Daniela Alves

Innovative Moments in Grief Therapy: Reconstructing Meaning Following Perinatal Death.

This article presents an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the Innovative Moments Coding System (IMCS). Inspired by M. White and D. Epstons narrative therapy, the IMCS conceptualizes therapeutic change as resulting from the elaboration and expansion of unique outcomes (or as we prefer, innovative moments), referring to experiences not predicted by the problematic or dominant self-narrative. The IMCS identifies and tracks the occurrence of 5 different types of innovative moments: action, reflection, protest, re-conceptualization, and performing change. Results documented the process of meaning reconstruction over the 6 sessions of treatment, and demonstrated the feasibility and reliability of analyzing narrative change in this form of grief therapy, opening it to comparison with other approaches.

Meaning Coconstruction in Group Counseling: The Development of Innovative Moments

This study discusses a model of group counseling, the narrative mediation path (NMP), which is a unique narrative, multimodal approach that combines four narrative modes (metaphoric, iconographic, writing, and bodily) and the narrative group. The purpose of the NMP is to foster reflexive processes with underachieving university students and to improve their academic performance. The study analyzes a single case of group counseling for seven underachieving economics students at an Italian university and the process of meaning construction among NMP narrative modes and the follow-up session. It applies the innovative moments coding system, a reliable method for studying change by tracking narrative innovations in sessions. More specifically, we focus on how innovative moments (IMs: action, reflection, protest, and reconceptualization) evolve during the four different narrative modes and the follow-up session. The findings suggest that the NMP fosters narrative innovations, mainly of a reflexive nature (reflection and reconceptualization). Moreover, during counseling and the follow-up session, the pattern of change is primarily characterized by reconceptualization IMs, the most complex form of narrative innovation.

Ambivalence and Innovative Moments in Grief Psychotherapy: The Cases of Emily and Rose

Several studies have suggested that the process of narrative change in psychotherapy occurs through the emergence and expansion of moments of novelty, known as innovative moments (IMs), that allow changes in the problematic self-narrative responsible for the clients suffering. However, as these IMs challenge typical (and problematic) ways of acting, feeling, and thinking, they may also generate discrepancy or uncertainty. Clients may reduce uncertainty by returning to the problematic self-narrative immediately after the emergence of an IM, thus ensuring the homeostasis of the previous meaning system. This cyclical movement is a form of ambivalence, which can maintain problematic stability across therapy and lead to therapeutic failure. In this study, we identified return to the problem markers (RPMs), which are empirical indicators of the ambivalence process, for all IMs in two cases of constructivist grief psychotherapy. Both cases evidenced a high percentage of IMs with RPMs, and the evolution of IMs and RPMs along treatment was significantly correlated. We suggest that stability of the ambivalence process in grief psychotherapy may represent a form of self-protection from the anxiety or guilt of releasing pain as a disconnection from the deceased.

Innovative Moments in Humanistic Therapy I: Process and Outcome of Eminent Psychotherapists Working with Bereaved Clients

This project entailed an intensive qualitative analysis of six-session psychotherapies conducted by three eminent humanistic psychotherapists working with bereaved clients. The Innovative Moments Coding System (IMCS), rooted in narrative therapy, is designed to measure change across therapy orientations. Research using the IMCS suggests that the psychotherapy change process occurs through the emergence, elaboration, and expansion of identifiable change moments for a client—innovative moments (IMs)—which present as exceptions to a clients presenting problematic narrative. There are five identified types of IMs: action, reflection, protest, reconceptualization (RC), and performing change (PC). The current study aimed to inform theory regarding the patterns of IMs across three humanistic approaches—constructivist, person-centered, and existential—when working with bereaved clients, while linking these patterns to observable change in each clients functioning. The alliance between each client and therapist was also assessed across the therapy process, showing consistently strong alliances across the three cases. Findings from the current study reinforce the salience of reflection, RC, and PC IMs in successful grief therapy cases, and also suggest the importance of meaning-making interventions in grief therapy. Clinical implications and suggestions for future research are also addressed.

Ambivalence in grief therapy: The interplay between change and self-stability.

ABSTRACT This article explores the role of ambivalence in grief therapy within a narrative framework. From this perspective, change starts with the occurrence of innovative moments, which can be nullified by reaffirmation of the problematic self-narrative as a sign of ambivalence. This study analyzed ambivalence in six complicated grief cases using the “Return to the Problem Coding System.” Markers of ambivalence emerged in all cases, with a decreasing profile in cases with greater symptomatic improvement, suggesting an association between clinical change and ambivalence evolution in therapy. Addressing ambivalence may bring to light important aspects of client’s self-reconstruction after a major loss.

Relational schemas as mediators of innovative moments in symptom improvement in major depression

Abstract Objectives: Innovative moments (IMs) are exceptions to the maladaptive framework of meaning that typically motivates clients to seek psychotherapy, and previous studies have shown that IMs are associated with psychotherapy outcomes. While IMs are exceptions that occur at the level of the therapeutic conversation, relational schemas are more stable patterns, and their increased flexibility may facilitate change during psychotherapy. With this in mind, we tested the hypothesis that IMs contribute to outcomes by improving the flexibility of relational schemas. Method: The Core Conflictual Relationship Theme (CCRT) was used to assess relational schemas. IMs were evaluated using the Innovative Moments Coding System. The sample included 22 clients diagnosed with major depressive disorder. The flexibility of the three components of the CCRT (Wishes, responses of the self (RS), and responses of others (RO)) were tested as mediators between IMs and outcomes. Results: The flexibility of the RS was a mediator between IMs and outcomes, but Wishes and RO were not. Conclusion: These findings align with previous research showing that RS is the component most open to change, whereas the other components seem less sensitive to change during brief therapy. Clinical or methodological significance of this article: This study shows the mediation role of relational schemas in the association between in-session events (innovative moments (IMs)) and the symptoms improvement. It contributes to the literature that emphasizes the importance of relational schemas in psychotherapy by using a mediation model, which has rarely been tested.

Innovative Moments in Humanistic Therapy II: Analysis of Change Processes Across the Course of Three Cases of Grief Therapy

The current study is an extension of a complementary investigation examining links between process and outcome within six-session psychotherapies in which three eminent psychotherapists each worked with a bereaved client, using person-centered, existential, and constructivist approaches, respectively. The Innovative Moments Coding System (IMCS) was used in both studies to examine processes of change in the moment-by-moment unfolding of grief therapy. The initial studys findings help inform theory regarding the relevance of humanistic interventions when working with bereaved clients, particularly those that help promote meaning making in the wake of loss. The current investigation extends the original by offering a fine-grained analysis of the progression of innovative moments (IMs) in the context of good-outcome grief therapy, liking specific therapy procedures with positive indicators of client functioning, while providing case illustrations of each therapy dyad. Findings highlight the promise of humanistic approaches in grief therapy, and suggest directions for further research in this area. Implications for future use of the IMCS in psychotherapy process and outcome research are also discussed.

Finding Meaning in Loss: A Narrative Constructivist Contribution

Bereavement, understood as the loss of a significant person through death, can challenge the mourner’s self-narrative in a way that requires active meaning reconstruction to revise or reinstate a sense of significance and security. When this natural process of making sense of the death and one’s life in its aftermath is complicated, meaning-oriented therapy can help to reconstruct a self-narrative that integrates the loss while also affirming the value of life. In this chapter, we address two narrative processes playing a central role in narrative change in the course of bereavement: the processing of the event story of loss and the accessing of the back story of the relationship to the deceased. We then outline a Meaning in Loss therapy protocol that encompasses distinct but complementary narrative-constructivist techniques, and illustrate its application in a case study.