Elina Weiste

A Comparative Conversation Analytic Study of Formulations in Psychoanalysis and Cognitive Psychotherapy

The uses of formulation in cognitive psychotherapy and psychoanalysis were compared, by means of conversation analysis, using 53 audio-recorded sessions as data. Two formulation types were found in both approaches: highlighting formulations, which recycle the clients descriptions and recognize therapeutically dense material, and rephrasing formulations, which offer the therapists version of the clients description and focus on subjective experiences. These formulations may be interactional bearers of common factors in psychotherapy. Two other formulation types were exclusive to one or another approach. Relocating formulations, found only in psychoanalysis, propose that the experiences in the clients narratives are connected to experiences at other times or places. Exaggerating formulations, found only in cognitive psychotherapy, exaggerate the clients talk by recasting it as something that is apparently implausible. The contrast between relocating and exaggerating formulations suggests that, despite recent theories in the two approaches being more compatible, interactional differences still exist between cognitive psychotherapy and psychoanalysis.

Epistemic asymmetries in psychotherapy interaction: therapists' practices for displaying access to clients' inner experiences.

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the clients experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio-recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the clients inner experience. In the formulations, the therapists and clients co-described the clients experience, demonstrating that the clients inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the clients talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the clients inner experience was called into question.

Normalizing in student counseling: Counselors’ responses to students’ problem descriptions

University students seek counseling to discuss concerns about their academic skills, motivation, time management and well-being. This article examines the conversational activity of normalizing recurrently used by counselors to manage students’ negative emotions and troubles-telling. Normalizing refers to an activity in which something in the interaction is made normal by labeling it ‘normal’ or ‘commonplace’ or by interpreting it in an ordinary way. Three uses for normalizing were identified in a sample of 16 videotaped counseling sessions: (1) supporting the student’s position, (2) challenging the student and (3) presenting the student’s problem as workable. We argue that normalizing is a means of addressing students’ problematic emotions and offering support, yet in a way that maintains an orientation toward problem solving. Furthermore, while normalizing seems to serve affiliation, suggesting that the problems are not unique, it can be treated either as delicate or as problematic by the counselors and by the students.

Relational interaction in occupational therapy: Conversation analysis of positive feedback

Abstract Background: The therapeutic relationship is an important factor for good therapy outcomes. The primary mediator of a beneficial therapy relationship is clinician–client interaction. However, few studies identify the observable interactional attributes of good quality relational interactions, e.g. offering the client positive feedback. Objective: The present paper aims to expand current understanding of relational interaction by analyzing the real-time interactional practices therapists use for offering positive feedback, an important value in occupational therapy. Methods: The analysis is based on the conversation analysis of 15 video-recorded occupational therapy encounters in psychiatric outpatient clinics. Results: Two types of positive feedback were identified. In aligning feedback, therapists encouraged and complimented clients’ positive perspectives on their own achievements in adopting certain behaviour, encouraging and supporting their progress. In redirecting feedback, therapists shifted the perspective from clients’ negative experiences to their positive experiences. This shift was interactionally successful if they laid the foundation for the shift in perspective and attuned their expressions to the clients’ emotional states. Conclusions: Occupational therapists routinely provide their clients with positive feedback. Awareness of the interactional attributes related to positive feedback is critically important for successful relational interaction.