Narrative and emotion integration processes in emotion-focused therapy for complex trauma: an exploratory process-outcome analysis

The Narrative-Emotion Process Coding System (NEPCS) is a behavioral coding system that identifies eight client markers: Abstract Story, Empty Story, Unstoried Emotion, Inchoate Story, Same Old Story, Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Each marker varies in the degree to which specific narrative and emotion process indicators are represented in one-minute time segments drawn from videotaped therapy sessions. As enhanced integration of narrative and emotional expression has previously been associated with recovery from complex trauma, the purpose of the present pilot study was to examine the contribution of within session NEPCS markers to treatment outcomes for clients undergoing Emotion-Focused Therapy for Trauma (EFTT). The NEPCS was applied to two early, two middle, and two late videotaped therapy sessions selected from two recovered and two unchanged complex trauma EFTT clients. Exploratory statistical analyses established that unchanged clients expressed significantly more Unstoried Emotion than recovered clients, and a significant stage by outcome interaction effect was found for Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Finally, limitations of the current study are identified and implications for future research and clinical practice are addressed.