Process and Outcome of Narrative Therapy for Major Depressive Disorder in Adults: Narrative Reflexivity, Working Alliance and Improved Symptom and Inter-personal Outcomes

The inter-subjective and dialogical nature of narrative therapy, as commonly practiced, remains unarticulated. Further, there currently exists no rigorous empirical research investigating the process or outcome of narrative therapy. The research aim, to investigate the process and outcome of narrative therapy, comprised theoretical and empirical objectives. The first objective was to articulate a theoretical synthesis of narrative theory, research and practice. The process of narrative reflexivity was identified as a theoretical construct linking narrative theory with narrative research and practice. The second objective was to substantiate this synthesis empirically by examining narrative therapy processes, specifically narrative reflexivity and the therapeutic alliance, and their relation to therapy outcomes. The third objective was to support the proposed synthesis of theory, research and practice and provide quantitative evidence for the utility of narrative therapy, by evaluating depressive symptom and inter-personal relatedness outcomes through analyses of statistical significance, clinical significance and benchmarking. Founded in theories of self, language and narrative (James, 1890; Bruner, 1986; Gergen, 1991; Hollway, 2006; Vygotsky, 1934/ 1987), narrative therapy was conceptualized as involving dialogical and intra-personal processes. Narrative therapists generally apply a story metaphor and commonly focus on the inter-personal field (White, 2007). This thesis recognised the storied and inter-personal nature of narrative therapy, but proposed this does not represent narrative therapy in its entirety. The notion of story connotes monological processes, inconsistent with the conversations of narrative practice, and neglect of intra-personal dimensions is inconsistent with narrative notions of inter-subjectivity.