Emotional experience in psychotherapeutic interaction : Conversation analytical study on cognitive psychotherapy

The dissertation examines how emotional experiences are oriented to in the details of psychotherapeutic interaction. The data (57 audio recorded sessions) come from one therapist-patient dyad in cognitive psychotherapy. Conversation analysis is used as method. The dissertation consists of 4 original articles and a summary. The analyses explicate the therapist s practices of responding to the patient s affective expressions. Different types of affiliating responses are identified. It is shown that the affiliating responses are combined with, or build grounds for, more interpretive and challenging actions. The study also includes a case study of a session with strong misalignment between the therapist s and patient s orientations, showing how this misalignment is managed by the therapist. Moreover, through a longitudinal analysis of the transformation of a sequence type, the study suggests that therapeutic change processes can be located to sequential relations of actions. The practices found in this study are compared to earlier research on everyday talk and on medical encounters. It is suggested that in psychotherapeutic interaction, the generic norms of interaction considering affiliation and epistemic access, are modified for the purposes of therapeutic work. The study also shows that the practices of responding to emotional experience in psychotherapy can deviate from the everyday practices of affiliation. The results of the study are also discussed in terms of concepts arising from clinical theory. These include empathy, validation of emotion, therapeutic alliance, interpretation, challenging beliefs, and therapeutic change. The therapist s approach described in this study involves practical integration of different clinical theories. In general terms, the study suggests that in the details of interaction, psychotherapy recurrently performs a dual task of empathy and challenging in relation to the patient s ways of describing their experiences. Methodologically, the study discusses the problem of identifying actions in conversation analysis of psychotherapy and emotional interaction, and the possibility to apply conversation analysis in the study of therapeutic change.Väitöskirja kuvaa terapeutin ja potilaan välistä vuorovaikutusta kognitiivisessa psykoterapiassa, erityisesti tapoja, joilla terapeutti vastaa potilaan kuvauksiin ongelmallisista tunnekokemuksista. Tutkimuksen aineistona on 57 ääninauhaa yhden terapeutin ja potilaan istunnoista. Tutkimusmenetelmänä on keskustelunanalyysi. Väitöskirja koostuu neljästä empiirisestä artikkelista sekä yhteenvetoartikkelista. Tutkimuksessa eritellään terapeutin erilaisia empaattisia vastauksia: potilaan tunnekokemukseen keskittyviä vastauksia sekä vastauksia, joissa viitataan kolmannen osapuolen toimintaan. Tutkimusaineistossa terapeutin empaattiset vastaukset yhdistyvät tulkitseviin tai haastaviinkin interventioihin: terapeutti voi samassa vastauksessa yhdistää empatiaa ja tulkintaa, tai empaattiset vastaukset voivat pohjustaa tulkintoja tai potilaan ajatustapoja kyseenalaistavia vuoroja. Tutkimuksessa analysoidaan myös vuorovaikutustilannetta, jossa terapeutin ja potilaan välillä on erilinjaisuutta käsillä olevan toiminnan luonteesta. Analyysi näyttää, miten terapeutti käsittelee tätä erilinjaisuutta ottamalla vuorovaikutustilanteen reflektiivisen tarkastelun kohteeksi. Vuorovaikutusta tarkastellaan myös siinä tapahtuvan muutoksen näkökulmasta. Tutkimus ehdottaa, että terapeuttista muutosta voidaan lähestyä kahden puheenvuoron välisen suhteen muutoksen kautta: analysoimalla samankaltaisia vuorovaikutuksen sekvenssejä terapian eri vaiheissa. Tutkimuksessa löydettyjä vuorovaikutuksen piirteitä verrataan aiempaan tutkimukseen ns. arkikeskustelusta (ystävien väliset keskustelut) sekä vuorovaikutuksesta lääkärin vastaanotolla. Tutkimus pohtii tapoja, joilla yleiset vuorovaikutuksen normit muuntuvat terapeuttisen työn tarpeisiin. Tutkimus osoittaa, että terapeuttiset tavoitteet voivat myös törmätä yhteen arkikeskustelun käytäntöjen kanssa. Tutkimuksen tulokset liitetään myös kliinisiin keskusteluihin empatiasta, tunteen validoinnista, terapeuttisesta yhteistyösuhteesta, tulkinnoista, epätarkoituksenmukaisten uskomusten kyseenalaistamisesta sekä terapeuttisesta muutoksesta. Tutkimuksessa kuvattu terapeutin työ voidaan nähdä erilaisten kliinisten teorioiden integraationa käytännön työssä. Yleisellä tasolla tutkimus ehdottaa, että vuorovaikutuksen yksityiskohtien tasolla psykoterapia toistuvasti toteuttaa kahtalaista tehtävää: toisaalta empaattista ymmärrystä ja toisaalta muutoksen ehdottamista suhteessa potilaan tapoihin suhtautua kokemuksiinsa. Metodologisesti tutkimus käsittelee vuorovaikutuksellisten toimintojen tunnistamista psykoterapian ja emootioiden keskustelunanalyyttisessä tutkimuksessa, sekä keskustelunanalyysin mahdollisuuksia terapeuttisen muutoksen tutkimuksessa

'Delayed response' in psychodynamic psychotherapy

A recurrent theme that is addressed in psychotherapies is the client’s conflicting emotions. This article discusses discursive practices of working on conflicting emotions during psychodynamic psychotherapy. We focus on a phenomenon that we refer to as a ‘delayed response’ and analyze the client’s uses of interactional means, such as a display of negative experience, to invite affiliation or empathy from the therapist. The therapist, however, does not take a turn in the first possible place after the client’s turn. Recurrently, the therapist’s silence is followed by the client’s new turn that backs down from the emotional experience under discussion. After these retractions, the therapists respond with a turn that is responsive both to the retraction and to the initial display of negative experience that occurred prior to it. We argue that the timing of the therapist’s response in these sequences is in the service of psychotherapeutic work on conflicting emotions.Peer reviewe

Recognition and Interpretation: Responding to Emotional Experience in Psychotherapy

Peer reviewe

Distributing Agency and Experience in Therapeutic Interaction : Person References in Therapists' Responses to Complaints

The primary means for psychotherapy interaction is language. Since talk-in-interaction is accomplished and rendered interpretable by the systematic use of linguistic resources, this study focuses on one of the central issues in psychotherapy, namely agency, and the ways in which linguistic resources, person references in particular, are used for constructing different types of agency in psychotherapy interaction. The study investigates therapists' responses to turns where the client complains about a third party. It focuses on the way therapists' responses distribute experience and agency between the therapist and the client by comparing responses formulated with the zero-person (a formulation that lacks a grammatical subject, that is, a reference to the agent) to responses formulated with a second person singular pronoun that refers to the client. The study thus approaches agency as situated, dynamic and interactional: an agent is a social unit whose elements (flexibility and accountability) are distributed in the therapist-client interaction. The data consist of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis, and the method of analysis is conversation analysis and interactional linguistics. The main findings are that therapists use the zero-person for two types of responses: affiliating and empathetic responses that distribute the emotional experience between the client and the therapist, and responses that invite clients to interpret their own experiences, thereby distributing control and responsibility to the clients. In contrast, the second person references are used for re-constructing the client's past history. The conclusion is that therapists use the zero-person for both immediate emotional work and interpretative co-work on the client's experiences. The study suggests that therapists' use of the zero-person does not necessarily attribute “weak agency” to the client but instead might strengthen the clients' agency in the sense of control and responsibility in the long term.The primary means for psychotherapy interaction is language. Since talk-in-interaction is accomplished and rendered interpretable by the systematic use of linguistic resources, this study focuses on one of the central issues in psychotherapy, namely agency, and the ways in which linguistic resources, person references in particular, are used for constructing different types of agency in psychotherapy interaction. The study investigates therapists' responses to turns where the client complains about a third party. It focuses on the way therapists' responses distribute experience and agency between the therapist and the client by comparing responses formulated with the zero-person (a formulation that lacks a grammatical subject, that is, a reference to the agent) to responses formulated with a second person singular pronoun that refers to the client. The study thus approaches agency as situated, dynamic and interactional: an agent is a social unit whose elements (flexibility and accountability) are distributed in the therapist-client interaction. The data consist of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis, and the method of analysis is conversation analysis and interactional linguistics. The main findings are that therapists use the zero-person for two types of responses: affiliating and empathetic responses that distribute the emotional experience between the client and the therapist, and responses that invite clients to interpret their own experiences, thereby distributing control and responsibility to the clients. In contrast, the second person references are used for re-constructing the client's past history. The conclusion is that therapists use the zero-person for both immediate emotional work and interpretative co-work on the client's experiences. The study suggests that therapists' use of the zero-person does not necessarily attribute "weak agency" to the client but instead might strengthen the clients' agency in the sense of control and responsibility in the long term.Peer reviewe

Jaetut empaattiset tunteet kirjallisuuspiirissä

Kaunokirjallisuuden lukeminen on liitetty empatiakykyyn. Tässä artikkelissa kysyn, miten kirjallisuuden herättämät empaattiset tunteet ilmenevät kirjallisuuden sosiaalisessa vastaanotossa. Tutkimuksen aineistona on yhteisöllisessä asuinkorttelissa järjestetyn kirjallisuuspiirin kokoontumisten (4) videonauhoitukset ja menetelmänä keskustelunanalyysi. Kuvaan kolmea vuorovaikutuksellista keinoa, jolla kirjan henkilöihin kohdistuvaa empatiaa jaetaan ryhmässä: piiriläisten kannanottoja, kirjallisuuspiirin vetäjän ymmärrysehdokkaita sekä topikaalisia siirtymiä kirjan ulkopuoliseen maailmaan. Tutkimus ehdottaa, että yksilön tunteiden tavoin myös empatiaa voidaan ilmaista ja jakaa kollektiivisesti. Tutkimuksen tulokset tukevat aiemmassa tutkimuksessa kuvattua kirjallisuuspiirin keskustelujen institutionaalista luonnetta toisaalta analyyttisen puheen ja toisaalta oman lukukokemuksen ja kirjan ulkopuolisen maailman kuvailun vaihteluna.Peer reviewe

What about you? Responding to a face-threatening question in psychotherapy

Publisher Copyright: © 2022 John Benjamins Publishing Company. All rights reserved.In psychotherapy, the envisioned change in patient's feelings, thoughts and behaviour often targets their self-experience. This threatens simultaneously the patient's face and the therapeutic relation. We focus on face-threats in transformative question-answer sequences where therapists question the patient's face by shifting the focus of talk on patient's self and in response patients confront the dilemma of having to choose between saving their face or the relation with the therapist. Data come from 47 video recorded psychotherapy sessions conducted in Albanian language. Analysis shows that patients resist the transformation but only after making considerable efforts to save both their face and the therapeutic relation. We conclude that challenging the patient's self-experience is a delicate task in terms of the therapeutic relation.Peer reviewe

Professional non-neutrality: criticising the third party in psychotherapy

Using audio-recorded data from cognitive-constructivist psychotherapy, the article shows a particular institutional context in which successful professional action does not adhere to the pattern of affective neutrality which Parsons saw as an inherent component of medicine and psychotherapy. In our data, the professional’s non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapist’s actions that convey a critical stance towards a third party with whom the patient has experienced problems. The data analysis revealed two practices of this kind of critique: (1) the therapist can confirm the critique that the patient has expressed or (2) return to the critique from which the patient has focused away. These actions are shown to build grounds for the therapist’s further actions that challenge the patient’s dysfunctional beliefs. The article suggests that in the case of psychotherapy, actions that as such might be seen as apparent lapses from the neutral professional role can in their specific context perform the task of the institution at hand.Peer reviewe

Terapeuttinen muutos vuorovaikutuksessa : Keskustelunanalyysi muuntuvasta sekvenssistä

A process of change within a single case of cognitive-constructivist therapy is analyzed by means of conversation analysis (CA). The focus is on a process of change in the sequences of interaction, which consist of the therapist’s conclusion and the patient’s response to it. In the conclusions, the therapist investigates and challenges the patient’s tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patient’s responses to these conclusions are recast: from the patient first rejecting the conclusion, to then being ambivalent, and finally to agreeing with the therapist. On the basis of this case study, we suggest that an analysis that focuses on sequences of talk that are interactionally similar offers a sensitive method to investigate the manifestation of therapeutic change. It is suggested that this line of research can complement assimilation analysis and other methods of analyzing changes in a client’s talk.Peer reviewe

Misalignment as a Therapeutic Resource

The article reports conversation analysis of a single cognitive psychotherapy session in which an interactional misalignment between the therapist and the patient emerges, culminates, and is mitigated. Through this case study, the interactional practices lead- ing to a rupture in therapeutic alliance and the practices leading to its mending are explored. In the session the therapist pursues investigative orientation in relation to the patient’s experience under discussion, whereas the patient maintains orientation to “troubles-telling.” The diverging projects of the participants amount to overt misalign- ment. Eventually, the therapist brings the relationship of the patient and herself as a topic of conversation in ways which turn the misalignment into a resource of therapeu- tic work. The microanalysis of actual interactional patterns in this single case is linked to discussions of therapeutic alliance in psychotherapeutic literature.Peer reviewe

From Engagement to Disengagement in a Psychiatric Assessment Process

In a longitudinal conversation analytical (CA) case study, we examined patient engagement in a psychiatric assessment process (nine clinical interviews) with a young woman who eventually received the diagnosis of personality disorder. Based on Goffman, we consider engagement in interaction as consisting of three facets: engagement in the action at hand, bodily engagement with the co-participant, and engagement with the local moral order of the encounter. The patient begins the assessment process with high engagement and ends it up in low engagement. Yet, during this process, the patient oscillates between moments of high and low engagement. We show how the Goffmanian idea of engagement can be elaborated by CA. On the other hand, the Goffmanian view enriches CA by bringing to the foreground the interconnectedness of the different facets of engagement. A video abstract is available at .Peer reviewe