Liisa Voutilainen

Recognition and Interpretation: Responding to Emotional Experience in Psychotherapy

Based on conversation analysis (CA) of audio-recorded therapy sessions, the article explicates practices of responding to the patients emotional experience in cognitive-constructivist psychotherapy. First, the article describes two types of therapists actions after the patients descriptions of an emotional experience: recognition and interpretation. In recognition, the therapist displays that she understands the patients experience and sees it as real and valid. In interpretation, the therapist points at something that can be heard as implicit in what the patient expressed. Second, the article shows that these two actions are combined in specific ways in the therapists turns at talk. It is suggested that recognition (emotional responsiveness) is a prerequisite of the therapists more interpretive actions that imply access to the patients experience. The empirical findings are discussed in relation to sociological studies on management of emotions in institutions and psychotherapeutic debates on cognitive and emotional aspects of therapeutic processes.

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 leading 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 patients experience under discussion, whereas the patient maintains orientation to “troubles-telling.” The diverging projects of the participants amount to overt misalignment. 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 therapeutic work. The microanalysis of actual interactional patterns in this single case is linked to discussions of therapeutic alliance in psychotherapeutic literature.

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 professionals non-neutrality functions as a tool for achieving institutional goals. The analysis focuses on the psychotherapists 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 confirm 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 therapists further actions that challenge the patients 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 specific context perform the task of the institution at hand.

On the Asperger experience of interaction: Interpersonal dynamics in dyadic conversations

Abstract We compared the patterns of affiliative and dominant behavior displayed in male dyads where one participant has Aspergers syndrome (AS) with those displayed in male dyads with two neurotypical (NT) participants. Drawing on

Responding to What Is Left Implicit: Psychotherapists’ Formulations and Understanding Checks After Clients’ Turn-Final Että (“That/So”)

ABSTRACT This article examines a specific linguistic practice in psychotherapy in Finnish: ending a turn at talk with että (“that” or “so”). Making että the final item leaves some aspect of the turn implicit and invites the recipient somehow to deal with that implication. This happens in everyday interactions generally. However, whereas in everyday conversation the recipient usually does not explicate the implicit content of the turn, in psychotherapy the therapist may draw out different aspects of the implicit content and offer it to the client for confirmation. We will show that these practices are in service of addressing the problematic contents in the client’s telling and in managing resistance. We argue that the ways in which therapists depart from the practices of everyday conversation to deal with the implicit can be seen as institutionally specific means of working with previously avoided themes and integrating them to the client’s self. Data are in Finnish with English translation.

Conversation Analysis and Psychotherapeutic Change

Psychotherapy is geared to facilitate change. Many types of psychotherapy aim to increase the clients’ contact with their problematic experiences that have been previously vaguely known or avoided. The chapter discusses how conversation analysis (CA) can be used to describe such psychotherapeutic process. Based on the authors’ research on cognitive therapy, systemic therapy and psychoanalysis, it is shown that implicit and explicit orientation to longitudinal development of themes that are worked within the therapy relates to sequential contexts in which they are discussed; the process in which the content of a problematic experience becomes more salient in the interaction unfolds in changing relations between the participants’ actions. The chapter introduces the notion of a ‘focal sequence’ as a point of departure for the investigation of such processes.

Empathy, Challenge, and Psychophysiological Activation in Therapist–Client Interaction

Two central dimensions in psychotherapeutic work are a therapist’s empathy with clients and challenging their judgments. We investigated how they influence psychophysiological responses in the participants. Data were from psychodynamic therapy sessions, 24 sessions from 5 dyads, from which 694 therapist’s interventions were coded. Heart rate and electrodermal activity (EDA) of the participants were used to index emotional arousal. Facial muscle activity (electromyography) was used to index positive and negative emotional facial expressions. Electrophysiological data were analyzed in two time frames: (a) during the therapists’ interventions and (b) across the whole psychotherapy session. Both empathy and challenge had an effect on psychophysiological responses in the participants. Therapists’ empathy decreased clients’ and increased their own EDA across the session. Therapists’ challenge increased their own EDA in response to the interventions, but not across the sessions. Clients, on the other hand, did not respond to challenges during interventions, but challenges tended to increase EDA across a session. Furthermore, there was an interaction effect between empathy and challenge. Heart rate decreased and positive facial expressions increased in sessions where empathy and challenge were coupled, i.e., the amount of both empathy and challenge was either high or low. This suggests that these two variables work together. The results highlight the therapeutic functions and interrelation of empathy and challenge, and in line with the dyadic system theory by Beebe and Lachmann (2002), the systemic linkage between interactional expression and individual regulation of emotion.