Saturday, October 20, 2007

Clarifying Narrative Retelling for Difficult or Traumatic Experiences

Entry for 18 October 2007:

I didn’t cover the Narrative Retelling Task last year in EFT-2, but thought we should this year, so that was last night’s topic. Narrative Retelling task is particularly relevant to PTSD, which is where we developed our initial formulation in the mid-90’s. Therapy is full of narratives, big and small, and we haven’t always been friendly to them in the person-centred/experiential tradition. Still, over the past 20 years, narrative has emerged as a key framework for looking at therapy, culminating in Angus & McLeod’s (2004) big handbook.

The Narrative Retelling task is an adaptation of Rice’s Systematic Evocative Unfolding, but the marker is a difficult or painful life event, rather than a puzzling personal reaction, which means that process goes forward differently. However, the task had not been systematically studied until Emily Breighner, one of my students from Toledo, took it on for her master’s and now PhD dissertation research. In the process, she has developed a revised task model, updating the one published in Learning Emotion-Focused Therapy.

However, various other tasks are wound up in traumatic difficult life events, and thus need to be sorted out in figuring how best to help clients. Last night, when we practiced the Retelling Task, this became more clear than it had previously. In particular, these related tasks include:
-Unfinished Business (if the main thing is something left unsaid or undone toward an important other),
-Meaning Creation (when a sense of injustice or unfairness is primary), and
-Problem Solving (if the person is right in the middle of dealing with an ongoing difficult or traumatic situation).
All these came up last night in practice sessions, which required the work to go off sideways into the more appropriate task. This means that what people mostly learned was how to stop what you’re doing at a given moment and change to a more important (at that moment) task.

This, however, leaves somewhat open the question of when Retelling is the optimal task. It seems to me that the essence of the Retelling marker is an Emotional Injury of some sort. The Emotional Injury marker has been formulated by Les Greenberg and Sue Johnson in the context of Emotion(ally)-Focused Therapy for couples (EFT-C), where it is a central issue in relational distress. However, emotional injuries also motivate clients to seek individual therapy, and are wound up in a variety of presenting problems, including depression, PTSD and (I now believe) Social Anxiety. Emotional injuries stem from a variety of sources, including physical attacks of injuries (in PTSD), interpersonal betrayal or abandonment (PTSD, loss-based Depression), childhood bullying or humiliation (Social Anxiety). To the extent that the injury is experienced in a context of loss, the person will feel sadness, which will motivate them to seek comfort by telling the story of the injury, and Narrative Retelling will be an appropriate task to offer to the client. This seems to me to be a useful clarification of the Narrative Retelling marker.

One of the issues raised by participants last night was the possibility of reinforcing traumatic experiences, that is, re-traumatizing clients. This is exactly what I believe dissuades many therapists from working directly with their clients’ trauma experiences. The PE-EFT analysis of this issue is that what is needed is for the client to re-experience the trauma but in a different context, thus transforming it. And of course an experience cannot be transformed unless it is first re-activated and experienced in the moment.

The different context explains why Retelling a trauma doesn’t make it worse: Because the retelling involves a controlled re-experiencing in a caring, empathic environment, provides an antidote to the emotional injury: the person experiences their injury being attended to tenderly by a caring other, which is precisely what was missing in the traumatic event. In fact, from an attachment perspective, the most telling injury is the emotional rather than the physical injury. Being genuinely understood and prized in moments of emotional injury is inherently soothing and healing.

Angus, L.E., McLeod, J. (Eds.) (2004). The Handbook of Narrative and Psychotherapy : Practice, Theory and Research. Thousand Oaks, CA: Sage.

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