Comparing Narrative and Emotion Processing in Two Versions of Emotion-Focused Therapy for Trauma: Imaginal Confrontation vs. Empathic Exploration

A goal of Emotion-Focused Therapy for Trauma (EFTT) is narrative and emotion integration for trauma recovery (Paivio & Pascual-Leone, 2010). EFTT employs two re-experiencing interventions. Clients in Imaginal Confrontation (IC) imagine the perpetrator of abuse in an empty chair across from him/her and express thoughts and feelings. Clients in Empathic Exploration (EE) imagine the perpetrator in their minds eye and expresses thoughts and feelings to the therapist. EE is considered a less emotionally evocative alternative to IC. EFTT-IC and EFTT-EE are equally effective (Paivio et al., 2010), and may evidence unique pathways to recovery. The Narrative-Emotion Process Coding System (NEPCS; Angus et al., 2017) is a behavioural coding system that identifies 10 markers that are clustered into Problem, Transition, and Change Markers. The NEPCS markers and subgroups represent narrative-emotion process indicators occurring within one-minute time segments from videotaped therapy sessions.

The current study investigated differences in the proportion of NEPCS markers and subgroups between the EFTT-IC and EFTT-EE conditions, and the relation to treatment outcome. The NEPCS was applied to two early, two middle and two late videotaped therapy sessions from four recovered and four unchanged EFTT-IC and EFTT-EE clients (N=16). In regard to Problem Markers, Negative Binomial Regression analysis revealed a main effect for Problem Markers, and a main effect and stage by condition interaction for Superficial Storytelling for EFTT-EE versus EFTT-IC. There was a stage by outcome interaction for Unstoried Emotion for unchanged versus recovered EFTT-IC clients. In regard to Transition Markers, there was a stage by condition interaction for the Transition Markers in EFTT-IC than EFTT-EE, and a stage by outcome interaction for Inchoate Storytelling for recovered versus unchanged EFTT-EE clients. In regard to Change Markers, a stage by outcome interaction was present for Unexpected Outcome Storytelling and Discovery Storytelling for recovered versus unchanged EFTT-IC and EFTT-EE clients. Finally, there was a main effect and a stage by condition interaction for No Client Marker for EFTT-IC versus EFTT-EE clients, and a stage by outcome interaction for recovered versus unchanged EFTT-EE clients. Implications for EFTT therapists, limitations of the current study and directions for future research are discussed.