Narrative Processes in Emotion-Focused Therapy for Trauma

Emotion-focused therapy for trauma (EFTT) is an evidence-based, short-term therapy for clients dealing with issues stemming from child abuse trauma. Unique challenges are associated with this form of trauma, including emotion regulation difficulties and narratives devoid of affect or personal meaning.

Narrative processes in EFTT focus not only on the content but the quality of client narratives &&&8212; that is, how a client recounts his or her experiences. 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. 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.

In this video, Drs. Lynne Angus and Sandra C. Paivio demonstrate and discuss key therapeutic interventions that encourage and direct a client through narrative and emotion-focused processes to gain acceptance and clarity on unresolved issues.

Emotion-focused therapy for trauma (EFTT) is an evidence-based, short-term (16&&&8211;20 sessions), individual therapy for men and women dealing with issues stemming from child abuse trauma. Therapy is grounded in current experiential therapy theory and research and integrates recent developments in the areas of emotion, affective neuroscience, attachment, and trauma.

Child abuse trauma is associated with a constellation of long-term effects, and disrupted narrative and emotional processes are at the core of this constellation. These include symptom distress, emotion regulation difficulties, narratives that are devoid of affect or personal meaning, and self and relational difficulties. EFTT includes strategies for reprocessing trauma feelings and memories &&&8212; particularly unresolved feelings (anger, sadness, fear, guilt, shame) and unmet needs in relation to abusive and neglectful others (usually attachment figures).

The emphasis is on accessing previously inhibited adaptive feelings and meanings (e.g., anger at violation, sadness at loss), in the context of an empathically responsive therapeutic relationship, so that the adaptive information associated with these emotions can be used to modify maladaptive meanings associated with fear, avoidance, and shame.

In terms of narrative processes, EFTT focuses not only on the content but the quality of client narratives, such as the presence and type of affective experience (adaptive, maladaptive), level of emotional arousal, level of emotional engagement with trauma material, and narrative coherence and reflectivity or meaning exploration. Interventions access healthy sub-dominant aspects of client experience that are used to promote the construction of narratives that are more differentiated, complex, detailed, personal, affective, and meaningful. Knowing the narrative and emotion processes typical of each phase of EFTT, along with the associated therapeutic tasks and intervention strategies used to promote change, can guide effective intervention at each phase of therapy.

During the early phase of therapy clients begin to disclose autobiographical memories of childhood abuse and neglect, sometimes for the first time. The therapist's job is to communicate compassion for suffering, provide safety and support, and encourage narrative disclosure. As such, EFTT therapists are attuned and responsive to how client emotions are expressed and how stories are told during therapy sessions. Problem narratives characteristic of unresolved trauma early in therapy can be devoid of affect, devoid of coherent content due to overwhelming affect; vague, impersonal, and general; and lacking in insight or meaning. Interventions address emotion regulation difficulties, begin emotion awareness training, and promote narrative specificity, with a focus on affective experience.

The middle phase of therapy focuses on promoting client self-development. Re-experiencing of traumatic events and confronting imagined perpetrators evoke maladaptive emotional processes (e.g., fear, avoidance, guilt, shame) and self-experience. Problematic narratives concern views of self that are unclear, or self as powerless victim, worthless, dirty, unlovable and vulnerable to rejection/abandonment, inferior and incompetent, to blame for the abuse, and unable to tolerate and avoidant of emotional pain. The latter frequently results in difficulties identifying and expressing emotional experience (alexithymia).

In the process of exploring these dominant narratives, therapists help clients identify and express core affective experience that define self, support the emergence of healthy sub-dominant aspects of experience, and begin to integrate these alternate healthy resources into more adaptive self-narratives.

The late phase of therapy focuses on healing attachment injuries. As clients' distress is reduced and they begin to feel stronger, they are better able to confront imagined abusive and neglectful others and fully experience and express adaptive anger at violation and grieve the many losses they have endured. The therapist's job is to help the client express and explore the meaning associated with these adaptive emotions, integrate this new information into current meaning systems, and construct more adaptive meaning and narratives concerning self, others, and traumatic events.

Change narratives later in therapy are characterized by greater reflectivity and coherence, are focused on the present and future rather than the past, and concern self as more powerful, confident, and worthwhile. Abusive and neglectful others are seen as more human, life-sized, and responsible for harm and, in some instances, the dominant narrative becomes one of understanding and forgiveness.