The Narrative Processes Coding System: Research Applications and Implications for Psychotherapy Practice

Lynne Angus, Heidi Levitt, and Karen Hardtke

Department of Psychology, York University, North York, Ontario

The Narrative Processes model is focused on the strategies and processes by which a client and therapist transform the events of everyday life into a meaningful story that both organizes and represents the clients sense of self and others in the world. Some investigators have elected to use clients within session descriptions of relationship events or micronarratives as their unit of narrative analysis. In contrast, we are centrally interested in the development of the macronarrative framework in which the singular events described in a therapy relationshipmicronarrativescome to be articulated, experienced, and linked together in such a way that the clients sense of his or her life storyin essence, the sense of selfmay be transformed at the conclusion of the therapeutic relationship. The following paper details the Narrative Processes theory of therapy and the coding system that has been developed to identify and evaluate empirically key components of the model. Findings emerging from the analyses of successful psychotherapy dyads are described and the implications for future research and practice are discussed. 1999 John Wiley & Sons, Inc. J Clin Psychol 55: 12551270, 1999.

Psychotherapy researchers (Gonalves, 1995; Luborsky, Barber, & Digeur, 1992; McLeod & Balamoutsou, 1996; Neimeyer, 1995) have begun recently to address the role of narrative in psychotherapy, and in so doing have borrowed largely from the conventions of written narrative form to guide their selection and analysis of stories told in therapy sessions. A growing chorus of psychotherapy practitioners (Schafer, 1992), linguistic
The authors gratefully acknowledge that this study was supported in part by a Standard Grant from the Social Sciences and Humanities Research Council of Canada. Correspondence concerning this article should be addressed to Lynne Angus, Department of Psychology, Rm. 213, York University, 4700 Keele Street, North York, Ontario, Canada, M3J 1P3.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 55(10), 12551270 (1999) 1999 John Wiley & Sons, Inc.

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researchers (Gee, 1985), and psychotherapy process researchers (Angus, Levitt & Hardtke, 1994; Angus & Hardtke, 1994) is suggesting the stories that unfold in the context of the coconstructive, spoken dialogue of the therapy session are different in form, and at times function, from written accounts of life events. This perspective on the therapy dialogue is consistent with Schafers (1992) notion of narration in psychotherapy in which he argues that oral narratives in therapy sessions are not like literary fiction in which there is a clear beginning, middle, and end to the story. For Schafer, the acts of narrating, giving an account, presenting a version, developing a story line, telling, revising, and reinterpreting are all core components of the narrational approach and are key to successful outcomes in psychodynamic psychotherapy. Findings emerging from a series of studies (Levitt, 1993; Greenberg & Angus, 1993; Angus & Hardtke, 1994; Hardtke, 1996) analyzing narrative-discourse parameters in psychotherapy sessions, drawn from a variety of therapy approaches, offers empirical support for a broader application of Schafers narrational approach to conceptualizations of psychotherapy discourse as a whole. Specifically, the Narrative Processes theory of therapy (Angus & Hardtke, 1994) is predicated on the assumption that all forms of successful psychotherapy entail the articulation, elaboration, and transformation of the clients self-told life story or macronarrative. Both client and therapist achieve this goal by collaboratively engaging in 3 distinct modes of inquiry: 1) External Narrative Mode, which entails the description and elaboration of life events in which the question of what happened is addressed; 2) Internal Narrative Mode, which entails the description and elaboration of subjective feelings, reactions, and emotions connected with the event that addresses both the question of what was felt at the moment the event was occurring, as well as what is experienced now in the therapy session; and finally 3) Reflexive Narrative Mode, which entails the reflexive analyses of issues attendant to what happened in the event (external) and what was felt (internal) in which the question of what does it mean is addressed. These narrativeprocessing modes encompass both the cognitive and experiential strategies that both clients and therapists engage in when coconstructing stories about self and others. The Narrative Processing approach to psychotherapy has clear implications for both psychotherapy researchers and practitioners. In the following paper the components of the Narrative Processes Coding Modelnarrative-process sequences and topic segmentsand Coding System will be addressed first, followed by a discussion of relevant research applications for the coding system and practice implications for psychotherapy practitioners. Narrative Processes Model According to the Narratives Processes theory of therapy, the goals of productive therapy are threefold. First of all, the client and therapist focus on the remembrance of past events and the description of current events and imagined experiences in order to fill the gaps of what has been forgotten or never fully acknowledged, and hence, not understood. Secondly, client and therapist undertake a detailed unfolding and exploration of associated perceptions, sensations, emotions, and thoughts such that the lived experiences of the event can be engaged, and perhaps articulated, for the first time. The third goal entails the reflexive analysis of the related experiences and circumstances of what happened such that a new understanding or story is formed that either supports or challenges the implicit beliefs about self and others that underscore the dominant narrative. In the context of psychoanalytic psychotherapy, Nye (1994) argues that much of the work of exploring and reconstructing the meaning of events or memories happens in the

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dialogue between client and therapist, in the talk about the events that have occurred in the clients life. Accordingly, in order to understand how narrative functions in psychotherapy, it is also critical that we examine the reflexive talk about events in which client and therapist collaborate in the generation of new ways of conceptualizing and seeing the clients life story. In the context of the Narrative Processes model, the descriptions of subjective experiencing and relationship events are viewed as providing both clients and therapists with a rich spawning ground for the creation of new meanings and shared understandings. In terms of the functions of spoken narratives, we argue that in the External sequences the narrator or client attempts to verbally show the therapistby means of descriptive, specific detailsthe scene, setting, and actions entailed in an event. The more detailed and specific the description provided by the client, the more opportunity the therapist has to develop an imagistic rendering of the event and to adopt empathically the internal frame of the client. Additionally, a number of investigators (Bucci, 1995; Salovey & Singer, 1993; Borkovec, Roemer, & Kinyon, 1995) argue that the articulation of a detailed description of an episodic memory may provide the client with an opportunity to access more fully emotions and thoughts experienced in the context of a past event. Accordingly, some therapists intentionally will shift clients into an External narrative sequence by asking the client to give a detailed concrete example or life event to exemplify a general concern or issue in order to facilitate a reexperiencing as opposed to a retelling of past memories and significant events. A growing number of developmental (Stern, 1989) and personality researchers (Epstein, 1984; Janoff-Bulman, 1992; Salovey & Singer, 1994) are suggesting that key episodic memories may function as schemas or templates in the context of the development of the individuals self theory, or what we term the clients macronarrative. Epstein (1984) points out that a persons theory of self and the worldmacronarrativeis a preconscious, experiential, and conceptual system that automatically structures experiences and directs actions. A key therapeutic strategy to access core components of the clients macronarrative is to ask clients to describe significant memories present to conscious awareness and to encourage the articulation of important but forgotten past experiences and events in the context of External narrative sequences. The generation of new experiential and conceptual meanings in the context of the External narrative sequences emerges the engagement in both Internal and Reflexive narrative-process sequences. Internal sequences function to show or describe to the therapist the emotions and feelings reexperienced by the client in the showing and telling of the event (external) or entail the description of new emotions or feelings emerging in the moment during the therapy session. In the context of dealing with physical and psychological trauma, Harber & Pennebaker (1992) have provided compelling research findings that demonstrate that emotional disclosure in the context of trauma narratives is predictive of positive immunesystem response in survivors. In a similar vein, Borkovec et al. (1995) argue that obsessive worrying in distressed clients functions to suppress the key psychological change processes of imagery recall, affect, and emotional processing in the context of the experienced traumatic events. For Borkovec et al., the articulation and processing of distressing emotions is a key therapeutic task when working with chronically anxious clients. While a growing consensus of psychotherapy researchers (Greenberg, Rice, & Elliot, 1993; Greenberg & Safran, 1989; Mahoney, 1991; Pennebaker, 1995) are recognizing the importance of emotional disclosure as a basis for the generation of new meanings of self and others (Greenberg & Pascual-Leone, 1995) and macronarrative change, psychotherapy approaches differ to the extent in which they priorize the description of what was experienced in the past

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versus focus on the processing of emotion schemes emerging in the session. The more evocative and descriptive the client can be regarding their experiencing in the session, the greater the opportunity the therapist has to resonate empathically with and attune to the clients feeling state (Angus, 1990). We have found the use of individual metaphor phrases (Angus, 1996) to be particularly productive within the context of Internal narrative sequences. Finally, in the Reflexive sequences the client attempts to make meaning of his or her experiences by exploring personal expectations, needs, motivations, anticipations, and beliefs of both the self and those individuals who play significant roles in the clients life. It is in the context of reflexively processing current and past experiences that client and therapist begin to coconstruct a meaningful framework of understandingor macronarrative reformulationthat coherently organizes, and provides an understanding of, the clients current and past experiences in the world. In terms of within-session patterns, Reflexive narrative sequences ideally follow upon a depth of engagement in either External or Internal narrative sequences in the therapy session such that both client and therapist engage in a process of shared meaning making in relation to the clients understanding of self and others in the world. Greenberg & Pascual-Leone (in press), citing findings from Pennebakers (1995) work with trauma survivors, argue that reflexive elaboration and meaning creation can be an important therapeutic consequence of client emotional expression if the therapist actively facilitates the clients focusing on the creation of new meaning (Reflexive narrative sequence) from the aroused emotional material (Internal narrative sequence). Reflexive narrative processing that does not emerge from the detailed description of events and emotional expression may be a client marker of shallow, automated processing (Borkovec et al., 1995) in which the client appears to be retelling a well-rehearsed script. By asking the client for a specific example of the problem or concern, and hence shifting the client to describing and showing a specific instance (External narrative sequence), the therapist may help the client to engage in a kind of depth of Internal and Reflexive narrative processing such that deeply painful, and at times disturbing, feelings and beliefs about self can be articulated and understood in ways that engender new meanings and perspectives on self and others. Drawing on the work of Spence (1982), client descriptions of what happened (External sequences) and how it felt (Internal sequences) entail processes of client-mediated memory reconstruction. In contrast, the clients within-session elaboration and characterization of new feelings (Internal sequences) emerging in the showing and reexperiencing of the event, as well as the active search to make past events and past and current feelings understandable (Reflexive sequences), entails both clients and therapists active participation in coconstructive processes of meaning making. With this model it is argued that all three narrative-process sequence types have an important function to fulfil in the coconstruction of the clients macro- or self narrative and as such are present, although in varying degrees and patterns, in all therapeutic modalities. Narrative Processes Coding System In order to conduct an empirical investigation of narrative processes in psychotherapy, a systematic method for the identification of therapy-discourse parameters associated with narrative-processing modes was developed (Angus & Hardtke, 1994). The Narrative Processes Coding System (NPCS) and revised manual (Angus, Hardtke & Levitt, 1996) has evolved from the first authors continuing interest in the role of metaphor and figurative language in psychotherapy (Angus, 1990, 1992, 1996; Angus & Rennie, 1988, 1989), as

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well as earlier research projects that entailed the origination (Marziali & Angus, 1986) and development of a sequential coding system (Marziali & Angus, in preparation) appropriate for application to the therapy discourse. The Narrative Processes Coding System provides researchers with a rational, systematic method of unitizing therapy transcripts, regardless of therapeutic modality. The NPCS is a two-step process that enables the researcher to: a) reliably subdivide and characterize therapy session transcripts into topic segments according to content shifts in verbal dialogue, and b) further subdivide and characterize these topic segments in terms of one of three narrative-process mode typesExternal, Internal, Reflexivethat are termed narrative-process sequences for coding purposes: i. External Narrative Process Sequences that include description of events (past, present, and /or future; actual or imagined) ii. Internal Narrative Process Sequences that include a subjective /experiential description of experience; iii. Reflexive Narrative-Process Sequences that include analysis of current, past and /or future events. As a form of discourse analysis, this categorization system deals with interactional units that can include both client and therapist turn taking. In terms of Kieslers (1973) descriptive classification of psychotherapy process measures, the NPCS is a nominal method for the categorization of psycholinguistic dimensions of the therapeutic interaction. Given that the entire therapy session transcript (summary unit) is used for the identification of topic segments (contextual units) and narrative sequences (scoring units), the NPCS can also be characterized as a comprehensive category method. Topic Segments Topic segments are identified when a shift or change in subject (for example work, family, relationship with significant other, etc.) occurs during the psychotherapy session discourse. For research purposes, a topic-segment shift can be further categorized as representing: i. Domain shift: entails a description or overview of a new content area; or ii. Facet shift: entails a detailed elaboration of different facets of a general content area. Topic Segments are interactional units that may contain verbal interchanges between clients and therapists. The beginning of a new topic segment is often marked by: a) questions posed by the therapist signaling a topic change and hence, the beginning of a new topic segment; b) the client clearly introduces a new topic; c) a change in verb tense signaling the elaboration of a specific content area or past experiences; and /or d) following a distinct pause by the speaker. The ending of a topic segment is often marked by: a) an affirmation that what has been said has been understood by the therapist and /or the client (ex. Mm-hm); b) a pause in the conversation; or c) a summary of the preceding issues. The length of topic segments varies from dyad to dyad. In a recent study (Hardtke, 1996), it was found that in a sample of five therapy dyads (approx. 75 therapy sessions), the average length of a topic segment was 30 transcript lines, with a range of 10 to 133 lines.

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Once identified, each topic segment is labeled according to: a) Relationship Focus: identifies whom the topic segment is addressing, whether it be an issue regarding self, other(s), or self in relation to other(s); and b) Issue: describes the primary issue or focus of the discussion that comprises the topic segment. The following example of a topic segment entails the description a specific-content areaa clients relationship with her mother-in-law. The relationship focus identified by NPCS raters for this segment is self in relation to mother-in-law, and the key issue is characterized as Mother-in-laws visit. Relationship Focus: Self / Mother-in-law Issue: Mother-in-laws current visit T: Good morning, how are you? C: OK. It has been a pretty hectic week. My Mother-in-law arrived in town. Shell be staying with us for two weeks. Shes just taken over the house. Shes cleaning everything. I mean, she even went out and bought Ajax (cleaning powder) and spent almost an hour scrubbing the kitchen sink. I mean its not like the place was dirty. I made sure it was spotless before she arrived. The night before I even got up to check everything over so I could clean whatever was missed. She always does this. T: Okay, your Mother-in-law arrived for a visit and what, the next day you walked into the kitchen and she was cleaning your sink? C: Yeah, she arrived Thursday afternoon. R. (husband) picked her up from the airport. The next morning I dropped the kids off at school and when I got back there she was in the kitchen scrubbing the sink, you know with Ajax. So I just stood there with a dazed look on my face and said, you know, that she was on vacation and if the sink was dirty I would clean it. Well she said something like she knew I was busy and she was only trying to help. T: mm-hm. C: Yeah and like she always does this. T: mm-hm. So how does it make you feel when she acts like this? C: I feel like shes intruding. I mean shes the guest. I dont know I just want to scream I get so frustrated. She makes me feel hopeless, like a little kid. There is no point telling R. (husband). He just sides with her. I just get really upset. I just feel like one of the kids when shes around. T: mm-hm. So when she visits you feel like she is the parent and youre the little kid? C: Yeah, like when she cleans or says that Im not dressing my kids right I feel like Ive failed again. It is so aggravating. No matter how hard I try I cant please her. I think Im starting to experience panic attacks when I know shes coming for a visit. T: Panic attacks? C: Like before she arrived I had a headache for a week. My stomach was in a knot and I could hardly eat. I just felt really tense and nervous. I just know that she will find something to criticize me about. T: Mm-hm. C: And I dont know why I feel so obsessed with pleasing her anyway. She usually only comes to visit twice a year. I mean its not like were really close. Ive talked to R. (husband) who says I should just put up with her for two weeks, then forget about her. But I cant seem to do that. Maybe its because I felt she never thought much of me. She was against R. (husband) and I marrying. We were both still in school when we married. Shes always given me the impression that she thought R. (husband) would marry someone who would be more than a housewife. Why dont I have the

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guts to stand up to her? Why do I let her invade my home? I always let her take charge. I should stand up for myself and tell her what I think about all her cleaning and stuff. Maybe if I stood up to her shed respect me more? Or at least she might shut up! T: hm. C: I dont know. I do know that I dont want to waste my time with you talking about her for the whole hour (laughs). (shift / end of Topic Segment #1 / beginning of Topic Segment #2) To date, topic-segment analyses have been completed on 09 good-outcome dyads (Greenberg & Angus, 1993) and 09 poor-outcome Brief Experiential psychotherapy dyadsa total of a 270 fully analyzed psychotherapy sessions. In terms of interrater agreement levels for the identification of topic segment units in the transcript, it was found that after 2025 h of training, raters were able to establish a 90% hit rate (Cohen Kappa .78) for both the identification of Topic-Segment units and the labeling of central issue and relational focus. Narrative Process Sequences Once the therapy session transcript has been unitized according to topic shifts, each topic segment is further subdivided and coded in terms of shiftsexternal, internal, or reflexivein narrative processes type. The resulting units of text are coined narrative sequences. The number of narrative sequences in each topic segment naturally varies. The client and or clienttherapist interaction may remain in a certain narrative-processes mode throughout the entire segment or shift between them. For rating purposes, a narrativeprocess sequence should be no less than 4 transcript lines. It has been found that with 2530 h of training time, raters are able to identify reliably and categorize Narrative-Sequence units in therapy session transcripts. Using a sample of five therapy transcripts, raters interrater agreement levels8388% (Cohens Kappa .75)were found to fall within an acceptable range. Identifying External Narrative Sequences. When an individual provides a descriptive elaboration of a life event (actual or imagined / past, present, or future), the narrative sequence is coded as External. Two distinctions are made within this narrative-sequence type. The client may: a) provide a general overview of the event or b) highlight a specific incident or event (past, present, or future; actual or imagined). The following are markers to help the researcher identify external narrative sequences: a) the description of personal memories, and therefore a shift in verb tense may indicate the start of an External narrative sequence; b) concrete examples used to demonstrate issues raised in all of the narrative-sequence types; and c) an External narrative sequence may be describing either a specific event or an event that is a general description or composite of many specific events. The following dialogue is an example of an External narrative sequence that was identified within the context of the Mother-in-law Topic Segment: T: Good morning, how are you? C: OK. Its been a pretty hectic week. My mother-in-law arrived in town. Shell be staying with us for two weeks. Shes just taken over the house. Shes cleaning everything. I mean, she even went out and bought Ajax and spent almost an hour scrubbing

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T: C:

T: C:

the kitchen sink. I mean its not like the place was dirty. I made sure it was spotless before she arrived. The night before I even got up to check everything over so I could clean whatever was missed. She always does this. Okay, your mother-in-law arrived for a visit and what, the next day you walked into the kitchen and she was cleaning your sink? Yeah, she arrived Thursday afternoon. R. (husband) picked her up from the airport. The next morning I dropped the kids off at school and when I got back there she was in the kitchen scrubbing the sink, you know with Ajax. So I just stood there with a dazed look on my face and said, you know, that she was on vacation and if the sink was dirty I would clean it. Well she said something like she knew I was busy and she was only trying to help. mm-hm. Yeah and like she always does this. (shift /end of narrative sequence / External)

Identifying Internal Narrative Sequences. When an individual provides a descriptive elaboration of subjective experiences or points of view, the narrative sequence is coded as Internal. It is an experiential description and entails a description of how one feels in relation to ones self and /or to others. The following are cues to help the researcher identify Internal narrative sequences: a) the therapist asks directly how the client feels; b) frequent use of words describing emotions (ex. sad, angry, frustrated); c) emotional expressions such as sighing, crying, or shouting; d) metaphoric descriptions of experiential states (ex. I feel as if I am going to explode!); and e) long pauses in which the individual appears to be searching for words to articulate an experiential state. The following dialogue is an example of an Internal narrative sequence identified in the Mother-in-law Topic Segment: T: mm-hm. So how does it make you feel when she acts like this? C: I feel like shes intruding. I mean, shes the guest. I dont know I just want to scream I get so frustrated. She makes me feel hopeless, like a little kid. There is no point telling R (husband). He just sides with her. I just get really upset. Just feel like one of the kids when shes around. T: mm-hm. So when she visits you feel like she is the parent and youre the little kid? C: Yeah. Like when she cleans or says that Im not dressing my kids right I feel like Ive failed again. It is so aggravating. No matter how hard I try I cant please her. I think Im starting to experience panic attacks when I know shes coming for a visit. T: panic attacks? C: Like before she arrived I had a headache for a week. My stomach was in a knot and I could hardly eat. I just felt really tense and nervous. I just know that she will find something to criticize me about. T: mm-hm. (end of Narrative Sequence / Internal) Identifying Reflexive Narrative Sequences. Reflexive narrative sequences are identified when an individual focuses on the reflexive or interpretive analysis of event descriptions and /or descriptions of subjective experiences. In these instances, the individual attempts to understand his / her own feelings regarding self, others, or events. The following cues help the researcher identify Reflexive narrative sequences. The individual: a) examines own behavior in situations / relationships; b) plans future behavior alternatives; c) examines own thinking in situations; d) explores own emotions in situations; e) discusses patterns in own behavior and /or that of others, f ) is self questioning using words such as why, maybe, I guess, I wonder, I realize, I think, It could

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be, and I dont know may all be markers depending on their context. The following dialogue is an example of a Reflexive narrative sequence identified in the Mother-in-law Topic Segment: T: Panic attacks? C: Like before she arrived I had a headache for a week. My stomach was in a knot and I could hardly eat. I just felt really tense and nervous. I just know that she will find something to criticize me about. T: mm-hm. (end of narrative sequence / Internal) (shift / beginning of narrative sequence / Reflexive) C: And I dont know why I feel so obsessed with pleasing her anyway. She usually only comes to visit twice a year. I mean its not like were really close. Ive talked to R. (husband) who says I should just put up with her for 2 weeks, then forget about her. But I cant seem to do that. Maybe its because I felt she never thought much of me. She was against R. (husband) and I marrying. We were still in school. Shes always given me the impression that she thought R. (husband) would marry someone who would be more than a housewife. Why dont I have the guts to stand up to her? Why do I let her invade my home? I always let her take charge. I should stand up for myself and tell her what I think about all her cleaning. Maybe it I stood up to her shed respect me more. Or at least she might shut up Research Findings and Implications for Therapeutic Practice Narrative-Process Sequences In terms of assessing Narrative-Process sequences in psychotherapy transcripts, both the frequency and pattern of narrative-sequence codes occurring within an individual therapy session or across a completed therapy relationship can be identified and evaluated. Furthermore, with this strategy the predominance of particular narrative modes in different therapeutic modalities and /or outcome groups can be evaluated. More specifically, within the context of the Narrative-Processes model, it is argued that it is the pattern of narrative-process sequences and topic-segment shifts that is of interest for psychotherapy practitioners and researchers rather than the over all dominance of one narrative-sequence type or topic focus in the therapy. Specifically, the Narrative-Processes Coding System (NPCS) was designed to identify and track the patterns of narrative sequences that occur most frequently in a particular therapeutic modality, as well as empirically ascertain the frequency with which therapists or clients initiate shifts into the different narrative-sequence categories. Given that therapists and clients are viewed as coconstructing meaning during the therapy hour, it is expected that both clients and therapists will initiate narrative-sequence shifts during the therapy hour. The NPCS offers an empirical index of therapist and client agency, in the therapeutic relationship, by generating a precise accounting of the number of narrative-mode shifts initiated by client and therapist. Moreover, it is argued that different psychotherapy models tend to priorize different combinations of the three narrative-process sequences in their theories of therapy, and therapists adherence to these models can be evaluated empirically by means of the NPCS methodology. For example, in Process Experiential psychotherapy (Greenberg et al., 1993) it is emphasized therapists should be process-directive (therapist initiates marker-driven narrative-sequence shifts) with an explicit goal of accessing emotional schemes (Internal

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narrative sequences). Furthermore, with this approach new meanings and understandings (Reflexive narrative sequences) are viewed as emerging out of the processing and elaboration of emotional schemes in the session. Accordingly, within the context of the Narrative-Processes approach, the ProcessExperiential therapist would be expected to initiate client shifts into the description and elaboration of felt emotions and feelings (Internal-narrative mode) followed by shifts to the articulation and differentiation of new meanings (Reflexive-narrative mode) emerging from the disclosure and processing of emotions. In essence, with this therapeutic approach new meanings are thought to emerge from the clients elaborated processing of core emotional schemes in which a dynamic pattern of Internal and Reflexive narrativesequence modes are viewed as essential for the facilitation of second order or deep structural change (Lyddon, 1993). In contrast, the External mode is viewed primarily as a necessary starting point for the real work of accessing and articulating felt emotions (Internal sequences) and elaborating new meanings (Reflexive). The analyses of narrativesequence patterns in good outcome, brief Process Experiential therapies (Levitt, 1993; Hardtke, 1996) have confirmed that effective Process Experiential psychotherapists indeed do priorize consistently shifts into Reflexive and Internal narrative sequences. Using Log Linear statistical procedures, Levitt (1993) established that the predominance and patterns of narrative-sequence types identified in three early, three middle, and three late sessions from three brief, good-outcome psychotherapy dyads were significantly different from one another. For this study, therapists representing three distinctly different modes of brief-therapy interventionProcess Experiential, Perceptual Processing, and Psychodynamicwere asked to select one successful psychotherapy dyad for intensive narrative-sequence analyses. Using standardized outcome measures (Beck Depression Inventory; Beck, Steer, & Garbin, 1988; the Tennessee Self-Concept Scale; Fitts, 1965; and the Social Adjustment Scale; Weissman & Bothwell, 1976), all three clients were identified as having achieved clinically significant outcomes at the termination of therapy and consented to participate in the research study. All three clients were self-referred female adults and reported no previous psychiatric history or use of psychotropic medication. All three therapists2 male and 1 female had over 20 years of therapeutic experience and two were founders of their respective therapeutic orientations. The Perceptual Processing therapy model (Toukmanian, 1992) maintains that clients are in need of broadened perceptual bases for processing and gathering information. The Perceptual Processing therapist attempts to focus clients attention on processing patterns so that increasingly functional and flexible perceptual processes can be developed. The Process Experiential orientation is emotionally focused and directed towards the evocation and restructuring of emotional schemes (Greenberg et al., 1993). Different Client-Centered and Gestalt therapy interventions are used to facilitate clients emotional experiences and assist them in reorganizing or restructuring these schemes. The Psychodynamic approach is predicated on the assumption that psychological difficulties are rooted in unconscious inner conflicts and represented in interpersonal relationship patterns (Arlow, 1989). A focus on current and past relationship patterns and the use of interpretation distinguish the brief, psychodynamic therapy approach. Adherencerating analyses of the selected therapy session tapes established that all three dyads represented the core characteristics of their respective therapeutic models and approaches. All of the therapy sessions selected for analysis in this study were transcribed and then randomly sorted for rating using the Narrative Processes Coding System. Two Clinical Psychology graduate students underwent 30 hours of NPCS training and then rated five randomly selected session transcripts (approx. 20% of the total sample). The two

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raters established an interrater agreement level of 88% for topic-segment and narrativesequence identification (Cohens Kappa .75). A further sample of three sessions were rated by both judges toward the conclusion of the analyses and confirmed that interrater agreement levels had been maintained throughout the therapy session analyses. In terms of the log-linear narrative-sequence analyses, it was confirmed that the three therapeutic approaches were significantly different from one another in terms of both the number of identified narrative sequences ( p 0.0007) and the type of narrative sequences (External, Internal, Reflexive) identified in the therapy sessions across the three therapy dyads ( p 0.0001). More specifically, in the Psychodynamic therapy sessions a pattern of Reflexive (40%) and External (54%) narrative sequences predominated in which therapist and client engaged in a process of meaning construction (Reflexive) linked to the clients descriptions of past and current episodic memories (External). An intensive analysis of the patterns of occurrence in sessions revealed that External sequences in the Psychodynamic therapy sessions were either bound by consecutive strings of External sequences or alternated with Reflexive narrative sequences. Bucci (1995) and Greenberg et al. (1993) both argue that retrieving memories and describing life events in therapy may help clients revive and experience specific emotional and cognitive states connected with the incidents. By means of the exploration of implicit connections between episodic memories (External sequences), and the elaboration of new understandings connected to these themes, the Psychodynamic therapist attempts to engender new perspectives and insights in relation to interpersonal conflicts and relationship issues. In contrast to the Psychodynamic therapy sessions, the Process Experiential therapy sessions evidenced a pattern of Internal (29%) and Reflexive (46%) narrative sequences in which the client and therapist engaged in a process of identifying and differentiating emotional experiences (Internal) and then generating new understandings of those experiences (Reflexive) during the therapy hour. As compared to the other two dyads, the proportion of Internal narrative sequences were three times higher in the Process Experiential therapy sessions than in the Perceptual Processing sessions and five times higher than in the Psychodynamic sessions. The primary goal of Process Experiential psychotherapy is to assist clients in developing more differentiated and functional emotion schemes, and the evidence from the NPCS analyses indicate that this goal is achieved by an alternating focus on client exploration of experiential states (Internal narrative mode / sequences), followed by meaning-making inquiries (Reflexive narrative modes /sequences) in which new feelings, beliefs, and attitudes are contextualized and understood. And finally, the Perceptual Processing therapy dyad revealed a pattern of consecutive Reflexive narrative sequences (54%) occurring across topic segments in which client and therapist engaged in extended reflexive analyses of both life events (External, 36%), and to a lesser extent emotional experiences (Internal, 10%). The chaining of the Reflective narrative sequences appeared to facilitate an extended client inquiry into core selfrelated issues in which automatic processing patterns were identified and challenged. While the restricted sample size for this study necessarily limits the generalizability of the findings, certain trends are worthy of note. The three Narrative Sequence types do appear to capture differential therapeutic processing strategies representing differing therapeutic approaches. Moreover, the patterns and predominance of the Narrative Sequence modes are consistent with the stated goals and aims of the different therapy approaches. The next step in the development of this research program will be the investigation of narrative-sequence and topic-segment patterns in larger samples of both good- and pooroutcome brief therapy dyads in order to validate the findings emerging from this case study analysis.

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Relational Themes and Topic Segment Shifts While there has been an increasing interest in the identification of content topics (Brown & Yule, 1983; Planalp & Tracy, 1980; Reichman, 1978; Sigman, 1983) and key-content themes (Luborsky & Crits-Christoph, 1990) in selected therapy sessions, very few psychotherapy researchers (Milbrath, Bauknight, Horowitz, Amaro, & Sugahara, 1995) or practitioners have developed methods or strategies to represent the emergence and predominance of content themes across therapy sessions. The Narrative Processes system is in part designed to identify the frequency and pattern of content topics or topic segments as represented in sequential psychotherapy sessions. In terms of the Narrative Processes Coding method, a topic-segment shift is characterized by either the introduction of a new topic or the elaboration of a specific facet of a broader topic domain. Furthermore each topic segment can be characterized in terms of the central issue under discussion and the relational focus of the discussion. The collation and sorting of individual topic segments into recurring relational and /or issue-based themes provides a method for naming and tracing the emergence of core themes across therapy sessions. It is the analysis of core therapeutic themes that provide an understanding of the content of the clients macronarrative or life story as represented in the cut and thrust of the therapeutic discourse. As stated previously, topic shifts may initiate a clear change in content focus or they may represent a focused elaboration of a subpart or facet of a larger issue or domain. Constant within-session topic shifting, with rapid shifting from one content domain to another, may indicate that both client and therapist are having difficulty finding a sustained focus of inquiry in the session (Rasmussen & Angus, 1996). In contrast, sessions in which clients and therapists collaboratively initiate shifts into thematically related topics, or pursue facets of one content domain, convey a sense of having established a shared focus of inquiry in the session (Rasmussen & Angus, 1997). Therapists can strategically initiate topic-facet shifts by asking clients for specific information in relation to core issues, by asking clients to provide specific examples of general concerns, and by identifying thematic connections between past concerns and present issues. These strategies help to facilitate a shared, extended inquiry into key concerns and also help to establish a sense of coherence and focus in the therapy hour. Findings from a qualitative, comparative analysis of metaphoric expression in psychodynamic therapy with Borderline and nonBorderline clients (Rasmussen, 1995; Rasmussen & Angus, 1996, 1977) indicate the nonBorderline clients and their therapists identify experiencing a sense of narrative coherence in their therapy sessions in which topic-facet shifts occur predominantly in the context of core client issues. Conversely, Borderline clients and their therapists reported searching for and having difficulty finding shared understandings and coherence in sessions in which Topic Segments frequently shifted from one seemingly disconnected issue or relationship focus to another. Based on a Grounded Theory analyses of postsession Interpersonal Process Recall interviews conducted with the Borderline clients, Rasmussen (Rasmussen & Angus, 1996, 1997) argues that disjunctive topic shifts typically were initiated by Borderline clients in response to feeling emotionally overwhelmed in therapy sessions. In these instances, therapists focal inquiries were experienced as feeling too close to home for Borderline clients comfort levels. Borderline clients appeared to initiate topic shifts at these critical moments in therapy sessions in order to shift awareness and attention away from internal feelings and emotions and instead focus on new and often unrelated topics. In turn, therapists report feeling confused, puzzled, and frustrated by their Borderline clients propensities to change topics at those critical moments in sessions. Ther-

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apists report feeling less satisfied with therapy sessions in which there have been frequent topic shifts in the therapy discourse. In particular, therapists seem to experience a lack of closure and describe feeling as if little depth of understanding has been achieved in the therapy sessions. Although these findings should be treated cautiously given the limited sample size, a few interesting trends should be highlighted for psychotherapy practitioners. First, it may be helpful for therapists to regard radical client-initiated shifts in topic focus as possible markers of client emotional distress, especially when topic shifts occur in the context of moments of heightened emotion in therapy sessions. Further exploration and articulation of what emotions the client actually experienced in the session, prior to the initiation of the radical topic shift, may be a productive route to accessing core conflicts and emotional schemes (Angus & Gillies, 1994). Second, therapists may facilitate the development of a shared sense of narrative coherence and focus in the therapy relationship by initiating topic-facet shifts in the context of salient client issues and concerns. Therapists facilitation of topic-facet shifts helps both clients and therapists to develop a more differentiated, contextual understanding of clients key concerns and aids in the germination of core themes that integrate disparate client experiences across sessions. And finally, therapeutic interventionssuch as Gestalt two-chair and empty-chair dialoguesinitiated within the context of core client themes also function as topic-facet shifts in which more differentiated, new understandings of key client concerns emerge within sessions. Discussion The Narrative Processes system provides psychotherapists with a conceptual framework within which to embed an understanding of the roles and functions of three narrative process modesExternal, Internal, and Reflexiveas they relate to processes of macrolevel narrative coconstruction in the therapy hour. It is argued that differing therapy approaches in their theories of therapy practice priorize unique patterns of narrative sequence types in the quest to facilitate significant client change. The Narrative Processes Coding System (NPCS) is based on the primary assumptions articulated in the Narrative Processes model and offers psychotherapy researchers a systematic, empirical method for the identification of both content domains and narrative-sequence types in therapy session transcripts. A definite strength of the Narrative Process Coding System (NPCS) is that it provides psychotherapy process researchers with a standard unit of analysis for the segmentation of psychotherapy session transcripts representing differing therapeutic approaches. Additionally, the NPCS tracks the processes of narrative construction in therapy in at least three different ways. First, the recurrence of content-identified topic segments in the therapy discourse can be charted within and across sessions, and the degree to which a focus emerges in the therapy discourse empirically can be evaluated. Furthermore, using the topic-segment labeling system, topics representing a particular relationship issue can be easily identified in the coded therapy transcripts and then assessed for changes in cognitive- and experiential-processing style by standardized psychotherapy measures such as the Experiencing Scale (Klein, Mathieu-Coughlan, & Kiesler, 1986). Secondly, the narrative-sequence patterns characteristic of good- and poor-outcome psychotherapies can be identified as well as narrative patterns that characterize differing therapeutic approaches. Selected narrative-sequence patterns can be further assessed using standardized process-rating measures. And finally, the degree to which the client or therapist

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initiates topic-segment and narrative-sequence shift within session empirically can be assessed. Furthermore, with the NPCS both the frequency and type of narrative-sequence shifts initiated by client and therapist can be ascertained. The Narrative Processes Coding System also provides psychotherapy researchers with a rationally based, empirical method for the unitization of the therapy session discourse in terms of shifts in narrative-process modes (narrative sequences). By providing psychotherapy researchers with a common unit of analysis for the application of a variety of different process measures, research findings from different research projects could be combined to increase the power of statistical analyses for the assessment of therapeutic trends and outcomes. In essence, the NPCS provides a shared framework for the implementation of collaborative projects in the domain of psychotherapy research. Ongoing research using the NPCS includes the sequential analyses of topic-segment and narrative-sequence patterns in both good- and poor-outcome Client Centered and Process Experiential psychotherapies. In these studies we are strategically targeting characteristic narrative-sequence patterns for further assessment of client vocal quality and depth of experiencing in order to understand better the differential roles of the three narrative-sequence modes in the facilitation of client change. References
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