Therapeutic change in interaction: Conversation analysis of a transforming sequence (original) (raw)

Abstract

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.Le processus de changement dans un cas unique de thérapie cognitive-constructiviste est analysé au moyen d'une analyse conversationnelle (CA). Le focus est le processus de changement dans une séquence d'interaction, séquence composée de la conclusion du thérapeute et la réponse du patient à celle-ci. Dans les conclusions, le thérapeute investigue et challenge la tendance du patient à transformer ses sentiments de désappointement et de colère dans un blâme de soi. Au cours de la thérapie, les réponses du patient à ces conclusions sont reformulées: du premier rejet de la conclusion du patient, à l'ambivalence, et finalement à l'accord avec le thérapeute. Sur la base de cette étude de cas, nous suggérons qu'une analyse qui se focalise sur une séquence langagière similaire interactionnellement offre une méthode sensible pour investiguer la manifestation du changement thérapeutique. Il est suggéré que cette ligne de recherche peut compléter une analyse de l'assimilation et d'autres méthodes d'analyse du changement dans le discours du patient.Um processo de mudança dentro de um único caso de terapia cognitivo-construtivista é analisado por meio da análise da conversação (AC). O foco está em um processo de mudança nas sequências de interacção, que consistem na conclusão do terapeuta e da resposta do paciente a ele. Nas conclusões, o terapeuta investiga e desafia a tendência do paciente para transformar os seus sentimentos de decepção e raiva em auto-culpa. No decorrer da terapia, as respostas do paciente a estas conclusões são reformuladas: a partir da primeira rejeição da conclusão do paciente, para então ser ambivalente e, finalmente, chegar a acordo com o terapeuta. Com base neste estudo de caso, sugerimos que a análise que se concentra em sequências de fala que são semelhantes interaccionalmente oferece um método sensível para investigar a manifestação da mudança terapêutica. Sugere-se que esta linha de pesquisa pode complementar a análise de assimilação e de outros métodos de análise das mudanças na conversa de um cliente.Tramite l'analisi conversazionale (CA), è stato analizzato un processo di cambiamento in un caso singolo di terapia cognitivo-costruttivista. Ci si è focalizzati sul processo di cambiamento nelle sequenze di interazione, che consistono nella conclusione del terapeuta e nella risposta del paziente ad essa. Nelle conclusioni, il terapeuta indaga e sfida la tendenza del paziente a trasformare i suoi sentimenti di delusione e rabbia in autocritica. Nel corso della terapia, le risposte del paziente a queste conclusioni sono state riformulate: ad un primo rifiuto della conclusione da parte del paziente, ad una successiva ambivalenza ed, infine, a concordare con il terapeuta. Sulla base di questo studio, suggeriamo che un'analisi che si focalizzi su sequenze di discorso che siano simili a livello internazionale, offre un metodo sensibile per indagare la manifestazione del cambiamento terapeutico. Si suggerisce come questa linea di ricerca possa essere complementare all'analisi con il modello dell'assimilazione e ad altri metodi di analisi del cambiamento nella conversazione del paziente.

Figures (1)

Rejection of the Conclusions with her mother, in which her mother ignored what she had told her about her own success in work. Just before the excerpt, the therapist and the patient have started to discuss this event. They have both noted that the mother did not say what one could have expected from a recipient of such news—+.e., she did not congratulate her, give her praise, or respond in a positive way. In the beginning of the excerpt, the patient moves on to repeat how she reacted to her mother’s lack of response: She left the scene. The first excerpt shows the starting point to the process we describe. This is the only instance in the session of the sequence in which the therapist brings out the patient’s critical stance. Before this excerpt, the patient has talked about a movie, and how she had felt lonely and rejected after seeing it. The therapist has asked if the movie brought up memories from the patient’s childhood. As an answer to this, the patient recounted a recent event

Rejection of the Conclusions with her mother, in which her mother ignored what she had told her about her own success in work. Just before the excerpt, the therapist and the patient have started to discuss this event. They have both noted that the mother did not say what one could have expected from a recipient of such news—+.e., she did not congratulate her, give her praise, or respond in a positive way. In the beginning of the excerpt, the patient moves on to repeat how she reacted to her mother’s lack of response: She left the scene. The first excerpt shows the starting point to the process we describe. This is the only instance in the session of the sequence in which the therapist brings out the patient’s critical stance. Before this excerpt, the patient has talked about a movie, and how she had felt lonely and rejected after seeing it. The therapist has asked if the movie brought up memories from the patient’s childhood. As an answer to this, the patient recounted a recent event

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References (55)

  1. Angus, L., Levitt, H., & Hardtke, K. (1999). The Narrative Processes Coding System: research applications and implica- tions for therapy. Journal of Clinical Psychology, 55(10), 1255Á 1270.
  2. Antaki, C. (2008). Formulations in psychotherapy. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 26Á42). Cambridge: Cambridge University Press.
  3. Antaki, C., Barnes, R., & Leudar, I. (2005). Diagnostic formula- tions in psychotherapy. Discourse Studies, 7(6), 627Á647.
  4. Bercelli, F., Rossano, F., & Viaro, M. (2008). Clients' responses to therapists' re-interpretations. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 43Á62). Cambridge: Cambridge University Press.
  5. Boothe, B. (2001). Gespra ¨chsanalyse in der Psychologie [Con- versation analysis in psychology].
  6. In K. Brinker, G. Anton, W. Heinemann & S.F. Sager (Eds.), Text-und Gespra ¨chslinguistik. Linguistics of text and conversation. Ein internationales Handbuch zeitgeno ¨ssicher Forschung (pp. 1655Á1670). Berlin: Walter de Gruyter.
  7. Buchholz, M.B. (Ed.) (1995). Psychotherapeutische Interaktion. Qualitative Studien zu Konversation und Metapher, Geste und Plan [Psychotherapeutic interaction. Qualitative studies on conversation and metaphor, gesture and plan]. Opladen: Westdeutscher Verlag.
  8. Buttny, R. (1996). Clients' and therapist's joint construction of the clients' problems. Reseach on Language and Social Interac- tion, 29(2), 125Á153.
  9. Davis, K. (1986). The process of problem (re)formulation in psychotherapy. Sociology of Health and Illness, 8(1), 44Á74.
  10. Drew, P., & Heritage, J. (1992). Analyzing talk at work: an introduction. In P. Drew & J. Heritage (Eds.), Talk at work: interaction in institutional settings (pp. 3Á65). Cambridge: Cam- bridge University Press.
  11. Heritage, J., & Watson, R. (1979). Formulations as conversational objects. In G. Psathas (Ed.), Everyday language (pp. 123Á162). New York: Irvington Press.
  12. Heritage, J. (1984). Garfinkel and ethnomethodology. Cambridge: Polity Press.
  13. Honos-Webb, L., Surko, M., Stiles, W.B., & Greenberg, L. S. (1999). Assimilation of voices in psychotherapy: The case of Jan. Journal of Counseling Psychology, 46, 448Á460.
  14. Hutchby, I. (2002). Resisting the incitement to talk in child counselling: Aspects of the utterance ''I don't know''. Discourse Studies, 4(2), 147Á168.
  15. Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G.H. Lerner (Ed.), Conversation analysis: Studies from the first generation (pp. 13Á31). Amsterdam/Phila- delphia: John Benjamins.
  16. Krause, M., de la Parra, G., Arı ´stegui, R., Dagnino, P., Tomicic, A., Valde ´s, N., Echa ´varri, O., Strasser, K., Reyes, L., & Altimir, C. (2007). The evolution of therapeutic change studied through generic change indicators. Psychotherapy Research, 17(6), 673Á689.
  17. Laitila, A., Aaltonen, J., Wahlstro ¨m, J., & Lynne, A. (2005). Narrative process modes as a bridging concept for the theory, research and clinical practice of systemic therapy. Journal of Family Therapy, 27(3), 202Á216.
  18. Lave, J., & Wenger, E. (1991). Situated learning. Legitimate peripheral participation. Cambridge: Cambridge University Press.
  19. Leiman, M. (1997). Procedures as dialogical sequences: A revised version of the fundamental concept in Cognitive Analytic Therapy. British Journal of Medical Psychology, 70, 193Á207.
  20. Leiman, M., & Stiles, W.B. (2001). Dialogical sequence analysis and the zone of proximal development as conceptual enhance- ments to the assimilation model: The case of Jan revisited. Psychotherapy Research, 11(3), 311Á330.
  21. Lepper, G., & Mergenthaler, E. (2005). Exploring group pro- cesses. Psychotherapy Research, 15(4), 433Á444.
  22. Lepper, G., & Mergenthaler, E. (2007). Therapeutic collabora- tion: How does it work? Psychotherapy Research, 17(5), 576Á 587. Lepper, G., & Mergenthaler, E. (2008). Observing therapeutic interaction in the ''Lisa'' case. Psychotherapy Research, 18(6), 634Á644.
  23. Leudar, I., Sharrock, W., Truckle, S., Colombino, T., Hayes, J., & Booth, K. (2008). Conversation of emotions: On turning play into psychoanalytic psychotherapy. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 152Á72). Cambridge: Cambridge University Press.
  24. Martin, C. (2004). From other to self. Learning as interactional change. Uppsala: Acta Universitatis Upsaliensis.
  25. MacMartin, C. (2008). Resisting optimistic questions in narrative and solution-focused therapies. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 80Á99). Cambridge: Cambridge University Press.
  26. Melander, H., & Sahlstro ¨m, F. (2009). In tow of the blue whale. Learning as interactional changes in topical orientation. Journal of Pragmatics, 41, 1519Á1537.
  27. Mondada, L., & Pekarek Doehler, S. (2004). Second language acquisition as situated practice: Task accomplishment in the French second language classroom. The Modern Language Journal, 88(4), 501Á518.
  28. Muntigl, P., & Horvath, A. (2005). Language, psychotherapy and client change: An interdisciplinary perspective. In R. Wodak & P. Chilton (Eds.), A new agenda in (critical) discourse analysis (pp. 213Á239). Amsterdam/ Philadelphia: John Benjamins.
  29. Pera ¨kyla ¨, A. (2004). Making links in psychoanalytic interpreta- tions: a conversation analytic view. Psychotherapy Research, 14(3), 289Á307.
  30. Pera ¨kyla ¨, A. (2005). Patients' responses to interpretations. A dialogue between conversation analysis and psychoanalytic theory. Communication & Medicine, 2(2), 163Á176.
  31. Pera ¨kyla ¨, A. (2010). Shifting the perspective after the patient's response to an interpretation. International Journal of Psycho- analyis, 91(6), 1363Á1384.
  32. Pera ¨kyla ¨, A., Antaki, C., Vehvila ¨inen, S., & Leudar, I. (2008). Analysing psychotherapy in practice. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation Analysis and Psychotherapy (pp. 5Á25). Cambridge: Cambridge University Press.
  33. Pera ¨kyla ¨, A., & Vehvila ¨inen, S. (2003). Conversation analysis and the professional stocks of interactional knowledge. Discourse and Society, 14(6), 727Á750.
  34. Pomerantz, A. (1984). Agreeing and disagreeing with assessment: Some features of preferred/dispreferred turn shapes. In J.M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. 57Á101). Cambridge: Cambridge University Press.
  35. Pomerantz, A. (1986). Extreme case formulations: a way of legitimizing claims. Human Studies, 9(2/3), 219Á229.
  36. Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51Á60.
  37. Reyes, L., Aristegui, R., Krause, M., Strasser, K., Tomicic, A., Valde?s, N., Altimir, C., Ramirez, I., De La Parra, G., Dagnino, P., Echa?varri, O., Vilches, O., & Ben-Dov, P. (2008). Language and therapeutic change: A speech acts analysis. Psychotherapy Research, 18(3), 355Á362.
  38. Sacks, H. (1992). In G. Jefferson (Ed.), Lectures on conversation, Volumes I and II. Oxford: Blackwell.
  39. Sacks, H., Schegloff, E.A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language, 50, 696Á735.
  40. Schegloff, E.A. (2007). Sequence organization in interaction: A primer in conversation analyis, Volume 1. Cambridge: Cambridge University Press.
  41. Sellman, J. (2008). Vuorovaikutus a ¨a ¨niterapiassa. Keskusteluana- lyyttinen tutkimus harjoittelun rakenteesta terapeutin antamasta palautteesta ja oppimisesta. [Interaction in voice therapy. A conversation analytical study of voice training, therapist's feedback and learning.] University of Helsinki: Publications of the Department of Speech Sciences 54.
  42. Stiles, W.B. (2002). Assimilation of problematic experiences. In J.C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 357Á 365). New York: Oxford University Press.
  43. Stiles, W.B., Elliott, R., Llewelyn, S.P., FirthCozens, J.A., Margison, F.R., Shapiro, D.A., & Hardy, G. (1990). Assimilation of problematic experiences by clients in psy- chotherapy. Psychotherapy, 27, 411Á420.
  44. Streeck, U. (2001). ''Ja, genau, genau''. Besta ¨tigungen als Versuche des Patienten, die Kompetenz des Psychotherapeuten als eigene zu deklarieren. Eine gespra ¨chsanalytische Untersu- chung. [''Yes, exactly, exactly''. Acknowledgements as the patients' attempts to declare the competence of the psy- chotherapist as that of their own. A conversation analytical study.] Psychotherapie und Sozialwissenschaft, 1, 74Á94.
  45. Streeck, U. (2008). A psychotherapist's view of conversation analysis. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 173Á187). Cambridge: Cambridge University Press.
  46. Vehvila ¨inen, S. (2003). Preparing and delivering interpretations in psychoanalytic interaction. Text, 23, 573Á606.
  47. Vehvila ¨inen, S. (2008). Identifying and managing resistance in psychoanalytic interaction. In A. Pera ¨kyla ¨, C. Antaki, S. Vehvila ¨inen & I. Leudar (Eds.), Conversation analysis and psychotherapy (pp. 120Á138). Cambridge: Cambridge Univer- sity Press.
  48. Vehvila ¨inen, S. (2009). Problems in the research problem: criticism and resistance in academic supervision encounters. Scandinavian Journal of Educational Research, 6, 185Á201.
  49. Voutilainen, L., Pera ¨kyla ¨, A., & Ruusuvuori, J. (2010a). Recogni- tion and interpretation: Responding to emotional experience in psychotherapy. Research on Language and Social Interaction, 43(1), 85Á107.
  50. Voutilainen, L., Pera ¨kyla ¨, A., & Ruusuvuori, J. (2010b). Profes- sional non-neutrality: Criticising the third party in psychother- apy. Sociology of Health & Illness, 32(5), 798Á816.
  51. Vygotsky, L. (1978). Mind in Society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.
  52. Warner, M.A. (1997). Does empathy cure? A theoretical con- sideration of empathy, processing, and personal narrative. In A.C. Bohart & L. Greenberg (Eds.), Empathy reconsidered: New directions in theory research & practice (pp. 125Á141). Washing- ton DC: APA Press.
  53. Wenger, E. (1998). Communities of practice. Learning, meaning and identity. Cambridge: Cambridge University Press.
  54. Wootton, A. (1997). Interaction and the development of mind. Cambridge: Cambridge University Press.
  55. Young, R.F., & Miller, E.R. (2004). Learning as changing participation: Discourse roles in ESL writing conferences. The Modern Language Journal, 88(4), 519Á535.