86 research outputs found
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 professionalâs non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapistâs 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 conïŹrm 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 therapistâs further actions that challenge the patientâs 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 speciïŹc context perform the task of the institution at hand.Peer reviewe
Terapeuttinen muutos vuorovaikutuksessa : Keskustelunanalyysi muuntuvasta sekvenssistÀ
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 therapistâs conclusion and the patientâs response to it. In the conclusions, the therapist investigates and challenges the patientâs tendency to transform her feelings of disappointment and anger into self-blame. Over the course of the therapy, the patientâs 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 clientâs talk.Peer reviewe
Patient involvement in problem presentation and diagnosis delivery in primary care
This article reports a conversation analytic study of primary care physiciansâ orientations to different types of patientsâ problem presentation. Four types of problem presentation are examined: 1) symptoms only, 2) candidate diagnosis, 3) diagnosis implicative symptom description, and 4) candidate diagnosis as background information. The analysis shows that both in receiving the problem presentation at the beginning of the visit and in delivering a diagnosis later on, doctors address the patientsâ presentations which involved or implied a candidate diagnosis. In contrast, following a symptoms-only type of problem presentation such references predominantly are not made. The study suggests that patientsâ problem presentation has a crucial role in shaping the doctorâs communication patterns also in the phases of consultation in which the patientâs active participation is of lesser significance, such as the diagnostic phase. The findings are discussed in relation to the question of patient participation in the medical consultation. The data consist of 86 video-recorded Finnish primary care consultations for upper respiratory tract infection including both child and adult patients.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 patientâs experience under discussion, whereas the patient maintains orientation to âtroubles-telling.â 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
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