Motivation and emotion/Book/2023/Narrative therapy and emotion

Overview
Narrative therapy was first introduced by Michael White and David Epston in the early 1990s. (Poon, 2007) Throughout the development and establishment of this therapeutic approach, the key message that White and Epston aimed to address was that “each person’s life is a story in progress that can be viewed from a variety of perspectives and that can have any number of outcomes.” (Poon, 2007)

Narrative therapy can be described as a “strengths-based approach to psychotherapy”. (Rice, 2015) It encourages collaboration between the client and therapist, attempting to separate clients from their problems or traumas and empower them to feel capable of living the life they want. (Rice, 2015) When the client and therapist work together to focus on strengths rather than problems, this “helps promote a more collaborative atmosphere where the narrative therapist can admire the client outside of the problematic context.” (Rice, 2015) Ultimately, separating an individual from their problems and focusing on their strengths encourages the person to externalise their issues by “finding new and alternative ways of looking at things and exploring new possibilities about life”. (Poon, 2007) Emotions play a key role in shaping the narratives and stories that individuals construct, as they are “our primary way of making meaning.” (Greenberg, 2021) Narrating emotions helps individuals to express, understand, and share their emotions. The way that individuals tell stories influences how others react to their emotions, and impacts how individuals cope with emotions themselves. (Habermas, 2018)

Displayed in figure 1 is the amygdala. The amygdala plays a significant role in emotion formation and is the part of the brain that is responsible for interpreting incoming sensory information that should be considered of value or potentially threatening. (Greenberg, 2004) An individual’s feelings are a result of certain neuronal processes that occur within the cerebral cortex and subcortical structures, including the amygdala. (Šimić et al., 2021) The neuronal activations that arise from these parts of the brain are responsible for an individual’s thoughts, language, and behaviour. (Šimić et al., 2021)

Focus questions:
 * What effect does emotion have on narrative therapy?
 * In which circumstances is narrative therapy used?
 * How can specific motivation/emotion theories and research help?

What is Narrative Therapy?
Narrative therapy is a “strengths-based approach to psychotherapy” (Rice, 2015) and involves “understanding the stories or themes that have shaped a person’s life”. (Sween, 1998) Narrative therapy holds an individual’s stories or narratives as the “basic unit of experience”, acknowledging that “stories guide how people act, think, feel, and make sense of new experiences.” (Sween, 1998) Narrative therapy focuses on how these narratives are written and can be rewritten to allow people to address issues or traumas in a more productive way. (Sween, 1998)

The interpretation of an individual’s narratives or experiences is at the core of narrative therapy, ultimately allowing for these experiences to be broken down into narrative structures, providing a framework for understanding them. (Rice & Fisher, 2015) The narrative organisation of emotional experiences supplies a sequential timeframe, helping clients to identify a beginning, middle, and end to their story so that causal connections between actions and emotions can be identified and meaningfully understood. (Angus & Mcleod, 2004)

Narrative therapy is categorised as a “future focused approach” as it is goal directed. (Rice & Fisher, 2015) This means that narrative therapists focus on what the changes in the client’s life will look like when the problem is no longer as much of a problem, rather than focusing on the cause of the problem. (Rice & Fisher, 2015) Treatment plans are tailored by therapists to be more positively worded and emphasise the ways in which improvement will be noticed, rather than how the problem will be resolved. (Rice & Fisher, 2015)

In order to assist clients with shifting their perspectives, narrative therapy highlights the point that “a client or family will rely on their strengths to overcome problems in their lives.” (Rice & Fisher, 2015) This can be encouraging for the client as it fills them with the belief that they themselves are also a key part of the therapeutic process. (Rice & Fisher, 2015)

When is Narrative Therapy Used?
Narrative therapy is practiced in individual and group counselling settings, including family therapy. Using narrative therapy, a therapist will work with individuals or families to find an alternate solution by “externalising oppressive experiences, facilitating a revised narration of their maladaptive perspective which they have internalised”. (Ricks et al., 2014) In both individual and group therapy, therapists use narrative therapy techniques in conjunction with creative art and writing techniques to encourage clients to deep dive into their narratives to increase clients’ exploration. (Ricks et al., 2014) Ultimately, this helps clients to remove themselves from their “problem-saturated perspective”. (Ricks et al., 2014)

Additionally, narrative therapy is also useful when treating clients with trauma disorders, in particular individuals suffering from complex trauma and multiple traumas. The therapist will typically ask the patient to describe their emotions, thoughts, sensory information, and physiological responses in detail. (American Psychological Association, 2017) The patient establishes a chronological narrative of their life including both positive and traumatic experiences. It is believed that the technique of also incorporating positive narratives contextualises the network of cognitive, affective, and sensory memories within a client’s trauma. (American Psychological Association, 2017) This allows for the memory of a traumatic episode to be more easily refined and understood. (American Psychological Association, 2017)
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The Role of Emotion in Narrative Therapy
Throughout narrative therapy, the role of emotion is to add meaning to the client’s experiences. Emotions are typically shared with others by putting the experience into narrative form. (Habermas, 2018) Narrating emotions assists individuals with expressing, understanding, and sharing them. (Habermas, 2018)

Emotions and narratives interact to form meaning and sense of self, the evocation and articulation of emotions is critical to changing life narratives. (Angus & Greenberg, 2011) Emotions play a central role in narrative therapy, serving as the vehicle through which individuals give meaning to their experiences and construct their life stores. According to Angus and Greenberg (2011), emotions and narratives are closely connected in shaping individuals’ perception of reality and self-identity.

Emotion's Role in Narrative Formation and Expression
Emotion plays a significant role in narrative formation and expression within the context of narrative therapy, serving as the raw material that infuses narratives with depth, authenticity, and meaning. (Amir Assouline & Mendelsohn, 2023) Emotional arousal activates the amygdala, impacting the formation of long-term memories in relation to emotional events. (McGaugh et al., 1996)

Substantial evidence has established that when a particular experience involves high emotions, it will be remembered more clearly, accurately and for longer periods of time than a neutral event. (Tyng et al., 2017) Emotional memory enhancement involves "the integration of cognitive and emotional neural networks, in which activation of the amygdala enhances the processing of emotionally arousing stimuli while also modulating enhanced memory consolidation." (Tyng et al., 2017)

Narrative therapy provides a way for clients to express and process their emotions. (Amir Assouline & Mendelsohn, 2023) All individuals have daily experiences of events that they seek to make meaningful. The stories people hold about their lives are created by linking events together in a particular sequence across a time period, and finding a way of explaining or making sense of them. (Morgan, 2000) The meaning given to these narratives forms the plot of the story. Emotions influence the tone, perspective, and themes of these narratives, and act as a lens through which individuals interpret and make sense of their experiences. (Morgan, 2000)

Fun Fact: Emotions arise from activations of specialised neuronal populations in several parts of the cerebral cortex, notably the anterior cingulate, insula, ventromedial prefrontal, and subcortical structures, such as the amygdala, ventral striatum, putamen, caudate nucleus, and ventral tegmental area. (Šimić et al., 2021)

Externalisation within Narrative Therapy
One of the key principles in narrative therapy techniques is externalisation. This involves referring to client's problems as "entities in and of themselves". (Rice & Fisher, 2015) This technique of externalising can be understood in terms of scaffolding, beginning with low-level distancing tasks such as naming and characterising the problem, then building to high-level distancing tasks that have clients making plans to act upon the newly understood concepts they have formed. (Chan et al., 2012) This is in attempt to reduce the feeling that the problem resides within the individual, allowing the therapist and client to work together to describe ways of thinking about problems separate to the persons identity. (Rice & Fisher, 2015)

A substance abuse case study in a hospital in Hong Kong examined the potential of using photographs in narrative therapy to assist with externalising clients problems. The key observations from this study were that the proportion of higher-level distancing statements increased with the progression of the consultation, in line with the intended outcome of the therapeutic approach. (Chan et al., 2012)

Additionally, the techniques of externalisation and re-authoring can "significantly contribute to the development of children's social and emotional skills", evident through an empirical study conducted in 2016 which involved 353 8-10 year-old children over a two year period. (Beaudoin et al., 2016) Results from the study showed that children who were provided with the narrative therapy intervention significantly improved in terms of their "self-awareness, self-management, social awareness/empathy, and responsible decision making", when comparing data between their first stories as well as those in the control group. (Beaudoin et al., 2016) Findings also stated that there was no significant gender difference. (Beaudoin et al., 2016)

Narrative Therapy with an Emotional Approach
Narrative Therapy with an Emotional Approach (NTEA) is a therapeutic approach that combines elements of narrative therapy and emotion-focused therapy to help individuals understand and process their emotions. This approach allows a person to ‘re-author’ their life stories by focusing on positive interpretations, aiming to create new positive life narratives that focus on alternative stories instead of negative stories. (Seo et al., 2015)

Table 1. Narrative Therapy in comparison to Emotion-Focused Therapy

NTEA integrates these two approaches, seeking to help individuals to reframe their life stories and engage with and process their emotions in the context of these stories. By doing so, NTEA aims to foster a more positive sense of self and promote emotional well-being. (Seo et al., 2015) In practice, a therapist using NTEA would work with a client to explore and reconstruct their life narratives while simultaneously helping them to identify, understand and manage their emotions. (Seo et al., 2015) This integrated approach can be particularly effective in addressing issues related to identity, self-worth and emotional well-being. (Seo et al., 2015)

Case Study

A study investigated the effectiveness of Narrative Therapy with an Emotional Approach (NTEA) in treating depression.

The study involved 50 participants from Korea (ages not provided) with depression, divided into an experimental group (24 participants) and a control group (26 participants). The experimental group underwent eight sessions of the NTEA program. Various scales were used to measure the effects of the program, including self-awareness, hope, positive and negative emotions, and depression levels.

The results showed significant differences in hope, positive and negative emotions, and levels of depression between the experimental and control groups. This suggests that NTEA can be an effective intervention for individuals with depression, as it focuses on fostering positive experiences and helping patients construct affirmative life stories, ultimately contributing to a more positive sense of self.

Narrative Exposure Therapy and Trauma
Narrative Exposure Therapy (NET) is a treatment used for clients with trauma disorders, including complex trauma and multiple traumas. (American Psychological Association, 2017) This treatment style involves emotional exposure, in particular to the memories of traumatic events, as well as the reorganisation of these memories into a chronological narrative. (Robjant & Fazel, 2010) Within NET, the guidance of a therapist will help the client to establish a chronological narrative of their life, including both positive and traumatic experiences. The incorporation of positive experiences into the narrative can contextualise the network of cognitive, affective, and sensory memories within a client’s trauma. (American Psychological Association, 2017) Ultimately, this allows for the memory of a traumatic episode to be filtered and understood by the client in a simpler way. (American Psychological Association, 2017)

Through their ability to resonate with clients’ emotions and provide empathetic support, therapists create a safe space for this transformational work. (Gelso, 2011) The integration of emotions into narrative exposure therapy is essential for addressing trauma. Research on the brain and trauma indicates that traumatic experiences can alter neural pathways and impact memory encoding (van der Kolk, 2015).

NET provides the patient with a sense of freedom to reflect on their own life, in turn cultivating a feeling of personal identity. (American Psychological Association, 2017) This provides a different approach to many other treatments, as it places a clear focus on recognising and creating a recollection of events that occurred in a way that recaptures the patient’s self-respect and acknowledges their human rights. (American Psychological Association, 2017)

Narrative Exposure Therapy and Trauma Recovery
NET is used to treat the effects of trauma, particularly in refugees, and to prevent psychiatric illness. (Gwozdziewycs, 2013) This typically involves helping the individual to recount the story of what happened to them until it no longer elicits anxiety.

A meta-analysis on the use of NET for the effects of trauma among refugee populations reviewed all quantitative studies related to narrative exposure methods for treating trauma or post-traumatic stress disorder in refugees. Results found that "the ability to construct healthy narratives of traumatic experiences corresponds to a healthy recovery process." (Gwozdziewycs, 2013)

Another useful aspect of NET in trauma recovery is that it involves emotional exposure to the memories of traumatic events and the reorganisation of these memories into a coherent chronological narrative. (Robjant & Fazel, 2010) This acknowledges the impact of emotions on personal narratives and facilitates the exploration and expression of these feelings. Results from treatment trials in adults have demonstrated the superiority of narrative exposure therapy in reducing PTSD symptoms compared with other therapeutic approaches. (Robjant & Fazel, 2010)

Emerging evidence states that "NET is an effective treatment for PTSD in individuals who have been traumatised by conflict and organised violence, even in settings that remain volatile and insecure." (Robjant & Fazel, 2010)


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Emotional Resonance and Empathy
A therapist’s ability to connect with clients and their emotions is a key aspect of effective narrative therapy. Emotional resonance involves the therapist’s genuine understanding of the client’s feelings. Rogers (1951) defined what he considered to be the active components in the therapeutic relationship as empathy, congruence, and unconditional positive regard. These were seen as the ideal conditions offered by the therapist. (Ardito & Rabellino, 2011) Through empathy, therapists can help clients feel heard, understood and supported in their journey towards narrative transformation. (Gelso, 2011)

Emotional Coherence and Integration
Assisting clients with integrating their emotional experiences into narratives is one of the key tasks of a therapist in narrative therapy. There are two strategies therapists can use in these situations, including asking deconstructive questions and re-authoring questions.

Deconstructive questions are used to help narrative therapists and their clients to better understand the clients’ prob­lems and dominant narratives. (Rice & Fisher, 2015) This approach helps narrative therapists to learn about the influence and effect of a problem on clients.

Similarly, re-authoring questions help to build and support alternative stories by "examining life outside the problem." (Rice & Fisher, 2015) This also helps to "clarify client preferences and values, develop alternative stories in realms of action and meaning, examine new possibilities from alternative stories, and develop support for the enactment of new stories." (Rice & Fisher, 2015)

By combining these two approaches, clients are more easily able to weave their emotions into a comprehensive and positive story. Achieving emotional coherence allows clients to develop a more integrated sense of self and a deeper understanding of their own narratives. (Dan-Glauser & Gross, 2013)

Cultural Variation in Emotional Expression
Narratives encompass an active act of sense making through which individuals give meaning from their experiences in line with their cultural expectations. (Wang et al., 2017) Within emotion-centric narrative therapy, it is important to recognise and respect cultural diversity. (Wang et al., 2017) Cultural norms significantly influence how individuals express and navigate emotions, and therapists are required to be aware of this to understand that what may be considered appropriate emotional expression in one culture, may differ in another. The integration of culture can enlighten therapists to better understand the cognitive and social underpinnings of narratives. (Wang et al., 2017)

Ethical Navigation of Intense Emotions in Emotion Focused Therapy (EFFT)
Narrative processes in EFTT focus on the quality of client narratives, including how a client recounts his or her experiences. (Angus & Paivio, 2017) Therapists trained in this approach pay attention to the presence and type of affective experience, level of emotional arousal and engagement with trauma material and narrative coherence. This involves providing appropriate support and coping mechanisms, as well as establishing boundaries to prevent emotional overwhelm. Narrative process interventions access healthy sub-dominant aspects of the client's experience and use these to promote construction of more detailed and meaningful narratives. (Angus & Paivio, 2017)

Conclusion
Throughout this book chapter, the key aspects of narrative therapy have been explored. The strengths-based approach to psychotherapy provides a strong focus on the ways in which narratives are written and can be rewritten to better equip individuals to address their issues or traumas. Key narrative therapy techniques such as externalisation, deconstructive questions and re-authoring questions have been explored and explained, and the role of emotion in narrative formation and expression has been analysed, revealing that when an experience involves high emotions, it is remembered more clearly, accurately and for longer periods of time than a neutral event. Various other therapeutic methods have also been analysed, such as NET, EFFT and emotion-centric narrative therapy, to further explore the connections between narrative therapy, emotion and trauma.

Answers to focus questions


 * Emotions serve as the raw material that infuses narratives with depth, authenticity, and meaning. Emotional arousal activates the amygdala, impacting the formation of long-term memories in relation to emotional events. Emotions influence the tone, perspective, and themes of narratives.
 * Narrative therapy is practiced in individual and group counselling settings, and used to treat clients with various types of trauma. By incorporating positive narratives into story-telling, this contextualises the network of cognitive, affective, and sensory memories within a client’s trauma.
 * EFTT focus on the quality of client narratives, including how a client recounts his or her experiences, promoting the construction of more detailed and meaningful narratives. NET can be used to treat the effects of trauma, particularly in refugees, and typically involves the individual recounting the narrative of their traumatic experience until it no longer elicits anxiety.

Key takeaways


 * The purpose of narrative therapy is to separate individuals from their problems, allowing them to view their experiences more positively and better cope with emotional distress or trauma.
 * Emotions and narratives interact to form meaning and sense of self, the evocation and articulation of emotions is critical to changing life narratives.
 * Emotional arousal activates the amygdala, impacting the formation of long-term memories in relation to emotional events.
 * Narrative therapy provides a strong focus on the ways in which narratives are written and can be rewritten to better equip individuals to address their issues or traumas.