Within psychotherapy, client storytelling is fundamental to the development of the therapeutic relationship and allows a shared context of meaning and understanding to emerge between client and psychotherapist, typically based on personal memories of past experiences (Angus, Lewin, Bouffard, & Rotondi-Trevisan, 2004). When clients provide narrative accounts of personal experiences in psychotherapy, they disclose information related to the self (Brewer, 1996) that plays an important role in identity, emotion, behaviour, and personality change processes (Singer & Salovey, 1993). As such, client storytelling also helps the psychotherapist to understand the client’s complaints and current modes of adjustment (Howard, 1991).  Moreover, Angus and Kagan (2007) argue that it is a client’s willingness or capacity to disclose emotionally salient  personal stories – in a detailed, specific manner – that helps facilitate psychotherapist empathic attunement, which in turn contributes to  the development of  secure relational bonds and productive therapeutic relationships (Constantino & Castonguay, 2007).

Recent research on autobiographical memory (ABM) has demonstrated that the specificity of disclosed memories differs for depressed versus non-depressed samples (Williams et al., 2007). In particular, when compared to non-depressed controls, clinically depressed subjects demonstrate a bias for over-general, non-specific ABM disclosure (i.e., collated series of events in summary form) and show difficulties accessing specific, single-event autobiographical memory narratives (i.e., descriptions of a singular or episodic event). This is important as the inability to access and integrate specific episodic ABM may result in the following long-term negative outcomes: (a) reduced self-coherence, (b) increased rumination and worry, (c) impairment in social problem-solving, and (d) reduced capacity to imagine future events (Conway and Pleydell-Pearce, 2000). As such, some researchers have proposed that over-general ABM constitutes both a marker of current depression and vulnerability to future depression (Williams et al., 2007).

Research findings to date suggest that the bias found in depressed clients’ narratives towards over-general ABM disclosure may have important implications for psychotherapeutic treatments of depression. A recent study by Boritz, Angus, Monette, and Hollis-Walker (in press) examining ABM specificity in depressed clients undergoing brief Emotion-focused psychotherapy and Client-centred psychotherapy demonstrated a general tendency towards greater specificity in disclosed ABMs over the course of psychotherapy, suggesting that the over-general ABM bias in depression may be  subject to change over the course of treatment. Based on these findings, the question emerges: What can clinicians do to facilitate client shifts to greater specificity?

Attending to the Narrative – Listening for the Story

As disclosures of emotionally-salient autobiographical memories are foundational to the therapeutic change process, it is important that therapists attend closely to these personal stories and encourage the articulation, elaboration, and differentiation of narrative accounts.  Angus and Hardtke (1994) identified narrative processes that occur during psychotherapy. In the process referred to as the external narrative mode, client and psychotherapist work to articulate current and past events that are important for a thorough understanding of the client’s macro-narrative, or life story, but have been forgotten or never fully acknowledged by the client. External narrative sequences often entail the descriptive elaboration of autobiographical memories. For psychotherapists, such personal stories can be rich opportunities to further elaborate and explore the important emotional meanings, intentions, and goals that guide and inform clients’ actions in the world. Accordingly, asking a client to provide a specific example of an abstract issue or problem they are currently discussing can be a highly productive shift event during the treatment hour.

Getting Specific — Accessing Emotions and Self-Narrative Meaning Change

Increased specificity of autobiographical memories also provides greater access to emotionally-salient experiences that can be re-engaged and re-defined during the course of psychotherapy, such that new self-experiences and relational perspectives can emerge and be transferred to other domains of life (Greenberg & Angus, 2004). The accessing and retelling of the specific memory in the present and the enactment of the self and potentially a significant other in the remembered context may deepen the client’s experience.  In particular, guiding clients to use very specific detail in the retelling of a story can potentially evoke the same emotions and emotional intensity as when the event was actually experienced (Singer & Salovey, 1993). As noted earlier, the psychotherapist can also use these details to generate his or her own internal image of the memory being narrated to respond empathically and guide appropriate therapeutic intervention (Angus et al., 2004; Angus & Kagan 2007). It is the symbolization of primary emotional experiences – evoked by the disclosure of salient ABMs – that often promotes the construction of new personal meanings in the context of important life events, in turn leading to new ways of viewing the self and identity reconstruction.

To summarize, clients’ disclosures of specific, autobiographical memory narratives  makes an important contribution to the development strong therapeutic alliances and provides psychotherapists with a key opportunity to facilitate client shifts to productive emotional processing – and the construction of new personal meanings – during the treatment hour. It may be helpful for clinicians to keep the following recommendations in mind when working with clients’ stories: 1. Psychotherapists can facilitate client movement from over-general to specific ABM narratives by requesting specific examples if none are provided (e.g., “Can you recall a specific incident where you felt scared and unsure?”), or by elaborating on those specific ABMs provided by clients themselves. The expression of emotion in the context of an autobiographical memory (over-general or specific) is an indication that it has personal significance to the client, and may be worth exploring further; 2. Psychotherapists can help clients explore and elaborate specific ABMs by encouraging vivid and evocative description (e.g., descriptions of place, people present, smells, sounds, etc.). Enlivening the telling of the story may also include the representation of beliefs, goals, intentions, actions, and emotions, contextualized within the narrated event (e.g., “What did it mean to you that she noticed you were feeling unsure of yourself?”). This serves to slow down the automatic schematic processing associated with over-general ABM; and 3.  From the disclosure of specific ABMs arises the possibility of identifying new outcomes – in particular, memories of past experiences or new experiences that challenge the “same-old story” encapsulated by the over-general ABM (e.g., “It sounds like something was different about this experience?”) Psychotherapist attunement to these shifts, and identification and expression of them to the client, may result in increased client agency and opens new possibilities for hope.

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Tali Z. Boritz, Ph.D.

Tali Boritz is a psychologist and clinician scientist at the Centre for Addiction and Mental Health (CAMH), and an Assistant Professor in the Department of Psychiatry at the University of Toronto. She received her PhD from York University in Toronto, Canada, and completed her postdoctoral training at CAMH. She joined the Borderline Personality Disorder Clinic at CAMH in 2012. Her research primarily focuses on psychotherapy process and outcome, with particular emphasis on the treatment of personality disorders. Her current research program aims to elucidate mechanisms of change in personality disorders, including the successful negotiation of the therapeutic alliance.