Process of change in emotion-focused therapy: Narrative theme analysis and the development and application of a change process model

The primary purpose of this intensive, case analytic study was to identify and categorize core relational themes, drawn from all therapy session transcripts comprising three good and three poor outcome clients who engaged in emotion-focussed therapy for depression. A total of 104 therapy sessions were coded using the Narrative Process Coding System to identify topic segments containing key issues and salient emotions. Modified grounded theory methods were then applied to generate narrative themes for three self-relational focuses (view of self, view of self in relation to significant other, and view of self in relation to all others), and for a therapy/therapist relational focus.; Based on an intensive content analysis of the narrative themes generated for the self-relational focuses, four global categories or stages of change processes emerged and were labelled: Problem Statement/Description, Exploration, Transition, and Demonstrated Change. For the therapy/therapist focus, four descriptive global categories emerged: Pragmatics/Education, Rapport-Building, Therapy Process, and Overall Therapy Experience. All global (and refined sub) categories of change were developed into a Process of Change and Integration (PCI) model that was used to track and compare patterns and trends of self-change processes among the clients.; Results suggested that the two outcome groups could be best distinguished by narrative themes generated for the good outcome group that contained lower percentages of topic segments classified as Problem Statement/Description, lower percentages of Negative Therapy Process segments, and higher percentages of Positive Overall Therapy Experience segments. A trend also emerged where two of the three good outcome clients exhibited higher percentages of Demonstrated Change in their view of self relational focus.; Further intensive analyses on two clients suggested that the model's original definition of Demonstrated Change (as engaging in positive new observable behaviours) may be a better marker of good therapy outcome if it was revised to include feeling different (i.e., more positive) towards self and/or others. Results also indicated that good therapy outcome appears to be facilitated by both the development of a strong therapeutic alliance in the early phase of therapy, and the client's ability to overcome resistance in therapy within the first half of therapy.