A Model of Narrative Development: Implications for Understanding Psychopathology and Guiding Therapy
Story-telling is one of the psyche’s basic functions. All of us organize our experience in the form of narratives in order to give meaning to events, make forecasts about how situations will evolve, guide our actions in relationships and make our self-experience coherent. Here we present a theoretical model which starts out from the hypothesis that, when they are created, the narratives we continuously relate to ourselves and others do not have a pre- existing form. We propose a model for understanding the way each organizational level is formed in the mind, and works and interacts with other levels; and what psychological disorders could affect it, ranging from the basic, where there are simple aggregates of mental images, to the more complex, where there are true and proper stories, in which the characters of the internal scenario interact with each other. According to our model, it is possible to hypothesize the existence of:
(1) a pre-narrative level, and
(2) a proto-narrative level, followed by three extended narrative levels:
(3) a procedural unconscious narrative level,
(4) a conscious prepositional narrative level, and
(5) a verbal interactive narrative level.
Our hypothesis is based on:
(1) a review of various theories from different fields of research; and
(2) illustrative clinical material obtained by recording psychotherapy sessions with severely personality-disordered patients.
Story-telling is one of the psyche’s basic functions. All of us organize our experience in the form of narratives, justifications for our actions and myths (Bruner, 1990; Labov & Fanshel, 1977; Sarbin, 1986). There is a narrative structure to various forms of knowledge, such as the story a young man tells to his friend about an amorous rendezvous. But even a sequence of mental images that a mind can only just make out could be seen as a micro-story. Sarbin (1986) and Bruner (1986), in their comments on experiments carried out by Michotte (1946/1963), note that the mind tends to construct narratives that serve to put the simplest events in a cause-effect sequence; for example, a person who sees two moving rectangles tends to provide an explanation in narrative form: ‘It is as if A’s approach frightened B and B ran away’ (Hermans, 1996a, p. 36).
Even a developmental relationship is based on the construction of stories or unconscious scripts which, on the basis of memorized action sequences, guide the interactions that follow. Bowlby’s (1969) definition of these sequences of gestures and interactions with their (albeit unconscious) story form is ‘internal working models’ (IWM). In this regard, Holmes (1999) defines narrative as the capacity to link ‘raw experience’ to a world of meaning: this is a developmental function deriving from early attachment experience. According to Holmes (1999, p. 59):
Psychological health . . . depends on a dialectic between story- making and story breaking, between the capacity to form narrative, and to disperse it in the light of new experience.
We present here a hypothesis about the nature of narrative organization based on the following premise:
(a) There are discontinuous neural processes-images, sensorial perceptions, somatic sensations, etc.-that can continuously form themselves into stories. Representations of a chaotic nature are incorporated progressively into sequences with a greater level of narrative consistency.
(b) The least structured level of narrative organization is that of neural activation profiles. The intermediate level is that of sequences of semi-structured emotionally marked images. The most clearly defined level is that of the stories we tell to ourselves and others in order to give meaning to reality, organize our actions in the world, regulate our mental states and experience a sensation of ourselves that is stable over time.
(c) The body has a leading role in the process of progressive narrative organisation. The sequences of images containing, during a particular unit of time, the representation of the somatic state that is most important for personal meaning give a direction to the story currently being constructed.
(d) There is a hierarchical organization between the various levels, but there is also a movement backwards from the more organized levels to the more basic ones.
If we were to reason in line with the narrative psychotherapy paradigm, it is not enough to talk of stories; we also need to define the story structure to which we are referring. This is necessary to observe the dysfunctions that affect each level of structure. We hypothesized that identifying the dysfunction affecting a certain type of narrative would allow clinical treatment to be better adjusted to deal with the mental area that really is damaged.
According to Dimaggio and Semerari (2001), stories can be affected by psychological disorders in various ways. A story may be comprehensible and well shaped (Bruner, 1990; Grice, 1975) but at the same time dysfunctional: if I believe that my efforts to reach a goal will be rendered useless by the envy of the gods, and I give up beforehand on putting together a project, my life will probably be somewhat disappointing. But other people will grasp my story and, if they are therapists, they will be able to help me to modify it.
We hypothesized that in severely personality-disordered patients, the disorders would involve the story structure as well. Stories can be lacking in certain elements which make it understandable and provide a shareable point of view between teller and listener. Other stories can be incoherent and chaotic and a listener unable to decode the meaning of what they hear.
In both cases the clinical challenge was not to change the meaning of the patient’s discourse but to achieve a mutually agreed text or create one where before there was emptiness and silence. Only after this would it be possible to put together a treatment programme.
Dimaggio and Semerari (2001, p. 15), following on from Neimeyer (2000), who talks about ‘narrative disruptions’, maintain that a clinically well-shaped story:
should be set out in a well-ordered space – time sequence. . .; b) should make explicit reference to inner states, in particular emotional experiences. . .c) should include a description of the problem that is clear. . . d) should be put together with, as a reference point, a developed theory of the listener’s mind. . . e) should be relevant to the interpersonal context. . . f) should be endowed with an adequate thematic coherence and merge only partially with other narratives . . . g) should provide relevant knowledge of welldefined areas in the world of relationships; h) should integrate inner states and reflect at least in part somatic states and emotions felt and expressed in coherent meaning themes… i) an individual needs to have the ability to imagine multiple stories.
Questions and purpose
What are the various types of narrative alteration, and what form do they take clinically?
In the next part of this article we look closely at the contribution made by the neurosciences and cognitive psychology in demonstrating how subjective experience takes on narrative form. We then look at conscious narratives and the dialogical aspects that are a feature of them. We present a model in which narrative thought is constructed at several distinct levels (see Fig. 1):
(1) pre-narrative, and
followed by three extended narrative levels:
(3) procedural unconscious narrative,
(4) conscious prepositional narrative, and
(5) verbal interactive narrative.
The various levels interact with each other: the foundations of the more complex ones are built on the more simple ones, although the latter also receive data minute by minute from the former and use them to achieve a clearer definition.
Figure I. Narrative building: interaction between the various levels in ascending order of narrative construction.
We applied the following procedure:
(a) definition of the level of narrative construction;
(b) presentation of a clinical example of its alteration; and
(c) theoretical considerations about the level described, how it works and how it interacts with the other levels.
The main thrust of this study was concerned with the proto- narrative level and-to a lesser extent-with the conscious prepositional narrative level. Our interest in the protonarrative level was due to the fact that it receives less attention from the supporters of Narrative Theory. This is probably because they have been more concerned about conscious and verbal/interactive narratives, which tend to be a more natural topic for them to focus on (but see Greenberg & Angus, 2004; Lysaker & Lysaker, in press, for some interesting exceptions). However, the conscious propositional level is the one that is the easiest to decipher when reading raw clinical material (diary and session transcripts).
The pre-narrative level
According to Damasio (1999), the brain is continuously portraying bodily states, partly in the form of conscious mental images. Alongside these it creates images of the objects that are in the outside world (i.e. events and others) and in the inside world (i.e. thoughts, memories and sensations). The interaction with these objects causes continuously modifications, even if they are often imperceptible, to the state of one’\s organism. As a result during this interaction, our representation of our bodily state is modified and we are informed about it: we register the causal relationship between the appearance of an object and the change in our somatic state. When, for example, we are about to hit a football, our brain instantly portrays to us what the consequences will be for our organism, through the activation of a specific pattern linking our neurons (a ‘neural profile’; Rolls & Treves, 1994; Tucker, 1992). This profile combines a series of representations that are activated simultaneously-that of the event (the kick), that of the state of one’s organism immediately prior to the event (our leg in a raised position), and that of the organism immediately after the event (the impact felt by our foot)-into one complex representation. The mind creates a wordless sequence, a neural sketch of what happens to the organism in the environment that surrounds it.
The brain maintains traces of these neural link patterns in its ventromedial prefrontal cortices (Damasio, 1999; Siegel, 1999). These traces contain the neural basis for describing the association between an event, the state of the organism that it has brought about and the emotion felt (satisfaction for a good shot at the goal). We use these latent traces as required to build up mnemonic images by recall. When the traces are reactivated we feel the emotion in question again in a similar way to the original experience.1
The causal relationship-at a neural level-between the presence of an object and state of the organism is the first, unconscious level of narrative organization.
The proto-narrative level
We call the micro-sequences of mental images continuously occupying our consciousness ‘proto-narratives’. These images are emotionally marked. We portray the world to ourselves through these image/emotion aggregates, as well as with words. Emotions have a drawing out function, recalling images in line with their characteristics and their hedonic tone (see the ‘mood induced memory’ described by Bower, 1981): sadness evokes images of loss, and joy evokes images of merriment.
In a severely disturbed patient, emotions that are too intense can lead to the images evoked being selected in an uncontrollable way, and this in turn reinforces the activating emotion. On the one hand this phenomenon leads to the construction of a poor narrative landscape, in which only stories giving expression to one or a few emotions are produced; on the other hand, images that are not consistent with the emotional tone are not recalled to memory; the patient is thus unable to articulate and distinguish the meaning of events. The following clinical excerpt illustrates these phenomena.
Giulio is 48 years old and suffers from a paranoid personality disorder. He describes the feeling of ‘violence’ and affront he experiences each evening when he hears the sound of his neighbours’ footsteps coming from the floor above. In these instances he feels angry and becomes aggressive and vindictive. The therapist realizes that between the activating event-becoming aware of the sounds-and the emotional reaction there are some elements missing: what would the neighbours’ motivations and purpose be in offending him? He therefore tries to help the patient to reconstruct the entire sequence but induces only anxiety. The patient makes some effort to evoke an image, but the sole conclusion is that what is making him so angry is the ‘somatic feeling of sexual compulsion’ that the neighbours are trying intentionally to provoke in him through the noises.
His anger and sense of violence only evoke scenes in which they occupy the whole stage: the patient is unable to recall other thoughts that could help him to experience less disturbing emotions.
In other patients, however, their lack of emotional marking leads to the appearance of images that are inconsistent with each other: there is no theme to a story as it unfolds but it stays confused and fragmented. In the extract that follows, related by Serena, a borderline patient aged 29, emotional experience is missing, and the story is chaotic.
P: . . . oh, I don’t know, I wander, I’m like a graceful feather in the wind. Ah, by the way, I hurt myself. Perhaps it was on purpose because I was at the metro station. It was very early and I was going to work and I got my left knee stuck in a door. . . and since there were lots of people, someone inside helped me get up and well still. . . (she smiles).
T: Sure, and what could have happened to you?
P: If the train had started off, I don’t know where I’d have ended up. It would have cut me to shreds.
T: Think how glad you must have been.
P: Yes, well, I don’t know why. . . obviously I’m okay… I believe this work keeps me occupied, I don’t know.
It is not only the shifts in theme that are striking but also the fact that the clear image of her knee getting stuck is not accompanied by an appropriate emotion (anxiety for the risk she was running or relief for having escaped danger). The patient’s expression (a smile) reveals that, even if her ability to recall visual images is intact (unlike the previous patient), they are not associated correctly with her somatic states; the fact that the sequence of images remains for only a short time on her mental scene is due to this inability to associate. The lack of emotional marking stops the images mixing together to create a narrative sequence that is comprehensible, and the therapist finds it difficult to comprehend the patient’s mental state.
Many authors have tried to define the nature and functions of mental images (Johnson-Laird, 1983; Kosslyn, 1975; Kosslyn & Pomeranz, 1977; Marucci, 1995; Pribram, 1971; Shepard, 1978). The most important aspect is that the image/emotion aggregates report the global and essential aspects of situations. Portrayal in the imagination encourages an overall examination of a situation because it brings together scattered elements (Kaufmann, 1980): for example, the image of one’s grandmother doing crochet also contains the outlines of the surroundings-perhaps an old armchair on which you used to sit by her side, her proud expression when you read her your homework or your contentedness. When a sequence of images appears in the mind, many and various aspects of a subjective experience are put together within a narrow time window; each aspect comes from a sensorial medium: we see a face against the background of a landscape we know, we hear sounds, we smell odours, we experience a specific physical sensation and an emotion that is vague or clear.
In the space of a conscious image, we perceive and feel at the same time:2 this is the result of what happens at the pre-narrative stage. Only some of the image/emotion aggregates become conscious and take on the form of flashes with a concise description of a mental scenario. We assume that it is the emotion that determines which image sequence will have access to consciousness.
Images do not surface in consciousness in orderly sequences: at this moment, as we write, we are looking for the right words to express a concept. Is our mind perhaps ‘fishing’ exclusively among images that concern the subject we are dealing with? Not exactly: as we concentrate, we realize that, while we are forming the concept, at the same time we undertake other operations, of which only a few become conscious. There is a sequence of images in which we are praised for the quality of something we have written, together with pleasant emotions (and this encourages us to dedicate the evening to writing). This alternates with a sequence of an opposite nature (our writing being criticized), which is emotionally unpleasant. But at the same time ? flash makes its appearance: we are in front of a plate of spaghetti, together with emotions that it is easy to guess. This has very little to do with what we are writing and we have to make an effort to recover our concentration. In Giulio, the force of the emotion of anger prevents him from processing images that are outside the context strictly connected with the emotion: the sexual threat. His mind generates only scant scenes that do nothing to prepare him for tackling the complexity of the world of relationships and producing alternative explanations for his neighbours’ behaviour.
Various authors theorize that a normal human brain has a structure based on units, or ‘modules’, functioning in a relatively independent way and working simultaneously, most of them unconsciously (Baars, 1988; Fodor, 1983; Gazzaniga, 1988). When one of these unconscious modules is activated, Gazzaniga maintains, there is a generating of images, mental states and behaviour, the cause of which we are unaware of. An example is a man who is suddenly irritable with a friend during a party because the image of the latter looking too insistently at his wife has passed across his mind, together with the emotion of jealousy and a flash that has adultery as its theme. he is probably only conscious of this latter sequence of images and not of the fact that it originated from his having, below the consciousness threshold, caught his friend’s look. Perhaps, as the evening goes on, the micro-story about adultery develops further, and the man starts imagining how his wife is going to be unfaithful to him in the months to come. All this takes place in the privacy of his internal dialogue, without his wife having the least suspicion of his thoughts or feeling any attraction whatsoever towards his friend.
What has occurred? There has been a ‘selection’ of a sort, as a result of which the mind has activated sequences of images with a common emotional theme. These sequences gradually build up into more complex stories that are capable of guiding actions. The emotions not only make it easier to recall images of experiences (Christianson, 1992), but also contribute to the building of them. The example of the party, \like that of the paranoid patient, indicates that primary images become enriched with other elements: a narrative becomes more complex if the mind dwells upon it for long enough.
What links mental images to the more organized narrative levels? According to Guidano (1987), images are the most basic level of representation/construction of the self.
The stringing together of images in episodes is, to use a biochemical metaphor, the ‘primary structure’ of complex narratives; the enzyme that puts together the various units is emotion. Emotion helps to make an image stay quite a long time in mental space and to generate narratives that are consistent with itself.
The most significant micro-stories or flashes are stored in specific brain areas and are activated when we run into situations in which some of their salient emotional characteristics are repeated (Damasio, 1994, 1999; Kaplan-Solms & Solms, 2000).3
When the image of an emotionally marked situation is activated, the emotions select other images that are relevant to the theme, and the result is an enriched micro-story, which is then stored in its turn, ready to be recalled in its entirety. Thus, by reactivating a representation we can store it again in a modified form (Bjork, 1989).
According to Damasio (1994), recalling mental scenarios, knowledge and perceptual-sensorial elements requires a continuous on- line integrating operation, within a time window of at least several seconds. The elements to be integrated are:
* current representations of the body based on non-conscious neural patterns,
* the emotional tone linked to them,
* current representations of the outside world (sensorial signals), and
* what we see as potential future scenarios.
If the action takes place within the same time window, the various parts that make up a scene can be linked together: the observing ego has the impression that everything is happening in the same place. The final effect is an impression that inner experience is made up of sequences of micro-scenarios: the image of our favourite singer singing a song, a wave in the instant in which it breaks on the rocks. The images that are recalled in memory have the same structure as perceived images: for the mind, perceiving and remembering are similar operations.4
Let us recall here the first narrative level hypothesized in our model: neural representations of the relationship between object and bodily state.
Let us define the second level, proto-narratives: sequences of emotionally marked images or flashes-happening now or being recalled- of which we are conscious. We hypothesized that it is frequently altered in patients with personality disorders.
Alterations of proto-narratives in clinical practice
According to Janet (1889), a psychological disorder can be due to a lack of synthesis by the mind, and this can be expressed in various ways. If there is no emotional marking of images, the components of experience are not joined up into meaningful sequences. This is termed ‘impoverished narrative’ (Dimaggio & Semerari, 2001; Dimaggio et al. 2003b; Salvatore, Dimaggio, Azzara, Catania & Hermans, 2000). This phenomenon is to be found, for example, in alexithymic patients, by whom, if we are to follow Damasio’s (1994) reasoning experiences are perhaps lived in a way that is detached from the emotional state: sequences of recalled images are not marked somatically and a story is a sequence of facts and gestures in which it is impossible to grasp an underlying emotional state or an intentionality. A number of authors (e.g., Falcone, 1999; Krystal, 1974; Taylor, Bagby, & Parker, 1997) consider alexithymia a deficiency in the processing of and differentiating between the components in emotions that pertain to cognition and imagination. This deficiency can affect the producing of mental images, the somatic marking of the images during the experience in question and the recalling of it, and/or their integration into ordered narrative sequences. In the light of the ideas that we have been putting forward in this article, alexithymia can be interpreted as a deficiency affecting the pre-narrative and proto-narrative levels.
In the following excerpt taken from a course of therapy involving Matteo, who was suffering from a severe avoidant personality disorder, the images evoked are without emotions and, as a result, appear to be without order or purpose. The story has no intelligible plot:
P: … then she went to Switzerland for a year, for work, then she came back, we started seeing each other again, but nothing special, there wasn’t any attraction before, none, at least on my part… I was in Milan… as time went by we kept on seeing each other, let’s say ever more frequently, okay? But a year went by, that is from October to June. . .I remember my friends saying to me ‘look, you’ve got the means’. I almost couldn’t believe it. ‘But no,’ I would say, ‘perhaps you’re making a mistake’. . . I’ve always lived in a male environment and so, when it comes to women, I don’t know tor what reason, let’s say I could even make a few conjectures, but I don’t know: why do I have all these difficulties in relationships? To sum up, as time gradually went by, obviously something began to flourish, on both sides of course. Probably, if it had only been on my part, nothing would ever have got going, if she wasn’t interested in me or hadn’t made a move, I don’t know, to have a serious relationship with someone, with a girl I mean, is difficult for me . . .
T: But what are you thinking when you find yourself in these situations?
P: I think of too many things.
It is impossible to understand whether the fundamental problem is embarrassment, a feeling of low self-esteem or difficulty in portraying to oneself the other’s mental state, but it seems certain that the patient is not experiencing any vivid feelings of being in love, any enthusiasm or joy, and to the therapist the relationship seems undefined and vague in nature.
In certain pathologies there can be a proto-narrative dysfunction that is context-dependent: in dependent personality disorder, a patient, in the absence of a reference figure, does not have access to emotionally marked scenarios indicating their goals (Carcione, Conti, Dimaggio, Nicolo, & Semerari, 2001; Carcione & Falcone, 1999; Carcione, Nicolo, & Semerari, 1999). The mind does not have the ability to ‘select’ image sequences providing orientation towards specific choices. There can be fragmentary images-a sign that the pre-narrative level is intact-but it is impossible for these to ‘develop’ into ordered and complex sequences, or alternatively they stay out of focus and change along with any change in the relationship context. With co-ordination with the other, it is possible for a dependent person to choose a future scenario that has already been selected and defined (that proposed by the other) to occupy their empty space. The other’s story becomes temporarily their own.
We have been able to see, moreover, that mental images are not created in a compact form: we continuously join together elements from the various sensorial and emotional codes. If this function is not carried out correctly or is unstable, our experience is fragmented, and we enter the realm of the basic narrative integration deficit (Dimaggio & Semerari, 2001). This is to be found in schizophrenia, in which injuries, often of a biological nature, undermine the ability to synthesize coherent scenarios in which the
characters have a dialogue with each other (Lysaker & Lysaker, 2001). But these symptoms are to be seen in dissociative disorders and borderline personalities, too. A person can thus experience an agreeable bodily sensation, and at the same time have an unpleasant thought, whilst recalling a memory that has no link with either the former or the latter. The excerpt from Serena’s course of therapy quoted above is a prime example. Here the therapist confronts the patient with the deficit:
P: (laughing) I’m tired.
P: Yes and so?
T: Welcome back.
P: Thanks and, well, I haven’t been too well [. . .] One evening I was really ill (laughing) there are twenty two of us on the course.
T: Let’s be clear about this: it worries me when you say you’re not well and laugh at the same time.
T: This worries me.
P: I know, in fact. . .
T: Because maybe the result is that you yourself don’t feel taken seriously, isn’t that the case? If you’re not well, you should grimace.
P: I’ll die (laughs) laughing.
The interpersonal hypothesis (Liotti, 2000) seems to identify the basis to this disorder correctly. The process of synthesizing proto- narratives does not occur in the patient’s mind in isolation. Caretakers help a child to identify its emotional states, select images and significant memories, exclude from consciousness anything that is not relevant to the context and appease disturbing emotions. In the early phases of the development of an attachment relationship they can be important in influencing the formation of new synaptic links or neural profiles (Goldsmith, Gottesman, & Lemery, 1997). If there is a change in a developmental relationship, a child can experience images or bodily sensations that they do not know how to aggregate. Their consciousness as a result becomes unstable and does not produce orderly sequences of images through the organization of coherent proto-narratives. At the narrative levels proper, the stories formed are themselves confused.
It would appear that narrative integration deficits also involve the process of passing from the proto-narrative level to other, more complex ones. Often there is a dissociation between the elements making up one story or between different stories; there is no thematic consistency to control access to consciousness by sequences of images sharing the same emotion. In syndromes like the borderline or dissociative ones, there can be a chronic lack of regulation of emotional s\tates. The emotions, being too intense and changeable, can have the role of ‘selecting’ images, cognitions and metacognitions, but the sequences selected are completely off the subject and often antithetical (Kernberg, 1975). The result is mere fragments of stories, in which it is true that a reasonable link can be made between the images and decipherable underlying emotions but the latter are not sufficiently stable: an emotion is only for a moment a force for the joining up of mental images. The result is a fragmentation generating a further lack of control of emotions (Dimaggio & Semerari, 2001, 2004). It is likely therefore that in these syndromes the hampering of the autobiographic narrative level is a phenomenon subordinate to the disorganization of more basic levels of narrative construction.
The narrative levels
We suggest that the next step on from proto-narratives is ‘extended narratives’ (Damasio, 1999), which act as a substratum to the continuity and integration of experience. This level is similar to the previous one but takes place in a more ample setting and over a longer period; it links present to past experience (and the future foreseen), which is a part of our autobiography (Mancuso & Sarbin, 1983) and which we identify as being ours from any viewpoint and in any moment that we look back over it.
Within our model the extended forms of narrative are organized on a number of levels:
(a) Procedural unconscious narrative level, in which elements of the propositional code are absent.
(b) Conscious propositional narrative level, in which various dispositional representations are linked together, making a story more complex and sophisticated, as we saw previously. Here the cognitive and metacognitive elements that rewrite and enrich a story are joined together; they have linguistic characteristics.
(c) Verbal interactive narrative level: this originates from the dialogue with others, and because of this, we are able to share experiences, build mutually agreed meanings and negotiate the significance of experiences themselves.
The procedural unconscious narrative level
This is the level involving relational experiences with parent figures, organized in the mind as scripts about interaction and interactive procedures for the guidance of a patient’s action in the absence of conscious meta-representations. The behaviour of Marcello, who is 28 years old and is suffering from a slight mental retardation, avoidant personality disorder and obsessive-compulsive disorder, provides an example of these processes.
During the activities of the rehabilitation centre at which he is enrolled, Marcello and the staff often replay the same scene. A member of staff asks Marcello to become involved in an activity, and Marcello refuses. Sometimes the staff insist. At this point, Marcello bursts into rage and insults whoever is insisting. Then he escapes to the outside courtyard and, in front of the entrance and from behind the parked cars, ruminates angrily over how to get his revenge.
If one was to ask Marcello the reason for such behaviour, he would not be able to define it; that is, he does not have conscious meta-representations of the behaviour that has been activated. The sequence is a very rigid story, which for an external observer could be described as follows. If Marcello becomes aware of emotional closeness and pressure towards interpersonal contact, he feels emotions that disturb him, varying from distress to shame. he decodes the arousal as a sensation of threat and humiliation and reacts with anger, evoking the figure of his father. The latter, by giving him protection, re-establishes the dominance – submission relationship between him and the staff: ‘He’s coming here and he’ll show you.’ The sequence has the form of an IWM (Bowlby, 1969), in which an interactive script guides behaviour without having access to conscious representation. Similarly, according to Stern (1989, 1997) the self that gets told about originates from interpersonal experiences that are lived through repeatedly, which he defines as ‘representations of interactions that have been generalized’ (RIG).
This is a procedural-unconscious narrative form of knowledge. A child is frightened, tries to get near to its mother and stops worrying when its mother carries out some codified actions: taking it in her arms, speaking to it with a calm and gentle tone of voice and stroking it. This unfolds like a short story: initially the child is afraid and looks for a comforting figure; the first possible ending is that the figure is present and carries out certain actions that calm it down, while the second is that the figure is absent, and the child remains distressed. The story has some very rigid constraints, of which the child is not conscious in its actions, but which perhaps it portrays in advance to itself in the form of semi-structured sequences of images: it perceives only certain signals to be soothing and only that figure (or a few others) is (or are) able to deliver them successfully. This kind of interaction requires that the child has a procedural representation of the caregiver’s inner contingent state. Harris (1989) clearly documents a basic perceptual mechanism which gives a normal child an immediate understanding of others’ emotional states, starting from the observation of those others’ facial expressions. This permits the child-after repeated interactions-gradually to develop:
(a) an articulated theory of other’s mind, and
(b) the capacity to think about oneself in relation to others, which Fonagy, Steele, Steele, and Leigh (1995) call the ‘reflexive self-function’ (RSF). RSF is closely related to narrative skills: ‘. . .in order to tell a story about oneself in relation to others one has to be able to reflect on oneself-to see oneself, partially at least from the outside. . .’ (Holmes, 1999, p. 54).
This assumption is confirmed by research on adult attachment patterns with Adult Attachment Interview (AAI; Hesse, 1999; Main, 1995; Main, Kaplan, & Cassidy, 1985): there appears to be a close connection between attachment experience in childhood and narrative style in adulthood (Holmes, 1999). These authors (see also Fonagy et al, 1995) have given form to the ideas of Bion (1963) and Matte Blanco (1975) about the continuous transformation of raw mental experience into conscious thoughts following formal logical rules.
A small child, according to Stern (1989, 1997) does not have any experience of a narrative self until 3 or 4 years old. By this age, according to Goswami (1991), ‘analogical reasoning’, involving finding links between new and old events, can also be observed: repetition of an interaction renders the development of new structures of narrative representation possible. The interaction conforms to particular scripts: the child and its interactive partner have to perform a certain number of emotionally important scenes according to rigid sequences.
It is a question therefore of actions guided by procedures and not by conscious thought, organized as in a story and made up of a series of scenes portraying desired and undesired states of the world following on one from another, diachronically. It is the fact that there are structural constraints to the script and its being repetitive that lead us to classify these procedures among the more complex narrative forms.
The conscious prepositional narrative level
There is evidence that from around 3 or 4 years of age, a child is able to enter the conscious propositional narrative level (Mandler, 1984): here, it constructs conscious narratives that are not unlike those in adulthood. Current interpersonal relationships (see previous level) thus end up being guided by memorized patterns of experience that can be related. Here we can see how a dysfunctional IWM becomes a story that is related during a session:
T: … both the episodes you’ve told me about. . .
P: but there are other sides to it too that cause me pain . . .
T: no, let’s carry on with the same subject, I mean the two episodes you told me about. . . On the one hand the one involving smoking. . .
P: wait a moment, consider that. . .
T: one moment, let me finish. . .
P: you should apologise . . .
T: then I’ll let you speak as much as you like. . .
P: yes, but I’ve always been used, since I was little . . .
T: . . . while . . .
P: to them going sshh, signalling with their finger that they wanted me to be silent
T: I didn’t know
The interaction with the therapist activates an autobiographical sequence in which the theme is expression being blocked by an authoritarian figure. The therapist sets off the patient’s protest unintentionally, but the latter manages to describe the interpersonal schema the two were enacting (directed by procedural, unconscious and emotional memory) in their relationship.
Mnemonic interpersonal relationship patterns have been defined in various ways: relational schemas (Baldwin, 1992), model scenes (Lichtenberg, Lachmann & Fosshage, 1992), role-relationship models (Horowitz, 1987), reciprocal role procedures (RyIe, 1995), core conflictual relationship theme (Luborsky & Crits-Christoph, 1990) and prototypical narratives (Goncalves, Korman, & Angus, 2000). The core aspect of these models is that each of us possesses a set of representations, of both the procedural unconscious and conscious propositional types, which includes, according to Baldwin (1992), at least the following elements:
(a) an interpersonal script containing expectations about how an interaction will proceed;
(b) a self schema for how self is experienced in that interpersonal situation; and
(c) a schema for other persons, including an expectation about how the other will react in that situation.
In addition to this core aspect, which refers to dual relationships, there are representations of the relationship in progress, of the context in which it is developed and of the reciprocal roles t\hat are activated. According to Horowitz (1991), we also need to consider schemas of schemas.
At a more sophisticated, cultural level, we find:
(i) a representation of groups, of the rules underlying them and of belonging to them; and
(ii) values and ideals, represented in the form of myths: religious texts or prototypical family memories in which significant figures conduct actions that constitute a reference mythology.
We continuously compare the state of the self and of the world here and now with representations of the past and of our plans for the future. For example, some people can recall the scene of their mother talking about how her future husband courted her and she fell in love with him to help them choose whom to marry and where. Narrative is the tool that the mind, so to speak, uses to keep this knowledge together.
As we have already argued, narrative organization is functionally based in the brain. This does not mean that culture, one’s developmental history or new knowledge acquired, passes by in vain, without leaving any traces in the representation of oneself. The important point is that the stories that one’s mind constructs and portrays to itself are tied substantially to one’s bodily state. This requires that one’s stories be consistent with bodily experience, ascribe a meaning to what is registered by somatic perceptions, and guide action in line with what the body is able to carry out. I could fantasize about flying but I need to keep clearly in mind that there is a difference between fantasy and reality if I do not want to put my life at risk every time I distractedly and absentmindedly go over a bridge. Another example is a story in which a man is his own myth and describes himself as being an invincible hero, while not considering the feeling of weakness that sometimes takes hold of him when faced with difficult tasks or the displeasure he experiences when his partner is away; this is a dysfunctional story.
Dario is 30 years old and suffers from narcissistic personality disorder. he confesses, somewhat perplexed, to his therapist that he feels himself to be invulnerable like a superhero in an American comic book. he is unaware that life is ageing him. His girlfriend has split up with him. he phones the therapist in great distress: he has found himself perched on the ledge on the facade of his building and thinking about throwing himself off it. he has no idea how he got there.
This mythical story, with Dario a spotless and fearless hero and his own myth, is untenable: it does not incorporate his weaknesses, physical signs of unease, fragility or his need for protection. Dario suffers from some sexual dysfunctions and cannot reach ejaculation, but he does not speak about this during his sessions. These dissociated elements, although not incorporated in his conscious narrative, make themselves felt, and Dario feels himself to be abandoned and worthless and is stirred by fantasies about suicide.
The verbal interactive narrative level
The final level of narrative building is complex narratives, which we can ‘relate’ in the form of an inner or interactive dialogue. The various characters that live in our mental world interact between themselves by weaving a continuous dialogue, taking on reciprocal positions (dominant/submissive, idealized/idealizing) and exchanging points of view about the world (Hermans, 2001; Hermans & Kempen, 1993). When this dialogue is not permitted, a patient cannot use functioning parts of the self to cope with problem parts. For example, in the following extract, taken from the diary of Tina, a 26-year-old patient suffering from dependent personality disorder, there is a character which is critical towards the protagonist self, which is seen as being inadequate. The result is that the patient adopts a dependent stance towards others (‘their opinion is worth more than mine”) and suffers from attacks of anxiety:
. . . I’ve no self-esteem, I consider that I’ve got nothing good to offer or even if I do I manage to spoil it and spot a fault in it. I’m very good at getting discouraged. There’s always something about me that’s not right. When we’re getting ready to go out, I look at myself in the mirror and I like what I see. Then I go out, I meet up with my friends and all of a sudden I feel inferior to them. I’m no longer pleased with myself, I feel out of place . . . full of doubts. The Tina in the mirror no longer exists; her place has been taken by a girl who is full of doubts, about how she dresses and how she makes herself up.
We can also see how the narrative is told from the point of view of an observer self, which describes the reaction between critical character and dependent character. This observer self provides the foundations during therapy for the adopting of a critical distance from the dependent role that Tina has always played.
In dialogical constructivism, under the inspiration of Bakhtin (1984) and Vigotskyi (1978), one’s mental scenario is inhabited by various characters, voices or positions continuously negotiating the meaning of the world and each of them the author of a story with a particular perspective (Hermans, 2001; Hermans & Hermans-Jansen, 1995; Hermans, Kempen, & van Loon, 1992; Leiman, 1997; McAdams, 1993). These characters tell stories in which memories of developmental relationships and culture traits are absorbed by a person and continuously subjected to modification when they interact with the world. Each character is the author of its own story in a manner that is relatively independent from the others. It is only thanks to the dialogical interaction between the characters in the internal scenario that a dominant voice, an action control centre or a core recognized by the person themself as being the basis for their sense of personal identity, emerges.
We write and rewrite the story that comes out of this internal dialogue; we foresee new plans, adopt new ways of seeing the world and modify the dominance hierarchy between the characters (Hermans, 1996b). Psychotherapy is one of the moments in which it is possible to make stable modifications to an internal dialogue, allowing, for example, characters with the ability to contemplate a patient’s thoughts with critical detachment to emerge or letting new characters express themselves (Dimaggio et al., 2003a; Dimaggio et al., 2003b; Hermans, 2001; Neimeyer, 2000; White & Epston, 1990). But in this respect psychotherapy should operate in a patient’s so- called ‘zone of proximal development’, identify at what (narrative in this case) skill level they are at and lead them on to the stage that immediately follows (Dimaggio et al., 2003a; Leiman & Stiles, 2001; Vigotskyi, 1978).
Another example is that shift that psychoanalysts term ‘the passing from passive to active’ (Weiss, 1993): a defenceless victim, at a certain point in their life, takes on the role of a sadistic persecutor, or a frightened and bewildered person can become that reassuring and attentive figure that they were looking for. In Hermans’ terminology there has been an alteration in the dominance hierarchy between the various possible positions.
Other authors focus on the inconsistencies in or incompleteness of a patient’s autobiography and, linked to this, their sense of self (Neimeyer & Stewart, 1998). Gustafson (1995) notes that the periods in a person’s life in which there are problems are marked by gaps in their story. Polkinghorne (1991) draws attention to the way in which narratives ‘decompose’ or ‘disintegrate’ when they are no longer able to incorporate new or forgotten phenomena within the domain of experience. Similarly Wigren (1994) asserts that problems occur when an individual is unable to develop a narrative that includes their traumatic experiences, like violent assaults or incest. Each of these situations leaves a person with a fragmented sense of continuity of self; this can bring about a dissociation of consciousness.
The existing narratives and internal dialogues need to make way for new scripts which, following Kelly’s (1955) line of thinking, allow us to foresee, anticipate and know in a more adaptive manner the environment around us. They form a map of the world that is continuously being redrawn (Dimaggio, Serio, & Ruggeri, 1995).
On this level a patient adjusts, rewrites and improves the stories that have been built up on the other levels. The contrary is also true, in that stories already formed and which a patient feeds on in their social world serve as a model for the morphogenesis of their stories, a sort of organizing principle rendering the sensorial element in aggregation processes, described by Damasio, compatible with the stories that are possible within a culture (Gergen & Gergen, 1988).
We conclude with an example in which there is a consolidated and functioning verbal-interactive narrative level: an extract from an advanced stage in Matteo’s course of therapy:
Perhaps the problem, I was thinking about it now, because I experience it in such a strong way, because. . . the others make the most of their lives, I’m always thinking about this Polish woman, she has a social outlook of a certain type and a self-image that’s probably positive too; but I on the other hand have been doing nothing, since I was 16 years old, except fleeing from life, and so I don’t have a positive image of my social life, I’ve got a negative one, and it’s reinforced by these periods that happen to me every so often when I feel handicapped. So on top of the negative emotionality I have, this reinforces the underlying tendency to avoid all social contacts that I’ve always had and have had to bear since I was an adolescent. That’s the underlying problem because I started to avoid social situations, to avoid going to school, I would run away, you see? But then in the toilet, this is something that I just can’t understand the reason for, I would masturbate, I’d be in the toilet for t\hree hours and then I’d go home; it was as if I had a violent urge; that’s why I was saying earlier ‘if only I could hang my sexuality up on a peg’. I can’t because I’m commanded by my sexuality; however this is all linked to my not having a social life, as if at a certain point in my life, in my psycho social development . . . as if mine was a psycho-asocial development . . . This has led me to live all situations as a handicap . . . on the one hand I live my everyday life, I’m 40 now, and on the other I ask myself, ‘But what sort of life am I leading?’ What am I doing? It’s as if I was someone with a building with just a roof but no floors, no ground floor . . .
The patient is now observing his life and is capable of putting together a story that takes account of what he has done, what he remembers and the emotions he has experienced. There is a functional dialogue between a suffering voice describing his life and a hopeful voice identifying the problems the patient is trying to solve.
We have presented a model of progressive narrative construction, directly applicable to the clinical context. Our model theorizes five narrative levels:
(3) procedural unconscious narrative,
(4) conscious propositional narrative, and
(5) verbal interactive narrative.
According to this model, clinicians should identify which dysfunctional narrative level a patient has if they are to plan the goals of a course of therapy and make suitable adjustments to treatment. For example, a patient might report about an event, and the therapist is unable to grasp the states of mind that they experienced during it. According to our model, the therapist could ask him or herself if the patient’s problem is an inability to recall sequences of images marked by emotions (proto-narrative level), the enacting in the therapist-patient relationship of an internal working model based on the emotional detachment of an authority figure perceived to be harsh and critical (procedural narrative level) or the result of the emergence of a self voice that is so highly self-critical as to inhibit any spontaneity in the telling of the experience to another (conscious narrative level).
In the first case, therapy would be aimed at reconstructing patients’ emotional states, including via the frequent recalling of the emotions felt during verbal and non-verbal exchanges with the therapist (Greenberg & Angus, 2004); in the second case, it would seek to make the patient conscious of IWMs and their role in unconsciously regulating action; in the last case, it would try to foster the emergence of voices remaining in the shadows, by catching them when they show themselves-in stories or during interaction in sessions-especially when the patients themselves are unaware of them.
We are aware that there are some limits to our work, one of these being epistemological: first of all, the link between neurophysiological findings and their explanation and the phenomenological descriptions of clinical material is speculative. For clinical use, this model would require a detailed description of some individual cases with particular dysfunction levels and a demonstration of what a clinician should do in order to tackle them.
As regards research on the psychotherapeutic process, data are available to support the model hypothesized here. An example is the work of Stiles and his colleagues (Stiles, 1999; Stiles, Osatuke, Glick, & Mackay, in press); it shows how patients undergoing psychotherapy describe their experiences at first in the form of vague sensations and somatic states, and then later, if the therapy is successful, assimilate their experiences and succeed in identifying their emotions, in integrating the latter into their discourses and in mastering their problematic experiences. Translated into the language we have been using, Stiles’s work supports the hypothesis that patients construct their discourses with ever more articulate degrees of narrative and that treatment should concentrate on the narrating skills that they actually have at their disposal.
1 We use the terms ‘emotion’ and ‘bodily state’ indiscriminately because here we are focusing on the most basic dimension of emotion, the somatic one (Damasio, 1994, 1998).
2 For a more detailed study of the relationship between emotion and perceptual events, see also Adelman and Zajonc (1988); Ekman (1983); Frijda (1986, 1993); Izard (1971, 1990); Laird (1974); Lazarus (1966); Oatley and Johnson-Laird (1987); Scherer (1984); Smith and Lazarus (1993); Strack, Martin, and Stepper (1988); and Tomkins (1963).
3 Damasio differentiates the image-cortical areas (inferior sensitive cortices) from the dispositional ones (superior cortices). The contingent emotion focuses attention on a specific matter, thus orienting the activation of image-areas by dispositional ones towards the representation of image-sequences connected with that matter.
Kaplan-Solms and Solms document with some clear neurobiological and neuro-imaging data the relationship between the function of some specific brain areas and the structuring of dream image sequences. Damage to the right parietal cortex-the more ‘emotional’ one-is connected to an inability to give an order to the sensorial images constituting the manifest content of a dream.
4 For an up-to-date review regarding the relationship between memory and narrative processes, see Siegel (1999).
Adelman, P. K., & Zajonc, R. B. (1988). Facial efference and the experience of emotion. Annual Review of Psychology, 40, 249-280.
Baars, B. (1988). A cognitive theory of consciousness. Cambridge: Cambridge University Press.
Bakhtin, M. (1984). Problems of Dostoevsky’s poetics (trans. Caryl Emerson). Minneapolis, MN: University of Minnesota Press.
Baldwin, M. W. (1992). Relational schemas and the processing of social information. Psychological Bulletin, 112, 461-484.
Bion, W. (1963). Elements of psychoanalysis. London: Heinneman.
Bjork, R. (1989). Retrieval inhibition as an adaptive mechanism in human memory. In H. L. Roediger & F. I. M. Clark (Eds.), Varieties of memory and consciousness: Essays in honour of Endel Tulving (pp. 309-330). Chichester: Wiley.
Bower, G. H. (1981). Mood and memory. American Psychologist, 36, 129-148.
Bowlby, J. (1969). Attachment and loss: Vol I. London: Hoghart Press.
Bruner, J. (1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.
Bruner, J. (1990). Acts of meaning. Cambridge, MA: Harvard University Press.
Carcione, A., Conti, L., Dimaggio, G., Nicole, G., & Semerari, A. (2001). Estados mentales, deficits metacognitivos y ciclos interpersonales en el trastorno de personalidad per dependencia. [States of mind, metacognitive shortcoming, and interpersonal cycles in dependent personality disorder]. Revista de Psicoterapia, 45, 39- 63.
Carcione, A., & Falcone, M. (1999). Il concetto di metacognizione come costrutto clinico fondamentale per la psicoterapia [The concept of metacognition as a basic clinical construct]. In A. Semerari (Ed.), Psicoterapia cognitiva del paziente grave [Cognitive psychotherapy of severe patient] (pp. 9-42). Milan: Raffaello Cortina Editore.
Carcione, A., Nicolo, G., & Semerari, A. (1999). Il deficit di rappresentazione degli scopi. [The deficit in goal representation] In A. Semerari (Ed.), Psicoterapia cognitiva delpaziente grave [Cognitive psychotherapy of severe patient] (pp. 141-164). Milan: Raffaello Cortina Editore.
Christianson, S. A. (Ed.). (1992). Handbook of emotion and memory. Hillsdale: Erlbaum.
Damasio, A. R. (1994). Descartes’ error: Emotion, reason, and the human brain. New York: Putman.
Damasio, A. R. (1998). Emotion in the perspective of an integrated nervous system. Brain Research Reviews, 26, 83-86.
Damasio, A. R. (1999). The feeling of what happens. Body and emotion in the making of consciousness. New York: Harcourt Brace.
Dimaggio, G., Salvatore, G., Azzara, C., & Catania, D. (2003a). Rewriting self-narratives: the therapeutic process. Journal of Constructivist Psychology, 16(2), 155- 181.
Dimaggio, G., Salvatore, G., Azzara, C., Catania, D., Semerari, A., & Hermans, H. J. M. (2003b). Dialogical relationships in impoverished narratives: From theory to clinical practice. Psychology and Psychotherapy: Theory, Research and Practice, 76, 385- 410.
Dimaggio, G., & Semerari, A. (2001). Psychopathological narrative forms. Journal of Constructivist Psychology, 14, 1-23.
Dimaggio, G., & Semerari, A. (2004). Disorganized narratives: The psychological condition and its treatment. How to achieve a metacognitive point of view restoring order to chaos. In L. Angus & J. McLeod (Eds.), Handbook, of narrative psychotherapy: Practice, theory and research (pp. 263-282). Thousand Oaks, CA: Sage.
Dimaggio, G., Serio, A. V., & Ruggeri, G. (1995). L’architettura narrativa delia personalita osservata nel sogno: Le Autonarrazioni Nucleari Ricorsive (ANR) [The narrative architecture of personality as observed in dreams: Core recursive self-narratives (CRS)]. Psicoterapia, 5, 67-82.
Ekman, P. (1983). Autonomic nervous system activity distinguishes among emotions. Science, 221, 208-210.
Falcone, M. (1999). Alessitimia. Un deficit metacognitivo. Psicoterapia, 16/17, 111-118.
Fodor, J. (1983). The modularity of mind. Cambridge, MA: MIT Press.
Fonagy, P., Steele, M., Steele, H., & Leigh, T. (1995). Attachment, the reflective self, and the borderline states: The predictive specificity of the Adult Attachment Interview and pathological emotional development. In S. Goldberg, R. Muir, J. Kerr (Eds.), Attachment theory: Social, developmental and clinical significance (pp. 233-278). Hillsdale, NJ: Analytic Press.
Frijda, N. H. (1986). The emotions. Cambridge: Cambridge University Press.
Frijda, N. H. (1993). The place of appraisal in emotion. Cognition and emotion, 7(3/4), 357-387.
Gazzaniga, M. S. (1988). The dynamics of cerebral specialization and m\odular interactions. In L. Weiskrantz (Ed.), Thought without language (pp. 430-450). Oxford: Clarendon Press.
Gergen, K. J., & Gergen, M. N. (1988). Narrative and self as relationships. Advances in Experimental Social Psychology, 21, 17- 56.
Goldsmith, H. H., Gottesman, I. I., & Lemery, K. S. (1997). Epigenetic approaches to developmental psychopathology. Development and Psychopathology, 9, 365-388.
Goncalves, O. E, Korman, Y, & Angus, L. (2000). Constructing psychopathology from a cognitive narrative perspective. In R. A. Neimeyer & J. D. Raskin (Eds.), Constructions of disorder: Meaning- making frameworks for psychotherapy (pp. 265-284). Washington, DC: American Psychological Association.
Goswami, U. (1991). Analogical reasoning. What develops? A review of research and theory. Child Development, 62, 1-22.
Greenberg, L. S., & Angus, L. (2004). The contributions of emotion processes to narrative change in psychotherapy: A dialectical constructivist approach. In L. Angus & J. McLeod (Eds.), Handbook of narrative psychotherapy: Practice, theory and research, (pp. 331-350) London, Sage.
Grice, H. P. (1975). Logic and conversation. In P Cole & J. L. Moran (Eds.), Syntax and semantics. (Vol. 3, pp. 129- 178). New York: Academic Press.
Guidano, V F. (1987). The complexity of the self: A developmental approach to psychopathology and therapy. New York: Guilford Press.
Gustafson, J. P. (1995). Dilemmas of brief therapy. New York: Plenum.
Harris, P L. (1989). Children and emotion. The development of psychological understanding. Oxford: Basil Blackwell.
Hermans, H. J. M. (1996a). Voicing the self: From information processing to dialogical interchange. Psychological Bulletin, 119, 31-50.
Hermans, H. J. M. (1996b). Opposites in a dialogical self: Constructs as characters. Journal of Constructivist Psychology, 9, 1- 26.
Hermans, H. J. M. (2001). The construction of a personal position repertoire: Method and practice. Culture & Psychology, 7(3), 324- 366.
Hermans, H. J. M., & Hermans-Jansen, E. (1995). Self-narratives: The construction of meaning in psychotherapy. New York: Guilford Press.
Hermans, H. J. M., & Kempen, H. J. K. (1993). The dialogical self: Meaning as movement. San Diego: Academic Press.
Hermans, H. J. M., Kempen, J. K., & van Loon, R. J. P (1992). The dialogical self: Beyond individualism and rationalism. American Psychologist, 47(1), 23-33.
Hesse, E. (1999). The Adult Attachment Interview: Historical and current perspectives. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 395- 433). New York: Guilford Press.
Holmes, J. (1999). Defensive and creative uses of narrative in psychotherapy: An attachment perspective. In G. Roberts & J. Holmes (Eds.), Healing stories: Narrative in psychiatry and psychotherapy (pp. 49-68). Oxford: Oxford University Press.
Horowitz, M. J. (1987). States of mind: Conflgurational analysis of individual psychology (2nd ed.). New York: Plenum Press.
Horowitz, M. J. (1991). States, schemas and control: General theories for psychotherapy integration. Journal of Psychotherapy Integration, 1(2), 85-102.
Izard, C. E. (1971). The face of emotion. New York: Appleton- Century Crofts.
Izard, C. (1990). Facial expressions and the regulation of emotions. Journal of Personality and Social Psychology, 58, 487- 498.
Janet, P. (1889). L’automatisme psychologique. [The psychological automatism]. Paris: Alcan.
Johnson-Laird, P N. (1983). Mental models: Towards a cognitive science of language, inference, and consciousness. Cambridge: Cambridge University Press.
Kaplan-Solms, K., Si Solms, M. (2000). Clinical studies in neuro- psychoanalysis. Madison, CT: International Universities Press.
Kaufmann, G. (1980). Imagery, language and cognition. Bergen: Universiteforlget.
Kelly, G. A. (1955). The psychology of personal constructs. New York: Norton.
Kernberg, O. (1975). Borderline conditions and pathological narcissism. New York: Jason Aronson.
Kosslyn, S. M. (1975). Information representation in visual images. Cognitive Psychology, 7, 341-370.
Kosslyn, S. M., & Pomeranz, J. R. (1977). Imagery, propositions, and the form of internal representation. Cognitive Psychology, 9, 52- 76.
Krystal, H. (1974). The genetic development of affects and affect repression. Annual of Psychoanalysis, 2, 98- 126.
Labov, W, & Fanshel, D. (1977). Therapeutic discourse: Psychotherapy as conversation. New York: Academic Press.
Laird, J. D. (1974). Self-attribution of emotion: the effects of expressive behaviour on the quality of emotional experience. Journal of Personality and Social Psychology, 29, 475-486.
Lazarus, R. S. (1966). Psychological stress and the coping process. New York: McGraw-Hill.
Leiman, M. (1997). Procedures as dialogical sequences: A revised version of the fundamental concept in cognitive analytic therapy. British Journal of Medical Psychology, 70, 193-207.
Leiman, M., & Stiles, W. B. (2001). Dialogical sequence analysis and the Zone of Proximal Development as conceptual enhancements to the assimilation model: The case of Jan revisited. Psychotherapy Research, 11, 311-330.
Lichtenberg, J., Lachmann, F. M., & Fosshage, J. (1992). Self and motivational systems: Toward a theory of psychoanalytic technique. Hillsdale, NJ: Analytic Press.
Liotti, G. (2000). Disorganized attachment, models of borderline states and evolutionary psychotherapy. In R Gilbert & K. Bailey (Eds.), Genes on the couch: Explorati