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Angus & Greenberg's book "Narrative in emotion-focused therapy" (1st post): context

I was due to go through to Glasgow today for the fifth workshop in this seven seminar emotion-focused therapy (EFT) series.  Sadly my back has been playing up ... as it occasionally does ... and it really doesn't make good sense to travel.  The soreness is getting better nicely, but it can do with a bit more TLC as I gradually mobilise more.

I am enjoying and I think benefitting from this EFT training.  It can entwine well with CBT and other forms of psychotherapy too.  Not going to the workshop today has given me a chance to revisit one of the areas of EFT work that I was particularly intrigued by earlier in the course ... the combining of EFT with narrative therapy.  Back in January, I wrote the post "Emotion-focused therapy workshop series (third post): narrative therapy and trauma processing".  I noted: Les Greenberg & Lynne Angus's book "Working with narrative in emotion-focused therapy: changing stories, healing lives" came out just last year. The book description comments "In psychotherapy, as in life, all significant emotions are embedded in important stories, and all significant stories revolve around important emotional themes. Yet, despite the interaction between emotion and narrative processes, emotion-focused therapy (EFT) and narrative-informed therapies have evolved as separate clinical approaches. In this book, Lynne Angus and Leslie Greenberg address this gap and present a groundbreaking, empirically based model that integrates working with narrative and emotion processes in EFT.  According to Angus and Greenberg's narrative-informed approach to EFT, all successful psychotherapy entails the articulation, revision, and deconstruction of clients' maladaptive life stories in favor of more life-enhancing alternatives ...".  There is encouraging emerging work that is relevant - for example last year's paper by Vromans & Schweitzer "Narrative therapy for adults with major depressive disorder: improved symptom and interpersonal outcomes".

And the more I think about it, the more seriously I am attracted to this territory.  I'm a huge fan of our attempts to use evidence-based approaches when we try to help our clients.  Compassion calls out for us to be as effective as we can be in relieving suffering and good science helps us distinguish what's genuinely useful from what's hogwash.  There can easily be problems though with this evidence-based medicine (EBM) approach. Like Mulla Nasruddin and his lost keys, we can look very thoroughly but in the wrong place - see for example November's post "Psychotherapists & counsellors who don't monitor their outcomes are at risk of being both incompetent & potentially dangerous".  There's a real surge in energy for narrative-based approaches as a way to humanise, balance and increase the helpfulness of EBM.  There are many recent papers highlighting this hope - examples include "The marriage of evidence and narrative: scientific nurturance within clinical practice", "Narrative and psychiatry" and "Narrative vs evidence-based medicine--and, not or". A whole issue of the journal "Psychotherapy Research" last year explored a variety of relevant narrative-based approaches, and last month's British Journal of Psychiatry featured a major review article "Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis".  Its abstract reads "Background: No systematic review and narrative synthesis on personal recovery in mental illness has been undertaken.  Aims: To synthesise published descriptions and models of personal recovery into an empirically based conceptual framework. Method: Systematic review and modified narrative synthesis. Results: Out of 5208 papers that were identified and 366 that were reviewed, a total of 97 papers were included in this review. The emergent conceptual framework consists of: (a) 13 characteristics of the recovery journey; (b) five recovery processes comprising: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (giving the acronym CHIME); and (c) recovery stage descriptions which mapped onto the transtheoretical model of change ... Conclusions: The conceptual framework is a theoretically defensible and robust synthesis of people's experiences of recovery in mental illness. This provides an empirical basis for future recovery-oriented research and practice."  Narrative approaches are very much flourishing!

Further recent research papers continue to support the relevance of these ideas.  See, for example, Adler's "Living into the story: agency and coherence in a longitudinal study of narrative identity development and mental health over the course of psychotherapy" with its comment "Narrative identity is the internalized, evolving story of the self that each person crafts to provide his or her life with a sense of purpose and unity. A proliferation of empirical research studies focused on narrative identity have explored its relationship with psychological well-being. The present study is the first prospective, multiwave longitudinal investigation to examine short-term personality change via an emphasis on narrative identity as it relates to mental health. Forty-seven adults wrote rich personal narratives prior to beginning psychotherapy and after every session over 12 assessment points while concurrently completing a measure of mental health. Narratives were coded for the themes of agency and coherence, which capture the dual aims of narrative identity: purpose and unity ... Results indicated that, across participants, the theme of agency, but not coherence, increased over the course of time. In addition, increases in agency were related to improvements in participants' mental health. Finally, lagged growth curve models revealed that changes in the theme of agency occurred prior to the associated improvements in mental health."  Fascinating to see this emphasis on the importance of agency & purpose.  As so often happens with these kinds of insights, it's easy and interesting to link sideways ... for example, to the emphasis on Commitment in Acceptance & Commitment Therapy (ACT), how Autonomy is so highlighted in Self-Determination Theory, the increasing contextualising within broader Values & Life Goals in Behavioural Activation, the emphasis on Meaning in modern understandings of Wellbeing, and even components of my own "Two-seven-two model of integrative psychotherapy".

In tomorrow's post I will focus down more specifically on "Angus & Greenberg's book on narrative in EFT".

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