Chaos To Coherence

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Chaos To Coherence: Psychotherapeutic Integration Of

Traumatic Loss
a b b
Robert A. Neimeyer , Olga Herrero & Luis Botella
a
University of Memphis , Memphis, Tennessee, USA
b
Ramon Llull University , Barcelona, Spain
Published online: 16 Aug 2006.
To cite this article: Robert A. Neimeyer , Olga Herrero & Luis Botella (2006) Chaos To Coherence: Psychotherapeutic
Integration Of Traumatic Loss, Journal of Constructivist Psychology, 19:2, 127-145, DOI: 10.1080/10720530500508738
To link to this article: http://dx.doi.org/10.1080/10720530500508738
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Journal of Constructivist Psychology, 19:127145, 2006
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ISSN: 1072-0537 print / 1521-0650 online
DOI: 10.1080/10720530500508738
CHAOS TO COHERENCE: PSYCHOTHERAPEUTIC

INTEGRATION OF TRAUMATIC LOSS
ROBERT A. NEIMEYER
University of Memphis, Memphis, Tennessee, USA
OLGA HERRERO and LUIS BOTELLA

Downloaded by [Universidad de Chile] at 12:44 25 May 2014
Ramon Llull University, Barcelona, Spain
Traumatic life events have the power to disrupt those self-narratives with
which people order their life experience, by challenging their organization,
promoting the development of problem-dominated identities, and fostering dis-
sociation of aspects of the experience in a way that precludes its integration.
We briefly consider these processes at levels ranging from the biogenetic, through
the personal-agentic, to the dyadic-relational, and ultimately to cultural-lin-
guistic levels of narrative structure, and then present the results of a grounded
theory analysis of psychotherapy to reveal the pragmatic and rhetorical strate-
gies by which it counters such disruption. Results suggest the means by which
a client and therapist collaborate to help the former reconstruct the meaning of
her mothers suicide, ultimately moving toward greater coherence and hopeful-
ness in the narration of her life.
At age 37, Sandra1 sought psychotherapy for a range of com-

plaints, including corrosive self-doubt and guilt, anger, and mari-
tal difficulties with her second husband. It soon became evident
that her problems were longstanding, dating to her traumatic
discovery, at age 11, of the lifeless body of her mother, who had
1
Sandra is the pseudonym of a client who received services as part of a research
protocol at York University, Toronto, Canada, who consented to her therapys being
recorded and analyzed as part of a broader process-outcome study. We appreciate her
willingness to contribute her data to this project, and thank Dr. Lynne Angus for help-
ing us gain access to these transcripts.
Received 4 September 2005; accepted 1 November 2005.
Address correspondence to Robert A. Neimeyer, Department of Psychology, Univer-
sity of Memphis, Memphis, TN 38152, USA. E-mail: neimeyer@memphis.edu
127
128 R. Neimeyer et al.
ended her life with a gunshot wound to her head. In the tumul-
tuous years that followed, Sandra and her siblings were sepa-
rated, as each was sent to live with different relatives. In her case,
she was taken into the custody of a severely alcoholic uncle, as
her own fathers drinking in the aftermath of his wifes suicide
led to his death five years later. For these and other tragic out-
comes Sandra blamed her mother, who she believed destroyed
not only her own life but also those of her husband and children
through her violent death by her own hand.
Now, over 25 years later, Sandra sought help in reclaiming a
life that had gone tragically awry on the verge of her adoles-
cence. As she said of her mothers suicide in her opening re-

marks, I cant forget it . . . I thought it would become more
diminished in my mind, but it resurfaces [and] takes a lot of
forms for me, including a self-limiting and self-destructive lifestyle,
interpersonal problems, and a pervasive sense of confusion about
the suicide itself. In her words, Its not quite as organized as I
would like it to be . . . . Its been bothering me for a long time,
and its all diffusion. Through therapy Sandra hoped to achieve
greater clarity about the tragic episode and its general impact on
her life, and find a way toward a future less dominated by the
past.
How can we understand the impact of traumatic loss such as
that which Sandra encountered, a loss that seemed to play a
defining role in her life course? And how can we conceptualize
psychotherapy as a process by which to redress that loss, and
consolidate a sense of self and life that is more sustainable? In
addressing these questions we will first introduce a narrative
conceptualization of traumatic bereavement, identifying various
forms of disruption of life-narratives and briefly noting their neu-
robiological, personal, and social dimensions. We will then apply
these concepts to Sandras case, and turn toward a qualitative
analysis of the process and outcome of Sandras therapy to eluci-
date the means by which traumatized persons can move from
chaos toward coherence.
Identity and the Self-Narrative
Viewed through a broadly constructivist lens, ones sense of self

can be seen as a narrative achievement (Neimeyer & Levitt, 2001a).
Psychotherapeutic Integration of Traumatic Loss 129
Specifically, people are seen as constructing meaning of their life

experiences by punctuating the seamless flow of events and orga-
nizing them according to recurrent themes (Kelly, 1955/1991),
which in turn scaffold the plot of ones life story, and confer
on it a modicum of consistency over time (Neimeyer, 2000). Technically,
the self-narrative has been defined as an overarching cognitive-
affective-behavioral structure that organizes the micro-narratives
of everyday life into a macro-narrative that consolidates our self-
understanding, establishes our characteristic range of emotions
and goals, and guides our performance on the stage of the social
world (Neimeyer, 2004, pp. 5354). Thus, in this definition, a
self-narrative need not be related verbally to another in order to

play a vital self-organizing function for the individual. Like all
other significant aspects of human development, it emerges epi-
genetically from the coaction of multiple levels of systemic orga-
nization, ranging from the biogenetic, through the personal-agentic,
to the dyadic-relational, and ultimately to the cultural-linguistic
(Mascolo, Craig-Bray, & Neimeyer, 1997).
At a biogenetic level, self-narratives are anchored in broadly
distributed neurological structures that subserve autobiographi-
cal memory and narrative reasoning (Rubin & Greenberg, 2003).
Almost every brain system is involved in this process to a greater
or lesser extent (see Cozolino, 2002, for a detailed review). On
the one hand, implicit learning and memory (especially during
childhood) contribute to the lifelong power of automatic schemas
that pattern our perception of the life events in our narratives
(Liggan & Kay, 1999; Siegel, 1999), priming retrieval of certain
memories as a function of the sensorial cortex and emotional
states regulated by the amygdala (see Kandel, Schwartz, & Jessell,
1991). On the other hand, explicit memory involves the medial
temporal lobe, whose storage entails the long-term potentiation
of neurons in the hippocampus and cortex (Kandel, Schwartz, &
Jessell, 1991). The process of cortical consolidation turns these
meaningful memories into permanent ones as they are differen-
tiated and integrated into our deeply felt sense of personal and
social identity. Emotion and the limbic system regulate the en-
tire process due to their powerful appraisal role, as both left
hemispheric language skills and right hemispheric spatiotempo-
ral processes contribute to an articulated and well-formed self-
narrative. Finally, the integrative functions of the orbitofrontal
cortex provide critical coordination of social cognition, emotion,

meaning construction and action planning (Siegel, 2001).
At a personal-agentic level, the self-narrative provides a means
of assimilating experience into existing structures of meaning,
and when events such as profound loss challenge their adequacy,
these very structures normally undergo revision to accommodate
them to changed circumstances (Neimeyer, 2005b). Thus, although
narrative development cannot be said to become more true in
an objective sense over time, it does tend toward greater adapta-
tion, in the sense of representing an ever more complex resource
for organizing emotionally relevant experiences and for negoti-
ating the social world (Guidano, 1991).

At a dyadic-relational level, self-narratives provide the scaf-
folding for interpersonal accounts of our experience, whether in
the form of descriptions of the events of our day to a family
member when we return home from work, or anguished attempts
to winnow meaning from problematic life stories told in the pres-
ence of a psychotherapist (Harvey, 2000; Neimeyer & Levitt, 2001b).
Moreover, social behavior is often motivated by the attempt to
recruit audiences for a (selective) performance of the self-narra-
tive, underscoring the extent to which such life scripts are en-
acted, and not merely recounted, in the presence of others (Goffman,
1959). Of course, these living narrations are not solipsistic in
origin, but instead represent the dialogical appropriation of the
voices of others into the self (Bakhtin, 1981; Hermans & Dimaggio,
2004); we come to see our selves in part as we are seen. In this
sense the self-narrative, however personal, is always extensively
coauthored by relevant others.
And finally, at a cultural-linguistic level, self-narratives repre-
sent importations of the themes, roles, and discourses available
in a given culture, for better or worse (Burr, 1995; Neimeyer,
1998). Because any given life is lived at the intersection of many
competing group memberships and (sub)cultural matrixes, the
resulting identity options are virtually guaranteed to be multiplistic
and contradictory (Efran & Cook, 2000), and the narrated self
socially saturated and less than fully coherent (Gergen, 1991).
As a consequence, even under favorable circumstances, a ten-
dency toward narrative coherence operates as a system principle
that is never fully achieved.
Traumatic Disruption of the Self-Narrative
Although changes in the self-narrative are typically progressive,

moving the system toward greater levels of differentiation and
integration, there are circumstances under which life events dis-
rupt this evolutionary development, profoundly challenging its
adequacy at several levels of the epigenetic model. We will briefly
discuss three that have relevance for an analysis of Sandras story
to provide background for understanding processes of narrative
repair in her psychotherapy.
Narrative Disorganization
Dramatic life events, and especially those of a traumatic kind,

have the potential to introduce experiences that are not only
radically incoherent with the plot of a persons prior life narra-
tive, but that invalidate its core emotional themes and goals as
well (Neimeyer, 2000). At a biogenetic level, this can be under-
stood in terms of the toxic effects of intense and chronic stress
and trauma on most of the brain systems sketched aboveand
particularly on the limbic system and the integrative role of the
orbitofrontal cortex (Schore, 2001, 2002). Thus, it is not surpris-
ing that an experience as intense and traumatic as Sandras im-
pairs ones capacities for narrative organization of a stable sense
of self, or even making sense of the loss itself, as has been em-
pirically observed in research on survivors of suicide (Currier,
Holland, Coleman, & Neimeyer, 2006). Moreover, because inse-
cure attachment patterns have been demonstrated to be a pre-
dictor of increased vulnerability to such toxic effects (Siegel, 2001),
Sandras case is especially serious because it was her primary at-
tachment figure who committed suicide. Such a tragic loss can
therefore be viewed as operating at levels that range from the
neurological through the personal to relational, undermining a
secure and coherent sense of self and other. This deeply per-
sonal loss was compounded by the broader repercussions of her
mothers suicide, which also shattered the structure of her fam-
ily, and introduced a train of secondary losses whose integration
into a coherent life narrative was highly problematic.
Note that our use of self-narrative disorganization does not

necessarily imply a verbal account of life experiences that is con-
fusing or unintelligible from the standpoint of a listener, although
narrative organization at this interpersonal communicative level
is also possible (Dimaggio & Semerari, 2001). Instead, we em-
phasize the phenomenological coherence of the self-narrative, the ex-
tent to which it confers a modicum of consistency across time to
identity-relevant life transitions.
Narrative Dominance
Dominant narratives are those that colonize an individuals sense

of self, constricting identity options to those that are problem-
saturated (White & Epston, 1990). In terms of traumatic experi-
ences, the defining impact of the event can install a traumatic
self as the nucleus around which the self-narrative develops, elab-
orating subsequent life experiences that are emotionally congruent
with it (Neimeyer, 2000; Neimeyer & Stewart, 1998). Neurologi-
cally, this can be understood in terms of the extreme emotional
intensity associated with the trauma, which impairs the brains
capacities for explicit learning and reasoning, while triggering
an immediate process of implicit learning and memory (Siegel,
1999). The result can be an inability to forget the most distressing
and intrusive memories of trauma (typically encoded in soma-
tosensory, emotional, perceptual and behavioral terms), combined
with a paradoxical inability to integrate this implicit memory with
an explicit pretraumatic self-narrative with which, by definition,
it was radically incongruent (see Wylie & Simon, 2004, for a re-
view of studies on the neurobiological indelibility of traumatic
memories). The dominance of a (post) traumatic identity can
then be consolidated at personal and social levels, as it functions
as an interpretive framework for integrating subsequent life ex-
periences and relating and enacting them with others. Finally, in
extreme cases, stigmatization of survivors can further contribute
to the assignment of dominant identities at a cultural-linguistic
level. Sandras harsh self-criticism, cyclical relational problems
with both her family members and workmates, and dominant
self-narrative of woundedness as a function of her mothers
suicide can be understood in these terms.
Narrative Dissociation
A third process of narrative disruption concerns the dissociation

of the traumatic memory, in the dual sense of excluding aspects
of it from both conscious awareness and the narration of ones
experience in a social context. The result is a silent story that
resists integration into the self-narrative (Neimeyer, 2005a). At a
biogenetic level, such dissociation represents a by-product of the
functional disconnection between the implicit and explicit memory
systems resulting from the shutting down of Brocas area, liter-
ally instilling the feeling of speechless terror reported by many
trauma survivors (Spiegel, 1999). Continuing to hold the experi-

ence in an unassimilated form can serve understandable defen-
sive functions at a personal level (Stiles, Osatuke, Glick, & Mackay,
2004) and protect the survivor from potential social censure or
disenfranchisement (Neimeyer & Jordan, 2002), but only at the
cost of personal and relational wholeness. For Sandra, the silenc-
ing of the story was reinforced by the family taboo on discussing
the mothers suicide, compounding the difficulty of integrating
the experience at personal or social levels.
From Chaos to Coherence: The Therapeutic Process
Although her mothers death happened 30 years ago, Sandra still

found it very difficult to speak about it at the point of her entry
into therapy. Nonetheless the traumatic bereavement and the
losses of other relatives as an extension of the catastrophe contrib-
uted to her great difficulty in establishing intimate and secure
relationships with significant people in her life. At the point she
came to therapy, Sandra was living with her second husband
and his two children from a previous marriage, and was resolved
to improve her relationship with them. It quickly became evi-
dent that this would require attention to the impact of the suicide,
and an attempt at reconstructing its meaning in a way that opened
new possibilities for her current life (Neimeyer, 2001).
With the aim of understanding this process of meaning re-
construction, we conducted a pragmatic-rhetorical analysis of her
psychotherapy. We understand pragmatic analysis as addressing
the question Why does the speaker say what she says? and rhetorical
analysis as addressing the question How does she try to get what she
wants by saying what she says? (Herrero, 2004; Herrero & Botella,
2002).
To conduct this analysis, we began by assuming that one of
the common factors in psychotherapy is fostering a transforma-
tion in the clients self-narrative (Botella, Herrero, Pacheco, &
Corbella, 2004). Neurobiologically, this can be equated to help-
ing the client reconstrue her autobiographical memories so as
to achieve a higher level of integration and narrative coherence.
Specifically, in the case of traumatic grief, these transformations
work by counteracting the disruptive effects of the original trau-
matic event, and promoting their assimilation at personal and
relational levels.
To study the pragmatic-rhetorical strategies used by Sandra
and her therapist, we carried out a qualitative analysis of the
transcript of her 12 sessions of psychotherapy using grounded
theory methodology (Glaser & Strauss, 1967). Because of space
limits, in this article we briefly present the results of the analysis
corresponding to Sandras first psychotherapy session (for a com-
plete discussion of these strategies, see Herrero & Botella, 2002).
Answers to the question why? are presented in the form of
core categories derived from the grounded theory analysis of the
therapists speech turns, corresponding to four objectives evident
in the early stages of therapy: (1) to establish the discursive con-
tract in psychotherapy and negotiate the therapeutic context; (2)
to help the client to construct a more intelligible narrative of the
critical event, that is, to elaborate a more coherent story of the
suicide and a more complex image of her mother to counter her
posttraumatic narrative disorganization; (3) to help the client
transform her dominant discourse of woundedness into one en-
tailing pride in surviving; and (4) to do all this in a dialogical
climate that helps the client find a voice for dissociated or un-
assimilated features of her experience, not only in the therapy,
but also ultimately in relationships with relevant friends and family.
We further considered how the therapist pursued these goals,
phrased in terms of the strategies she used to pursue several
pragmatic objectives, as follows:
HOW DID THE THERAPIST NEGOTIATE THE

DISCURSIVE CONTRACT IN THERAPY?
The psychotherapeutic conversation is different from other
kinds of conversations, so therapist and client needed to establish
the rules of their discursive contract. This was carried out through
keys of contextualization, that is, the signs that allow partici-
pants in the interaction to identify its context, determine who
they are talking to and what discursive genre they are, or will be,
involved in (Maingueneau, 1999, p. 20). Our qualitative analysis
revealed that the therapist helped to establish these keys by rely-
ing on the following strategies: (a) using authority; (b) clarifying
positions or disparity; (c) marking of asymmetry in the relation-
ship; (d) assuming expertise; (e) clarifying; (f) seeking consensus;
(g) inviting or restricting thematic elaboration; (h) introducing
emotional terms; (i) authorizing or granting permission; (j) re-
questing; and (k) negotiating therapeutic goals.

Thus, once the rules of the language game of therapy are
established, the game starts as does the effort towards establish-
ing a good therapeutic alliance. The following excerpt illustrates
some of the strategies mentioned. It also exemplifies the way in
which the therapist embodies a theoretical tradition (in this case,
humanistic-existential) with its own vision of psychotherapeutic
change processes. This tradition is different from that of thera-
pists belonging to other discursive communities, and so the therapist
socialized Sandra in this therapy model and at the same time
negotiated her agreement with a particular vision of her prob-
lems and processes of change.
T: So you came in, and we mutually talked about your desire, and you
just talked about your desire to feel more worthy somehow, and to be
able to accept that you are a worthy person, to kind of shed this dark
cloud. And it seems that a lot of that is tied up with the events in
your life, particularly your mothers suicide, and how your whole life
fell apart as a result of that. So it seems that one of the things that we
sort of implicitly agreed upon was that it would be valuable to look
at, look at some of those painful feelings, to explore them, to fully
articulate them. Um, and I think in the process of doing that, be-
coming more clear on those kinds of things, being able to express
some of the things you maybe have never been able to express, some
of who you really are and how you really felt, that this sense of worthi-
ness and deserving will come as a by-product of that . . . .
C: Theres, I guess whats difficult is that, I suppose, theres a lot of
things there. Theres a lot of messages, a lot of things that are float-
ing around. I dont know, Im having difficulty in sort of, you know,
Okay, heres your life, take about ten minutes (laughs), go to it!
Here the therapist constructed the clients current problems

as something closely linked to a critical event in her past. Both
then proceeded to define the effects of the clients mothers sui-

cide as something that destroyed her life and challenged and
violated Sandras beliefs. The therapist linked the consequences
of the clients traumatic bereavement to her lack of self-accep-
tance, developing a vision of the critical event as something with
a life of its own, present throughout the clients life in different
forms. At one point she metaphorically described it as a shadow,
as if it were something ever-present but intangible that Sandra
had tried to ignore, and which consequently was left as a vague
but volatile experience. This formulation corresponded to the
therapists theory that therapy is the right place to talk about this
issue and to express emotions that, like the critical event, had
been kept hidden. Sandra readily accepted this formulation be-
cause she felt she was unclear and disorganized about herself
and her own story and therefore could not understand why she
did things that were destructive for herself. The confusion she
felt was also evident in her very understanding of her need for
therapy.
T: Right. So theres something then for you, very disconcerting about

being in this position where youre feeling, where you dont have
that structure or organization.
C: Yeah, I feel sort of like I havent quite sorted all of this out yet, so
. . . [T: Right.] Im sure it will come, as you say, as I get to know you
a little bit better and it will get a little bit easier for me to talk about
it.
T: Okay. So its hard for you to come in here without it being sorted
out, without a clear focus, without a clear . . . .
C: Yeah, yeah. Because I know I want to be here but I guess . . . Im not
sure why Im here (laughs).
In line with this vision of the problem, the therapist formu-

lated Sandras change process as entailing the expression of feelings
through their exploration, articulation and confrontation, so that
Sandra could clearly see what happened to her and in so doing
turn a disorganized experience into a story with organization
and structure. To this end, the therapist defined therapy as the
space where those experiences and painful feelings that Sandra
can barely articulate in other contexts can be verbalized.
Leading the therapy further in the direction of working with
emotions, the therapist said, And thats what well do here. I
mean this is an opportunity to express those . . . things, give a
voice to how did you really feel, become clear yourself and get
some support in that. As a result of the expression of her emo-
tions, the client would accept herself better, as, according to the
therapist, to repress how [you] feel is denying reality, and with
it, Sandras own self.
HOW DID THE THERAPIST ENHANCE THE CLIENTS

DISCOURSE AND THUS CONTRIBUTE TO INTELLIGIBILITY?
Another group of pragmatic-rhetorical strategies we identi-
fied through the qualitative analysis were those we have called
enhancing the clients discourse, because their objective was to
help the client to elaborate her narration of the event, and in

this way to understand the conflicts she expressed in the session
and her attitude with regards to them and to life in general. We
found that the therapist helped the client to elaborate her dis-
course by using the following strategies: (a) yielding the speech
turn to her; (b) ratifying and expanding metaphors; (c) internal-
izing the clients voice, through ventriloquism, paraphrasing, and
mirroring; (d) asking: open, closed, and indirect questions; (e)
engaging in joint productions; (f) permitting the clients inter-
ruptions; (g) externalizing; and (h) being aware.
With all these strategies, the therapist helped the client to
make sense of her problems, thus enhancing the production of
the discourse that helped integrate the plot structure of her life
story. By listening carefully and actively, constructively mirroring
the clients discourse and working with metaphors elaborated in
the therapeutic relationship, the therapist helped Sandra become
aware of her own fear of suffering and her way of protecting
herself from pain by avoiding intimate relationships in which she
could be abandoned or hurt. She further connected the clients
current relational problems to the devastating experience of feel-
ing abandoned after her mothers suicide and her fathers alco-
holism. It was as if Sandra had concluded that, if she were not
enough of a reason for her parents to fight for life, how could
she expect that other people would not hurt or abandon her?
C: (voice wavering) I feel there will be a judgment passed on me . . .

T: . . . Right, right, yeah, so somehow it will reflect on you . . .
C: . . . that Im responsible or that Im a nut like she is or something,
and that its hereditary or something.
T: Yeah, so that incident will color peoples perceptions of you. Almost
this sense of that you will be misinterpreted or misunderstood, that

people will not understand.
C: Oh, yeah, No wonder she acts like that, look what her mother did,
you know.
T: Oh, yeah, oh, and that would be so horrible to know that people
were saying that or thinking that [long pause] . . . . I mean theres
almost a sense of, I was going to say, being tainted by this incident.
C: Yeah, because in my mind its such an atrocity. It certainly defies the
religious aspect. We were brought up in a very high Anglican envi-
ronment. Its, theres that sort of . . .
T: Its an atrocity yeah, in your view, yeah, it sort of violates everything,
all . . .
C: . . . the things we should believe in and I like to think, or would like
to think that I believe in . . .

T: . . . and thats a part of you, and so hard to accept in a way, that that
is a part of you.
C: Yeah [long pause].
T: Yeah, and I can well imagine your fear that others would perceive
you through this light . . . .
In this segment of therapy, the client first introduced a metaphor

to refer to the effects of the incident as if others would pass a
judgment upon her. The therapist expanded this theme, at the
same time replacing the metaphor of judgment with that of re-
flection, perhaps with the intent of mitigating its impact on the
client. The client accepted this reformulation, but elaborated it
slightly by saying that it was as if other people could view her
own psychological stability in light of her mothers suicide. How-
ever, there was a sudden change of metaphor when the client
referred to the suicide as an atrocity. The therapist ratified the
use of this metaphor with the term violation. Notice how, while
the client initially was referring only to its invalidation of one
aspect in her life (religion), the therapist provisionally expanded
this focus (violates everything), a dilation of the events impact that
the client readily accepted and elaborated. Finally, the therapist
introduced once more the idea that the client was afraid of thinking
that other people see her in that light. It is noteworthy that in
this and many other passages the client and therapist extended
or completed one anothers utterances in a process of cocon-
struction that wove together their separate subjectivities.
By using these strategies, the therapist helped the client to
integrate her mothers suicide into her own narrative and ulti-
mately to reconstruct the partial vision the client had of her
mother into a more complex image of her. This began a longer

process by which the two worked toward a coherent narrative of
the suicide, as well as to grapple with the dominant narrative of
Sandras being viewed always in light of the event.
HOW DID THE THERAPIST HELP THE CLIENT LIBERATE

HERSELF FROM DISCOURSES THAT OPPRESSED HER AND
DIALOGICALLY TRANSFORM HER WAY OF MAKING
SENSE OF WHAT HAPPENED TO HER IN LIFE?
The analysis indicated that the therapist helped the client to
do this through the following strategies: (a) validating positive
narratives; (b) using double voice or third speaker dialogue;

(c) internalizing the therapists voice; (d) explaining common-
alities; (e) recognizing needs and wishes; (f) deferring to the
client; (g) transforming the clients sense of time; and (h) cocon-
structing theories that imbued the clients experiences with meaning.
By using all these strategies, client and therapist worked to
achieve a transformation in the way the client told her story. The
following example illustrates how client and therapist commented
on the clients difficulty getting angry with her mother about her
suicide due to the messages of other family members that she
had internalized.
T: And I think it must be hard, or I wonder, is it hard then to really feel
legitimately angry about, towards your mother? That you somehow
...
C: Thats right, because I probably try to, probably, because all sorts of
messages have also been fed to me about how I should feel about
this. This is obviously a very sick individual that would do something
like this.
T: So, You should understand, you should be compassionate.
C: Right, right. Im an intelligent person and I should be able to under-
stand that devastation and how, I should be able to accept that she
had to have been crazy herself to do something like that.
T: Right. So somehow that understanding kind of cancels out your, uh,
your feelings?
C: Yeah, I should be able to just get on with it and thats that. Thats my
family. Its water under the bridge, you know, get on with it. Its
not easy. I cant forget it, its there.
By using the double voice (Bakhtin, 1986) or the third

speaker (Peytard, 1993), the client expressed statements that
belonged to other speakers, but that nonetheless had been
appropriated into her own narrative of the mothers suicide, re-

inforcing the silencing of the clients own perspective. Through-
out this segment of therapy, the client presented other signifi-
cant peoples messages about how she should feel and her own
opposition to what she really felt. Until the moment she asked
for therapeutic help, she seemed to have been oppressed and
distressed by these discourses (That understanding kind of cancels
out your, uh, your feelings?). However, in therapy, with the therapists
help, Sandra voiced her own feelings as well as her construction
(and reconstruction) of her mothers suicide and its consequences
in her life. In doing so, the client developed an active attitude of
recognition of her own needs and wishes, which would not re-
main silent anymore. In this way, a narrative transformation began
to take shape: (a) from the dominant narrative of shame and
woundedness the client had when entering therapy to an even-
tual narrative of pride in having survived to all the traumatic
events of her past and ultimately the construction of herself as a
strong woman; (b) from a relationship the client had with her-
self based on destructive dialogues to a relationship with herself
based on her own needs, wishes and resources; and, most impor-
tantly, (c) from feeling undeserving of being loved, a victim of
fate and determined by her mothers suicide to developing a
position in which she felt she deserved and was loved in her past
and, in contrast to the beginning of therapy, was the main char-
acter in her own story, a strong person and a survivor.
HOW DID THE THERAPIST CONSTRUCT THERAPY AS A

SAFE PLACE IN WHICH THE CLIENT COULD FEEL UNDERSTOOD?
Our grounded theory analysis demonstrated that the thera-
pist did so by using the following strategies: (a) comforting Sandra;
(b) empathizing with her; (c) summarizing and checking that
the client felt understood; (d) clarifying possible misunderstand-
ings; (e) providing her with safety in the context of the thera-
peutic relationship; (f) validating or acknowledging the clients
discourse; and (g) offering herself as a useful resource.
With these strategies, which coincide with the so-called com-
mon factors in psychotherapy, the therapist helped create a cli-
mate that felt sufficiently safe for the client to explore what hurt
and frightened her, and to do so in the presence of a person
who helped her understand herself without judgment. In this
way, Sandra was able to voice feelings and stories that had been
prohibited and managed to express the inexpressible and give
shape to material that had been volatile. Since her mothers
suicide, Sandra had been getting messages from her family that
encouraged her to forget and keep on just pretending that noth-
ing so terrible had happened.
The following segment illustrates the clients difficulty for-
giving her mother for what she did (and did to them) as well
as the safety the therapist offered her to express her uncensored
feelings.
C: This particular book was talking about forgiveness and true forgiveness,
and if you cant forgive, truly, really forgive, um, and let it go, what-
ever it may be . . . . And Ive thought about it a lot because I like to be
able to pretend that I forgive what she did, but I dont. I think about
it and I get very angry, I get very fired up, and I think, How dare you!
T: Right.
C: How dare you leave us in that situation and how dare you give birth
to children and not take care of them! How dare you! Just simply,
How dare you!
T: How dare you do this to them, to us, to me!
C: Its so selfish and so unfair.
T: Yeah, yeah, yeah, so theres all these lofty principles. Youd love to be
able to really do it . . .
C: Right.
T: But at the moment, thats not where youre at.
C: No.
T: I hear you, yeah, loud and clear.
As can be seen in this short therapy vignette, the client could

now express her anger as well as her difficulty forgiving and for-
getting due to the resentment she still harbors. Ultimately, Sandra
became able to talk about her feelings with different family members,
thus breaking with the family secret. As a result, she and others
began to share stories that offered alternative depictions of her
mother, in a way that allowed Sandra to construct a fuller story
of who she was as a person and a parent, in both her positive
and negative aspects.
Conclusions
Sandras story illustrates how (a) a traumatic loss can result in

narrative disorganization for the person experiencing it; (b) the
survivor of trauma can live under the sway of a dominant narra-

tive of the self as wounded and deficient; and (c) material that
cannot be elaborated is dissociated from the self-narrative, as
well as silenced in relation to other people. In such a case, thera-
peutic work can aim at helping the person to (a) integrate the
critical event into his or her life narrative; (b) construct alterna-
tive visions of self such as, in this case, that of a survivor; and (c)
voice in therapy (and beyond it) those aspects of the trauma that
have not been elaborated as a way of assimilating them into a
new narrative that has greater scope and coherence.
By the end of therapy, Sandra had reconstructed many mean-
ings around the traumatic loss of her mother, as well as other

significant losses and their implications for her life. In terms of
intelligibility, the client became conscious of her habit of posi-
tioning herself in relationships so as to protect herself from the
pain of possible abandonment. Likewise, Sandra became aware
of the need to accept herself rather than blame herself for her
mothers fateful decision. In terms of transformation, the critical
event was no longer a fragmented experience waiting to be inte-
grated into her life story, nor was it inexpressible or inexplicable.
Instead, new feelings and meanings were articulated and found
validation in the context of the therapy and in Sandras extended
family.
The impossibility of constructing an image of her mother at
the beginning of the therapy gave way to a construction that
balanced both positive and negative aspects of her mother and
their relationship. In this process, Sandra was able to forgive her
mother, and by the end of therapy felt liberated from the bad
karma that her mothers suicide had meant for her. Moreover,
Sandra was ultimately able to overcome a feeling of shame about
her history and replace it with one of pride, which brought about a
change in her subjective attitude toward each of the main figures
in her life story. With a fuller, but nondominant integration of her
mothers suicide, Sandra transcended the regressive narrative of
her past and began to sketch the outlines of a more progressive
future (Herrero & Neimeyer, in press). As Neimeyer, Prigerson
and Davies (2002) observed, the loss of a close affectionate re-
lationship due to death implies a deep challenge for our adapta-
tion as human beings (p. 8). Thus, renarrating (and reliving) a
story in which the client regains the capacity to feel loved implies
accepting her story without shame, and being able to reenter

relationships without activating the narrative of fear of abandon-
ment. Thus, reconstructing the meaning of her mothers suicide
(as well as their relationship) involved a simultaneous reconstruc-
tion of her own identity.
In summary, we find the concept of narrative coherence a
helpful orienting principle in therapy, even if we acknowledge
the impossibility of its complete realization. Indeed, the inevita-
bility of incoherencein the form of life events, traumatic or
nontraumatic, that disrupt the predictable plot structure of our
lives or that prompt us toward greater thematic complexity
serves as a major engine of psychological growth. We believe that

Sandra achieved such growth as she struggled to voice, integrate,
and ultimately transcend the traumatic disruption of her own life
story in psychotherapy, and we hope that the application of a
qualitative analysis of the pragmatic and rhetorical dimensions of
this therapy helped to demystify this process.
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Chaos To Coherence

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Journal of Constructivist Psychology

Chaos To Coherence: Psychotherapeutic Integration Of

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CHAOS TO COHERENCE: PSYCHOTHERAPEUTIC

OLGA HERRERO and LUIS BOTELLA

Ramon Llull University, Barcelona, Spain

At age 37, Sandra1 sought psychotherapy for a range of com-

cence. As she said of her mothers suicide in her opening re-

Identity and the Self-Narrative

Viewed through a broadly constructivist lens, ones sense of self

Specifically, people are seen as constructing meaning of their life

self-narrative need not be related verbally to another in order to

cortex provide critical coordination of social cognition, emotion,

ating the social world (Guidano, 1991).

Traumatic Disruption of the Self-Narrative

Although changes in the self-narrative are typically progressive,

Dramatic life events, and especially those of a traumatic kind,

Note that our use of self-narrative disorganization does not

Dominant narratives are those that colonize an individuals sense

A third process of narrative disruption concerns the dissociation

trauma survivors (Spiegel, 1999). Continuing to hold the experi-

From Chaos to Coherence: The Therapeutic Process

Although her mothers death happened 30 years ago, Sandra still

HOW DID THE THERAPIST NEGOTIATE THE

questing; and (k) negotiating therapeutic goals.

Here the therapist constructed the clients current problems

then proceeded to define the effects of the clients mothers sui-

T: Right. So theres something then for you, very disconcerting about

In line with this vision of the problem, the therapist formu-

HOW DID THE THERAPIST ENHANCE THE CLIENTS

help the client to elaborate her narration of the event, and in

C: (voice wavering) I feel there will be a judgment passed on me . . .

this sense of that you will be misinterpreted or misunderstood, that

to think that I believe in . . .

In this segment of therapy, the client first introduced a metaphor

mother into a more complex image of her. This began a longer

HOW DID THE THERAPIST HELP THE CLIENT LIBERATE

narratives; (b) using double voice or third speaker dialogue;

By using the double voice (Bakhtin, 1986) or the third

appropriated into her own narrative of the mothers suicide, re-

HOW DID THE THERAPIST CONSTRUCT THERAPY AS A

As can be seen in this short therapy vignette, the client could

Sandras story illustrates how (a) a traumatic loss can result in

survivor of trauma can live under the sway of a dominant narra-

ings around the traumatic loss of her mother, as well as other

accepting her story without shame, and being able to reenter

serves as a major engine of psychological growth. We believe that

Bakhtin, M. (1981). The dialogic imagination. Austin, TX: University of Texas

Harvey, J. H. (2000). Give sorrow words. New York: Brunner Routledge.

neural science. New York: McGraw-Hill.

perspective on resilience. In R. Snyder (Ed.), Coping with stress (pp. 47

Journal, 22, 201269.

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