Miguel M. Gonçalves

Narrative Therapy and the Nature Of “Innovative Moments” in the Construction of Change

In the narrative metaphor of psychotherapy, clients transform themselves by changing their life stories. According to White and Epston (1990), the construction of change occurs from the expansion of unique outcomes—or innovative moments, as we prefer to call them—that is, the development of episodes outside the problem-saturated narrative. Unique outcomes operate as exceptions to the rule (i.e., to the problem-saturated story) that can be changed to a new rule (i.e., a new narrative). We suggest that some forms of unique outcomes can operate as shadow voices (Gustafson, 1992) of the problem-saturated story, allowing a temporary release from the problem, but facilitating a return to it. In our view, there is a particular type of unique outcome—reconceptualization—that facilitates sustained change. This kind of innovation facilitates the emergence of a meta-level perspective about the change process itself and, in turn, enables the active positioning of the person as an author of the new narrative.

Innovative moments and change in narrative therapy

Abstract Narrative therapy suggests that change happens by paying close attention in therapy to “unique outcomes,” which are narrative details outside the main story (White & Epston, 1990). In this exploratory study, unique outcomes were analyzed in five good-outcome and five poor-outcome psychotherapy cases using the Innovative Moments Coding System (Gonçalves, Matos, & Santos, 2008). Across 127 sessions, innovative moments were coded in terms of salience and type. In accordance with the theory, results suggest that innovative moments are important to therapeutic change. Poor- and good-outcome groups have a global difference in the salience of the innovative moments. In addition, results suggest that two particular types of innovative moments are needed in narrative therapy for therapeutic change to take place: re-conceptualization and new experiences. Implications for future research using this model of analysis are discussed.

International comparisons of behavioral and emotional problems in preschool children: Parents' reports from 24 societies

International comparisons were conducted of preschool childrens behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

Tracking novelties in psychotherapy process research: The innovative moments coding system

Abstract This article presents a method for the assessment of innovative moments, which are novelties that emerge in contrast to a clients problematic self-narrative as expressed in therapy, the innovative moments coding system (IMCS). The authors discuss the theoretical background of the IMCS as well as its coding procedures. Results from several studies suggest that the IMCS is a reliable and valid coding system that can be applied to several modalities of psychotherapy. Finally, future research implications are discussed.

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.

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.

Innovative moments and change pathways: A good outcome case of narrative therapy

OBJECTIVES Our aim was to explore the development of innovative moments (i-moments) in therapeutic conversation and to study how they match our heuristic model that accounts for the development of change, drawn from previous empirical research. DESIGN In this therapeutic process research, we analysed a good outcome case of narrative therapy with a woman victim of intimate violence. METHODS This case, composed of 12 sessions, was analysed with the Innovative Moments Coding System: Version 1. This coding system allowed the identification of five different types of innovations (i-moments) that appeared during the therapeutic process: action, reflection, protest, re-conceptualization, and performing change. For each session, an index of temporal salience was computed, as the percentage of the time in the session that client and therapist spent talking about each i-moment. Our analysis procedures provided a quantitative and also a complementary qualitative approach. RESULTS Data showed that the types of i-moments emerged differently throughout the process. Early sessions were characterized mainly by action and reflection (low temporal salience), middle sessions were found to have mainly protest i-moments (low or middle temporal salience), and final sessions were characterized by the combination of high salient re-conceptualization and performing change i-moments. CONCLUSIONS Findings suggested that narrative change seems to develop in a cyclical way, in which different types of i-moments contribute to the development of a new self-narrative in different phases.

How collaboration in therapy becomes therapeutic: The therapeutic collaboration coding system

BACKGROUND The quality and strength of the therapeutic collaboration, the core of the alliance, is reliably associated with positive therapy outcomes. The urgent challenge for clinicians and researchers is constructing a conceptual framework to integrate the dialectical work that fosters collaboration, with a model of how clients make progress in therapy. AIM We propose a conceptual account of how collaboration in therapy becomes therapeutic. In addition, we report on the construction of a coding system - the therapeutic collaboration coding system (TCCS) - designed to analyse and track on a moment-by-moment basis the interaction between therapist and client. Preliminary evidence is presented regarding the coding systems psychometric properties. The TCCS evaluates each speaking turn and assesses whether and how therapists are working within the clients therapeutic zone of proximal development, defined as the space between the clients actual therapeutic developmental level and their potential developmental level that can be reached in collaboration with the therapist. METHOD We applied the TCCS to five cases: a good and a poor outcome case of narrative therapy, a good and a poor outcome case of cognitive-behavioural therapy, and a dropout case of narrative therapy. CONCLUSION The TCCS offers markers that may help researchers better understand the therapeutic collaboration on a moment-to-moment basis and may help therapists better regulate the relationship.

The role of mutual in-feeding in maintaining problematic self-narratives: Exploring one path to therapeutic failure

Abstract According to the authors narrative model of change, clients may maintain a problematic self-stability across therapy, leading to therapeutic failure, by a mutual in-feeding process, which involves a cyclical movement between two opposing parts of the self. During innovative moments (IMs) in the therapy dialogue, clients’ dominant self-narrative is interrupted by exceptions to that self-narrative, but subsequently the dominant self-narrative returns. The authors identified return-to-the-problem markers (RPMs), which are empirical indicators of the mutual in-feeding process, in passages containing IMs in 10 cases of narrative therapy (five good-outcome cases and five poor-outcome cases) with females who were victims of intimate violence. The poor-outcome group had a significantly higher percentage of IMs with RPMs than the good-outcome group. The results suggest that therapeutic failures may reflect a systematic return to a dominant self-narrative after the emergence of novelties (IMs).

A dynamic look at narrative change in psychotherapy: A case study tracking innovative moments and protonarratives using state space grids

Abstract This study aims to further the understanding of how innovative moments (IMs), which are exceptions to a clients problematic self-narrative in the therapy dialogue, progress to the construction of a new self-narrative, leading to successful psychotherapy. The authors’ research strategy involved tracking IMs, and the themes expressed therein (or protonarratives), and analysing the dynamic relation between IMs and protonarratives within and across sessions using state space grids in a good-outcome case of constructivist psychotherapy. The concept of protonarrative helped explain how IMs transform a problematic self-narrative into a new, more flexible, self-narrative. The increased flexibility of the new self-narrative was manifested as an increase in the diversity of IM types and of protonarratives. Results suggest that new self-narratives may develop through the elaboration of protonarratives present in IMs, yielding an organizing framework that is more flexible than the problematic self-narrative.