The Emergence of Innovative Moments in Narrative Therapy for Depression: Exploring Therapist and Client Contributions

Abstract

According to the narrative framework, clients seek therapeutic help due to the constricting nature of problematic self-narratives and psychotherapy should contribute to the elaboration of narrative novelties and innovative self-narratives. We term these narrative novelties as innovative moments (IMs) and developed the Innovative Moments Coding System (IMCS) to study them in psychotherapeutic discourse, differentiating five types of IMs: action, reflection, protest, reconceptualization and performing change IMs. Previous research studies using the IMCS with narrative therapy, emotion-focused therapy and client-centered therapy show that action, reflection and protest IMs appear in good (GO) and also in poor outcome (PO) cases while, reconceptualization and performing change IMs are more typical of good outcome (GO) cases. In this study, we will address how these IMs are co-constructed in the therapeutic dialogue through the discussion of three particular forms of IMs’ emergence in psychotherapy. These forms of emergence refer to different degrees of client and therapist participation: (1) IMs produced by the therapist and accepted by the client; (2) IMs prompted by the therapist and developed by the client; and (3) IMs spontaneously produced by the client. The exploratory analysis of three initial, three middle and three final sessions of contrasting cases (a GO and a PO) of narrative therapy for depression showed that IMs produced by the therapist were more associated to the PO case, while IMs prompted by the therapist were more associated to the GO case.

Ambivalence, resistance, and alliance ruptures in psychotherapy: It’s complicated.

“…A prototypical example would be “I felt less depressed this week and happier, but I’m still a depressed person.” The first part of the sentence is an innovative moment, the second—a devaluation of the change occurred (i.e., an ambivalence marker). The presence of ambivalence markers is predictive of unsuccessful therapy, both in narrative, as well in cognitive-behavioral therapy (Braga et al, 2018), whereas innovative moments alone may or may not contribute to outcome, depending on the different type of innovative moment and different degree of client-therapist participation (Cunha, Spínola, & Gonçalves, 2013).…”

Exploring innovative moments in a brief integrative psychotherapy case study.

“…The case study methodology presented here is in accordance with previous case study approaches examining IMs, with the aim of contributing to the growing field of research concerning the role of IMs in therapeutic change (e.g., Alves, Fernández-Navarro, Baptista, et al, 2014; Cunha, Spínola, & Gonçalves, 2013; Ribeiro, Bento, Salgado, Stiles, & Gonçalves, 2011). The uniqueness of case study methodology in psychotherapy, contrary to research conducted at the sample level, is that it allows for direct access to the phenomenon (Stiles, 2007), and permits a multiplicity of unique and complex observations.…”

Reconceptualization innovative moments as a predictor of symptomatology improvement in treatment for depression

“…It is expressed as a temporal contrast between past problematic aspects of the self (e.g., I was …) and more adaptive present ones (e.g., I am …). CP describes an understanding of the process of how and/or why this shift was possible to attain, according to the clients' perspective (Cunha, Spínola, & Gonçalves, ; Gonçalves et al, ; Gonçalves & Silva, ). The following clinical vignette (translated from one of the cases analysed in the present study) illustrates reconceptualization's two components.…”