The story-teller, the story and change : a narrative exploration of outcome in brief experiential treatments for depression

Abstract

Although conceptualizing clinical phenomena in terms of "narrative" has come under the purview of investigators in the psychotherapy research field, few have developed research agendas that include assessing treatment outcome from a narrative approach. Fuelled by the notion that the stories people tell about themselves are essential threads in the fabric of their self-identities, this study presents the first comprehensive investigation of participant post-treatment and follow-up change applying the Narrative Assessment Interview (NAI; Hardtke & Angus, 1998) and it illustrates the rich and meaningful material gleaned from a triangulated methodology. The NAI was developed for this study to provide a heuristic method to investigate the impact of psychotherapy treatment over time on clients' self-perception and on the aspects of self they wished to change in treatment, as illustrated by their stories. The NAI was administered at baseline, post-treatment and again 6-months following treatment to a sample of 20 participants who took part in a brief-experiential treatment program for depression. Comparative post-treatment analyses of participants' baseline NAI profiles indicated that the recovered group differed from the non-recovered group along the dimensions of self-perception, treatment goals in terms of desires for self-change, and degree of convergence between how they viewed themselves and how they perceived they were viewed by others. Analyses of participants' post-treatment and follow-up self-stories indicated differing patterns of autobiographical memory subtypes. Results also strongly suggested that those participants who recovered from their depression were able to solidify gains made in treatment in their stories of change, thereby suggesting that the ability to generate alternative stories may indeed be an important marker of client change and treatment efficacy. Qualitative analyses of the NAIs of two participants with contrasting outcomes highlighted the value of using a pluralistic approach in the investigation of the clients' experience of change, as well as illustrating the potential utility of the NAI as a tool for both researchers and clinicians.