An Examination of the Interrelation of Narrative and Emotion Processes in Emotion-Focused Therapy for Trauma

Abstract

According to narrative-informed approaches to psychotherapy, self-narratives that no longer align with lived experience, and thereby impede coherent meaning-making, often bring individuals into treatment. Exposure to trauma can result in fragmented or disorganized self-narratives, and Emotion-focused Therapy for Trauma (EFTT) (Paivio & Pascual-Leone, 2010) is one treatment approach that helps trauma clients access, explore, and integrate traumatic memories into coherent personal narratives. The Narrative-Emotion Process Coding System (NEPCS 2.0; Angus Narrative-Emotion Marker Lab, 2015) is a video-based coding system that consists of 10 narrative-emotion markers (i.e., client storytelling processes) that have been divided into three NEPCS marker subgroups, based on their degree of narrative-emotion integration: Problem, Transition, and Change markers. The aim of the current study was to examine the relationship between NEPCS markers and outcome (i.e., recovered vs. unchanged) across stage of therapy in a complex trauma sample receiving EFTT (N = 12 clients). The key hypotheses included: recovered clients would have significantly higher proportions of Transition markers in the early and middle stages of therapy, and significantly higher proportions of Change markers in the late stage of therapy, while unchanged clients would have significantly higher proportions of Problem markers across all stages of therapy. Additionally, recovered clients would have significantly higher proportions of shifting (i.e., movement between one NEPCS marker and a different NEPCS marker), and significantly higher proportions of productive shifting (i.e., movement away from Problem markers), whereas unchanged clients would have higher proportions of unproductive shifting (i.e., movement to Problem markers). Results suggested that, in line with theoretical expectations and previous NEPCS research applications, recovered clients showed significantly higher proportions of Transition and Change markers, whereas unchanged clients demonstrated higher proportions of Problem markers. Increased levels of NEPCS shifting, or flexibly moving between NEPCS markers, was also associated with recovery. Furthermore, recovered clients demonstrated significantly higher proportions of productive shifting, while their unchanged counterparts demonstrated more unproductive shifting, suggesting that the type of narrative flexibility may be an important prognostic indicator. A direction for future NEPCS research is to elucidate therapeutic interventions that facilitate client movement from unproductive to more productive modes of narrative-emotion processing.