Seminar 7 Psychology
“The basic idea of CA is so simple that it is difficult to grasp. CA studies what an utterance does in relation to the preceding one(s) and the implications it poses for the next one(s). As Hutchby and Woofitt (1998, p.15) put it, the next-turn proof procedure is the most basic tool in CA. That is, the next turn is taken as evidence of the parties orientation to the prior turn there and then. This methodical procedure is CA’s gateway to the participants’ own understandings as they are revealed during actual interaction, thereby providing material for an analytic explication.” (Arminen, 1999, p. 251)
In this topic we are exploring how the design of turns in therapeutic talk determines outcomes for clients and therapists. We are bringing our knowledge of the mechanics of interaction to understanding the professional particularities of therapeutic face-to-face communication.
“Sequentiality involves relations of nextness between utterances (turns-at-talk): ‘Next turns are understood by co-participants to display their speaker’s understanding of the just-prior-turn and to embody an action responsive to the just-prior turn so understood’ (Shegloff, 2007b:15). This kind of relation between turns is ‘endemic to the organization of conversation’ (Shegloff, 2007b) and as such, it is the backbone of the possibility of intersubjective understanding between humans (Heritage, 1984b; Schegloff, 1992d). (p. 552)
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“What makes psychotherapy a specific form of institutional interaction is perhaps most distinctively linked to its inferential frameworks. […] in psychotherapy, there is an endemic orientation in the therapist, and usually also in the patient, to examine the patient’s talk beyond its intended meaning. […] Many interactional practices of psychotherapy, investigated by CA, involve therapists’ and patients’ methods of recognizing, examining, and dealing with this ‘beyond’. (p.552)
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Approaches to psychotherapy fall into five broad categories:
Psychoanalysis and psychodynamic therapies
Behavior therapy
Cognitive therapy
Humanistic therapy
Integrative or holistic therapy
Formulations
‘local editing’ (Antaki, 2008), where the therapist focuses on an aspect of the patient’s talk
‘The therapist “exploits” the design of formulation by packing into it new material. The claim of “saying the same thing”, inherent in formulations, is there [eg. it’s a bit like you were saying], but the content is remarkably altered. We might say that such packages are used to suggest that the therapist is wording a layer of the unconcious meaning of the patient’s talk. (Vehviläinen, 2003).
Four types of formulations (Elina Weiste & Anssi Per äkylä (2013) A Comparative Conversation Analytic Study of Formulations in Psychoanalysis and Cognitive Psychotherapy, Research on Language and Social Interaction, 46:4, 299-321, DOI: 10.1080/08351813.2013.839093), (p. 316).
The task of highlighting formulations was to receive the clients’ descriptive accounts: They were used to recognize the therapeutically salient parts of the clients’ turns and invite them to continue their narrations. These formulations largely mirrored the content and lexical choices of the clients’ turns. Thus, these formulations were strongly contingent on the clients’ prior turns and made relevant a confirming response. These formulations also did preparatory work toward the subsequent actions of the therapist, as the therapists often returned to the content of these formulations in later phases of the sessions. This kind of turn design has much in common with the description of formulations that Bercelli et al. (2008, p. 47) have presented.
The task of rephrasing formulations was not only to receive the clients’ accounts; rather they also transformed them into descriptions that were more apt for therapeutic work. In these formulations the therapists did not use the same lexical items as the clients but instead renamed the clients’ experiences. By focusing on the clients’ subjective experiences, rephrasing formulations invited the clients to engage in psychological self-reflection. The clients responded with agreements (or disagreements) extended with personal descriptions. In their next turns, the therapists continued to work with the clients’ experiences.
Relocating formulations were connected to the preparation for, delivery, or reworking of interpretative statements. These formulations invited the clients to agree (or disagree) with the formulation and its extended elaboration.
Exaggerating formulations were used to prepare for or deliver a challenge to the client’s way of thinking. Sequentially, the therapist redesigned a description given by the client in such a way that engendered an expectation to disagree with the formulation.
Antaki, C. (2008 ). Formulations in psychotherapy. In A. Peräkylä, C. Antaki, S. Vehviläinen, & I. Leudar (Eds.), Conversation analysis and psychotherapy(pp. 26– 42). Cambridge, England: Cambridge University Press.
“a formulation allows the therapist to propose a version of the client’s talk which moves it in a therapeutically-oriented direction, in the sense of suggesting, as Peräklyä and Vehviläinen put it ‘that the patient’s answers index an underlying mental pattern’ (2003: 739). (p. 630)
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Interpretations
The therapist proposes additional meaning in what the patient has said.
From the therapist’s perspective (therefore different from formulation of what the patient is saying) [eg ‘I think that’]
If no or minimal response from the patient, the therapist adds to her interpretation, ‘creating new opportunities for the patient to respond’ (Peräklyä, 2012, p. 562)
Peräkylä, A. 2008. “Conversation analysis and psychoanalysis: Interpretation, affect and intersubjectivity”. In Conversation analysis and psychotherapy, Edited by: Peräkylä, A., Antaki, C., Vehviläinen, S. and Leudar, I. 100–119. Cambridge, , England: Cambridge University Press.
Questions
Questions used more in some types of therapy (eg less so in psychoanalysis where the therapist responds to the patient’s narrative)
Optimistic questioning, “built so as to prefer answers from [patients]that affirm… their agency, competence, resilience, abilities, achievements, or some combination thereof” (MacMartin, 2008, 82; cited in Peräklyä, 2012)
An example of optimistic questioning from MacMartin, 2008, p. 83-84, cited in Peräklyä, 2012
Three part sequences in therapy
At every turn, the client has the opportunity to reject, re-frame, accept or endorse the therapist’s interpretation. And subsequently the therapist can then abandon, refine or extend the interpretation.
The therapeutic relationship
““As a curative factor, the relationship may thus be more important than, for example, the insight brought about through interpretations. (p. 564)”
What particular features of interaction strike you as important for the relational aspect of therapy?
Activity: Resistance in couples counseling
The extracts of data we are going to examine are from a (2013) paper written by Peter Muntigl (full details and copy of the paper are available below).
"The general picture of the interactional dynamics between Dave and the others (i.e. counsellor and spouse) was this: the more the counsellor and Lisa disaffiliated with Dave’s resistance and the more pressure they placed on Dave to take up his epistemic obligations, the more Dave withdrew by not answering and the less the counsellor was able to maintain progressivity and realize her counselling goals." (pp. 34-35).
"Thus affiliation is repaired, but at the ‘cost’ of the therapist’s having to abandon what may have been a therapeutically profitable line of discourse in which mutual elaboration and development of a certain issue or a new innovative perspective could have been achieved (Goncalves & Ribeiro, 2012) (p. 341)
Muntigl, P. and Horvath, A.O. (2014). The therapeutic relationship in action: How therapists and clients co-manage relational disaffiliation. Psychotherapy Research, 24(3), 327–345.
Summary
We must be wary of the methodological limitations of conversation analysis (CA) Forrester, M. (1999). Conversation analysis: a reflexive methodology for critical psychology. Annual Review of Critical Psychology, 1(1), 34-49.
CA provides an orientation to the practices attended to by the speakers themselves, but we are not privy to intent, motivation and so forth.
CA positioned to make distinct contribution to the therapeutic relationship, detailing the discrete and cumulative practices that enable trust and alliance between therapist and patient.
You can see that the 'how' of talk has primordial importance in therapeutic talk. For the workshop that follows, you will be analysing a sequence from couples therapy, and try to answer the question, "how the hell does the therapist manage to maintain affiliation with both the husband and wife?"!
