Lynne Angus

Narrative change in emotion-focused therapy: How is change constructed through the lens of the innovative moments coding system?

Abstract The aim of this study was to advance understanding of how clients construct their own process of change in effective therapy sessions. Toward this end, the authors applied a narrative methodological tool for the study of the change process in emotion-focused therapy (EFT), replicating a previous study done with narrative therapy (NT). The Innovative Moments Coding System (IMCS) was applied to three good-outcome and three poor-outcome cases in EFT for depression to track the innovative moments (IMs), or exceptions to the problematic self-narrative, in the therapeutic conversation. IMCS allows tracking of five types of IMs events: action, reflection, protest, reconceptualization, and performing change. The analysis revealed significant differences between the good-outcome and poor-outcome groups regarding reconceptualization and performing change IMs, replicating the findings from a previous study. Reconceptualization and performing change IMs seem to be vital in the change process.

EMPATHIC RELATIONAL BONDS AND PERSONAL AGENCY IN PSYCHOTHERAPY: IMPLICATIONS FOR PSYCHOTHERAPY SUPERVISION, PRACTICE, AND RESEARCH

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Innovative Moments and Change in Emotion-Focused Therapy: The Case of Lisa

This article presents an intensive analysis of a good-outcome case of emotion-focused therapy—the case of Lisa—using the Innovative Moments Coding System (IMCS). IMCS, influenced by narrative therapy, conceptualizes narrative change as resulting from the elaboration and expansion of narrative exceptions or unique outcomes to a clients core problematic self-narrative. IMCS identifies and tracks the occurrence of five different types of narrative change: action, reflection, protest, reconceptualization, and performing change. This is the first attempt to use the IMCS with cases outside the narrative tradition. We discuss the results, emphasizing the commonalities and major differences between this case and other good-outcome cases.

Maintenance of Gains Following Experiential Therapies for Depression.

Follow-up data across an 18-month period are presented for 43 adults who had been randomly assigned and had responded to short-term client-centered (CC) and emotion-focused (EFT) therapies for major depression. Long-term effects of these short-term therapies were evaluated using relapse rates, number of asymptomatic or minimally symptomatic weeks, survival times across an 18-month follow-up, and group comparisons on self-report indices at 6- and 18-month follow-up among those clients who responded to the acute treatment phase. EFT treatment showed superior effects across 18 months in terms of less depressive relapse and greater number of asymptomatic or minimally symptomatic weeks, and the probability of maintaining treatment gains was significantly more likely in the EFT treatment than in the CC treatment. In addition, follow-up self-report results demonstrated significantly greater effects for EFT clients on reduction of depression and improvement of self-esteem, and there were trends in favor of EFT, in comparison with CC, on reduction of general symptom distress and interpersonal problems. Maintenance of treatment gains following an empathic relational treatment appears to be enhanced by the addition of specific experiential and gestalt-derived emotion-focused interventions. Clinical and theoretical implications of these findings are presented.

Narrative and emotion integration in psychotherapy: Investigating the relationship between autobiographical memory specificity and expressed emotional arousal in brief emotion-focused and client-centred treatments of depression

Abstract Clinically depressed individuals have consistently been shown to demonstrate a bias for overgeneral autobiographical memory (ABM) disclosure, a strategy used to protect against the access of intense, primary emotions that may accompany specific memories. The present study examined how ABM specificity in client narratives was related to expressed emotional arousal in brief emotion-focused and client-centred psychotherapy for depression. Emotion episodes identified in two early-, two middle-, and two late-therapy transcripts drawn from 34 clients from the York I Depression Study were rated for degree of ABM specificity and expressed emotional arousal. A hierarchical linear modelling analysis demonstrated that greater ABM specificity was associated with higher expressed emotional arousal for clients who were no longer depressed at therapy termination.

Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive–behavioural therapy

Abstract Expectancy violations have generally been neglected in psychotherapy research but may have important implications for therapy process and outcome. A qualitative approach was used to examine discrepancies between actual experience and expectations in client posttreatment accounts of cognitive–behavioural therapy. Nine good- and nine poor-outcome cases were included. Good-outcome clients frequently reported disconfirmation of process expectations, including surprise that therapy was collaborative, that they had the freedom to direct therapy, and that they were comfortable and could trust the process. Poor-outcome clients generally failed to report such experiences. Good-outcome clients also reported gaining more from treatment than expected, whereas poor-outcome clients reported being disappointed. These findings suggest an important role for expectancy disconfirmation in therapy.

Therapist empathy and client anxiety reduction in motivational interviewing: “She carries with me, the experience”

In this article, we examine the use of motivational interviewing (MI) to treat generalized anxiety disorder (GAD) by means of case illustration that focuses on four categories drawn from the clients experience of the key ingredients in MI therapy. The case illustration, drawn from the York study on combining MI and cognitive behavior therapy in the treatment of GAD (uses the clients pre- and post-therapy narrative interviews) to arrive at categories representative of the clients experience of MI therapy. The results of the qualitative analysis highlight the key contributions to positive client outcomes and readiness for change in brief MI therapy for GAD.

Toward an integrative understanding of narrative and emotion processes in Emotion-focused therapy of depression: Implications for theory, research and practice

Abstract This paper addresses the fundamental contributions of client narrative disclosure in psychotherapy and its importance for the elaboration of new emotional meanings and self understanding in the context of Emotion-focused therapy (EFT) of depression. An overview of the multi-methodological steps undertaken to empirically investigate the contributions of client story telling, emotional differentiation and meaning-making processes (Narrative Processes Coding System; Angus et al., 1999) in EFT treatments of depression is provided, followed by a summary of key research findings that informed the development of a narrative-informed approach to Emotion-focused therapy of depression (Angus & Greenberg, 2011). Finally, the clinical practice and training implications of adopting a research-informed approach to working with narrative and emotion processes in EFT are described, and future research directions discussed.

Narrative change in emotion-focused psychotherapy : a study on the evolution of reflection and protest innovative moments

Abstract Innovative moments (IMs) are exceptions to a clients problematic self-narrative in the therapeutic dialogue. The innovative moments coding system is a tool which tracks five different types of IMs—action, reflection, protest, reconceptualization and performing change. An in-depth qualitative analysis of six therapeutic cases of emotion-focused therapy (EFT) investigated the role of two of the most common IMs—reflection and protest—in both good and poor outcome cases. Through this analysis two subtypes (I and II) of reflection and protest IMs were identified, revealing different evolution patterns. Subtype II of both reflection and protest IMs is significantly higher in the good outcome group, while subtype I of both IMs types does not present statistically significant differences between groups. The evolution from subtype I to subtype II across the therapeutic process seems to reflect a relevant developmental progression in the change process.

Introduction. One case, multiple measures: An intensive case-analytic approach to understanding client change processes in evidence-based, emotion-focused therapy of depression

There is an emerging consensus in the psychotherapy research literature (Kazdin, 2008; Moras, 2006; Westen, Novotny, & Thompson-Brenner, 2004) that a more differentiated and specific understanding of how client change occurs is critical for the identification of key mechanisms of change in evidence-based treatments of depression. Additionally, as Greenberg (1986) points out, converging strands of research evidence are required in order to provide a convincing case for the therapeutic effectiveness of specific evidence-based treatments. In light of these concerns, single-case methods have recently gained attention as an effective way to demonstrate the usefulness of clinical interventions and provide insight into the specific nature of change processes that contribute to effective therapeutic outcomes (Castonguay, 1993; Mergenthaler, 2008; Morgan & Morgan, 2001), especially in the context of community-based samples (Fishman, 2007; Lampropoulos et al., 2002). Curiously, the potential contributions of intensive case-analytic methods for enriched theory building and elaboration (Stiles, 2007), in the context of completed randomized controlled trials (RCTs) of evidence-based treatments of depression (Angus & Hardtke, 2007), have received far less attention in the research literature. The purpose of this special section is to address this gap in the psychotherapy research literature. Recognizing the potential benefits of RCT design for multiple single-case analyses, Les Greenberg and Lynne Angus codeveloped the York I therapy transcript data bank, which now contains all session transcripts for six recovered and six unchanged clients who participated in the York I RCT. This transcript data bank has become a rich spawning ground for international psychotherapy process research collaborations in North America and Europe and was the basis for two research symposia presented at the 2004 International Conference of the Society for Psychotherapy Research in Rome. The papers in panels addressed a diverse array of process research findings emerging from the intensive singlecase analysis of Lisa, a young woman who underwent emotion-focused therapy of depression (York I RCT) and demonstrated clinically significant change, and recovery status, at therapy termination and 6-month follow-up. In light of the lively discussions sparked by the panel presentations in Rome, and in the context of exploring the potential contributions of intensive case analyses for the identification of key processes of change and enriched theory building in evidenced-based treatments, this special section presents four studies that afford readers an opportunity to conduct their own indepth, critical analyses of convergent and divergent findings emerging from the application of five different measures of client change processes evidenced in one intensive case analysis of emotionfocused therapy of depression: the case of Lisa.