Aarno Laitila

Making sense of multi-actor dialogues in family therapy and network meetings

In recent years, a number of family therapists have conceptualized psychotherapy as a dialogical activity. This view presents family therapy researchers with specific challenges, the most important of which is to find ways of dealing with the dialogical qualities of the multi-actor dialogues that occur, for example, in family therapeutic conversations. In this article, we propose some preliminary ideas concerning qualitative investigations of multi-actor dialogues. Our aim is to work toward an integration of Bakhtins theoretical concepts with good practices in qualitative research (e.g., dialogical tools and concepts of a narrative processes coding system) in order to make sense of family therapy dialogues. A specific method that we have called Dialogical Methods for Investigations of Happening of Change is described. This method allows for a general categorization of the qualities of responsive dialogues in a single session, and also for a detailed focus on particular sequences through a microanalysis of specific topical episodes. The particular focus is on the voices present in the utterances, the positioning of each speaker, and the addressees of the utterances. The method is illustrated via an analysis of a couple therapy session with a depressed woman and her husband.

Narrative Process Coding System in Marital and Family Therapy: An Intensive Case Analysis of the Formation of a Therapeutic System

The aim of this study is to investigate whether the method (Narrative Processes Coding System) for studying the narrative sequences of individual psychotherapy developed by Angus and Hardtke (1994) can be applied in a family therapeutic process. According to the results narrative process coding system adds new dimensions and gives new depth in the narrative understanding of family therapeutic process. In micro-analytic interactional level it shows the complicated interactions between narration, plot, and narrative process type.

Application of The Assimilation Model in The Context of Family Therapy: A Case Study

In this case study the aim was to apply the APES (Assimilation of Problematic Experiences Scale) model to the analysis of the family therapeutic treatment process. This was done as a qualitative methodological triangulation in a case of the family of a 10-year old psychotic boy. The study suggests that assimilation model is suitable for many kinds of data in analyzing family therapeutic treatment processes, makes the change more comprehensible, and yields information about the effectiveness of experiential family therapy techniques.

Increasing Responsibility, Safety, and Trust Through a Dialogical Approach: A Case Study in Couple Therapy for Psychological Abusive Behavior

This article reports an analysis of conjoint therapy for psychological intimate partner violence, treated via a dialogical approach. The article reviews current controversies surrounding this treatment modality and its outcome. The dialogical approach is presented as an appropriate method for analyzing and understanding the issue of violence, but it is emphasized that the focus on communication does not involve a return to a systemic perspective on intimate partner violence. Four important dimensions are identified as emerging in conjoint treatment for psychological intimate partner violence, namely responsibility, safety, trust, and the role of the therapists. The Dialogical Investigations of Happenings of Change method was used to analyze the transcripts of the therapy sessions. The results on these four dimensions, as identified via a dialogical method, are illustrated with transcript vignettes. Finally, there is discussion of the contribution that the dialogical approach can make in conjoint therapy for psychological intimate partner violence, with mention also of the implications for research and for clinical practice.

Possibilities for Intervention in Domestic Violence: Frame Analysis of Health Care Professionals’ Attitudes

ABSTRACT. Violence is a serious problem, and social and health care providers are in a key position for implementing successful interventions. This qualitative study of 6 focus groups with professionals (n = 30) examines the health care professionals’ ways of framing a domestic violence intervention. Of special interest here is how professionals see their own roles in the process of recognizing and helping victims of domestic violence. By using Erving Goffmans frame analysis, this study identifies several frames that either: a) emphasize the obstacles to intervention and justify nonintervention, or on the contrary, b) question these obstacles and find justifications for intervention. The possibilities for intervention are further explored by analyzing the ways in which the dynamics between the different frames allow redefinition of domestic violence interventions. Despite the challenges involved in a domestic violence intervention, there seems to be potential for change in personal attitudes and reform of professional practices. The research findings underline the role of social and health care professionals as members of a larger chain of service providers working collaboratively against domestic violence. Implications for practice and directions in policy and future research are suggested.

The association between physicians’ attitudes to psychosocial aspects of low back pain and reported clinical behaviour: A complex issue

Abstract Background and aim Physicians’ attitudes predict clinical decision making and treatment choices, but the association between attitudes and behaviour is complex. Treatment guidelines for non-specific low back pain (LBP) include recommendations of early assessment of psychosocial risk factors forchronic pain, patient education and reassurance. Implication of these principles is demanding, and many patients are not referred for appropriate treatments due to a lack of systematic screening of psychosocial risk factors for chronic pain. Even though health care providers recognise the need for psychosocial assessment in LBP, psychosocial issues are seldom raised in acute settings. The aim of this study is to evaluate how physicians’ attitudes towards assessing psychological issues of LBP patients are associated with their treatment practice, and to assess if their clinical actions follow current treatment guidelines. Methods The study was amixed methods study of primary care physicians (n = 55) in Finland. Physicians’ attitudes were measured with a psychological subscale of attitudes to back pain scales for musculoskeletal practitioners (ABS-mp). Treatment practice of LBP was evaluated by as king physicians to describe a typical LBP treatment process and by asking them to solve a LBP patient case. Members of the research team individually evaluated the degree to which psychosocial issues were taken into account in the treatment process and in the patient case answer. Qualitative and quantitative data were combined to examine the role of attitudes in the treatment of LBP. Results The attitudes of physicians were generally psychologically oriented. Physicians who addressed to psychosocial issues in their treatment practice were more psychologically oriented in their attitudes than physicians who did not consider psychosocial issues. Only 20% of physicians mentioned psychosocial issues as being a part of the LBP patient’s typical treatment process, while 87% of physicians paid attention to psychosocial issues in the LBP patient case. On the level of the treatment process, radiological investigations were over-represented and pain assessment, patient information and reassurance infrequently performed when compared to LBP guidelines. Conclusions Although primary care physicians were generally psychosocially oriented in their attitudes on LBP, psychological issues were inconsistently brought up in their reported clinical behaviour. Physicians recognised the need to assess psychosocial factors. Those who were psychologically oriented in their attitudes were more inclined to take psychosocial issues into account. However on a process level, evaluation and treatment of LBP featured biomechanical principles. LBP guidelines were only partially followed. Implications Clinical behaviour of physicians in the treatment of LBP is complex and only partly explained by attitudes.

The Sally-Anne test: an interactional analysis of a dyadic assessment.

BACKGROUND The Sally-Anne test has been extensively used to examine childrens theory of mind understanding. Many task-related factors have been suggested to impact childrens performance on this test. Yet little is known about the interactional aspects of such dyadic assessment situations that might contribute to the ways in which children respond to the test questions. AIMS To examine the interactional factors contributing to the performance of two children in the Sally-Anne test. To identify the interactional practices used by the tester administering the task and to describe how interactional features can pose challenges in the critical belief and reality questions for both the tester and the testee. METHODS & PROCEDURES The Sally-Anne test was carried out as part of a project examining childrens interactions in a technology-enhanced environment. The present study uses video recordings of two children with communication disorders (one with a current diagnosis of autism spectrum disorder [ASD]) and an adult tester. We draw on a multimodal approach to conversation analysis (CA) to examine the sequential organization of the test questions and answers. OUTCOMES & RESULTS The children drew on diverse resources when producing responses to the test questions: responding verbally, pointing or manually handling objects. The tester treated these responses differently depending on how they were produced. When the child pointed at an object and verbally indicated their response, the tester moved on to the next question apparently accepting the childs answer. When the child manually handled an object or produced a quiet verbal response, the tester repeated the question indicating that the childs actions did not constitute an adequate response to a test question. In response to this, both children modified or changed their previous responses. Through monitoring each other, the tester and the child produced actions highly responsive to the features of each others conduct, which underpinned the conduct of the test itself. CONCLUSIONS & IMPLICATIONS Childrens responses in the test might not be solely indicative of socio-cognitive capacities but also show orientation to interactional nuances. The study proposes that children can demonstrate diverse ways of responding to questions, yet testers may treat these as test-irrelevant behaviours if they do not correspond to the scoring criteria. A video-based CA study can broaden our understanding of childrens pragmatic competencies in responsiveness that may not always embody an expected form. This can have implications for the development of future assessment tasks and revision of existing scoring practices.

Dealing with negative connotations in family therapeutic treatment of an enmeshed family: A case study

In psychotherapy the moments when negative connotations of diagnostic remarks become apparent are also the moments for change. To be able to use those moments for positive outcome calls for, according to this case study: 1) An inquiring approach and attitude to therapeutic work which translates to the challenging of basic hypotheses and the unambiguous meaning of diagnostic signs starting from the referral and continuing through the treatment process. 2) The integration of the nonverbal experiential technique with the verbal reflective approach, which can be conceptualized as a double description of the problem situation, and which allows reframing, or recontextualization. 3) A diagnostic conversation that is carried out during the whole treatment process, and is predisposed to change.

Introducing Novelties into Therapeutic Dialogue: The Importance of Minor Shifts of the Therapist

Psychotherapy research has been able to reveal how the therapists do what they are able to articulate as their basic repertory of doing psychotherapy. The research has also shown that the therapists do additional, equally important things which are not usually included in their own accounts of their therapeutic practice and preferences. Therapeutic skills consist of parts which are different layers of therapists’ personal learning histories and professional experience (i.e. vertical expertise), and of other parts which are more context-interactive and relational knowledge based (i.e. horizontal expertise). In this chapter, I am making an effort to construct a picture about the evolution of the therapist’s actions in the beginning phases of four consecutive couple therapy sessions of a young intercultural couple (neither of them or the therapists were using their native tongue in therapy sessions). This is done through a microanalytical reading of session transcripts using dialogical tools and the concepts of Narrative Processes Coding System (NPCS) developed by Angus et al. The emphasis of the inquiry is on the responsive nonchallenging joining and therapist’s attunement with the couple’s interactive approach, minor shifts in the narrative process modes, and some more openly interventive turns through which the therapist introduces novel ways of approaching and dealing with the issues emerging in the therapeutic dialogue. The outcome of these therapist actions is considered both in the microanalytical context of immediate conversation negotiating the couple’s relationship and in the context of this four-session process. The contribution of this perspective aims to provide tools both for marital and family therapy training and research.

Children’s disclosures of sexual abuse in a population-based sample

Most previous studies on disclosing child sexual abuse (CSA) have either been retrospective or focused on children who already have disclosed. The present study aimed to explore the overall CSA disclosure rate and factors associated with disclosing to adults in a large population-based sample. A representative sample of 11,364 sixth and ninth graders participated in the Finnish Child Victim Survey concerning experiences of violence, including CSA. CSA was defined as having sexual experiences with a person at least five years older at the time of the experience. Within this sample, the CSA prevalence was 2.4%. Children reporting CSA experiences also answered questions regarding disclosure, the disclosure recipient, and potential reasons for not disclosing. The results indicate that most of the children (80%) had disclosed to someone, usually a friend (48%). However, only 26% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for non-disclosing was that the experience was not considered serious enough for reporting (41%), and half of the children having CSA experiences did not self-label their experiences as sexual abuse. Relatively few children reported lacking the courage to disclose (14%). Logistic regression analyses showed that the perpetrators age, the age of the victim at the time of abuse, and having no experiences of emotional abuse by the mother were associated with disclosing to an adult. The results contribute to understanding the factors underlying childrens disclosure patterns in a population-based sample and highlight the need for age-appropriate safety education for children and adolescents.