated and understood in ways that engender new meanings and perspectives on self and
others.
Drawing on the work of Spence (1982), client descriptions of what happened (External
sequences) and how it felt (Internal sequences) entail processes of client-mediated memory
feelings (Internal sequences) emerging in the showing and reexperiencing of the event as well as
the active search to make past events and past and current feelings understandable (Reflexive
sequences) entail both clients and therapists active participation in co-constructive processes of
meaning-making. With this model it is argued that all three narrative process sequence types
have an important function to fulfil in the co-construction of the client's macro or self narrative
and as such are present, although in varying degrees and patterns, in all therapeutic modalities.
systematic method for the identification of therapy discourse parameters associated with narrative
processing modes was developed (Angus & Hardtke, 1994). The Narrative Processes Coding
System (NPCS) and revised manual (Angus, Hardtke & Levitt, 1996) has evolved from the first
author's continuing interest in the role of metaphor and figurative language in psychotherapy
10
(Angus 1996; Angus 1990; Angus, 1992; Angus & Rennie,1989; Angus & Rennie,1988) as well
as earlier research projects which entailed the origination (Marziali & Angus 1985) and
development of a sequential coding system (Marziali & Angus, in preparation) appropriate for
The NPCS provides researchers with a rational, systematic method of unitizing therapy
transcripts, regardless of therapeutic modality. The procedure entails two steps which enables
the researcher to: a) reliably subdivide and characterize therapy session transcripts into topic
segments according to content shifts in verbal dialogue; and b) further subdivide and characterize
these topic segments in terms of one of three narrative process types -- External, Internal and
Reflexive -- which are termed narrative process sequences for coding purposes:
i. External Narrative Process Sequences which include description of events (past, present
of experience; and
iii. Reflexive Narrative Process Sequences which include analysis of current, past and/or
future events.
As a form of discourse analysis, this categorization system deals with interactional units
which can include both client and therapist turn-taking. In terms of Kiesler's (1973) descriptive
classification of psychotherapy process measures, the NPCS is a nominal method for the
categorization of psycholinguistic dimensions of the therapeutic interaction. Given that the entire
therapy session transcript (summary unit) is used for the identification of topic segments
11
(contextual units) and narrative sequences (scoring units), the NPCS can also be characterized as
Topic Segments
Topic segments are identified when a shift or change in subject (eg., work, family,
relationship with significant other) occurs during the psychotherapy session discourse. For
research purposes, a topic segment shift can be further categorized as representing one of the
following :
ii) Facet shift : which entails a detailed elaboration of different facets of a general content area
Topic segments are interactional units which may contain verbal interchanges between
clients and therapists. The beginning of a new topic segment is often marked by: a) questions
posed by the therapist signalling a topic change and hence, the beginning of a new topic segment;
b) the client clearly introduces a new topic; c) a change in verb tense signalling the elaboration of
a specific content area or past experiences; and/or d) following a distinct pause by the speaker.
The ending of a topic segment is often marked by: a) an affirmation that what has been said has
been understood by the therapist and/or the client (ex. "mm-hm"), b) a pause in the conversation,
or c) a summary of the preceding issues. The length of topic segments varies from dyad to
dyad.. In a recent study (Hardtke,1996), it was found that in a sample of 5 therapy dyads ( 75
therapy sessions), the average length of a topic segment was 30 transcript lines, with a range of
10 to 133 lines.
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Once identified, each topic segment is labelled according to: a) Relationship Focus :
identifies whom the topic segment is addressing, whether it be an issue regarding self, other(s),
or self in relation to other(s), and b) Key issue : describes the primary issue or focus of the
The following example of a topic segment entails the description a specific content area
- a client's relationship with her mother-in-law. The relationship focus identified by NPCS raters
for this segment is self in relation to mother-in-law and the key issue is characterized as mother-
in-laws visit.
C: OK. It has been a pretty hectic week. My Mother-in-law arrived in town. She'll be staying
with us for two weeks. She's just taken over the house. She's cleaning everything. I mean, she
even went out and bought Ajax (cleaning powder) and spent almost an hour scrubbing the
kitchen sink. I mean it's not like the place was dirty. I made sure it was spotless before she
arrived. The night before I even got up to check everything over so I could clean whatever was
missed. She always does this.
T: Okay, your Mother-in-law arrived for a visit and what, the next day you walked into the
kitchen and she was cleaning your sink?
C: Yeah, she arrived Thursday afternoon. R.(husband) picked her up from the airport. The next
morning I dropped the kids off at school and when I got back there she was in the kitchen
scrubbing the sink, you know with Ajax. So I just stood there with a dazed look on my face and
said, you know, that she was on vacation and if the sink was dirty I would clean it. Well she said
something like she knew I was busy and she was only trying to help.
T: Mm-hm.
T: Mm-hm. So how does it make you feel when she acts like this?
13
C: I feel like she's intruding. I mean she's the guest. I don't know I just want to scream I get so
frustrated. She makes me feel hopeless, like a little kid. There is no point telling R.(husband).
He just sides with her. I just get really upset. I just feel like one of the kids when she's around.
T: Mm-hm. So when she visits you feel like she is the parent and you're the little kid?
C: Yeah, like when she cleans or says that I'm not dressing my kids right I feel like I've failed
again. It is so aggravating. No matter how hard I try I can't please her. I think I'm starting to
experience panic attacks when I know she's coming for a visit.
T: Panic attacks?
C: Like before she arrived I had a headache for a week. My stomach was in a knot and I could
hardly eat. I just felt really tense and nervous. I just know that she will find something to
criticize me about.
T: Mm-hm.
C: And I don't know why I feel so obsessed with pleasing her anyway. She usually only comes to
visit twice a year. I mean it's not like we're really close. I've talked to R.(husband) who says I
should just put up with her for two weeks, then forget about her. But I can't seem to do that.
Maybe it's because I felt she never thought much of me. She was against R.(husband) and I
marrying. We were both still in school when we married. She's always given me the impression
that she thought R.(husband) would marry someone who would be more than a housewife. Why
don't I have the guts to stand up to her? Why do I let her invade my home? I always let her take
charge. I should stand up for myself and tell her what I think about all her cleaning and stuff.
Maybe if I stood up to her she'd respect me more? Or at least she might shut up!
T: hm.
C: I don't know. I do know that I don't want to waste my time with you talking about her for the
whole hour (laughs). (shift / end of Topic Segment #1 / beginning of Topic Segment #2)
To date, topic segment analyses have been completed on 09 good outcome dyads
(Greenberg & Angus, 1993) and 09 poor outcome Brief Experiential psychotherapy dyads - a
total of a 270 fully analysed psychotherapy sessions. In terms of interrater agreement levels for
the identification of topic segment units in the transcript, it was found that after 20-25 hours of
14
training, raters were are able to establish a 90% hit rate (Cohen Kappa +.78) for both the
identification of Topic Segment units and the labelling of central issue and relational focus.
Once the therapy session transcript has been unitized according to topic shifts , each topic
segment is then further subdivided and coded in terms of shifts -- external, internal or reflexive --
in narrative process type. The resulting smaller units of text are coined narrative sequences. The
number of narrative sequences in each topic segment naturally varies. The client, and/or
client/therapist interaction, may remain in a certain narrative process mode throughout the entire
segment or shift between the three types. For rating purposes, a narrative process sequence
It has been found that with 25-30 hours of training time, raters are able to reliably
identify and categorize narrative sequence units in therapy session transcripts. Using a sample of
5 therapy transcripts, ratersinterrater agreement levels - 83% - 88% (Cohens Kappa .75) were
/ past, present or future), the narrative sequence is coded as External. Two distinctions can be
made within this narrative sequence type. The client may a) provide a general overview of the
event or b) highlight a specific incident or event (past, present or future; actual or imagined).
15
The following are markers to help the researcher identify external narrative sequences: a)
the description of personal memories, and therefore a shift in verb tense may indicate the start of
an External narrative sequence; b) concrete examples used to demonstrate issues raised in all of
the narrative sequence types; and c) an External narrative sequence may be describing either a
specific event, or an event which is a general description or composite of many specific events.
The following dialogue is an example of an External narrative sequence which was identified
C: OK. It's been a pretty hectic week. My mother-in-law arrived in town. She'll be staying with
us for two weeks. She's just taken over the house. She's cleaning everything. I mean, she even
went out and bought Ajax and spent almost an hour scrubbing the kitchen sink. I mean it's not
like the place was dirty. I made sure it was spotless before she arrived. The night before I even
got up to check everything over so I could clean whatever was missed. She always does this.
T: Okay, your mother-in-law arrived for a visit and what, the next day you walked into the
kitchen and she was cleaning your sink?
C: Yeah, she arrived Thursday afternoon. R.(husband) picked her up from the airport. The next
morning I dropped the kids off at school and when I got back there she was in the kitchen
scrubbing the sink, you know with Ajax. So I just stood there with a dazed look on my face and
said, you know, that she was on vacation and if the sink was dirty I would clean it. Well she said
something like she knew I was busy and she was only trying to help.
T: Mm-hm.
C: Yeah and like she always does this. (shift/end of External narrative sequence).
points of view, the narrative sequence is coded as Internal. It is an experiential description and
entails a description of how one feels in relation to one's self and/or to others. The following are
16
cues to help the researcher identify Internal narrative sequences: a) the therapist asks directly how
the client feels; b) frequent use of words describing emotions (eg. sad, angry, frustrated); c)
experiential states (ex. I feel as if I am going to explode!); and e) long pauses in which the
individual appears to be searching for words to articulate an experiential state. The following
segment :
T: Mm-hm. So how does it make you feel when she acts like this?
C: I feel like she's intruding. I mean, she's the guest. I don't know I just want to scream I get so
frustrated. She makes me feel hopeless, like a little kid. There is no point telling R.(husband).
He just sides with her. I just get really upset. Just feel like one of the kids when she's around.
T: Mm-hm. So when she visits you feel like she is the parent and you're the little kid?
C: Yeah. Like when she cleans or says that I'm not dressing my kids right I feel like I've failed
again. It is so aggravating. No matter how hard I try I can't please her. I think I'm starting to
experience panic attacks when I know she's coming for a visit.
T: Panic attacks?
C: Like before she arrived I had a headache for a week. My stomach was in a knot and I could
hardly eat. I just felt really tense and nervous. I just know that she will find something to
criticize me about.
Reflexive narrative sequences are identified when an individual focuses on the reflexive
these instances, the individual attempts to understand his or her own feelings regarding self,
others or events. The following cues help the researcher identify Reflexive narrative sequences.
17
The client may be actively : a) examining his or her own actions in situations/relationships; b)
planning future actions alternatives; c) examining his or her own thinking in situations; d)
exploring his/her own emotions in situations; e) discussing patterns in his/her behaviour and/or
that of others; or f) self-questioning using words such as "why," "maybe", "I guess," "I wonder,"
"I realize," "I think," "It could be," "I don't know" may all be markers depending on their context.
The following dialogue is an example of a Reflexive narrative sequence identified in the mother-
T: Mm-hm.
C: And I don't know why I feel so obsessed with pleasing her anyway. She usually only comes to
visit twice a year. I mean it's not like we're really close. I've talked to R.(husband) who says I
should just put up with her for 2 weeks, then forget about her. But I can't seem to do that.
Maybe it's because I felt she never thought much of me. She was against R.(husband) and I
marrying. We were still in school. She's always given me the impression that she thought
R.(husband) would marry someone who would be more than a housewife. Why don't I have the
guts to stand up to her? Why do I let her invade my home? I always let her take charge. I
should stand up for myself and tell her what I think about all her cleaning. Maybe it I stood up
to her she'd respect me more. Or at least she might shut up!
frequency and pattern of narrative sequences occurring within an individual therapy session or
across a completed therapy relationship, can be identified and evaluated. Furthermore, with this
strategy the predominance of particular narrative modes in different therapeutic modalities and/or
outcome groups can be evaluated. While our research investigations are at a preliminary stage of
development, some noteworthy trends have already emerged from our ongoing research
endeavours.
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More specifically, within the context of the Narrative Processes model, it is argued that it
is the pattern of narrative process sequences and topic segment shifts that is of interest for
psychotherapy practitioners and researchers, rather than the overall dominance of one narrative
sequence type or topic focus in the therapy. Specifically, the NPCS was designed to identify and
track the patterns of narrative sequences which occur most frequently in a particular therapeutic
modality as well as empirically ascertain the frequency with which therapists or clients initiate
shifts into the different narrative sequence categories. Given that therapists and clients are
viewed as co-constructing meaning during the therapy hour, it is expected that both clients and
therapists will initiate narrative sequence shifts during the therapy hour. The NPCS offers the
precise accounting of the number of narrative mode shifts initiated by client and therapist.
combinations of the three narrative process sequences in their theories of therapy, and therapists
adherence to these models can be empirically evaluated by means of the NPCS methodology.
sequence shifts) with an explicit goal of accessing emotional schemes (Internal narrative
sequences). Furthermore, with this approach, new meanings and understandings (Reflexive
narrative sequences) are viewed as emerging out of the processing and elaboration of emotional
Accordingly, within the context of the Narrative Processes model, the Process-
Experiential therapist would be expected to initiate client shifts into the description and
19
elaboration of felt emotions and feelings (Internal narrative process mode) followed by shifts to
the articulation and differentiation of new meanings (Reflexive narrative process mode)
emerging from the disclosure and processing of emotions. In essence, with this therapeutic
approach, new meanings are thought to emerge from the client's elaborated processing of core
emotional schemes in which a dynamic pattern of Internal and Reflexive narrative sequence
modes are viewed as essential for the facilitation of second-order or deep structural change
(Lyddon 1995). In contrast, the External mode is viewed primarily as a necessary starting point
for the real work of accessing and articulating felt emotions (Internal sequences) and elaborating
new meanings (Reflexive sequences). The analyses of narrative sequence patterns in good
outcome, brief Process Experiential therapies (Hardtke, 1996; Levitt, 1993) have confirmed that
effective Process-Experiential therapists do indeed consistently priorize shifts into Reflexive and
Using log linear statistical procedures, Levitt (1993) established that the predominance
and patterns of narrative sequence types identified in 3 early, 3 middle and 3 late sessions from 3
brief, good outcome psychotherapy dyads were significantly different from one another. For this
study, therapists representing three distinctly different modes of brief therapy intervention --
successful psychotherapy dyad for intensive narrative sequence analyses. Using standardized
outcome measures (Beck Depression Inventory; Beck et al.,1988; the Tennessee Self-Concept
Scale; Fitts, 1965 and the Social Adjustment Scale; Weissman & Bothwell,1976), all three
clients were identified as having achieved clinically significant outcomes at the termination of
All three clients were self-referred female adults who reported no previous psychiatric
history or use of psychotropic medication. All three therapists -- 2 male and 1 female -- had
over 20 years of therapeutic experience and 2 were founders of their respective therapeutic
are in need of broadened perceptual bases for processing and gathering information. The
increasingly functional and flexible perceptual processes can be developed. The Process-
Experiential orientation is emotionally focused and directed towards the evocation and
restructuring of emotional schemes (Greenberg, Rice & Elliott, 1993). Different Client-Centred
and Gestalt therapy interventions are used to facilitate clients emotional experiences and assist
on the assumption that psychological difficulties are rooted in unconscious inner conflicts and
relationship patterns and the use of interpretation distinguish this brief, psychodynamic therapy
approach. Adherence rating analyses of the selected therapy session tapes established that all
three dyads represented the core characteristics of their respective therapeutic models and
approaches.
All of the therapy sessions selected for analysis in this study were transcribed and then
randomly sorted for rating using the NPCS. Two clinical psychology graduate students
underwent 30 hours of NPCS training and then rated 5 randomly selected session transcripts
(20% of the total sample). The two raters established an inter-rater agreement level of 88% for
topic segment and narrative sequence identification (Cohens Kappa .75). A further sample of
21
three sessions were rated by both judges toward the conclusion of the analyses and confirmed
that inter-rater agreement levels had been maintained throughout the therapy session analyses.
In terms of the log-linear narrative sequence analyses, it was confirmed that the 3
therapeutic approaches were significantly different from one another in terms of both the number
of identified narrative sequences (p=0.0007) and the type of narrative sequences (External,
Internal, Reflexive) identified in the therapy sessions across the three therapy dyads (p=0.0001).
and External (54%) narrative sequences predominated in which therapist and client engaged in a
process of meaning construction (Reflexive) linked to the clients descriptions of past and current
revealed that External sequences in the Psychodynamic therapy sessions were either bounded by
Bucci (1995) argues that retrieving memories and describing life events in therapy may help
clients revive and experience specific emotional and cognitive states connected with the
(External sequences), and the elaboration of new understandings connected to these themes
(Reflexive sequences), the Psychodynamic therapist attempts to engender new perspectives and
sessions evidenced a pattern of Internal (29%) and Reflexive (46%) narrative sequences in which
the client and therapist engaged in a process of identifying and differentiating emotional
experience (Internal) and then generating new understandings of those experiences (Reflexive)
22
during the therapy hour. As compared to the other two dyads, the proportion of Internal
narrative sequences were three times higher in the Process-Experiential therapy sessions than in
the Perceptual-Processing sessions and five times higher than in the Psychodynamic sessions.
The primary goal of Process Experiential psychotherapy is to assist clients in developing more
differentiated and functional emotion schemes and the evidence from the NPCS analyses indicate
that this goal is achieved by an alternating focus on client exploration of experiential states
sequences) in which new feelings, beliefs and attitudes are contextualized and understood.
Reflexive narrative sequences (54%) occurring across topic segments in which client and
therapist engaged in extended reflexive analyses of both life events (External, 36%) and to a
lesser extent emotional experiences (Internal, 10%). The chaining of the Reflective narrative
sequences appeared to facilitate an extended client inquiry into core self-related issues in which
While the restricted sample size for this study necessarily limits the generalizability of
the findings, certain trends are worthy of note. The three Narrative sequence types do appear to
approaches. Moreover, the patterns and predominance of the Narrative sequence modes are
consistent with the stated goals and aims of the different therapy approaches. The next step in
the development of this research programme will be the investigation of narrative sequence and
topic segment patterns in larger samples of both good and poor outcome brief therapy dyads in
order to validate the findings emerging from this case study analysis.
23
While there has been an increasing interest in the identification of content topics (Brown
& Yule, 1983; Planalp & Tracy, 1980; Reichman, 1978; Sigman, 1983) and key content themes
(Luborksy & Crits-Christoph, 1990) in selected therapy sessions, very few psychotherapy
researchers (Milbrath, Bauknight, Horowitz, Amaro & Sugahar, 1995) have developed methods
or strategies to represent the emergence and predominance of content themes across therapy
sessions. The NPCS is in part designed to identify the frequency and pattern of content topics or
Processes Coding method, a topic segment shift is characterized by either the introduction of a
new topic or the elaboration of a specific facet of a broader topic domain. Furthermore, each
topic segment can be characterized in terms of the key issue under discussion and the relational
focus of the discussion. The collation and sorting of individual topic segments into recurring
relational and/or issue-based themes provides a method for naming and tracing the emergence of
core themes across therapy sessions. It is the analysis of core therapeutic themes which provides
an understanding of the content of the clients macro-narrative or life story as represented in the
As stated previously, topic shifts may initiate a clear change in content focus or they may
within-session topic shifting, with rapid shifting from one content domain to another, may
indicate that both client and therapist are having difficulty finding a sustained focus of inquiry in
the session (Rasmussen & Angus, 1996). In contrast, sessions in which clients and therapists
collaboratively initiate shifts into thematically related topics, or pursue facets of one content
24
domain, convey a sense of having established a shared focus of inquiry in the session
(Rasmussen & Angus, 1997). Therapists can strategically initiate topic facet shifts by asking
clients for specific information in relation to core issues, by asking clients to provide specific
examples of general concerns, and by identifying thematic connections between past concerns
and present issues. These strategies help to facilitate a shared, extended inquiry into key
concerns and also help to establish a sense of coherence and focus in the therapy hour.
Rasmussen & Angus, 1996; 1997) indicate the non-Borderline clients and their therapists identify
experiencing a sense of narrative coherence in their therapy sessions in which topic facet shifts
occur predominantly in the context of core client issues. Conversely, Borderline clients and their
therapists reported searching for and having difficulty finding shared understandings and
coherence in sessions in which topic segments frequently shifted from one seemingly
interviews conducted with the Borderline clients, Rasmussen & Angus (1996; 1997) argue that
disjunctive topic shifts were typically initiated by Borderline clients in response to feeling
emotionally overwhelmed in therapy sessions. In these instances, therapists focal inquiries were
experienced as feeling too close to home for Borderline clients comfort levels. Borderline
clients appeared to initiate topic shifts at these critical moments in therapy sessions in order to
shift awareness and attention away from internal feelings and emotions and instead focus on new
In turn, therapists report feeling confused, puzzled and frustrated by their Borderline
clients propensities to change topics at those critical moments in sessions. Therapists report
feeling less satisfied with therapy sessions in which there have been frequent topic shifts in the
therapy discourse. In particular, therapists seem to experience a lack of closure and describe
feeling as if little depth of understanding has been achieved in the therapy sessions.
Although these findings should be treated cautiously given the limited sample size, a few
interesting trends should be highlighted for psychotherapy practitioners. First, it may be helpful
for therapists to regard radical client-initiated shifts in topic focus as possible markers of client
emotional distress; especially when topic shifts occur in the context of moments of heightened
emotion in therapy sessions. Further exploration and articulation of what emotions the client
actually experienced in the session, prior to the initiation of the radical topic shift, may be a
productive route to accessing core conflicts and emotional schemes (Angus & Gillies, 1994).
coherence and focus in the therapy relationship by initiating topic facet shifts in the context of
salient client issues and concerns. Therapist facilitation of topic facet shifts helps both clients
and therapists to develop a more differentiated, contextual understanding of clients key concerns
and aids in the germination of core themes which integrate disparate client experiences across
sessions. And third, therapeutic interventions -- such as Gestalt two chair and empty chair
dialogues -- initiated within the context of core client themes, also function as topic facet shifts
in which more differentiated, new understandings of key client concerns emerge within sessions.
Discussion
26
within which to embed an understanding of the roles and functions of three narrative process
modes -- External, Internal and Reflexive -- as they relate to the construction of macro-narrative
themes in the therapy hour. It is argued that differing therapy approaches, in their theories of
therapy practice, priorize unique patterns of narrative sequence types in the quest to facilitate
significant client change. The NPCS is based on the primary assumptions articulated in the
Narrative Processes model and offers psychotherapy researchers a systematic, empirical method
for the identification of both content domains and narrative sequence types in therapy session
transcripts.
A definite strength of the NPCS is that it provides psychotherapy process researchers with
a standard unit of analysis for the segmentation of psychotherapy session transcripts representing
differing therapeutic approaches. Additionally, the NPCS tracks the processes of narrative
construction in therapy in at least three different ways. First, the recurrence of content identified
topic segments in the therapy discourse can be charted both within and across sessions and the
degree to which a focus emerges in the therapy discourse can be empirically evaluated.
Furthermore, using the topic segment labelling system, topics representing a particular
relationship issue can be easily identified in the coded therapy transcripts and then assessed for
(such as the Experiencing Scale; Klein, Mathieu-Coughlan & Kiesler, 1986). Second, the
narrative sequence patterns characteristic of good and poor outcome psychotherapies can be
Selected narrative sequence patterns can be further assessed using standardized process rating
27
measures. And third, the degree to which the client or therapist initiate topic segment and
The NPCS offers the promise of providing psychotherapy researchers with a rationally-
based, empirical method for the unitization of the therapy session discourse in terms of shifts in
narrative process sequence types. By providing psychotherapy researchers with a common unit of
analysis for the application of a variety of different process measures, research findings from
different research projects could be combined to increase the power of statistical analyses for the
assessment of therapeutic trends and outcomes. In essence, the NPCS may provide researchers
and clinicians with a shared framework for the implementation of collaborative projects in the
Ongoing research using the NPCS includes the sequential analyses of topic segment and
narrative sequence patterns in both good and poor outcome Client-Centred and Process-
narrative sequence patterns for further assessment of client vocal quality and depth of
experiencing in order to better understand the differential roles of the three narrative sequence
modes in the facilitation of client change. And finally, it will be important in future studies to
more fully explore the full range of roles and functions which narrative mode and topic changes
Authors Note
The authors gratefully acknowledge that this study was supported in part by a Standard Grant
from the Social Sciences and Humanities Research Council of Canada. We would also like to
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